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FashionableRyanRN

FashionableRyanRN

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FashionableRyanRN has 1 years experience.

FashionableRyanRN's Latest Activity

  1. FashionableRyanRN

    Is this a sentinel event?

    You're totally right. What's weird to me is that we get lumbar drains and EVDs ALL THE TIME--daily--and some patients dump a lot more and a lot faster than others, especially depending on a multitude of factors. For instance, if I have a super combative and wild patient with an EVD in 5-points, he could still be moving around enough to dump 10-15 mL of CSF in a matter of 5-10 min. This is to be "expected" of such a patient in this situation, though we should always do our best to keep the patient as calm as humanly possible (neurosurgeons HATE paralytics and sometimes don't like sedation based on patient prognosis). However, it's a crime to everyone on my unit that I took my honey sweet time drawing off 10 cc in a controlled manner, and according to an order from the neurosurgical team? It makes no sense....The lines are super blurred here, in my opinion.
  2. FashionableRyanRN

    Is this a sentinel event?

    I work in the neurosurgery ICU, and on my unit, the typical unspoken protocol for drawing CSF from EVDs mandates drawing off an absolute maximum of 1-1.5 cc of CSF for labs/cultures over 1-1.5 min (at an approximate rate of 1 cc per min) when we receive CSF collection orders. Ask my manager and my supervisors and this is what they tell you. This is also what preceptors on my unit will teach; however, I cannot find this in writing anywhere. This event happened a few months ago, maybe even last year when I was newer to the neuro population, and was the first time I had drawn CSF for labs, however...I am wanting to check my story with some neuro nurses to ask about whether or not this was a huge no-no or if this is a rare exception. This just recently resurfaced at work when I asked, and my coworkers always don a face of sheer panic when I tell them. Please let me know if any of you can help clear this up for me: I had a super sick patient with an EVD and multiple comorbidities. I received orders to draw extensive CSF labs from the patient's drain. Over the phone (not through text), the provider nonchalantly ordered for me to draw off an alarming 10 cc of CSF from the patient's drain. I quadruple clarified this order with the provider over the phone, asking more than once to make sure they indeed meant 10 (!!) and asked my charge nurse multiple times as well. I was explained that this is not a normal order by my charge, but to be sure to document that notification and to follow through with the task as ordered. I probably spent almost literally 20 min straight drawing the CSF as slowly as possible, as not to cause any harm to the patient. Like I stated above, my coworkers literally freak out when I tell them this story, so I am curious to know if this is something anyone else has experienced as well. I often pride myself on being a safe nurse, however, even a year later this still gets to me and I always wonder if I made the right decision
  3. FashionableRyanRN

    Experienced RN/New to ICU...Help!

    Reading this gives me a lot of confidence, as it seems we are similar in our experiences! I will definitely make some time to begin stocking the room carts as they are already stocked so that I can help my memory when it comes to an urgent/emergent situation and so that I'm not flopping about to find the alcohol wipes haha I do currently question whether or not I made the right move, and I often think about the fact that I could transfer back to my old unit, but I do want to afford myself the opportunity to learn and grow before I make this decision; so, like you put it, hopefully I, too, will look back on these feelings with a fond smile and sense of humor lol Thank you again for sharing :)
  4. FashionableRyanRN

    Gave Blood transfusion too fast maybe?

    I don't know if your facility's policies are just much different from mine, but a patient with a Hgb of 3.2 at my facility would certainly have 2-3 units of blood ordered to transfuse STAT and our start rate is 75. Then, we can bump it up to 150 so long as the patient had no reactions during the initial 15 min period and their vitals are stable. In order to qualify to run that fast the patient's PMH would also have to be exempt from CHF and could not currently have any third-spacing or pulmonary edema present. I believe...not 100% sure...you could also max out the rate at 200 as long as the aforementioned statements apply, so I am 1,000,000% confident you did not administer the blood too quickly lol Also, keep in mind that that is actually a very expected, and desirable outcome. That rise in Hgb is exactly what I would expect from only one unit (hence the reason I said I am surprised they ONLY received one right away). Many times I have had patients with borderline Hgbs that require multiple transfusions because their bodies cannot maintain its Hgb level for a myriad of reasons. You will eventually see the ones who have a Hgb of 6 and only end up with a Hgb of 7.1 after the transfusion and they fall right back below 7 by the end of the shift. It happens, but you did nothing wrong :) No reaction, so no worries. Don't be so hard on yourself!
  5. FashionableRyanRN

    Experienced RN/New to ICU...Help!

