Content That armyicurn Likes

armyicurn, BSN 5,683 Views

HI, got questions? Just ask. :)

Sorted By Last Like Given (Max 500)
  • Apr 13

    5 am-The alarm goes off . I get up bleary eyed wishing I could crawl back to bed. I have put in 5 days at my regular M-F job. This is day#6. This job helps me, help my college bound kids.

    6 am-I get ready, pack my lunch and am out the door. My steps have a spring just like the weather! Fitbit 500 steps!

    6.45 am-I am at work ready for my shift. I listen to the controlled chaos in the Nursing office. The phones ring constantly, the outgoing Assistant Directors of Nursing(ADN) are finishing up their administrative report, attending pages and answering questions from the Staffer. Staff call from different units. Requests, demands, threats of protests of assignments.

    7.20 am-I finally start getting report. The report is constantly interrupted by phone calls from charge RN/ Union rep RN asking for more staff on a weekend especially when their unit had sick calls at the last minute.The staffer is directed to take all calls so that we can finish report. Report is done and the night ADNs leave/stay to finish up their report and the day is on!

    7.50am-The day ADNs go over staffing with the staffer for the day and the oncoming shift. I am covering all critical units (ED, Dialysis, Cathlab, OR, MICU, CICU, NICU, Telemetery, L&D and postpartum. I get my printout with all the names of the staff for the day and night shift.

    8 am-I catch up with what's going on in the hospital (yes, some gossip!), drink my coffee as I call the operator and give her my pager number and the units I am covering. I go online, check our EMR for any issues with patients that were mentioned in report, go over the orders for the one to one observation patients and check the status of the Emergency Room admitted pts that are waiting on beds. Now I am ready for rounds.

    8.30am-10.30am: My first round is a quick one to each unit as I check for hospital discharges, meet the charge RNs and eyeball all units for any potential issues.The pager goes off constantly as I move from unit to unit.

    10.30am-11.30am: Discharge rounds. Meeting with social work,managed care, chief medical resident, home care etc as we go over all discharges in the house. I inform them of how many ED pts are waiting on beds.

    11.30am-11.40am-Meet with patient logistics and go over bed situation and potential discharges.

    11.40am-2pm-Unit to unit rounds. Check staffing(schedule book) against paper, speak to the teams, resolve issues, attend Rapid Responses and all codes.

    Some of the issues:

    1. -ED Patient complaints-Pt can't breathe. Family can't get help from anyone as they are busy! Get staff to help pt.

    2. -Attending MD complaint-Cannot get social worker. Patient just lost his wife in a traumatic car accident. Hunt and find the social worker who is not responding to his pages!(I know where this one in particular hides!).

    3. -Family complaint-Dad was wandering around ED, peed on himself, was never given food. Planning to call Dept of Health and their lawyer. Spoke to RN taking care of patient and asked her to make sure that pt is put by the nurses station or is eyeballed frequently. Spoke to logistics to expedite bed as pt has been waiting two days in the ED for an isolation bed.

    4. -ED Charge RN-Floor is not taking report. Called floor who is transferring out another pt to the CICU. Compromise. Take report in 40 minutes. Called operator to page housekeeping to expedite bed cleaning. Requested ED to send pt up in 1.5 hrs after alerting floor.
    Thank charge RN in the ED and ask her to call me if any issues that she cannot resolve.

    5. -Dialysis-Worried charge RN, Staff cancelled. Go through staffing with her to see who can stay/come early/call in. Come up with a plan.Move on to the next unit.

    6. -Cardiac cath recovery. Pt stable. Staff on Facebook. Pleasantly tell her to refrain from social media at work.

    7. -OR-Pt in surgery. Post op RNs waiting.Pretend not to notice the food spread around! No issues.

    8. -ICU-Pt needs one to one. No staff available. Call staffer for discuss if we can pull staff from a different unit to help. If not, ask them to put their Nursing Attendant.Staffing ratio safe.

    9. -CICU-Pt being terminally extubated. Wife and children at bedside. Healthcare proxy not there. Staff not sure if the rest of the family knows. Speak to the daughter who is worried if her mom could handle this.Patient married for 64 years, wife has Alzheimer.Reassure family, answer their questions, refer to the MD for specifics, huddle with the Nursing staff to plan for any issues, alert security and ED charge RN in case wife has any issues. Stretcher on standby.

