a new grad's gripes - page 2

I really hate it when the ED brings me a pt. on levo, takes them off the pump, doesn't tell me, and leaves the room, and then I take a pressure and the BP is TANKED, and I'm like CRAP! THE LEVO isn't even hanging! I have been a... Read More

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    Quote from MikeRNWI
    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.)
    Quote from czyja
    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..

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    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.
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    Perhaps you were just tired when you posted this, but overall it is really negative and you seem really unhappy about where you work.

    I really hate it when the ED brings me a pt. on levo, takes them off the pump, doesn't tell me, and leaves the room, and then I take a pressure and the BP is TANKED, and I'm like CRAP! THE LEVO isn't even hanging! I have been a nurse for like 5 minutes, and this has happened to me 3 TIMES!!!!!

    If this happened to me once, the next time I would have a pump available for all admits. When I admit a patient from the ED I always have at least 1 and usually 2 pumps available, I also try to be available when the patient gets to the SICU so I have the ability to ask any last minute questions.

    Or when fellow nurses who CLEARLY have MUCH easier assigments, or ONE PATIENT sit around and ******** while I run around frantically with a newly admitted, unstable patient. (This doesn't often happen)

    Are the other nurses assignments really so much easier, or are they just a little more experienced in caring for these patients? Have you asked for help and they refuse or are you expecting them to just know how busy you are?

    Docs that don't order labs for patients that REALLY need them. And then I have to choose between getting the info we all need to care for the patient properly, and doing things that kinda out of my scope of practice. Someone who had blood transfused the day before & was on K-phos doesn't get a CBC, BMP & phos, or ANY other labs to boot? Really?

    Someone who was transfused yesterday does not necessarily need aCBC daily unless you have some evidence of active bleeding. Depending on how much electrolyte supplementation your patient recieved, they may or may not need to have them rechecked. Did you ask the physician for his or her reason for not ordering the labs.

    I have worked in critical care for 35 years. Maybe you can find a mentor in the ICU you are working in that can help you be happier and more comfortable in the ICU.
    Good luck and I hope things get better for you.
    Nccity2002 and esie like this.
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    ....and you know what I hate the most?? New grads who always blame others for their obvious lack of organizational skills...
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    To the OP: I'm a year out and I'm still there many days. But you learn to tread water. And after switching units, I now know how important unit culture is to my professional satisfaction.

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