gemini81sg

I recently heard of a Electrophysiology (EP) NP who took iphone photos on an inpatient unit of a pt's abnormal rhythm (ECG strip) and sent it to to the EP MD who was following this pt for his opinion. The NP sent this photo immediately to his phone. Also, a RN took a photo with an iphone of a pt's monitor simply to get a picture of the unique waveform changes while a swan was being inserted. NO pt info was in photo nor were fellow staff members viewable; the pt was not aware the photo was taken. The photo was simply for personal educational purposes to the RN and was not shared with anyone. I'm not interested in hearing about personal electronic devices being used in patient rooms as I know this is not appropriate, but I would like to know how others feel in regards to the HIPAA portion of these 2 situations. Both nurses, BSN and ANP, in both situations clearly understand HIPAA at this point in their careers. Are these situations considered punishable? Illegal?

I started out on a Med/Surg floor, a very busy one that had a lot of variety in regards to patient disease processes. I found this to be a very good place to start as a new grad as it allowed me to get a solid foundation in my nursing skills from an inpatient standpoint. I bugged my nurse manager the entire first year about transferring to the ICU. I was told time and time again that "all nurses should at least do one year on Med/Surg before going to the ICU, but two years is better yet". I eventually transferred to a CV-ICU in a bigger city. Best decision I ever made. I learned all about hemodynamics, cardiac output monitoring, vasoactive drips, swan ganz catheters, art lines, mechanical ventilation, etc. This is what CRNA programs want out of their applicants. CV-ICU also includes experience with heart and lung transplants, VADs, CVVH, ECMO, Balloon pumps, TAHs, etc. Because this was a big city there seemed to be open positions on the unit all the time. The unit is very high stress, high intensity (usually a code or two per week) and I think that is why there seemed to be a high turnover. This is the only ICU I know of that hires new grads on a regular basis. My initial training was 6 months minimal, which included many weeks of classroom and online training. It was a very stressful unit, but I loved the busyness, the constant new challenges and the adrenaline rush that came with working on this unit. So you may want to look into going to a bigger city, but I would strongly suggest getting a good solid year on a Med/Surg unit. I think it most closely resembles the type of care you will give once you are in the ICU. I have also worked in the ED and while this area does permit lots of general nursing skills, you don't have the same ability to study your patient's cases and problem solve by trending patient data/history to assessment data the same way you do in the inpatient setting. Also, your physical assessment skills are much more 'focused' in the ED, whereas on Med/Surg you are doing a more thorough assessment which will strengthen these skills. Hope this helps! Good luck! :)

hokieicurn: Just wondering if you have any additional certifications such as ACLS, PALS, NRP, TNCC, CCRN, etc.? These are things you may want to consider to improve your chances, especially the CCRN. Your place of employment may even pay for these certifications, mine did. Also, minimal ICU experience is 1 year. This is a requirement to any accredited CRNA program. The ICU experience should involve hemodynamics, vasoactive drips, mechanical ventilation and so forth. Many of the programs list very specific requirements they are seeking from their applicants, but you can always call and speak with the program director to get a feel for what they require and prefer in their applicants. This should give you a good idea as to whether to spend the time, energy and money applying. Good luck! :)

bloomRN: I was just wondering if you wouldn't mind sharing some of your stats - GPA, ICU experience, Certifications (CCRN, TNCC, PALS, etc.)....?? Also, which schools you applied to...?? Thanks!

One night at work one of my fellow co-workers, a somewhat new nurse to the unit, approached me stating that she couldn't understand why Dr. so and so was so rude to her on the phone when he was calling in to check on a patient. I asked what happened. This nurse explained to me that she gave 5 mg of Coumadin to a patient admitted with a diagnosis of GI bleed, positive hemoccult stools, a hemoglobin of 8 and an INR of 3.4. Luckily the patient received a transfusion shortly thereafter and the INR came down. Strangely enough, the same physician had just recently continued this patient's home coumadin on admission just hours before and pharmacy entered the order regardless of the admitting diagnosis.

Hello GucciRN22, When I read your post, I felt like I was reading something I had written! You and I have similar nursing background and I have also been working on a CV-ICU for about a year now. I know I have had similar feelings as yourself and I have come to the conclusion that these feelings are very normal. Learning this type of unit is so complex and is truly a specialty of its own. This means that it will take time and trial and error and redundancy of performing specific skills before one is truly comfortable and confident. My advice is that you hang in there and try to get involved in situations and experiences that you feel the weakest in. If you do this eventually you will gain the knowledge and ability to perform tasks and skills with confidence. When you are having a bad day (..and we ALL do!!) just think about when you first started and how far you have come from there....the growth you have already achieved. There are some nurses out there that enjoy letting you know how incredibly smart they are...and sometimes informing you of just how 'unsmart' you are. And sometimes physicians have a way of making you feel as if you are a physician who should be diagnosing.....you are the nurse! To me it seems like the nurse is expected to be all the specialties sometimes.....cardiac, renal, pulmonary...psychology for cryin out loud!! Just try to answer what questions you can and when you don't have the answer (for the physician) then tell them you don't have it. Each day at work, I take notes of all the little things that I questions or didn't quite understand. Then when I get home I look things up. I keep a lil notebook with me at work with notes on each body system that includes different illnesses, treatments, ect. I have also bought books specific to the things that I was struggling with. The "Nursing Made Incredibly Easy" series has all types of wonderful books that can be used as resources. I keep two of them in my bag at work and use them often. When I started on my unit, everyone said that it takes at LEAST on year to really feel comfortable there, so just keep that in mind. Remember it will take time and people will make you feel very small sometimes, but this is life....just try not to take it too personal and move on. Take the positive from every situation. You CAN do it, you will get better at what you do. And in the end, if you find it isn't for you, then maybe it is time to search one of the many other areas in nursing. Good luck to you!! nurseatheart81 :redbeathe

