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Double-Helix, BSN, RN 34,706 Views

Joined Apr 5, '11 - from 'New Jersey'. Double-Helix is a Nurse, Children's Hospital. She has '6' year(s) of experience and specializes in 'PICU, Sedation/Radiology, PACU'. Posts: 3,364 (54% Liked) Likes: 6,601

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  • Nov 13

    Quote from RegularNurse
    I think you are new to nursing. One of the things you will learn is that stuff happens. Just be cool and do your job.
    OP is not in the nursing field. He/she is a patient sitter, and has been employed as such for all of 5 days. It sounds like her employer offered very little in the way of instruction or orientation AND she is being sent to various hospitals/units with little consistency or time to develop a routine. She was placed with a patient who had needs beyond what she was trained or expected to do (and probably should have had a psych tech or security present instead of a brand new sitter) and given poor guidance from the hospital staff. I think we can cut her a break for being a little upset about the situation and wanting to take action to prevent it from happening again.

  • Nov 9

    That is clearly a definition of a CVICU. It’s possible that the unit used to be called something else, or was merged with another unit, and that why two staff members refer to it differently. Without asking them specifically, it’s hard to be sure.

  • Nov 9

    Sounds like a facility-specific definition. I would think that a cardiac recovery unit does post-operative care for short-stay cardiac procedures that don’t require ICU admission, such as cardiac caths, ablations, stents, other minor cardiac procedures. My hospital called this the “CPRU” (cardiac procedural recovery unit). Bypass/open heart patents would be recovered in the CICI.

  • Nov 6

    I've only been a PICU nurse for three months, but I have gained a huge perspective in that time! Being a PICU nurse is exciting, heart-breaking, frustrating, scary, and wonderful all at the same time.

    Imagine taking care of a child on ten seperate medication drips who is on a ventilator, has three central lines, arterial line, a CVP and a foley. You're drawing hourly blood gases and blood glucose levels, counting all of your I&O's hourly, monitoring the ventilator settings, constantly alert for any changes in vital signs, making sure your syringes of pressors don't run out, hanging so many medications that you are running out of lines to use. You're giving updates to the docs and making adjustments to your drip rates based on their orders. You need to turn your patient every two hours, which requires two other nurses to help move the patient and keep the breathing tube in place. To top it all off, you have angry family members scrutinizing everything you do and demanding that certain non-essential things be done immediately.

    Being a PICU nurse is never boring. There is always something new, something that needs to be done. I've taken care of kids with so many different diagnoses that I couldn't possibly list them all. Our unit is a 19 bed PICU that takes all different kinds of kids. Our hospital has a pediatric cardiac surgery program, so we always have at least a few cardiac patients with various congenital cardiac defects. Depending on the season, we usually have a couple kids with viral illnesses, particularly RSV in the winter months, one or two babies on observation for apnea, asthma exacerbations, ex-preemies with chronic medical issues and heme-onc patient. Most of the pediatric surgical cases bypass the PACU and we receive them directly from the OR. So we get tonsillectomies, thoracotomies, traumas, amputations, appys, cardiac cath's, neuro surgeries, etc, etc. Our general peds floor does not have monitoring systems, so any patient that requires continous monitoring of any kind (HR, rhythm, O2 sats, respiratory) comes to PICU.

    Skills:
    Solid assessment skills are crucial. Kids can't tell you when something is wrong. You have to know what's normal and what isn't and be alert for any changes that might indicate the child is deteriorating.
    Critical thinking: why is this patient presenting like this and what does it mean? What am I going to do if this kid goes south? What do I need to have on hand in the room in case of an emergency?
    Prioritization and time management: You've got a lot to do. You need vital signs on all your kids at noon time and you also have three IV meds to hang, several po/GT meds, one kid needs an enteral feed and the other needs labs drawn and another has an infiltrated IV. What's most important? What can you get done early?
    Communication: With docs, with parents, with the kids. Parents of sick kids are nervous wrecks. They have a lot of questions. You need to be able to explain what is happening in terms that they can understand. You need to explain things to the child. You need to convince a sick and scared child to swollow their medications. You need to explain to the doctor why you think one of your kids needs a different type of treatment. A big part of your job is communicating. And don't forget giving and receiving report.

    My day begins at 6:45am and on a good day I leave at 8pm. Most days I eat lunch at the nurses station in five minutes so I am never far away from my patients. If I use the bathroom once I am lucky. But these are "my" kids, as I refer to them. They are my responsibility and whether I've taken care of them for an hour or three shifts, I love them. There is no other specialty like PICU, and there is no other place I would rather be working.

  • Oct 30

    Quote from Renegade girl
    Its not a matter of trying different areas of nursing because I know I wont like it. In school I did not like any of my clinical rotations.
    It’s really way too early in your career and experience to be saying this. There are so many areas that a nurse can work- the great majority you never even hear about while you’re in school. There are nurses that work for insurance companies, pharmaceutical companies, nurses that work in law firms, nurses that work in research institutes, nurses that work in informatics and technology. There are areas of nursing where you would never have to touch a patient if you didn’t want to. There are plenty of ways to direct your nursing career into a job you find more fulfilling. Additionally, like others have said, you have plenty of opportunity to go back to school and pursue another degree. People start college programs in their 30’s, 40’s 50’s. You are way too young to be “stuck” in anything.

