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Speaking as an ICU nurse, i can tell you that not all are ocd's but a lot are. You really kinda have to be, because you have 1 or 2 patients and then if you pass it along to someone who isn't so nice, we'll you'll hear about it the next day, actually the manager will hear about it the next day. Is this what you're going through? I mean the next day you come in and the previous nurse will berate you about the little things you ''forgot'', I'm not talking about important things, but like some not so important things like when they come in there's 50 cc's of urine left in the foley bag that can accomodate over 2 liters, and which you also emptied an hour before when you did your I/O? There's really nothing you can do about it, you just have to shrug it off. But then after awhile it does get to you and you become anal retentive about your patients, making sure everything is pretty much perfect. Then once you start to orient a new nurse, they will also think that you're pretty much OCD.....So the best thing is just leave your work when your shift ends and forget about it. Good luck!

Thank you both, Gauge and Siri...You've cleared things up for me...There's a dual program Adult/Geriatric NP that I'm really interested in pursuing with the hopes of seeing patients from clinic to inpatients to nursing homes. Thank you both.

Yes thank you, I guess I was thinking of a specialty in a way where you can see your patients thru the whole continuum, clinic and inhospital, and was wondering if you need to be dual certified. Thanks a lot!

I had a question on another thread that's similar to this, and no one has answered yet, so I guess I should pose it here...My question is if you're an FNP or an ANP practicing well care in a clinic and your patient becomes acutely ill. Now I know IM physicians do consult specialists left and right, there's no question about that. Though what I would like to know if anyone would like to answer is, working in a clinic, is it a common practice to have hospital priviliges so that you can follow your patients during their in-hospital stay, or would you need to be a dual cert ACNP for that? Meaning as ANP or FNP's with acutely ill patients that you sent to the hospital from your clinic, would you then be able to round on your patients off clinic hours to see your patients in the hospital and still be this patient's primary HCP, order lab tests/meds/treatments etc? Is that even possible? And I understand the notion of putting consultants on your patients such as pulmonologists/cards/nephro depending upon your patient, but I guess my question is, is it common place to have single certified FNP to follow a patient from a clinic to hospital thru discharge, as the primary HCP, or would you have to give up your patient to have a different attending like an attending physician assigned by let's say the ED to manage the patient while they're in the hospital. I guess it's kind of like the same as an IM/FP physician having a critical care patient and giving up that patient completely to the Intensivist group, and them seeing and rounding their patients everyday with the attending physician in the background while the patient is critically ill, but in the case of ANP/FNP it's from well care to acute care. Would dual ACNP/FNP help to have continuity, or it doesn't matter? Sorry if this sounds confusing, but I'm looking at programs such as ANP and I'm wondering if I would need ACNP to follow your own patients thru their whole stay, which really appeals to me. Thank you very much.

LOL this made me chuckle and made my day, too funny.

A solution for missed orders that is used by a lot of nurses so that they can cover themselves is the end of shift chart audit with the oncoming nurse. Therefore a nurse can go home knowing that when she checked off with the oncoming nurse, all the orders throughout the shift was taken care off. It takes only a minute.

Hello, to all practicing NP's especially the one's in primary care. I just have a question...If you're an FNP or ANP who functions as sole Primary care provider for your own patients in a clinic for well care, and then your patients become acutely ill, does that mean you would have to consult an internist to manage the patient and maybe do an admission? Or are most ANP and FNP usually have admitting priviliges that they can manage the patient in the hospital? If not, and you're an ANP or FNP, then would you need to be certified as an ACNP to have admitting priviliges in the hospital, handling the patients hospital stay, rounding on your in hospital patients? Is that within a scope of an ANP or FNP, how bout if they're dual certified as ACNP, would that be within their role? Or is that encroaching upon the role of Internal Medicine Physician?

Yes, per oxyhemoglobin dissociation curve, a right or a left shift depending upon the temperature. Source: http://www.ventworld.com/resources/oxydisso/dissoc.html Here's an interactive module where it shows the change in oxygen saturation when the only variable changing is temperature. http://www.ventworld.com/resources/oxydisso/oxydisso.html

Here's a video of a student who made the error of picking up the cellphone in the middle of a lecture...

PRN med I would, if you push the 1cc mso4 and leave it as is then it will take time for the IV solution to push it in, and your patient would be in pain for awhile. I guess I'm being anal.

po here, x 18 doses usually, then patient can be transferred to the floor. Some attendings prefer to keep their patients in the ICU until the 18 doses is finished, with tylenol overdose, but some physicians transfer the patients after 36 hours or 9 doses depending on the labs.

One can say that pulse palpation can be dependent upon the skill of the person performing the palpation. Sometimes, during a code there's a lot of chaos, and a doppler could be another aid. There are times when you have flow with less than palpable pulses, and at these times, when you have a weak pulse that's not palpable but is evident thru the doppler, then your interventions could change - for example not doing extra defibs on a patient with a weak pulse that's found only by a doppler, as oppose to defibrillating a person because the staff couldn't palpate the weak pulse. Technicality I know, but can be helpful at times.

If the pt's already on lisinopril, you can safely say that he's at a higher risk for incidence. For the warning, research non selective cox inhibitors.

LOL sorry that annoys u augigi, I was giving her an incentive. To tell you the truth, and as of course you know, it's difficult to get people in without ''bait''. I for one, love inservices from the drug companies, it takes me away from the chaos of the unit, I could sit down and have a nice and quiet for a few minutes. Even if it does sound crude, it is a great form of advertisement. It becomes a symbiotic relationship between the two. As a lot of nurses in the unit knows, ''food and gifts'' are what the companies use to get them in the conference room. You'll see a lot of them by the nursing station and say, ''guys we have food in the kitchen, and an inservice'' I'm not saying it's a bad thing, actually it's a good thing, the companies get their points across, and the nurses learn at the same time. Again, I apologize.

That's what I heard about community hospitals that don't have fellows or interns, they pretty MUCH are more autonomous because they don't have residents that would be there in a minute, so I heard typically the RN's from community hospitals would have to be pretty fast, and can function well alone.