burn out

we used it the first time the other day but it didn't help. the patient still needed 100mcg fentanyl and 70/mcg/kg/min of propofol and still breathing on cpap on vent.

If you really wanted to impress me, know what is normal i.e.lab values, vital signs, sinus rhythm,hourly urine output. because everything we deal with will be abnormal.

yep... versed or propofol for sedation and amnesia and fentanyl for pain. Propofol in OR is a different ballgame and in the hand of CRNA or Anesthesiologist a totally different scope of practice.

You knew something needed done, now so you called the neurosurgeon but then you didn't complete the order you obtained. The order did not need to be approved by the fellow, you should have just done the ct scan.

Yes physical therapy is vital early in patients that have been extubated because they are weak as kittens. However, how do you get active rom out of someone that is sedated and how do they bear weight? I really don't want to reseach something I think is ludicrous.

Please show me the research that intubated/sedated patients on vents that are put in chairs result in less trachs than those kept in beds turned q2h and the hob up.

You have to be a control freak because you control everything about your patient, their heart rate bp, breathing,pain, urine output, if they eat if they don't, if they move, if they poop...kind of get the picture?

It sounds like we all are doing a bunch of different things out there with propofol,versed and fentanyl. Is there no universal protocol? When we use propofol or versed we use the Rass scale of -2 or -3 . Propofol max is 50mcg/kg/min and fentanyl max100 mcg/hr. We combine either propofol or versed with fentanyl but never propofol with versed.

i've watched but can't really relate to her. She makes it look like nurse take their patients narcotics and have affairs wih co-workers. Definitely not a reality show.

I guess it may depend on the reason for the line, I kept a c-line 6 months in a patient in home care to receive chemo. It was removed because the chemo was over. No infections no problems.

Show me a Hamburger Helper Dinner that does not use milk and do you really think I am going to go in the back yard to milk a cow to get that milk.(My milk supply dried up a long time ago.) I take much pleasure in knowing that my milk has been pasturized and is safe to drink and I can buy it at the store. Read the post on the Athelon product that is in use in India for filtering out viral diseases such as HIV, Hep C and some tumour producing toxins. They mention that the failure of their product is based largely on financial risks, lack of funds for government testing and approval not to mention to supply the amount of devices that will be required.

My first day off orientation in ICU 20 years ago, my first patient on my own..the end of the day... a patient that was considered stable 12 hours earlier... sedated on a vent with a Blakemore tube, Swan Ganz cath, 16 units of blood, pressors galore on his way to surgery and survived later on. I have never had that bad of a day again. Now I feel the "rush" but I know I have to get things done or else my patient is going to die. The doctor may order the stuff but I am the one doing the stuff and I have to work fast.

The most dangerous nurse is the stupid nurse that doesn't know they are stupid and refuses to ask questions.

I am sure when Salk developed his polio vaccine, and Pasteur developed penicillin and homogenized milk people wondered how in the world would the amount required to vaccinate every person, produce enough antibiotics to treat every person, and how do to treat all that milk from all those cows for all those people was considered quit a financial and heroic challenge. Where would we be today if the challenge was not taken up? We owe it to future generations to continue to pick up the gauntlet and overcome our challenges...that is why the human race has survived..it is all about survival not just of one person but the whole of mankind.

I don't usually tell people what I do unless it comes up in conversation because unless a person has walked in a nurses shoes do they really know what it means to be a nurse. My family does not nearly comprehend what I do in a days time. Strangers have their own preconceived ideas and I am sure they do not even come close to the reality of nursing(perhaps even would be insulting). My patients however know I am a nurse and it doesn't matter to them if a nurse is a RN or LPN but they can tell the good ones from the bad ones and they let you know. If you are even on this website I think that says that Nursing is more than what you do, it is who you are.

We are talking apples and oranges. I am sure every hospital has their own policies about what ICU nurses and floor nurses can do. However, in the grand scheme of things it is our own states Board of Nursing the ultimately that determines the scope of practice and at that level there is no difference between the two (same license, same test, same pay, same job) We all are created equal it is our experiences that make us different and many nurses hide behind their fears and are afraid to make new experiences for themselves to learn new skills, new techniques that makes them better nurses.

Do you not have IV pumps that do the calculations for you?