    10. -NICU-Speak to the family of a baby who was terminally extubated and is in mother's arms. Comfort, listen, speak to the RN taking care of patient. Requests call back from charge RN when the baby dies.

    11. -L&D- Discuss issues the nurses have with the ED nurses when pts are send in distress upstairs without stabilizing. Talk to the ED triage RN and reinforce safety first. Follow up with patient. Asthma teaching.

    12. -Post Partum-Remind staff that they are up for inspection and discuss baby friendly initiatives. Ask them to get rid of the formula bottles that are hiding in plain sight! 13. 13.

    -Telemetry: Speak to the charge RN who wants an extra NA to sit with a confused patient. Round on the patient, who is sitting up in bed eating lunch, answering appropriately, call bell on the floor! Requests RN to make sure that the call bell is within reach and recommends that the patient be on enhanced observation.

    2.30pm-Go back to staffing office and go over staffing for 3-11pm and 7pm with staffer.
    Bathroom break, hurried lunch that is constantly interrupted with pages. Call from managers on unit issues.

    3.30pm-5pm- Attempt to start with administrative report,check on my family, answer pages, call supervisor of radiology, CT, Ultrasound, lab with unit issues. Page central supply, linen and pharmacy supervisors with issues.

    5pm-6pm-Last rounds on problem areas.Receive calls about expiration in the NICU & CICU pt.

    6pm-6.30pm-Last huddle with staffer on staffing after sick line is checked.Check EMR for unit and house census. Finish up report.

    6.30pm-Code called overhead. Attend the code, expediate x-ray, stat meds from pharmacy, keep family updated, support staff, make calls to get a stat bed in the ICU.

    7PM-Ready for report, pager going off, phones ringing-----! The circle of life!

    I have noticed that I enjoy building teams, planning with the staff for the best outcome, encouraging staff when they have a rough day and calling them out when they are not professional. I am able to guide them to react professionally when people are in their face. Much as I love the one on one interaction with the patient, I am able to do a lot more as an administrator guiding the hospital ship through choppy and calm waters!

    So... Calling all potential captain ADNs! Make a difference every day! This I say as I limp out at the end of my day! Fitbit-9270 steps! I sure could use some M&M (Massage and Motrin)!

  • Mar 18


    I would have loved to have seen how they would have reacted to my actions if it was THEIR family member in that bed!

    We are notorious for "practicing medicine" on nights. We have a LOT of autonomy on our units on nights because the drs and surgeons trust us to do what's best for their patients. They know we have the skills and brains. They do NOT let green nurses, newbies, or idiots take care of their patients. They will literally say, when wheeling the patient out from the CVOR, "DO NOT let, ***** take care of my patient!"

    We are currently re-writing our ECMO protocols right now w/ one of our Intensivists and CT Surgeons. This is a process.. but I'm very optimistic on where it's going. Our CM highly encouraged the "CLIPBOARD NURSES" to attend as well.

  • Mar 12

    Sounds like a code. 44/20 with a HR = PEA (not guessing you could've found a pulse with that, especially on ECMO) You didn't say A-V or VV, but it doesn't really matter. Should have something on hand to show them for patients on ECMO.

    All that aside, they are idiots and if they think you guys were "practicing medicine without a license" you should insist that they fulfill their obligation and responsibility to formally complain to your state board of medicine on behalf of the patient as well as the state attorney general for criminal investigation. Knowingly withholding information about criminal activity is a crime and they could be held culpable.

    Morons throwing around stupid and incendiary accusations like that need to be taken to task. Guessing they'd back down pretty quickly.

  • Oct 22 '16

    Are you a brand new nurse that just obtained the first job in the Emergency Room? Or an experienced nurse that has decided to master a new specialty? Well, which ever boat you might be in, here is a head start for you. Below is a list of medications that I promise you will be using time and time again while working in the Emergency Room. This looks like it might be an extensive list, but as time goes on, you will know the entire list inside and out.

    In alphabetical order and not limited to. . .

