beekindRN

I did the first two days ? I had no idea it was that bad. My face hurt and I had a headache, but I was functional. I even stayed up about 24 hours the day after the fall because of work and family obligations. What NOT to do when you have a concussion! Thanks!

I'm breaking my no-sceeen rule to rant. I fell last week and gave myself a gnarly concussion the afternoon before my first night of three. I worked two days, but the third day I left at the beginning of the shift because I almost passed out three times while receiving report. It wasn't until then that I went to the ER. Because I postponed my rest, the ED staff said I'll get worse before I get better and my healing time is different (ie. I still can't drive and I have to avoid screens, even though it's been days ago). I'm currently off until I follow up with my PCP about restrictions. As of today, I have vision changes, dysathria, aphasia, short-term memory issues, dizziness, and a little bit of nausea. My boss knows this because she checked up on me last night... ...then asked if I wanted to work tonight because they were short-staffed. Would YOU want your ICU nurse to be concussed? Didn't think so.

Totally reasonable to be mad. Our CCU consists of an ICU and a step down unit. In ICU, I'm doing total care, but that's q2h oral care, q2h turns, one or two baths, and a couple poops. We're so short staffed, I can do most of it myself. It's not the end of the world. They're also intubated and sedated lol so it's uncommon that they're needy. In our step down unit, we have four patients and it's hard to not have a CNA! We staff an aide in our stepdown unit before ICU!

This is real, real morbid, but I love the smell of a body bag. It's such a fresh plastic scent. IV tubing is nice too, but not as strong.

I agree. It all depends on rhythm. If the patient is v-fib or v-tach, that's not a perfusing rhythm. Ask the MD, if possible. "Doc, patient is in [insert rhythm here] with a thready pulse. Would you like to continue CPR?"

I'm fairly certain we're on call the whole shift. The latest I was called in was 1 am on a 7p to 7a shift. We're unofficially cleared at 1 am. Usually if something awful comes in after that, they'll shuffle teams and the charge will take a patient. Irrelevant, but the worst that I've been called in for was for one med/surg patient post-cath....I work ICU. She had no PM meds and just slept off her Versed. I had been specifically placed on call because I had a migraine and it was the only way I could stay home without calling out...so I was just a bit irritated. /rant over/

Burns. I can deal with gangrene, I can deal with wounds, I can deal with pressure ulcers. But ugh, burns freak me the heck out. I even skipped class in nursing school that day. But mine is fairly easy in that I deal with it by not working a burn unit ?

Nope nope nope. I only read the first paragraph and skimmed the rest. I'd check your laws for staffing ratios at the very least. 1) We had a dry spell this summer. We follow a strict staffing ratio, and one night our census was so low that it left one RN (a new grad, nonetheless) and one CRN (who is a bada** RN but had only been in the CRN role for two weeks at this point). They had a code and it was pretty devastating. There wasn't even resources to even begin the code appropriately. Thankfully, the patient was fine, but it really opened admin's eyes to the potential dangers. Apparently they were turning a patient and couldn't hear the vfib alarm on another patient at the nurse's station. When they left the patient's room and heard the alarm, they scrambled to start a code. 2) Our critical care unit consists of a 14-bed intensive care unit and an 8-bed progressive care unit. The PCU hss a minimum of 2 RNs and usually one tech. These patients are still VERY ill, in that they'll be downgraded to PCU a day or two after extubation and stay in PCU for a week or so. We are allowed to have feeding tubes and drips. Sometimes our patients are a "wait to intubate" ED admit, that they keep PCU level overnight until the pulmonologist can intubate in the morning. We RNs each have a 4-patient team (My team last week was two Afib with RVRs, one post-heart stent who kept having long runs of vtach with reperfussion, and one with respiratory failure satting a sustained 82% on continuous BiPap). It's TOUGH. Sometimes the other RN is JUST as busy, and often our aide will "float" to ICU to clean a stool or turn a patient. If my patient goes downhill, and the other RN is doing a med pass down the hall and our aide is in ICU, I'm pretty screwed. It's happened before and it will happen again. Sometimes I'll call my CRN on my cell and holler for them. This unit is L-shaped too, so there's many places you really can't yell for help. The two RNs and one aide make me nervous, I can't imagine one RN!!

