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frozenmedic

frozenmedic

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  1. Unfortunately, nobody can give you a definite answer about whether or not a patient will sue. The fact that you know another nurse who made an error with Epi is also not helpful as cases may be settled by the hospital before ever involving RN staff, the RN involved may not be allowed to discuss a closed claim they were involved in, or the patient may have never filed a malpractice claim. Many more errors are made than lawsuits filed, and the magnitude of an error is not the single deciding factor in a patient's behavior. Attitude of the healthcare team is at least as important as any error that occured. Patients are much more likely to bring suits against healthcare providers they dislike, when they feel communication is poor, or they feel like healthcare providers are hiding something from them. Many patients report they sue less for their own financial benefit, instead they want to get answers or to prevent similar errors from happening to others. These are some of the reasons many facilities will now openly admit errors to patients, and offer a sincere apology soon after the error is recognized. It sounds like this didn't happen in your case, and obviously this cannot be changed. There are different types of malpractice claims, but generally the patient must show that some harm occurred to them because of the malpractice. In this person's case it sounds like they experienced temporary symptoms, and possibly a longer than normal hospital course for their disease process. While in the grand scheme of things, these are relatively modest, temporary harms, the patient can also claim damages for loss of work, "pain and suffering," or any other conceivably related losses. Realistically, you have relatively shallow pockets, and patient's will often choose to sue a hospital or health system in addition to just the individual provider. The bottom line is you can't change this patient's behavior any more, but you probably need to develop some better strategies for protecting yourself in the future. If you are this worried about this event, you are probably so distracted you're going to make another error. Consider your own personal malpractice insurance going forward. Your employer's coverage serves them, not you.
  2. frozenmedic

    Ebola and CPR

    I can almost guarantee there isn't an official policy, and you're assuming you actually know the patient has Ebola. If they came in from outside the hospital as a working arrest, and looked like someone dying from a viral hemorrhagic fever, I assume you would put on all the PPE you could immediately find, and go about coding the patient, at unknown great risk to yourself and the facility. That being said, I have been on a hospital isolation team in the case of Ebola or other serious communicable disease outbreaks. In the case of a patient with known or suspected Ebola for routine patient care we were trained to wear a high level hazmat suit with respirator etc. Because this is such a rare situation, we didn't have a CPR policy. What we did have was a realistic discussion on the potential risk/benefit of performing CPR in this situation. Consider that a person who has arrested from Ebola likely has severe blood loss from sources including GI tract, mucous membranes, pulmonary tree, skin hemorrhages etc, plus an on-going sepsis picture. This is not an easy clinical picture to fix, combine that with the known terrible survival rates from CPR from sudden cardiac death (which is potentially reversible if due to acute coronary artery occlusion) and you have a situation that is likely non-reversible. While performing CPR, intubation,and whatever other aggressive interventions are required, even with specialty PPE there is likely to be tremendous body fluid exposure risk to personnel, given the realities of Ebola's clinical course in particular. We were taught that there is no PPE designed to prevent transmission of highly infectious diseases under the physical performance of CPR; even the highest level biohazard suits used by researchers doing lab work routinely on these disease assume a very controlled environment without physical exertion. Combine all of this, and what you have is a morally difficult situation, but one nonetheless where CPR is not likely to be offered as an intervention.
  3. frozenmedic

    Dosage calculation

    You exist?!?!?!? I have also spent hours successfully teaching students dimensional analysis and cannot understand why it is not the educational standard. The other formulas to memorize are indeed ridiculous, error prone, and non-transferable to other situations. Read the "Letters After My Name" post and do exactly as he/she says!
  4. frozenmedic

    Full Practice Authority

    This. So much this. I want to post it in every breakroom and have it printed on cards for when I have to sigh at my coworkers with 3 months of experience who are already in DNP programs. I have never seen a better and more hilarious summation of the problems with DNP curriculum and the navel-gazing nursing academics who created it. FWIW: Physicians are studying this stuff too...the difference is "Clinical Informatics" is a dedicated TWO YEAR fellowship after medical residency. But sure, let's toss that into a DNP program and call it covered too.
  5. frozenmedic

    Will you get your DNP

    Damn! If only that "Nursing Practice" part of the degree actually added some you know.....extra advanced nursing practice. Where on earth is the nursing field going?
  6. frozenmedic

