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nursgirl (3,286 Views)

Joined Jan 6, '09 - from 'southern CA'. nursgirl is a RN. Posts: 111 (37% Liked) Likes: 164

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  • May 14 '14

    Actual conversation:
    Patient: But...I haven't had sex for 6 months
    Nurse: Well, according to ultrasound you are 5 weeks pregnant. I assure you, you are indeed pregnant.
    Patient: I don't understand, how can this be?
    Patient's boyfriend: Is it possible she got pregnant without semen?

  • May 14 '14

    This is why I cover every object in my house smaller than a 2liter bottle with vasoline or KY. I have avoided this tragic accident so far in my life but it happens to so many people so often, I can't help but fear I'm going to fall over some day and SPLUNK-right up the ole orifice something will go. I figure it will be a lot less traumatic if I keep everything in my house lubed up just in case.

  • May 14 '14

    I was offered the ED job and I start in June! I'm excited but really nervous too!

  • Sep 6 '12

    Hi everyone

    I have been an operating room nurse for nearly eight years. I really enjoy what I do but I have had dreadful call ins over the last month. Over one weekend I worked an extra 20 hours on top of my normal 40 hours. Last night I worked all night so was up for 20 hours without sleep... then went home and had two hours sleep, and had to wake up to return to work but luckily my boss said stay home.

    Anyway, when I get this tired and have been working crazy hours I find myself asking "why do we do it?". I know why I went into nursing to help people etc but I do find the call ins take its toll physically. Sometimes if I have had a really rough night or last few days with call ins I get to the point where I feel like I could break down and cry. This morning I really felt like I couldn't concentrate at all so was so grateful I didn't have to work.

    I know some people will probably say I should give up the call ins and as much as they are a burden sometimes I still love the rush of adrenaline you get from being involved in an emergency case.

    What's everyone's experience with call ins in the operating room? Do you get worn out with on-call? How long have you been doing it? I'd be interested to hear from you.

  • Oct 6 '11

    Yes- for most it does take a long time to be completely comfortable. I'd say it took me almost 2 years to really feel confident. Some days will be tough. Remember you have to get along with a team of people so don't take things too personally. Remember that you are in a stressful situation so surgeons and other team members may snap but keep in mind the job you have to do and let that be your focus. Don't act like a know it all. OR teams hate that! Walk fast and speak up. It's hard to hear everyone when you have masks on and suction and machines going. You can't be timid. But don't be overly eager either. Don't cross sterile fields so be very aware of your surroundings. The surgical techs can be very over protective of the sterile environment- which they should be as you should too! So be mindful of the blue. Enjoy this time and learn as much as you can! Good luck!

  • Oct 6 '11

    Just know that it takes a LONG time to get totally comfortable. Most people say at least a year. We train for 6 months before we are left alone. We circulate and scrub.

  • Oct 1 '11

    *rubs hands together* Ah! I feel like I can have some authority on this! I, too, came from a med/surg-but-mostly-post-op floor, which was my first job out of school for a year, and now am in the OR.

    Whether you are circulating or both scrubbing and circulating depends on the facility. Where I work, we are trained to both circulate and scrub (or "scrubulate" as they like to call it!). We have OR techs who scrub, and while the RNs mostly circulate, it's helpful to be flexibile enough to scrub if needed. Also, they work with you on your preferences; there are some RNs where I work that primarily scrub.

    Scrubbing is more than just handing instruments. You are responsible, with the help of the circulator, to make sure your case cart has everything you need for the cases for the day. Sometimes you are running around gathering supplies and making trips down to CPD (central processing department, where everything is sterilized). You make sure all the equipment in the room is in working order. You set everything up, which for some big cases like in neuro, can involve two mayo stands, two back tables, and a million instruments and pieces of equipment, and is just a major to-do. The scrub, along with the RN, is responsible for the count. Counting instruments and keeping track of everything can be quite the task (I did a plastics case with 97 needles last week! Talk about exercising organization skills!) Scrubs become well-versed in individual doctors preferences, and are great multitaskers; I've seen experienced scrubs pass instruments, cut grafts, ask for suture, and start a count all at the same time. You are an advocate for the patient in that you are keeping an eye out that sterile technique is maintained. When clueless med students are in the room, you have to be extra vigilant.

