RC1

There is a serious lack of teamwork at my facility which becomes painfully evident every time we have "one of those nights". This was one of those nights for sure. It still doesn't excuse anything as far as I'm concerned though. What would happen to a nurse who behaved in this way? I'm pretty sure he or she would be looking for a new carreer, a new job at the very least. And as far as interpersonal issues go, there were no issues until this individual was asked to do a little honest hard work by someone whom she refuses to accept as an authority. Anyways, thanks for the input. I haven't been back since the incident but I'm going in tonight. We'll see what, if anything, has transpired in my absence.

My state board of Nurses Examiners states that it exists to protect the public against nurses who are, for whatebver reasons, unsafe. My point then is this, the CNA comes into contact with the public as much as and, in some cases, more than the RN or LVN yet, to my knowledge, they are not in any way answerable to any authority outside of their facility and, as such, nullify the raison d'être of a state board of nurses examiners. I have recently had an issue with a CNA whereby she acted unprofessionaly in front of a pt by telling him several times "I hate your nurse" that nurse being me. Furthermore, she acted outside of her scope of practicewith the same pt by disconnecting an IV line connected to a dilaudid PCA pump (for purposes of changing a gown). As if that weren't bad enough, she then jeopardized the pt's safety by tossing the running IV line onto the dirty floor and interefered with his therapy when the pt hit his PCA button twice only to have his medicine leak out onto the dirty floor. What's more, I observed her falsify a legal record record by entering 20 resp/min in her VS log sheet while I stood right beside her and counted 12 (for the same pt). This is the second time I have caught a CNA/PCT not recording an accurate repsiratory rate for a pt on a PCA pump. Needless to say, I am furious. My question then is this does anybody know of an authority beyond the immediate employer that regulates their ability to come into contact with the public? I have already sent letters to my chain of command but if they refuse to fire this person I want to go higher. What's more, I feel she is a threat to the public's safety and should be barred from working in a situation where she is providing "care" for the public. If she were a nurse, her license would be forfeit for these violations of the NPA. Her lack of a state licensing authority and the overall increased demand for CNA's should not be a license to act with impunity. Any thoughts?

only an RN can do the initial admission assessment-technicaly. An LVN/LPN can do one however but an RN must verify it's clinical veracity. Regarding everything else, I would asvise you to use your computer to download a copy of you nurse practice act which should be located on your states board of nursing web site or available directly from them via snail mail.

I wasn't aware that I had personaly singled you out as such. Could you show me where I did that?

50Cal writes: I have been nursing for about seven months now. The speed came at about 4.5 months when I learned the necessary "order of operations" that would allow me to maximize my efficiency. I think one aspect of developing and maintaining speed that has been overlooked and needs to be addressed is good old coffee. My first order of operations is always to drink at least one cup of coffee before hitting the floor. Remember, decaf is the enemy. Another thing that I find helpful is showing up early and spending about 15-30 minutes off the clock setting yourself up for success. I always show up at least 30 minutes early. After making a pot of coffee, I find my pt list and read their charts as much as possible. I make sure the previous shift isn't leaving me with untended to BS. I look at the MAR (E-MAR in my case) to see whose getting meds first and I prioritize. I even walk past all the rooms, if possible, and put eyes on the patients to make sure they're A.) breathing; B.) stable; and C.) "as they should be" all before having even clocked in. In short, I amp myself up with coffee; take care of a few little things that will minimize potentialy time consuming chaos (chaos is the other enemy), and I develop a good plan that will allow me to provide the most efficient and safest care possible before I am at the mercy of the madness. It works like a charm.

MainLV writes: 1.) Not necessarily, not that I have noticed at least; however, I haven't been looking for it either. Actually, I think American media has more to do with perpetuating the various American stereotypes than anything else. 2.) Yup, all the time in fact. I have noticed that the older generation of patients tends to have the most difficult time with accepting "male nurses." I could tell you some stories. 3.) Of couse; although, not any more so than in any other capacity (imho). I think the differences become much more problematic when the male nurse hits the floor and is thrust into instant minority status. When your livelihood is at stake, it's a whole different ball game. Inevitably, you will be forced to play "office politics" against a coven of bitter, spiteful, man hating witches who blame white males for everything that is wrong in the world. My advice: talk about how much you love Hillary Clinton. Then, work your way into management. 4) Not only yes but hell yes.

