Latest Comments by Lev <3

Lev <3, BSN, RN 46,225 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: 2,799 (53% Liked) Likes: 5,199

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  • 0

    One of our usual drunks at my old ER coded (and lived).

  • 1
    brownbook likes this.

    I think "will come in scrubs to help out" is a common denominator. Spend some time away from the desk!

  • 5

    Quote from Ruby Vee
    I've had good managers and bad ones, too. The good ones will listen to the story, the problem, both sides of the argument before reacting.

    The good managers will support their employees and then, if required, discipline them behind the scenes. I had a colleague make a really dumb mistake, and she made it in the middle of physician rounds. Voices were heard loudly exclaiming about the morons that work in this ICU, and how did someone so stupid make it through nursing school. The manager went in, defused the situation, told the physicians they needed to apologize for their rudeness toward her nurse (and waited until they did) and then whisked the nurse into her office for a little talk. Only after my colleague was done crying over being humiliated so publically did the manager discuss the actual mistake with her. And although not everyone knows it, there was discipline involved as well. The bad ones -- and this was me -- will pile on publically and then never seek out the rest of the story. "Did you, Ruby, tell Dr. Iusedtobeapathologistandamnowtryingoutcardiacsurge ry that he was a moron?" "No, ma'am. I only told him that if he wanted to do a heart transplant on every patient who had a cardiac tamponade, he'd better have a cousin in the enforcer business to go around and line up donors for us. He told me that only an idiot would say that to a man who had just finished telling a patient's wife her husband was going to die without a transplant, so I told him that only a moron would talk to the wife about a heart transplant without at least checking with his Fellow about opening the chest because the experienced ICU told him his patient had a tamponade and he needed to get on it NOW rather than after his pizza break." (OK -- I was somewhat more tactful -- but the manager didn't understand my POINT. The patient had a tamponade -- needed to be fixed now. He didn't need a transplant, although he would have needed a pine box had the charge nurse not dragged the Fellow out of the OR -- the resident was so sure he was right and I was wrong he wouldn't even PAGE him -- and we opened the chest.) She told me I needed to apologize to Iusedtobeapathologistandamnowtryingoutcardiacsurge ry; the Cardiac Surgery Fellow brought HIM to apologize to ME.

    A bad manager tells you that if you need Wednesday off because the biopsy came back positive and the HMO's only oncologist is only available on Wednesday in the clinic three hours away, you'll need to find your own replacement. A good manager asks you how you're doing, and if Wednesday is the absolute soonest you can get an appointment and if she can call her friend who is the oncologist's scheduler's mother to see about getting you in sooner. And by the way, I've taken you off the schedule for Wednesday and if you need any other days off, please let me know.

    A poor manager hears about you being on your cell phone all day while your orientee (who is nearing the end of her orientation) and tells you that you're obviously not fit to precept. A good manager asks you if anything is going on at home, because you're not usually on the phone at work. When you tell her that Mom has Alzheimer's and your sister programmed your cell phone number into Mom's direct dial and Mom has been calling you all day looking for your father, who died two years ago, a good manager takes you off the schedule so that you can fly home and sort out Mom's living situation, faxes the FMLA papers to you in hour home town that is so small there's no cell phone coverage and sends you an Edible Arrangement because that's all you have the time and energy to eat.

    A bad manager accosts you at 7:35, waves your rhythm strip which is already analyzed and signed in your face and says "This is inadequate charting." A good manager wanders by at 7:35, sees that you've already posted your rhythm strip and says "Good -- now we'll have documentation that he actually WAS in atrial fib so that cardiology resident will have to believe that nurses can distinguish A fib from that other rhythm."

    A good manager either knows the job and can do it well, or understands the outlines of the job and trusts her staff to do the job well and believes them when they tell her that they need more X, Y and Z and perhaps someone could talk to Dr. Dick and explain to him that "Yes, nurses can analyze a rhythm and if he ever again refuses to come when called because of a serious dysrhythmia, she'll be having a talk about it with the Highest Head Honcho of Doctoring." A bad manager will talk to her nurses about not pestering Dr. Dick at nigh because he needs his sleep.

    Ruby Vee, I love your stories!

  • 1
    Tencat12 likes this.

    Saying "she's here all the time" is the type of triage language/tunnel vision that gets people killed.

