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In the ICU, we are on the ground floor, and each room has it's own window. The window opens out from the bottom, with a locking mechanism to prevent it from opening very far. We had a patient last night who was admitted for unrelated reasons which I will not get into. He did, however, have some preexisting "coco for cocoa puffs" issues. He was also a med-surg boarder and with no beds available, he was ours for the night. All night long he bothered us. Talking to himself, getting out of bed, pulling out his IV's and in general being a pleasantly confused pest. At around 4am, we had another patient on the unit who took a turn for the worse, requiring all the nurses to assist with stabilization. We were all busy with this patient for at least an hour. When the ruckus had settled down, the nurse in charge of caring for the "coocoo for cocoa puffs" guy went in to check on him. She emerged immediately from the room with a look of alarm on her face, asking "Has anyone seen my patient???" The first step was to check the bathroom in the room, and under the bed. No patient. This was quickly followed by a check of all the hallways, the employee bathroom and lounge, and any other nook or cranny where cocoa puff guy could have stashed himself. We called security. They couldn't find him either. This was now a hospital wide man hunt. A closer inspection of the room and the equipment therein revealed the following: 1.) EKG monitor unplugged from the wall (so NO alarms) 2.) IV tubing disconnected from the patient and neatly coiled in the bed. 3.) IV pump turned off. 4.) Chair pushed up to the window. 4.)EKG cables and blood pressure cuff still connected to the tubing hanging out of the patient's window. Yep, the patient had managed to squirm his way out of the small space at the bottom of the window. In his hospital gown and nothing else. I will never know how he did it, being a somewhat larger than average gentleman. He turned up about an hour later in a wheelchair with one of the ER nurses who had seen a man in a leather jacket, baseball hat and hospital gown headed down the stairs from the parking lot back towards the hospital. Naturally she thought this was strange, and stopped him. As it turns out, the patient had actually gone home, gotten some of his belongings, which apparently he couldn't go another minute without, and returned to the hospital. He was fine, although he just couldn't understand why none of us could stop laughing. I think the nurse in charge of his care will need a vacation and medication for anxiety and high blood pressure

On the first or second day post-op, we always get orders to put our open heart patients in the cardiac chair. We had just finished helping one of my fellow nurses put her patient in the chair, when the monitor started alarming. Sure enough, the pt was in V-Fib. Oh crap. We all run in and are pulling the patient off the cardiac chair, and onto the bed, when i hear a funny little popping sound above my head and to the right. The spike on pressure bag for the CVP line on the Swan had been pulled out as we transfered the patient over. The 1 liter bag of NS emptied out in less than five seconds in the same way a balloon flies around a room when it is let go. I looked up just in time to get a full face blast, and then watch as in slow motion, the bag sprayed each of my co-workers, and the patient. When it was all over, fits of hysterical laughter alternated with chest compressions. When the er dor arrived, not 30 seconds later, he just looked at all of us and the soaking patient, shook his head, and said "tell me later." The patient made it!

dmarie, please don't be disheartened by the seemingly neverending stream of negativity that is posted here. It is not as it appears. I would say that the majority of nurses chose this profession because they have a love for it, and want to help. And I dare say that most of us really enjoy our jobs. One of the things that i found, when i was fresh outta school, is that most people don't want to hear about what we do everyday. My husband, for example, didn't want to hear that my night at work envolved holding in my arms the hysterical mother of an 18 year old boy who was pronounced brain dead after being involved in an MVA with a drunk driver while going to the store to get a gallon of milk for his mother. I can't say that I blame him. There are very few people who truly understand what we really do, or want to hear about it. Even while you are in school, you are finding the circle of people who you can really vent to about what your work day was like. Mostly, those are co-workers, or in your case, classmates. But for those of us on whom the work day has had a true emotional impact, sometimes talking about it at work isn't enough. And we want to know that we are not alone in the experience. Or, that someone is simply paying attention and listening to us. There are times, when the only way to move past a truly disturbing situation is to lay it down to a group of strangers, who understand what you are going through, and know that they understand it. That, amoung other things, is what i like to think places like this are for. Keep working hard, and know that helping people to navigate the worst times in their lives in the easiest way possible can be very rewarding! Good luck to you!

