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CrazyGoonRN 10,334 Views

Joined Aug 14, '09. Posts: 429 (30% Liked) Likes: 338

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  • Nov 21

    Quote from Buyer beware
    So the crew was unhappy about the election and that Trump was elected. So I take it from the majority of posters so far that that was a bad thing?
    that's the wrong take on it. the staff could be as happy or unhappy as they like about the political situation but all that should be discussed in front of a patient being readied for surgery was the patient, or the surgery. It was pre-op not a cocktail party.

  • Nov 21

    The day after the election I had minor surgery. During the preparatory phase, the crew began to negatively discuss the presidential election, specifically their unhappiness with the president elect.

    I said "Are you really going to talk about Trump?", in disbelief.

    Thankfully, they shut the ---- up.

    I think I'll mention this on the feedback survey. I thought it inappropriate. The patient shouldn't have to correct professionals in this way.

  • Oct 5

    What a nurse has available to sedate/wean with is entirely up to the physicians. Each hospital/physician has their own protocols and "comfort levels" if you will for what they do with patients needing sedation. Can a nurse ask for certain medications to assist with weaning or increased sedation? Of course! Does that mean it will just be handed to them if the physician is not accustomed to ordering those things? Consider for a moment that one might not fully understand the situation as explained and therefore doesn't have all the answers or the moral high ground.

    Take the title of the thread for what (I assume) is it's intent: a little dark humor after a crappy, busy day.

    We all know how ugly it can get when a patient has an undesirable outcome and lawyers get involved. No need to hash it out.

  • Oct 5

    Do I agree that fentanyl is an analgesic and not a sedative? Yes. Do I stick to my physician orders of ramsey of 2-3 and make sure my pts are not in any distress and titrate when needed? Yes. Do I wean my pts off of sedation when it is time for weaning parameters and always continue to assess? Yes. I think BOTH the nurse and patient had a bad day and I dont think that you have to be so harsh when another fellow nurse is venting about a bad day. If you feel there could have been more done then say so, just do it tactfully.

  • Oct 5

    Well we are trying to wean her off the vent so she doesn't end up with a trach. I can't keep going up on the fent or she won't initiate her own breaths. And that was the first time she bit her tube. I don't routinely tell my patient they are going to die. I was doing everything I could to keep my patient alive.

  • Oct 5

    Quote from elizabeth321
    oh my god....if I am ever tubed I pray to whoever is listening to sedate me properly....it is a skill! When someone is delerious they can't be "reasoned" with and bringing up the "your gonna die" card is really cruel.
    I don't think this nurse purposefully tried to be cruel or not fully sedate her pt. It sounded like a very busy busy day, and it was unfortunate that this pt had to code bc of biting her ETT. And I do agree that pts do not always know what they are doing when they are on diprivan,fentanyl, or versed. Should sedation have been titrated up, yes, but I dont think this nurse knew about it until it happend, like I said a code and an emergency intubation can cause you to be busy. Hindsight is always 20/20.

  • Oct 5

    One way or the other.....they WILL stop chomping on that ETT.

  • Oct 5

    Quote from CCRNdude
    Out of curiosity, why do you guys/gals think so many hospitals pay ICU and ER nurses a critical care differential?
    One hospital that I work for pays us a whopping $2.00/hr critical care differential, which comes out to an extra 4k/year. My per diem gig pays staff pays critical care nurses (ICU, ER, and PACU) an extra 7k/year. Progressive care is paid a slightly lower differential, and med/surg and tele do not receive differentials at all. I'm not saying it's right, but that's just the way it is.

    I like Harveyslake's analogy in a prior post that compares the worth of a smart phone vs a simple cell phone and a short order cook vs a gourmet chef. I think it's spot on. I've had nights in ICU where I've been busier than I ever was working on the floor. The stress that comes along with helping other units with rapid response, being the hospital's IV start team, and cleaning up the rest of the hospital's mess makes working the floor not so bad. From my experience, taking care of 5 patients in no way compares to the stress of having multiple family members breathing down your neck while taking care of their family member who is maxed out on 5 pressors and is barely hanging on by a thread. There's just no comparison.

    Then again, where I live we have patient ratios where med/surg tops out at 5, tele 4, PCU 3, and ICU 2. If you live in a state that gives you 8 patients then I suggest you move or change specialties because that sounds like horrid working conditions.

  • Oct 5

    I just enjoy debate for the sake of debating. I honestly don't care either way. I don't mean to offend anyone. I'll be the first to say that med/surg is hard work. However, we're all entitled to an opinion. To the individual who asked if ICU housekeepers deserve more pay, I would have to respond by saying...touche. Additional training and certifications are not required by ICU housekeepers though, so I would say no. ICU housekeepers do not deserve more pay.

    One thing I would like to poing out is that intensivists earn a higher salary than internists. Sadly, I think that your post reticently illustrates exactly how administration views both nursing and housekeeping: as an expense that can be cut.

