WalkieTalkie

lol, yes, conSERvation, not conVERsation... darn auto-correct :)

I'm not sure about my current hospital, but a unit similar to the one you described in my old hospital was 1:3-1:5 depending on acuity and shift (nights had more patients). Your assignment sounds INSANE and UNSAFE!

My hospital does a "blood conversation" approach for all patients: Blood Management Program | Saint Lukes Health System NoBlood - Transfusion alternatives. Blood management.

Sir, you are 30-something years old. Whining, flailing around, causing drama, and wigging out are not acceptable behaviors in an ICU when you are completely alert and oriented. I understand that you are in pain and are anxious. However, you have refused every remedy available to treat your pain. I have offered you morphine, Dilaudid, Tylenol, Ativan, and Xanax. You have refused each one. In addition, asking for "my momma" and causing a scene all for an IV start is pathetic. You are not mentally handicapped or otherwise incapacitated. Get over it! Oh, and when momma arrives, you should really listen to her, because she's getting annoyed with you too!

I've been on nights for 7+ years. I have met most of my friends through work!

Amen to this! I would actually think it would be more sanitary to have a tampon which is changed at regular intervals, than to have a Foley with a pad. I know it's going to sound gross, but it seems like a Foley in contact with a saturated pad would be a breeding ground for bacteria, as the blood is a great growth medium! I wonder if anyone has ever done research on this particular subject? Heh...

Some of the nurses I worked with at my old job have started taking Provigil, and they really like it! They told me it has helped their sleep/wake cycle immensely. These are all nurses who have been working nights for a long time and who still have problems with their sleep/wake cycle. As for your heart rate, it's possible Provigil could speed it up. It certainly is a possible side effect. However, you won't know unless you try it. I take Adderall daily for AD/HD. It doesn't make me tachycardic unless I take multiple doses cuncurrently of something like pseudo or phenylepherine when I have a cold. You'll just have to be cognizant of this if you try it. I'd ask your doctor for a short script, like maybe a 7 day supply just to try it out. As far as drug tests are concerned, modafanil is not included in a standard drug screen. In addition, it's generally ok to test positive for medications which you take for conditions such as AD/HD, sleep disorders (narcolepsy), and for other medical conditions being treated by your physician. If you are concerned about whether or not you can take a medication at work, contact your state's board of nursing. Personally speaking, since I do take Adderall, I obviously test positive for amphetamines on my drug screens. This has never been a problem for any of my employers. The nurse or physician responsible for the results will ensure that the script is legal, and it doesn't result in a problem for me personally, as the information is confidential in your employee health record. I'd rather have a nurse who is awake than one who is halfway asleep, distracted, or otherwise unable to be completely alert!

Wow, called the Missouri BON today and spoke with a super friendly lady who was glad to help me out. She said as long as she can verify my Nebraska RN online, I should have a temp license by the end of the week. Great news!

The unit I used to work in is half full of CV surgeons who don't mind if you give a little volume. Unfortunately, the other two surgeons are micro-managers who want to be called for every measly change that could easily be fixed with protocol fluid orders. Because of them, we currently have no PRN fluid bolus orders on our post CABG order sets. I'm hoping this is different at my new job.

If it makes you feel any better, I saw an anesthesiologist intubate a patient and he couldn't figure out why his sats sucked after he had him tubed. Well, as it turns out, he forgot to hook the ambu bag up to O2! It happens to the best of us!

Thanks for the tip... I will give them a ring!

I don't know if anyone has any suggestions for me, but here's my story... I am currently licensed in Nebraska and I moved to Kansas a week ago. However, I will be working in Missouri. Initially I was told that I could work with my Nebraska license for 30 days until I got my endorsement. Apparently I don't qualify for the 30 day grace period of working in Missouri with my current compact license because I live in Kansas (a non-compact state). I'm so incredibly frustrated. My Nebraska license expires on October 31st. I had originally inquired with Kansas about whether or not I needed a license here too. They acted like I needed a Kansas license to be endorsed in Missouri. I got all the paperwork filled out for Kansas, thinking I'd apply for my Missouri license once I moved because I believed I could work for 30 days on my current compact license. Unfortunately, I later found out that I don't even need a Kansas license! Thankfully, I hadn't sent in the paperwork for Kansas before finding out that I didn't need it. I was completely misled by the Missouri BON's website regarding my compact license. I even called their robophone and it basically states something to the effect that one can work with a current compact license from another compact state. I finally got a hold of someone from the Missouri BON by e-mail, and she said I can't work with my Nebraska license since I now live in Kansas I'm set to start hospital orientation on Monday. I'm extremely worried that I will be in trouble or out of a job because I don't yet have my Missouri endorsement. I sent in all my paperwork sans the fingerprints Tuesday. I wasn't able to get a fingerprint appointment until this afternoon. I guess I'll just call the Missouri BON after I get printed and let them know I'll be mailing them my receipt. I really hope that they can get me a temporary license quickly. I'm kind of freaking out here, and I feel like an imbecile for being so mistaken about this whole process. I guess I don't understand why it matters where I live for 30 days since I still have a valid Nebraska nursing license and it's a compact state. I completely understand the need to endorse my license in Missouri, but why can't they let me use my current license? Does anyone have any suggestions? :smackingf This is why every state needs to be a compact state! There's a reason we all take the same test!!!! *sigh*

Personally speaking about Ambien, I used to take it occasionally for insomnia. I would get up and make whole meals in the kitchen and not remember it until I woke up in the morning to find a kitchen full of dirty dishes. I once even bought some stuff on eBay and didn't know it until the package showed up at my door! My girlfriend said I would wake up and have entire conversations with her, but I wouldn't remember any of it in the morning. Aside from that, I have had NUMEROUS patients go bananas after taking Ambien. One patient who had been completely alert and oriented prior to taking it pulled out his dialysis line in the middle of getting SLED. Another patient got confused and thought it was time to get up and go to dinner at 0300 (he kept asking for a couple of hours). He ended up halfway out of bed after taking it. Thankfully he didn't accidentally pull out his new LVAD! The worst experience I had was a 80-something lady, who went from sweet to evil within 30 minutes of taking it. She actually ended up drawing blood on my poor new orient! Keep in mind, these are only a few of my examples! The saddest thing that has happened related to Ambien, is the death of a friend of mine who took it for insomnia. One night after taking it, she got up and went for a drive in her car on the wrong side of the interstate. She did not have on her seatbelt. She had an accident and died. It was very tragic. Keep in mind, this girl was very familiar with the area, and would not have "accidentally" driven on the wrong side of the road. In addition, her toxicology screen showed Ambien as the only drug in her system. I wholly believe she would still be alive had she not been taking this medication. My rule of thumb with Ambien is this: If you are over the age of 60, I will not give it to you unless you have taken it before and the doctor has scheduled it for you. For some reason, the elderly seem to be more hostile and aggressive than younger people after taking it. Younger people seem to have more of the "sleep walking" effects. In general, I am hesitant to give it to anyone who hasn't taken it because I have seen so many things go wrong. I will try just about anything else listed under a patient's PRNs for sleep because it seems like 3/4 of the time something bad happens after a patient takes it. If a doctor suggests Ambien for sleep, I will ask for another med for my patient. I HATE AMBIEN. On a side note, my father takes it every night for sleep and has no problem. I guess if it works, it works, but IMHO, too many people have problems with it, and it's not safe.

I had the same thing happen to me with a patient who'd gotten a heart transplant. He was on pump a long time and had vasoplegic syndrome. Giving him lots of Neo and Vaso helped.

:yeah:EXACTLY!!!