pengwen

I worked as a CNA and LPN through nursing school and did fine. I really think both of these jobs helped me process the clinical aspects of being a nurse. Book work is great and needed but there is so much that can't be taught in the classroom that you HAVE to learn on the floor. Additionally I think there is not enough clinical time in nursing school to really learn everything you need to learn to be a nurse. In my class of 60 nursing students there were 4 people that didn't pass their boards. 2 of the 4 were the top students in our class and it was very surprising that they didn't pass their boards. When I talked to all 4 of these women they all did not have experience on the floor as a CNA or LPN before taking the RN boards. After finding out they failed all of them got jobs as CNA's on a Med/Surg floor before taking the boards again (I know 3 of them had to take pay cuts for this experience). So my thought is - even though it might be stressful to switch jobs right now, in the long run it would probably be better for you to gain the experience and clinical knowledge, only working on a hospital floor can bring. Good luck with all of your decisions and nursing school. It is worth it in the end!!! Gwen RN, BSN, CRNI

If any of you wanted to know (at least for the state of Utah) I found out my answer after some searching.... The action of taking a verbal order actually falls under the Pharmacy Pracitce Act for the State of Utah instead of the Nurse Practice Act (which is extremely vague). I was finally able to get my pharmacy manager write an email to the woman in charge of all pharmacy issues at DOPL. He asked her how many agents can be utilized in a verbal order. FYI - An agent is anyone that works for the MD/NP or is a tool in carrying out his/her orders. This means that the agent could be a secretary, CNA, MA, LPN, RN, etc. The Parmacy Pracitce Act states that a Pharmacist can take an order from the agent of the doctor. It does not say AGENTS and it does not say that an RN can take an order from another agent.... so we had to have this clarified. How many agents can be utilized??? In my home care agency, almost on a daily basis we see verbal orders passing anywhere from 1-4 agents (and on occation even more). For example: Field RN calls MD for a continuation order of a mediation. The MD's RN or MA (agent 1) calls the field RN (agent 2) and gives her a verbal order. The field RN calls the local nursing intake and gives the verbal order to the intake nurse (agent 3), who then calls the IV pharmacy intake nurse (agent 4 - this is what I am in my company), who then gives the order to the pharmacist. Mind you - the actual order is only written down by agent 4 or the pharmacist!!!! Scarry isn't it???? I just find this process to be so potentially dangerous both for the patients involved and also for me as an RN..... Anyway, the Pharmacy director for DOPL in the state of Utah responded to my pharmacy manager saying that there should only be one agent used unless it was absolutley necessary. Of course my manager believes that means she can take a verbal order from an agent anytime that she is familiar with the medication. I find this logic extemely flawed. I have wondered if she ever played the telephone game in elementary school.... So my manger still thinks that every nurse can choose to "interpret" what absolutely necessary means. Personally I am sticking to my guns. I will not take an order from an agent of the MD. I will only take an order from an MD or NP when it is necessary. I will always prefer an written order over a verbal order. In the meantime I am going to try and get the pharmacy act changed in the state of Utah to state directly that the verbal order can only go from one agent directly to the pharmacist. Thanks everyone for your input!!! Gwen RN, BSN, CRNI

I am so sorry you have to go through all of this...... This question is right up my ally. I got my CRNI (certified registered nurse of infusion) about 6 months ago. I mostly deal with home health infusion needs of all kinds. I help staff a home health ambulatory infusion clinic. I'm not sure what insurance you have but I am sure they would have a home health benefit. Home health would be such a better option for you in many aspects. 1. More convienient. The fact that you know how to access your own port is great! I know that my home health pharmacy sends out port-a-cath supplies all of the time to pt's that manage their own ports. You would access your own port and hook up to your infusion. My reccommendation would be an ambulatory infusion pump (they are about the size of a small foot ball) with a continuous infusion over 24-48 hours. It sounds like you might be reacting to the mg going too fast. Additionally - if you could do this at home/work then your life would be much better. The kind of pump I am telling you about can be put in a small pack around your waist and you can live a normal life.... 2. Less cost. Because you would be managing your own port you would not be charged a nursing visit and the extra costs of monitoring you during your infusion for such a long period of time. Oh yeah - the IV benadryl and phenegran you can give at home. You don't have to be monitored. We teach people all of the time to go home on these kinds of infusions. You would be taught to give it at the proper speed and proper strength. Anyway.... I hope that helps. Home health would be the best option for you!!

Thanks! Good advice. I will call tomorrow!! Gwen

I have seen one pt inject 10 cc of air (didn't have their glasses on while pulling up their saline syringe) into their PICC. It causes immediate chest pain and shortness of breath - but they are usually ok if they don't have any underlying cardiac/pulm issues. I agree with what was said about pt's not liking to see air being injected into them.... try to avoid it wherever possible! Gwen

We use stat loc's to secure our PICC line's also. I have noticed that our patients respond much better to them. If you have never seen a stat loc before it looks like a sticker with posts sticking up that you attach the PICC line too (it sounds strange - you have to see one to know what I'm talking about). We use them in stead of suturing our lines in. The MD who created the stat-loc did so because he got stuck with a needle when suturing a line in and got hep c from it...... Anyway... the number one reason I like the stat loc's is because of the ability to clean around and under the line. They are fabulous!!! Gwen

I went to the University of Utah - great school! I used to call my self a Low Paid Nurse when I was an LPN, because you do almost everything an RN does but you get paid $10,000/ yr less. It is really worth it to get your RN. In my program it was only a matter of an extra 2 semesters. Your RN will give you more flexibility and money :yelclap: !!! I would definately reccommend going all the way for your RN! Gwen

I worked on a hospital floor for 2 years as an RN before I came to home care (which I absolutely love!!!). All through nursing school and during the time I worked in the hospital it was a well known fact that RN's could only take a verbal order or telephone order from an MD or APRN. Since I have come to home care I have noticed that home care RN's (I work in intake and have seen it here especially) take verbal orders from RN's in the field or from MA's or receptionists at MD's office's. I have refused to do so because I think it was against Utah's nurse practice act. I have read the Utah's nurse practice act and it seems quite vauge. I don't see any specifics about taking verbal orders..... My boss has really put the pressure on me to prove that RN's cannot take verbal orders from other RN's..... does anyone know if this is a law or if this is part of instituational protocols??? Thanks! Gwen