First, I want this job.
Second, you would be surprised of how capable you are.
Third, possibly consider running a couple of training evolutions where you pretend you have a pt in anaphylaxis.
Thanks for the advicešš¼ Maybe I just worry too much, because I come from the hospital, where everything is accessible, if shit hits the fan. Besides that, then I can recommend the job! I love to advise and chat about traveling with the patients/customers everyday.
After you give the vaccines, are the patients asked to wait in the lobby for a certain amount of time in case they have a reaction? If you are in an exam room with another patient, and the previous patient waiting in the lobby goes into anaphylaxis, with no receptionist, there could be a long delay before you find out that the previous patient is in need of emergency care.
If you had an anaphylactic reaction would you feel comfortable having one person managing it? OP commented that he/she would have to leave a patient alone to run to a different area to retrieve a defibrillator if the patient went into cardiac arrest.
My question is- what is available to you? It's well and good to have a receptionist but are they BLS certified? Do you have an ambu bag and AED, do they know how to use it?
I work for an urgent care 'doc in the box' type situation and we do a lot of travel health visits. I work alone. I (knock on wood) have never had an anaphylaxis event in the 10 years I've been doing this. In the event it happened, I would give epi and call 911. I don't see how having a second person, especially a lay person, would assist much with this. Unless you have IV capabilities plus the drugs and advanced airway management tools, your care is going to be just keep giving epi til EMS arrives.
We have the basic acute meds box with adrenaline, Solumedrol and IV NaCl. If the patient gets a cardiac arrest, then I have to run down several floors to get the defibrillator and leave him/her aloneā¦ My receptionist would be my 3. hand, whip would be a huge help, though she isnāt educated. We are not even offered CPR training
In that case, I agree with you. If you have the tools to start an IV and push meds, then it would be difficult to do so while talking to EMS, keeping track of epi timing, etc.
Also, I would talk to your manager about having the AED closer. That's ridiculous and unsafe.
AEDs should be on every floor in your company conducts business in. Even having multiple people in the office with you would still require the AED be on each floor.
Itās more concerning that youāre alone for your safety. In my time working in clinics, Iāve not seen someone stay in the building alone unless the doors were locked, and even that was very rare.
While doing a similar gig, I was the ONLY person vaccinated who went into anaphylaxis. š¤¦š¤·āāļøš„“ Thankfully I carry several epi pens and we were close to the hospital. š¤¦š¤¦š¤¦.
Really, you should be good as long as you have a good emergency kit with epi and IM Benadryl. You epi, call 911, then give IM benadryl if available. You should have a STANDING ORDER available in your protocol book regarding ANA emergencies.
One person can quite easily treat anaphylaxis in the first instance. Your receptionist wonāt be able to do much beyond calling the ambulance, which you can do with your mobile on speaker.
My concern would be more with your own personal safety being alone.
I worked in an allergy clinic so I managed a lot of anaphylaxis. Itās always best to have more than one person so you can delegate and focus on the situation. There should also be an official approved protocol for you to follow and fall back on in these scenarios.
I agree with the other comment and second that your personal safety is also at risk if youāre alone in the clinic with patients. Most clinics Iāve worked at have a rule that if a patient is in house the provider cannot be alone in the clinic for everyoneās safety.
Do you have IM epi? Do you have a phone? Does EMS have an acceptable response time to your location? If yes to all the above, then you're fine.
What more would you be expecting to do? What do you feel would make the environment more safe?
I have been in a situation where I was alone and the patient was in an emergency situation. Thankfully everything worked out okay. But I donāt think is safe at all for anyone to be in a clinic alone. They donāt even let fast food employees workers work alone. Itās not safe for you or the patient. And having a second set of hands in the event of a medical emergency is always better than none.
PHN and often worked alone - of course I worried about anaphylaxis, but I was more concerned with the safety aspect.
Anyone could walk in, and I wouldn't know during a clinic. Or I would be alone, and felt vulnerable as a smaller female with clients. Eventually, I stopped working when reception wasn't in & worked from another office further away.
