neuro nursing

shay · Aug 25, 2002

Bump so someone sees it .

BadBird, BSN, RN · Aug 25, 2002

It depends if they are on the floor or ICU but I believe that you would have more Neuro checks, more trips to CT, possibly more IV medications if swallowing is a issue, a lot of neuro patients need a tremendous amount of emotional support and so do their families. Some of these patients are paralyzed and need total care. Patients with SDH can be a handful trying to climb oob, you don't want to let them fall and hurt themselves and sometimes restraints get them more worked up. On a regular MS floor the doctor might order ativan or haldol but with neuro they don't like to mask anything so you just have to deal with these poor patients the best you can. It can be very trying when understaffed and working a long shift but it can be very rewarding to see them recover. Check out the neuro forum you will get a lot more info there. Good luck.

Nurse Ratched, RN · Aug 26, 2002

At our facility ortho and neuro are paired on the same unit. Is this common in other places? If so, you'll get to do a lot of hips and knees, too! :)

NurseDennie, BSN, RN · Aug 26, 2002

I've done unit and floor both.

It's very, very, very interesting. You get a lot of experience in a short amount of time. Labs are incredibly important in neuro patients, little minute changes in any one of a million little variables can indicate the patient's about to step onto that slippery slope.

It's very, very, very physical nursing. You get a lot of people who need total care. They may or may not be conscious. They may or may not be able to swallow.

Staffing problems seem to be especially bad on neuro units/floors. There are usually openings, because a lot of times a nurse will be hired and realize that neuro is just not for him/her and move on.

If you work long enough in neuro (and how long "long enough" is, varies from nurse to nurse) you WILL be hurt. I guess that's true in other services, too, but seems to be especially true in neuro.

Some changes in personality that go with neuro problems equate to being a jerk. I had a 35 year old patient attempt to remove his IV with his teeth when I was getting him discharged "Fast enough." I thought that was indicative of some neuro problem, but it turned out he just was a jerk. Ah, well, live and learn.

It's like every other nursing job in the world. Incredible highs and incredible lows.

Love

Dennie

rncountry · Aug 26, 2002

Worked neuro trauma unit several years ago. And yes, labs are incredibly important, as well as nearly constant ongoing assessments. It is highly physical work, and like NurseDennie said, at some point you will likely get hurt. I have two incidents that will always stand out in my mind. One a head injury who had been acting fine grabbed both ends of my stethoscope which was hanging around my neck, and tried to strangle me with it. Kicked over an IV pole to get someone's attention as no one was at the desk where video monitoring was done on every room. The other one was a drunk, three days out, who planted his foot in the middle of my chest and kicked me across the room into the wall. He got 4 point restraints!

The other end of that is the very independent nature of your practice, at least where I was. The docs expected you to be able to order appropriate labs, etc... with a crashing patient or even one who was changing, so that when you called them all the ducks where in a row. I also loved the detective type work that I did sometimes, you know something is going on with the patient, but don't know why. Get various labs and so on and then put the pieces of the puzzle together. Neuro is very precise, there is not room for areas, and often snap decisions have to be made now. It makes for a very intense place to work. I loved it for two years until I started having nightmares about my kids on vents. Had many bad traumas right then and it just got to me. When I was divorcing and needed a day job which the unit didn't have available I left. Sometimes I miss it badly, particularly because I enjoyed working with nurses who were extremely careful with everything they did. Other times I don't miss it at all. I don't miss ducking and diving from head injury's, and I don't miss the intense sadness one sees. It did make my practice a very precise one though.

If this is what you feel you really want to do then go for it. You never know until you try it.

nimbex, RN · Aug 26, 2002

Our neruo unit has only 4 beds, 3 neuro surgeons... never any overflow. This unit takes fresh post op craniotomy's with ICP monitors and drains.... tremendous fluid resusitation monitored through CVP and arterial line monitoring, never swan ganz catheters. Usually vents and MANY standing orders for vasoactive drips.

It is a very challenging unit because you can't see the brain.. just the symptoms of changes, which are hard to decipher with multiple diagnosis and pre-existing conditions.

You can't "put them down" with drugs because you'll need to monitor their mental status so confusion and climbing out the bed is common, but the patient ratio.. Max 3 stable patient per nurse with a tech or two nurses for 4 patient is what makes this safe.

Although not for me personally, this is a very challenging a rewarding place in my hospital that many nurses LOVE...

You'll get many MVA's (motor vehicle accidents) with multiple body system traumas and you'll learn so much every day

I'm not a floor nurse and have tremendous respect for you:kiss so to me... this is a great opportunity for you professionally if you want the change... you'll focus on a specialty... as floor nursing seems to be task oriented and you can miss the "why am I doing this" with the tremendous load that you carry.

let us know what you decide....have you considered contacting the manager to arrange a 4 hour observation of the neuro unit to determine if it's right for you?

JMP · Aug 26, 2002

Lots of confused pts. Lots of total care pts.

Very physical. Good lead up to ICU .....if you want that.

NurseDennie, BSN, RN · Aug 26, 2002

Oh, and I love the neurosurgeons. The branesturgeons.

99% of the ones I've met have been too cooooool. The ones that haven't been have been the baby docs (residents) not yet trained up the way they need to go.

The other thing that's cool is even on the floor, you get the odd miracle recovery. I mean, I know you get them everywhere, but it's just SOOO cool to see somebody that you were breathing for a week or so ago, starting to be able to talk.

Love

Dennie

blue42 · Aug 27, 2002

Thanks everyone for all your helpful input. I actually just graduated last May and took a job in the recovery room. It is very interesting and challenging, but I am having some issues with a lot of aspects of the job. Mainly, although I am learning a lot, I feel like maybe I am missing out on parts of floor nursing, such as time management, etc., just the basics of nursing. And I have always been fascinated with the human brain and all the neuro disorders. So I don't know how much longer I am going to stay at my current job. Can anyone give advice ? Am I missing out on necessary experiences I need to get from floor nursing? I am very confused.

caroladybelle, BSN, RN · Aug 27, 2002

Lots and lots of totals, families in denial, physical labor, and critically ill people.

Sorry, I would stay in Oncology any day over Neuro.

bestblondRN · Aug 27, 2002

You either love neuro or hate it. I guess the reason I love it is the complexity of the patients and the need to constantly be observant for subtle changes that indicate a problem. It's very challenging in that regard, so if that's what turns you on, go for it!

Yes, there is a lot of physical labor involved. These patients are as total as total care gets, but usually a neuro staff are pretty good about helping each other with those aspects of care.

Are the families "demanding"? Well, that depends--I don't think it's different from any other area of the hospital, but you will spend LOTS of time educating families about the various disorders. I think the chronic population (MS patients, seizure disorder patients, etc.....) are the most difficult ones, and their families can be equally as difficult. A new brain injury or spinal cord injury is like any other acute patient--lots of education needed coupled with the challenges of stabilizing the patient. I used to have a stroke family education and support group once a week to address questions and provide consistent information--P.T, Soc. Work and Nursing ran the meetings. Generally excellent turnout.

I hope you are still considering Neuro after everything posted here--it's challenging, but very rewarding.