NrsGuy

Hey, I haven't used a permacath for end of life situations. The rationale between not using it for anything but HD is to preserve the line for HD - prevent any issues that would contaminate the line or require it to be changed. In this case, because the patient is EOL and will likely not need HD again, in theory, it would be clinically acceptable to use for med administration. That said, you need to follow the policy of your facility. If I were in your position, I would likely get an order from the doc that states, "okay to use permacath for med administration during hospice care.” good luck!

Hi all, So I'm 4 months into returning to the bedside in the SUCU after a long hiatus in non-nursing roles. I missed SICU so I decided to come back. So far, I'm loving it - but I am struggling with a few things in particular and would appreciate some advice. 1) Documentation - IDK if it's just me, if I'm really slow at charting now, or if charting has become quite extensive since I left the bedside - but I find myself charting after 7:30 most shifts. I usually leave by 8pm but sometimes I'm at work charting till 9. What am I doing wrong? I feel very confident with patient care and collaborating with the providers but when it comes to documenting, it literally takes me forever. Is this a bad look? Does it make me a "bad" nurse? I want to get better - faster and remain accurate - but it's deff taking a toll on my confidence. I know I'll get better with it in time, but right now it's kicking my butt!! 2) Because I have ICU background, there's an expectation that I know everything - but I don't and I'm not afraid to say that I don't know how to do something or that it's been years since I've done something and I need some backup. The energy I receive from some nurses is that I'm being burdensome. I'm 90% independent but for things I've never done in years or hospital-specific requirements, I always ask. Is there something wrong with that? How should I manage this? 3) Finally, I'm older than most of the folks in the unit - and I'm not really there to make friends but I do have collegial relationships with most. But since I was in the bedside the last time around, it seems like there's been a generational shift and there's a significant proportion of younger nurses which can lead to feeling isolated during a shift. Anyone else experiencing this and how do you overcome it? Just looking for some straight talk so I can be better and feel more fulfilled. I'm really happy where I'm at and my number one priority is to become the best bedside sicu nurse I can be and provide the best care possible. Thanks in advance and all suggestions appreciated!

Don't sweat it. Hurst Nursing Review. Not only will I guarantee you'll pass the NCLEX in under 80 questions, but it will also make you a better nurse! Good luck ?

I know this is an old but still want to comment for any younger nurses reading this. At first my thought was why is your preceptor allowing you to give medications on your first week? You should be shadowing for at least 3 shifts. But then I remembered you're an experienced nurse with two years med surg experience. The medication you gave was NOT a critical care medication. Patients receive meds via OGT routinely in med surg. The fact that you drew this medication in an IV syringe rather than a toomey syringe tells me you don't have the basic nursing skills that a med surg nurse with two years experience would have. That said, that does not mean you cannot be a good ICU nurse - it just means you need to do an inventory of your skill set - go on Google and search "nursing skills checklists,” and brush up on your skills. If you haven't done something before, or if it's been a while since you've done it, ASK first. I have over 10 years experience as a nurse, 5 of them in critical care, and sometimes when I'm doing something risky, I still ask a more senior nurse to come and watch me or standby why I do it to ensure I have backup in case something goes wrong. HUMILITY will go a long way but also understanding that peoples lives are at risk is crucial here. From my standpoint, the blame falls on you, the preceptor, and the nurse manager equally. You didn't verify the 5 rights, it was your second day on the unit so your preceptor should have been watching you like a hawk even before you drew the medication, so he didn't verify the 5 rights either, and the nurse manager failed to assess your nursing skills and understand where there might be gaps and how they can help you fill in those gaps. I'd love an update to see what happened but hopefully, they gave you a two week observational period where you're learning nursing and ICU skills and validating your competency before allowing you to continue and I also hope they didn't just term you and/or you didn't quit/transfer back to your unit. The most important thing about med errors is to acknowledge them, understand why they happened, and our systems in place to make sure it never happens again - at the end of the day, if one nurse made the error, it's likely that another nurse can make that same error.

So I'm a nurse with 5 years critical care experience - I've done pretty high acuity surgical / trauma ICU, med Surg ICU and also Neuro ICU. I left the bedside for 5 years and now I'm returning to critical care because I want to prep for CRNA school. I've been offered a job at a smaller tertiary hospital in a mixed ICU (cardiac, med Surg, neuro) with a pretty decent acuity level...no balloon pumps or EVD's though. I really connected with the management team. But I've also been offered a job at a more prestigious hospital in their CTICU/CCU. I didn't really vibe with the manager - they were nice and kind but I really connected with the other ICU's team on another level. So I'm tempted to choose the smaller hospital but was wondering what all of you thought. Of course the priority is getting into CRNA school but I also want to be in a supportive unit where I have good relationships with management. Any thoughts would be greatly appreciated. Thank you!