buddiage

You will be doing so many things in med-surg. The COOLEST part of this is, you are gonna get PAID while you figure out what calls to you! How cool is that? You will be exposed to different disease processes and wound care, and certain aspects of patient care are gonna get your attention and pique your interest. You're gonna talk to nurses that came from other floors and hospitals, and you are gonna find your way. What is even better is, if something isn't a good fit for you, you can always switch! There's a no lose situation for you! :)

I've been in the hospital in a CCU, CVICU, and have been a transport nurse (on an ambulance) for 10 years. I've really enjoyed the 'nerdy' aspect of critical care, but I feel especially connected on a more spiritual/human level with hospice patients and families, which I think speaks to me more. Ultimately to me, the reality of dying is the moment of all truth- an opportunity for a death bed and reflection of your relationships. One of the things I don't like about my job (I think nursing can say this generally), is I'm annoyed with trying to make people live that should be allowed to say good-bye. I see the view of death as something feared and scary. I feel like I want to do my part in changing it. For whatever reason, I feel comfortable (and privileged) to be a part of someone's world when they are in a crisis. Critical care has definitely given me a sometimes salty and gritty view of things and the state of the human race sometimes but I don't get this way with the dying. I want the opinion and view of people that left critical care to do hospice. What made you like it more/less? Did you have friends that challenged the choice of hospice, as if you were "downgrading" the value of your nursing care you provide? (My husband, an ICU nurse, says, "Ew, why would you want to do that?") I've only dealt with hospice through transporting them home or to hospice facilities (as well as caring for them in the hospital). Any words of advice? Did you get bored? Feel more fulfilled in your job (perhaps you felt your purpose in life was this, and feel content)? I work a ton of hours in transport and haven't picked up in the hospital in almost six months (per diem). The thought of going there turns my stomach. I'm thinking of just axing that altogether. Sorry for the wordiness, but I don't know hospice nurses and I want your input please. I've been thinking about this for about 2 years and now I'm burning with it practically.

I read a story that the hospital I was considering went union. Thanks for your input!

I'm considering a move to Covina area from Washington. I want to review the contract that the nurses have with the hospital I am considering. I looked up CNA. There is nothing to review. Where are these contracts at to look at? WSNA has them all online.

I am quite shocked at the STUPIDITY of what people say. We ALL have our specialties. THANK GOD. There's enough work for everyone, so let's not step on eachother.

Honestly, you aren't going to know if it was truly worth it until you become a nurse, and some people can't imagine NOT being a nurse despite the fact that their job frustrates them. IMO, if I were you, the idea of more money sounds good. I'm in a situation where I am almost done with a divorce and I'm on my own. I hate living in an apartment, miss my house with a big ol yard. What I've learned in 3 years of nursing is: I aboslutely am smitten with some aspects of being a nurse. My attitude at my job I think has enabled my survival there, and I can actually enjoy aspects of it. I think this applies to any job though. My favorite part of nursing is patient education. My least favorite parts of nursing is jumping through all the 'bs' hoops that supposedly make pt care better. These thoughs race through my mind as I become a slave to the computer and not in with my patient. I also don't like the nature of health care which is 'do more with less.' I hate that I feel like ultimately EVERYTHING rests on my shoulders and therefore if anything goes wrong, it's my fault. The floor you work, the work culture on the floor you work will have an impact on how you feel about your job too. This is just my

I'm wondering if you sprain your wrist and have a 'demigod' for a medical director in the situation described, I wonder if the physician examining you would be inclined to treat you the way the medical director would want you to be treated. Would he or she stand up for you? Hmmmm...

Another nurse union? I tell you, we are so fragmented with different organizations and associations that I feel we don't have a chance at changing anything. Frankly, I scared how healthcare is moving. I love the idea that healthcare could be available to everyone, but I am VERY leery that working conditions would be triply worse than they already are.