Our staffing is odd right now. We have a lot of agency nurses finishing their contracts and a lot higher acuity patients than normal. We're WICKED short-staffed. My boss asked last week if I was willing to work a dayshift instead of a nightshift to help them out. Sure, I'd said, no worries. I'm nervous because this would be my first dayshift off of orientation, though I've been on my own for nightshift for a few months and I'm not sure if I like it or not. The following week, I'm scheduled to take a vacation. Long story short, she needs help on another dayshift and will give me an extra THREE vacation days. Heck yeah, I'd said, but please don't abuse my offer. She has asked twice more if I'm willing to work dayshifts, to which I apologized but said I'm not able to at this time. I don't mind helping out, but I'm out the $4/hr shift differential and I'm helping them out without any incentive (for reference, our bonus shifts are $20 bonus/hr). My husband works second shift and nights give us more time together, but I just found out I have hypothyroidism and I'm exhausted to the core...nightshift does not help this. Should I say no to swing shifts or see if I like days better, but ask for an incentive? If I prefer days, I may ask for a dayshift position should one come available. I'm still trying to figure this all out... Any tips?

Full moon was the 15th ?

1000x times yes! I'm not sure how your schedule is done, but I'm able to view online everyone who will be working with me. I like to pick a "preceptor," so I never go into a shift clueless. I know who loves to teach and who is receptive to helping me improve my skills. Usually it's our charge nurse, but sometimes a staff nurse is just that good! I'm also very honest. If I am experiencing something new or unfamiliar, I let our charge and a couple staff nurses know. This way, they check in frequently to see if I need help. That's a huge help, and I feel less dumb asking for advice and help. Good luck! This is such an exciting time!

If you sat outside his room monitoring him all night, that's continuous monitoring. I would call the MD and say he is not currently Afib with RVR but with his extensive cardiac history, I'm afraid he will convert without us knowing on a non-telemetry floor. I work in ICU and have had two different patients convert into Afib with RVR in the 140s to 190s...completely asymptomatic. That's great that they don't feel it, but that's a HUGE risk for stroke. I called the MD, who is very laissez faire, incessantly. It took many hours, but I got my patient back on a Cardizem drip. Don't be afraid to vocalize your concern. If your charge is not reacting appropriately, and it seems as though she isn't, contact your house supervisor if you have one. Call the MD available at nights. I hate calling people at night, but they're on call for this reason. Best of luck to you!

This is wicked -- thank you so much! This patient had JUST arrived to our ICU, so she didn't have an A-line and her pulse ox wasn't reading even on her forehead. I don't hope for another code soon, but should they have one, I'm definitely hoping for an A-line. Thanks!!

We do not have access to feedback pads, but are the process of introducing them at our facility. I thought the aide's compressions were well timed, as I was recording and literally watching the clock. Her compressions to me did not seem slow, but a couple other nurses said she was going much slower than everyone else and seemed tired. I love your recommendations on recording the time. Thank you!

I participated in a code yesterday that was textbook. Everything went as expected, but the overall prognosis for the patient was extremely poor. This was her fourth (and seemingly endless) code in just a couple hours. My question is we had two nurses who were absolutely jackhammering their compressions. I thought it quietly but didn't say anything, as I'm a new nurse and didn't want to argue during a code and potentially compromise quality care. I also accepted that our efforts were most likely futile anyways. However, an aide who is in nursing school later pulled me aside and noted that these compressions seemed incorrect. She provided slow, deep compressions and even started she was humming "Stayin' Alive" to maintain a proper beat. She was berated briefly during the code by a nurse for performing "tired" compressions due to her "slow" rate, but I thought she allowed for complete chest recoil and maintained an even, appropriate rhythm. Next time, how do I address incorrect compressions professionally and appropriately?

