Content That Lev <3 Likes

Lev <3, BSN, RN 45,226 Views

Joined Jun 3, '11 - from 'Another planet'. Lev <3 is a ED Registered Nurse. She has '4' year(s) of experience and specializes in 'Emergency - CEN, upstairs, troll bashing'. Posts: 2,750 (53% Liked) Likes: 5,084

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  • Mar 21
  • Mar 20

    To keep track of medications administered, I suggest not discarding any ampoules or wrappers, keeping them all in a tray for later, when you'll have to write down in some form or another what was done.
    I suppose most people have heard this one before, but to understand what the speed of compressions should be, do it in rythm with "Staying Alive" by the BeeGees.
    EtCO2 is interesting because it is an early indicator for return of spontaneous circulation (when it will usually skyrocket) and a consistently low EtCO2 during the rescucitation attempts may be indicative of a poor prognosis.
    If you can't establish an IV, you can use the endotracheal route (dosage *3 than what would have been used in the IV) - as always, per physician order!

  • Mar 20
  • Mar 16

    Nice summary.

    A couple of points that I would add for those who are inexperienced with codes:

    1) Every two minutes, *something* should be happening... either meds or a shock...

    2) Be sure that *someone* is immediately acting as the recorder. It doesn't necessarily have to be on the code sheet but someone needs to know *when* and *what* right from the inception. This can be as simple as a piece of silk tape on your pant leg or writing on the bed sheet, or even on the drug packages themselves.

    3) If you're recording: Keep careful track of time... it's very irritating when the recorder says, "Um, it's been... um... about two minutes..." Also, if you're recording, it can be helpful to give the team a 10-second countdown to the next pulse check, just to minimize the delay and bumbling/fumbling...

    4) Don't be afraid to speak up... either with suggestions, delegations, observations, or critiques (particularly of the quality of compressions, which can be hard to maintain/sustain).

    Strong post, Lev.

  • Mar 16

    Great article! The only thing I would add is that, while it is true that when there is no perfuming rhythm or patient is pulseless, the patient cannot sustain a viable BP, I have learned in ACLS classes that monitoring BP can also help monitor effectiveness of CPR. IIRC, when the diastolic blood pressure is less than 10, it is a sign of ineffective compressions.

  • Mar 15

    Quote from clh8987
    Hi there!
    I have been a nurse about three years, I have only worked in memory care/ALF and some rehab/SNF. I have finally applied for some hospital jobs and actually got an offer from an ER in my area. I shadowed there today and really enjoyed it...my lack of confidence just really plummeted when I saw how much I don't know all the nurses told me I would have a long orientation and that I would learn it over time.

    My dilemma is... that when I started applying I got a little apply crazy and now have a few interviews on a med surg floor at another hospital tomorrow. I really enjoyed the ER and need to give them an answer by Friday. I don't want to miss this opportunity in the ER but what I am wondering is if I am putting myself at a disadvantage starting in the ER with no hospital experience?
    Really need advice on this...
    The good news is that you are not a new grad; you've had some experience. Nothing against new grads; I am none of those who feels a new grad can start in an ER. But I digress...I do not think you are putting yourself at a disadvantage. Full disclosure though...I am a die hard ER nurse who started out as a new grad there. I say go for the ER. Either unit will be challenging, so what is your passion? Those ER nurses are correct. No one expects you to know everything. Even experienced nurses navigate a steep learning curve when changing specialties. Good luck and have fun!

  • Mar 15

    I had a year in med surg before transitioning to the ED and I still felt like I knew nothing. I had a 12 week orientation and still ask a lot of questions. If you liked the ED and the environment is supportive, go for it!!

  • Mar 15

    The problem I have with all of the Jakes I treat is that many of them expect me to drop everything I'm doing all at once to give them their IV dilaudid and phenergan even if I am providing care to another patient. If it takes me more than two minutes (not an exaggeration), they pitch a fit. If I don't "push it fast" or if I dilute it, my practice and technique is questioned. If I refuse it due to them being hypotensive or difficult to arouse, I am nurse ratchet who doesn't care about their pain.

    They are so nauseous and in so much pain yet they can chow down on potato chips and starbucks despite being NPO. They claim that PO Dialudid doesn't "treat" their pain yet will ask for it one hour after getting their IVP of Dilaudid. That's interesting. I thought it didn't "work". And then, down the hall you'll have a patient ready to be discharged home with hospice already in the active stages of dying who fervently denies pain whenever I try to encourage him/her to let me medicate him/her.

    Don't get me wrong. I am professional and courteous to every Jake I encounter. If I know someone with undeniable pain is going to be discharged soon, I try to encourage them to move over to PO pain meds because we all know Dilaudid or Morphine IVP is not available at home. I cannot make someone change their ways and I cannot cure a drug addiction. If a pain med is ordered, I will give it if it is safe to do so. However, it is incredibly difficult not to resent these type of patients when they use manipulation to get their way and monopolize my time. I have other patients whose needs are just as important as Jake's.

  • Mar 15

    I would honestly suggest taking the class as in general the patient population you work with will be harder to from if they used a lot of drugs intravenously. Prepare yourself. you can do it!

  • Mar 14

    Grab a legal pad. Begin taking physical notes of everything that you've asked that was not done. Date and time each entry. Have a witness to each of these occurrences with you whenever possible. Do this for each shift that you work with these individuals for a week or two. At the end, make copies and give one to the HUCs (you should have one running tab for each of them), give one to your manager, and keep a couple of copies for yourself.