Pt had scant crackles in bases, but sats fine (97 to 99 percent), and no SOB. Lung assessment hadn't really changed since being there, and she had been on her back for a few days. EBL- can't remember the number, but it was hardly worth mentioning. As far as CHF, no echo had been done currently in our facility while I had her. I believe she had a previous EF of 60 percent. Pt was warm and dry. I am guessing that she was volume depleted, her urine output was OKAY, but for someone on NS 100/hr, I wasn't impressed with the output. Which reminds me, one of the reasons why I was concerned about killing her blood pressure is because I wasn't wanting to kill her kidney perfussion. I don't recall her labs exciting me much either. I believe her Cr was up a wee bit. It's hard to convey everything without the chart in front of me ;0), but I did solicit for some food for thought. I did not call the physician (I'm not afraid to, but I'm a night shifter and like to call only when I really need to). FST6 and others, thanks for your thoughts.

NO, no lisinopril, just metropolol. random things i remember: ef of 40%. I dont recall digoxin on her sheet. My supervisor said she would've given the metropolol. I had heard (but was corrected by her today) that diltiazem affects bp, just not as profoundly as betablockers. For rate control, the Ca+ Channel blocker was, in my understanding, the way to go. I was frustrated b/c I felt a little like I got my nose slapped by my supervisor, and I was mad at myself for making the mistake. I told two other nurses what I did, and nobody flinched, which made me wonder, is it me or is it our floor that could use some education on beta blocker vs calcium channel blocker. I was hoping for anybody's point of view to give me a "I didn't look at it that way before" inspiration. The better worded question is when is it appropriate to hold metropolol vs cardizem. I don't want to inspire an argument, just want people to share.

she has a history of afib. had gone in and out of it. the plan was to wait until her INR came down so that she could get the surgical proceedure. after proceedure she was restarted on coumadin. i might add her b/p had been on the soft side since admission, despite cardiazem and fluids going at 100/hr. i'll add- you cannot cardiovert someone unless you know they do not have a clot in there heart somewhere, which means they get a TEE to see...and, our pts are always on heparin. plus...this lady is in and out of it from what I got in report, but she's been in it for 3 days now :-) btw, i did a preceptorship in the icu, and learned so much. you will too.

Totally see your point, but b/p actually IMPROVED as heart rate went slightly up. I'm glad you shared your view, because I also want to see just how many people would've done what. i'd love to take a vote on my unit, but that won't happen.

situation: rhythm a-fib, with rate 100-130's systolic lood pressure: 82 and 91 in different arms ns going at 100/hr (for 2 days!) diltiazem drip 5mg/hr metropolol 50mg bid i held metropolol d/t blood pressure, but i'm keeping an eyeball on the rate. up diltiazem to 10mg/hr about 5 hrs into shift after heart rate reaches occaional (not sustained) 140's. pt had screw put in femer, and was out of pacu for 2 hours when i got on shift. systolic bp 2 more times during shift is 90's, 1 time making it to 102. my question: which medication would you have held and why? i asked my supervisor/ manager of the unit just how much diltiazem affects b/p and asked her what she would've done in my position. i've been a cardiac nurse for 1.5 years and have always held the metropolol if they are on a dilt drip, because i thought that dilt was the way of controlling rate in afib. anybody want to share their brain with a greenhorn?

That (google one) was an excellent source! Thank you!

I do ask that one member of the family be the "representative" usually if phone calls are crazy...etc, but in this situation the only two were right in the room! :0) Thank you Dolcevita. It's just eye popping to review situations like that and think, "wow. I survived that!"

Sounds plausible. If you find out, let me know. :0)

I couldn't agree more.

Thanks for your replies. I just got through with a reply and it erased! Urgh... so... To clarify: I never speak medical jargon to pt families, and when she let me know she was a physician I just went forward (speak medical "jargon" but chose my words carefully). Had they threatened me like the dentist, it would've changed the scenario. I documented my butt off with EVERYTHING I did. Dr was aware, charge was aware. The pt had pain issues which of course helps the situation. This was the second pt I've had whose family member was a doc. The first one I had was at another hospital. The pt's son was an anesthesiologist at the hospital that I worked. *gulp* The best thing I did was review POC, progress notes, drugs (I was floated to the special care unit, and they see natrecor more often than I do, so I reviewed it anyways), and doing that gave me wonder woman braclets to deflect whatever was thrown at me. It was just difficult, because I had other pts who need care too!

God doesn't have a magic wand. He works through people like you. What a nice story.