The Good Samaritan Act was put in place so that people would stop to help in an emergency, rather than passing on for fear of getting sued. The rational being, some help (even without much medical training) is much better than no help. Here's the catch. YOU as a licensed health care provider, are held to the standards of your profession, because you know much more than the average joe. So, if you choose to stop at the scene of an accident, you have to be prepared to deal with whatever you find there. Example: I came across a MVA, T-bone mc vs. auto at high rate of speed with massive DSI to the auto, where there was no EMS on scene. The mc rider, obviously really hurt, altered, combative, obvious extremity deformities, bleeding everywhere, the works. Some poor well intentioned woman, was trying to remove his helmet. I just had to stop. I stopped the woman from removing the helmet, and introduced myself as a nurse. By doing this, I had just assumed responsibility for this accident victim and the victims in the car until relieved by EMS. I work trauma, and it's terrifying being there with no equipment, and just the ABCs, because let me tell you, i wasn't about to do open mouthed CPR on this kid's bloody face. I'm not saying not to stop. I'm simply saying that if you do, be prepared to deal with whatever you find, and see it through. Because if EMS hasn't arrived, you're in charge and responsible. As long as you do everything to the best of your professional knowledge and ability, the Good Samaratin ACt should protect you. If EMS is already on-scene, you shouldn't stop! You are just another source of traffic, and they probably don't want or need your help. And come prepared! My car now comes equipped with a fully stocked emergency pack. Just in case!

This is a difficult subject for all the great reasons that have been previously discussed on this thread. Question: Can we justify paying entry level BSNs, with no experience, a higher salary than RNs with years of experience? Especially when those more experienced RNs are providing more expert care? The bottom line is this.... Do you want to be compensated for the extra education you have worked hard for and EARNED? Nursing is one of the ONLY fields in which higher education (your BSN), on average gets you NOTHING (or next to nothing) in the area of compensation. The only way the nursing community will ever be fully recognized as a profession, and properly compensated for the hard and technically difficult work we do is to start CHARGING for it! It has to start somewhere, people! Do paralegals (even those with years of experience) make the same salaries as the lawyers they work for? NO! Why? The lawyers won't allow it! We are one of the only professional communities who allow our new members to be treated this way! We penalize higher education with average pay. I do understand the opinions of all those with decades of experience who say that new nurses shouldn't be paid more, and that there is no substitute for experience. You're right! But in 2 or 3 years, those new nurses will be more experienced, with a BSN perspective, making them more valuable than ever to the advancement of the profession. This profession has a history of being taken what we are handed, and for bickering amoungst ourselves. And I say again, it has to start somewhere! For the advancement of the discipline of nursing as a profession, this has to stop! We, as a community, have to start recognizing the long term benefits of higher education (both for the patient, and the nurse), and compensating accordingly! (I will now get off my high horse!)

so my fellow nurses and i had a very heated debate last night at work about precordial thumps. i have thumped patients and seen it work, i have thumped patients and seen it not work. several of my co-workers are of the opinion that the precordial thump has fallen out of favor and is no longer taught as part of the acls protocol. i have never heard that, but they say they're pretty sure. what i have heard is that most precordial thumps are not delivered with enough force to generate the energy necessary, and that's why they're not done as often. so i'm settling a debate. to thump, or not to thump, and why?:crash_com:lol_hitti

For the most part, I do think that the tele and med surg nurses have it a little rougher than we do in the ICU. That is not to say I'm not busy, I'm always busy. But it's a different kind of busy. Floating to the tele or medsurg floor is a nightmare for me. In the ICU you are required to know very detailed information on your patients. Not knowing can be very dangerous. So i'm a detail and a control freak by habit and necessity. Trying to find out that much info on 5-6 pts is impossible, and frustruating. But it's a very well ingrained habit and I can't just stop doing it. So I spend the entire shift micromanaging. NIGHTMARE. So, yes, I think in general, floor nurses have it harder. Having said that, spend one shift in the shoes of an ICU nurse whose patient is crashing for the entire shift, and you'll understand why we're so anal! That's the kind of stress there's barely a name for. Give me good ol' ICU any day!!