I work on a 32 bed med-surg/tele floor on the night shift (in Texas). We typically have 3-5 nurses including 1 LVN (who can do a hell of a lot); and a CNA. The CNA is "convenienely" designated as a PCT (pt care tech) however. On a good night, we have a 1:5 ratio; on a typical night, we run 1:6; on a particularly bad night, we'll go to 1:8. I have heard that we have gone to 1:9 occassionally, but it's a rare thing fortunately. Acuity is just beginning to be addressed; unfortunately, they're all pretty high acuity in their own way. The charge nurse is expected to take PT's, be they new admissions or curent Pt.'s.

In my experience, I have yet to find a pain that can't be controlled with adequate, but safe amounts of Dilaudid. I'm not a big fan of morphine. It appears to simply take the persons mind off of the pain whereas Dilaudid really seems to block up pain signals. I like the dilaudid because it acts more rapidly too; although, the shorter duration will keep you busy. I think it's critical to use prescribed PO analgesia such as Hydrocodone or Ultram in a round the clock manner and then use the IV narcotics for breakthrough pain; however, all too frequently, I see the PO meds being forgotten about and the IV meds being used solo. At night, I think there's nothing wrong with giving IV phenergen with the intention of both reducing nausea but promoting rest as well. A soundly sleeping PT is, IMO, not suffering. If there's any benzodiazepines available, I'll probably give them too provided the PT's respirations are good. Also, the use of the pain scale is pretty mandatory in assessing the effectiveness of your measures. Frequent VS observations are pretty useful too.

You're welcome. Sure, thanks for asking.

As America transitions from a manufacturing economy staffed by an indigenous workforce to a multi-nationally run global economy staffed increasingly by foreign sources, it becomes necessary to adapt to the changing workplace environment. Historically, the professional class has provided the greatest degree of security against the various market forces. In other words, doctors, lawyers, and nurses do not have to worry about their jobs being outsourced and; what's more, because of the advanced level of education required to enter the professional class, we are relatively well shielded against the threat of cheaper imported labor that plagues the traditionally male dominated manufacturing and construction industry. Because of the prohibitively high investment of time and money involved with becoming a Doctor or Lawyer, it is only natural that many men turn to nursing. That being said, there is little doubt that many men, such as myself, also enjoy the spiritually rewarding experiences of providing aid to those in need. I am, of course, only speaking for myself. This was the basic thought process that led to my decision to become a nurse.

All I said was that compassion and conservatism are mutually exclusive. I stand by that. You did a fine job of standing up for your beliefs but you have not suggested anything that indicates I am wrong. While that's quite possible, I'd have to know you better to make that claim. Tell me then, why are you loyal to this party of miscreants? Maybe you should take the hint? Liberals are only intolerant of intolerant people.

There's no need to limit the logical progression of a dialectic because it might make a few people uncomfortable either. What's more, there's no reason for nurses not to discuss US politics and how it relates to their circumstances. The bottom line is, the Republican/conservative ideology is incompatible with the kind of compassion that is supposed to be inherent to our profession. This incompatibility is becoming more and more evident. This is just my opinion of course but I think anybody would be hard pressed to make a sound argument against my position; compassionate conservatism is an oxymoron.

As far as I'm concerned, the people already banded together to support the rights of corporations to walk all over their employees when they voted George Bush back for another four years of short sighted self serving Republican leadership. That walking all over employees includes, among other things, facilitating the importation of cheaper labor. Political plug over.

HellllloNurse, it sounds like it's time for you to move. It's like I always say, if you want to catch fish, you have to go fishing where there are fish. The beauty of nursing is that it allows you to do just that. The U.S. job market has come to this I think. My Grandmother, God bless her soul, was a nurse during the Great Depression (and WW2). She and her colleagues were largely spared the worst effects of those hard times because of the job security inherent to their profession. Anyways, I'm sorry if you're unable to pick up and move and I understand that not all of Texas is experiencing the nursing shortage to the same extent. The larger cities do seem to be the best places to go fishing for nursing jobs. The compact allows you to practice in Arizona where your skills are in even higher demand (from what I understand).

That doesn't apply to humans anymore, not in advanced countries at least. I'm sure it still works that way in Africa and other impoverished high population regions where selection is still natural though. Whenever I hear that term, "survival of the fittest" I have to point out that "fittest", in the Darwinian sense, is a measure not of health necessarily but of reproductive success. It would be more precise to say, "survival of the creatures that are able to make the most copies of themselves before they die." Perhaps the conditions necessary for it to "work its magic" have never fully been realized. The advent of commercial air travel is one of those factors that greatly increases the ability of a bug to cause disease. I'm sure there were plenty of deadly diseases that weren't a problem to most of the world until the etiological agent was able to hop a ride on a carrier bound for a new country full of susseptible hosts. Look at the havoc that European pathogens wrecked among Indian populations in early America as an example.