    1. Albuterol
    2. All of your fluids NS 0.9, Dextrose 5% NS 0.9, Lactated Ringers. . .
    3. Alteplase
    4. Amiodarone (Push and Infusion)
    5. Aspirin
    6. Ativan
    7. Atropine
    8. Atrovent
    9. Azithromycin
    10. Bacitracin
    11. Cardiac Arrest Medications (See your ACLS Textbook)
    12. Cardizem (Push and Infusion)
    13. Catapres
    14. Cefepime
    15. Ciprodex (Otic Drops)
    16. Ciprofloxacin
    17. D50 Push
    18. Decadron
    19. Dilaudid
    20. Diphenhydramine
    21. Dobutamine
    22. Dopamine
    23. Epinephrine (Push and Infusion)
    24. Esmolol
    25. Etomidate
    26. Fentanyl
    27. Flagyl
    28. Fluorescein Strips
    29. GI cocktail: Maalox, Donnatal & Lidocaine (PO Mixture)
    30. Haldol
    31. Heparin
    32. Ibuprofen
    33. Insulin
    34. Kayexalate
    35. Ketamine
    36. Ketorolac
    37. Labetalol
    38. Levophed
    39. Lidocaine (Injection, IV Push & Infusion)
    40. Magnesium
    41. Mannitol
    42. Morphine
    43. Narcan
    44. Neosynephrine, (nasal spray & IV Infusion)
    45. Nitroglycerine (Pills, Paste & IV Infusion)
    46. Ondansetron
    47. Pepcid
    48. Phenergan
    49. Plavix
    50. Prednisone
    51. Propofol
    52. Protamine Sulfate
    53. Protonix
    54. Rocephin
    55. Rocuronium
    56. Romazicon
    57. Silvadene Cream
    58. Silver Nitrate sticks
    59. Sodium Bicarbonate (Push and Infusion)
    60. Solumedrol
    61. Succinylcholine
    62. Tetracaine (Ophthalmic Drops)
    63. Tylenol
    64. Unasyn
    65. Vancomycin
    66. Verapamil
    67. Versed


    Some of the medications are listed as the brand name and some of the medications are listed as the generic name. It is imperative that you are comfortable with both. Yes, I did do this on purpose, to not include both within this article. I am a teacher at heart, and I could not write this article without some homework involved!

    Also, know what your hospital's policy is for administration of all of the medications listed above. What might be a normal practice at one facility, could get you a write up at another. Along with that, as always, never forget the medication administrations safety rules we all were taught in nursing school.

    Oh yeah and how could I forget the life saving enemas! Saline and Mineral Oil.

    Lastly, I will leave you with another tip for all new Emergency Room Nurses. Go through all of body systems and learn what the emergencies are for those systems. Master those and you will feel comfort in knowing that when you are drowning, you have ruled out all of the time sensitive emergencies for your patients. Once this has occurred, go down that list again and prioritize your patients from there. The Emergency Room is a no joke place to work, very fast paced and stressful. Mastering this list will help take away some of the stress and improve your overall flow. Give the department some time though, when it gets difficult don’t quit. It can be very overwhelming at first, but I promise it will get better.

    Michael M. Heuninckx RN-BSN

    ****Extra Medication Safety Tip****
    Set your medication pumps up for success, not failure. When programing your pump to administer a high alert medication, set the rate to match the volume to be infused. This will prevent the entire bag/bottle of medication being accidentally administered to the patient due to your programming error. If this safety measure is not in place, it could lead to a catastrophic and life threatening event for your patient. Imagine if an entire bag of Cardizem was administered, or the whole bag of Insulin or the whole bottle of Nitroglycerin?! Yikes!!! It only takes an extra second and when the hour is up: go back to set the pump again, reassess your patient, ensure that they are improving and not getting any worse, and continue on with the rest of your patients that need your services.

    If you like this article then you might want to check out Michael’s new book for nurses...

    Code Blue! Now What? Learn What To Do When Your Patients Need You The Most!

  • Sep 5 '16

    So I've never posted a video here so forgive me if I'm doing it the wrong way. I made a YouTube video about an alternative therapy to the EpiPen given its recent popularity in the news lately.

    As required by AN, there is a link to all nurses in the description and the video itself

    I'd appreciate any feedback you might have. I know some of you will have some constructive criticism, but please keep it friendly.

    I made this video very fast because it's a hot topic right now and I didn't want to miss out. A video will usually take me 2 weeks to edit, gather material, voice over and other stuff. I made this whole video in 5 hours, so I apologize for any mistakes you might find

    Enjoy the video.

