Content That Lev <3 Likes

Lev <3, BSN, RN 42,445 Views

Joined Jun 3, '11 - from 'Another planet'. Lev <3 is a ED Registered Nurse. She has 'A few' year(s) of experience and specializes in 'Emergency - CEN, upstairs, troll bashing'. Posts: 2,602 (52% Liked) Likes: 4,791

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  • Oct 26

    Not checking an oxygen tank is simply poor practice. I understand that we all get busy sometimes, and none of us are perfect as nurses or people. I also understand that mistakes are made, and things are sometimes forgotten. But checking an oxygen tank should not be something that slips your mind as the bedside nurse. Especially not when the patient is on 12 liters of oxygen, and has multiple pulmonary/respiratory complications/issues.

    At some point in the orientation process, it may be time to talk to your unit educator. If you are teaching, and trying your best to orient her to the department without results, it is worth mentioning to the educator. At all the facilities I have worked at, the educator was responsible for handling length of orientation, helping to schedule classes, and ensuring that new hires were growing in skill/competency during their orientation periods. I am sure it is much the same at your hospital.

  • Oct 25

    Quote from Lev <3
    I get the feeling that this poster does not have prior relevant RN experience, or has very little experience.

    From taking two graduate level NP classes (advanced pharmacology and advanced patho), I already know that there are resources and treatment algorithms out there for many common conditions such as hypertension, diabetes, and high cholesterol. It seems like this poster was not very well prepared.

    That's because the OP is a troll punking y'all.

  • Oct 25

    Report the facts only, not what you think or feel about the facts. The med was recorded as given early, then the documentation was changed. As for the incorrect dose, the narcotic count should reflect that and you should always report an incorrect narcotic count that you cannot resolve.

  • Oct 25

    I've worked in both ED and ICU, but I've only ever precepted in various critical care units. Usually for orientees who are unsure of rhythms, I take them into the room, and ask questions. "What rhythm do you see on the monitor? Do we need to immediately intervene related to the rhythm/rate/blood pressure? Do you have any concerns about the rhythm, or how it relates to the patient's chief complaint?" I try to be gentle with these, and not make my orientee feel like I'm belittling or insulting them.

    During downtime on the unit (which is seldom), I also tried to make it a point to show my orientee rhythm strips (especially of concerning rhythms like A. fib, A. Flutter, V. Tach, V. Fib, and various degrees of heart blocks). I would ask what the rhythm was, and ask my orientee what should be done if the patient converts into one of these rhythms. Together, we would review treatment algorithms for each rhythm.

    As far as giving her telemetry patients alone, I wouldn't feel comfortable with that. I would supervise, even if from a distance, until I felt that she was more competent with identifying various rhythms, and knowing what to do in the event of an acute cardiac issue.

  • Oct 25

    She wasn't talking about the coag blue top. Both blue (Aerobic) and purple (Anaerobic) tops are both blood cultures.

    The blue goes first, but honestly if your line is already primed with blood, I don't personally see the reason you couldn't reverse the order. But I'm not the brightest....

  • Oct 25

    That was so beautiful ! Wow! I will never forget this post. Thank you for sharing that.

  • Oct 23

    Ok... I will also admit to eating ice cream in bed.

  • Oct 23

    I remember my first job working on a surgical unit and leaving a patient unnecessarily on CL 2 days post op. I did nothing because the MD hadnt come in and placed an order to advance her diet. Starving and I did nothing about the patient not included in rounds. I got my ass chewed out well by a senior nurse. I learned something very valuable and almost 30 yrs in I've been proactive since.

    It was a lousy 2 days for the patient but it wasn't wasted on me.

    Better to learn by less critical mistakes than a biggie.

  • Oct 23

    Was there a deficit in this patient's care? Yes.

    Did you find it and get it addressed? Yes.

    Might it have been better for the patient to have received alternate IV fluids sooner? Perhaps.

    But you DID use critical thinking to determine that the patient's nutritional needs were not being met. Apparently that put you miles ahead of the physician writing the orders, and the pharmacist filling them. If you view this as your error, please help me understand why. I think you should be applauded.

  • Oct 23

    I love the unpredictability of the ED. There's a controlled chaos and then there's a category 5 hurricane of chaos but it is where I thrive. I'll post more when I've had coffee. It is time for me to clock in.

  • Oct 23

    I think one huge difference is the pace/predictability of the shift, time management, and prioritizing.

    One thing I love about ICU (because I'm pretty neurotic) is that for the most part, I can plan my shift. Unless the patient is actively trying to die and you're mid-code, you can generally get a sense for when things will need to be done. Even though the plan may be altered if your patient is unstable, there's generally still a relatively clear sense of the plan (if not, it's going to be a rough shift). Maybe the sense of control is an illusion, but I feel like ICU is better for control freaks.