    The ciruclator definitely does more than document. You are running the show. When you first come in, you, along with the scrub, check equipment in the room, and help make sure they have everything they need to set-up. You are the contact person for everyone else involved in the patient's care- they are in touch with the nurse caring for them from where they are coming and to where they are going, with the doctor, with anesthesia, with sales reps, and making sure everything is in order for the cases you have. You go get the patient, speak with them and the family, verify name, birthday, procedure, right/left and is it marked?, NPO status, allergies. Discuss what to expect and where the family is to go. Take the patient back. Then this is busy time. Not only are you keeping track of all your important time notations (time you came in the room, time patient was induced, time the time-out was done, time surgery started, etc) and making sure it lines up with anesthesia's times, but you are calling the anesthesiologist, sometimes paging the surgeon, helping transfer the patient, initiating a time-out (and exercising your confidence and assertiveness as most physicians don't want to listen *cough*), standing by during induction, helping with positioning (which, depending on the procedure can be a hell of a job) and securing the patient, placing padding to prevent ulcers, doing a look-over assessment on the patient as you do so, setting up for caudal if necessary (though I think that might just be peds), placing the Bovie pad, inserting a foley, doing a count, doing another time-out because God knows its a miracle if the anesthesiologist and the surgeon are in the room at the same time, prepping the surgical field, helping secure draping, plugging things in, turning on equipment and adjusting settings, putting local and maybe additional prep on the field, fetching whatever the scrub needs, AND THEN documenting. Whew!

    And even then, depending on the case, you're still running around for a lot of it. Think about it - besides the anesthesia team who has their own stuff to worry about, you're the only non-sterile person in the room. That means anything like answering phones, making calls, getting report and making sure your next patient is set up and ready to go, fetching what is needed during the surgery, handling any specimens, handling any labwork, keeping the room clean and organized (like the dirty sponges that seem to get tossed around), monitoring who is in the room and what times they are in/out (time notation seems to be big in the OR), updating the count, getting an oxygen tank and monitor ready for when the patient wakes up, contacting PACU, etc etc...you stay busy! All the while, keeping an eye and ear out for your patient (if you hear that monitor change, you better be over there!) because you are their ultimate advocate.

    So I agree that anyone that says OR is boring has never been an OR nurse!

    I found that a lot of people gave me crap about "losing my skills" and "being bored" but I actually found out that apparently, many people were pretty jealous I was leaving the floor for the OR. I will never go back. I love it here.

    Also, there is a particular anesthesiologist who encourages me to do the IVs sometimes so I don't lose that skill. If you end up working with nice ones, ask! I'm sure they'd be okay with it!

    As far as other skills, yeah, you're not going to be putting in an NG or anything, but you gain a whole new invaluable knowledge and skill set.

    If you can both scrub and circulate and get trained in different services, I don't see how it can be boring - it's something new every day!

    As far as advancement, at my particular hospital, we don't use RNFAs, but that is an option. I personally plan on getting CNOR certification to better myself. There is an opportunity for advancement where I work (and I imagine most places) of a "team leader" role, which means you are basically the charge nurse of your service (cardiothoracic, neuro, general, etc) and you have a little more responsibility and authority. And of course, OR charge nurse, clinical nurse specialist, educator, manager, etc. If you are at all interested in being a CRNA, then the OR is where you need to be.