    Here is my rebuttal to all of your comments:

    1) Who would come to the critical care section of a forum (an area of the site that critical care nurses obviously frequent) and expect critical care nurses to not state that they should get more pay? I'm sure if we went to the corrections/prison section of this website and asked them if they deserved to get paid more, they would more than likely say yes. I'm sure plenty of med/surg nurses feel that they're entitled to more pay, which I think is reasonable. If we asked ED nurses if they deserved to be paid more than ICU and med/surg nurses, the ED nurses that I know would respond with a resounding "YES!!"

    2) I never implied that med/surg nurses weren't with their patients 24/7. Pointing out that med/surg nurses are with their patients 24/7 is pretty much stating the obvious.

    3) There are obviously a lot of different variables that affect profit and loss. At my hospital, ICU does bring in quite a bit of revenue. Likely because our boss rides us about not being wasteful with resources. Also, our physicians do a good job of justifying ICU level of care to medicare, transferring patients to subacute rehabs ASAP, downgrading asap and/or convincing the family that palliative care is the best option. No family? Ethics consult is put in QUICK to evaluate quality of life. Our intensivist pay is affected by our unit's revenue. No revenue? No bonus.

    4) If a patient's crashing, who does the med/surg nurse call for a higher level of care? Me. The ICU/RRT nurse to evaluate and see if the patient meets ICU criteria. Patient needs an IV and nobody else can get it? Call ICU. Patient's about to code? Call ICU. Patient codes? We need ICU. Patient is VIP and the family is too high maintenance? Put them in the ICU.

    5) I've worked med/surg. It's hard work that requires good time management and a lot of patience. I'm glad there are nurses that enjoy it. I got burned out by it, so I went from med/surg--> tele--> intermediate care --> ICU. It's not like I've only worked ICU and I'm claiming that ICU nurses should get paid more. The floors are very stressful. While I'm not as physically exhausted working in ICU, the stress is at a different level since there are different stressors, in my opinion.

    Out of curiosity, why do you guys/gals think so many hospitals pay ICU and ER nurses a critical care differential?

  • Oct 5

    I think they should. We respond to codes, Rapid Response Team's, Stroke Alerts, Trauma Alerts, etc in my hospital. Also there is no busier unit in the hospital than our ICU. We are required to do more education than everybody and we are required to hold more certifications than everybody and can take any type of patient. For these reasons I think we should.

  • Oct 5

    Well, this argument is as old as time. The correct answer is yes, critical care nurses should be paid more than med/surg nurses. The only nurses that disagree have never worked critical care. If a code is called, who shows up, a floor nurse? If a patient is crashing do they get transfered to a med/surg floor? ICU nurses have a skill set far beyond anything a med/surg nurse possesses. Part of the problem in nursing is that nurses often accept the a nurse is a nurse banter from administration. The fact is, in just about every human endeavor, except nursing, the better your skills and training, the better your earning potential. When I get floated to the floor, the patients are well cared for. If a floor nurse gets floated to an ICU and has to take care of a real ICU patient, well,...the outcome would be less than desirable. Not knocking floor nurses in the least. They work hard too, however, let's be realistic. A neuro surgeon makes a lot more than a family practice physician because he has a different, more advanced skill set. The family practice Doc probably sees many more patients in a day and does a lot more paperwork than the neuro surgeon but the one with more advanced skills and training takes home the bigger pay check. Why should nursing be different??? Let the flaming begin! 😀

  • Oct 5

    Sorry to bump an old thread, but I thought I'd throw my $0.02 in.

    I've done both med-surg and ICU. Everywhere I've worked has a "Critical care" differential. In my opinion, this is absolutely fair. I never claim to work harder than a med-surg nurse, but critical care requires more education and skills. ICU nurses where I work have to maintain PALS and ACLS. We must train annually on balloon pumps, impellas, and other technologies. We must know several protocols like hypothermia, DKA, etc. I can't believe anyone wouldn't support at least a buck or two more an hour for specialized nursing roles.

  • Oct 5

    Quote from opossum
    6 patients?! What if I miss something??
    THIS. I've never worked M/S, but the idea scares me. Even most of my nursing school clinicals were done on step downs or ICUs. A nurse I worked with made a rude remark about a patient who came back to us after coding on the floor (trach secretions I think). And all I could think was 'how would you know?' You wouldn't. They aren't all hooked up to monitors. You can't stand in one 'room' (or curtain) and see your other patient. You wouldn't know. And I wouldn't have the slightest clue as to what to do if we floated.

  • Oct 5

    Quote from vera4130
    THIS. I've never worked M/S, but the idea scares me. Even most of my nursing school clinicals were done on step downs or ICUs. A nurse I worked with made a rude remark about a patient who came back to us after coding on the floor (trach secretions I think). And all I could think was 'how would you know?' You wouldn't. They aren't all hooked up to monitors. You can't stand in one 'room' (or curtain) and see your other patient. You wouldn't know. And I wouldn't have the slightest clue as to what to do if we floated.
    Vera , I like your honesty !

  • Oct 5

    If anyone needs more money it is LTC and med-surg nurses! I honestly don't know how they do it. Just be happy you got the job you wanted, not many can say that.


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