terryalbright

Had a Littman and found it so heavy around my neck that I actually went out and bought a cheaper model!

Yes, of course, each patient is different and at the end of the day that is what must be remembered--- just giving my general rule of thumb. I work in my provinces only Level One Trauma Centre but central lines are really a final option for us, only used if the pt is truly crashing. Otherwise, if our Dept can't get a line or two, we still have an IV Team to troubleshoot and then the next choice is to Interventional radiology for a PICC Line.

The only time I go A/C (any size) is when the pt is crashing and it's the easiest access or there is nothing else periprheral. One can usually track the basilic vein (in "averge veins") far down enough as to not occlude a pump due to arm flexion. I believe that a tweny is a good all-purpose size unless it is a pt. with a bleed, then I will try 18, usually foolowed by a second site for Panto. Then you have the option of more rapid fluid infusion as well as the ability to switch around . Another option (in really good veins) is a double lumen 18/20. CT usually prefers 18g, as they can control infusion rates if less pressure is required but they can get by with less, rest assured, so go with your gut on size/location. After all, everyone's sense of "feel" and needle handling is different. In pt's going to O.R. anesthetists usually prefer lower, outer arm for ease of access when the pt. is positioned on the table, again allowing opportunity for an 18 or 20 guage vs. 20/22 in the hand. My rule of theumb: the bigger the better-- just go slow and easy. At least, that has been my experience.

I guess the other reason I wouldn't go back to school was the fact that we didn't ( and still don't) have a bridge programme here in N.B. I think now that the entry to practice is Bn, you may be able to challenge some labs but that is about it. At the time when I was considering, I could have gone to a diploma programme. I was sitting and writing entrance exams and thinking "you really don't want to do this, start all over again. Moreover, my marriage was falling apart so that really clinched it. When I got the call saying I was accepted I felt that I couldn't take the chance even if I wanted to do so. UNB has been working on a ladder programme for awhile but nothing yet, as far as I know. Now, at 52, I am not inclined to look into it anyway. I like what I am doing and have gone into other interests. (politics)

In some areas where I work there is still a real "turf war" going on but I also see growing acceptance as the RNs learn we are not out to replace them, rather to complement them in a way that is in keeping with our training. When I was first hired full time I was the second LPN to get full time employment at my hospital in over 13 years and many, many more have followed. Personally, I have no desire to be an RN. If I had, I would have gone back to school when I had the chance. I see more and more RNs tied up with paperwork, studies, etc. and less at the bedside, which is where I want to be. T

Well, we are not allowed to use the word "nurse" without using the qualifier "practical" in front of it. I am part of a pilot project using LPNs on the IV team but I have worked in Specimen Collection as an LPN- Phlebotomist for the last 18 months. All of the girls in that clinic are LPNs. In the sense that we provide nursing care we are indeed nurses. We aren't cooks! But it is true that when a medical personnel asks for a nurse, they mean an RN. However, to the patient, we are nurses. LPNs are bedside care specialists and a very valuable part of the care team, as are the RNs, the Physios, etc. Casuals would probably get $18.00/hr but right now full-time and part-time are at $17.06 if at the top pay scale. By the end of the contract, 2007, we will be at $19.08 I believe "en francais" the proper term is infirmiere auxilaire immatricule. Don't get too hung up on the title. It is what you do, the care that you provide, that is important. Your LPN training will help if you decide to advance to RN later. T

Hi, I'm an LPN in Saint John and that old (very old) story about getting rid of LPN's is just that... a STORY. There is such a shortage of nurses now that our scope of practice has increased to the point of giving meds on some floors in hospital, initiating IV's ( which is what I do) peritoneal dialysis exchanges, (done that too, including setting up the cycler for patients who use that instead). When I first graduated we were not allowed to do very much at all, mostly custodial care, vitals, etc. so with additional education we have come a long way, baby! I am happy to see these changes, feel much more like I am working as a valued team member.

I don't think those are stupid questions! As far as the pressure on the lok while flushing, I will usually try to draw back first. If there is a LITTLE resistance when flushing, I don't worry but I wouldn't force it. The small amt. of blood in the lok would be mixed with saline and unlikely to clot but if it did I don't think it would work. Since it is the patients blood, and the lok was applied using aseptic techniqye, I don't see infection as being a high risk since blood is normally sterile and any pathogens that might be present would be from the patient. I would just keep an eye on the site, as usual.

I wear gloves if my skin is really dry, if the pt. is on precautions, (yes, we still gown, glove and mask for MRSA although most of us consider it a waste of time and equipment), or if I have any (even minor) superficial cracks. The way I see it, a glove won't protect me from a needlestick and I am one who was trained without gloves. If I wear a glove I make sure it fits snugly.