Bagboy

I'm happy to report that most nurses in the US aren't doing it either. Yep, it's abundantly clear that you are not like most of us. I mean "most" of us aren't on a forum condemning a huge group of people (none of which you actually know) for what a small minority NOT even on this forum are doing. I know very few nurses who are doing any of the stuff you're railing about. Social media uses algorithms that learn what your viewing habits are, and then they feed you endless amounts of it....making that content seem far more common that it really is. Did any of us say it's cool...or that that's what professionalism is about? You're coming on here just looking for a fight. Meanwhile, we're just chillaxin' and thinking, "Who the *** is this raving lunatic!?!?" It would have been easy enough to begin a conversation about the topic, solicit feedback, thoughts, etc without going into attack mode and making yourself look like a fool. ??‍♂️

This is an ancient thread, but still great conversation. :) I have a hunch that the docs are charting triple flexion because they're not convinced the movement is anything more than a spinal reflex that can be stimulated in even brain dead patients. I see charting like that in my Neuro ICU as well. I'm in a Critical Care Consortium right now, and in the neuro lecture, the educator told us to not use the lower extremities when using painful stimuli to determine the motor score. He referenced the American College of Surgeons' Trauma Quality Improvement Program (TQUIP). So I looked it up.... https://www.facs.org/quality-programs/trauma/tqp/center-programs/tqip/best-practice In the section entitled Management of Traumatic Brain Injury, it mentions: "The location of the stimulus (central or peripheral) should be standardized and used consistently. To describe the motor response, only the reaction of the arms should be observed, not the legs." I think if you actually scored true triple flexion, it would get a +1, because it does not reflect any cerebral function at all. I see nurses pretty routinely crank on a toenail bed, and when the patient moves the extremity, they say, "She's withdrawing from pain" and score it a +4. Unfortunately, in my neuro training (which was pretty recent), the pain reflex, spinal reflex, withdrawal reflex or whatever you want to call it, is something that was never discussed. But it seems pretty important to know. I'm attaching an interesting conversation on Reddit about the topic. The highlights are mine.

I'm learning the NIHSS, and having some problems with terminology regarding "Best Gaze." I hope some of you brainiacs can unravel this for me in simple terms. "1 = partial gaze palsy - abnormality in one or both eyes, but forced deviation is not present. If the patient has a conjugate deviation of both eyes that can be overcome by voluntary or reflexive activity, the score will be 1. If a patient has an isolated peripheral nerve paresis (CN III, IV, or VI), score a 1." I *think* the "partial gaze palsy" means that one of the eyes is not able to completely move along the horizontal plane because either the medial or lateral rectus muscles aren't being properly innervated by CN III or VI to pull the eye either left or right. What is "Forced deviation"? I also don't understand the part that says, "...that can be overcome by voluntary or reflexive activity." Also, how am I supposed to know, "If a patient has an isolated peripheral nerve paresis (CN III, IV, or VI)"? I'm looking on Google and YouTube but just can't seem to wrap my mind around these terms!!!!

I can't figure out how to navigate that website to see particular specialty listings. It just lists "Registered Nurse 2," etc. Anyone know how to better navigate it?

thth21, are you still working there? If so, are you still really liking it? I just applied today.

Not sure what you mean about finding Nevada "scary." I've known travel nurses who have worked in Vegas as well as some who used to work there as regular staff nurses, and they all spoke positively about the experience. It was nursing just like anywhere else to them. Is there a specific example of what you mean?

Curious how folks are liking Renown Regional in Reno. I'm looking to shift gears and move into ICU nursing, which I've not done before. Anyone in the ICU currently?

Wolf at the Door, curious about the reputation of Sunrise that you mentioned. Is that from the nurse perspective or stuff reported by patients who have been there? When I think of reputation, I'm most curious as to whether a hospital would be a quality working experience (learning opportunities, support, etc). I've worked at some places that fit that criteria, yet plenty of patients would tell you the place is garbage for one reason or another. You probably know how that goes. Patients get pissed off at Hospital A and feel inclined to go to Hospital B and with evangelistic zeal tell everyone there within 10 feet of them how terrible Hospital A is. Haha.

Why ICU? I like puzzles. In dialysis, I've spent years going to every corner of the hospital to dialyze patients, and ICU is by far the most interesting and challenging to me in terms of trying to understand the disease process, therapies, etc. It's intriguing walking into an ICU room where there's a train wreck and trying to put all of the pieces of the puzzle together. And the more I learn, the more interesting it seems to become.

Thanks for the reply, ICUman. I have both of those on my radar. I've virtually walked right into every nursing job I've had without much problem, which was pure luck. Haha. I'm wondering if they will be wanting only nurses with prior ICU experience? Any with particularly bad reputations to stay away from?

Hi, everyone. I'm contemplating moving to Vegas this fall from California. I started my nursing career with three years in a large Kindred Hospital (LTAC) along with a couple years in an ER. The last 8 years I've been the Dialysis Clinical Coordinator for DaVita at my current hospital. I'd like to get into a good ICU but have zero ICU experience. Any Vegas info, tips, recommendations? I'm seriously nerdy (love to study and learn) and really want to buckle down and be an awesome ICU nurse.

This pretty much nails it. I'm an RN and never have wrapped my mind around how some RNs get on this holier-than-thou kick. I abhor the memes I see about nurses saying their job is to keep the docs from killing people, etc. It's totally demeaning, unprofessional, and makes them look like fools. I can't imaging working in critical care without the help of the awesome RTs!! I've always had really great relationships with them and found them indispensable to the team. They are literally partners to me. I'm not superior to them one bit. We work together; we collaborate. I need them, and I can't express how much I appreciate them! RTs rock! :)