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Ellen in Ont

Ellen in Ont

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  1. Ellen in Ont

    Christmas in the spirit or not?

    I truly believe you get out of Christmas what you put into it. Not that it has to be done in a hurry - the exact oposite. I always try and be completely ready by Dec 1 (except to put up the real trees - two of them). Then I can relax and enjoy the holiday. I start thinking about next years gifts while I am at boxing day sales. Everyone on my list gets a present that shows that I have chosen it just for them and shows that I have taken an interest in their lives throughout the past year (remembering if they say they like a certain something or that they just painted their bathroom and get matching towel for example). The gifts represent not an obligation for me but a sign of my love. My greatest joy at Christmas is watching others open them. I do the baking a month in advance so that I can take my time and put the extra touches in it. I love giving these homemade goodies to everyone who comes to visit or to people who don't have the time to do it themselves. I go overboard with the decorations both inside and out because I enjoy the pleasure it brings to everyone who visits. The decorations have been collected over the past thirty some years and taking each one out brings back wonderful memories. My cards are always mailed early so mine will be the first one everyone receives and remembers (I chose them the year before at the after Christmas sales). The fact that I have to work over Christmas (12 hour night shifts the 24, 25 and 26) only causes a little sigh but then I am thinking about how to make it a better time for the other staff I am working with as well as the patients that have to spend the holidays in hospital. My house will be filled with family staying with me for the holidays and I am thankful that my brother doesn't need his open heart surgery until after the holidays so we can all enjoy the time together. On the 26th I am giving a big supper with all the trimmings for about 15 people and then work that night again. I am thankful that I don't have to stay and do the cleanup. My oldest son won't be home Christmas day for the first time but I am happy he and his new wife will be home for the 26th for supper. So Christmas is all in your attitude and your heart. You make the decision on how you will handle the stress or commercialism or the fact you have to work. You make the decision about whether you will be happy or not. I wish you all a very Merry Christmas in your heart. Ellen
  2. Ellen in Ont

    Refusing an assignment

    For the first time in our ICU, last month we signed a workload grievance. When we recognize the conditions are unsafe, and we have gone through all the channels to correct this, the workload grievance shifts the blame back to the hospital. The staff who signed it now have to have a meeting with the union and administration to deal with the issue. We still haven't had this meeting however. This doesn't fix the workload that shift or result in any immediate fix, but it is the only way to move for change that the hospital will sometimes listen to. That night we had 6 patients, five of whom were vented and the sixth was a fresh post-op who was extubated after just a couple of hours to put the ventilator on someone else - we only have 5 vents in the hospital. We only had three staff after 11:00 pm (the RT also leaves at 11:00). The only way we made it through the shift uneventfully was that WE WERE LUCKY! If any of the patients had started crashing, it would tie up at least two of the three staff leaving the other one to handle the whole unit. Luckily it was an unusually quiet night and everyone was stable.
  3. Ellen in Ont

    smallpox link

    A smallpox outbreak has always been my greatest concern. That is the scenario I have been trying to plan for. I recently contacted Dr. D. A. Henderson (one of the original people who eliminated smallpox and currently is head of bioterrorism defence at John Hopkins (this is not his correct title - I will try and find it and post it later). I asked him if it was possible to use arm to arm transfer of vaccine if the supply of vaccine ran out. Here is his reply. "The scheme you propose could be done. In fact, this was the technique employed for propogating vaccine throughout most of the 19th century. The problem is that such as Hepatitis B and C, as well as HIV, can be transferred in this manner and so, unless one's back is really against the wall, this is not a technique to be advocated. D.A.Henderson " I would like to know more - for example how much do you use, how do you actually do it, can it be collected and mixed with say saline to dilute it to make it go farther, how do you lessen the risk of bacterial contamination, can it be dried and stored etc. Many questions and very hard to find answers.
  4. Ellen in Ont