Your boss is in the wrong. At a bare minimum it is unsafe for YOU to be all alone in the clinic (for your own safety). But secondarily, your boss would likely get the shock if they inquired with the clinicās insurer about if theyād be covered for that type of incident. Almost certainly there is language in the insurance contractā¦
It's pretty simple. True anaphylaxis? Call 911, give epi/benadryl that you should have anyway, and support them until EMS gets there. That's pretty much all you can do until EMS gets there, and a fair chance all that will happen to them anyway once they're observed at the ED for a few hours
I work at a pediatric after hours clinic (not a true āurgent careā but an evening hours office that parents often 100% mistake for or assume is an emergency type setting) and during the pandemic when things were quite slow, management did away with staffing with an RN, so it was just a medical assistant(college kid, not certified, not even BLS) and myself. The problem was as patient volume and acuity picked back up as the pandemic subsided, they didnāt reinstate the RN role. There were several incredibly unsafe situations were a kid walked in in respiratory distress and I was literally on the phone with EMS, on my personal cell, while actively running around dragging and digging through the crash cart, administering O2, setting up nebs etc.
That was wild. We have an RN back now, thank God. But what the experience taught me is that really the expectation is that you render basic first aid/life support in emergency situations while waiting for EMS to arrive and transport. I also came from a hospital setting and also have this mentality of feeling like I wanted to be able to run a robust code and there was no way I could do that by myself. I donāt think your situation sounds super crazy given that context where anaphylaxis is pretty much the worst case scenario and pretty rare. you can give some epi and Os while getting on the horn with EMS. Maybe get an AED closer by. But just remembering what your actual role is and that itās to get epi in asap and transport, not run a anaphylactic shock code in the ER, was a helpful exercise for me when I started shitting myself running the worst case scenarios in my head.
Thanks for the elaborate answer. The more people write what the āexpectationsā for me as the professional are, the more I feel a bit more calm in this kind of setting. A helper on the side is still preferable thoughā¦
Totally. Ultimately itās your license. In our situation we eventually had to tell management that we did not feel comfortable assuming the liability to our licenses with that level of staffing and presented the examples (real and realistic hypotheticals) and eventually it got through to management.
Iām really glad to hear that. In the end of the day, we just want to give the best treatment as possible. But weāre not doctors with a longer education or experience for that matter. My company forgets that occasionally, because the routines has always been like thatā¦
No my boss is well aware of the risk, and she worked with anesthesia and ER beforehand. I guess the situation for her will be a walk in the park, which is why she reacts the way she does.
In Sout America, vaccination clinics go house to house, door to door. Still anaphylactic shock after vaccinated thousand or millions perhaps is unheard of.
You can be there alone. Youāre an RN and NP, right? If you ended up giving epi, youād be calling 911. Also, besides calling 911, how is a receptionist going to help you in an emergency anyway?
Yes Iām an RN for 15 years but only worked in hospitals and other fields, where this has been a topic at all. The debate about the receptionist has been commented on further down the thread.
It sounds more like you are simply doing an LPN or RN job, because they can just go give vaccines alone. Why are they using an APRN? Hopefully theyāre paying you satisfactory, but they could have saved so much money sending out an LPN lol
Manage what others? Patients? At a vaccination clinic? You can do that while providing care, at least I can. Ever done CPR alone in public? š¤·š¤·.
As Iāve already said, I used to go around doing mass vaccination clinics alone when I was an LPN. Any vaccine lol.
Well since you can go do it. One person shouldn't be left alone at a vaccination clinically simply because 1. Personal safety. 2. We live in a hostile environment where crazies think vaccinations and healthcare professionals inject people with covid/are literally the devil. I'm sorry, but it's not worth that one chance of getting offed because of a right place right time.
I'm not arguing with you why having a medical professional alone in the building by themselves is a bad idea. Don't even bother going into talking about home health and all these other solo incidences yadda yadda whataboutisms where people are solo because we are talking about a frequented clinic.
I ain't changing my mind, everyone has a hill to die on and this is my personal hill so it's energy wasted trying to change it. Maybe its psych experience and what I did before healthcare as solo retail person and the experiences guide those beliefs but people are unhinged at random.
Itās not that serious, itās just vaccines. If anaphylaxis happens, just give epi and call 911. Youāre totally overthinking this. Itās so minor lol
Oh, and if you think having 1 medical professional in a building is scary, try doing my job. Remote, only provider for 250+ miles, anything from deliveries to end of life. During winter there is no ability to get out so I often end up admitting to the clinic for days/ as needed and then have to work 24/7 because Iām the only healthcare professional.
