pebbles 6,640 Views
Joined: Jan 5, '02;
Posts: 561 (11% Liked)
; Likes: 126
17 year(s) of experience
Trauma acute surgery, surgical ICU, PACU
I will do them if I think a pt will truly benefit and isn't getting relief from other therapies. I actively resist if the pt "expects" it, in the same way they expect hotel service. It's a nicety on top of regular duties that I give if I feel motivated.
Emotional intelligence is not a replacement for inadequate support from management or HR.
i have to add my to this post, a month ago we received a pt. at er unconscious, however, on his chest it stated "no blood products" .:redlight:
In my ICU, I took care of a former ICU nurse once who had attempted suicide, written DNR on her arm with marker, and called 911 after a while. It was pretty awful on an emotional level. She was "one of us". I think she was full treatment because she was suicidal and therefore "not competent to make treatment decisions". It's one thing to joke about it, but to see it like that was hard....
We have had two new grads hired recently into our unit that previously never hired new grads. It's been a learning process for everyone. We have a VERY acute ICU, and a lot of pt turnover, movement, etc. We've also had people recently come from very sub-acute backgrounds (such as rehab or nursing home) to the ICU and seen that sometimes it just doesn't work out. Sometimes it does, but sometimes it doesn't.
I really feel that only a "strong" new grad, one with critical thinking skills who can think on her feet as well as in a classroom can truly handle ICU. The trouble is, if a person is so new and hasn't worked in other settings as a nurse, how do you know their strengths.
When people are overwhelmed, they don't learn. We have one new nurse that really hasn't learned very well and isn't becoming proficient after more than a year - because she is overwhelmed. I don't even know if she knows how much she "doesn't get" yet. People don't make any noise when they are drowning and that is very important to remember. It can be taxing on the staff around a new grad to watch her patients as well as their own, constantly guide, mentor, teach, etc. If the new grad is strong, she will learn and become more independent. I have seen that happen too, and it is very gratifying. But if she is not coping well, it can be tough for everyone.
I get a bit frustrated at the new nurses who chase the allure of the ICU and pooh-pooh what can be learned in acute care medicine or surgery. You don't just learn the time management BS "that I won't need in the ICU anyway so why bother learning it". You learn to tell sick from not-sick, when to really get help, how to manage basics on your own, how to communicate with sick people and their loved ones in a less critical setting, lots of valuable skills. It's become frustrating lately to be at work, look up and realise than none of the nurses around me can really be relied upon to handle a crisis because it is taking them sooooo loooong to get through the learning curve.
Some new grads can do just fine in an ICU that has good support systems in place. I would talk to your manager and educators about how you are doing relative to their expectations. NOBODY is expected to be an expert right out of the box. Feeling like you aren't managing is normal in the first year no matter where you are working.
Localizing would be a pt reaching to his ETT when suctioned or reaching toward your hand to stop you when you apply painful stimuli. Withdrawal is just simply pulling the limb away from the pain.
I always try to remind myself that being extremely self-absorbed can be a huge aspect of the sick role - for a pt and their family.
I remember one guy I had while I worked on a surgery ward, took it so personally that I wasn't cheerful and waitressy. "You could at least smile!" He snarled.
When I told him I just wasn't smiling because I was concentrating on not making an error with his IV pum programming and that I was also worried about another pt of mine who was "very sick", he knew not to take it personally, and we got along much better.
I don't think "There is someone else who is very sick" violates privacy, it just gently lets them know that they aren't the centre of your world, without hitting them over the head with it.
My father in law still, several years later, takes issue with a nurse he had who was not cheeful and didn't offer him a basin or a warm blanket.... I remember visiting him the next morning after this, and he asked "what does code blue mean?" - It means your nurse was too busy to worry about a warm blanket and you should just have asked and not begrudge her the fact that you had to ask! Geez!!!
Amazon.com: The Doctor Will Not See You Now (9782895072430): Jane Poulson, John
I read this book a year or so ago and found it very interesting and enjoyable. Yes, this doctor must have some help from others to assess her patients. But she is absolutely the one doing the doctoring!
If it were me, I'd say let me sleep.
Oh yes. It was years ago, and it actually still haunts me, so I feel your pain.