    Question about Jackson Pratt Drains & retention sutures

    In our hospital all RN's remove JP's, hemovac's, sump drains and penrose's as well as all types of sutures, central lines, arterial lines and epidurals. We do have policies for all of these and are watched for the first one. I thought this was standard nursing procedures everywhere? One thing to watch for when removing retention sutures, if it looks like there is a lot of tension on them, I start by removing every second one. If the wound looks like it might open I stop and report this to the doctor. I also sometimes use steristrips in place of the ones I removed if it looks like there is still tension on the wound edges.
  5. Ellen in Ont

    Is NTG appropriate? (Cross-post)

    This probably isn't as in depth an explanation as you can get from others but here goes. We use Dopamine often with NTG (either patch or gtt) and as well add Dobutrex at times. All have different effects that can help when someone is having a problem with cardiac output. Nitro does more than dilate the vessels of the heart to improve perfusion there. It also causes general vasodilation which reduces the afterload (pressure the heart has to work against to eject it's volume of blood). This might also reduce the blood pressure but by adding Dobutrex and Dopamine it increases the preload and pumping efficiency of the heart to increase the forward flow of blood. Dopamine has different effects at different rates. At 2mcg/kg/min it is having no effect on the blood pressure, it is only increasing renal perfusion. To get it to where blood pressure is effected it needs to be at more than 5 mcg. The blood pressure your patient has is perfectly fine for having a Nitro patch on and I wouldn't even hesitate to start a Nitro drip on her. We only start getting concerned when it goes down to the low 90's. But then you can increase the Dopamine to compensate. If you had a Swan in her you could see the improvement in cardiac output when the Nitro and Dopamine and/or Dobutrex are adjusted upwards. What I would be more concerned with is a rise in heart rate from the Dopamine which reduces filling time and therefore cardiac output. She might need a beta blocker added (she probably will have this if her Troponin comes back positive). Hope this helps.
  6. Ellen in Ont

    How is code blue announced at your facility?

    Our hospital is a "quiet hospital" which means the overhead paging system is only used for the different codes. We have code blue followed by the room number, code pink for a pediatric code, code red for fire, code yellow for missing patient followed by a description, code black for a bomb threat, code green for evacuation etc. The only other thing announced is nurse assistance followed by the unit (that unit needs nursing help for up to two hours and any unit who can send someone does) or nurse alert (which means a nursing emergency and they need nurses stat for a short time). It is a big shock to go to other hospitals where the paging system is used almost constantly. I appreciate the quiet in ours even more. We do use the code blue even in ICU because other staff also come to all codes (RTs, ER nurse (usually records there), security (can act as runners if needed) and pastoral care to sit with the family). Instead of the overhead we use the phones or pagers for everything else.
  7. Ellen in Ont

    HELP with skill please!

    One other trick. If there are no open areas or incisions on the patient's leg, I find they go on easier if you use baby powder on their legs first. Don't worry, you'll get it.:)
  8. Ellen in Ont

    Do you mix your own IV's?

    The only premixed IV fluids we use are Lidocaine and Heparin. Everything else we mix ourselves. KCL is treated no differently than any other drug in our stock cupbaord and is even kept on the shelf beside the 10 and 30cc bottles of NS and sterile water. This has always made me a little nervous. Now I think I will ask about at least having it moved to a separate location.
  9. During the first "Survivor" episodes, I heard a cute saying that would fit here. You are sooo off the island!
  10. Ellen in Ont

    ER or ICU?

    I agree completely. They are totally different and have completely different focuses. If you really want ICU then apply for your apprenticeship there. It will go a long way in getting a job there when you are finished. It will also give you a feel for the ICU and help you to decide if that is the area for you.
  11. Ellen in Ont

    Anyone Here Interested (or already in) Nursing Informatics?H

    You chose not to get e-mails through your profile so you will have to get replies here unless you change it. I have been an ICU nurse for 11 years and I have also done some work in nursing informatics (I co-ordinated the introduction and training in a workload measurement system in my hospital). I definately believe you need some experience in hospital before you start into informatics. You need to understand what it is like at the bedside. Nursing informatics involves teaching these nurses to incorporate computers into their work and you need to be able to see it from their point of view. If you are interested in technology while nursing, there are many areas that offer this. ICU and Dialysis are very technical and I am sure there are many other areas depending on your hospital. Just my two cents worth.
  12. Ellen in Ont

    Why 12 hr. shifts???

