nurselambda

I work at an outpatient surgery center where minor surgeries and pain management procedures are performed. Those type of interventions are routinely done under MAC, or "twilight sedation". I work there as a perioperative nurse for some time now, the team is nice and I feel pretty comfortable doing my job. Recently the anesthesia provider usually working there left on medical leave for a few months and was replaced by an older anesthesiologist. He occasionally works there, and is known for is ill bedside manners and heavy sedation style, which patients often complain about. Recently, a young patient came in for a cortisone injection to be done under sedation. I was doing the intake, he was in his early 20's, certainly overweight but with health problems other than pain in his back due to a car crash. He was anxious and his pulse was in the 90's, which I charted. His other vital signs were wnl. He is transported to the OR to have his procedure done. A few minutes later he is brought back to me completely unresponsive. His first set of vital signs show his pulse was now in the 130's, and BP 20 points above the baseline, which is highly unusual for someone receiving sedation. I look at the anesthesiologist who was at bedside, who says "What do you want me to do, just give a minute to wake up"'. Minutes go by and his pulse remains between 120's and 130's, still unresponsive. After, a few minutes the other physician who performed the injection comes to check on the patient, looking concerned that he hasn't wake up. After 15 minutes in recovery, his pulse still tacchy, he now opens his eyes but looks totally stunned. I reach out to the anesthesiologist who tells me "I'm sure his pulse was already like that before the procedure and you just didn't pick up on it". After 20 minutes, the patient is able to talk a little bit and I ask if he's in pain. He answers "in the chest". I then rush to notify the anesthesiologist who was sitting playing chess on his cellphone. He finally comes to asses the patient. I also notify the other doctor. His first order was to push more versed, which had no effect on the patient. After a few minutes he then ordered to have him transferred to the ER. Later in the day when everyone was gone, he came up to me and said "So he was already tacchy before" in an aggressive way, getting close to me. I answered that he wasn't. Then he answered in a smart *** tone "well let's have a look at his pre-op EKG strip". I showed it to him. He looked at it said "he was in high 90's. Well my point is that he wasn't at 60" then walked away. Fast forward, the patient cardiac workup found nothing wrong with his heart and the ER docs suspected the anesthesia drugs to have caused the ordeal. I kept a professional conduct the whole time, but the way that doctor acted angered and disgusted me by his dishonesty.

Hello all, 2 months ago the clinic I work at hired this new part-time nurse. We became friendly instantly sharing our professional experiences and career prospects. I commented to her that I would be open to a move although I am not particularly dissatisfied with my current. I know she works at Davita. It happens that I had applied to in the past when I was fresh out of shool, and when I mentioned that to her, she immediately said she would be happy to refer me to a job there. "She's so nice! " I thought. Few weeks later I submitted a general application on the company's website, just to test the waters, and a few days later I sent her a text message telling her about it. "Why didn't you tell me!" she said getting excited in what had been until then a lukewarm conversation. She immediately asked me for my email address and my resume to forward it to her boss. She even texted her to tell her about me. "She's so nice!" I thought again. Today, I have been researching more about the job, the pay they offer, the company culture, just to make sure I wouldn't shoot myself in the foot by switching jobs. It turns out that the pay they offer isn't exactly stellar, but also I noticed that their "referral program" is very developed, and it seems like they offer staff members cash rewards for referring new hires. My interest for the job and respect for that girl instantly dropped. I saw 2 red flags in 1 sitting. Great workplaces do not need to pay their employees to help them find new employees, and that referral system really sounds like something ponzi schemes do. That company is having difficulty hiring and retaining staff. I also wasn't too happy to find out someone was about to make a few thousand dollars on my back. What do you think?

Hello all, I am a new graduate and after lots of looking I finally managed to land my first hospital job. The hospital who hired me has 6-week preceptorship program for new grads, which I was more than happy about. The unit I was assigned to has a few other new hires. The preceptor I was assigned to is a young lady with a friendly enough yet assertive (hear loud and cocky) personality. Talking to her I found out she has 1.5 years of hospital experience, and I was her first preceptee. I didn't think anything about that first. I have been working with her for 2 weeks now, and I can say she overall knows what she is doing, I have been developing some second thoughts and mixed feelings. She can be blunt. I witnessed her yelling at a patient who underwent a BKA 3 days prior for no real reason. To me also, making feel like I should already know and act with the most confidence. Not only that but I started questioning her skills. It's been several times that she induces in error but refuses to admit she was wrong. The biggest question mark occured the other day. One of her patient needed an NG tube to be inserted, and she told me she had never done it before. For the record, I inserted 2 NGT while in nursing school. She got the charge nurse involved to guide her through the process. Long story short, it costed the poor patient a few bouts of vomit to have the tube inserted. The X ray confirmed that the tube was inside the right lung... The medical team had to be called and the tube placement had to be fixed. After the incident, I noticed her picking at me in an semi aggressive way. Back at home, I was giving the day and the 2 weeks a re-run. I feel like I really starting to hate the job already. I'm the type of person that's quiet at first. I starting thinking that precpeting is not for everyone, and certainly not for the "hyper" personality type. Not only that but someone with 1.5 years of experience shouldn't probably be teaching either. What do you think?

Hello all, I'm a new grad RN and I recently started the first job hunt. One LTC hospital got back to me within hours of applying. The HR person informed me that scoring at least 80% on a 40 NCLEX-style questions test was the first step of the application. I was surprised to be asked to take another test after having passed the NCLEX just a few weeks ago. It got me wondering how common is taking a competency test as part of a job application? Thank you for your input.

Right, obviously I'm only considering those program who would consider my academic background.

Hello all, I recently graduated from an ADN program and since I already have a bachelor degree in a another medical field I am seriously considering enrolling in an online FNP in the near future. I am curious about the workload an online FNP program requires, I was wondering how it compares to a pre-licensure program and if doing it while working would be a realistic option. I appreciate your time and input

Where I get confused is when calculating the infusion rate, the volume to infuse is only the diluent (250 mL of D5W), or the diluent (250 mg) AND the drug (1.6 mL) ?

Hi everyone I have this drug dosage calculation problem that is giving a hard time. Order: Nitropress 40 mg in 250 mL of D5W for 90 minutes Drug parameter or range: 0.3 to 8 mcg/kg/min Patient weighs: 75 kg Available: 50 mg/ 2mL a.  1 mg = ______ mcg b. What is the drug parameter/range?  c.  Is the Nitropress dose within normal range? ______ d.  Drug calculation ______ e.  Determine the volumetric infusion rate If some of you wouldn't mind giving their input, I would appreciate. Thanks !IV

I would join too!

Ok here is my story. I hold a background in psychology. One day I discovered the nurse practitioner profession at my job and immediately saw myself compelled to this profession. I then gathered all the info needed to figure out how get to the job. I put muself through community college to take all the pre-requisites courses needed to apply to a entry-level master's degree in nursing all this while working full-time taking 3 classes a semester. I was so much into it it was no problem. I aced all the classes and was subsequently accepted to my first choice school. Finally the program started I started with good grades. After that I had a hard time getting along with people in my class. For some reason some people started gossiping behind my back making fun of my accent all the time. I tried to ignore it but I have to admit that I wasn't able to not allow it to get to me. I sort of started feeling depressed, turned off by the school and disinterested in studying. Of course my grades dropped and I ended up failing one class. Now I'm not sure about what to do do. Should I go back? Should I just do something else? Thanks for reading.