The family hovered over me all night. for three weekend nights in a row. They snapped and snarled at me when I asked the pt basic assessment questions. ("Are you having any pain?" - "SHE HASN"T HAD THE SURGERY YET followed by a glare"). Yeah, some people have pain even before they get thier tumor removed, sue me for asking. They made unreasonable demands. I basically got zero breaks for 3 nights in a row because they were so demanding, and I could not get adequate time to work with my other pts. It was awful.
Then they went to my manager on monday and said that I had ignored their mother's pain, that there had been no nurse in the room for hours at a time and that they were given no information.
I was lucky. My manager was a good one, and I had good documentation. This pt had an epidural, so I had been documenting my frequent assessments, plus comments on the vital signs records about all the care assessments and interventions, explanations, etc. Complete with times to the minute, showing how often I was in that room and all that I did for her.
My manager showed this to the family and asked them if they were saying that all this was a lie - and they had no response.
My boss actually phoned me at home to talk about this and ask where all their anger was coming from.
Probably poor coping and needing to lash out, we figured. The pt had symptoms for months and had been sent away by numerous doctors before actually getting some tests done and finding out she had stomach ca.
After that she was moved to a different ward and I hard the family were terrorizing staff there too.
But to me this is no excuse. We are not figurative punching bags for people to manipulate or take things out on.
If I get a sense that a pt or family are getting "angry" in their coping, I do some CYA charting and make sure my general documentation is detailed and specific.
I took care of a pt who died in our trauma step-down as a result of severe fractures she got from falling out of a hoyer at a nursing home. Turned out the sling hadn't been pushed properly into the slots on the lift arm. The CNA who had taken the short cut that day and lifted her alone to get it done faster was absolutely devastated.
I have no knowledge of what (if any) disciplinary action the CNA faced, but in this case the family were understanding about it being an accident - they were the ones who wanted to hurry as they were taking their mom out for a family outing - and also she was elderly and in very poor health. But still.
Florence Nightingale faced some pretty stiff opposition to some of the changes that she tried to bring about to cleanliness and lifestyle in improving the outcomes of soldiers. And that's just what's known and documented about her life. Never mind the fact that she tried to bring about change and she was a women with little or no power! There was a LOT of politics and rules that had to be done and gotten around so nurses could do their jobs back then - and in any age. It's life.
I think the disillusionment hits us all sooner or later. It does suck that all this politics affects the patient care. But you know what, it always did. People who are good nurses will be able to see through all that, deal with the politics in time and still be able to reach patients and take care of them. It's hard in the first year or so. But don't lose heart. Once you find better ways of dealing with "the politics", you'll find your groove again with the patients.
Don't romanticize the past - the past was way worse than you imagine.
This is a VERY common thread topic if you go back a few pages.
You might want to look at some of the other "new grad ion ICU" threads as well....
It's a mixed bag and it really depends on the supports in place and the expectation of your employment.
In *my* hospital, a new grad out of school would never be a safe consideration for ICU because we aren't set up to preceptor and educate them. Others are different. We are a tertiary care centre, but the smaller community hospitals in my area have always hired and trained new grads. Therefore, opinions will vary. You should not go by what people from other places and the internet tell you, you should look into what programs there are in your location and whether other new grads have been successful in ICU's there.
Tips for getting into ICU as a new grad? - Nursing for Nurses
Does a Med-Surg preceptorship placement hinder an ICU position after grad? - Nursing for Nurses
i want to start off my career in icu once i graduate - Nursing for Nurses
New Grad BSN to start in MICU - Nursing for Nurses
New Grad starting off in ICU - Nursing for Nurses
I'm an experienced nurse.
The reason I don't post too much on this forum is that I have worked in the field of nursing for 11 years and reading all these threads on here is sometimes like reading work stuff. I'm on a couple other online communities for nurses that aren't as active as this one too. The sheer volume of what's posted on here and the small amount of threads I find interesting, stimulating or relevant to my own working life means I can see however many pages of threads and still feel like there is not much I want to say in them. YOu've also seen how some of the same topics come up repeatedly, that has an impact as well.
My time off and my break time, I just prefer to do other stuff. I'm more choosy about which threads I want to post in now. It could be that the majority of posters are people who just haven't gotten to that point yet. The world of nursing is so new to them, it's all interesting, it's all worth hashing out in discussions. So they are more active.
I work in an SICU and our biggest problem is VAP....
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