a new grad's gripes

meandragonbrett · Jan 30, 2010

Ummm......

Welcome to being a new grad

Welcome to being a new grad in critical care

WalkieTalkie, RN · Jan 30, 2010

Yep, been there, done that... got over it (or at least pretended to), and my life got a lot easier :)

detroitdano · Feb 1, 2010

Leave work at work. Makes life easier.

I determine how well my shift went by how it goes when I leave. Did I leave 20 minutes after my shift ended? Did I have to wait 10 minutes for an elevator, and then when I got on, did it stop at every floor on the way down? If so, probably a bad shift.

Did I leave early? Did I not have to wait for an elevator and nobody else got on the entire way down? Probably a good shift.

Seriously, this has been flawless so far lol.

**NickiLaughs, ADN, BSN, RN** · Feb 2, 2010

I agree with the teamwork, that's probably actually my only pet peeve..... I will drop what I'm doing as long as it isn't some life-threatening task, and always go help a patient being admitted to our unit if it's on my side. I actually almost quit my job when I was on day shift because the nurses never helped eachother, when I got to nights I found out they were much more helpful and had a "team" attitude.

If I have help in there, and the patient has a stable airway/being bagged, I actually focus on getting the meds in my pumps 1st (and seeing if I'm about to run out of anything), asking what rate they had them at, etc. If it's just fluid, I worry about it after, then I switch them from the transport monitors to all of our monitors.

I think it pisses ER off sometimes, but I'd rather do it that way. When I was still training one time they didn't tell me the rate of a medication (I had forgotten to ask) and it took me 10 minutes of looking through all the paperwork to find out the rate.

colddeadpeople · Jul 23, 2011

IV pumps that fail during transport. MOST of them will hold a charge, but they're frequently failing with that continuous whine and can't be reused.

Telephones in disrepair. Some of them have been thrown away and not replaced.

Again and again, WHEN are you going to get rid of the stupid computer charting system? The initial charting on two patients burns a half hour out of your mornings WITHOUT interruptions, and that's WITH computer lag-times. We tolerate this. And visitors are a real problem.

And the NEW computer system isn't a fix. Or do you not know that?

Again, too many visitors with their whims and demands.

Pharmacy short-staffed: Stat meds must be hand carried. Delivering meds takes a tech off of order entry and pharmacy chores. Stat meds occur ALL of the time. Frequently, a nurse must leave the unit and go get stat meds themselves. STAT meds usually require the same nurse to give them. They are stat so it must be important, but that nurse must LEAVE to go get the stat meds.

AND this leads to:

Sedation drips. Diprivan is safe but being phased out by some inane logic foisted upon the populace by a few stupid physicians actions. (GI facilities with re-used syringes and bottles, cardiologist Murray killing a superstar, et. al.) We can grab a diprivan out of the machine at any time.

Versed, Ativan, Fentanyl drips are utlized in it's place but must be mixed and delivered by pharmacy. This is a huge increase in manpower and creates a stupid safety issue with an inability to quickly sedate agitated patients facing dangerous self extubation. This also creates a labour intensive (and ER doc expensive) reintubation with it's associated recovery periods. Don't tell me this doesn't occur.

Taking LABS to the lab. This is completely crazy. A nurse must HAND CARRY labs to the lab. There are a FEW lab techs that will take and deliver labs to the lab for us, but it also is dependent upon where they are heading throughout the hospital. Night shift says the lab does it all the time for them. Day shift must be special.

We try to staff for patients (and frequently can't do it safely) but we don't staff for visitors. In other words, we're already ******, but here comes the visitors. Many of them are nice and helpful.

I'm sorry, but most of them are not. ****** off visitors means lower scores, doesn't it? Visiting hours two times a day for 15 minutes a day shows that we have control of the situation and, believe it or not, nurses can PLAN their day and keep their patients safer. You tell them 15 minutes because this always turns into 30 minutes with getting them all in and out. With scheduled visiting hours we PLAN for the visitors, we schedule the ****-wipes, everything looks PEACHY when they come in, we are READY for the stupid questions, we answer them and we ALL kick them ALL out at the SAME TIME, no matter what, with SECURITY (what a concept, huh) always there to prod them out. The ICU critical care patients get to do what they are SUPPOSED TO DO, rest and sleep, and the hospital scores improve. There are less infection control issues too, with fewer people transferring infections, with fewer supplies being wiped out by repetitive visitors coming in every 20 minutes all day. THINK of the MONEY to be SAVED. Employees have LESS STRESS. EVERYTHING is BETTER with FEWER VISITORS.

ICUenthusiast · Jul 24, 2011

I think getting a pt from ER is generally never the best experience, but you learn to live with it cause it really really seems it doesn't get better regardless of what hospital you're at. (If someone can tell me all their admits from ER come up with everything properly in place, meds done and charted, etc, please let me know where you work!!!!!)

