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dontbetachy90 BSN, RN

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  1. dontbetachy90

    Feel like I don't know anything

    I did misunderstand! Looking for trouble where none exists No worries!
  2. dontbetachy90

    Team player

    I judge each situation differently. When I am in report with the other charge nurse going over 24 patients and Miss True tells me "she kind of don't got time to run and get a boxed lunch," I tell her that I am in report, I ask her if she knows the process for obtaining extra lunches after the kitchen has closed, and I let her know that she can delegate that task to a clerk or nursing assistant, but that I cannot help her. When she commands me to do an ultrasound IV, I ask probing questions, such as whether she has tried for herself (because that is our policy) or if one of her peers has tried yet, what the patient needs the IV for/if they need it right this moment etc. If the patient truly needs the IV and I don't sense a task is simply being dumped onto me for the sake of dumping, I will make it a priority. If it's not a priority for me, then I let her know I have such and such that I must deal with and if she needs it sooner than x amount of time, she may call the SWAT nurse. I don't always refuse to help when I am being offered these demands, and I would never intentionally not help someone simply for the sake of putting my foot down, but I know when I'm being manipulated or condescended to and the task is something that she can handle on her own. I'm a fairly patient and reasonable person. In your opinion are these behaviors something I should address with my manager, or just chalk it up to a nurse with a bad attitude?
  3. dontbetachy90

    Please help - need to get over shyness!

    I agree with you that being quiet and being shy are not mutually exclusive traits! I think if you start small, as others are saying, you will slowly grow more and more confident. Achieving this may not necessarily make you more talkative (unless your comfort level with your peers increases), but it will help improve your shyness so that when you DO have something to say, you can do so confidently without those feelings of nervousness. All it takes is a little bit of confidence to accomplish anything you need to, and this truly will come with time. It is wonderful that you recognize this as something that you can improve upon in order to become a stronger, more well-rounded nurse. Good luck!
  4. dontbetachy90

    Unstable Angina Pre-CABG management

    I wrote this from memory so forgive me for lack of accuracy but this was written in the impression on the stress test: "large fixed defect at the inferior posterior wall highly suspicious for underlying infarct "
  5. dontbetachy90

    Need advice

    As a step-down/progressive RN, I agree here. Interventional cardiology is a nice place to be (pre/post cath, PPM/AICD, post-TAVR, etc, though every one is slightly different) but in my opinion, you would benefit more from cardiac step down if your plan is CCU. On step down, you will have more patients which will teach you time management and broaden your knowledge base in terms of caring for a variety of acute and chronic diseases. In addition you will also have very ill patients, sometimes patients that should probably be in ICU but are not deemed hemodynamically unstable enough given some policy (on high-flow oxygen/bipap and maybe not responding the best but not requiring intubation yet, blood pressure not low enough to require pressors but still low enough to keep you busy and make you nervous, on an insulin drip but not DKA, etc.) That, and you will bounce your patients back and forth to CCU on occasion, you will have codes (any floor can have codes, but step down affords you plenty of coding opportunities), you will still likely see and even recover some cardiac interventional patients, the list goes on. You will also get your fair share of overflow patients as well. Some of your patients will be ambulatory, some of your patients will be total care on multiple drips, tube feed or TPN, with drains and tubes coming out of every which way. Step down is a great place to start because like I said, you will see a little and a lot of many different things, and you will build a strong foundation as a nurse in general. From there, you can pretty much take your skill-set and knowledge base anywhere. Some brand new nurses start out in ICU and do fine, and others say they wish they had the foundation and basic skills mastered prior to transitioning to ICU. Everyone is different! I hope you find what you are looking for and best of luck!
  6. dontbetachy90

    Unstable Angina Pre-CABG management

    I agree, which is why I am scratching my head. Isn't unstable angina considered ACS? And how can we be sure he was not having an acute MI if we neglected to investigate further with additional trops and repeat EKG? The patient had no interventions performed during cath, shouldn't the goal be to keep him chest pain free until surgery? It was not as though he had a history of PCI/CABG/CHF and was maxed out on medical therapy, ranexa and imdur etc. The resident did not agree with any of it, and left me baffled and questioning my practice. Still scratching my head, by the way...
  7. dontbetachy90