My school said that this would "exclude" you from starting this semester, and you'd have to reapply for the following semester. I, like you, missed my timeline for vaccinations. I was in the middle of planning for a wedding I wasn't sure I wanted and a very close family member was dying. I spoke with our dean and she accepted my "late" vaccines with a slap on the wrist, provided I had proof of appointments or attempts to get said vaccinations. Good luck, OP! It's probably nothing more than a wake-up call.

I provided a non biased report, but explained the issues and encouraged oncoming nurses to glance at some notes entered about her behavior. My shift brought aboard a team conference with management and even HR! I heard she's been a bit better since then.

I told her ? When she was being particularly manipulative, I told her I was going to document all care given and conversations had appropriately, and that my goal is to provide good care. She was not pleased.

The ED knows and doesn't mind a bit! They even tubed up chocolate chip cookies and warm wipes to her last night ?

Update: I'm back in this unit but do not have her as a patient. I have been commended by two house supervisors and three nurses on how I handled the situation. Management is VERY aware, everything was documented as close to real-time as possible, and incident reports were filed. She apparently tried to get another nurse fired during dayshift yesterday...yikes! Y'all wanna know the real kicker? She put in for a work transfer to our unit....heck no! Thanks for all your advice! Our Dean of Nursing had a loooong talk with her earlier today.

Hello all! I recently had a shift that left a bitter taste in my mouth. One of my patients was a coworker from another unit. Let's call her "Claire." Claire works in the ED and is a well-regarded nurse. She received many gifts from colleagues and doctors offices, and I responded to many calls during my shift of physicians "just seeing how she's doing." I know Claire fairly well, and she's a very kind person. I did NOT know she was a terrible patient. She kept a list at the bedside and made note of all the "errors" I made during my twelve hour shift. For example, she was due an antibiotic. I scanned her bracelet, asked her name and DOB, scanned the med, administered the med. Then, she asked for a tylenol for fever...and then a pain pill...and don't you know she can't take her pain pill without Zofran? So after my FOURTH trip to the med room, I scanned her bracelet, scanned the med, and administered. She claimed I made an error by not asking her name and DOB the fourth time. Another time, she claimed I entered a drug into the IV pump incorrectly and reprogrammed it herself. It was a med you could give over a 1.5 hour to 3 hour window. I programmed it for 1.5 hours. She had a TON of IV antibiotics and with her IV being a 20 in her forearm, I figured 1.5 hours would be fine. My charge nurse agreed with me. She then requested I bring in new IV flush bag, primary tubing, and secondary tubing with every antibiotic. She would stop the programmed flush after the abx administration, and even once claimed I caused phlebitis by running two abx one right after the other. However, there was a 20 cc programmed flush, and I even alternated IV sites with every antibiotic. She has already gotten a colleague of mine fired due to the "errors" she made. I made a ton of narratives regarding the situation, and the nurse and house supervisor were both aware during the situation. Has anyone else experienced this? No matter what I did, I was wrong in her eyes. I'm not really worried about it, I just wished I had handled the situation better.

I'm an ICU nurse. After a particularly rough shift, my coworker and I were discussing things that scared us $#!+less. It did not involve codes, CRRT, vssopressors, pulling sheaths, emergent intubations... ...we both agreed: A walkie talkie who is not on the tele. Ugh, my worst nightmare. So much can go wrong. I have so much more control over a sedated, ventilated patient. As an ICU nurse, I could NOT do what you do. I love my line of work, but it taught me to recognize we all have our specialties.

I've felt this way about jobs in the past. I'm blessed at my current job with wonderful coworkers, and I feel that makes the difference. I would talk to your doctor about the potential for depression. Those sound like the symptoms I had before I was started on medicine. The medicine gave me the motivation to improve everything else. It gave me the umph I was needing. I'll be thinking about you in the weeks to come. Best of luck to you!

My first thought -- I have crippling anxiety. As an adult, I'm on medication but as a child, I was on my own and my symptoms were entirely unmanaged. My anxiety specifically manifests itself in heart palpitations, high blood pressure, and dizziness. I can recognize my anxiety now, but I remember how scary it felt as a child. Potentially it's psychological? It may be nothing, but it's very real to him. That's something an EKG wouldn't show ?‍♀️