  • Oct 22

    Quote from canoehead
    I thought my current hospital wouldn't pass JCAHO, but they got an exceptionally high rating, and posted it for the public to see. I think it's a schmoozing contest, with no real life consistency among hospitals. I've worked somewhere that changed their rules "because JCAHO said so" but two other hospitals in the same area didn't have the same rule- no drinks at the nurses station, for example. Only one out of five American hospitals I worked at, in the ten years I was there, had the no drinks rule, but they were RABID about it. I resigned within 6 months on that one because I require water to function.
    Per JC standards, covered drinks are acceptable in patient care areas. Open drinks are not. So a water bottle with a sealed lid would be fine.

  • Oct 22

    What it really comes down to is depth of the vein and length of the catheter. Ideally you want at least 2/3 of the length of the catheter inside the vessel to avoid dislodgment from shifting of the tissues and skin above the vein. In an antecubital vein there is greater potential for movement of the catheter within the vessel related to bending of the elbow. For that reason, I always choose a longer catheter for an AC vein and don’t prefer them for long term use whenever possible. If it is an IV that needs to stay in for several days, some kind of arm immobilizer should be in place to help prevent this kind of movement. For a short term infusion on an adult patient that can be trusted to refrain from bending the arm, I wouldn’t worry about it- provided that it’s not a super deep vein and a short catheter.

  • Oct 16

    This needs to be addressed with whoever is documenting the inaccurate vitals. If it’s another nurse or an aide, bring them with you when you do your own assessment. Make believe you are giving them the benefit of the doubt by saying something like, “I wanted to bring you in here so we could look at this patient together. I noticed that you documented a RR of 18/min, but I just counted 40/min and it’s such a significant difference that I’m concerned he’s getting sicker. Can we check his RR together and can you let me know if this is how he was breathing when you did his vitals?” I’m almost certain that pointing out that you are actually doing your own assessment and explaining the importance of an accurate RR will help this person pay more attention to accurate counts- at least with your patients. If the incorrect assessments persist then I’d suggest writing it up and asking your manager to address it.

    Also, does your unit ever present safety stories at staff meetings or morning huddles? Most of the time RR are inaccurate because staff don’t realize the significance of accurate documentation. The case you described with the ICU patient should be presented as an educational lesson to all staff about the importance of noticing trends in vitals and the implications of inaccurate documentation.

  • Sep 29

    It’s unlikely that anyone on this forum will be able to help you. You’re working in Saudi Arabia, where the rules and processes are completely different than the US and Canada, where most of the members here are from. Are you a citizen of Saudi Arabia or another country? I honestly have no idea where to direct you for information because I’m not at all familiar with nursing or working in Saudi Arabia.

  • Sep 10

    Yes, the gap in time since graduation without work experience could hurt your chances at getting a job. It could also hurt your ability to practice, as you would be taking a year long break from nursing practice and knowledge. Without experience to ingrain that knowledge, you're likely to forget quite a bit in that year, and struggle with your first nursing job far more than the average new grad.

    I echo the advice of previous posters. There are many options for learning Spanish- even advanced Spanish or medical Spanish, that don't require living in another country. Identify some programs/classes near you and seek out nursing positions that offer a schedule allowing you to work and learn Spanish. If you work at a hospital that serves a large Spanish-speaking community, that's great, but I would advise you against "practicing" Spanish with your patients. Many hospitals have a policy that only an approved medical interpreter may translate for patients.

  • Sep 5

    I suppose the other concern is that if you have a severe extravasation in the AC, you've compromised all IV sites distal to that AC. If a hand vein extravasates, you can still use veins above that site.

    Absolutely, frequent site assessments and brisk blood return are a must.

  • Sep 5

    They are my patients and they are kids. Yes, I will refer to them a patient as “my kid” when speaking to a doctor or coworker. Such as, “My kid in room 6 spiked a temp, could you order blood cultures?” or “My kids both needed new IVs this morning.” I’d never refer to them as “mine” when speaking to their parents, though.

  • Aug 28

    It depends on what kind of job you're looking for. Do you want to work for an EMR company doing training and education? Or do you want to work for a hospital building and designing the EMR system and consulting on other technology related issues? Either way your first step is to find a job in a hospital system (bigger systems will have more opportunities), get to know the electronic documentation system and meet people within the IT and informatics department who can help you network.

  • Aug 25

    It depends on what kind of job you're looking for. Do you want to work for an EMR company doing training and education? Or do you want to work for a hospital building and designing the EMR system and consulting on other technology related issues? Either way your first step is to find a job in a hospital system (bigger systems will have more opportunities), get to know the electronic documentation system and meet people within the IT and informatics department who can help you network.

  • Aug 25

    You're probably getting different answers because the answer is different for lobectomy and pneumonectomy.

    For a lobectomy or wedge resection, the patient can be turned on either side, and should be repositioned from side-back-side regularly. This facilitates ventilation and lung expansion.

    After a complete pneumonectomy the patient is placed supine or on the operative side only. The reason for this is because the mediastinum (connective tissue and membranes that separate the lungs) isn't held in place by lung tissue. Placing the patient on the non-operative side could cause the mediastinum to compress the remaining lung or push/pull the vena cava, interfering with blood flow.

    Source: Drain's Perianesthesia Nursing, A Critical Care Approach, 6th edition. 2013.


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