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2 rn's both bsn, ond nearly NP fin leave bp high

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the nites the nites (New) New

This ADN took over after 2 consecutive 4 hr shifts had fin for 2 rn's, both bsn, one nearly done w/NP, one a Critical Care float who is paid more b/c she comes to our ICU as a float--they both had one pt., nasal cannula, alert nsr post stroke clot retrieval, sbp ord 110-140 w/ iv push meds if over 140. Both 4hr shifts the bp was 160-170, this adn came on at 4 am and had to correct w/iv p meds and bath the pt who had not been bathed. I of course had another sick vented trauma pt. I am an adn w/20 yrs experience and hope the ones pushing for the bsn completion in nursing I hope this pt was their mother.

Hope you don't fall off your high horse and crack your cranium, some useless BSN might take care of you- the point being that we have all followed nurses regardless of degree or experience whose performance has been less than stellar and if we're around long enough it will eventually be us who is less than perfect. happens to everybody- hope you had the stones to point this out in report to the offending nurse and didn't just run around the unit proclaiming what crappy nurses they are and how much better your care and skills are. remember no one is perfect.

So I have a few questions for you given your vast superior knowledge to the rest of us who dared to get a BSN or god forbid a MSN.

1. how far out of the stroke was the patient?

2. Who wrote the order for the goal systolic pressure of 110-140.

3. What was the patient's blood pressure when the order was written.

4. What did the patient's blood pressure fall to after administration of the iv push medication?

5. When you called to question the order (which I am sure you did given that you are super nurse) what rational did the physician give for that blood pressure target.

6. Did the bath save the patient's life? Did all neurological symptoms disappear thanks to soap and water?

Hopefully you can tell my sarcasm is laid on thick with this reply but in all seriousness if the stroke occurred in the last 2 weeks (i am assuming it was if she is still in the ICU) and it was my mother I don't want the physician who wrote that order nor the nurses who didn't at least call the doctor for the rationale behind it to take care of her.

So what principle of after stroke care should ypu have thought of before you gave the iv meds?

Congratulations on gaining your degree and not passing away or getting fired as that is the only 2 things that 20 years experience proves.

BTW the best nurse I have seen in 20 years of healthcare was a associate's degree nurse with 2 years experience.

TheCommuter, BSN, RN

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 15 years experience.

Do you want praise? If so, I'll bestow it upon you. You are a great nurse. You did well. You deserve recognition and a pat on the back.

Now that we've gotten that out of our system, here's the blunt reality: recruiters and HR managers at many hospitals across the US are giving nurses with BSNs preference for recruiting, hiring and retention, but I suspect you already know this.

In other words, you can jump on the BSN degree bandwagon to ensure your future in acute care hospital nursing, or you can take your chances in your local employment market with the ADN degree.

Regrettably, many of the people who do the hiring do not care how good or skilled a nurse with an ADN or diploma may be. Without the BSN degree, the day may arrive where your employment application will be tossed aside to make room for applicants with baccalaureate degrees.

I have an ASN degree, but am enrolled in a BSN degree completion program as a hedge against the future.

SummerGarden, ADN, BSN, MSN, RN

Specializes in ED, ICU, MS/MT, PCU, CM, House Sup, Frontline mgr. Has 13 years experience.

OP: I am a former ADN nurse. I went back to school for the very reasons posted above; recruiters were not interested in me in descent paying parts of this country because they only hired BSNs. If you think you are safe because you are not likely to jump ship and work for someone else, you are wrong.

Employers are figuring out that there are ADNs that know that the market is changing and so refuse to leave despite their current facility pushing for BSNs or above! So, in order to get rid of those ADNs they are trying to offer incentives for early retirement. When that does not work, they have a massive layoff of all RNs. Afterwards (and very quickly) they open up positions and offer the RNs that were dismissed opportunities to reapply for newly posted jobs. Guess who does not get hired back to work?

These employers get away with ignoring the applications from their former ADN nurses because of their new educational requirements and the HR filters set up to ignore those that do not meet the requirements. Hopefully you will retire sooner rather than experience this new trend in nursing. Otherwise, brace yourself. It is only a matter of time before your employer catches up to the rest. Good luck.

Whatever does the first post mean? It is illiterate claptrap.

Edited by kungpoopanda
clarity

jrost80RNBSN

Has 1 years experience.

Maybe with your BSN, you could learn correct grammar and punctuation.

So what does this prove, that no one is perfect? I've seen as bad, or worse, but all my complaining would only make me look petty, jealous, and less than classy. But better to vent about it here, than on the job.

WoosahRN, MSN, RN

Specializes in PICU. Has 10 years experience.

So you were too busy with your patient to help the float staff but you still managed to take notice of orders for the patient and the nurses actions or perceived lack of actions (and you took the time to be aware of their degree status)? And then you came to a forum to share how this must show that all degrees are worthless and what a great nurse you are for noticing all of this? If you had concern for a patient in real time, did you feel satisfied that the nurse was floundering or did you think about the patient that might have been affected.

As you can see, your post isn't endearing yourself or your cause to anyone so far.

dudette10, MSN, RN

Specializes in Med/Surg, Academics. Has 10 years experience.