    Continue this process for the next week or two. Then, add your manager's manager and your facility's risk manager to the list of recipients. If nothing is done at this point, it will DEFINITELY not be done, and should be an eye opener for you.

    Personally, I'd never allow myself to become that comfortable with any job so as to put up with that b******* for a solid year; let alone ten! The fact that the employers, employees, and physicians have allowed this to continue on for so long says a lot about the culture there. You mentioned that some physicians were being embarrassed by these advances. At my hospital, this flirting behavior can be construed as harassment and there are policies against this. The responsibility of reporting is expected from the witness to this act as well as from the victim, because any witness can be offended by these acts even if said person was not the target of the act itself.

    Once you add that twist to your complaint, and show how it's impeding your work and interfering with patient care, it's an entirely new ballgame because harassment in the workplace is forbidden.....at least it is and has been in every single place I've ever worked. If this still doesn't work, you can notify your facility's regulatory body. You should be protected against retaliation from your employers and from a hostile work environment. Most people don't want to take these 'extreme' measures, thinking it's not that serious. But look at your situation. Don't you think it is? I think that your complaint will be addressed at the risk management level is you take it that far.

    This is a great time to extract that harassment policy and make copies to attach to your observations. Good luck to you...

  • Mar 10

    Quote from Extra Pickles
    Can anyone come up with a college of nursing that will enroll a student who has a 1.25 GPA? Other than the for-profit schemes, a college that has students who pass the NCLEX? Anyone?
    She didn't say her GPA was 1.25. She said that a transcript (from another school) from 8 yrs ago brought it down 1.25. But, your point is still valid. Even in the best case scenario, 4.0 GPA that was brought down 1.25 would result in a 2.75 GPA which is still not competitive.

  • Mar 6

    Quote from teachable
    I have no intention of making excuses, good or bad, right or wrong this is what happened. The first clinical day, they are things I could have helped, but I don't believe the third unsat was entirely fair considering they took only the word of others, particularly those in an environment that clearly wasn't student-friendly to begin with. When they called me in to ask me about the clinical day, they had already made up their minds about the unsat, so nothing I said mattered, and I don't feel like that was appropriate. I can't change it, do anything about it. They said I could redo the semester "if I still qualify" and the F might make that impossible.
    I've always been curious as to the frequent use of this statement by students. As a student, how would you know what is appropriate action from the credentialed instructor who, by the way, holds the license you're trying to acquire? What would have been appropriate or acceptable to you, the student?

    As for the "jerk" of a surgeon, he was probably trying to alleviate some of your anxiety. Not all surgeons feel the need to walk on water. This same display was done by a surgeon towards me during my clinical rotation in 1985. When he offered me the cyst that he'd just removed, I took it from his hands and headed directly towards the garbage pail with it until a couple of OR nurses caught up with me and stopped me. Hey, I was gonna throw the thing in the trash...he didn't want it and I didn't need it. (What can I say? I was a dumb nursing student once...not to imply that you're dumb).

    No one wants to be disciplined...none of us. And until we are called onto the carpet for inadequacies, we tend to pass by the mirror without so much as a glance. As inappropriate as you feel these "unsats" are, I'm willing to bet that it will be a long time before you make those same three mistakes again.

    Now this time thing. I am a stickler for being on time, not because I was disciplined, but because I learned my lesson a long time ago. I ran late once, and since my colleagues knew that I was coming, none of my duties were done for me; and I had what was left over after everybody had picked over the assignment. When I arrived, I was so far behind in medications, charting, and had to deal with such selfish patients and family members who didn't care that I'd just arrived; they wanted things done yesterday. My entire routine was screwed up for hours to come. Toss in the fact that my new admit rode up on the elevator with me, and I had the shift from hell!

    I would say to not take these things personally. But you should because the lessons learned here should make you a better student and someday, an efficient nurse. Time management, accountability, and powers of observation (eyes and ears wide open ) are among the biggies in the nursing world.

  • Mar 6

    Quote from teachable
    I was called into the office and wasn't told by another clinical instructor that they had received an email from the O.R. Director that I was reported to have been "nodding off" or "sleeping" on a couple of instances.
    I will not repeat the other respondents' suggestions...

    Nonetheless, you should have outright denied that you were nodding off or sleeping instead of attempting to explain that you were trying to "re-center" or "refocus." in general, school officials do not like hearing unique explanations.

    This is a tough lesson. Some people can get away with bloody murder while others are punished for lesser infractions. Good luck to you.

  • Mar 6

    Quote from DinaLaz
    Thanks for the feedback everyone, I have a considerate amount of social anxiety so the thought of coming up to a random stranger and asking to interview them was very daunting.... but after your replies I sucked it up and approached an upper classman. It wasn't as scary as I thought it would be, she was very nice and helpful.
    See? You pushed yourself out of your comfort zone and it paid off. It will continue to pay off in the future because you're going to have to communicate with a lot of people you don't know- patients, their families, that doc on call you've never met, the list goes on.

  • Mar 6

    Quote from DinaLaz
    Thanks for the feedback everyone, I have a considerate amount of social anxiety so the thought of coming up to a random stranger and asking to interview them was very daunting.... but after your replies I sucked it up and approached an upper classman. It wasn't as scary as I thought it would be, she was very nice and helpful.
    You're going to have to do this on an almost hourly basis as a nurse. Good for you!


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