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Double-Helix, BSN, RN 34,662 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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  • Aug 13

    What point are you at in clinical? Is this your first year of clinical experiences? I only ask because being placed in a geriatric-focused hospital/floor is super common for first semester of clinical.

    I guess my advice is to just focus on honing your assessment skills. Geriatrics is a good place to do this. Learn as much as you can from each patient and just bear in mind that whatever condition your patient has, some day as an ED nurse or whatever, you will very likely come across that condition again.

  • Jul 22

    Quote from Emergent
    It means you had sex outside of the sanctity of marriage. You also had negative thoughts about someone in power. You kicked your dog three times, and picked your nose while driving. Additionally, you made politically incorrect comments and were disrespectful to the joint commission.
    ...and you ate young nurses.

  • Jul 20

    If you're concerned about your license then you should be just as concerned about holding indicated meds without any apparent rationale other than what appears to be a personal bias. I get that it often feels like you're losing some sort of personal battle every time you give a patient an opiate where there is some component of seeking involved, but it's important to keep that separate from an objective assessment of whether or not the medication should be held, particularly in a post-surgical patient.

    It would be reasonable given that list to ask that it be condensed to a single long acting and prn order in addition to the toradol. but the doses are all relative and can't really be compared to every other patient, it's quite possible that giving a Norco or two to another patient is far more risky than giving an opiate tolerant patient 4mg of dilaudid.

  • May 23

    Quote from kschenz
    I'd be filing a report for medical neglect. She may not meet the requirements for an investigation but you will have done your part as a mandated reporter. Poor kid.
    This is what I just finished doing. The person was kinda snippy with me (I'm sure working at those phone centers is awful) but it is done

  • May 3

    "I finally can hear myself think".

  • May 1

    I still remember a patient from one of my clinicals (LPN) on a med-surg floor. I was assigned a stable patient post-colectomy who needed frequent wound care. She was fairly young, and in a lot of abdominal pain. It was personally affecting, because my mother has Crohn's (previous dx UC) and had been through multiple (partial then full colectomy with ileostomy, J-pouch with stoma reversal) surgeries when I was a child. The primary nurse was very busy and couldn't bring a PRN, and my instructor was somewhere busy with other students, so I ran to grab warm blankets for her to hold to her abdomen (flashbacks to those days playing by the couch, my mom curled up with a heating pad to ease the pain). I felt awful that I couldn't do more for her in that moment. But - it helped. Afterwards, she thanked me and said, "You're going to be a great nurse." The feeling of problem solving something I didn't have full control over and seeing the emotional relief of someone who's suffering has been noticed and at least somewhat relieved, that reaffirmed my choice to pursue a nursing career.

  • May 1

    I would say the night I was called into work to be 1:1 with a new resident who kept trying to roll his w/c out the door. I came in and one of the sons were there. I asked him to tell me about his father, the work he did, hobbies, children,grandchildren just in case I would need to talk with him about anything to help him settle in. Son also told me they didn't realize that Dad was so bad as Mom kept the severity of his condition hidden. I also told him that in my experience it usually takes about 2 weeks to feel comfortable in a facility and will do better once that happens. He was also impressed that I would come in on a day off to sit with his father. Every time I saw the son after that night, he would tell people that I was an angel who helped them all that night. Not only could I be of help with the resident, but also the family.

  • May 1

    It's gonna sound bizarre, but when other nurses (who don't know I'm nurses) thank me for being patient/understanding when I'm a patient. Also what the PP said, the small thank you's from patients or family members.

  • Apr 30

    This isn't a glamorous story, but: 18 yr old girl, injured in a freak accident at her own graduation party. She'd arrived on my unit shortly before I came on. She was very fortunate -- she was blinded in one eye (optic nerve severed), but escaped what could have been a severe brain injury. She was naturally very scared, however. That a.m. towards the end of my shift, as I was showing her dad how to get to the caf, he said "She said she's really glad you were her nurse."

    When a TBI patient comes to visit us and say "thank you for saving my life" -- when s/he had been minimally responsive when she'd transferred to an LTACH months before.

    19 or 20 yr old young lady, deliberately run over by her boyfriend. Mom was devastated -- told me she knew she would get a phone call from a hospital someday. She wasn't one of those family members who interrogate staff, but was terrified. That first day, she was acting....regressive? "Mommy's here sweet baby girl," etc., would barely let go of her daughter's hand. On day 3, I had finally earned enough trust that Mom finally was able to go home and shower and sleep! That was very gratifying for me!

    My big worthy-of-TV moment: A woman a life-threatening condition, in the SICU after a caesarean birth. She was still intubated, VSS, but didn't look good from the get-go. A few hours later her HR started to slowly climb, BP started to slowly fall. My spidey sense told me it wasn't a simple need for fluid or blood products, and I told the resident I really feel uneasy about this one, and had she considered putting in a central line? She agreed... good thing, because about when she was finished was when the pt really started to decline. Within minutes, she coded, and began to require several pressors. She ended up getting an IABP at the bedside to buy some time to get to the OR (as her planned procedure was now emergent). I was still pushing epi and bicarb while rolling her into the OR! (Remember the Christopher Walken "more cowbell" SNL sketch? A picture of it popped into my head from all the "more epi," "more bicarb" from the code team leader. ) She came back on ECMO, and CRRT, with 2:1 nursing plus a perfusionist. And her baby has a mama.

