Night__Owl

I'm not fishing anything out of a sharps container unless a gun is held to my head. I'll get fired, I'll flip burgers instead of being a nurse, I don't care.

IO access is usually only needed in the field, since it's pretty much your only option if peripheral IV insertion fails. In the hospital in an emergent situation, I would expect either anesthesia or the EM doc to be able to place a central line, or as someone else said, a large bore peripheral into an EJ.

The hospital I used to work for was a small private hospital which competed with a large public hospital. One of the ways they helped keep staff was having no-weekend positions. In our ICU, there was a crew of people hired specifically for Friday, Saturday, Sunday, and got a weekend differential for it. The weekday employees worked three days between Monday and Thursday. We weren't asked to work the weekend unless several people on the weekend crew were sick. I think this is the best way to operate. There was actually a healthy demand for the weekend positions, because of the more laid back environment, the higher pay, predictable schedule with all three days grouped together. That was worth it to a lot of people, so in the two years and change that I worked there, I can count on one hand how many weekend shifts I worked, outside of holidays.

I've used a "doc in a box" computer before l, and I strongly doubt that there was "no one else in the room." The tele doc computer cannot "roll into the room" like some kind of android. It's a COW with a webcam. A nurse pushed it in there. Now, if the nurse brought it in, set it up, and then left afterward, I would say that was an inappropriate move, but in my facility an RN was always supposed to be present when the doc was on the line.

I've got a wild idea. Maybe, considering this man had just hours of time left, the MD did not want to delay his visit whatever amount of time it would have taken for him to physically arrive there. If youve got three hours left, and it takes the specialist just 45 minutes to get to the hospital, well, that's a quarter of the man's remaining life.

I get it, but at the same time I think it's ridiculous. I use nicotine replacement to keep me from going back to smoking. But every "smoke free" hospital around here, heck even my insurance company, treats that as same as smoking. I'll quit using nicotine when I'm sure I won't go back to smoking when the craving hits. I can't help it I grew up where I did, and started smoking when I was 12. I did what I needed to in order to quit though, and I think it's a shame that there's places I'm still essentially locked out of for that reason.

What do you think?

I'm fairy certain we had a Clark in the ICU I worked in. A tech who iirc had failed out of nursing school, but had just enough knowledge to be dangerous. Unit Clark went into the room of a vent patient, saw that the IV pump was alarming and said "infusion complete" and turned off said propofol infusion. Without telling anybody.

Is it possible for you to take shorter shifts? I know there are many EDs out there which have both 8 hour and 12 hour shifts. What is the minimal duration and frequency that you need to sit in order to be relatively comfortable, and not killing yourself in the name of your job?

Yes, imagine a pt with VS HR 90, BP 150/90, O2 sat 96. BUT.... they are breathing 45 times a minute over the set rate of 20. It's important information, as is knowing if the patient is never breathing over the vent at all.

I've used both, both are good, but I definitely prefer phenobarbital. You usually don't want any pt on the floor receiving the high doses of benzos, because of the respiratory risk involved. I've seen patients withdraw so hard that if they were awake at all they were a danger to self, so if they were dosed only to the point of not being combative, hallucinatory and self destructive, they were all but snowed. And snowed is very close to "not managing airway" so they needed to be watched closely, i.e. in ICU. And you never know what someone's tolerance is, some people naturally only have a very narrow window between a treatment dose of a benzo vs a knockout dose. You don't wanna find that out when you do your hourly rounding and find your pt blue.

When I smoked, I didn't have a chronic cough (didn't smoke enough years to get one, thankfully.) But I DID have a markedly longer recovery period after getting a cold. Hard to clear it out when you're constantly deadening your cilia with nicotine and smoke.

I was scraping above passing almost every semester. Did not have to tell anyone my grades when applying for jobs, had an offer waiting when I graduated. My overall still looks decent because of how high it had to be to get into nursing school in the first place.

It's simpler than this thread has become. If patients want to refuse care from you because of your gender, your age, your race, or because they just don't like the way your face looks, that's their choice, as are the consequences. You just say ,"I can help you to the bathroom/on the bedpan now, or you can wait until a female employee is available, but it could be up to X amount of time before one is, as they all have their own patients who are just as important as you are. What would you like to do?" If it's something like inserting a foley or checking a cervix, you can also explain the possible medical consequences of waiting for that "other" type of person to be available. And if the person, for whatever valid or otherwise reason they like, decides those consequences are acceptable, then it isn't on you, so go on about your day.

PCU stands for Progressive Care Unit. It's usually an intermediate unit, for patients recently out of ICU, or those who are too high acuity for Med surg, while also not requiring ICU care either.