XYRNMN

Not suggesting you guys are doing it wrong, but research tends to show that if facility survival rates for proning are lower than average it is likely the pts are not being proned early enough in their course. Just a thought.

We use the Rotoprone as well, but there are times one isn't available right away so yeah we prone on the regular bed. Part of it is we gatch the bed a bit so that the top half is at about 20° and the lower half has been put in reverse trend so that when prone the person is kind of slumped over that hump in the middle. It's hard to explain but if you try it with a coworker and play around with the bed settings you can find a position that they can tell you feels halfway okay and keeps them from sliding down. Plus lots of pillows and we ALWAYS have RT at the head when proning/supining. ALWAYS.

I'm assuming that you're in the US and are talking about going on an international trip to a poor or underdeveloped area to participate in vaccination clinics or other stuff like that, right? Teams (nurses, a doc or two, and sometimes other disciplines) from my Twin Cities hospital go just about every year to Guatemala, Nicaragua and Vietnam. It usually involves staff from several hospitals, not just mine. One place to start if you're trying to find out if anything like this has been done at your facility - go talk to your Director of Nursing or Chief Nursing Officer or whatever they call it there. He or she will likely know if nurses from your hospital have participated. In addition to staff going on a trip, we keep "mission boxes" on most units where if somebody opens up a Femostop or a suction kit and realize you don't need it but it's still clean it gets put into the box. Before the actual trip somebody goes through it and figures out what stuff may be useful in that environment (in the US just about everything is one-time-use-only; much of the world re-uses or repurposes equipment/supplies/devices many times over). Then those things are shipped over in advance (so they don't cost $$$ with the airlines).

This.

No worries. :) I think the general public gets the idea from TV; patient goes flatline and they whip out the paddles and save him.

Gonna pick a little more at that nit... The GOAL of defibrillation is to get back a viable rhythm, but the act of defibrillation itself does not restart the heart. Defibrillation overwhelms the heart's electrical system, stunning it, leading to a momentary cease in all electrical activity. Then, if the myocardium has enough oxygen it will restart itself in an organized rhythm. I know, details, details, but that's the business we're in.

In my Twin Cities ICU (MNA union) there is no hourly diff for having any certification. There is, however, a yearly 'bonus' of something like $350-500. Not nothing, but nothing super.

My wager is that immobility is the more likely component. Well, that plus something else that increased coagulability of the blood.

In my Twin Cities area ICU the pt and the machine both get a nurse, so, 2 RN's in the room - this is for as long as it is felt that it's necessary, then if the pt is stable (in ICU terms) then it's a 1:1. Never will the CRRT nurse have another pt.

It's been a few years since I posted to this thread, but here's another one: On my former med/surg unit I worked nights. When walking up and down the halls it was habit to glance into open rooms, you know, just to make sure nobody's on the floor or anything. On one trip back to the nursing station I half-glanced into 309 and as I passed I though, huh, who was that lady sitting in the chair? So, I doubled back to check, the room was completely empty but the rocker was slightly moving. I wasn't terribly exhausted that night, I felt like I was thinking straight, so, I don't think this was a delusion. Down the other wing, several times, I had various patients ask me to "please tell those children to stop running in and out of my room, they're noisy and it's hard to rest". (Paraphrase, of course.) This happened in the middle of the night, no visitors were around. And, this unit used to be a peds floor years earlier. Weird. It's one thing if you have a dementia pt, a sundowner or someone in DT's say these things, but when you have a mentally intact patient that's not on any narcotics say the same things, it gets your neck hair standing up.

Yay for me!!! I've been working 12 hour nights for over 6 years now in a very intense med/surg unit, and have become completely burnt out in that capacity. Applied for HH within the same company a week or two ago, had an interview this morning, and got a call with an offer early this afternoon! (I gotta remember to thank my references!) So, this is gonna be a HUGE change with a steep learning curve, but it sounds like the orientation/preceptor program is quite comprehensive and is 3-6 months long. I don't have every detail yet, but I'm gonna be issued a laptop & pager, and there's cellphone reimbursement, mileage reimbursement and sounds like there will be some cool tele-monitoring gadgets in some of the homes. As a technology nut, I'm looking forward to learning about new devices and things. I am taking a pay cut, about $5 an hour less than I'm currently getting, but most of that is due to the $4 night shift diff. But it's worth it in my opinion. I'm just so glad to be getting away from nights; it's really gotten hard to deal with the twice-weekly jetlag and never being able to do anything fun in the evenings with my wife and/or friends. I still have to work a month more in my current unit, but that'll be a snap since I have the new job to look forward to. Anyway, I'm just super excited about this change and figured I'd post it here since I already have called all the people I wanted to tell about this awesome news! :) -Kris

Our e-clock rounds everything from x:55 to x:05 as clocking in at x:00. If you swipe your badge at x:06, it rounds it to x:15 and you are late. As far as serious tardiness, I believe that if you arrive one minute past a half hour after your scheduled start, it is as bad as a No Call/No Show. Even if you work the rest of the shift, it's still as serious as an NC/NS. After one of those, you meet with the mgr. After two, you meet with mgr + HR. After three, you turn in your badge and start looking for a new job. Personally, I like to show up 15 minutes before I have to clock in. Like someone else mentioned: early is on time, on time is late. If you start out running behind, your whole shift can be screwed up. -K

That's so right on! I love that doc's response: "Oh my...", I'm 'picturing' an english accent in my head as I read that. Squirrels on crack, I love it!!! :rotfl: -K

Yep, the nice thing about Zofran is I can fairly confidently tell my pt that it will either relieve the nausea, or do nothing at all. Pretty much zero adverse effects, in my 7 year experience. I'm sure there are exceptions, but it's really nice to have a drug like Z that you know will have pretty rapid positive results. I still occas. give Compazine, but like I said earlier, I take great care in administration/dosing and I am frank and up front with the patient beforehand that if they've never tried Comp. before they might experience some unpleasant effects for a few hours. I don't scare them, I do mention that it's only in an unknown smallish fraction of the population, otherwise the drug wouldn't be on the market at all. But, having experienced firsthand the unbridled wrath that Compazine has on my brain/body for several hours, I really really don't want to subject any patient to that. That said, I've seen it work very well for many patients, but it does demand due caution. -K

Don't have the time right now to detail my at work routine, but here's my between-shift routine. 12 hour nights, 45 miles away. Get off at 0730, leave ramp 0735, get home 0820, call wife who is already at work at 0830, eat a bit until 0840, lights out 0900. D*** alarm sounds at 1625. S&S&S until 1650. Get dinner going at 1700. Wife gets home 1710. Watch news while dinner cooks. Eat around 1730-1740. Get on scrubs at 1750. Out the door 1755-1800. Arrive in ramp at 1840. Punch in on the unit at 1855. 3 on, 1 off, 3 on, 3 off, 3 on, 8 off.... Rinse and repeat as necessary. ~K