    But most of the time, it's a simple "thank you" from someone on the worst day of their life. Those "thank yous" make it all worthwhile!

  • Apr 30

    As a relatively new grad, probably 1-2 years off orientation, I walked into a night shift and got told I was in charge. I told them I had no training and literally no idea what charge even does. I got told to suck it up, buttercup.

    It was me and 2 nurses who had about 6 months of experience, and 3 completely fresh new grads (literally less than a month off orientation). So total of 6 nurses for 36 patients, myself included. Not so bad, I mean, not great, but we'd all seen worse.

    2am, patient codes, it's open heart surgery so we code these people for absurd lengths of time, so anyway, I basically run this code for 10 minutes until anyone else bothers to show up, then we code the patient for another 30-40 minutes, she lives, I transport her to CCU, and then I'm in the elevator coming back up to my floor, I'd washed my hands but still had blood splashed up to my shoulders from post open heart CPR (messy). I cried in an elevator because I had been so afraid that if I had made even one error in those first 10 minutes, there was no backup to catch it. The weight of the responsibility was crippling for that 15 second elevator ride. And then I got my **** together, wiped my tears by the time the double doors opened, and went right back out there and helped my nurses write their code notes, catch up on patient care and charting, and try to provide emotional support to the nurse who had been caring for the patient who coded and tell her she did nothing wrong and didn't miss anything.

    At the time, I was scared out of my gourd, but I just ran on autopilot and did what needed to be done. I was so glad she was asystolic and it was an easy algorithm (kind of a crummy thing to be glad for, but what can you do?)

    When I think back, though...I proved myself on so many levels that night. I could handle a code, I could handle being in charge with no support, I could handle teaching and mentoring my staff, and nobody died. Those new grads remember that night and respect me for it to this day. The specifics of that night have honestly faded into the background for me, but the part where I could definitively say that I'm the reason that patient lived...that hasn't faded.

    That moment when you get someone back from a code.
    That moment when you surprise even yourself with your leadership, knowledge, and skill.
    That moment when you turn off the waterworks because your 15 seconds of feelings time are over and you've got to put on your brave face and help your peers.
    THAT is why I'm in this profession.

    (Yes, I realize this sounds really cocky. Just run with it. Sometimes nurses have to be confident.)

  • Apr 23

    WAIT! DON’T GO!

    I pulled the car to the side and put my hazard lights on.

    “Ok, where is this I have to go?” I asked the staffer at homecare.

    I jotted the address and put it in my GPS. That would be my last patient for the day.
    When I finally made it to the address, my heart sank. I was in the middle of the projects. Huge buildings, drunks and drugged out people sitting on the benches. An occasional family sat on a bench, soaking up the sun. I saw very few kids outside. People looked me up and down as I passed them, my homecare RN ID prominently displayed. I plastered a shaky smile and wished people good afternoon as I passed them. Some ignored me, some smiled and some looked vacantly on. I finally got into the building. I was going to Apt 124 K on the 17th floor. The warnings of never to take the stairs in the projects rang in my ears as I waited for the elevator. The elevator was small with a gate that I had to pull close. On the 17th floor the corridors were long with dim lighting. My heart in my throat I started walking trying to find the apartment.

    Every instinct screamed at me to turn back and leave but I forced my steps ahead. What would happen if someone yanked me into one of these apartments? No one would know. I would never see my family again I thought. I finally reached the apartment and rang the bell. No one answered. Hoping that the patient was not there, I rang the bell a couple more times. No answer. Relief coursed to me as I turned to escape back to the safety of my car and started walking.

    Behind me, the door opened and I heard “Wait! Don’t go”! I turned around and froze.
    A huge young black man stood at the door with a bare chest. His shorts were barely visible under his pendulous belly.

    “Are you the nurse?”

    “Yes, Good afternoon Peter! My name is Annie.” I masked my fear under a smile as I walked back towards him.

    “Come in” he turned back slowly and walked into the apartment.

    I hesitantly entered although my feet were trying to pull me in the opposite direction!
    The apartment was cold and bare. I looked around. He had disappeared. I walked past a kitchen and saw a door at the end of the corridor and walked to it. Something cold touched my leg and I looked down and saw a cat. I entered the room and found Peter sitting on the bed staring at me breathing hard. There was no other furniture except a TV and a few plastic milk crates. The cat followed me into the room. I hung my bag on the door.

    “I am sorry. I don’t have any place for you to sit. You could sit on the bed.” He said softly.

    “Thank you but I think I found a seat!”I stacked the milk crates together, put a newspaper from my bag on top and sat on it.

    “Thanks for opening the door”, I smiled looking him in the eye. Peter talked slowly and I realized that he was intellectually challenged. My brain went into high gear as I looked at him. He was short of breath and was breathing hard after minimal exertion. I could hear a slight wheeze across the room. Since all he had on was shorts, I could see his skin that was dry and the 3 plus edema on bilateral ankles. I saw a half-eaten Chinese takeout on his bed and a 2 liter Coke bottle on the floor.

