February 27th, 2010
When discussing the “appropriate path” for preparation of nurses and
nursing specialties, the discussion often spins around to what HAS been
utilized and what paths individuals have taken to arrive at successful,
challenging, lucrative, (insert your favorite adjective) careers. This is
unfortunate — discussions about education preparation are, or should be,
about the FUTURE. What do we need to do to assure that the fresh faces in
our profession are well prepared to take on the role? What do we need to
do to assure that they meet with willing preceptors and institutions who
are welcoming, supportive, and nurturing? What kind of knowledge do they
need to gain in the classroom environment that will translate adequately
and RAPIDLY at the bedside? What kind of educational preparation do they
need to continue building the recognition and acknowledgment that we ARE a
profession? How will they be best prepared to gain the respect and the
seat at EVERY important discussion that we so desire and that will be of
significant benefit to health care in the world? This dialogue is NOT
about how we have arrived at where we are but a discussion of how we can
assure that those who come AFTER us are better equipped EARLIER to do the
work that needs to be done.
I have traveled the long path: LPN, ADN, BSN, MSN, CNM, and am working on
my dissertation. I LOVE formal classroom education. THAT is where I obtain
the knowledge that I apply at the bedside, in the office, in the
courtroom, and wherever else I practice nursing. I understand that others
will find different opportunities to learn and grow. I honor those
different paths and seek to learn from THEM what their life lessons have
provided. All knowledge is valuable and should be honored as such. Read the rest of this entry »
Tags: BSN, college degree, higher degree, legal nurse consultant, nursing education, nursing student, registered nurse, RN
Posted in Legal Nurse Consultants | 3 Comments »
January 6th, 2010
We have finally reached a time in health care where the term “Living Will” is used fairly comfortably on a daily basis when delivering medical care. We ask our patients on admission to any facility if they have a Living Will and a designated health care surrogate to act upon their wishes should they become incapacitated. If they don’t currently have one, we print up a standard form, have them fill it out, sign it, get witnesses and within minutes we create a Living Will for them! It has taken over two decades, but I believe that at this point in the evolution of health care practice, the general public can converse on the subject of “Living Wills”. Big sigh of relief.
But….now we have come to new crossroads. One new issue we face relates to the importance of choosing an appropriate & faithful health care surrogate. What’s the point of creating a Living Will and designating someone as a health care surrogate if–at the time you need them to speak out in your behalf–that person decides to go against your wishes? How is that ethical? How is that fair? What duty does your health care surrogate have to uphold your wishes once you are unable to make decisions for yourself? And, what is the consequence of choosing a different decision than the one that person initially wanted? At this point in time, there is no legal consequence. The health care surrogate has the final word. Thats a powerful role to assume!
In my region of Florida, our critical care units deal with a very elderly population. My colleagues & I encounter this type of situation all too frequently. A 93-year old widower with severe COPD gets admitted from an assisted living facility with his fourth bout of pneumonia in 2 years. He comes to us in bad shape…confused, agitated, hypoxic, shocky, dehydrated. His kidney status is bordering on renal failure. We receive his Living Will and health care proxy forms which state that his only child, a son in Pennsylvania, is his health care surrogate.
Read the rest of this entry »
Tags: dialysis, DNR status, end-of-life decisions, health care proxy, Health Care Surrogate, hemodialysis, ICU, legal nurse consultant, linkedin, Living Will
Posted in Legal Nurse Consultants | 6 Comments »
October 6th, 2009
A 32-week parturient comes in with infection of unknown origin. She has had nausea and vomiting for 48 hours and has been unable to keep anything down. Acute renal failure due to dehydration is diagnosed. An IV is placed, and an external fetal monitor is applied. The baby’s tracing is questionable with decelerations. The decision is made to do a STAT C-section. Her starting white blood count is 26,000/ml, and her hemoglobin is 13.6 Gm/dL.
The patient is taken to the operating room. Her vital signs are heart rate - 130, blood pressure - 130/70, and pulse oximeter - 96%. The decision was made to avoid regional anesthesia because of her infection. General anesthesia is induced once the staff is ready to make incision. Vital signs remain stable throughout the procedure, and blood loss is estimated at 700 mL. Total IV fluids given is 4,800 mL. Urine output is minimal with 30 mL dark yellow urine. IV fluids are continued wide open. Heart rate has decreased to the 90’s.
Fifteen minutes prior to going to recovery, the patient’s blood pressure starts dipping into the 80’s. Heart rate increases to 120-130. Blood pressure is treated with Neosynephrine with minimal response. IV fluids continue wide open. At the end of the case, urine output totals 150 mL dark yellow urine. The patient is easily extubated without problem. Her blood pressure remains in the 80’s and 90’s, requiring vasopressor support. Her diastolic blood pressure falls with a range of 18-23 in the recovery room. Read the rest of this entry »
Tags: blood loss, cesarean, CLNC, CRNA, hypotension, legal nurse consultant, tachycardia
Posted in Legal Nurse Consultants | 3 Comments »
October 2nd, 2009
A “culture of safety” as defined by the National Academies of Sciences is “an integrated pattern of individual and organizational behavior, based upon shared beliefs and values, that continuously seeks to minimize patient harm which may result from the process of care delivery.”
If you’ve been in healthcare for any period of time you’ve heard the term “culture of safety” but, what does it really mean?
Let’s do a little background check on the development of the modern patient safety movement….. Hippocrates, I’m sure you heard of him, had the first concept with “first, do no harm”.
Then in the 70’s & 80’s, Joint Commission, professional liability insurers, medical groups & academia responded to injury rates by instituting audit requirements, clinical guidelines, safety research and articles. Healthcare professionals really thought we were on a roll and improving our patient care and felt good about what we were doing. Read the rest of this entry »
Tags: healthcare, LNC, nurses, patient safety
Posted in Legal Nurse Consultants | 4 Comments »
September 29th, 2009
Trying to break into an area previously unknown to me is really a fairly new experience for me, as I have been doing basically the same two kinds of nursing for many years: home health care and emergency nursing. The two go together well, as you can do one during the week, the other on the weekend. Or one during the day and the other at night, depending on your level of insanity. I had not tried to go to a new unit or new type of nursing in a long time, and I never expected much in the way of “snags” as I entered the exciting new world of Legal Nurse Consulting.
I first started to interact with my local chapter of Legal Nurse Consultants while still in my college program to “teach me the ropes.” I also joined an online exchange of LNC’s. I was absolutely fascinated with the stories they exchanged and the camaraderie they seemed to share in both groups.
However, not all the nurses were so welcoming and open to new people. The old adage: “Nurses eat their young” lifted a gnarley head and growled a few times. Not many of that type still exist, but they are out there. I even have had my head rather swiftly chopped off when asking a classmate what she was doing with her LNC credentials. That was a surprise! Then a person by the name of Claire Hull invited me to new kind of nurse exchange called, The JERK, short for Juris Education Resource Knowledge. I am just quirky enough to find that interesting, so I came. Read the rest of this entry »
Tags: emergeny nursing, encouragement, home health care, JERK, Juris Education Resource Knowledge, legal nurse consultant, LNC, nurses, support
Posted in Legal Nurse Consultants | 3 Comments »