    Looking for options/opinions

    I agree with the other two comments, here. Acute care nursing is a tough gig; our patients have acute and chronic diseases that need managed, we are micromanaged like no other to meet certain standards, we are not only nurses but social workers, pharmacy techs, computer specialists (not literally of course but you get what I mean), and on top of it, we take the brunt of the frustration from patients, families, and MD's who believe all we do in a day is pass meds, clean poo, and click on boxes. And as you said, we do all of this with what WE believe to be improper support. It can be downright miserable, but it does pay better than most other nursing gigs. Are you on day shift? If not and if it is an option, would you consider transitioning to night shift? The hours may seem dreadful to some, and the staffing is certainly no better, but there are obstacles that days must face that simply don't occur as often on nights. I worked with a (now retired) nurse who worked all over -- cardiac step down, pre-op, ED, mostly day shift, who wound up spending her final 20+ years working night shift on my cardiac intermediate/progressive unit because she was fed up with the crud that was day shift. Have you and others discussed these concerns with management? Are they offering incentive pay to get more people to work? My hospital has been offering $40 incentive over base pay for nearly 2 years now in attempts to alleviate our staffing issues, though lately, even that is not enough to make people want to come in. There is just something about our line of work that we nurses are not thrilled about, hmm, what could it be? Take some time to explore other options -- maybe a smaller facility that is not quite as busy would suit you better? One of the hospitals in our area is considerably smaller; we have a nurse who used to work on that cardiac step down who transitioned to ours and was blown away by the difference in patient population and how busy our unit was, as ours is intermediate and progressive care and theirs was intermediate only, but more akin to a cardiac med-surg than anything. A smaller hospital's ICU, while still challenging in a variety of different ways, may not be as chaotic as a PCU or step down, where your ratios are higher but your patients are sometimes just as ill as those ICU patients. I also know a nurse who works in home health and loves it, but picks up per diem at the hospital when the incentive pay is being offered. Forgive me if I have been babbling, but I can surely empathize with your struggle, as can many others. I hope you find something that suits you better! Sometimes a change of scenery is all you need, even if from one area of total chaos to another. Good luck!
  8. dontbetachy90

    Team player

    Manipulation is key here. I work with a nurse (call her Miss True, because nothing she says is true) who TELLS ME what I will do to help her, especially when I am charge nurse. "I'm gonna need you to do this ultrasound IV." "My patient needs a boxed lunch, I kind of don't got time to get her one so I'm gonna need you to." "You're going to go in there with me to talk to this family about code status." There was a time I was watching another nurse's patients while she was on lunch and I went to assess a patient who was crying out in pain. The nurse heard the cries from the break room and came in to see what was going on. Then, in walks Miss True, coming to save the day as always and push my incompetent self aside. When the patient was crying and speaking intelligibly, Miss True looked me square in the face said, "She told you to go away" in a rude, flat tone. I do my best to be respectful to all, and make it a point to ask each person how they are doing and if they need help on any of my shifts, especially when I am charge. As rude as that nurse is, I still ask if she's doing okay and offer help (and follow through, of course) when things get hairy. Like someone else said, don't get down and roll in the mud with them, but don't let them walk all over you, either. Take note when they are unfair, condescending, and rude; when the final straw has been reached, you will have an arsenal to help plead your case. I have yet to go to my manager because I haven't felt so totally violated by her petty behaviors, but I can imagine there will come a day. Work relations are such a drag sometimes.
  9. dontbetachy90

    Please help - need to get over shyness!