  • Aug 7 '16

    they had someone else drive you home with security riding behind you? ain't no way nobody would have gotten in my car and driven me anywhere!! what kind of crap is that?? i have never heard of such foolishness!! they would have fired me on the spot if they taught i would have complied with that!!

  • Aug 7 '16

    If your employer goes so far as to deny you access to your car, or if they want a search of the car or your person...that's the point where I would insist the police be called. The police can determine if you are under the influence enough to make driving unsafe, and the employer has no right to take that freedom away from you.

  • Aug 7 '16

    Quote from Jesusismycopilot
    I don't have words of wisdom for you, but I want to share my story so you know that you are not alone. I have been looking for a nurse with a similar experience. Here is what happened to me...

    In May, 2016, in the middle of my shift, I was approached by the Nurse Manager. She informed me that I needed to follow her immediately. She escorted me past my Supervisor and peers; I was taken to the Administration offices. In addition to this Nurse Manager, there was a Director of Nursing, a Director of Human Resources, and another person sitting behind a computer. I was informed he would be typing notes during this meeting.

    I asked why I was there. At that point, the Director (whom I never met prior to that day) informed me that I was being investigated for diversion; I felt like I was blind-sided by a truck! The Director asked me to empty my pockets; I immediately complied and nothing was found. Also, I offered my car key and locker key; she accepted my locker key, but stated my car key wasn't necessary. I offered to submit to any testing and would allow her to search my home. I stated that I would do whatever was necessary to demonstrate that I was not diverting. I shared that I was a long-term (26 years) and loyal employee with excellent annual reviews and no Pyxis discrepancies of any kind!

    The Director informed me that they would be collecting a urine sample and if I refused I would be terminated immediately. I restated that I had already agreed to being tested. I was escorted to Employee Health to provide a urine sample. Upon returning to the Director's office, the contents of my locker were loaded onto a utility cart. The Director informed me that my belongings were removed from my locker while I was in Employee Health. She then proceeded to search my belongings; nothing was found. At that point, she informed me that I was suspended without pay, had me surrender my ID badge, and informed me that I was not to discuss the investigation with my peers. If I had questions, I was to call her.

    Two weeks later, I received a phone call informing me to attend a meeting the next morning. At this meeting, I was informed that all suspicions were unfounded and I was being returned to work with back pay. Since I had scheduled vacation during my suspension, they used my paid-time bank to pay me. I assured them, I was in not on vacation while I was waiting for them to get back to me. After waiting for 2 weeks in limbo, I was physically and emotionally exhausted. I asked them if they received my messages/emails asking them for an update and telling them that my emotional and physical health were getting worse with each passing day that I waited for their answer. I was informed that my requests had been received, but they wanted to complete the investigation before returning my calls/emails.

    I knew it would take 3 days to get the urine screen back, but waiting 2 weeks with NO information was torture. I ended up under the care of my physician who referred me to a mental health provider. I was diagnosed with a severe anxiety reaction and began medication and counseling. My providers placed me on medical leave. I've now been diagnosed with PTSD.

    Despite multiple requests to understand the basis for the accusations, I have not been given answers. Whenever I ask a question, I'm repeatedly informed that there is no record of me being investigated for narcotic diversion.

    My leave is running out and I am terrified of returning to the same position. I don't understand WHY I was accused in the first place and WHY it took 2 weeks to get back to me! I asked if there were discrepancies, patient complaints, of if I appeared to be 'under the influence'. I was informed that there were no discrepancies and no complaints, and they would not be discussing anything else because there is no record of the investigation in my employee file.

    If I leave this employer before August, 2017, I must pay back the entire amount of tuition benefits. It is a large sum; I would need to take a personal loan, extend the mortgage on my home, or tap into my retirement savings early and pay a penalty (I am only 54 years old). I have located an attorney that charges only $100 for a one hour consult; I have an appointment on Tuesday.

    I understand your feelings and concerns; this is not a situation that I ever dreamed I would be facing in my spotless (up to this point) career. I will keep you in my prayers.
    Unbelievable! And after all that, there is no record of any investigation! Right out of George Orwell. I hope your attorney is really good. And that when this is all done, you own yourself a hospital.

