mrphil79

Union or not... if you give 5 months notice, they need to figure it out. How can they not figure it out with 5 months, but they can cover your entire job if you give 2 weeks notice when you quit? THIS crap is why I won't go back to staff - I'm a grown a$$ man and I won't be told I can't take a vacation that I planned out responsibly.

I'm offering an actual fact in response to the original question about why anesthesiologists can prescribe most meds, whereas CRNAs can't... But for some reason you seem to be hearing my words as "CRNAs are undereducated cavemen" and want to be defensive about it. I'm fully aware that people in a specialty are familiar with their common drugs, and I never disparaged CRNAs in any way whatsoever in my response. Not sure why you want my words to be a pi$$ing contest, when I'm really doing nothing but stating straight up facts. Kind of an odd response, really...

Yeah... perhaps my point is being a bit twisted here... I'm not arguing that anesthesiologists should be regularly prescribing all kinds of medicines or that they in fact do - I'm just stating why they have the ability to do so compared to a CRNA, which was the exact question I was responding to. At the end of the day, the anesthesiologist (just like a psychiatrist or radiologist) has the education and training to prescribe basic meds like that if they so choose - the CRNA, unless they're also a NP, doesn't generally get that same training.

Well to be fair, the anesthesiologist went through the entirety of medical school and years of residency that include multiple specialties -- the CRNA has been trained specifically to focus on anesthesia and anesthesia related health issues/procedures (pain management, blood patches, etc...). The CRNA's scope of training doesn't generally include the use of augmentin or terbinafine outside of the basic pharmacology class that all APRNs have to take. The anesthesiologist, however, did have to learn all of that to make it through residency before starting to specialize in anesthesiology.

Seriously... nursing students need to be taught the realities of the profession... Specifically that patients aren't always rainbows and sunshine and so happy that you're helping them... Sometimes they literally bite, kick, punch, spit, scream, etc... Nursing school instructors tend to "Florence Nightingale" up their ideas of what it's going to be like. Then when we get new nurses, they are paralyzed the first time someone yells at them - they literally think they have to take it and back away pleasantly with a smile and an apology because Mrs Collins in nursing 2 said so... That just ain't real life. They need to know that this is common - not to scare them, but because they need to know how to handle it. You can absolutely tell a patient you won't be talked to that way. You should absolutely set limits with these patients. You can absolutely protect and defend yourself. You can absolutely press charges. You can absolutely file an incident report. You can absolutely refuse to clean a 97 year old dementia patient who bites and hits until you get a second or third set of hands. And you can ABSOLUTELY refuse to continue employment at a facility that refuses to take these problems seriously.

If you only had 47, who had the rest? Things like this are exactly why I can't at all understand why people are OK working in these facilities - you had 133 patients and didn't even know. The fact that this could even happen in the first place is insane - why does anyone work in a place where this even has a chance of happening?

NOT coffee - for the love of god NOT COFFEE. Because then you end up with a room that smells like C Diff flavored coffee, it doesn't cover the smell, only adds another layer You should throw 2-5 drops of peppermint or lavender oil into a nebulizer with like 5ml from a flush - run it at like 1LPM. It works quite well

But you have no real justification for saying this other than someone told you this a long time ago. You can't justify being SUPER specific about every microscopic thing we are expected to chart (gave a warm blanket, flushed IV, clipped right thumbnail, 16 BMs with peri care each time, Tylenol at 16:13 due to pain level of 3 with complete relief of pain within 35 minutes, etc…) and then suddenly say "oh except names, those must be top secret only available by subpoena.” It makes no sense.

This is a great answer.

There's a ton of state schools that don't charge out of state tuition for their NP programs no matter what state you're from — many of them range in cost from $15,000 to $25,000. total, For the whole shebang. when you Google NP programs, your top Google hits are gonna be the schools that charge 40,000, 55,000, or even 65,000 or more for their programs. Dig deeper. If you really want to be an NP, it's worth spending some considerable time finding the best school for you, not just looking at the top 7 that come up on a Google search. The public (far more affordable) schools aren't gonna advertise and pay for those Google spots...

First thing - and sounds like you're already addressing it - is to get off that floor. Those people sound terrible. The people you work with DO make some of the biggest differences in your day. I've never understood why nurses stay on a shift/unit or in a specialty/hospital that they literally cry about on the way to work. There is no award at the end for staying in a miserable job. Move floors. Change specialties. Change hospitals. Go to school again to learn informatics. Become a midwife. Teach. There's LITERALLY more than a thousand things to do that aren't on that ortho floor you hate - both bedside and away from bedside. So, look forward to this move - don't go in to the ICU with these thoughts and feelings, rather go in fresh and ready for a new challenge that you might love and learn as much as possible in your experience.

Especially in a code, narcan has no downside. Only a possible upside. Bicarb actually is really important because you need to help the body keep at least a normal-ish pH because it goes acidic during the code from, among other things, buildup of co2. Generally I'll give it every 3rd or so epi - unless I know low ph is the problem then they're getting more. Calcium can help with possible hyperkalemia, hypocalcemia, hypermagnesemia, or OD from calcium channel blockers. While there are not specifically in the algorithm, remember that the algorithm includes finding and fixing the H's and T's - and that's what these meds attempt.

If you're considering a MSN or NP - use the down time at work to study and do school work.