I am sorry that I have no sympathy..well maybe just a very little. This is perhaps my pet peeve in nursing. ICU nurses and floor nurses take the same nursing boards and have the same nursing license, but why is the ICU held to so much more accountability and responsibility than a floor nurse. In your case you even have ACLS certification. I can understand that you may have been out of your comfort zone but without taking full responsibility you could have been involved in taking care of the patient to LEARN so that the next time you get pulled to ICU you can take care of that patient. There is too much already expected from ICU nurses without any fair compensation...for example MET Team calls. Surprise there is no magic fairy dust that falls on patients when they come to ICU...it is the knowledge skill and EXPERIENCES of the ICU nurses that make the difference and only because they have sought out the opportunities to learn instead of cowering behind it is "legally and morally wrong for me to learn." I believe every nurse has the responsibility of learning from every patient so that increase their skill and knowledge to better serve the ones they care for in the future. Too many sit back complacent and quiet in their comfort zones and administrations backs them to the point that they become disabled. We practice nursing skills on all DNR patients...DNR does not mean that you don't take care of them just that your do not resuscitate them..BIPAP is not intubation and is not a resuscitative measure..the patient has to be breathing on their own which is a natural process. Many patients in our facility are on the floor on BIPAP what about the people with sleep apnea that use BIPAP everynight? This is not out of the scope of a floor nurse . Many Tele units have cardizem drips and push dig and lopressor...once again not out of the scope of a floor nurse. The only difference is the setting. What are you not capable of doing..what is out of your scope?

I have just completed 8-12 hour shifts in a row (remember God took a break on the 7th day). Stress is an understatement. There is not one muscle on my arms and neck that does not hurt. I call doctors names out in my sleep(gets me in trouble with my husband). So many decisions, so much responsibility....I guess the real question is why do I do it ? I must get something out of it but I can't figure it out. I do know that it is not for the money.

I believe there are enough nurses if they would let us just do nursing functions. But if the phlebotomist can't get the blood-let the nurse do it, if Resp. Therapy can't get to the vent soon enough to make the change, let the nurse do it. If one doctor wants to tell another doctor something..have the nurse tell him. If the family needs updated..let the nurse do it. If the patient needs a drink of water, bedpan or cleaned up ...tell the nurse. Most of the families really don't come to see the patient at visiting times they come to "talk to the nurse" . Why sit and scream about a nursing shortage when they can't even keep the ones they have now. Of course we all know who benefits from the nursing shortage..the hospitals.

I question the competency of the patient. If the patient can express their concerns of having the tube removed would they not be competent to make their own decisions and thus nullify the state of the medical power of attorney. On our medical surrogate forms in the hospital it is explicit and states that when the patient can make their own decisions the surrogate will no longer be bound ..is that not so with MPOA?

Do you really think politicians are going to listen to nurses...we can't agree on one thing as a group..not even on who we are and what entry level. The politicians are just catering to the huge number of us..trying to make us feel important. The politicians are the ones that help create this huge debacle in health care along with the insurance companies, they are the ones that control it to their best interest and we (nurses, doctors and patients, hospitals) are held hostage to them.

I have filled in frequently for our unit secretary due to staffing shortages and I was so glad to get back to my nursing position the next day. Not only does our secretary take off orders but she gets our hourly vital signs and urine output, collects specimens, answers call lights and help us turn and clean patients. She has the respect from managers as well as doctors. I challenge every nurse to walk a day in the secretary's shoes and you will be given a new respect for her...she is my right hand.

You may or may not even be mentioned. Once you give them something to go on to start an investigation they will be very thorough in going back and pulling all her charts and medication records from the narcotics list etc. They will be quit certain of what they are doing when they make the charge and you do not even need to be brought into it. Good luck. But the simple fact that you saved yourself does not mean you have to save the world ..You have made tremendous progress, if you simply want to notify your supervisor of your suspicons then you have met your obligations and can go to bed knowing you did what was expected. If nothing comes of it you know you did the right thing. You have integrity..be proud.

My hospital has been restraint free for over a year (I thought it was now a JACAHO standard now). It has not been bad in fact I think it is better in our ICU. We no longer have restraints on ventilated patients..until we are waking them up to extubate. As for our psychotic patients it is easier to keep them in bed now then them fighting the restraints. I don't think we have had one fall on the unit in the last year.