Hello, I have lived in Green Bay, WI for a number of years and worked at a local hospital for about 6 years. There is somewhat of a freeze in the Green Bay area. I have heard from my manager that one hospital is even laying off some of their RN's due to the 'economy'. For this reason, I have since relocated to Milwaukee, WI as I had been wanting to begin a career in the ICU. The hospital I previously worked for stated that they would not pay for any additional training so that I could transfer to the ICU there, despite a need for RN's there. In fact, I was told by my manager that she is also unable to fill needed positions in the Med/Surg dept due to a "hold" (not a "freeze"). You may interpret that as you will. The reason I am replying is that I have come to find that Milwaukee has a vast hiring market for RN's at the Aurora sites - St. Lukes, Sinai, West Allis. If you go to aurora.org you can look for jobs there. As a new employee for Aurora in Milwaukee now, I am surprised at the vast number of new grads they hire, even in the ICU, which was unheard of at the Green Bay facility that I previously worked for. Not sure if you are interested in relocating to Milwaukee, as I know I wasn't initially, but there are certainly jobs here and more importantly they are not afraid of hiring new grads. I was greeted with a warm welcome, not too mention good pay and so far so good. Feel free to message me if you have any other questions. Good Luck! nurseatheart81 :redbeathe

Hello, I am also interested in becoming a CRNA. I did not get hired in the ICU following graduation for the same reasons you have explained, but I do know that it does happen sometimes. I noticed that any of the nurses who have gotten hired in the ICU where I work, started there first as a Nurse Extern in the ICU. But otherwise, it may be difficult. But I did want to mention that I have just spent one year working on an acute care med/surg floor and it was well worth it. There you will really put your skills into action and see a variety of illnesses that will help you to gain a better understanding. Although, your enthusiam for the ICU is high and perhaps you feel that you don't want to waste time working anywhere else, you may want to rethink this. Any good experienced nurse will tell you that it is good to get a little med/surg experience prior to working in the ICU, it will only benefit you, I promise. I have just accepted a position in a Cardiac ICU where I met a man who did not have a heart, he was living on a machine. I am extremely excited about the transition, but I am also glad that I have gotten a baseline of knowledge from the med/surg unit I worked on. Good luck to you on your venture! nurseatheart81 :wink2:

Thank you everyone for the feedback so far. To TiredMD: I recently had a patient's son (POA-HC also), tell me that he wanted his terminally ill father resusitated, but he only wanted us to do a couple of 'pumps' to his chest, but not too many because he didn't want us to put his father through any additional suffering...no really, I'm serious here! So I get your point about how confusing DNR/DNI status can be to patients and their families. After all, a couple of pumps isn't going to do much. While I understand the part where you say that it is less liability to simply allow patients be a full code, I also feel that I have an obligation to at least initiate the education when appropriate. I have just always been under the impression that this was out of my 'scope of practice', therefore, I could not. I tried to find some legal and factual information on this, but was unable to find any on my state's (WI) website. Again, thanks everyone for the feedback! nurseatheart81

Hello Everyone, I was just wondering if anyone can offer any information regarding the legal and ethical concerns of initiating code status in dying patients. I currently work on an inpatient oncology unit where I feel code status is often taken lightly. I have observed physicians come out of a room and state, "Well, that patient is lucky if he's got 6 months". Or they will often say that a patient has a fatal condition, but 'little do they know' how severe it is. This astounds me as a nurse. My heart aches for these patients and their families. Perhaps if they were better informed then they could complete their advanced directives and be more prepared for the inevitable. I see them wasting away in a hospital room when they could be spending their last moments in the comfort of their own home. I've seen families who, because they didn't know how serious their loved one's condition was, missed out on spending more time with them in their last moments. As a nurse I feel that I have little to no control in changing this. I have had physicians ignore my pleas to inform the patients and their families or initiate code status despite knowing that death was likely near. Does anyone know what the legal scope of practice is for a nurse in terms of discussing code status with patients and their families? I have had nurses tell me that I cannot bring up the topic until the physician does. And often times when I do suggest this to the physician, I am ignored or made to feel belittled for requesting it. This makes me feel as though I am not being a good patient advocate. Any feedback would be appreciated. Thanks! nurseatheart81

