Slobgob

She wasn't talking about the coag blue top. Both blue (Aerobic) and purple (Anaerobic) tops are both blood cultures. The blue goes first, but honestly if your line is already primed with blood, I don't personally see the reason you couldn't reverse the order. But I'm not the brightest.... :)

There is no simple answer, because quite frankly it changes with every different doctor and personality. The relationship can vary GREATLY. Here are a few different types of docs: 1) They value your input and ability to care for the patient. 2) They tolerate you, but aren't sure you are necessary. 3) They don't even know you exist. 4) They believe are a stooge of admin sent to question their medical judgement. 5) They purposely avoid you and try to undermine you with the other docs. 6) You are the first person they turn to when in a bind. I believe I can work with these 6 different docs all in a single day. Do they respect CMs? I feel that if you poll the majority, the honest answer would be "no". More like most "tolerate" us in the same vain that they "tolerate" the paperwork.

I'll lend my two cents here. I use to be terrible... now I'm known as the "IV Ninja". Reasons you have trouble floating the catheter: 1) The gauge is too large. A hard stick usually means small or tortuous veins. A smaller gauge for MANY reasons is superior to large ones. I'm generally speaking of a 22. The last hard stick I placed, it lasted 9 days before he D/Ced. Less infiltration, less external leaking, less phlebitis, easier catheter floating, less pain. 2) You are entering at too steep an angle. You will surely get blood flash, but floating a catheter against a vein (as opposed to at the same angle) will be difficult or blow the vein. This is not obvious for easy sticks, but shows itself on hard ones. The angle, in some cases, is not much more than a PPD injection. 3) You aren't in far enough. If at least half your needle isn't in... go further before you advance the catheter. Oh. And. Practice. You can call yourself the IV Ninja too. Volunteer to start EVERYONE'S IVs. Give it 5 years... then check back with us. =)

*deletes long commentary defending myself* Just so I don't waste anyone's time wondering... yes, my life sucks. =)

Congratulations. That said. And I certainly hosted a furious debate in my mind about a response... You took the test 5 times. Let's say you get 5 patients your first day, how many will you "fail"? From now on, you don't get to fail. You don't get to "pray to Jesus" that you won't error and still expect that you'll end up okay. This sounds harsh. I know this. I'm not completely cold. But I've seen both sides and I've watched gross incompetence from nurses that barely know what they're doing. I suppose I just want to say: We're not playing school anymore. Sometimes you only get one chance. With someone's well being in your hands, are you willing to fail again?

Hmmm... where to start? I'll start with a quote from good advice that you seem to respect: "I realize the RN situation in Hawaii is particularly bad" So, right here. We all agree there is a problem yes? " I would like to add that I am getting tired of hearing this type of advice." Better we should keep quiet? Let people move here and THEN find the inevitable situation of living in an expensive paradise with no job? "A person who will remain “nameless” has been trying to prevent RN's from moving to the Island for at least two years now with extremely negativity, exaggeration, and pessimism" Are you a new grad? Do you work everyday with new grads who graduated in 2008 or 2009 and are still working as CNAs on the floor. There is not a nurse here (I speak of the floor nurses only) who doesn't know a half-dozen or more new grads who speak everyday of the frustrating situation... and all this in a nice depressing tone. "Being that it's temporarily so competitive in Hawai'i right now" From my perspective, this started around the middle of 2006 for new grads from the mainland. Maybe a year later it started for island new grads. The jobs didn't dry-up, just the hospitals' willingness to train people for them did. How long before we're out of this? 1,3,5 years? Does the word "temporary" really matter when Sally Newgrad from Tennessee who is honestly asking if she should pack-up and move here without any support in place, hoping that she'll land a decent job before her savings run dry? "It’s obvious why this person patrols the message boards" Why? You really think that more than 0.01% of nurses in this world have even heard of Allnurses.com, much less visit the Hawaii forum. I would be surprised if I've counted more than 50 names in the last few years. "It is a temporary problem that will not last!!" On this we agree. But again, if you want to move this summer to Hawaii, does it matter that the problem will fix itself by 2013? "There is a severe nursing shortage." Really? When was the last time you were placed on mandatory overtime? =) Where are the big bonuses to move here? The sign-on bonus? The extra perks? The nurse-patient ratios going up? The outcry that patients are at risk because there are no nurses? The newspaper articles demanding better patient care. They don't exist. And we're talking about experienced nurses here. You want to show me all the new grad openings? If you find some, let me know. I'd like to pass it on. I know you're a decent person. I give you this benefit of the doubt because you're a future RN who's spending time getting to know the community... who's trying to help. But you should also lend that courtesy to others. You should consider that there are people here, myself included, that spend their time trying to help others. You may not trust one person on this board... but when EVERYONE is saying the same thing... do you still not trust the message? Just think about it: As experienced RNs who are entrenched in our hospitals... why would be waste our time in a conspiracy to stop the evil mainland new grads? =)

Just a friendly suggestion: Put God in your back pocket for the interview. Just for a little bit... its okay, he'll survive. =)

"Job security." Hah! My wife says the same thing. "If you guys cure everyone, you'll have no patients." I could live in that world.... I'd just get a job at an old folks home taking care of all the 100 yr olds... =)