Sorry. I can't say if you "did good" or not. In the ICU after stroke? Must have been VERY recent. Ever heard of permissive hypertension? Reduction of BP post-stroke should not be abrupt, maximum of somewhere around 20 mmHg after intervention, I believe.

dudette10, RN, BSN w/ three years experience

abbnurse

Has 29 years experience.

Whatever does the first post mean? It is illiterate claptrap.

Thanks for saying this....I cannot understand at all what is being said here, especially the title of the post. Is the OP asking for something, or telling us something? Everyone else who has responded seems to understand, maybe I'm just loopy tonight. Anyway, the responding posters are some of my favorite AN members, so always enjoy reading their opinions....but, sheesh, I'm still lost. :confused:

Thanks for saying this....I cannot understand at all what is being said here, especially the title of the post. Is the OP asking for something, or telling us something? Everyone else who has responded seems to understand, maybe I'm just loopy tonight. Anyway, the responding posters are some of my favorite AN members, so always enjoy reading their opinions....but, sheesh, I'm still lost. :confused:

I think the OP was so shocked and flabbergasted it affected her ability to express herself coherently.

abbnurse

Has 29 years experience.

:laugh: Definitely! You know, after I read it for the fourth or fifth time, I actually (kind of) got it....but for a minute there I felt like I was attempting Sudoku (and I am absolutely terrible at Sudoku)....

Edited by abbnurse

calivianya, BSN, RN

Specializes in ICU.

My facility uses a goal of 160 systolic for fresh strokes - it increases perfusion to the brain. Dropping a stroke patient's BP as low as 110 is a big no-no. Good for your coworkers for recognizing an inappropriate order and not following it. Maybe you should read a little more about how post-stroke patients are typically managed before assuming your coworkers were wrong.

Doctors are not gods; they can make mistakes. Don't fall into the trap of doing what a doctor says no matter what. It is your license on the line if the patient is harmed because of something that you did. "Just following orders" is not a card you can play because you are an educated professional, too, and you should know better.

You come in, do what you need to do for how the patient is presenting at the moment, and call it a day. You are only responsible for what you do on your shift. What someone else did or did not do is on them, and the responsibility of the manager of your unit to deal with if things are done inappropriately.

As an LPN with multiple years acute care experience, there are many MD's who are all over the shop when it comes to where their ideal SBP comes into play. And that is not even at the ICU level. The MD's I was working with want fresh (or nearly fresh) strokes at 160ish SBP, due to perfusion issues--so perhaps a call to the MD for a clarification could have been a thought. Because this is a ICU level patient, could be that in fact the SBP was holding its own until your assessment. Given the odd nature of how an acute stroke and aftermath presents, anything is possible. As you know, there are even MD's who want manual BP's as they tend to believe that the automatic cuffs put a BP "too high"--is it possible that the manual BP was around what it needed to be? Who knows, but you can only do what you can as a patient presents to you.

Be careful, and I say this with the best intentions, you have 20 years experience. You can't get this in a year or 2, no matter what the degree. However, you may find yourself on the teaching end of an inservice on why SBP control is important, before they thank you for your 20 years of service, and find a way to let you go to hire 2 more BSN's for the salary they are paying you. Happens every day.

If the patient was continually monitored, it will be up to the RN's before you to explain the rationale behind why if a SBP was recorded (and those monitors record everything) as over range for the order, there was no intervention. Per an order.

I would however, look at how the patient is trending--and response to your intervention. If an hour later we are still in the same situation and the patient is not responding, you may have to call MD for further orders. Which stinks at 2am, however, I am sure the MD is going to be very interested in how the patient came to the place that they are at present. And you can only state what you came on shift to, your intervention per order, and otherwise, you can not say for certain what the heck happend.

I get the frustration. When highly educated nurses are held in such regard as well as paid more for not doing things correctly, it gets old, quickly. With that being said, there is a huge thing about "evidence based practice" however, RN's need to get into the habit or clarification of orders as opposed to interventions or no interventions based on them exculsively.

Edited by jadelpn

We have nurse that could venture into full literature here! The responses were just like from the renaissance drama times!

Ruby Vee, BSN

Specializes in CCU, SICU, CVSICU, Precepting & Teaching. Has 40 years experience.

This ADN took over after 2 consecutive 4 hr shifts had fin for 2 rn's, both bsn, one nearly done w/NP, one a Critical Care float who is paid more b/c she comes to our ICU as a float--they both had one pt., nasal cannula, alert nsr post stroke clot retrieval, sbp ord 110-140 w/ iv push meds if over 140. Both 4hr shifts the bp was 160-170, this adn came on at 4 am and had to correct w/iv p meds and bath the pt who had not been bathed. I of course had another sick vented trauma pt. I am an adn w/20 yrs experience and hope the ones pushing for the bsn completion in nursing I hope this pt was their mother.

WOW! I guess that shows you that education is useless, huh!

One thing that education helps with is basic written communication skills. Perhaps those more educated nurses you're bashing could have communicated the information you're trying to get across in a more coherent and understandable manner.

You are always going to run across nurses who didn't get their job done, who leave things undone no matter what their level of education. Are these nurses chronically leaving things for the next shift? Or was this a one-time thing, perhaps because the one nurse floated and wasn't aware of unit standards and protocols?

If you yourself have a bad shift one day, don't finish your work or make a bad call, I hope no one treats you the way you've treated those nurses.