arbley

I agree, Platon20. And I love that we are finally getting some protocols in place to prevent folks from heading too far down the sepsis highway before we catch on. While catching someone heading into septic shock earlier by using the various monitoring devices available to us is immensely helpful, it just doesn't play out that way alot of times. I think we all understand the basic pathophysiology involved here - the sepsis causes the entire arterio-venous container to relax and subsequently expand significantly. I've heard it said that the capacity of the circulatory system could be anywhere from 2 to 6 times larger than it was pre-sepsis (yes, that "2 to 6 times" remark is an anecdote which I can't support with research). The problem is, the volume of blood in circulation hasn't increased a bit. At this point, its been my experience that using pressors is like throwing cottonballs at a charging elephant. Pretty ineffective. The receptors that respond to the pressors aren't working right either, because they are septic too. Volume, volume, volume, volume - it takes many liters to fill the greatly expanded circulatory system. Worry about fluid overload? Nope - not now. If it becomes an issue - good - the patient finally has enough circulatory volume to maybe maintain enough blood pressure and perfusion to sustain their internal organs and brain. Now you can deal with the overload if need be. I love this stuff!

There should be no need for the "holier than thou" routine, and there is really no excuse for being a general crab. But - having said that - ICU is a different world, as are most specialty units. This certainly adds to the attitude differences. ICU nurses are notoriously detail oriented, they generally have just two patients to care for. Those two patients get ALL their attention. ICU nurses also have a different sort of relationship with the MD's and with the other hospital departments. A couple of easy examples come to mind. In my experience in several ICU's - small hospitals - big hospitals - it is fairly common for nurses and docs to be on a first name basis - they work more collaboratively than on the floors (generally) - they spend much more time together. Other hospital departments also seem a little more responsive to requests from ICU. Work on a floor and demand immediate delivery of something from Central Supply? Won't usually happen. Work in ICU and do the same thing? Better results. Just the way it is. I worked as a float nurse for a few years and was able to observe lots of this, over and over and over. I worked in ICU for many years and saw it from that angle too. I think ICU's do have an attraction for certain types of people. So what was I thinking in going from ICU to Home Health? Lots of control to none? I don't know. Its an interesting change and an interesting contrast. Phew - I gotta wind this up. When you transfer to ICU, your views WILL change because you will see some things from a different perspective. You can still be nice though! :)

I worked with fresh heart pts. up until a couple of months ago. We had some patients arrive in our unit straight from surgery already extubated. Obviously that won't work with some patients. Depends on the surgeon, the anesthesiologist, and the patient. Generally, if they did not arrive extubated, we got it done within a couple of hours, had them dangle within approx. 8 -12 hours, up in a chair for breakfast the next morning, and out to the step-down unit in that afternoon. Many studies have shown that the sooner pts are (safely) extubated and moving around, the better their recovery. Of course there are always patients that are more unstable and more challenging than others. Some do stay intubated for a few days and spend significant time in the ICU. I obviously know nothing about your father's general state of health or respiratory status, but if both are anything resembling acceptable, I would have some serious questions for that surgeon.

Hopefully, Dougb61's cynicism and unhappiness are not evident to the patients he cares for. Sadly, feelings like that are hard to hide. As a couple of others have said, there are certainly pros and cons to any profession. Please don't let a few negatives change your mind. Nursing can be a very rewarding profession in many ways. Another nice thing about nursing is that there are so many career options available to you. I became an RN at age 37, worked a little med-surg, lots of ICU, cardiovascular research, long-term acute care (administration), more ICU, cardiac step-down (administration), more ICU. Then I made a really big shift, away from the hospital setting and the ICU (where there are lots of men working in nursing) to a position as Director of a home health agency. I love it! My point is not really to advertise my relatively frequent job changes, but rather, to show a few of the MANY options available to you with a nursing degree. If your heart says "go" - please listen - you won't be sorry.

I am a new director of a small home health agency. This agency recently obtained a Prothrombin machine and the nurses have been using it for monitoring PT's per MD orders for our coumadin patients. I think this test falls under our CLIA Certificate of Waiver and that we can bill Medicare for the test instead of absorbing it into the PPS payment as they have been to this point. Anybody have the info? Thanks in advance for help you can offer.

Larry, correct me if I'm wrong, but I understood your post to mean something positive. I think what Larry meant was, There's no way you are too old. Don't just sit there and THINK about it. Just do it.

Not often, but every once in a while a patient will ask me if I am a male nurse. My answer is usually, "Last time I checked." That whole male thing just gets old. I tell patients my name and that I am their nurse. I think it is funny when folks feel compelled to remark on my gender. as if I, or they would not know otherwise.

Why no mention of the pharmacists that supplied the stuff? Even if there was Diprivan laying about all over the unit, it had to be accounted for somewhere.

Didn't want to keep looking for the exact right thread for this one. It IS the middle of the night. Just looking over some MD orders on my patient. Found one that says, "Culture fluid from Rear." After laughing for a while I realized it means R. Ear.

The comma shows up as part of the link. That is why it doesn't work. Even with the comma removed I end up with a strange page. Tried the old Google search and it still didn't work.

Hey JHUNurse! You started this topic and then bailed out. What's the matter? Don't you like the responses? As far as bagging an MD . . . . be careful what you wish for. you might get it.

Most nurses have equipment that they prefer, and it varies from one nurse to the next. Personally, I find butterflies a little bit awkward and slow. I first learned to draw blood using a vacutainer with a 21g needle. These work ok if you are used to them, but they can collapse some of those puny veins because they can exert too much suction. For cases like that, I prefer a syringe w/22g needle. I shy away from the 23g needles, whether butterfly or not, because the lab folks have drilled into my head that the smalled the needle, the greater the possibilities of hemolysis. If that happens you just have to draw it again anyway. And, think about this. Do you give blood through a small bore IV? Why not? Because small bore IV's can beat up the red blood cells pretty badly sometimes.

I worked as a CNA in a nursing home while I was in nursing school. One day when I entered a patient's room, I saw a row of little brown balls about the size of marbles on the window sill. I really wasn't sure what they were until I got a little closer. Yup! it was a row of little turd balls drying in the sunshine. Looked like it would have made good slingshot ammo. :chuckle

I am a relatively new manager of a cardiac surgery step-down unit. We have "regular" staff, pool staff, part-time staff, local agency staff, and travel nurses. Usually our staffing and census are such that floating is not an issue, but when it is, it comes with some headaches and some problems that I am not sure how to address. Their traditional way of doing the float thing is to just look at the "float book" and see who has to go this time. The problem is that I have ended up with my reliable, skilled nurses leaving to work a shift on another unit, and nothing but pool, travel, or agency nurses on my unit. I do not think this is a wise practice and it is not acceptable to me as it concerns patient safety, quality of care, and retention of my regular staff. I am thinking of instituting a no-float policy for the regular staff, and having the pool, agency, part-time, and travel nurses float first. I am just not sure I can get away with it. The in-house politics may make it difficult. I have made a start on changes, but any great ideas as to how to institute new policy on this, and how to present to staff would be appreciated.

The other night at work, our respiratory therapist was busy suctioning a patient. He had almost completed the job to his satisfaction, but wanted just a little more. He says to the patient (no kidding), "I'm going to go down on you one more time and get you all sucked out." I could not keep a straight face.