ap_NRN

Heck no, you are fine. I worked a neuro med surgical floor (not nearly as critical as yours) and it was standard to receive an order to open up a csf line and allow up to 20-30 cc to drain into the sterile bag over 20 minutes. This was explained to me coming directly from a neurosurgeon. He did state that you don't want to do more than 30cc at a time, though. The body would have a tough time creating more csf to keep up at that point, and patient would probably experience a wicked headache. Hope that helps:)

Are you at magic or treasure valley? I know their system well, they are the only ones that use the term "HUC" anymore. It is interesting to me that they are attempting to change policies like these when they really should focus on their pay scale, which is not at all competitive. I've since left the state for greener pastures. I have no advice, just good to hear from another one of us in the trenches:)

I feel you, ThePrincessBride. Love the username by the way. Just the other day I was discussing this issue with some coworkers. An alert and oriented visitor was using the patient's shower in their room and when confronted *nicely* about it, he screamed, attempted to throw me into the nearest door (I saw it coming so I dodged thankfully), then violently kicked a portable computer into a wall. He was escorted out of the building. A week later I came back and he was in the room AGAIN. I'm like . Management's response? "We talked to him and they threatened to leave AMA, so he promised not to do it again if we didn't anger him and we shook on it." Ok, super cool Did I mention that he also liked to LURK around the nutrition center downstairs at night, like a CREEP, and every female that witnessed his violent fit (he's a large, 6+ foot tall dude) is no longer comfortable going downstairs for lunch on night shift OR to our poorly lit parking lot to grab something. I got the usual "he promises to be better" crap when I mentioned female fear with him there. From EVERYONE. I've been doing this for 10 years, and I'm a millennial. I'm tired of being treated like total trash. If I wanted to be paid like **** and treated like a punching bag I would go back to my prenursing job at McDonald's when I was in my teens... I'm pushing hard for an NP and then I'M **** OUT. I'm not looking in the rearview mirror. Sorry for all the cusswords, I'm as tired of it as you are. You're not alone. Bye, Felicia:roflmao:

I've been in your shoes, VeraT. About 7 years ago I got a needle stick injury from a positive Hep C patient that jerked away during a blood draw, poking me. I immediately washed the site and notified management. I was terrified, and probably didn't sleep for a week. After the first year, my doc was confident I never got it and I never got symptoms. A little secret- I went back and retested myself 2 years in a row because it kept me up at night sometimes, but it was always negative. I wish there was someone with experience that could have told me it would be ok and what the odds were, but maybe I can share and be that someone for you. It WILL BE OK. The odds are enormously LOW. Trust me, I spent weeks researching the heck out of it. You can request some time off with PTO under sick leave if you need time to breathe. I did this, and it was so worth it. Spend time with your friends and family, and try not to focus on it. I found out later in my career that many MANY nurses have been through this so you are not alone, and it is far from uncommon. You will get through this! After all, if nurses weren't tough this industry would have died out a hundred years ago.

Our unit is stroke certified with spine surgeries and tele and 36 beds. We are magnet certified on EPIC. Step-down takes immediate strokes, we take them 24 hours post TPA. VS and neuro checks are hourly for all stroke/brain surgeries/lumbar drains. If a nurse takes 2-3 brain/strokes, ratios are 4:1 which includes a surgical patient (or two, if we are short staffed). If a nurse has 4 brains/strokes, it stays 4:1 with no taking on any fresh post ops and keeping same patient assignment next day. We are a 500 bed small hospital in a rural state in the west.

And to think I was cocky enough to believe there is nothing left out there to disgust me, Ive seen it all... umm nope!! GAG:barf02:

Thanks all. Appreciate the feedback:)

Apologies for the long post, but I am very frustrated and would like to hear from my home health and hospice peeps on this one. I currently work for the second largest home health and hospice agency in my area and have been there about a year. I was originally hired to do on call 3-day weekends for hospice, as outlined in my job description. Since then multiple changes have occurred in the workplace, from structure to job description, to expectations, and nearly every nurse has quit in both agencies. The turnover is extremely high throughout the year and this agency hires a lot of travelers. Long story short, my experience at this company has been rocky from the start, including inexperienced supervisors (we have been through three since last year), promising that my license points for speeding in the last 3 years would not affect my ability to apply for the job (they decided to give me a write up my first week, stating they had forgotten about the point policy when they hired me and this would appease management so I could keep my job), very poor training and orientation of case managers, and lack of support on the job. This resulting in poor coordination during the week and 18+ hour days on weekends for me (like ordering multiple meds and delivering to homes, visits for needs/supplies that were not addressed by case manager during the week). Fast forward to 6 months, and I was informed a weekend back up nurse would no longer be available. We have had a steady but busy census around 30-40. When I brought up the possibility of staying up all weekend due to workload/lack of backup and driving tired/dangerously, I was told this was unlikely to happen and things would be fine. Wouldn't you know, this very scenario began to occur at regular intervals about one weekend every month. At the 8 month mark of employment, I was informed the on call nurse for HH had quit and I would be taking over call, admits, and visits on weekends for home health in ADDITION to hospice. Home health census is larger, around 300. I was told I would have a backup nurse for HH if things got chaotic. I was told this was a temporary situation as they were interviewing applicants. This was four months ago. This entire year has been awful but the last 4 months have been a special kind of hell. I am salaried for 40 hours (both work and on-call time included) and now regularly work (boots on the ground, excluding call time) 40-50 hours every weekend for both agencies, with no backup for hospice (which can be much busier). It's a 50/50 shot that the backup nurse for HH will answer the phone, so no backup there either. This basically means I am not getting paid for being on call. I could work during the week for 40 hours in the hospital, not be on call, and make the same amount of money. At this time a typical weekend is around 40 patient calls, 5-7 visits/day, 2-3 admits per weekend, and no sleep from friday night to sunday early morning. Recently I had a weekend with a death and an admit (requiring extensive assistance for discharge from inpatient to home) that were occurring at the same time, resulting in poor care and pissing off both families. I had also been up for 30 hours straight without sleep. Attempts to contact my supervisors for assistance went unanswered (this is typical). I am at the end of my rope here. I planned to use this job as an entry into hospital case management in the future. I feel like my position is being abused, but have nothing to compare my experience to. Does anyone here consider this experience on par with this specialty? Is this normal? Or do I need to just tough it out? I'm considering a position in hospital CM or utilization review, but I'm not sure if I have the experience (3 years LPN, 2.5 years med-surg RN). A friend of mine was hired into hospital CM with 1 year experience, but I think she just knows the right people. Any comments/advice from hospice and home health nurses greatly appreciated.