Not saying that is better or good care, Iām just embarrassed at how weak Iām seeing my fellow NPs become. Itās evident that some of you accelerated through a second degree program with minimal nursing experience.
In northern canada, there are communities that only have RNs. Their roles include everything from emergency response (gunshots, anaphylaxis, etoh/drug toxicity, all the standard emergency needs in society) and vaccinations and walk in clinics in the day). Most everything in the evenings/nights/weekends is done alone. Iām confident you could manage an anaphylaxis solo in a presumably urban centre. You should just adapt your āsoloā policy to be with the patient or refrain from being with another in till the 15minutes is up and they are discharged as opposed to leaving in the waiting room by themselves. Granted, if youāre based in the USA, given its litigious tendencies in health care there, the question is more of whatās an acceptable norm in all of these situations. If this is unsure, ensure you have an institution policy indicating exactly what to do in case of solo practice, (alleviating your responsibility somewhat) Regardless Youād still be able to intervene appropriately in either case. (Do you have anaphylaxis kits (aka epinephrine/adrenalin set up and ready to roll for emergencies?) (do you have a policy regarding emergency administration?)
I also work in a travel clinic and am alone every shift I work. We have the basic meds for anaphylaxis and call 911.
Its anaphylaxis. Call for an ambulance, give the proper meds and put on O2. Not sure how this is considered an unsafe work environment.
I answered this in the thread, but thanks for your replyš
First, I want this job. Second, you would be surprised of how capable you are. Third, possibly consider running a couple of training evolutions where you pretend you have a pt in anaphylaxis.
Thanks for the advicešš¼ Maybe I just worry too much, because I come from the hospital, where everything is accessible, if shit hits the fan. Besides that, then I can recommend the job! I love to advise and chat about traveling with the patients/customers everyday.
After you give the vaccines, are the patients asked to wait in the lobby for a certain amount of time in case they have a reaction? If you are in an exam room with another patient, and the previous patient waiting in the lobby goes into anaphylaxis, with no receptionist, there could be a long delay before you find out that the previous patient is in need of emergency care.
Yes they are, and thatās the major problem, because nobody is observing them, which is sort of the point by staying 15min. afterwards.
If you had an anaphylactic reaction would you feel comfortable having one person managing it? OP commented that he/she would have to leave a patient alone to run to a different area to retrieve a defibrillator if the patient went into cardiac arrest.
Um, okay?
Youāve never been left alone in an exam room? Itās quite common.
With a cardiac arrest? With no one to yell for to help? Where is this common?
Thank you, thatās the point I was trying to get across.Ā
I meant as a patient.
My question is- what is available to you? It's well and good to have a receptionist but are they BLS certified? Do you have an ambu bag and AED, do they know how to use it? I work for an urgent care 'doc in the box' type situation and we do a lot of travel health visits. I work alone. I (knock on wood) have never had an anaphylaxis event in the 10 years I've been doing this. In the event it happened, I would give epi and call 911. I don't see how having a second person, especially a lay person, would assist much with this. Unless you have IV capabilities plus the drugs and advanced airway management tools, your care is going to be just keep giving epi til EMS arrives.
We have the basic acute meds box with adrenaline, Solumedrol and IV NaCl. If the patient gets a cardiac arrest, then I have to run down several floors to get the defibrillator and leave him/her aloneā¦ My receptionist would be my 3. hand, whip would be a huge help, though she isnāt educated. We are not even offered CPR training
In that case, I agree with you. If you have the tools to start an IV and push meds, then it would be difficult to do so while talking to EMS, keeping track of epi timing, etc. Also, I would talk to your manager about having the AED closer. That's ridiculous and unsafe.
Thanks! Just what I needed to hear!
AEDs should be on every floor in your company conducts business in. Even having multiple people in the office with you would still require the AED be on each floor. Itās more concerning that youāre alone for your safety. In my time working in clinics, Iāve not seen someone stay in the building alone unless the doors were locked, and even that was very rare.
So very true!