    It's been interesting because a girl who is my age and has similar experience as I do started at the same time as me, and I love it and she hates it. She says that she doesn't like working as a team - she enjoyed having her own load of patients and doing her own thing and not working so much with other staff - and doesn't like that the patients are asleep for most of the time. If these are things that you think would bother you, then I would reconsider. Personally, I thought floor nursing was hard. 7 patients at a time (I worked nights), lots of pain management, lots of complaining, lots of trying to make everyone happy at once....the dynamic is different in the OR. You DO see the patient awake, even if it's only for a half an hour total. You are still a very important figure to them and their family, and you are there calming them up until the moment they go to sleep. That's enough "patient contact" for me. Though I hear this is the biggest issue when people get to the OR and realize they don't like it. OR nursing is challenging, but I think it's much easier than floor nursing, and not as exhausting.

    Like I said, I love it. I'm really happy I made the decision to go to the OR. Good luck with your decision!

  • Sep 29 '11

    It is suspected that the majority of healthcare workers carry MRSA. I worked in a hospital for awhile that was trialing full contact precautions with all ICU patients to help prevent MRSA infections. It worked- no nosocomial infections in 12 months. Pretty amazing!

  • Jul 17 '11

    Quote from Atlas09
    If your patient is on high dose pressors you should have an A-line to draw labs off of period. Titrating high dose pressors without an A-line is just plain dangerous. I've titrated one low dose pressor off of a cuff before, but nothing that I felt was a high dose or anyone on more than one gtt.
    And if you can't get an order for that (which has happened to me before, unfortunately), lab needs to draw directly from a vein. If you have anything running in any of the lumens, it will affect your lab results.

  • Jul 17 '11

    If your patient is on high dose pressors you should have an A-line to draw labs off of period. Titrating high dose pressors without an A-line is just plain dangerous. I've titrated one low dose pressor off of a cuff before, but nothing that I felt was a high dose or anyone on more than one gtt.

  • Jul 17 '11

    I have a 2nd interview this week for a job working weekend nights in the ICU at a local hospital. I am a new grad, and I did shadow a nurse in the ICU at a hospital where I had clinical awhile back so I have a vague understanding of what an ICU nurse does. But I am really interested in hearing from all you ICU nurses: what do you like the most about your job, and what do you like the least?

  • Jul 17 '11

    Depends on the new grad.

    I started along with other people who were also straight out of school like myself. Some did not do well and continue to be mediocre. I strived to learn everything I could and after having been there only two years I've got the veteran nurses on the unit saying "Go ask Dan, he probably knows."

    We are also a large teaching hospital that strives on continuing education. Our orientation was nothing less than stellar. If a new grad starts off in an ICU where the orienting nurses look down on lack of experience and the grad has no help off the unit such as mock codes, lectures, etc. they will suffer for it no matter their intelligence. The unit has to support them in order for them to be successful.

  • Jul 14 '11

    The following name has been changed and the situation slightly altered to protect the privacy of those involved. However, it remains a 'true story' about a lesson learned through an elderly woman

    I first met Grace after I had been at the nursing home for about three weeks. I was orienting with the LPN who was on the wing where Grace was going to be staying.

    Grace was a very frail little woman. When she stood up, the top of her head barely came to my shoulders, and I am not a tall person. I am five foot five. I could wrap both of my arms around her and could have picked her up if necessary. She had gray hair, in a short curly style like so many of the elderly do. She sat in her wheelchair, with slippers on her feet and a plaid blanket over her lap. She had a concerned look on her face, and she was licking her lips, which I later came to see quite often when she was anxious or worried.

    Grace's son was with her and they had just come from a tour of the facility. Grace's son had been with his mother most of the day and was trying to get ready to go home.

    I had stepped into the room because Grace's son had pressed the call light. I went to answer the light.

    Grace's bed was the closest to the door. She was in her wheelchair and her son was standing next to her holding her hand.

    "She has to use the bathroom," Grace's son asked in a polite way.

    "Ok," I said, smiling at Grace. "Do you use a walker?"

    "Yes," answered Grace in her polite ladylike voice. Her voice tone sounded slightly concerned, which I soon learned was a normal tone for her.

    I found a gait belt, made sure Grace had her slippers firmly on her feet, found her walker and helped her out of the wheelchair toward the bathroom.