    Meanwhile, there is no 'shift plan' in the ED; you never know who/what is about to come through the door, and you are constantly reprioritizing (you do that in ICU, too, but not nearly to the same extent). You have to become confident triaging and providing basic stabilizing care to every single type of patient and condition you may see (neonates to pregnant teens to folks in their mid-90s, asthma attacks to heart attacks to snake bites). By contrast, ICU nurses may be specialists (i.e. neuro, cardiac, neonatal, etc.) You can have an ED shift where all of your patients are low-acuity, and have illnesses that don't actually require an ED visit, a la urgent care (i.e. tooth pain, back pain, sore throat); that same shift, you may get someone spurting arterial blood from a wound. I once had an ED patient who was sitting up, filling out discharge paperwork, eating a ham sandwich one second, and coding the next. You have to be comfortable going with the flow, looking at the big picture, and making a new plan on the spot. As an ICU nurse, that thought makes my skin crawl.

    On a similar 'control freak' note, ICU nurses usually want to know every minute detail about every body system in their patient, whereas ED nurses are more concerned with what is going on right at this minute as it pertains to the presenting problem. Neither approach is right or wrong, just a totally different mindset (which can cause some tension when ICU nurses are getting report for ED nurses, lol). Similarly, ED nurses will have a new set of patients every single shift, whereas you could have the same patient for an extended period of time on your ICU; consequently, you may get to know the patient, their medical history/assessment findings, and their family members.

    A third 'control freak' element (man, I keep thinking of more and more!!) is your medical knowledge of what's happening to the patient. In the ED, you often have medical mysteries on your hands, which is one reason for the aforementioned 'lack of plan' situation; it's harder to make a plan to address an illness when you don't know the underlying cause. The plan for someone with a bowel perforation is very different from the plan for somebody with bad gas. Many ED nurses seem to think of it like a cool puzzle, and thrive on figuring out the root cause (kudos to them!) You get these mysteries in the ICU occasionally (in general, if you can't figure out why the patient is continually coding, it's going to be a rough shift), but more often, you've done enough tests that you know what is happening and why, and you use that info to create your handy-dandy plan.

    One thing I will say about (adult) ICU nursing: many of your patients will be intubated, disoriented, or exhausted (they are critically ill, after all), so you will be physically supporting them the greatest possible extent, but you may not be emotionally supporting them. One of the main reasons I chose to avoid adult ICU is that I witnessed many ICU patients who experienced a profound loss of dignity on the unit (not the fault of the nurses, but rather the nature of ICU care); that experience was very morally distressing for me.

    If you can, try to shadow before committing!! That can help you clarify what each type of nurse actually does (i.e ED nurses are rockstars at starting IVs, ICU nurses may be great at floating swans), and how they go about doing it.

    Best part: if you try one specialty and hate it, or if you're bored and want to branch out, you can always change specialties. That's the beauty of nursing

  • Oct 22

    I would make sure you're documenting everything clearly: "Notified Dr. Jerk of CO2 result, requested anesthesiology be notified. Anesthesiologist paged. See new order from Dr. Sleepy."

  • Oct 22

    You are 100% correct that he used you as a pawn to avoid directing his concerns to anesthesia. He did that because he is weak and unsure of himself. Most bullies are, and compensate by acting tough toward anyone they believe they can manipulate. You have unfortunately become that "anyone." It won't stop until you stand up to him, and in a somewhat public way. By the sound of your post, I believe that you are up to this challenge, but you have to be smart about how it is done so he can't claim that you have acted inappropriately towards him.

    Please seek the support of your manager and/or a respected nurse on your unit. Once you have their back-up, be ready for your next interaction with Dr. Jerkface. If he says or does anything inappropriate or threatens you, remain calm and inform him that you will continue your conversation at the nurse's station, then walk away. Once there, and with your mentor present as a witness, firmly but politely state that you will not be spoken to in a threatening manner. Suggest that he take some time to re-word his message to you. He will either get the message and knock it off, or he will explode in front of witnesses who saw you acting professionally. Either way, you win.

    As tempting as it may be to ask someone to intervene on your behalf, in my experience, that shows the bully that you are afraid, and the behavior grows worse. If you stand up for yourself, he will either give up or explode. Either works to prove your point. And as long as you have witnesses to confirm that you acted professionally, you will be able to defend any claim he might make that you incited his behavior.

    Personally, I prefer to get them in private and tell them to go to hell, but that's risky Good luck! You have a good head on your shoulders and are an asset to your unit.

  • Oct 22

    I'm actually not sure what they're calling it, that's why I contacted HR. I guess I'll know more once they complete things on their end. But thank you TheCommuter, as a nurse of 2 years I've never encountered this situation before. I really appreciate your insight!

  • Oct 22

    Did anyone tell you that this was a termination? I'm confused because this situation happens in my neck of the woods all the time.

    Here's how it goes...a nurse submits a notice of resignation for two weeks, four weeks, or whatever length of time. A petty, resentful manager declares, "We no longer need your services." The nurse is not required to work the length specified in the notice; therefore, he/she is told to not return.

    This is usually documented as a voluntary termination, a.k.a. employee-initiated resignation. Believe me when I say that workplaces bend over backward to avoid involuntary terminations, a.k.a. 'firings.' Firing an employee exposes employers to unemployment compensation claims that they wish to avoid paying.

    Therefore, I doubt your employment was terminated by your former workplace. I doubt you were fired. I'm 100 percent sure HR recorded it as a resignation.