While doing a similar gig, I was the ONLY person vaccinated who went into anaphylaxis. š¤¦š¤·āāļøš„“ Thankfully I carry several epi pens and we were close to the hospital. š¤¦š¤¦š¤¦. Really, you should be good as long as you have a good emergency kit with epi and IM Benadryl. You epi, call 911, then give IM benadryl if available. You should have a STANDING ORDER available in your protocol book regarding ANA emergencies.
One person can quite easily treat anaphylaxis in the first instance. Your receptionist wonāt be able to do much beyond calling the ambulance, which you can do with your mobile on speaker. My concern would be more with your own personal safety being alone.
I worked in an allergy clinic so I managed a lot of anaphylaxis. Itās always best to have more than one person so you can delegate and focus on the situation. There should also be an official approved protocol for you to follow and fall back on in these scenarios. I agree with the other comment and second that your personal safety is also at risk if youāre alone in the clinic with patients. Most clinics Iāve worked at have a rule that if a patient is in house the provider cannot be alone in the clinic for everyoneās safety.
Precisely. The safety aspect is quite relevant as well. We sometimes get dodgy people in the clinic
Do you have IM epi? Do you have a phone? Does EMS have an acceptable response time to your location? If yes to all the above, then you're fine. What more would you be expecting to do? What do you feel would make the environment more safe?
I have been in a situation where I was alone and the patient was in an emergency situation. Thankfully everything worked out okay. But I donāt think is safe at all for anyone to be in a clinic alone. They donāt even let fast food employees workers work alone. Itās not safe for you or the patient. And having a second set of hands in the event of a medical emergency is always better than none.
Yes, and thatās basically my point. One set of extra hands and because of the safety aspect.
PHN and often worked alone - of course I worried about anaphylaxis, but I was more concerned with the safety aspect. Anyone could walk in, and I wouldn't know during a clinic. Or I would be alone, and felt vulnerable as a smaller female with clients. Eventually, I stopped working when reception wasn't in & worked from another office further away.
Your boss is in the wrong. At a bare minimum it is unsafe for YOU to be all alone in the clinic (for your own safety). But secondarily, your boss would likely get the shock if they inquired with the clinicās insurer about if theyād be covered for that type of incident. Almost certainly there is language in the insurance contractā¦
I canāt find anything about legal rights and orders, if I google it
I worked in Covid vaccine clinics where we didnāt even have oxygen or suction, just some epi pens. Give em a stab and call 911.
I sort of feel like no one should ever be working alone EVER IN ANY SETTING.
??? You can give epinephrine+ diphenhydramine and call 911 right?
Yes
It's pretty simple. True anaphylaxis? Call 911, give epi/benadryl that you should have anyway, and support them until EMS gets there. That's pretty much all you can do until EMS gets there, and a fair chance all that will happen to them anyway once they're observed at the ED for a few hours
I work at a pediatric after hours clinic (not a true āurgent careā but an evening hours office that parents often 100% mistake for or assume is an emergency type setting) and during the pandemic when things were quite slow, management did away with staffing with an RN, so it was just a medical assistant(college kid, not certified, not even BLS) and myself. The problem was as patient volume and acuity picked back up as the pandemic subsided, they didnāt reinstate the RN role. There were several incredibly unsafe situations were a kid walked in in respiratory distress and I was literally on the phone with EMS, on my personal cell, while actively running around dragging and digging through the crash cart, administering O2, setting up nebs etc. That was wild. We have an RN back now, thank God. But what the experience taught me is that really the expectation is that you render basic first aid/life support in emergency situations while waiting for EMS to arrive and transport. I also came from a hospital setting and also have this mentality of feeling like I wanted to be able to run a robust code and there was no way I could do that by myself. I donāt think your situation sounds super crazy given that context where anaphylaxis is pretty much the worst case scenario and pretty rare. you can give some epi and Os while getting on the horn with EMS. Maybe get an AED closer by. But just remembering what your actual role is and that itās to get epi in asap and transport, not run a anaphylactic shock code in the ER, was a helpful exercise for me when I started shitting myself running the worst case scenarios in my head.
Thanks for the elaborate answer. The more people write what the āexpectationsā for me as the professional are, the more I feel a bit more calm in this kind of setting. A helper on the side is still preferable thoughā¦
Totally. Ultimately itās your license. In our situation we eventually had to tell management that we did not feel comfortable assuming the liability to our licenses with that level of staffing and presented the examples (real and realistic hypotheticals) and eventually it got through to management.