    After I had her situated on the toilet, I stepped out to give her some privacy, smiling at her son.

    Her son smiled back at me and then decided to use this opportunity to make his exit. "Well, I have to go now Mom" he called around the bathroom door. "I love you, and I'll see you tomorrow!" He began moving towards the door of the room.

    "I love you to" said the little voice quickly from the bathroom, "Don't go!"

    I love you, don't go.

    Grace's son left, and, as I helped Grace into her new bed in her new room in a new building that was going to be her new home, I thought about that phrase.

    I love you, don't go.

    How often had families thought those same words, even if they didn't realize it, when they had to make the decision to put their loved one in a long term care facility?

    I love you, don't go.

    How often had families thought it as their mother or their father would stare them in the eyes and ask, "Who are you?"

    I love you, don't go.

    How many families asked themselves that as their loved ones gave their last breath?

    I love you, don't go.

    How many of the elderly thought the same thing about their life, as the decision was made that they could no longer live by themselves?

    I love you, don't go.

    As they realized their spouse could no longer care for them?

    I love you, don't go.

    That their spouse had passed away and they could not live with their children?

    I love you, don't go.

    It is the unheard cry of so many.

    Don't go, don't go.

    And yet they must go. It all has to go, or seems to go in some way at some time.

    We all know this. We cannot all be there for our family, for ourselves, always.

    And so the elderly must go. And let go of some parts of their life they thought they would always have.

    When they finally let go, however willing or unwilling, they come to the nursing home. And then, they are part of my family.

    When Grace's son left the building, I became Grace's daughter.

    Oh, I was not her real daughter. We both knew that. I was so busy, in the weeks to come, when I was finally off orientation. I could only see Grace now and then during my shift.

    Grace's son came every day and played Monopoly with her. Grace had an amazing and loving son.

    But Grace's son could only be there part of the day, and not every day of the week.

    At night, when Grace was alone, I saw her. We saw her. The nurses, CNA's and I were her daughters.


    You see, we become the other family of those who cannot live with their families. We experience their joy, and their pain. We love them.

    And we don't want them to go.

    Grace became progressively sicker over the next several months. She had kidney failure, so she had to use the toilet all of the time. Her call light was always on, which made it very hard for the staff to answer every time she needed them. Short staffing is an issue not easily solved.

    When I would help Grace to the bathroom, I would joke that we were dancing, the way my arms were wrapped around her.

    "Let's leave and go dancing." She would say. "I haven't been dancing in a long time."

    I would go and change a dressing on Grace.

    "Just call me patches," she would joke.

    I would tell her that I had paperwork to do.

    "Just forget the paper work," she would tell me. "Let's go play Monopoly."

    And I would wish that I could. That I could drop everything, all the other residents who needed me, to just play Monopoly or to dance with this dear little woman named Grace.

    One night (early morning), Grace didn't seem quite right to me. I assessed her and her vital signs were within normal limits. Her heart rate was a little on the high side, but still normal. I still thought there was an issue brewing. I told her she was breathing heavy. "I'm fine," she brushed me off. "You know I get like this because I'm up and down to the bathroom all night." I monitored her closely the rest of the night, and passed my concerns along to the day supervisor.

    When I came in the next night, I was told that Grace was out to the hospital. Her heart rate had rapidly increased over the next two hours after I left, and it could not be brought down at the home. She had been admitted to the ICU for atrial fibrillation with rapid ventricular response.

    Grace came back about a week later.

    But she was not well.

    I heard from the staff that was standing outside the door on their smoke break before I even entered the building that Grace was back with a fast heart rate.

    "Grace is back and has a heart rate of 160" echoed in my head as I swiped my card, walked up the hall and went to put my things in the employee lounge.

    I initially entered the floor indignant that Grace was still in the building with a heart rate that fast. My mind was reeling with the impact that a heart rate of that speed would have on Grace's body systems. A rapid heart rate that was not controlled could only lead to complete system shutdown. I felt like screaming or crying as I got report. I did not understand why she was back at the nursing home and not in the hospital ICU.