My friend, one day, you will be 40 years old. Or 50... you will still have to be that old. So now that you've accepted that fact, you can chose to be a nurse at that age or not. You have no choice in getting older. The real question is, do you want to be a nurse or not.

Maybe others have had a positive experience. I had a pt whose son was a pharmacist and daughter was a psychiatrist. This pt was on a natrecor gtt. Pharmacist son, probably a nice guy, hovering over his dad (I'm a night shifter), wanting to know things like... what is his Cr clearance, how often was he getting antibx and at what dose, etc. I have to say, I had the pt of a saint, and I kept telling myself "loss of control over situation....sense of powerlessness.... what if that was my dad...." I went online to find the formula of the creat clearance. Showed him, included him, telling him from the get go "our pharmacist does this, the nurses never do this, so this is new." Then, daughter comes in. Asks a multitude of questions (how do his lungs sound, etc). I had my poop in a group, let me tell you, I jogged through all the meds and drips to be "prepared" before hand. I did not let the daughter know I knew she was a physician. She finally came right out and said, "I don't know if they told you or not, but I am a physician." I replied, "Ooooh! Okay!" I had been talking to her like any other family member of a pt. So I just cut to the chase. I was puzzled by some of her questions, because after all, she was a physician. I printed out a 16 page information sheet of natrecor and handed it to her. I did my best to give service with a smile. Soon after, my pt goes into A-fib. This is a side effect of natrecor. Call doc, get orders for amioderone and stop natrecor, told on call doc of situation. He was ready to deal. Pt daughter is disgusted with him going into a-fib and states she read that it is a side effect of the natrecor gtt, and acts like his care at my hospital sucks. I'm standing there, feeling I've done EVERYTHING with smile on my face and had full confidence in what I was doing. I have done everything, short of pulling my pants down and bending over, and probably was ready to do that next hadn't it been for my pt going into a-fib. I was recently put in the position of being the "family member" of a pt who was dying and on hospice. I was curious as to what was going on, did ask some questions, but never eluded that I was "a nurse" (and requested the rest of the family to not mention it). Anyone else have experience with dealing with doc family members, or even moreso, see your hospitalist deal with them?

Wow. This is a good thread. I had admited a pt with a COPD/ CHF exacerbation. Rapid Response team was called within 8 hours of her placement to our floor. She was a DNR. I had seen they had put her in a special care unit when I had come back from work. I can see from my station the rhythms on her unit as well as my own, and I had looked up to see her name and below it, pacer marks with either nothing after it or agonal looking waves. Finally, nothing but pacer spikes. This question was raised in my own mind. I did not know if she was made comfort care in addition to her DNR DNI status. Very good thread for my own recent experience.

I thank you for your responses. I got something now (which is better than nothing). Seriously, 1990's info? Man, doesn't any university want to know? I had a difficult time finding anything on the itnernet that described WHY as opposed to that it actually occurs. I'll bring it up at the floor rounds. If I get anything better, I'll post it so we can all be edified.

I get the cardiac cells are "irritable." I don't understand why oxygenated blood would cause dysrhythmias when the heart muscle needs the oxygen. What is going on here? Is there something happening with the electrolytes? Is there lactic acid buildup and then too quick of a shift with oxygenated blood? Someone help me out, please.

First of all- witty name :-) 2ndly- it might be your hospital. I am currently at a hospital where they are really pushing for us to NOT get pts that are not cardiac pts. I work on a cardiac care unit, as opposed to a tele unit that I started out in. I think it is a great place to start. At my first job, we had to print out and measure our own strips. At my (relatively new) job now, we have tele monitor techs (it was hard initially to relinquish control), and I liked the way things worked out for me. My typical patient is now a CHF exacerbation, ACS C/P RO, NSTEMI/STEMI...you get the drift. I hardly every see a small bowel obstruction anymore (believe me, I was GLAD to be done with one that was on our unit for 3 weeks!! The docs wouldn't move her, and all of us, including cardiology docs, were wondering why). Anyway, it's not always fire, trauma, and CPR, but it would be great to hone in the BASICS of what every CCN should know. If you are bored, work at a different hospital that might give you more of a challenge.