LuvMyGamecocks

I came across this thread as I'm researching what all you fine nurses have to say about the hospice profession. I'm thinking of making a change from LTC to home hospice.... Actually, the reason I'm a nurse is b/c of the way a nurse in ICU treated US as a family as she furiously attempted to save my grandfather's life. She focused on our pain knowing inside that her attempts would prove futile. We sat with him in peace after staff was told to just stop...no 15 IV lines/tubes, no CRRT, no blood from the episode w/DIC. We were given comfortable chairs, tissues and quiet. I recently admitted a inpatient hospice resident to our LTC unit...young doctor w/ brain Ca. The family came the night before admission to decorate his room w/ memorabilia from college and golf and family....Soooo many visitors brought beautiful signature posters to go w/ the decorations. We even got our house doc to give us an order to let him have beer on Fridays. :) One Friday, the family paid to hold his bed on the unit so they could take him for a weekend trip. He passed away on his favorite spot on the coast of the Carolinas, with his family surrounding him. I've learned of many deaths in LTC, but that one will likely stick with me for a while.

I, too, agree that they have their own stressors. But, having 5 months in LTC (doing nothing but Admissions/Discharges on a TCU and LTC unit) versus a year and a half on a telemetry PCU floor in a cardiac hospital, I understand the "LTC Super Hero" reference. Our RNs have 28 pts...but we have me to do Admissions/Discharges, a wound care nurse doing all treatments, an MD inhouse 5 days/week and a NP inhouse on weekends. I'm told we're lucky!

I have this and engraved it myself w/ a Dremel. Had to sand it down a little, but it was effective. Still in my possession after 2 years!

Hi! I, too, have a +TB reading that could probably be interpreted either way - as an induration OR simply a reaction to the PPD solution. It doesn't show up in the first step, but always shows up in the 2nd step for me. It's not a big deal, really. The last person to read a skin test for me recommended that I don't have any more skin tests b/c she thought it was an allergic-type reaction, rather than induration (which it had been called, previously). I just go to straight to CXR. Just be upfront about it - you'd be surprised at the lack of concern from potential employers (as long as your cxr is clear, of course ).

Just wondering if any of you will admit to ever burning a bridge with an employer? Did you feel bad, but really believe you were doing the right thing? Thanks for your honesty!!

A little more info...sorry for not including it before. Pt came in with c/o near-syncope, was hypotensive...received 1/2NS at 125 ml/hr until her lungs started to fill up, then it was stopped (only got about 400cc). Liver enzymes, WBCs - everything was WNL. The only thing out of whack was BUN and Creatinine. Calcium was even normal (which we don't usually see...it's usually ALWAYS a little low). Temp wasn't elevated, and BP was 110s/60s and not fluctuating. Did I miss anything? Thanks for your responses!! Keep them coming!!

Pt is fine..spent some time on a unit, but is back on my PCU/Telemetry floor for a couple of days.

I need some help understanding the physiology of this... Pt has widely varying blood sugars over 24 hour period. 300+ to 30s and 40s in late afternoon and early morning...no Lantus to speak of, and sliding scale coverage ordered ac&hs...eating well at meals. Electrolytes WNL (K 4.2), but BUN/Cr are elevated - initially 38/3.9, then it rose to 42/4.7 within 24 hrs...not a dialysis pt (yet). I understand why out-of-whack K+ can mess with blood sugar, but I don't understand a physiological reason for a pt to have such widely fluctuating blood sugars. Pt ended up getting four amps of D50 in a five hour period...BS was up to 250-300, then crashed again. We couldn't give pt any fluids b/c of all the fluid in lungs. Pt's body ending having enough of that...before the fourth amp, pt became responsive only to sternal rub, Code White was called, pt went to a unit. Can anyone shed some light? Any piece of the puzzle missing?

A reprimand? Really?

I'm trying not to develop a complex here... I'm a new grad (May), working on a tele unitwith 95% cardiac pts...tons of CP r/o MI, a-fib, pre-CABG, PPD/ICD placement kinds-of-pts. The cath lab asks for 2 INT's, at least 20G...CV surgeons want an 18G. The same month I started, the facility started stocking a new IV catheter - Nexiva. It's virtually bloodless (which it great), but it has a tendency to blow the veins. It has it's own kind of technique for insertion. Enough nurses complained about the tendency to blow a vein, so they are now giving us back the Jelcos. We have the choice of using either, but I like the cleanliness of the Nexiva catheter. MY problem is that I can't hit a vein with EITHER to save my life. I've attempted probably 30-35 sticks and hit 2. 2!!!!! 1 Jelco, 1 Nexiva. I'm off of orientation, but this is starting to really SUCK!!! I hate that I have to ask my co-workers (who are REALLY great about the whole thing) to try. Does anyone else use these? Can you give me any tips? Has anyone else taken a while to find a groove? Thanks!!!