    I agree with the previous comment, and I would like to add a few things as well! There is nothing wrong with being a quiet, introverted person, so personally I believe it is worth asking yourself why you wish to change this about yourself? You said it yourself -- your patients are appreciative of the care you provide, and you are able to adequately provide care and advocate when necessary! What about your practice makes you feel as though you need to change something about yourself that is so innate, such as your introversion? You say it is confidence you need; why do you feel are you not confident? Are you simply not confident enough in yourself to carry on conversations and make friends, or are there other areas you wish to be more confident in? For instance are there things as a nurse you don't know the answers to, or are you struggling in certain areas, like problem solving, therapeutic conversation (obviously if you are shy and not very talkative, this can be tricky!)? Do you feel anxious when having conversations with or making phone calls to physicians? Or are you worried that you are not well-liked by your peers, and do you wish to be part of the group that chit-chats and participates in work-outings? I ask these questions because as someone who is quite introverted myself, I struggled quite a bit with feelings of anxiousness and a lack of confidence when I first started as a nurse, as well. I was an anxious wreck any time I had to pick up a phone, or walk into a room with more than one family member, or have a crucial conversation with a coworker. It took me well over a year to really make friends with my coworkers, too., though this was not as difficult for me as the other things I mentioned, like phoning physicians or handling a disgruntled family. My struggle with feelings of anxiety has been ongoing, though it has improved dramatically. Yes, that anxiety has affected my confidence at times, but as the months and years go by, the mere exposure to these situations and seeing that I can (as you mentioned of yourself) adequately navigate through sticky situations to achieve my desired outcome, gives me more confidence. And who's to say how much confidence is enough, or not enough, or too much? That is subjective. My advice to you is to, like I said, examine exactly what it is you wish to achieve. Keep in mind there are a variety of nursing styles, and every nurse has their strengths and weaknesses, and it is this diversity that makes a team great! Some nurses are experts at critical thinking in emergency situations, some are the best therapeutic conversationalists known to man, some can multi-task like there's no tomorrow. Some people can do all of this, but are still not chatty with their peers. Some nurses have awesome relationships with their coworkers, but their patients greatly dislike them. You see what I mean? Figure out what your strengths are and build on them! The more you do this, the better you will become, and the confidence you build as a result will spew over into those other areas where you feel less confident. Start small. As for your work relations, ask people how their day/evening/shift/patient/dog/family etc have been doing, remember details about them. Compliment people, but only when you really mean it! (i.e. don't be a suck up.) Even if you are a little awkward, they will remember that you are attentive and caring and genuine, and may be more apt to include you in conversation. Recruit your coworkers to help you accomplish tasks. "Hey, Lydia. I know you are excellent at smoothing things over with really upset family members. I have this patient whose daughter hates my guts and thinks I can't pack wounds to save my life, would you mind helping me with this dressing change? I need some back up in there." I'm mostly kidding, but you get the idea. Let your coworkers know when you DO value their strengths; they will appreciate it. The little things add up over time. If they still exclude you, well, maybe you don't want to be friends with them anyway. Let work be work and friends be friends, and don't mix the two. Anyway, I hope I was able to help at least a little bit. Hang in there! You're doing better than you think :)
  10. dontbetachy90

    Dilated Cardiomyopathy

    Cardiac intermediate/progressive care RN here! I am sorry to hear this diagnosis has been sprung upon you; as a nurse you know that ANY new diagnosis can be troublesome and overwhelming, and as you mentioned you "aren't stressed," I'm sure you have thousands of questions buzzing through your skull. Did your husband have his cath yet? I can imagine one of a series of things has occurred: Perhaps he received stenting/PCI, or maybe given his AR and depending on the degree of vessel disease, he is a candidate for surgery. At any rate and as you know, there will be a series of medications he will be expected to comply with, and it is possible depending on his symptoms that he may be referred to cardiac rehab. As a cardiac nurse I of course advocate for rehab for patients, if anything to really help them get a grasp on their disease process and management strategies as well. As I'm sure you know, the main goals of treating cardiomyopathy include managing conditions that contribute to the disease, controlling signs and symptoms, stopping or slowing disease progression, and reducing complications and the risk of sudden cardiac arrest. Sometimes after PCI/revascularization and medical management, alongside risk-factor modification, patients can expect improvements in their eject fraction. Other times, they may become candidates for AICD/CRT therapy if arrhythmia become an issue. As you know, every patient and every situation is different, but lucky for him you are a nurse worth your salt and can help him navigate through "the human stuff." As a family member, you have every right to "be that awful RN family member," the key is knowing when to be "that nurse" and when to trust and let the doctors and nurses and specialists do their thing. I have faith that you can navigate these waters appropriately, but in the event you find yourself being a little too much to handle, know that those actions are more forgivable than many nurses would even admit. (I say this with a smile!) We are silly to expect family members, especially nurses who in all their glory are still trained to prepare for the worst possible outcome, to be cool, calm, and collected when faced with the immense amount of stress a new or scary diagnosis may bring, let alone a hospital stay where the food is sub-optimal, sleep is hard to come by, and everything dings and rings and rattles. Wishing you and your husband the best!
  11. dontbetachy90