    Until I went down to see Grace.

    You see, Grace knew that she had a fast heart rate. Grace knew that she was going to die. And she wanted to be 'home.'

    "You don't know how horrible it was" she told me. "I was all alone. I couldn't see anyone, and when I did, they were all gowned up. What kind of horrible place is that where no one cares? Stay with please, just stay with me." She held her frail hands out to me and the CNA's who were caring for her.

    "I don't want to be alone. Don't leave me here."

    Grace's room was at the end of hallway. I made the decision that she was not going to be alone. We had Grace lie down in her bed, and then we wheeled it out to the nurse's station.

    Grace was very restless. I would put the pulse oximeter on her finger and it told me that her heart rate was 159 beats per minute. It was horrible.

    Imagine running a marathon and how you feel when your heat is pumping so very fast. Grace's heart was pumping so fast every minute, she was panicked.

    And yet she did not want anything medical. She just wanted someone to be there and to hold her.

    She clutched a picture of her deceased husband tightly to her chest. She would look at him and then look at me.

    She didn't know what she could do to be comfortable.

    She would lie down and then sit up.

    "I wish I had done more" she would say about her life. "I should have done more."

    I would reassure her that raising her family was enough.

    "I know," she would say. "My son told me that."

    She would quote John 3:16 with me- she remembered it from her childhood: "For God so loved the world, that He gave His only begotten Son, that whosoever believeth in Him, shall not perish but have everlasting life".

    She would lean her head on my shoulder and clutch to her chest that picture of her husband.

    And I would think angry thoughts about how she could be so much more comfortable dying somewhere else, with maybe a controlled heart rate. But right here was where she wanted to be.

    And so, throughout that night, the CNA's and I took turns. We held her, comforted her, and cried countless wet and dry tears for her while doing care on other residents and while holding her.

    When I went home after my shift that morning I just cried into my pillow.

    Grace held on for about two more days. The night that we took turns sitting with Grace was the last night that she was really alert.

    And then she died.

    And although we all thought those same words that she had said to her son on her first day with us "I love you, don't go," Grace did go. She chose to die with us, outside the hospital, without maybe a more comfortable way, because she needed love.

    Without realizing it, we had allowed Grace her autonomy, her freedom to make her own choice, when she came back to us with an uncontrolled heart rate to die.

    So we held her, we comforted her, and we loved her.

    And because we loved her, we let her go.

  • Jul 2 '11

    most of us don't get much choice over whether or not we work nights, although we might get a choice about when. we also get a choice about how we handle our night rotations. there are plusses and minuses to working eight hour shifts, to working twelves, to working straight day shift, straight night shift or rotating. that's for you to decide for yourself. but here are some tips that have helped me and some of my night shift colleagues survive and thrive on the graveyard shift.

    attitude is everything. you can moan and whine about your lousy fate and getting stuck working graveyard shift, or you can approach it with a positive attitude. guess which one is more pleasant and might possibly even be more fun?

    night shift can be fun. often there's some downtime (not as much as some people think) where you can sit and chat with your coworkers and get to know one another. you can pick each other's brains about what to do in case of x or y and learn tips and tricks from the experienced nurses on your shift. i met my husband working night shifts with him, and our first date was an eight am drink after work. just us and all of the local alcoholics bellied up to the bar. drinks after night shift got to be a monday morning tradition and soon the entire shift was congregating for one -- or more -- drinks at the scarlett letter. because we got to know and like each other outside of work, we became a cohesive group and we had each other's backs. years later, i still miss the teamwork and camaraderie.

    get your sleep. take your sleep seriously. i've known more than one new nurse who regarded the days before and after her night shifts as days off and spent them cleaning, shopping or having fun. it's tempting, especially when we all know there aren't enough hours in the day. but it's a dangerous precedent. your body cannot function without sleep and sooner or later your brain won't function either. worse, you may not realize when you're making bad decisions and overlooking the obvious. install black-out curtains in your bedroom, invest in an industrial strength fan to block out the sounds of barking dogs and lawn mowers and take ambien or benadryl or whatever you need to sleep. if you cannot afford blackout curtains, aluminum foil over the windows works, although your neighbors may think you're growing marijuana in your spare time. (but that's another story for another article.)

