USAF RN Compentancy

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This is just an observation and a personal expercience I would appreciate input on. This is brought about by an incident when I attemped to call report on a pt from the ER to Med/Surg on a chest pain pt. The charge nurse of the Med/Surg unit flatly refused to take the patient until the half life of lopressor I had given had past (six hours), I was dumbfounded. And it took several meetings and memos to "allow' patients to the Med/Surg after receiving any cardiac IV medications prior to the half life "expiration."

I then began to wonder, how able are our nurses, as a whole, in taking care of wounded soilders/civilians when on deployment. The hospital I am currently stationed at ships out most of our trully critical pts, our traumas tend to be sprained ankles or if we are lucky a tib/fib fracture. I tried to keep up my skills in a civilian level one trauma center, but my additional duties, meetings, and other military related appointments either precluded me from having a life or to quit moon-lighting (I want a life). My command were not flexible in allowing me to work either, schedule comming out a week before it started, inconsistent shifts, and a general lack of understanding of what civilian nursing is all about.

When I was line side, our primary mission was to train for war, virtually everything we did revolved around it. Since I became an RN, the focus has shifted to other concerns. So I have some questions for all AD RNs

If/when Big Willie closes, where will nurses go to obtain or maintain our competancy in caring for truly ill pts?

Should new nurses be placed in clinics before having actual inpatient experience?

Should the command allow duty time for AD nurses to work in a nearby civilian hospital?

These are just the ramblings of a sleep deprived mind, thanks for reading

Major Domo

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Specializes in Anesthesia.
This is just an observation and a personal expercience I would appreciate input on. This is brought about by an incident when I attemped to call report on a pt from the ER to Med/Surg on a chest pain pt. The charge nurse of the Med/Surg unit flatly refused to take the patient until the half life of lopressor I had given had past (six hours), I was dumbfounded. And it took several meetings and memos to "allow' patients to the Med/Surg after receiving any cardiac IV medications prior to the half life "expiration."

I then began to wonder, how able are our nurses, as a whole, in taking care of wounded soilders/civilians when on deployment. The hospital I am currently stationed at ships out most of our trully critical pts, our traumas tend to be sprained ankles or if we are lucky a tib/fib fracture. I tried to keep up my skills in a civilian level one trauma center, but my additional duties, meetings, and other military related appointments either precluded me from having a life or to quit moon-lighting (I want a life). My command were not flexible in allowing me to work either, schedule comming out a week before it started, inconsistent shifts, and a general lack of understanding of what civilian nursing is all about.

When I was line side, our primary mission was to train for war, virtually everything we did revolved around it. Since I became an RN, the focus has shifted to other concerns. So I have some questions for all AD RNs

If/when Big Willie closes, where will nurses go to obtain or maintain our competancy in caring for truly ill pts?

Should new nurses be placed in clinics before having actual inpatient experience?

Should the command allow duty time for AD nurses to work in a nearby civilian hospital?

These are just the ramblings of a sleep deprived mind, thanks for reading

Major Domo

Most of these have already been addressed by AF NC.

1. Clinic nurses/non-bedside nurses have to do 160hrs(I think it is 160) in bedside areas per year to keep up their comptency.

2. Big Willie isn't the only hospital. It does offer the best experience, though. Keesler is ramping back up and just started its residency program back up. Not to mention Eglin, Wright Pat, Nellis etc. We also have the CSTARS progam, and Landstuhl has always been a popular training site (not to mention BAMC).

3. I have ran into what you are talking about several times AF med-surg nurses allowed to get away with saying I am not comfortable doing X and ER/ICU has to take over/can't transfer the patient.

4. No, new nurses should never be placed in clinics. Also, I don't think any AD AF nurse should work in the clinic unless it is management spot. All the clinic nurse spots should be converted to contract positions.

The AF NC has set up this culture and is up to us/our AF nursing leaders to break it.

Good Luck!

I hope your next shift goes better.

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Thats what Im scared of, I don't want to end up getting put in some clinic and end up losing my skills. Luckily I will be in the ED in wilford. That's just ridiculous. Honestly though if they have received lopressor IV and they are a chest pain, why are they going to the med/surg floor. Where I work now anybody who recieves any IV cardiac drugs or whose dx. is CP goes to remote telemetry at least. I could understand the other nurses point if you just gave it and send the pt. up. You would want at least some kind of cardiac monitoring immediately after, but to wait 6hrs for the expiration of the meds half life is absurd. It's an ER, pt. flow has be moving, stuff like that is what causes crazy backlogs and long wait times. A Med/surg nurse receives the same pharmacology teaching as an ER nurse, while in nursing school.

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Specializes in Anesthesia.
Thats what Im scared of, I don't want to end up getting put in some clinic and end up losing my skills. Luckily I will be in the ED in wilford. That's just ridiculous. Honestly though if they have received lopressor IV and they are a chest pain, why are they going to the med/surg floor. Where I work now anybody who recieves any IV cardiac drugs or whose dx. is CP goes to remote telemetry at least. I could understand the other nurses point if you just gave it and send the pt. up. You would want at least some kind of cardiac monitoring immediately after, but to wait 6hrs for the expiration of the meds half life is absurd. It's an ER, pt. flow has be moving, stuff like that is what causes crazy backlogs and long wait times. A Med/surg nurse receives the same pharmacology teaching as an ER nurse, while in nursing school.