    I love 12 hr shifts. I get a lot of time off between working two or three in a row (I am part-time). I also like the extra 4 hours per shift it gives you to get everything done. The rare times I have worked 8 hours (called in in the middle of a shift), I have been running to get everything completed. The extra time makes the shift a lot easier. You are also usually giving report to the person you took report from 12 hours ago. It makes it simpler and improves continuity. Of course you don't have much time or energy left over for housework or the family when you are working, but I find that knowing that if I just work these two days, I will be off maybe 3-4 days or longer, makes up for it.
  13. Ellen in Ont

    A nurse is a nurse is a NURSE???????

    In reply to CraigB-RN, I have worked in a 7 bed ICU in a rural hospital for 11 years. I also have my CCRN (or the Canadian equivalent, CNCC© (certified nurse critical care Canada). We are the only ICU within about 220 miles. We accept all kinds of patients (Peds, Post-partum, Medical, Cardiac, Surgical, Respiratory, and when the weather prevents evacuation to another facility (we are in Northern Ont), we must manage burns and head injuries until they can be flown out. We also do not have the Internist or Surgeon present 24 hrs/day and no respiratory therapists at night (we can set up and manage ventilators and make adjustments according to ABGs). Just because we do not see the Surgical acuity that you do, do not assume that our knowledge and experience does not count the way yours does. I respect the expertise of nurses in specialized units but feel that my knowledge is just as beneficial in studying for the CCRN exam. I am not trying to start an arguement, just trying to show another point of view.:)
  14. Ellen in Ont

    Painfully Slow Process

    Start with this organization: Canadian Organisation for Advancement of Computers in Health (COACH) http://www.coachorg.com/nisig/ Let me know if you need more info and GOOD LUCK! Angela[/QB] Thanks for all the information Angela. I'll check it out. Ellen
  15. Ellen in Ont

    Painfully Slow Process

    Congratulations on finding your niche! I have been considering this field for a while now but love where I am at present (ICU). However, my aging body isn't going to last there until I am 60! I have always loved technology and even have some experience. I was the co-ordinator for implementing and maintaining a computer-based nursing workload measurement system. I trained them not only in the system but also how to use the computer. I am also on the team developing and implementing computerized charting (Meditech) in our hospital. These things are almost as fun as my regular job! :) Do you have any information on certifications available in Canada or any organizations up here? I need a starting point for my search for information on this career choice.
  16. Ellen in Ont

    Drug seeking patients?

    I agree that we should be aware of the possibility of addiction in patients who constantly ask for pain medication. This has never stopped me from treating all requests for pain meds as legitimate, only allowed me to use my assessment skills in dealing with pain. Pain is one of my priorities and I treat it aggressively. However, I have seen a few cases where I believe they were misrepresenting their symptoms in order to get the meds. I work in an ICU/CCU and only last month we had a patient admitted with chest pain. He watched TV, read, joked with family etc when he didn't think we were looking. As soon as he saw us approaching his room, he turned off the TV, hid the book, stopped talking to family etc and started rubbing his chest and looking distressed. There were no change in his vitals, no ECG or enzyme changes. After treating his pain aggressively for about three days with IV Morphine, Nitro gtt etc.with no change in his complaints, the doctor ordered the IV Morphine changed to Tylenol #3. When I told the patient this, he became very angry, refused the Tylenol #3, stated he had "better stuff than that at home", also said "why didn't you tell me that the doctor was going to D/C the Morphine this afternoon - I've wasted hours here", and signed himself out. I still aggressively treat all complaints of pain but I also use my assessment skills to assess other reasons for frequent requests for narcotics.