    tell your mother, your sister, your best friend and your boyfriend that 9am to 5pm (or whatever works for you) is your sleep time and you are not to be disturbed unless there is blood (lots of it) or flames. you'll have to tell them more than once and sometimes less than tactfully. some people won't get it until you call them at 3 am to discuss your life insurance needs or to chat about your cousin hilda's new man. if you absolutely have to be available for emergencies with children or aging parents, get a beeper or a cheap cellphone and don't give anyone the number except for one person whom you trust to recognize an emergency and not to disturb you unless it truly is one. he might not realize this, but your husband is just as capable of discussion timmy's misbehavior with his teacher or meeting ellen at the emergency room.

    get some exercise. go to the gym before work, swim after work or walk on your break. you know you need to do this, and night shift doesn't make it any less necessary.

    eat. eat real meals. don't make the mistake of thinking that because it's night time you can snack all night without consequences. i have dinner with my husband for breakfast, leftovers for "lunch" at 1 am or thereabouts, and breakfast when i get home before i go to sleep. (if i don't eat, i wake up starving after far too little sleep.) that schedule may not work for you but whatever you do, eat meals and drink water. you need it.

    drive home safely. it can be done, even by those of you who are absolutely certain it cannot be, at least by you. i've driven home with the windows open and the radio going full blast, singing along with the most obnoxious songs on the radio. getting angry helps me stay awake, hence the radio tuned to right wing talk shows. there are days i've bargained with god -- "just let me stay awake until the next exit and then i'll pull over and nap, god, honest!" sometimes i do pull over and nap -- even five minutes may be enough to get you home in one piece. some people drink coffee and swear it doesn't keep them from sleeping once they get home, and some people eat breakfast on the way home. figure out what works for you and do it.

    avail yourself of the opportunities for afternoon coffee with your friend the stay-at-home mom on your wednesday off or breakfast with your sister after your shift and before she goes to work. meet your family for church at 8am on sunday and go to bed afterward. chat with your friend on the opposite coast in the wee hours if you have time at work, or on your night off. you may not have saturday night off every weekend, but you can make the most of the time you do have off. make the most of the opportunities to look up procedures, study the disease process you're most likely to encounter in your patients or make drug cards. there's often time in a night shift to do those things that you can't do during day shift when visitors vie for your attention.

    ask your colleagues at work (and on allnurses.com) for strategies that help them survive night shift, and if you have a great tip pass it along. i'd love to hear what works for you.

  • Jul 2 '11

    Quote from canesdukegirl

    Oh sure. I think that a lot of what you are referring to is the 'instant gratification' that our society demands these days. There are some that think nursing is too difficult at first...because IT IS...and don't weather the storm long enough to experience the nice calm seas that come afterward. Have you ever been completely frustrated when you first started to learn something-to the point of crying almost-and then after you have mastered the task, you wonder what in the hell you were so bent out of shape about? Same mentality. It takes a while to get the gist of nursing. It is SO worth it if you stick to it.
    I can't add to the discussion (I start my first shift as a nurse in about 50 hours), but I just had to comment on the brilliance of this statement. Nursing is a second career for me. I spent 10 years working professionally as a potter in a small shop. When I first started out, I hated it. My boss was hard on me, I felt incompetant compared to the others around me. I just knew I was meant to be a potter. After a year or so, I had my "aha" moment where everything seemed to click. I ended up running the shop and (if I can toot my own horn), I am a very talented artist.

    I fully expect my new career to be the same way. There will be days I hate my job, when I go home crying b/c I feel like a moron. But I know if I stick with it, things will click for me and I'll be a great nurse.

    More people need to read what you've said; life isn't easy, but if we stick with things, we can be more than we ever expected.


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