    Hey, all! The title may be slightly misleading, as my "experience" consists of only 1.25 years of nursing on a cardiac telemetry floor right out of nursing school. I became VERY good at a lot of cardiac nursing functions, assessments, and rhythm/rate identifications. I really enjoyed the cardiac aspect of care and I before I transferred to my current unit I felt extremely independent and was always on top of my game and I feel as though I was generally a good nurse all around (of course I had my off nights where I felt like I could have done better); however, about a week or so ago I started my job in the neurosurgical ICU. I work in a level 1 trauma magnet hospital in a major city in the U.S. and we get the sickest of the sickest. I thought with my bout of experience on my previous floor (being in the same facility, just a few floors up), I was well-prepared to quickly learn and adapt to the ICU setting. I am here to tell you that I have run into a few problems and I need some advice... 1. I know cardiac, and I know it well...but working in NSICU now, all we care about (unless the patient is actively in cardiac distress) is neuro, neuro, neuro...something I literally never really learned a lot about in my experience as a nurse and forgot a lot about since nursing school since I haven't been applying my neuro skills or full, in-depth neuro assessment. 2. I feel like, in general, getting used to where things are on the unit, getting used to where supplies are kept in the rooms, adapting to understanding their equipment and my new responsibilities and what I no longer have to do is absolutely throwing me off and it makes me feel incredibly stupid and worthless when someone is asking for a butterfly needle from the carts in the rooms and I don't even know which drawer to fling open to swiftly retrieve it, yadda yadda. 3. Lastly, the unit I left, I left with a heavy heart. I LOVED and adored ALL of my coworkers. They were amazing people and we all got along and worked very well together as a team. Now, I feel like 75-90% of my new coworkers are stuck-up and think they're better than me and they won't give me the time of day to even look in my direction. The only people I am getting to know are my preceptors (2 of them). Everyone seems so mean and rigid and I don't understand...I am always courteous, respectful, and humble in all of my interactions. Essentially, I feel insanely dumb. I feel like I am just starting nursing all over again with no education and no prior experience. I feel like a failure, which is a feeling that hits me hard because I always prided myself on my last unit as being an aggressively active nurse who was consistently spot-on with assessment changes and reporting needs for rapid responses, codes, rounding incidents, etc. I was NOT a lazy nurse, by any stretch of the imagination. Please give me some advice as to where I should be in my head space and what I should do...I feel so lost and my preceptor has such a tight leash on me that she won't let me learn because she keeps micromanaging everything I do without providing me opportunities to do things for myself while she monitors. TL;DR I have over a year of cardiac nursing experience that i felt that I excelled at, I just transferred to neurosurgical ICU last week, and I feel as though I know absolutely nothing and my new coworkers seem really mean and cold toward me. I really need some advice as to what I should do.
  6. FashionableRyanRN

    How serious is a verbal warning really?

    I appreciate your response. Fortunately, my absences are months apart. Ever since I had my tonsils removed right before going off to college, I have frequently acquired peritonsillar abscesses. The rate of acquisition used to be somewhat like every month for about the first year of this. Since then, the occurrences have begun to space themselves out, but I still do suffer from them from time-to-time, in addition, of course, to other common ailments out there. It's frustrating for sure, but I guess I do need to start figuring out a way to work with it when it happens. I wish my employer believed in excusing absences in exchange for a physician's note. :/
  7. FashionableRyanRN

    How serious is a verbal warning really?

    I completely agree. I personally don't believe being genuinely sick 5 times in 13 months is indicative of a distrustful employee. It is obviously more absences than expected, however, but illnesses do happen. I mean, we are literally surrounded by 10s of illnesses on a daily basis when we walk in the doors to our facilities. It's like HR forgets that we work to cure sick people. I think it to be honestly quite unreasonable to cast punishment upon someone for sequestering him/herself during a time of poor health. I would not want my nurse to be coughing up a lung and complaining about her sore throat. Anyway....just my opinion, I suppose. I must be a lunatic since this is clearly not the popular opinion.
  8. FashionableRyanRN

    How serious is a verbal warning really?

    I simply said that I'll come in vomiting if it puts my transfer on the line. I don't particularly care what she thinks of me, I just want to make sure at the end of the day I have my job. Our workplace is shrouded in an exceedingly lax atmosphere. I don't feel uncomfortable about many things. If I'm sick and unable to provide safe care to my patients, or am eligible to place a patient at risk of acquiring a nosocomial infection, I'm not going in, as you said.
  9. FashionableRyanRN

    How serious is a verbal warning really?

    I just called my manager to ask just in case. Turns out my transfer is only at risk if I receive a written warning. To answer your questions about why I have called out so much, the majority of these call outs have been because I truly have been too ill to show up and adequately and safely perform the required functions of my job. In college I literally never missed a class over the span of 4 years. Not one. I went sick sometimes and stuck it out. I am not, by any means, lazy, manipulative, or trying to take advantage of my employer. I consider myself very responsible and mature. This really concerns me, however, because I realize how bad this looks to my new employer. I would certainly be less-than-impressed with my new employee if he/she was riding the disciplinary protocol into my unit on day 1. I get it. I know it poorly reflects on my character. On the other hand, I am unsure of how to convince this new manager I am a worthy hire aside from showing him. Words mean nothing.
  10. FashionableRyanRN

    How serious is a verbal warning really?

    So you do believe a formal verbal warning could potentially reverse my transfer even after everything has already been finalized?
  11. FashionableRyanRN

    How serious is a verbal warning really?

    Hey, all! To provide an introduction and some background, I am a 23-year old nurse who works in NC at a nationally-acclaimed Magnet hospital and this month marks 13 months that I have been practicing in the nursing profession. I have spent all of this time working on a cardiac telemetry unit, however, I am slated to start my new job in the Neurosurgical ICU in just 11 days. The company I work for has a very specific, linear absenteeism protocol for supervisors to follow regarding, well, employee absences. You are allowed 3 without any reprimand whatsoever, and any absences taken in consistency (Ex: calling out all 3 days in a week) are considered a single absence "event," which is essentially one absence in the eyes of the employer. The 4th absence or absence event results in a simple informal verbal warning with no real consequence; however, the following absences result in a formal verbal warning, written warning, a final warning, and termination. My question is: I have just called out for my 5th time and I am afraid this will affect my job status and/or will cause my manager to place a freeze on my already-approved transfer to NSICU. How serious is a formal verbal warning? I am a diligent and reliable employee who has never been reprimanded for anything, and often regarded with a high degree of respect and warmth by my all of my colleagues, including my supervisors and manager. Taking this into consideration, am I in trouble next time I go to work? Should I be concerned for my job? I have a lot of anxiety, so I am already giving myself a stress ulcer.
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