Ems2n21

Wow. Lots of reading and information!! Awesome & Correct. Every working nurse has felt unable to care for someone who needs to be cared or has had an incident that could have been averted had they not been doing something else! I read the article. I have not read the proposed bill nor do I know how well CA is doing with the law they already have on the books and yet I am still going to reply. I will be reading the law proposal tonight. I can't say I agree with the poster in the standard number form to care for patients but I can agree with it being used to intelligibly staff those areas for a nurse count! Let me explain. Each person who commits to being a patient would be best served to be classified. Their location (like ICU vs school kid in school nurses office) would certainly help determine the patient classification. But so would many other factors be used to determine their classification which would determine nurse to patient ratio. Let's face it, we are talking about holding people/board of directors/administration accountable legally for decisions so we should make them very right & able to be completed. We have the science so let's put forth the rationale. Statistically speaking! A healthy 12yo standing fall statistically will not cause the damage (or require the amount of nursing care) of an 80yo. Nurse ratio for a patient requiring emergency care like CPR is not 2:1 or 3:1 like the ER assignment poster shows. I'm not saying we make ratios for every type of disease process or emergency just as I am not saying let's make assignments based on areas that people are patients (as on the poster). But we can assign a number to a person & decide assignments based on that number. Let's be honest, these short stories show need but should show the need for every nurse on duty in every environment. Examples: nurse at an outdoor camp with 6 alert kids at your feet. Sound simple? It is 100 degrees and they were all just stung by wasps and walked up at the same time. The camp doesn't have another nurse and you need support. We need to include expected responsibility of those who employ us when this happens. This isn't a school shooting. This is something the world would expect us to care for and have a GOOD outcome! Being prepared. ICU patient with Q1' blood sugar or lab draw who is on a balloon pump while in DIC. NOT a 2:1 assignment but could be with a 1:1 with appropriate 1:1 staff. Who does the ER waiting room ratio belong? One night on my way out after not eating, drinking, pooping or peeing for 14 hours of my 12 hour shift I decided to triage all the waiting room before I left. The designated triage nurse always had an assignment as well. This night everyone had an intubated patient & some had 2 or had RSI or a sedation to put a bone back or had a seizure that ended up intubated so nothing was going right and nothing was the normal expected. One of my 3 patients was a trauma who EMS could not intubate with head & face trauma along with BUE and chest trauma awaiting the trauma center ambulance because the helicopter couldn't fly and my other was an infant that resp & I took turns holding the ET tube because it seemed to migrate into the right main no matter what he did to secure it & we were waiting for the pediatric transport team for that patient. Those were just the 2 of mine I recall as I had the trauma room assignment that shift. After handing that assignment over (about 2 hours of the much needed 2 nurses working them and assisting the other nurses) I finally was able to leave but triaged the waiting room first as a nice gesture for those patients waiting hours already. Of the dozen waiting patients, 3 of them were ESI 3 so I brought them back and gave report to those nurses but one with back pain I decided to make sure her EKG was completed because her back pain couldn't be explained by injury and she ended up being a STEMI. The moral of this is incoming patients nurse ratios need special wording because those people are not classified yet. The unclassified, who is responsible? Like the guy sleeping in the waiting (so you thought) who has been dead for 2 hours. Now most ERs use nurses as greeters & a nurse places an ESI # to the patient. It partially works but care starts before a practitioner sees the patient & our nursing scope is WAY below our education and capabilities in every area nurses work! How many nurses do we really need for a pre-op area? If you have 21 people who arrive at 6am the ratio is gonna be much different than when they are ready at 8am. 6am they are walkytalky (generally or mostly independent). So one nurse could take care of all 21 if there are other staff but as IVs are placed & medicines are given & accuchecks for the NPO DM and such are done, the ratio should change to include many more nurses like the 3:1 or 6:1 but without patient classifications I don't think we can really place a ratio to an "individual" patient. Maybe to an area like you have done but that doesn't completely serve the individual patient who we ultimately serve and I know we can scientifically attribute "classifications" to patients with the "considerations" as to locations like schools, ERs, ICU, pre-op, intra op, camps, medical aids/urgent cares and all others who employ nurses. Patient classifications with "where you are" considerations for patient & nurse expectations is easy as Pi. So when a nurse goes on break or a patient codes - nurses already know who can pick up the extra load because statistically speaking we are prepared to meet the expectation "considerations" of an emergency, admission, discharge and general good outcome we desire for those we serve! To me, this is a start but I think our brilliant minded experienced and highly educated nurses can come up with perfection.. God bless.

In my experience I have found most school nurses lack good beginner to moderate emergency skills or knowledge in childhood illness & emergencies. Most have what I would assume beginner level but not all. I fell between moderate and expert when I started as a part time school nurse. My background was fire/rescue/EMS/ER nurse/camp nurse so I lacked pediatrician office nurse & knowledge of all immunization timing. Obviously ER gave me knowledge of the biggies to expect for the child coming to the ER with a fever or a booboo. You would benefit a ride along with a medic/EMT and definitely sitting with an experienced triage nurse. Simple things like a 5yo saying the have a bellyache require an assessment/decision that can have life altering consequences if we are wrong like in torsions and appendicitis. I once had an eye complaint during allergy season that ended up being an ulcer. Strong assessment skills are great but most important is EVERY ENCOUNTER REQUIRES AN ASSESSMENT! Don't blow off any kid for any reason. 99 times one will come & only need mommy TLC kinda care but that 100th time you will need to add the experience/training/expertise of being an RN. Don't miss that chance. Lastly, sit with a School Nurse who has all the credentials and papers that say school nurse (because it is a speciality) and find one that has the skills that you are weaker like the pediatric emergency/illness/assessment. Make sure you know who your medical direction is coming from & what it says! Personally I wrote my own and had a doctor sign it. Document each encounter & what the plan is & know the rationale for the plan. I am a great asset to the school nurse but I am NOT the whole school nurse. I have no desire to sit with parents or doctors to make a child's care plan or go through all the charts making sure whatever state requirements are met or sending the information to the state for their records. But that is part of being a good nurse. Know your resources & utilize them. Have an emergency plan for every likely emergency. Taylor your budget to fulfill the needs of the students. Find free stuff like Tylenol and maxi pads give out free boxes of their product (or used to). If you have a school that sends out half a dozen kids per week via ambulance, hire /contract an EMT from the local responsible responding EMS company. I would do this before hiring your own EMT by the school or district at least until you are completely comfortable with care and understand the local EMS protocols. God bless.