Kareegasee

Hey friends, I've decided I want to pursue a career in legal nurse consulting and am currently in the phase of gathering as much information about the field as I can. I am 33 years old and have been at the bedside for 11 years, in adult surgical trauma CC and emergency nursing. I've had a strong interest in law for years, and have recently begun to consider how I may incorporate my nursing knowledge into it. I briefly considered pursuing law as a secondary degree through a law program, however, my latest research has led me to exploring the avenue of legal nurse consulting. Does anybody with experience in this field have advice they'd be willing to share? I'd like to sit for the LNCC exam, but am wondering how to gather 2,000 hours of consulting experience, required to take the exam. What are the best ways to gather legal knowledge as a current ED RN, to prepare myself for the exam, and fulfill this time requirement? Open to any and all advice!

This is killing me. Why has there been so much discussion lately with new nurses and their emotional traumas over insulin? It's really not that complicated. If they are low, don't give the correction-dose or standing dose. Always give the carb coverage for a meal. Stop seeing the entire order as a complex formula and just use your common sense and nursing judgement: if you give insulin, their blood sugar will drop; if you don't, it will elevate. If you are in doubt, ask your charge nurse, supervisor, or doc.

It sounds to me like you feel responsible for the deterioration because his blood sugar happened to drop when you gave the lunchtime insulin for food he didn't eat. I think what really happened here is you had a patient who was developing sepsis, which caused the sudden drop in blood glucose and blood pressure. As a new nurse with a beginner's understanding of sepsis, you shouldn't be too hard on yourself. You did not cause this, and it is an experience to learn from.

This response shows the kind of behavior that people are referring to when they say that nurses eat their young. I would be embarrassed to act this way. Why don't you show some support for your fellow nurses and try to remember where you came from.

This makes me feel sick FOR you. Nobody should be feeling so much devastation and fear after a critical event like this. As nurses, we have a lot of responsibility, but the kicker is that we are also human! Humans make mistakes. Any gap in understanding should be taken as an opportunity to educate and improve. There has been a whole movement in critical care nursing alone that emphasizes the importance of being able to admit mistakes without being punished, and by punished we also mean being made to feel as you currently do. You are the "second victim." Look it up. I can see your reasons for doing everything that you did. You treated the hypoglycemia appropriately. I would have checked another BG, but I can see everyone has been through that already. Levimir and other long-acting insulins do not immediately affect any one critical value, and since you thought the previous low reading was resolved, you gave it as ordered. The opportunity that I see for improvement is better communication with your preceptor. You said she "saw" you giving Dextrose IVP, and that she was later "in the room" when you scanned the Levimir. It would be best to inform her aloud of your actions in any situations that require a response to a critical event. Even after the hypoglycemia was resolved, the entire concept of insulin and blood sugar levels should be discussed in light of an order for Levimir. And on that note, I strongly feel that the root of this entire situation was not you- a nurse who at the end of her orientation was striving to be independent and followed the orders at a level I can see many doing.... but the preceptor who in my mind, failed to follow up on many levels. Whether or not you told her of the low BG level, she should have at some point looked back to see what it was. She should have facilitated a conversation involving higher-level thinking and asked questions such as, "What kinds of things can cause new hypoglycemia in a patient that has been doing well with his treatment for diabetes? Do you think there could be an underlying problem at the root of this? After the low blood sugar is corrected, what steps should be taken to monitor the patient closer?" There are reasons we orient nurses, and it is to have these conversations as you approach independence in a new area. I would go about this in the following way: Set up a meeting with your manager. Admit what you have learned from this as well as ways you plan to improve. Continue to hold your head high and focus on staying positive. I don't think it would be inappropriate it to discuss your preceptor slamming doors instead of providing constructive feedback. But you could also just choose to focus on yourself. You should not be fired for this or put on probation.

I always knew critical care was where I wanted to be, but I wasn't able to get a position until a year into my career. I started in med-surg and took it as an opportunity to learn as much as I could!

I say go for the CVICU position. It sounds amazing. Your manager has no business saying all of those things to you, and they probably are incredibly exaggerated to begin with. You will learn so much there, and 1 year from now you will be looking back on how far you've come, and thinking about that time when you almost let somebody hold you back.

Since when do we have the luxury of allowing patient's body parts make us uncomfortable? For crying out loud, the girl was asking for medical care, not a wax job.

Wow, I didn't know that was an option. I might look into it!

Hey guys, I'm currently working toward becoming a flight RN and have recently completed my EMT-B program. I'm looking into mostly local programs to get my paramedic license, but I've recently heard about the RN to Medic program that Creighton University in Nebraska has. Have any of you completed or known anyone who has completed this program? In contrast to the typical EMT-to-medic education that ranges anywhere from 12-16 months in my state, this program is 2 weeks and uses the RNs ED/ICU knowledge base as the foundation for the medic skills learned. It appears that the state of Michigan has a program for accepting out-of-state paramedic certificates, so my only real concern is: Will a 2 week program adequately prepare me for the national medic test?

How does "staff's feelings" have anything to do with the necessary flow in and out of the ICU? Also, it's really not that difficult. My ICU requires them out asap, or ideally within 30 minutes. This is what you do: settle the new ED patient. Take 2 minutes and call the receiving RN of the transferring patient and give a report, allow for questions. Have your charge nurse coordinate the transfer of the patient, and an available nurse technician complete the transfer. An ICU nurse always needs to remain flexible and capable of meeting the demands of the unit.

This is totally something that I would have said too, if I didn't already know that PICC line use was reserved for RNs. Sometimes people's sincere desire to inquire becomes misinterpreted, either because questions may make the other feel threatened, annoyed, or that you are "pushing back." In the professional world, it should be reasonable to ask questions without having someone assume that your intentions are bad, especially given the fact that she knows you to be pleasant and cooperative. In my opinion, this situation highlights a failure by her (and many) to understand one another in the setting of two different viewpoints.

I hope you enjoy it, though I personally would have gone with the neuro ICU position, especially if your plans are to pursue an NP education. I've worked both types of positions, and I have learned that the ICU is hands down the best environment for learning, developing autonomy in managing patients, and gaining the ability to see the "big picture." Keep your options open.. you may find you wish to pursue a different area after a year or two.

Fluids can run faster through a large-bore IV with no cap on it than any size lumen in a central line (other than an introducer). A central line isn't required right away, it's just a perk that makes things easier. ED nurses have actual stuff to worry about, and it's not making your job easier. P.S. May I also mention that if you have time to worry about the central line not being there because you're not busy coding the patient, intubating, pressure packing fluids, etc., then you should thank the ED nurses for all the things they DID do?

I understand that there is a lot of evidence to support this, but to be completely honest, I think its pretty inconsiderate to shove all of those smells in one place unless you can be sure that everybody in the area is okay with it. I work with a couple girls who are into them and wear them to work. It's like being forced to smell heavily sprayed cologne in an elevator. Sure, the person who put it on thought it smelled good, but we all know that everyone else is secretly turning up their nose and wondering what he was thinking. You may love them but respect other people's right to not have their space invaded.