Let me preface, I work on a Cardiac Telemetry unit in Hawaii. Sadly, business is booming. There's a mound of evidence: Whole food, plant-based diet -> Reversal of Heart Disease, Diabetes, Stroke, Cancer. My intention is not debate on this subject, although I realize that its quite complex and probably out of my realm of expertise. I believe it. I want my patients to believe it. But how do I get through to them. My average discharge instructions look like such: See your PCP. See your Specialist. Stay Active. Don't smoke. Take Drug A Here is when you take Drug A Here is why you take Drug A Here is the side effects of Drug A Here is when you take Drug B Here is why you take Drug B Here is the side effects of Drug B Here is when you take Drug C Here is why you take Drug C Here is the side effects of Drug C Here is when you take Drug D Here is why you take Drug D Here is the side effects of Drug D Here is when you take Drug E Here is why you take Drug E Here is the side effects of Drug E And oh yeah... Eat a low-fat, low-sugar, low-cholesterol, high-fiber diet. GOOD LUCK! Clearly discharge is not the time to stress such a dramatic diet change. I need a more captive audience, not one that is itching to get out of the hospital. But when? Do you talk after their angioplasty/CABG? Before it? Do you set them straight... use the dreaded "Heart Attack" wording to scare them into attention? Do you point blank say "Look dude, these drugs/procedures are great and all, they probably saved your life this week... but you will be back... this will only delay your death. You want the cure?" I just don't know. Most of my fellow RN/MDs spend less than 1% of their time talking about diet/activity... cause we just don't think its getting through... we don't believe they will change. Are we part of the failure rate? Because we don't believe? Or am I just setting myself up for heartache. If I spend an hour one day talking about diet, explaining the physiology of it, showing them past medical studies with amazing results -> will I have a nervous breakdown when I see them munching on McDonalds? Will my MDs get upset? After all, our Cardiologists specialize in two things: Surgical and Pharmacological intervention. My message would, depending on how blatant I am, stress that these two methods are palliative methods at best, while the true cure costs only a few dollars more a week in your vegetable aisle and a nightly neighborhood stroll. Is it a conflict of interest to down play medical/surgical intervention compared to lifestyle changes... while at the same time, being employed by that same medical/surgical institution? Am I under cutting my MDs? Am I giving our patients an excuse to be "non-compliant" with their medications? I feel horrible right now. I feel that every patient who heard my "Oh yeah, eat healthy, you know how, just do it", discharge instructions... that part of their eventual death to heart disease/stroke/cancer/diabetes is on my hands. My conscience won't let me stay silent anymore. Where do I start?

Congrats. (I had a more "interesting" response typed out, but I hit the wrong button and it all disappeared. Apparently God doesn't like me saying naughty things.)

Hmmm... I've heard this "resume edge" rationale plenty times before... Not sure it works. I work on a floor where ACLS is required... but we let our new grads work 6-18 months before enrolling them. I guess we just feel that A) There are more important things to learn, and B) You'll get more out of the class after watching the tele monitor for months on end. It definitely can't hurt though. I just don't know if its worth it. Good luck! PS: I tell our newbies that ACLS is too dangerous for them to learn right away because they'll probably shock my patient while he's brushing his teeth. =P~

Nursing homes? I would think you'd be discharged from the military before you'd need one of those... Aren't people the the military relatively young and healthy? That's bad for business! =)

Wow. Never knew this was such an issue. pH? If green stuff comes out... its good. No need X-ray for placement in you're decompressing... but I suppose we get one before we start meds/feeding. Though... maybe we're just behind the times.

"lab work may reveal a very high bun and creatinine could this mean she is not getting her feedings" Yes. The NGT is in her lungs. Or so long, it reaches the cecum. "end stage renal failure could that cause lab results as such" No, ESRD causes high ALT/AST. Its liver failure that causes high BUN/CR. Little known fact. "lasix 60 mg every am would that make a difference in her lab values" Yes. It could. But I would worry about the hyperkalemia. Lasix plus Kayexalate is almost mandatory. Add insulin/D50 if needed. "she had average urine output maybe 400-500 every 8 hr shift would that have any bearing on lab values" Urine has nothing to do with blood. Please ask MD for 24hr CR Clearance. However, don't put on ice... it destroys creatine. "i dont know about any weight loss at this time " Megace or Marinol. Order it. Know it. Love it. Hope this helps. I'm also a CCU nurse... so always looking to help out. Let me know if ya need anything more. =)

"About those doctors? That doesn't seem to be the general physician consensus." Oh, forgot this part. I can only speak for our physicians who I generally think are good people... but their only points seemed to be: 1) Their profession is dead. 2) Its horrible being a MD. 3) They need a pay raise, not a pay decrease. 4) What we really need is tort reform (aka: Not letting them get sued.) Actually... one doc was for the bill. He's a Euro-hippie. As for the final point about Tort Reform. I gotta say, that I agree with. If MDs didn't have to pay so much money for malpractice insurance, if device makers didn't have to suffer similar fates.... if we didn't have to practice so much defensive medicine. Oh... is that a dream?