    As I went through a homecare assessment and a physical exam, I knew that he was in the beginnings of respiratory failure. His weight, diet, isolation and inactivity did not help matters. He barely cooked and relied on neighbors buying him groceries but that was a hit or miss. His sister lived an hour away but had her own problems. He could not walk to the store but relied on takeout food which did not help his congestive heart failure or asthma.

    His black cat that he called Camper (he always wanted to go to summer camp but could not afford it) was his only company even though Camper made his asthma worse. When I checked his back, I saw a stage two pressure ulcer on his buttocks and rash under his belly and breast. I gave him a nebulizer treatment and taught him about asthma, prevention and treatment. I then sat there and made a few calls to help him. One was to his MD to increase his Lasix dose and get refills on all his meds and discuss plan of care and referrals I needed for Peter.

    The second one was to his pharmacy to set up home delivery. The third one was to my central base to put in an order for a hospital bed and special mattress. The fourth one was to the social service dept. for an assessment referral and to hook him up with community services like meals on wheels and para transit for transportation. I spend around two hours at his apartment. I was subbing for another nurse that called out.

    When I left, he hugged me and thanked me and said, “I wish you were my nurse!” I hugged him back and said, “Don’t worry! You are in good hands!”

    He had tears in his eyes as I walked out the door and out of his life.

    When I left the building, I looked back at it wondering how many more Peters lived in those building, all alone with no one to help them. I sat in my car and cried for Peter. I called back base and asked the director to put a compassionate nurse to take care of him as the perdiem RN who had him as a regular patient just went in, took vitals and left. The director promised to follow up. I thought about all my fears that had surfaced when I first saw him and I was ashamed of myself.

    Then I thought of how I felt when I left his apartment and felt happiness and satisfaction that I was able to help a fellow human being. I realized that I was put in a position to help or ignore his needs and was able to make the right choice, even though it took an extra hour. The danger I faced going into the projects was overshadowed by what I was able to accomplish. That day, I was proud to be a nurse!

  • Apr 17

    I work for Epic and have been through many Go Lives. It is always a challenge and a learning curve for users but the attitude with which one approaches the Go Live makes a world of difference. If you anticipate it to be awful it probably will be, but it's a good tool and can be helpful, but it just takes getting used to. If you go into it with an open mind, and anticipate that it's new and different, you'll have an easier time. Use your support staff to show you tips and tricks because they'll become very useful once the support staff have gone.


    I think it's unfair to say that the Epic team "have no idea what they're doing". I wish you could understand the sheer amount of work it takes for an informatics team to produce a successful Go Live. The thing about Epic is that it's not the same at every facility as it's built out for that individual facility from the foundation system. Therefore, the Go Live support team that are on the floor are facing that version of Epic for the first time the same as you are, and as they likely didn't build it, they might not know every single little thing about what and how you need to see data that day. The actual builders and analysts are usually sitting in the command center trying to fix build issues as they arise, and the people you see on the floor are contracted support staff trying to help you navigate through the system. Epic is a hugely complex and detailed interface. It's not possible to know every single thing about every single aspect, and if you have a question about something, it could have been built by any number of different teams. If you ask someone who built the cardiology documentation about the ambulatory piece, they might not know the answer, but they can find out. Epic is built in many pieces by specialized teams and it has to come all together as one single interface.


    Sure it's frustrating in the beginning when it's unfamiliar but in the end you'll see how useful a tool it is.


    As a trainer you won't be certified as such, as that's reserved for analysts like myself and requires three trips to Epic headquarters to do courses and take three exams. Only then can you become certified in a specific specialty. You will be credentialed as a trainer, and will be working off strictly scripted tip sheets teaching specific workflows that will be outlined for you. You just have to become familiar for that specific workflow for the area in which you work.

  • Apr 5

    Wow.. just got another update from the neighbors, the baby is off ECMO and has woken up, opening his eyes and reaches for the ventilator tubing, they say he will have the ventilator removed soon- AMAZING NEWS!!


    They think he will be ok... I am FLOORED... didn't expect this news- still worry if they are seeing reflexes or if he is actually awake but my goodness, that is a miracle!!

    this little boy was blue and cold when I got to him, I thought for sure the CPR I was doing was for not, that he was gone, so glad I was wrong.

  • Mar 29

    I had many years of nursing experience, including Med/Surg before starting psychiatric nursing. My previous experience made my transition to psychiatric nursing much easier. For example, there are many psychiatric patients that will attention seek, manipulate, or as part of their mental disease process, present to nursing with medical complaints. It is important for the nurse to have experience and strong assessment skills to make appropriate decisions. Without this knowledge, a nurse would be sending patients to the ER almost continuously and feeding into some of the patients psychiatric conditions.
    As a psych RN, resources may be somewhat scarce and at times, you may be working without any other nursing or medical staff present. Therefore, autonomy and confidence are also important qualities to have. I personally think that some medical experience would be of benefit to a new psych nurse.

  • Mar 22

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