    Feel like I don't know anything

    Shame on me, indeed. I misinterpreted the message and thought brownbook was calling the OP dumb for asking such questions, and was attempting to stick up for OP. Shame on you for shaming me and shame on me for shaming you! No worries, here.
  12. dontbetachy90

    Feel like I don't know anything

    I'm a little late to the party. @brownbook , I apologize for making bad assumptions on this forum. That is the trouble with the internet, JKL33. I don't necessarily think my response that you find so unflattering, which I believe I had rectified by explaining why I responded the way I did, warrants you calling me "tachy," even if you think my username is cute. Remarks such as this are unnecessary entirely, and even a little bit bully-ish, which is the reason this conversation is occurring in the first place (because I wrongly assumed brownbook was being a little witchy to the OP. My mistake.) To each their own
  13. dontbetachy90

    Unstable Angina Pre-CABG management

    I recently encountered a situation in which a 60-something male with no PMH aside from 30 pack-year smoker was admitted for unstable angina, troponins negative x3. Probable large inferior infarct on Lexiscan, cardiac cath showed severe 3 vessel disease - circ, LAD, RCA all 80% occluded or more with severe left main calcification, no collaterals mentioned on cath report, EF 25-30%, no PCI performed, started on ASA, metoprolol, statin, and subcutaneous heparin BID. Basically I feel like this guy was one cigarette, a burp and a fart away from a lethal infarct, but hey. This occurred on a Friday, and the patient was planned for open-heart surgery/revascularization for Monday (no surgery over weekend unless emergent). That night, the patient began experiencing 10/10 burning CP radiating down right arm while at rest. HR 45-55 sinus brady, BP 154/80. One SL nitro resolved his pain and dropped his pressure to 99/60. The cardiology resident (brand new this month academic teaching service, not one of our usual MDs) was notified and did not wish to obtain EKG/troponin recheck. At this point the patient admitted he had been having SEVERAL episodes of this chest pain since the previous day without disclosing it to staff, and reported that he was having pain at rest whereas before, it was only with exertion; this info was relayed to the resident. This raised some concerns for me. Now, in my experience these types of patients earn themselves nitro/heparin infusions until they are ready for surgery, even with negative trops. Given inferior blockages, we use IV fluids (cautiously of course given EF) for BP support. I am inquiring whether that is common practice or the standard elsewhere as well. When my nurses and I expressed our concerns (twice) and asked whether the patient was appropriate for nitro/heparin etc, s/he said, "No, the patient is having angina, his trops were negative, this is chronic disease, we can't just put him on heparin and nitro. He already had a cath and now he is getting surgery. Continue to use SL nitro." (This conversation went in circles for 10 minutes and I felt as though we were being talked over the entire time.) This is not how I am used to seeing these types of patients being managed pre-operatively so I wanted to see what others thought. Thank you!
  14. dontbetachy90

    Feel like I don't know anything

    Perhaps just a different perception. The "voice" in my head as I was reading was not a pleasant one especially when she said the bit about these being dumb questions. To each their own, but yes, maybe I was being a bit sensitive
  15. dontbetachy90

    Feel like I don't know anything

    ( in response to brownbook ) Why so hateful? These are valid questions from someone who perhaps needs a little boost of confidence or reassurance, not for you to be confounded and invalidate these concerns merely because you did not have access to such a tool as this forum. Shame on you; I hope you never precept new RNs.
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