Latest Comments by BlueChocolateCat

I see you posted this a while ago, but I applied and was recently contacted to schedule an interview. I'm very nervous!

We do not have a solid policy. It really comes down to nursing discresion (unless the docs insist)

In our unit, we are able to give small neo pushes during moments of severe hypotension (MAPS <50) as rescue drug. I have most definitely gotten patients OOB to chair POD 1 on smaller doses of vasoactive drugs. And if they require a slight increase in dosage while in the chair? So be it. We rather maintain respiratory function, mobility, and skin integrity. However, if you have a patient that is extremely labile and you simply do not think they could tolerate the move OOB to chair, then notify the doc and wait until they are more stable.

In my cardiac surg ICU we prefer levo as a first line. If the patient isn't responding to levo (generally requiring doses over 10 mcg/min) we will add vaso. Amoung our ICU, there is some speculation that high doses of vaso may be linked to bowel ischemia?

Also, we will utlize vaso if the patient has persistant acidosis with a ph <7.30

I'm sorry if this doesnt pretain to your monitors, but on our monitors we are able to turn "pacemaker monitoring" on and off. Maybe certain monitors have this turned to OFF as a default?

I'm one of those nurses. I started off in a very high acuity CVICU as a new grad. I have worked here for just over a year and I'm still going strong. I know that I am improving as an RN every day. I have a lot of nurses around me that have worked here for many years and started as new grads. Ironically, some of the nurses that transferred to our unit from the medsurg/ SDU areas have really struggled with the vast difference in autonomy, critical thinking, time management, and prioritization.

I also am considering the pursuit of CRNA. Great thread!

Considering that lowering the patient's head of bed during an episodeo of hypotension is considered a solid NURSING intervention, that sounds very strange to me.

Generally, ICU nurses are allowed a slight increase in autonomy for obvious reasons.

If you have previous ICU experience at other institutions, I might consider presenting your observations to your nurse manager in an attempt to initiate positive dialogue. I am wondering if there is a group of nurses at this facility that have spent their entire careers there and simly do not know of how other ICU nurses function.

From reading this story, I don't think you did anything wrong at all. It sounds like you did everything right, and I probably would have given him the xanax as well. It was three and a half hours after a pain pill that he was tolerating well.

Out of curiousity though, did you give him the max dose rather than the minimum?

I read OPs first post and no others.

My impression of the situation is that you are working with a very burned out-short fused preceptor.

I don't think the situation with the wound-vac was your fault at all. For her to lose her cool so severely right in front of a patient is really not acceptable. I understand we are all human, but keep it together. I'd probably report this situation to your manager as your PRECEPTOR failed to offer guidance as required of her.

On the other hand, no need to appologize. You didn't act out of line.

Yet, I would advise you to pay special attention to some of your nonverbals and tone of voice. I know that at least for me, when I am particularly stressed, I have to pay close attention to my own body language as to not give off the wrong impression.

At my facility this would be grounds for immediate termination. Completely unacceptable.

I'm ready for the day that someone gets their chest re-opened at the bedside and we do direct cardiac massage.

I think the best one was the patient who was doped up on PCP or some crazy stimulant and was able to pick up a total care bed and actually throw it.

Move to Ohio.

I think the vast majority of my classmates are employed as RNs. I graduated in May 2014, passed my boards end of July 2014, and my first day of orientation was in the end of October 2014. I had two job offers. If you have experience, they will welcome you with open arms. There is definitely a shortage up here.

Moral of the story: I suppose the job situation can largely be related to your geographic location.

Cheez, that sounds like what YOU must be doing while you're at work

Nursing is not the answer.

I care for surgical patients and sometimes my patient's have scheduled opiates like tramadol or oxycodone. If I find that my 88 year old patient is simply too lethargic to get this dose, I'm going to hold the dose and document my RN assessment. I'm not necessarily going to page my on call at 3am to tell them I held a dose of tramadol... but I might run it by the appropriate LIP when they round.

And is your current position your first nursing position?

If I were you, it sounds like you have very little information. I would contact the person that gave you the verbal job offer and ask to have a fact to face meeting in order to clarify some questions about the position and orientation. Also, if you are unable to give a two week notice (which is extremely minimal within nursing and usually doesnt provide management appropriate time to obtain a replacement), you may need to ask if you can start your orientation a little later. Be upfront with them so they can understand your position. If you don't tell them and you don't ask questions, communication will never occur.

But besides all of this, the new position is for a "big hospital" and there has been zero paperwork and pretty much zero discussion?

I'm sorry, but this is your responsibility to get information for yourself. And it sounds like someone is missing something somewhere.

Also, this doesn't raise any red flags to you?