Richard Wolfe

How do you delete a post?

They withheld care from an unidentified, intoxicated, unconscious human-being based on a tattoo. That sounds completely unethical in every sense of the word. How do we know that he was not intoxicated when he had the tattoo and now regretted it? I read that they found a "DNR" form after he was admitted, but how do we know that he was not intoxicated when he completed the form? Would it be legally binding in the state of Florida if that were the case? What about if the "Do NOT Resuscitate" had been written in Sharpie? Would that be legally binding? The man obviously tattooed neither the "Do Not Resuscitate" nor the signature onto his own chest. How legal is that? How ethical is it for a provider to abide by the tattoo?

In your CCRN CRAM DVD set, you talk about an incident where you had an allergic reaction to a kitten. From there you tell a hilarious story about your experience.

Tell us more about you and the kitten and how you incorporated what you learned from that experience into your bedside practice.

No one survives a code and goes home with "no deficits".

Per the Doctor- "It's all just a bunch of FAKE NEWS."

That's because beyond theory, doctors know absolutely zero coming out of school. Everyone knows that, therefore they are very accommodating. APRNs are expected to have basic experience through bedside nursing. That is the way it is supposed to work.

First of all, you seem to be a little full of yourself. Secondly, you guys rock. I always tell my child that if I'm in a hospital that I want a nurse taking care of me. If I'm in the field, then keep that hospital nurse away from me and make sure an EMT or paramedic saves my life.

Clinical Ladder programs have been used for years to recognize nurses as they progress through levels of nursing practice starting at novice and culminating in an expert level. These ladders are often based on the five levels presented in Patricia Benner's Novice to Expert Theory. Here is a brief refresher of the five levels of Benner's Theory: Novice NurseA new nurse or a nurse with no experience in the field they are entering. Both the new graduate and the nurse transitioning to a new field of practice (for example- Med-Surg to Oncology) would be considered a Novice. The Novice learns rules and applies those rules universally to all patients. Advanced Beginner NurseThe Advanced Beginner Nurse has gained practical experience and has learned how to conditionally apply the rules on a patient by patient basis in future clinical situations. Competent NurseThe competent nurse has become more efficient and organized having learned from prior experiences. This nurse is starting to see how their clinical actions impact long-term goals. Proficient NurseThe Proficient Nurse views their patient holistically and has learned through significant practice how to distinguish between significant aspects of the clinical picture and those that are not as significant. Expert NurseThe Expert Nurse relies on intuition gained from years of experience and can hone in on key aspects of the clinical picture in order to achieve the best outcome for the patient. If your facility offers a Clinical Ladder Program, then you may wonder if it is worth the time and trouble to complete the requirements. I hope to help you to reach a decision by offering a brief look at a few of the pros and cons to climbing the Clinical Ladder. PROSMoneyMost people can use more money and a bonus offered by a Clinical Ladder Program is certainly a nice incentive. Some programs offer one time bonuses while others offer an increase in pay. RecognitionAchieving and maintaining a level on the Clinical Ladder is a way to both recognize your achievements and to distinguish yourself from others at your facility. NetworkingWorking your way through the Clinical Ladder process provides the opportunity to interact with those you may not have routine contact with. Examples include those in administration, leadership, education, and peers practicing in different clinical areas within your facility. Professional DevelopmentIf the money, recognition, and networking aspects of the Clinical Ladder are not important to you, then there is always the value of professional development. Participating in the Clinical Ladder program may very well lead to growth in your profession. One example would be a nurse of 20 years that never saw the importance of obtaining National Certification. Participation in the Clinical Ladder program may motivate the nurse to obtain certification to move up the Clinical Ladder. CONSTime and EffortThe Clinical Ladder program requires a significant amount of time and effort that may not pay off in the end. A 5% increase in pay offered as an incentive could be accomplished with a lot less headache by simply working a little bit of overtime. If you work 40 hours per week, then that would mean an additional 2 hours per week or one extra 8-hour shift per month. Add the overtime and possible incentives for working that extra shift and you are already ahead of the game. PoliticsUnfortunately, politics still plays a significant role in the nursing profession. Opportunities that allow an individual to advance up the Clinical Ladder may not be offered to nurses in an equitable manner. Lack of OpportunityFor example, you may be able to acquire points for achievements such as being a preceptor, learning new skills, or cross-training to other areas. However, there may not be money in the budget to cross-train or learn new skills. In addition, if there are no new employees on your unit, then your chances of being a preceptor are pretty much non-existent. Upfront ExpensesYou may be required to pay out of your own pocket to achieve skills such as National Certification. If your organization only offers reimbursement upon successful attainment of the certification, then you will initially pay hundreds of dollars up front and then wait until you pass to get reimbursed. The Rules Can ChangeIt can be extremely frustrating to put forth the time, effort, and possibly money into completing the Clinical Ladder Program only to find out later that the requirements have been changed. An example would be volunteering at the local blood drive for 8 hours each month thinking that it would count toward the community involvement requirement. Then right before you turn in your completed packet, the organization addends the requirements so that your participation at the local blood drive is no longer accepted toward that requirement. It Can DisappearOrganizations are not obligated to continue the program. All of your time and effort are for naught if your organization pulls the plug on the clinical ladder. What do you think? Are Clinical Ladder programs worth the effort or would you rather spend your time doing something else? Share your thoughts in the comments section and take the poll to let others know your opinion.

The fact that your patient died while receiving a blood product raises many questions. Was it the first unit? Was the code witnessed? What was the infusion rate? Did you follow hospital policy for blood product transfusions? Was there a trend that a reasonable and prudent nurse would have recognized? Did you disconnect the blood before, during, or after the code? What other medications were running at the time? etc. and so forth

I know that many vaccines work, but I also know that many do not. You can discredit the flu shot with research from the CDC. However, I still get the flu shot every year (mainly because I'm forced to at work). People tend to take an extreme perspective on every issue. With vaccines you have one group that swears all vaccines are effective while another group wouldn't take the shot if their life depended on it (which sometimes it does). My advice would be to take all of the old school vaccines and do a lot of research before you let someone inject you with a vaccine that has been on the market for less than ten years.

That's funny, but please no one take that seriously. You would be advised to get a lawyer for both that case and your Board of Nursing hearing if you plead the 5th. Plus, it will be on record that you plead the 5th (which can be brought up in trial) and also that a judge had to issue a Motion to Compel.

1. I've never heard of a deposition being voluntary. 2. Always carry your own insurance. The facility and their lawyer will throw you under the bus without hesitation. 3. If you are being deposed, then you must assume that you will be named in the suit. 4. Who leaked the Incident Report?

The correct answer to when to call a Rapid Response Team (RRT, Met Team, or even a CODE BLUE) is ......anytime that you feel that the situation warrants one. Simply put, you are allowed to trust your gut. However, if you call an RRT for pain meds, then that patient better have some other issues as well or else you will likely receive remediation.

I am assuming that you are either a foreign educated nurse or you are not a natural US citizen. If that assumption is correct, then six months sounds about right.