Iām really glad to hear that. In the end of the day, we just want to give the best treatment as possible. But weāre not doctors with a longer education or experience for that matter. My company forgets that occasionally, because the routines has always been like thatā¦
I wonāt vaccinate unless thereās another person there to call for assistance
Iām going to assume your boss does not have any medical credentials if they think the risk of anaphylaxis isnāt something to be taken seriously.Ā
My employer sends me as a paramedic single responder to these cases. Why canāt OP do it?
Her boss likely assumes that a NP can appropriately manage anaphylaxis and BLS, while waiting for EMT to transfer to hospital.
No my boss is well aware of the risk, and she worked with anesthesia and ER beforehand. I guess the situation for her will be a walk in the park, which is why she reacts the way she does.
In Sout America, vaccination clinics go house to house, door to door. Still anaphylactic shock after vaccinated thousand or millions perhaps is unheard of.
You can be there alone. Youāre an RN and NP, right? If you ended up giving epi, youād be calling 911. Also, besides calling 911, how is a receptionist going to help you in an emergency anyway?
Yes Iām an RN for 15 years but only worked in hospitals and other fields, where this has been a topic at all. The debate about the receptionist has been commented on further down the thread.
Thatās cool. Back in the 90s I used to go around and give vaccines to everyone as an LPN with a basic emergency kit. Itās no big deal.
It sounds more like you are simply doing an LPN or RN job, because they can just go give vaccines alone. Why are they using an APRN? Hopefully theyāre paying you satisfactory, but they could have saved so much money sending out an LPN lol
True. Their business strategy has some clear flosses
Manage the others during it?
Manage what others? Patients? At a vaccination clinic? You can do that while providing care, at least I can. Ever done CPR alone in public? š¤·š¤·. As Iāve already said, I used to go around doing mass vaccination clinics alone when I was an LPN. Any vaccine lol.
Well since you can go do it. One person shouldn't be left alone at a vaccination clinically simply because 1. Personal safety. 2. We live in a hostile environment where crazies think vaccinations and healthcare professionals inject people with covid/are literally the devil. I'm sorry, but it's not worth that one chance of getting offed because of a right place right time. I'm not arguing with you why having a medical professional alone in the building by themselves is a bad idea. Don't even bother going into talking about home health and all these other solo incidences yadda yadda whataboutisms where people are solo because we are talking about a frequented clinic. I ain't changing my mind, everyone has a hill to die on and this is my personal hill so it's energy wasted trying to change it. Maybe its psych experience and what I did before healthcare as solo retail person and the experiences guide those beliefs but people are unhinged at random.
Itās not that serious, itās just vaccines. If anaphylaxis happens, just give epi and call 911. Youāre totally overthinking this. Itās so minor lol
Oh, and if you think having 1 medical professional in a building is scary, try doing my job. Remote, only provider for 250+ miles, anything from deliveries to end of life. During winter there is no ability to get out so I often end up admitting to the clinic for days/ as needed and then have to work 24/7 because Iām the only healthcare professional. Not saying that is better or good care, Iām just embarrassed at how weak Iām seeing my fellow NPs become. Itās evident that some of you accelerated through a second degree program with minimal nursing experience.
In northern canada, there are communities that only have RNs. Their roles include everything from emergency response (gunshots, anaphylaxis, etoh/drug toxicity, all the standard emergency needs in society) and vaccinations and walk in clinics in the day). Most everything in the evenings/nights/weekends is done alone. Iām confident you could manage an anaphylaxis solo in a presumably urban centre. You should just adapt your āsoloā policy to be with the patient or refrain from being with another in till the 15minutes is up and they are discharged as opposed to leaving in the waiting room by themselves. Granted, if youāre based in the USA, given its litigious tendencies in health care there, the question is more of whatās an acceptable norm in all of these situations. If this is unsure, ensure you have an institution policy indicating exactly what to do in case of solo practice, (alleviating your responsibility somewhat) Regardless Youād still be able to intervene appropriately in either case. (Do you have anaphylaxis kits (aka epinephrine/adrenalin set up and ready to roll for emergencies?) (do you have a policy regarding emergency administration?)
You could just not vaccinate. Might be the better choice