pmdcjg

I am so very tired of nursing and healthcare in general. I have worked in pre-hospital as a paramedic for over 28 years and went through a bridge RN program for LPNs and Paramedic and got my ASN. Passed NCLEX first time and went straight to work in a local ED that I brought patients to routinely as a medic on the ambulance. This was a best fit for me into the world of nursing. I have only been a nurse for 5 years now and have worked in the ED full time and currently in the OR full time. I quickly became burned out of the ED. Just too much volume and high acquities. We ran a 1 nurse to 4 rooms (sometimes there might be more than one patient in your room such as a family from MVC with minor injuries). The ED is truly like a war zone and function via a very proprietary culture as well. I transitioned to the OR hoping to get away from the chaos. Well, that sure was wrong thought process. It did get me away from having to witness death on a daily basis and dealing with families and the aftermath of tragedy. I'm sorry but I got so tired of holding it together and no outlet until I was alone and could release the dam, only to have to return in a few hours for another long shift that never ended on time. The OR was a break from that particular situation. At first it was great. Probably just the fact that it was new and learning something different. Surgery is itself comprised of unique and proprietary culture too. The primary focus it seems to me is catering to the surgeons and moving at the speed of light. Well, common sense tells me that when you mix a fast paced pace in a highly critical and vulnerable area of nursing you will surely spell out DANGEROUS. In my opinion moving at the quick pace they want you to move in surgery (despite that management constantly talks about keeping our patients safe) is not a safe thing to do. We are questioned any time we are in the room late, regardless of why. It is always the nurse that is asked and looked upon for anything that happens in the OR room. They have even asked me why do anesthesia do that? Well, why don't you go ask anesthesia. Not cool since it is a team in the room with shared responsibilities, each having our own parts to play. I am the weekend circulator and work the Fri, Sat, Sun 12 hour shifts. Not too bad right. Well, not only do I circulate, I am their weekend charge nurse (without the charge nurse pay), OR coordinator, OR scheduler, OR secretary, OR Pre-Op nurse, OR Liaison, and anything else that they come up with. I have to circulate the cases, and then all the other stuff that is normally done by several other people during the normal workweek. There is only me and the scrub tech there. There is 1 PACU nurse there for us to take the patient to and they have to call in their other PACU nurse before we bring patient to PACU. OR on the weekends runs the same type cases they do during the week and then add in a few emergency cases that end up having to wait for an elective to be completed before we can do it. Really puts me in a bad spot and nursing license on the line every time I go to work. I've asked management for help and voiced my concerns about how unsafe it is for just the one nurse to function is so many different roles during a single case. Too many distractions and too many opportunities for errors to occur. But all they do is keep shifting the responsibility to others and then they still end up back in my lap of responsibility. Therefore I began to look into another area of nursing - employee health - occupational health. I took an employee health job with another large hospital system. This is an area that so far seems to be so much more relaxed and even quite interesting. I know there is a least a 10 point drop in my blood pressure when I am working at the employee health job as opposed to the OR. It is busy and seems to be more of administrative type work/nursing mixed with a little hands on. I really like it. The only problem so far is that it is only part time and I would like it full time so I can leave the OR all together and focus on this new area of nursing that I seem to like better now. Are there any other nurses out there with similar experiences of ED, OR, employee health? What are your feelings and opinions? Would really like to hear from you and any suggestions.

I am currently an active Paramedic in Georgia. I am in my last term of nursing school for RN as well. I can shed a little light on some of your questions in your post. In Georgia Paramedics cannot legally pronounce someone dead. When we are called to a scene (be it a residence, business, healthcare facility, etc.) we operate under protocols and standing medical orders that are preapproved by the medical director of the EMS/Ambulance service. We have SMO's in place that address cardiac arrests and also operate under the ACLS guidelines of American Heart Association. It is the discretion of the Paramedic on scene to decide based on clinical condition of the patient as to continue CPR, or even start CPR on a patient. This decision is backed by ACLS and the SMO in place by a licensed physican that is the approving medical director of those SMO's. If CPR has been established then we allow that to continue and call medical control and speak with the doctor and provide current patient clinical findings and our suggestion and then the doctor will give us the approval to stop resusitation efforts or to continue and transport. Generally, the doctor will support the Paramedic's decision/suggestion and that doctor then needs to sign the patient care report for that patient signing that he agrees with termination decision. If we respond to a call of cardiac arrest and no CPR has been established then the Paramedic makes the decision based on current patient clinical findings and no physican contact is usually needed if it is an abvious death such as those findings that are recognized by AHA such as mortal wounds, Asystole, hospice patient. If the death occurs in a healthcare facility the county coroner is notified. If the death occurs outside a healthcare facility then the county coroner must be contacted on all those death suspicious or not. It is the county coroner or medical doctor that pronounces a person dead, not the Paramedic. The Paramedic determines whether or not to start or continue resusitation efforts. If the death is outside a healthcare facility then the coroner comes and investigates the scene and the patient and then will decide to either release the body to funeral home or if autopsy must be done and then they will arrange transportation of the body to the state crime lab. It can be a little confusing at times. This is pretty much how it works in Georgia. I am sure there are some more finer details concerning the coroner and death pronouncement that i am not aware of. Nurses (RN's) should be allowed the same ability and supported in being able to make that determination of CPR or not. RN's are highly skilled and knowledable of patient care and it is in the best interest of the patient and the family that they be allowed to make that clinical decision.