My facility uses the Synergy Model set forth by AACN. Assignments are made using this model. Good luck! http://www.aacn.org/WD/Certifications/Content/synmodel.pcms?pid=1&&menu=

Yep. I work on a telemetry floor, but a buddy of mine works in the ER. He personally saw 4 cases Friday who wrote something similar to "Anxiety/chest pain/depression because MJ died.":

I had a + PPD, -CXR, and was referred to the health department. I haven't been yet, but they'll provide treatment at no cost. I'm NOT required to take meds to start at my new job (my first RN job).

I'm VERY lucky. The Dean of Nursing hand carries our endorsements to our State Board's office (which is about an hour away from campus)...as a matter of fact, they were in the office the day of our pinning ceremony (5/12/09). I had permission to test, tested on 5/26/09, passed, and results were on the BON website on 6/1/09. I would also be more than upset! Maybe after letting some time pass (to ease the sting), you could write a letter to someone explaining your experience. If you know this to be a common occurrence, maybe you could explain the impact on others. I don't know that it would work (and it certainly wouldn't change your situation), but writing a letter and knowing that someone "heard" your frustration might help to give you some closure about the whole thing. It must be VERY frustrating. Hang in there!

Transparent tape...not paper, not anything else...seems to pull out less hair. And Sharpie pens....they're my most favorite pen ever! The ink is dark like a regular Sharpie, but it doesn't bleed through the paper. Now all they need is a RED Sharpie pen.

Taken from the NCLEX Candidate Bulletin.... "Confidentiality Candidates should be aware and understand that the disclosure of any examination materials including the nature or content of examination items, before, during, or after the examination is a violation of law. Violations of confidentiality and/or candidates' rules can result in criminal prosecution or civil liability and/or disciplinary actions by the licensing agency including the denial of licensure." Interpret this however you want to... Carry on.

I was asked to complete a short survey after I took NCLEX (too frazzled to remember it was optional or not), but gender was a question with no option for "I'd rather not say"....must have been an optional survey, but it was AFTER it shut off at 75, so no chance for test interference.

Be careful - it's actually illegal to discuss NCLEX content...I'm pretty sure the comparison to Kaplan and Saunders is okay, but discussing a "main focus" and "math" is probably a no-no.

Count me in on this list...just scheduled NCLEX-RN for the 26th of May, reserved a hotel room nearby....now if my nails can hold up until then, I should be okay!!

Off topic, sorry! Why are using the 10cc flush on a peripheral line? I thought you only used a 10cc flush on central lines and PICCs?? Do you use them on peripheral lines if you're doing a blood draw? I'm asking out of ignorance - just graduated, taking boards within 2 weeks - I've never used anything but a 3 or 5cc flush. Please educate me?!? Thanks!!......carry on. :wink2:

I've seen wonderful things from Mist Therapy....looks like a little spray gun with ultrasonic? ultra-something mist coming from it. The only wound I've gagged from was a stage IV (bone and all) going from the top THROUGH the foot to the bottom. Pus oozing, lovely smell. It took 2 months, but daily mist therapy healed it!

After seeing my first code in clinical, I had nightmares about seeing his eyes. You know that look where the lights are on, but nobody's home? I dreamed that I was standing in the middle of his room (like I was when he coded), and he was staring at me with that look (like he was when he coded). Only, in the dream I stood there frozen while everyone moved frantically around me. I had that feeling where you feel like you want to move, but can't. It took a good three weeks before I started dreaming other things. I talked with my clinical instructor, and she said that it seems to be a common thing for nurses to have similar dreams. She said she dreamed that she fell asleep on the toilet at work and woke several hours hours later to several dead patients, and that another instructor dreamed about getting to the end of the shift to realize she had accomplished nothing and hadn't seen the first patient. My theory lies in the intelligent mind of a nurse. Our brains work and work and work, apparently even when we're sleeping. Maybe our subconscious takes the time at night (or day) to work through some issues that we have to push to the back to get through the day.

My conscience wouldn't allow me to consider this train of thought. 2 wrongs (or many wrongs) don't make it right. Others have worded it better than I have, but I agree with not being able to carry the burden of wondering if my choice was harming my patients. Science says they do, so that's what I'm going with. No fakes.

Ask yourself this...on the way home from work, do you think you would be happier if you had just left the CVICU or the cath lab? It sounds as if you may want to eventually get to a CVICU, even if you decided on cath lab first. That tells me you'd rather be in CVICU anyway, so why not start there? You also said you "really want to start on nights" and cath lab doesn't offer that. Just because it's a "sweet deal" does not mean it's a "sweet deal" for you. The tone of what you wrote indicates to me that you want CVICU more...go with your gut!! (I'm curious, though...only 3 months in CVICU for a new grad???) Edited to add: Congrats on the offers!!!!

I'm graduating in May (), and my husband has been nothing BUT supportive. It IS necessary to have those talks about what concerns him - if nothing else, he just needs to vent to you his concerns. Maybe just airing them out with a good talk will help. Maybe... When it gets to that point where you're in clinicals, tell him what you're days are like....and like others have said, it's NOT at ALL what you see on TV. There's no "Hey, baby...wanna find the nearest lockable closet?" when your hands are in someone's rectum placing a Fecal Management System. And at the end of a shift/day, your first instinct is to get to your car as soon as possible...NOT to seek out that cute guy from Radiology.