Gwenith is VERY right. I had the same goal when I graduated. TRAUMA!! So, as a new grad, i went to work in the ICU at a trauma center. Best thing i coulda done, i still haven't left! i LOVE it. If you want to find out if trauma is really your thing, go to a trauma ICU for awhile. I was very lucky, my hospital has a wonderful new grad program and strong preceptor program, so i got a great start. You will see EVERYTHING! Heads, hearts, anything weird that can happen head to toe. Most of these patients have much more going on than just neuro, so you will get plenty of practice with all your other systems too. :twocents:Good luck!

dansko!! i love them! and when the pair i have now wears out (going on 2 years w/ the same pair), i will buy another! i had exactly the same issue with being on my feet for 12 hours a day! so i found, for me anyway, the perfect pair of 14 hour shoes. my feet never hurt after a shift. be prepared tho, they're not cheap. and they fit differently than normal shoes, so make sure the place you buy them knows how to fit them properly. wishing you no more aching feet and good luck in your search!

ok, so i realize that i'm posting on the last page, and no one will probably see this, but.... this one would have to be for all us crazy night shifters out there. here goes...ya ready?? i see day people

We had a trauma come in that had been struck by a car while running across the street fleeing the police. We got him in the trauma room, and were in the process of cutting off his pants, when someone said "Oh my god.". The whole room went still. The man had a deli sandwich stuffed down the front of his briefs! One of the other nurses picked up the sandwich, turned to the police officer that had come in with the patient and asked, "Do you need this for evidence?".

One of the things I think we forget to realize sometimes is that we are human. Especially with the focus these days being on how litigious our society is. And as a new grad, you ARE going to screw up, and you ARE going to miss things. It's ok, we all do from time to time, but you have to give yourself permission to not be perfect. Learn from your mistakes and move on. And get in a routine of practicing all your patient safety stuff (checking arm bands, why are you giving this med? etc.) so that when you do miss something, hopefully it's something small. You missed giving a med? Wait till you've been out for awhile and see what gets missed! That's why this is a 24 hour a day, 365 day a year job. No one can do it alone. Keep your head up! And remember how you feel right now so that you can pass on to others that are in your position in the future that IT DOES GET BETTER!!!!

I really appreciate everybody's input! I guess I should have been a bit more clear in my first post. My hospital's standard dose of 20 mEq comes in 50 ml. And the policy is 20 mEq over one hour. Which is why I was so suprised to hear this other nurse tell me I could infuse it over 30 minutes. For all the reasons that Daytonite mentioned, I stuck with the policy. But I was curious, and wanted to see if anyone else had heard differently. Thanks!

I'm in the process of hanging my first 20 mEq of KCl on a patient with a 3.1 K+ who is having runs of SVT, and another nurse comes in and tells me if I have central access, I can run it at 100 ml/hr. Normally, I would trust this person's opinion entirely, but since I've never done it, seen it done, or seen any literature on it, I played it safe and stuck to the normal infusion rate. QUESTION: How fast can you SAFELY run KCl through central access??

Ok, so here's my method, and it may not work for you, you really just have to find your own routine. Heavy curtains or blacked out windows are a MUST! I also have a humidifier or a fan that I keep on to drown daytime backround noise. My boyfriend lives his life in the day like everyone else, so the days I'm off, i flip my schedule back so I can spend time w/ him. The night before I'm due back at work, I stay up as late as I can, usually 4am or so. Then off to bed and sleep most of the next day. If I know it's going to be a heavy night, or it's essential that I get a full 7-8hrs, a little benadryl goes a long way! Oh, make sure the ringer on your phone is turned off or down. My friends and family still call me while i'm sleeping!! Congratulations on your job, and good luck! Night shifts are a blast! Good luck!:roll