I'm currently traveling to a very small rural hospital. we all get report in huddle on all of the patients, because at any point during the day you may be helping someone to the bathroom, passing meds, or doing any one of 6000 other things that require you to know about the patient. In big hospitals you get report on your patients only usually, so if you're trying to help with vitals or give meds or do a discharge for a busy nurse or get someone to the bathroom or tell the rounding specialist some obscure lab value, you're gonna need to get in the chart. HIPAA allows you to view a chart if you have any work related reason to need the information. So when 107's nephew comes out and says she has to pee - I need to know if and how she ambulates, if I need a urine sample, if they're on chemo meds that require precautions when I flush the toilet, if they need orthostatic vitals that I can knock out while I'm there, etc... Now if they need help with the TV or closing the blinds, I've got no way to justify opening that chart.

It's been my consistent experience that the people who refuse the vaccine due to stated fears of it being new and untested and unknown side effects are the same people who aggressively seek out anti-viral drugs for Covid the second they get sick. For some reason those fears vanish when it's for treatment with drugs that are far newer, can be pretty darn hard on your body (liver especially), and at one point seemed to be changing every 2-3 months during the height of Covid. So, ask yourself if you'd take paxlovid if you got sick, and if you say yes to that then your fears to justify not getting the shot are probably not valid.

At places where the ekg machine syncs automatically into the chart - you usually need an order in place to be able to tie the ekg to their chart. Some places you can sync it up later if you needed a stat ekg - pretty common in ERs where the patient comes in and takes 85 years to get registered so you just do the ekg while you're waiting because heart attacks don't wait for the registration lady to finish scanning the insurance cards for the toe pain in the next bed LOL But you're gonna be hard pressed to find a board of nursing that wouldn't side with you on getting an ekg in an appropriate situation. And you DID have an order - you had a verbal order from the cardiologist, albeit after the fact... The thing I'm surprised you didn't get jumped on for was involving a cardiologist - unless you had standing orders for that, it's a decision that should be up to the hospitalist. Accelerated junctional and 1st degree blocks aren't butt puckering rhythms that warrant a page to cardiology unless you have a specific order to notify of any rhythm changes - and you'll quickly learn that the readings on the tops of EKGs are wrong a good 30-50% of the time. Honestly there's not a single rhythm that would cause me as the nurse to involve a cardiologist without a specific order in place - from NSR to 3rd degree to asystole, I'm dealing with the hospitalist on the floors and the ER doc if I'm in the ER. It's THEIR job to consult other docs. Definitely get the EKGs - but leave the cards consult to the hospitalist in the future.

No way - they've been pushing BSN forever. They somewhat successfully got rid of a ton of LPN/LVN options and hospitals nationwide stopped hiring them or required them to get their RN... But so many hospitals now are bringing back LPNs because they simply need the staff.

I know it wasn't exactly the point, but you do know you're lowballing the doctors' salaries, right?

My suggestion is to get it as cheap as possible - which may or may not equate to how fast it can be done. Spend as little as possible even if it takes 12-18 months longer.

It takes about 3-4 seconds to pull an IV... I gotta agree with another commenter - pull it while you are there, it's gonna probably take more time to come back later just for this... But as for calling the police, it's absolutely standard if you can't verify an IV was removed on DC/elopement/AMA from the ER to involve the police... If I have to call a facility about this and I can talk to a nurse (not CNA or secretary) and they say 'yup I pulled it', then I'm good... otherwise I need eyes on it to make sure it doesn't stay in - more often than not the cops will report back saying yeah he yanked it out in front of us while cussing you out (because usually the person wanted to keep it in for "reasons”). And even if it's a SNF, if the pt goes septic because it stays in for 3 weeks because nobody thought to check it (let's not pretend like your SNF is fully staffed, you don't even have someone to answer the phone…), it's gonna blow back on the responsible ER nurse as much as it is on the SNF staff...

The more you hear from management that "we are a family", the less you are going to be treated like family when anything goes bad. The hospital will protect itself every time, and only protect you if it benefits them in the process. Loyalty means nothing unless you're in a rare spot to be earning a pension - and even then you have to weigh your other options appropriately. At the end of the day, remember you owe nothing more than the current day's work in exchange for the agreed upon pay for that day. Never turn down whatever it is you consider to be a better opportunity out of loyalty to a facility that would drop you like a hot potato to save an hour's pay. When I train new nurses I ALWAYS emphasize that you don't in fact work for a hospital or doctor's office or clinic or school, you work AT those places but you actually work FOR your license.

I'm always stunned at the people who pay $40-50,000 to get an RN degree in the name of being done 5 months faster than a community college program that will cost a total of $9,000. No matter how the school tries to sell it, that 5 months is not worth an extra $40,000. And then the first two things everyone buys with their shiny new nurse paychecks is a new SUV or Jeep and/or a new set of boobs (and take loans for both the car and the surgery) and then they wonder why nothing really changed for them financially. ?‍♂️

If my employer comes after me in this situation, it's not a place I'm interested in working...

Also... Im eating and Im peeing. If nobody's dying, I have time to pee. If nobody's gonna die in the next half hour - call lights be damned, I'm gonna eat. If I'm working at a place where this becomes impossible other than oddball days where 3 people keep coding repeatedly , I'm out. Go work somewhere where this isn't an issue - a hundred thousand open nursing jobs, find one that lets you pee I've never understood nurses who use not eating or peeing as a weird bragging point... And I absolutely don't have Florence Nightingale syndrome - I'm not putting the hospital or my patients above my need to pee and eat.

If I've said it once, I've said it 1000 times... You mandate me *once* and it's my last shift. I'm done. There WAY too many nursing jobs out there for me to care about quitting this one. AND the hospital wants to staff so thinly that a two call offs in a 400 bed hospital puts 3 units in crisis mode... I'm not interested in being mandated because you can't staff appropriately.