PRicanRN,

I think it is just a misunderstanding on how most AF hospitals are set up. Tele at most AF hospitals are part of Med-Surg it is not a separate unit. I would presume that that particular patient would have went to med-surg on tele.

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oh ok I guess Ill find that out once I start working in wilford haha. because for a min. there I understood it was just a regular med/surg which was scary. In that case that nurse should know what he/she is doing. Are cardiac drips of any kind allowed on med/surg/tele in AF hospitals?

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Thanks for the responses, congrats on going to Willie's ER PRicanRN, I spent 2 years there and had a blast. Most of the AF Med/Surg floor has remote Tele, monitored by an ICU tech for the CP pts, Willie's might be different since the have such a large pt load. And from what I know, cardiac gtts are not routinely allowed on non-ICU/ER areas.

Concerning the 160hrs of bedside nursing, I have heard of that, but at my hospital all I have seen is clinics having every Thursday a "training day" where they are in-serviced for the most part. I guess I'll have to look that up.

The C-Stars program is hopefully a good expierence (I'll find out in September after my CCATT course)

Asta,

Major Domo

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PRicanRN,

Hey I noticed you are going to Wilford Hall and I am going to be stationed there after my COT and NTP. Have you already done COT and NTP? If so how was it and if not when do you go?

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my cot date is in August also, so I might be seeing you there, but I won't be going through the NTP(3yrs exp.), Ill be going straight to the ED in wilford hall.

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This is just an observation and a personal expercience I would appreciate input on. This is brought about by an incident when I attemped to call report on a pt from the ER to Med/Surg on a chest pain pt. The charge nurse of the Med/Surg unit flatly refused to take the patient until the half life of lopressor I had given had past (six hours), I was dumbfounded. And it took several meetings and memos to "allow' patients to the Med/Surg after receiving any cardiac IV medications prior to the half life "expiration."

I then began to wonder, how able are our nurses, as a whole, in taking care of wounded soilders/civilians when on deployment. The hospital I am currently stationed at ships out most of our trully critical pts, our traumas tend to be sprained ankles or if we are lucky a tib/fib fracture. I tried to keep up my skills in a civilian level one trauma center, but my additional duties, meetings, and other military related appointments either precluded me from having a life or to quit moon-lighting (I want a life). My command were not flexible in allowing me to work either, schedule comming out a week before it started, inconsistent shifts, and a general lack of understanding of what civilian nursing is all about.

When I was line side, our primary mission was to train for war, virtually everything we did revolved around it. Since I became an RN, the focus has shifted to other concerns. So I have some questions for all AD RNs

If/when Big Willie closes, where will nurses go to obtain or maintain our competancy in caring for truly ill pts?

Should new nurses be placed in clinics before having actual inpatient experience?

Should the command allow duty time for AD nurses to work in a nearby civilian hospital?

These are just the ramblings of a sleep deprived mind, thanks for reading

Major Domo

I've been on an AF Med/Surg floor (no longer on that unit) where this EXACT thing happened. I completely agree with you that skills need to be up to par to care for these patients but (yes...but) OIs caused MAJOR issues for the floor.

I am a very competent nurse and feel comfortable providing care to a variety of different patients but OIs are often stumbling blocks. I've updated a few OIs and presented them to both of our nurse councils, medical council, surgical council, P&T, etc....and over 1 1/2yrs later they are still "on the agenda" (i.e. not finalized).

I am not trying to make any excuses regarding this matter but when it comes to these experiences - it's up to you to make a change. Take it up the chain and update your OIs. The floor nurses don't have the same monitoring capabilities (at least not in my hospital) as the ED/SDU/ICU. Our medication OI has been updated (yet not approved...hahahahaha...bad joke) to reflect that patients receiving an IV pressor, etc wait an hour and receive an oral counterpart before admitting to a floor b/c floor nurses CANNOT push those pressors. Sure, in a deployed situation the rules change completely but JCAHO, etc.

Regarding the rotations to civilian facilities - that's exactly what we're doing right now. So far it's slow going but we're improving our working relationship w/a large trauma facility.

On a side note - our IV med issue regarding transfer from ED to floor was largely impacted by an ED nurse who transferred a nurse to floor w/o updating VS and the pt stroked upon arrival to the floor. Every hospital has interunit issues but we need to look outside 'eating our young' and remember it's all about the patient. I'm not a huge fan of the team-building training we do here but the tenets are simply patients first, attitudes/egos/drama take a backseat to patient care.

Regarding your line experience - I've only spent a short time on the line side but I'd move in a minute if my career allowed. I love the AF and I love being a nurse but the 2 don't play well together - or at least not in my limited experience. Are you prior enlisted or line officer crossover?

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what's OI??

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what's OI??

Operating Instruction - basically the rules/guidelines that military follow. When you go to COT you'll have OIs that will dictate your behavior, schedule, etc. For military hospitals these are the guidelines we adhere to (or change as needed) to comply w/JCAHO and other inspections, patient safety, etc.

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Specializes in Ortho, Med surg and L&D.
Thats what Im scared of, I don't want to end up getting put in some clinic and end up losing my skills. Luckily I will be in the ED in wilford. ...

Hello PRicanRN,

I'll be at BAMC, (aren't they close?)

Gen

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