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.

I haven't taken the CCRN, but I did do some studying on it before I decided to leave ICU. I'll be honest, I think it would be very hard to pass the test with only a written knowledge of vents. Not impossible, but highly difficult. There were also some other gadgets I was worried about being tested on, because at my hospital we rarely dealt with balloon pumps, Swann-Ganz, etc. I think ruby_Jane has it right. If your current hospital isn't open to cross training or transferring you, and the othe area hospitals won't take you, your only options are to stay in PCU, try a third specialty, wait and hope, or search outside your area.

When I was working ICU, there was a strong, unit-wide superstition about flies. More than once in the years I worked there, we would see a big, nasty house fly that had somehow found its way inside, and that was a clear sign that somebody in the unit was gonna make a celestial departure that night. Although we did avert it once or twice by hunting the fly down and killing it, if the fly got away it was game on. Every time.

Look, our jobs are not G-rated. These things can be really hard on you mentally, and everyone around you who isn't a sociopath understands that. Don't fall into the trap of trying to place blame on yourself. It sounds like you did the right things, by notifying your supervisor and involving the appropriate people quickly. And, take it from someone who knows: it is always harder to keep your head straight when it is your patient. When I was in ICU, most times when things hit the fan for someone in our unit our team would all jump in and push the primary nurse back to take a breather. One of the best code nurses I know, gets so bent out of shape when it's her patient that she can barely think straight. But point her at anyone else's patient and she is on like Donkey Kong. Getting freaked out when something happens doesn't make you incompetent, it makes you a human. I agree with Ace, you should try and debrief as best you can. See if you can identify anything you could have done better, or if there were any signs of deterioration that might have been spotted. Do this not to place blame, but to attempt to improve your practice and make you feel more prepared for the future.

The point of a trigger warning is not to protect people from hurt feelings. It's to be polite to those with PTSD, and physical reactions to certain things which they may not fully have control of. An appropriate use of a trigger warning would be ,"hey, this book we are about to read has a somewhat graphic rape scene in it on page 72. If that's something personal to you, be prepared when you read it or skip that page." Or ,"This movie has a scene that involves loud sounds like gunfire. If this is a trigger to anyone, let me know and I will mute the audio at that point." It is NOT intended for people to avoid hearing opposing viewpoints or generally being exposed to unpleasant things. That's what the misuse of it usually looks like, and that's why it's become so meaningless. We need to go back to the old-reliable term we used to use "Viewer discretion is advised."

I only worked at the bedside for two and a half years before getting burnt out. It wasn't the patients, it was the fact that the work environment was very nearly slavery. Eating lunch at the desk, having your bathroom breaks interrupted, having the quality of your work judged by the opinions of your patients. Getting more discipline about not filling out the correct form than you would over doing incorrect patient care. And the creeping, ever increasing workload that you're somehow supposed to do without diminishing the quality and safety of your work. Vote with your feet. If no one is willing to work in what has become a "normal" hospital environment, then the powers that be will have to change it. I loved working in my little ICU. What I did not love is having our tech position taken away, and on top of that sometimes walking into a short staffed night and having 3:1 instead of 2:1. "Here's 150% of your normal workload. Figure it out, and don't take shortcuts, because lives depend on you."

Sorry, I suppose I wasn't clear. I meant that all you had to do was pause whatever was running in for a few seconds, flush adequately and draw a waste tube. I wouldn't draw blood without pausing everything running into the lumens. But I've never had an out of whack result, and I don't pause for 15 minutes. I pretty much just bring in my supplies, pause the pump while I'm preparing my stuff, and then draw as soon as I have everything opened and laid out. So it may be paused for like, a minute and a half before I physically draw the blood out. The only time I ever got a bad draw was when I oopsed and forgot to pause the TPN at all, so it was running in one lumen as I was drawing out of the other. Maybe that's what happened to the nurse you followed.

There's a lot of superstition over these types of things. I will say, I've drawn a ptt from a heparin line, as well as a BMP from a TPN line. Never had unexpected levels, which would have been obvious with the BMP. If it's a central line, all you need to do is flush really well and draw an adequate waste. The blood is coming basically straight from the heart. All you gotta do is wait like, 5 seconds and whatever was running in will be more than cleared out.

Sounds like you handled it pretty well on your feet. I wouldn't want to throw any of my coworkers under the bus short of something truly dangerous. After all, if you get into a mess on the floor, it probably won't be your manager there to help you out. It'll be those coworkers you were asked to rat on. Is there (in your opinion,) truly anything to either persons claim? Is either nurse really not pulling their weight? Or is it just a case of conflicting personalities? I might would have left off the comment about being asked to spy, depending on my level of comfort with the manager, because s/he possibly could have found that as you taking a dig on her leadership for asking you. Other than that, I think a careful non-answer like you gave is probably the most appropriate.

Let me just say, I am somehow more concerned about the lack of teamwork in your department than you as charge. No hands on deck in a code? RIDICULOUS. Even if every other nurse on your unit is a day 1 new grad, they are competent to do compressions while you figure out how to save the patient. It's been ages since I did more than a round or two of compressions on a patient, because usually there's a number of BLS certified techs or newer nurses who can pitch that in, even if they aren't yet comfortable mixing drips or pushing meds. If that had happened somewhere that I was working, I'd be carrying a list of names with me to my supervisor, or their supervisor, or the CEO if it took it. That is so extremely morally wrong by any measure.

Davey, I don't mean she puts it in his AC vein. I mean she jams it straight into the bend of his elbow as deep as it will go, like it's a shot of epi to the thigh. Also, that scene in Mad Max: Fury Road where he gives Furiosa a direct transfusion of his own blood. A bent, dull needle in a woman who has hemorrhaged heavily, and he hits the vein first try.