  • Aug 7 '16

    Quote from Sour Lemon
    The only explanation I can think of (besides their version of events) is that you failed to sign out and someone else pulled it under your name. Are there any security cameras around the place that might show anything?
    I was wondering the same thing. Many facilities have cameras placed around Pyxis machines to show whom signed out what. The fact your urine drug screen is negative speaks volumes too.

    Once I was at a pyxis signing out meds when another RN raced over, pushed me out of the way and signed out a 10 mg MSO4, then ran back into a pt room. I was stunned. I also calmly signed it back in again, then marched over to the nurse in question and said: "Mary-Grace, you better get your butt over to the pyxis and sign that MSO4 out under your own name now or I'm going to go speak to Ron" (our nurse manager). She made noises about "It was an emergency", and "The pt was having CP, and needed it now". Not my problem. I also told her when things settled down that if she ever did that to me again that I was going to file a complaint. It never happened ever again.

    My point, not everyone is trust worthy just because they have a nursing license. The more I think about it, the more likely it is as Sour Lemon RN stated that you may not have signed out, and someone took full advantage of that.

    If there are cameras, or other evidence that exhonorates you, then I smell a lawsuit. That was handled poorly, and was humiliating. You need to light a fire under your attorney's arse, because he/she is not doing their to protect you.

  • Aug 7 '16

    Quote from mustanglover
    If you truly did not take out that drug, I suggest you contact a personal injury lawyer who specializes in labor/working. Lawyers do not charge for consultations so I suggest you report the one who charged you $100 to the bar association. If the lawyers you contact are demanding money upfront they are scamming you. The personal injury lawyer will take your case for free, if you lose you pay nothing, if you win the lawyer takes 20-30% from the settlement. If what you are saying is true we are not taking about peanuts, we are talking five figure settlement.
    This is not personal injury but administrative law that knows employment law and nursing license defense. (Like TAANA Executive Office - Home) Exactly what damages were resulting from this issue? What medical care did the nurse require as a result of the accusation?

  • Aug 7 '16

    If you truly did not take out that drug, I suggest you contact a personal injury lawyer who specializes in labor/working. Lawyers do not charge for consultations so I suggest you report the one who charged you $100 to the bar association. If the lawyers you contact are demanding money upfront they are scamming you. The personal injury lawyer will take your case for free, if you lose you pay nothing, if you win the lawyer takes 20-30% from the settlement. If what you are saying is true we are not taking about peanuts, we are talking five figure settlement.

  • Aug 7 '16

    The only explanation I can think of (besides their version of events) is that you failed to sign out and someone else pulled it under your name. I know it's usually possible to pull meds for a patient in a different department when some extra steps are taken. I would ask if any other medications were pulled at the same time.
    Are there any security cameras around the place that might show anything? How many other people were working with you that day? Have they had any similar incidents?
    I'm assuming there's no documentation that the pulled medication was actually administered.

  • Jul 30 '16

    This is a great case study! Thanks for sharing.

  • Jul 30 '16

    Last week, I took care of a 25 year old male, Mr. L, who had a motorcycle accident. He had bilateral femur fractures, a pelvis fracture, and a right tib-fib fracture. He was drinking during the accident and had a small subdural hematoma from not wearing a helmet. Upon receiving him from the Operating Room, he was intubated, sedated, and on pain medications. The orthopedic team had done an ex-fixation on his right lower extremity, plated his pelvis, and proceeded with a right ORIF of his femur fracture but not his left at this time.

    I was weaning off the sedation to get a full neurological assessment when he became tachycardic and tachypnic. When asked to follow commands, he would squeeze my hands but not wiggle his toes. He would open his eyes but not track when spoken to. He was becoming frantic and looked to be air hungry. At that point his oxygenation started to decline. I went from a Spo2 saturation of 98% down to 78%. I called the respiratory therapist to come assist and help bag the patient. We turned up his Fi02 to 100% and started bagging. I called the trauma service managing my patient and updated them on his condition.