    I agree with your ESI 1 designation. If she wasnt symptomatic (diaphoretic and tachypnic) then she would be an ESI 2. HR alone with a borderline BP and symptoms can put her in ESI 1 territory because either a) she will need fluid rescusitation and/or b) chemical/ electrical cardioversion (if afib rvr lets say)

  • 0

    Your Q-trainer scores should be going up as you get better at answering the questions. Perhaps you need some more content review. Did your review come with a way to access the Kaplan RN course book/content review book? It used to be available on Amazon's Kindle store for free as an E-book.

  • 5
    NanaPoo, TriciaJ, NurseSpeedy, and 2 others like this.

    Quote from tara07733
    That's the kind of manager that the thought of her leaving sends chills down your spine. She sounds great; you are lucky.
    You are right. When a good manager leaves, staff often follow if they can or leave themselves. Usually the person who replaced them cannot fill the big shoes left over.

  • 13

    I had a great manager who was willing to let me grow. When she hired me into the ED, I expressed that I wasn't sure the ED was for me. But she was ok with that and said that I would see many different patient populations in the ED and I could find which one I liked working for. A manager who doesn't feel like she has to hold on to her employees and not let them move on is a great one.

  • 9
    billswife, ruby_jane, TriciaJ, and 6 others like this.

    Quote from brownbook
    Willing to use common sense over policies.
    I think this is an often overlooked quality but in my opinion very important. Policies are good, but there are certain situations where rules can actually make things unsafe.

  • 0

    Efficiency, flow of patients, supplies, workloads, you name it.

  • 1
    Davey Do likes this.

    Over the past almost 6 years that I've worked in the hospital, I've had 9 managers. Some good, some bad, and some ugly. In your opinion, what makes a good manager?

  • 0

    I've worked in 2 EDs, the new one is more organized than the last. However, it is also a smaller ED with much lower volumes. How organized is your ED? Have working conditions gotten better or worse over the past couple years?

  • 1
    WKShadowRN likes this.

    The first treatment for hypotension in septic shock is fluids. (30ml/kg given as a bolus over 0.5-1 hour). The main hemodynamic factor which causes decreased BP is profound arterial vasodilation. Therefore, you must fill the tank and see if the patient is fluid responsive before starting any vasopressors.

    But even though their SVR is increased, they are still hypotensive.
    I think what he means is that although the SVR is increased initially as a compensatory mechanism to bring up the BP, eventually this mechanism fails and you have a shock state.

    Leukotrienes cause the bronchoconstriction. Medscape: Medscape Access

    The alpha effect includes tachycardia, increased strength of contraction, and increased cardiac output and therefore BP. However, the vasodilation in septic shock is so profound that this compensatory mechanism may fail. The vasopressors/constrictors clamp down on the vasculature and create some counterpressure to the bloodflow aka increased SVR and thereby increase BP. This is why volume is so important. You must fill the tank.

  • 0

    Possibly risk of hypotension?

  • 0

    The job may have been posted as full time, but she told management at the interview (maybe something came up from the time she applied to when the interview took place) that she could only commit to PT hours.

    Management must have liked her (or they were desperate for competent staff) and agreed.

    Regarding the benefits: How do you know what level her benefits are?

    It could just be that management is inexperienced with this type of religious accommodation and didn't even think to have this nurse work extra Sundays. It is also possible that when the nurse brought up the Saturday issue she may be have mentioned working extra Sundays but the manager was afraid of looking like she was discriminating and just said not to worry about it.

    You don't know the whole story. I don't think this would be an issue if your unit didn't have staffing issues.

  • 0

    The job may have been posted as full time, but she told management at the interview (maybe something came up from the time she applied to when the interview took place) that she could only commit to PT hours.

    Management must have liked her (or they were desperate for competent staff) and agreed.

    Regarding the benefits: How do you know what level her benefits are?

    It could just be that management is inexperienced with this type of religious accommodation and didn't even think to have this nurse work extra Sundays. It is also possible that when the nurse brought up the Saturday issue she may be have mentioned working extra Sundays but the manager was afraid of looking like she was discriminating and just said not to worry about it.

    You don't know the whole story. I don't think this would be an issue if your unit didn't have staffing issues.


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