    Full Practice Authority

    I can't agree with you both more! I think we are currently in a race to the bottom of NP outcomes. You can't browse the internet without an endless onslaught of, "It's-so-easy you can be an NP without ever changing out of your PJs," type ads for NP schools. How is it possible that an ever increasing amount of increasingly poorly trained NPs is a sustainable model? How are the quality NPs who practiced at the bedside, attended a rigorous school, and maintained on-going education going to keep their credibility in this sea of lunacy? Do MD students do moronic group projects? Maybe one or two...but it certainly isn't combined with reflective journaling as the basis of their education. They are also in school for four years before starting residency. Then they spend 3+ years decidedly not doing group projects, rather they have years of supervised practice in their own specialty, plus rotations in other, relevant medical disciplines. Oh, plus mandatory weekly specialty-specific educational lectures, morbidity and mortality conferences, case reviews, and on-going board preparation quizzes. You cannot possibly convince me that the "bedside nursing experience" an RN brings to NP school somehow makes up for all that. Source-married to an MD, been together through his medical school/residency and my nursing school.
  7. frozenmedic

    Anoxic Brain Injury - Nurse Accused of Not Treating Asthma

    I am a nurse and a paramedic. I have been both constrained by orders, and at the receiving end of many of those 911 calls. I have spent much of my career working out of the hospital, often without another advanced level provider to "check in" with. Although I quoted you, my comment wasn't to you specifically, but to the many commenters who were apparently unaware of how the essential medications they administer work on a basic level, and are seemingly blindly following orders/protocols. You speak of only nurses being able to perform an assessment, but why even bother if the knowledge base ends there? I have spent my entire nursing career frustrated by how hard the nursing field tries to separate itself from every other health profession. We have our own "diagnoses," our own innumerable "nursing theories," our own self imposed division of labor where only RNs are special enough to perform an "assessment." Then we chase our tails trying to stay in this fantasy world we have created, instead of seeking common ground just like every health profession. Example: I used to work at a large academic medical center where a nurse could use the 1-10 scale to "perform a pain assessment" while an aid, when performing routine vitals could ask the patient the same question and "record a pain score." It's ridiculous and patently false. EMT students (a semester long course with essentially the same hours as NA I) are taught patient assessment as the foundation for all further levels of care. Lifeguards and wilderness professionals too. So yes, I am a nurse, and while I am proud of the work I do, I can't help but be disappointed by the incredible diservice we have done to ourselves, our students, and patients. We start with an insane system of nursing education where reflective journaling, care plans, and RN professional socialization take precedence. Pathophysiology and pharmacology? These are mere afterthoughts. We end with RNs who know exactly who can do what orders and know what skills "separate" them from other healthcare providers, but have no idea of the science or the "why" behind anything, yet want more and more professional autonomy. This discussion is only one example, and that's what really disappoints me.
  8. frozenmedic

    Anoxic Brain Injury - Nurse Accused of Not Treating Asthma

    Though this may be true, and many people are implying that a "real" school nurse (as opposed to LPN, medical assistant etc) might have assessed and managed this situation differently; I'm alarmed by the amount of replies to this topic that are surprised to hear that Epi can be used in cases of refractory asthma, and that albuterol is also appropriate in cases of anaphylaxis. Both disease processes have a significant component of bronchospasm for which beta-2 agonists are appropriate. Albuterol is an (mostly) beta-2 specific agonist, while Epinephrine is both an alpha and beta agonist, and decreases mast cell release of inflammatory mediators. What are we saying here when nurses as a group apparently don't know the underlying physiologic mechanism for the diseases they manage and treatments they are offering?
  9. frozenmedic

    CVICU vs Float Pool

    Agree. For obvious reasons float nurses generally receive the more stable patients on a unit. You want the exact opposite of that. Take all the CVICU disasters you can.
  10. frozenmedic

    Need help...Specialty experience requirements

    My suspicion is you can't find any research because logically this speaks for itself. Travel nurses are generally given minimal orientation (2 shifts-2 weeks generally) and then expected to be able to safely care for patients in an unfamiliar environment. Therefore, their essential nursing skills need to be sharp. Many (new) nurses participate in extensive residency/orientation programs, which are great, but don't actually have a nurse working by themselves for 3-6 months, so at the year mark they actually have minimal independent practice time. Having a 2 year minimum generally ensures all nurses have the background they need to practice safely.
  11. frozenmedic

    Mg and K

    In the ICUs at my facility we have a nurse-driven protocol for supplementation of most electrolytes (K, Mg, Ca, Phos). The goal in each protocol is to maintain the patient around the mid to upper end of normal for most electrolytes. RNs will supplement as needed for the protocol and only call the provider when the patient does not responding to supplementation appropriately, requires excessive doses of a particular electrolyte, or is symptomatic and warrants faster replacement than the protocol etc.
  12. frozenmedic

