Elibri

Yeah, I was kind of surprised to read that you thought you would be able to be hired at that same hospital. That'll say anything at your exit interview/firing. IDK what to say about divulging that on your resume. Some places will retain the right to fire if you lie on an application. However, for obvious reasons, it'll be difficult to show a 3 week employment. If you do divulge it, you could try to spin it. Be honest and state the truth and then say that there was a personality/culture clash, and for a variety of reasons, you and the director decided it was best to not continue on a 12 week orientation if you weren't going to be a good fit for that unit/hospital. You wouldn't want to waste their time/resources/money, etc. Most HR people would see right through that. But, may also respect your honesty in the matter. I will say...that I don't think you should work LTC if that was not your original goal. And once you get hired by a new hospital, DO NOT let your anxiety over the last affect you moving forward. Act as if it is your first job post-grad and do your best. In a few years, none of this will matter. And you absolutely will work L&D again, if you work towards it. Good luck!

We've been doing this for some time. For our vented patients, we use pain control and some sort of sedative. We've switched to using Precedex more often. It can cause bradycardia and hypotension, takes awhile to titrate for effect but doesn't suppress respiratory depression so its great for weaning. Pt's can be on a low dose, awake alert but comfortable, not pulling at anything. I love it. We also use Freedom splints. They wrap around the elbow to prevent bending of the arm. It's supposed to prevent them from reaching for tubes, lines, drains, etc. Not fool proof but allows you to have more time to respond if they do reach something. I've noticed a few things....patients actually are more comfortable (for the most part) than when in restraints. They become less confused. 4 side rails are not considered a restraint when pt is sedated or on beds that actually turn the patient (safety issue). I employ family members and friends to keep the patients company and be their "sitter," unofficially of course. I am still closely monitoring but it gives me some breathing room to take care of my other patient. This usually works well in my experience bc it gives the family a job. They feel useful, don't bother you as much, and usually end up becoming exhausted, going home to sleep and thanking you for a job they just realized is harder than it looks. LOL. We also developed an ICU delirium policy that proactively assesses for delirium amd medicates..usually seroquel or some other antipsychotic. We stay away from benzos and benadryl bc it makes delirium worse. And after awhile you'll love it bc you won't have to do the restraint charting. Before this went into effect, I used to come on shift and remove restraints for certain appropriate patients just to avoid restraint charting. And as for sitters, we tried to get rid of sitters bc the money spent was ridiculous. But, they have realized that you do need them in certain cases. And there is a big difference in medical restraints vs behavioral restraints. Also, something we'll do in the ICU if we do have sitters, is actually chart in the room at the bedside on the WOW! to allow the actual sitter to help out the other nurses with their care and toileting of other patients for a certain amount of time. Or also if I'm gonna be in the room awhile giving meds or doing care, have ghe sitter round on other patients. You just learn to get creative. As with any change, theresna transition phase. Sorry for the long post but hope these ideas help.

I hope you are a preceptor, in advanced practice, education, or some sort of role where you can mentor, educate, and support our fellow nurses. Many of us have the same knowledge but the way you explain things and put it into perspective is your talent. If not already, i hope you look into further educating the nurses of our profession. Very well worded and educated response.

The more I've read of this thread, it seems likely to me that the patient came in with septic shock, complicated by her HF with EF 20%. Pt at high risk for arrhythmias. Usually these patients receive a defibrillator (AICD) just for that reason alone. also, zofran prolongs QT even further and someone with EF of 20% likely already had some ekg changes and possibly a prolonged QT on ekg. Along with all the other things that have been mentioned. But, still this lady died from acute chf exacerbation and cardiogenic shock sec to pna and septic shock. Great case study.

Yup! Ya gotta fill the gas tank before you start pumping. Using levophed on a septic patient that is by definition profoundly intravascularly dehydrated along with a reduced EF of only 20%, is a disaster waiting to happen, if not carefully managed. There should have been some modest fluid resuscitation at least. Maybe then followed by some lasix. But her EF of only 20% is the key factor here. Anything under 30%, you run the increased risk of arrhythmia's even under normal circumstances, along with dehydration, neosynephrine and (probably) not adequate fluid resuscitation, and you have the perfect storm. But, this is not to say that what was done was wrong by any means. This is simply life, there are so many others determining factors...time being the biggest factor. Could they have intubated to adequately fluid resuscitate her, would the heart have made it through that, would there have been enough time to give her fluids gently but yet adequately to prevent multiorgan failure (which obviously was already happening)? Point is, this lady came in with a low chance of survival. Its why i tell everyone I know that they should never wait to bring in the elderly. They're like children...they compensate, compensate, compensate, until they don't and then they crash.

Excellent, excellent response. I see too often that we intervene with patients based on standards of care without taking into account the individual patient. This is where the critically thinking nurse comes in and is so important. And, not to go into too much detail about this topic, but this is the expertise we're losing at the bedside. We are hemorrhaging experienced nurses and i feel bad for the newer generation coming in that won't have that mentorship that is so desperately needed. And i must say that you did absolutely nothing wrong in the care that you provided. In fact, this is how we learn. By going back and remaining the thjngs that happened.

Exactly. I understand that people must work, take care of children, and have little time for a variance in their schedule but how about having some of these family members rotate their visitation schedule throughout the stay? If its that important, someone will be there.

HUGE difference! And the prioritizing of all the other details of the situation can't always be translated in a post. Who knows what else was going on. I totally get what the OP is saying. It's always when you least expect it that some crazy event happens.

Unfortunately i feel like people responsible for staffing will say anything to get a warm body there