darcieg

The hospital I work at is making a big change that's making a big stink for a lot of people. Instead of assigning LPNs to direct patient care, they are now using LPNs as more of a resource (like they do with CNAs) and assigning the patients only an RN. This basically has cut the LPNs on the floor from about 6 per shift to 1 or 2. They had meetings and basically told the existing LPNs that they could go back to school to get an RN, or just transition through the change even though the hospital couldn't promise they would get many hours or keep the position they have now. I just want to know, is this unique to my hospital, or are changes like this going on in other places? What role do LPN/LVNs have where you work?

Thanks for the thoughts! I did end up 'discussing' the med order with the doc a lot. He was adamant that a smaller dose of demerol would be the best (the pt had various reactions to other drugs too) as long as it was pushed very slowly. I finally just said 'okay' but I did not give him any more on my shift and I advised the same for the next shift. I just felt bad that the pt's pain was not really controlled. We tried relaxation techniques too, but he didn't have much patience for that :icon_roll . I was off for a few days after that and I never did hear what was done for his pain the rest of the time. It's just one of those cases that sticks in my head.

I am a new ADN graduate and working on a medical floor and on my BSN, and my one true love has always been teaching. In school I had some instructors who were great, and some I barely survived , and I felt like one key component in their skill was how much floor experience they'd had. So from those of you who've been there, how much experience do you think a nurse should have before they are really ready to guide others?

The psych hospital I work for is pretty small. (We only have one RN on at a time and are on diversion if census gets too high) When we have a code green (for violence) it is policy that all staff respond. This includes everyone in the offices, therapists, secretaries, etc. Basically, this reults in one patient and about 15 staff members. The theory is that the pt will see how many people are there and decide it would not be a good idea to escalate. I think however, that the patient might feel trapped or backed into a corner and lash out more. Any thoughts?

I had a patient the other day who had had an abdominal surgery and was on an epidural drip when he came to our floor from the ICU. He had demerol ordered for break-through pain, and when the pain was bad enough he couldn't stand it, he finally asked for some more pain control. We had gotten very little report from the ICU staff, but I did hear that he was very sensitive to narcotics. I pushed the demerol slowly through his running IV, and then watched him closely. Within minutes his repirations were down to 4 and we had to Narcan him. Later, I found out that the amount of demerol I had orders to give him was the exact same amount that had been given to him in the ICU and caused him to code. I was very surprised that the anesthesiologist hadn't decreased the dosing or changed medications after the first event. I was even more surprised when he merely cut the ordered dose in half and put a note to "push slowly" for further breakthrough pain. I'm pretty new to nursing, so I guess I am wondering, is this normal? Are nurses frequently expected to choose between controlling a patient's pain and keeping them breathing?! :stone