    Destined to Be a Flight Nurse

    First off, this is a logarithm: This is an algorithm: There isn't anything inherently difficult about understanding the difference. To the OP- you have already received lots of good advice; but however you decide to proceed, I would add a few points. If you really want to be a flight nurse, once you settle into a (preferably high acuity ICU) unit, make your focus physiology and prioritization for the ultra critically ill. Understand why your providers choose to make certain actions, and why they choose NOT to. Your goal is to be able to understand how physicians think and work through a differential. Once you have only one patient to fly at a time, your time management skills become almost irrelevant. That means there will be days you have to choose to spend 15 more minutes listening to a consulting service rather than catching up on charting about your tasky pair. Your attitude is also essential. By their nature, flight crews are huge PR representatives for the hospital/agency they fly for. Those hiring for flight positions are not just looking for people who are clinically excellent. They want those who can also be called upon to make a positive impression at a terrified rural facility managing their first critical patient in months and a girl scout camp show-and-tell. This means you need to be known as the person on the unit who wants to do the best possible job regardless of the situation (helping your coworkers clean poop, precepting the "difficulty" orientee, etc); not the person who is only engaged when they have the sickest patient on the unit.
  13. frozenmedic

    Do your clot retrieval patients go to ICU?

    HDU=High Dependency Unit, a level of care between ICU and general floor. What the US would likely call step-down.
  14. frozenmedic

    Help!!!

    There are so many smart, well qualified people who want to get into flight, that programs can generally be quite selective. I don't know exactly how you "blew" your last interview, but it sounds like you may not have realized some of the very real non-medical aspects of this job- that flight crews are a marketing tool too. In addition to the actual CCT work, every flight program I know uses its crew in a PR capacity for the hospital-be it for safety fairs, fly overs for community events, or show and tell for nursing students. Later, when you're transporting patients, every time you march into an outside facility/fly to a scene you are likely to be interacting with non-hospital affiliated staff. Those people will see you as the embodiment of whatever program's logo is on your flight suit and you have to make a good impression. Every program needs people who will market them well because this is a business like any other. As far as I know, this is the purpose of the 5 minute presentation-to evaluate your personality, communication skills, and demeanor. It doesn't matter if you talk about puppies, scuba diving, or how to make killer tacos; what the program wants to see is that you are confident without being cocky, engaging, and articulate. Your topic should be whatever you can convey a personal interest in to the interviewers. On a more long-term basis, if you're having difficulty with landing a job, you may want to consider ICU experience (I know, groan here). Depending on how much scene vs IFT work you do, programs may view that as better preparation, and it better compliments (rather than overlaps) with your medic background.
  15. 1. What makes nursing a profession rather than simply an occupation? Overpaid naval-gazers with PhDs in "Nursing Theory," who tell you bedside care is the backbone of our profession, but haven't seen a real patient in 35 years. In an occupation I believe you are required to produce meaningful work. 2. What employment opportunities have you had(or plan to pursue)as an RN? I have nursed in multiple specialties. Long-term I plan to pursue a career in EMS. 3. What trends do you see in nursing that will impact the profession over the next ten years? We will have 10 more years to graduate "advanced" nurses with an ever increasing array of meaningless alphabet soup titles that nurses ourselves can't keep track of, much less our colleagues and the public. How we will continue to generate jobs for these people remains a mystery. 4. What are the benefits(if any)for having an advance degree in nursing I.e BSN The hospital benefits from being one nurse closer to the goals of BSN 2020, Magnet Status becomes obtainable, it looks great on promotional materials etc. Oh, you meant benefits for me, the nurse? I get to do my same job for the same pay without getting fired. 5. What hidden challenges to nurses face that the general public doesn't know? As a rule, the better/smarter/more capable a nurse is, the more frustrated they are by the nursing profession. 6. What keeps you in the field of nursing? Being a flight nurse. It is only slightly like the rest of nursing. 7. What advice can you give me about preparing for nursing school? Consider the multitude of other allied health options.
  16. frozenmedic

    CRRT and mobility

    I work in a unit that ambulates patients on CRRT all the time. We also ambulate people on VA/VV ECMO, external/temporary VADs, and combinations of all these support systems. We have been known to take these people outside as well. The type of support a patient needs is not an automatic rule out, but rather how stable they are once bridged to any therapy. At least in theory a patient should become more stable once bridged to the support they need, and subsequently able to increase their activity level while awaiting recovery or definitive care.
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