    I sent off an ABG to assess his oxygenation and a full set of labs. I re-sedated him and received an order for a bolus of pain medicine. I got him back to a resting rate and a lower tachycardia but his oxygenation was not improving. My first thought was a pulmonary embolism or fat embolism secondary to his long bone fractures. I mentioned this to the physician and they immediately ordered a stat CT Angio of the chest. An hour later, I was back in my room post scan with the radiologist calling with the result. There was a cluster of fat emboli throughout the left lung causing him to not oxygenate. I also mentioned to the physician that when I pulled the sample of blood I sent to the lab, there was large fat molecules that I wasted and sent in the tubes. The patient does not have a history of high cholesterol that would normally cause this to happen. I wasted some blood again to show them and brought to their attention that the last time I saw this happen, the patient also had the fat emboli travel to their brain causing severe brain damage that ultimately led to that patient’s death.

    Upon hearing this, the physician felt it was in due cause to order a stat head CT to check on the brain. My suspicions were right. I received a call from the radiologist stating he could see several new areas of infarct from what probably is caused from fat emboli showering into his brain. I called the physician immediately and informed them of this change in status. There really isn’t much you can do for fat emboli like you can for blood clots. There is no medicine to give to help dissolve them or remove them. At this time the only thing we can do his just help support him and maintain ample oxygenation. WhenI tried to reassess his neurological status again in the shift, my patient was not following any commands and his pupils were equal but sluggish.

    The physician had made several vent changes to help increase his saturation with no success. They called the attending on call and received an order for Nimbex to paralyze the patient so their respiratory drive was subdued. Not letting him work to breathe might allow his lungs to do a better job with the occlusions they had. I started the Train of Four (TOF) with a baseline of 4/4 twitches on 4 amps. I started the Nimbex per policy and titrated it up to a TOF of2/4 twitches. With the patient paralyzed, I was able to increase his saturation from 78% to 92%. I received an order for Flolan and the respiratory therapist connected and started this medication to help make the blood carry the oxygen easier throughout the body. I placed the “No pregnant caregiver” sign on the door and informed the staff of the new medication added.

    I then talked to the doctor about this young patient’s prognosis. I asked them what else we could possibly do for him and all they said was “just wait”. I had the physician call the patient’s mother and update her on her son’s condition. I felt that she should be here in case he doesn’t pull through this. An hour later, his mother and father were at the bedside crying over their son. Then the arguing started. The patient’s parents were not on the same page about their son’s quality of life. The dad made it clear that if the physicians felt he was not going to improve, that he wanted his son to be made a DNR and all this “nonsense” betaken off and for him to pass peacefully. The patient’s mother on the other hand, wanted everything done for her son no matter the result or consequence.

    I immediately called the chaplain to come to the bedside to help talk to the parents. I felt with their experience they could help them both make intelligent decisions and maybe come to a middle ground. I asked my charge nurse to come over and see if they could talk with them while I took care of their son. I still had so much to do. The ethical dilemma surrounding my patient is one I see a lot when it comes to families not agreeing on hard life choices. By the time my shift was over, the parents had agreed to give their son a certain amount of time before making any rash decisions. They would wait and see if the clots would migrate or move on and his condition improve or possibly decline. At shift change, I had his saturation at barely 90% adequately paralyzed and sedated per policy. He was on pain medications as well, and did not look like he was struggling like he was before. I feel like I made some really good decisions concerning my patient’s care and acted appropriately to get the best results that I could.

    It has been a week since I took care of Mr. L, and when I came to see how he was doing I was informed that he didn’t make it. He was so young to be taken so soon. The family came together in the end and agreed on letting him go when he stopped making any neurological progress,and his condition was declining despite the medical team’s hard work.

  • Jul 16 '16

    He was dead when you started. You did not fail him, CPR wasn't enough to restart his heart. While you are curious; the why is irrelevant. The family may not consent to an autopsy depending on his history.

    You saw a problem and you tried to help. You FIRST asked if 911 was called which was the most important step as clearly he needed more than CPR.

    Since this was not a professional relationship but Good Samaritan watch for the obituary to be posted. If the services are public, feel free to seek closure by offering your condolences to the family. Don't say I'm sorry my CPR didn't work it's likely the aunt & grandmother will identify & introduce you. Without knowing the history, it's likely the parents will be thankful you tried to help.

    If the services are private, then you can send your condolences via the funeral home. Tell the funeral director that if the parents wish to contact you they may this way it's on the parents terms not your need for closure. I've seen traumatic pediatric deaths go both ways. Open/public services and closed/private services. It's impossible to predict.