nursesaideBen

That'd be nice except that the company I work for doesn't believe in discipling physicians and buys into the whole MD=God mentality.

Thanks for all your support guys! I've been brooding over this all week.

This cardiologist is about to retire, some of the nurses have told me that he's adopted an "I don't want to be bothered" type of attitude.

This past weekend I had an oncology patient who was a full code. In the early morning hours about 0500 I was getting qshift VS and this patient's heartrate was 41. I looked at his chart and he was typically running in the 50's. B/P was normal. Patient denied, SOB, dyspnea, dizziness, palpitations, and CP. I spoke with my charge nurse and we decided to put him on tele to keep an eye on him. Well, it wasn't long until he started dipping down into the 30's and staying there. I called the attending which was his Oncologist and he ordered 1mg Atropine IV, I administered the drug and his heart rate came up into the 60's but by the time I was giving report to the dayshift nurse he was starting to dip down into the low 40's again. That day he had a cardiology consult, the cardiologist ordered a BNP and cardiac enzymes. That night I recieved report, labs hadn't come in yet and he was maintaining a HR of about 40. A couple hours into the shift his heart rate was averaging 25, labs came back his BNP was 970, suggesting CHF, and his enzymes were normal. Patient again was asymtomatic, B/p WNL etc. I paged his attending and notified him of the situation, he was going to order Atropine again, I told him it had been minimally effective last time so he told me to page the cardiologist. I did so, and he became very agitated with me stating, "He's asymptomatic, so I don't know what you want me to do." I stressed to him once again what his HR was, what his BNP was, that he was a Full code, etc. Finally he told me to call the oncologist to see if we could transfer him to PCU and the oncologist agreed. We immedidately transferred him he had a scheduled 2100 of Oxycodone which I did NOT administer because my charge nurse and I both felt it could cause his HR to drop even more. Once he was transferred I get a call from the PCU nurse, chewing me out for not giving this 2100, stating "He has cancer and is in pain he NEEDS his pain medicine, I don't understand why you didn't give it to him." I explained to her why, she continued to rant, until I cut her off and told her he was her patient now she could do what she wanted. Of course I didn't want him to be in pain but at the same time I didn't want to kill him either, was I in the right?

If you aren't able to get a job in a hospital, you should have no problem getting one at an Urgent Care Center, most like to staff themselves with mostly LPN's and CMA's.

I do IV pushes where I work. On my unit LPN's can push everything accept drugs like vasotec and adenocard unless an RN, MD, or PA is in the room. We don't typically flush our lines with Heparin unless it's to lock off a port-a-cath. If we have a PICC or other type central line to get "clogged" the RN supervisor has to deal with it.

I've only been working as a nurse on the MCU for 3 months now but I've come a long way. I'm starting to really love working, it's such a variety of pts and diseases, everything from UTI's to meningitis. I think the trick most nights is trying to keep a step ahead, getting enough of your work done so that if you have admissions or a patient go critical you aren't chasing your tail for the rest of the shift, but of course that's not always possible.

Post edited, Sorry about that! :)

I gave 2 during my OB rotation they were IM, felt so bad for those poor little babies lol

I believe you took my post out of context. I should have have put capable in quotation marks. I was simply repeating what I had been told which by no means makes it true. Didn't mean to anger anyone :

On our floor, if you're getting pain meds IV it's either Morphine, Dilaudid, or Fentanyl. Also we give a huge amount of Protonix both PO and IV and now apparently Zosyn is the antibiotic of choice for EVERYTHING because it's stacked up in our med refridgerator like fire wood lol

From what I've always been told, nurses recommending physicians is a big "No no" because we don't have the "capability" to refer patients.

Boy, that situation really stinks. I had a humdinger of a patient this past weekend, A/Ox4 no history of psychiatric problems, who told me he wished he had a gun so he could blow my head off because I came in the room at 0130 to hang an antibiotic. Didn"t really know what to say. Should have said "Hold that thought let me call Security" lol but it is ridiculous how some patients act and as others have stated you're only human any one of us under certain circumstances could lose it. You're doing the right thing by getting therapy, hold your head high, made a mistake can't undue it and you learned from it. Best of luck to you!

God ain't that the truth night FROM HELL!!!

When all your pts have PRN IV pain meds q3hrs When your alcohol dtx pts have nothing ordered for agitation None of your Pts's 1800 meds were given out All your pts are under contact isolation precautions for either C-Diff or MRSA When you have 2 admissions that have been on the floor since 1730 and NONE of the work has been done When it's Friday the 13th and also a Full moon out

I can take poop, pee, vomit, snot, but I cannot deal with any time of injury or illnes relating to the eyes! Just grosses me out, it's all I can do to put eyedrops in someone! lol

Manipulative patients love to pit staff members against staff members "Well day shift never did this or that or That nurse I had today didn't do this or that and said this and said that." Don't buy into it. I generally just say "I'm sorry you had a bad experience." document when appropriate, make sure the charge nurse is aware of the pts behavior, and pass it on in report. Hope this helps.

While we do primary care nursing at the hospital I work at here a few weeks ago we had a full unit and were short staffed as hell so the RN that was working on the same hall as me and I decided to kick it old school, she did the assessments, chart checks etc and I did the meds, IV's and wound tx, It worked out very well and the night went by a lot smoother in fact we got finished with all our work about half an hour early. I think it would really depend on how you or administration divide up the work and if you have a good team.

Make sure you check with your state to see what the scope of practice is for both roles before you decide. Here in VA for example the scope of prractice for NP's is much wider than the scope for PA's.

I am very very fortunate my RN co-workers are very Pro-LPN and in the type of setting, facility, etc it is difficult to really distinguish me from one of my friends who just graduated with a BSN. We're both primary care nurses, we both get the same types of pts, the main difference is that he can hang blood and push a couple more cardiac drugs than I. I don't know, there's just not a competition between me being the LPN and my co-workers being the RN's which I'm very greatful for, we all have our strengths and weaknesses and we just band together and get it done.

Commuter as usual is very correct. Some Pediatric LTC facilities do hire LPN's but as far as critical care goes you're going to have to get your RN to do that. Best of Luck to you!

That is annoying, what they don't realize is yeah you may only have 1-2 patients but they are 1-2 patients that are falling all to hell.

Good lord the past couple months have been hell on wheels. The past 3 weeks, no empty beds, multiple alcohol detox pts that have been combative and abusive so much so that security has had to been called, we've been seeing a TON of oncology pts here lately particularly lung ca, don't know what the deal with that is. It's just been absolutely crazy, I work the next three nights I'm praying it'll be better than what the past few weekends have been

As the others have stated it can be very draining at times. On night shift, it seems you're always working short and when you have patients with sun downer's syndrome, alcohol dt's, a patient going critical, or several admissions throughout the night that all you're doing is trying to chase your tail in order to get caught up. Luckily on the unit I work on we're very close knit and work as a team every night so you never really feel like you're "on your own". There is so much you can learn through med/surg that if you can pull through the tough nights it really makes the good nights that much better. Good luck to you!

Here in Virginia and other southern states, LPN's with 2 years of experience can travel working in Med/Surg, PCU, long term care, and home care. A couple of my friends are travel nurses and they say the pay and benefits are great but the bad thing is is that you don't get much of an orientation to the facilities so you're expected to be a self starter without needing much guidance. Hope this helps!