Hello, If you are interested in ever returning to Indiana, you may want to take your boards there then transfer your license later. But your best bet is to contact the Tennessee state board of nursing and find out what you must do to transfer a license (also, the Indiana state BON if you plan on ever returning there). From my understanding it isn't too difficult to transfer a license, but I have heard some states are more difficult than others. But no matter how much advice you get from here or anyone else, you will get the most accurate advice by contacting each BON directly. Good luck! Found this online: Tennessee Board of Nursing (615) 532-3202 local or 1-800-778-4123 nationwide You will most likely get a voicemail message. Just know that sometimes it can take a while for you to get a response. Nurseatheart81

I just came from working nights after about 4 years of it, so I certainly understand your frustrations as well as those from any night shift worker. Both shifts certainly have their advantages and disadvantages. Wouldn't it be nice if shifts had to switch just for a brief time to fully understand eachother?! I know that night shift doesn't necessarily mean sitting around and being bored. In fact, when I worked nights it was quite the opposite, but it was certainly more quiet (literally, less staff!), I have to admit. But that can also be its biggest disadvantage at times! It is difficult during the day with so many people wanting the patient....therapy, diagnostics, the doctors, etc. Often I have to hold multiple pills for procedures, then figure out which ones I should give hours later depending on whether they get them again soon. Sometimes a patient is NPO for a procedure but their blood pressure is sky rocketing, so I have to call the doc, check with surgery to make sure it is okay to have a sip of water with their blood pressure pill. I could go on and on, but I won't. :) Thanks for your post and encouragement! Nurseatheart81

My struggle as a first year nurse have been the frustrations of the system moreso than anything else. For example, patient's go for procedures and come back wanting results. I have to tell them that only the doctor can relay this info and I am not sure when he will be in (we never know for sure). Patients are always asking when their doctor will be in...again, I have no answer. Patients are confused as to what a "hospitalist" is and I find myself explaining this over and over again (they don't understand why the hospitalist changes each day). Some patients have even complained about having to pay for a doctor that they don't even know why he is seeing them. Another problem is foreign doctors who are difficult to understand. I have to continually explain to patients that they need to tell these doctors to "slow down" and to repeat info if they don't understand it. But by this time the doctor is gone and the patient still wants answers. All of these things are so time consuming and exhausting. It increases patient frustration and anxiety and the nurse takes the blunt of it. Lastly, the lack of time for each patient. I feel like I am always "in and out" because I have so much to do. I wear a locator in which the nurse's station can call me in a room. It seems like 9/10 times each shift, I am called out of a room during an assessment or procedure for a phone call or a doctor who wants me at the nurse's station or to go into a patient room with them. As a nurse, I feel like I am pulled in 50 directions so many times during a day. And phone calls...from every dept wanting info on patients...I must take 100 calls in a 12 hr shift! These are the things that "stink" about nursing. It makes it difficult to maintain the happiness of the patients and that is what frustrates me the most. As a nurse you are a housekeeper, psychologist, secretary, waitress, personal assistant and so forth. That's just the way it is! Thanks for listening! Nurseatheart81

I agree with everyone else....definetly file an INCIDENT REPORT! What if this patient would have commited suicide? Where I work, these patient's are generally on 15 minute checks. This needs to be reported, it is a big patient safety risk. The nurse who left, as well as your charge nurse, need to be held accountable and more importantly need to be aware that this type of situation is not tolerable. Good luck! Nurseatheart81

Thank you so much for the reply! It is much needed right now. As for our supervisor, she is brand new and not exactly what I would refer to as a "good" supervisor. The gossip and "clickiness" on our floor is horrible. My supervisor is joining right in and at times the start of it. She has even make faces and mocked a doctor while he was leaving the floor. If you get my point here, unfortunately, I don't exactly trust her. Anyways, I avoid gossip and turn my head from the moment I sense it is occuring. I have been in this field long enough to know to stay out of it. But at times, I feel that is why I am I being treated rudely, not that this gives me any incentive to join in! My boyfriend told me if they give me any more grief, to just tell them to ask my patients about me, to go right ahead and question their satisfaction with my nursing skills and care. It seems like common sense, but I wish I would have thought of that sooner when this nurse approached me with the "head's up". I come to work for the patients, not to make friends with my co-workers. It is just difficult when I don't know what to say or how to react to their rudeness. I am a "please", "thank-you", "I'm sorry" type of person, and it seems like I only make things worse being nice....It's SO confusing! Anyways, thanks so much for the advice and encouragement! Some days I feel like it is all for nothing, then my patients remind me that this is not in fact true. I do plan on transferring to the cardiac floor (where I wanted to be initially) because there is now an opening, so hopefully I can stick it out until then. Thanks again!! Nurseatheart81