And Idk about other places but getting a hold of propofol is harder depending on how many surgeons want it .. Pharmacy has explained to me that overall there's a nationwide shortage of the stuff. That said, there's a cheaper sedating agent that's easier to get called Precedex. It's great for a lot of sedating but it hasn't caught on yet with the majority it seems..

And I can feel you with lack of help from aides/sometimes fellow nurses. It sucks, but you learn how to stand up for yourself and tell someone you need help. And if no one helps, you go to your charge... and so forth.

MikeRNWI · Jul 25, 2011

Not sure where you can get Dexmedetomaine (Precedex) cheaper than propofol or midaz, Dex costs roughly 55 dollars/200 mcg bottle, while Midaz costs about a dollar/mg.

Considering Dex is dosed in mcg/kg/hr, while midaz is mg/hr, that is a substantial savings. I cannot find a cost of propofol, but studies have shown it is more cost effective then midaz at sedation.

Just my 2 cents! Dex is a great drug when it works, but one we have often found issues with, especially since it should not be used for prolonged ventilation (i.e., more than 48 hours.)

czyja, MSN, RN · Jul 25, 2011

That said, there's a cheaper sedating agent that's easier to get called Precedex. It's great for a lot of sedating but it hasn't caught on yet with the majority it seems..
.

This is off topic a little, but i think precedex is much more expensive than propofol. Some hospitals make the doc jump through many hoops to get it. Also, be warned- it can tank a bp quicker than you can say jack sprat. I spent the better part of a night shift managing a pt's adverse reaction to precedex. Other than that, its totally magic- works by a entirely different mechanism than propofol or benzos.

soapaddictOH · Jul 27, 2011

Being an ER nurse, I can tell you that whay might help is having a pump ready if you know the pt is on a Levo drip. We call report to the unit before we take a pt up. The nurse receiving report know all about any drips the patient is on.

Or when the ED chartS they gave Vanco at a certain time, but when I mull it over a little later, when I get my bearings, and I realize that Vanco should have been still hanging when they arrived, and then I call pharmacy, and they tell me Vanco was NEVER dispensed for this patient.

In our ER the meds are done completely different than the floor meds. We don't fax orders down, and Vanco is a standard med in our Pyxis. How long are you giving them to run Vanco in? I always chart meds, fluids, etc that I give a patient. Why wouldn't someone do that? I am making the transition from ER nurse (9 years) to SICU nurse in a few weeks. Maybe I'll see the difference once I start working in SICU, but for the most part I think our ER does an awesome job. I hate taking a pt to the unit, and everyone is talking at the desk, and we are transferring the patient ourselves (2 people), hooking them to the monitor and waiting for the nurse or anyone to come into the room.

ICUenthusiast · Jul 28, 2011

Not sure where you can get Dexmedetomaine (Precedex) cheaper than propofol or midaz, Dex costs roughly 55 dollars/200 mcg bottle, while Midaz costs about a dollar/mg.
Considering Dex is dosed in mcg/kg/hr, while midaz is mg/hr, that is a substantial savings. I cannot find a cost of propofol, but studies have shown it is more cost effective then midaz at sedation.
Just my 2 cents! Dex is a great drug when it works, but one we have often found issues with, especially since it should not be used for prolonged ventilation (i.e., more than 48 hours.)

This is off topic a little, but i think precedex is much more expensive than propofol. Some hospitals make the doc jump through many hoops to get it. Also, be warned- it can tank a bp quicker than you can say jack sprat. I spent the better part of a night shift managing a pt's adverse reaction to precedex. Other than that, its totally magic- works by a entirely different mechanism than propofol or benzos.

Generally, I have a better time sedating with precedex.. I've had more issues with BP and propofol. And at least at my hospital, the pharmacist says they can get the precedex cheaper to the pt than propofol. I'm not quite sure why this is the case, but I've given up on understanding the quirks with hospitals and stuff like that. My general understanding from the pharmacist is the shortage of propofol nationwide has made it less cost-efficient to use propofol outside of OR, when we have the ability to allocate some propofol to the floor at least.

It's also not hard to get the precedex for the physicians here, but there's a lack of education of the drug. But in general, yeah I'm thinking more short term sedation. Versed will always be a great drug, but it's quite a hassle with some pts when they only need a couple days.. then they sit in the benzo fog for too long after! Ideally, propofol shouldn't be used for long term sedation either though..

MissBrahmsRN · Jul 28, 2011

i work intermediate, when we get a patient on gtts from ER or ICU we are ready with another triple pump and we exchange our pump for theirs so no need to even move lines around. and we NEVER hand-carry labs unless the tube system is down and that is very rare, the CAs will run the labs downstairs. i figured every hospital had a tube system, and if now, why on earth would you need an RN to carry blood around?? when i was a volunteer i carried blood products and labs all the time.