kstockdaleRN

Along these same lines - all you new students out there - When you start nursing, you generally don'thave that "gut" feeling yet - BUT if you patient says "somethings wrong" or "don't let me die" PAY ATTENTION. They are always right.:)

Do not try to apply preparation H in your orifice, leave the cap on, subsequently LOSE the cap in said orifice and try to fish it out with toenail clippers while balancing on a wet bathroom floor with one foot on the edge of the tub. This is a prescription for surgery to remove cap and clippers. AND, you might end up with a 3-day erection and multiple nurses staring at you, trying to get a Foley in. :monkeydance: :monkeydance:

I have a question for all you male nurses out there - and this is just out of pure curiousity. My coworkers and I (mostly women, I admit) were discussing this - WHY do male nurses wear fanny packs? There are probably some fanny-pack-totin' female nurses out there, but we have mainly noticed the guys. Better yet, WHAT IS IN THEM? lol :) It's a mystery to us gals.

Well, I am one of the bad people out there making the phone calls. Yes, I admit it. *smiles* And, I don't like to get calls on my days off, either. I usually know the people who like to work the overtime, and call them first. However, I also know that new nurses feel guilty and will come in! This is my usual message to the always-present answering machine: "Hi, this is K___ from work, we are short again tonight from 11-7. I would be happy to offer overtime and bonus pay if you are interested in working. Please give me a call back if you would like to work. Thanks." I try not to lay on the guilt, and don't specify that I need a call back. If I am talking to a machine, I assume they don't really want to be bothered. However, I do TRY to give the person coming in extra the easiest team of patients, or fewest open beds for admits, a lunch pass. I do appreciate those who tote more than their load. And, I try to start early enough so that the person has time to get some sleep, get ready, etc. As long as the nursing shortage persists, and as long as people call in sick, I think this will be a routine thing. Our job is unique in that it keeps going 24/7/365. Those patients don't care that we are understaffed, they still want care provided. My advise is, do what you feel comfortable with - and no more. Don't feel guilty, and set your limits. And, there is no shame in taking the hours when you want the money, and taking your time off when you want the time. After all, most of us show up every day because we need that paycheck. We care about our jobs, probably more than most people, but the paycheck is the end result. Anyway, good luck, and just say NO! :)

I am not an ER nurse, but I have enjoyed reading this thread. Many of those "society owes me" people end up on the floors for DAYS. :) A lot of this thread applies to many areas of nursing, although we are not dealing with traumas at the same time. I personally take offense to nursing students who have not learned "real world" nursing yet stomping on the good time in here. :) Many of us can't go home to our families and complain about our day all the time - trust me, they get sick of it fast! This is a great place to vent with (mostly) like-minded people! Don't get me wrong, I love student nurses - I enjoy teaching what I know, and precepting. But I too learned what happens in the real world very quickly after nursing school - NANDA diagnoses don't apply here. Writing out complicated 10-page care plans doesn't apply here. Learning to organize quickly, prioritize, and do a lot of technical skills, a lot of charting, and a lot of social work with no break and hurting feet is the reality of it all. Nurses, like other jobs that continually deal with the public, learn to be quick judges of character, and trust us, we've seen it all. My hats off to ER nurses - you do it all, and you do it well.

I don't work CCU - just cardiac telemetry, but we get the occasional amiodarone. We have used peripheral lines, but always with a filter.

I too transitioned to ADON about 1 year ago. What a ride! I am still learning. Discipline is very hard for me. I feel like a babysitter sometimes. I feel overworked, stressed out, underpaid, etc. - but I'm still there. I am floor nurse when people call in, shift coordinator a lot of the time, and mediator all of the time. It is hard work - but I feel like I have grown in my judgement and skills. It is very true that you cannot be friends with your coworkers like you were before. It makes it very hard to remain unbiased when you go to lunch with someone every day. You have to remember that the eyes are always on you - if they even percieve favortism, the rumors will start. :) Good luck to you!

Love this thread! I don't work ER, I work cardiac, but I totally feel for you folks. My additions: If you berate the nurses, scream about needlesticks from phlebotomy, etc. you can bet that your IV will need changing and it will be a 16 or 18. If you go to administration because it took the nurse 10 minutes to get you your darvocet, and you think it is because you are a minority, you can bet that we won't kiss your @$$ the rest of your stay and wait on you hand and foot. If you tell us that you have sued this hospital once before, and you think it's a bad hospital, you can bet that will we chart every word you say verbatim. If you have horrible chest pain, but "nitro doesn't ever work", you can bet you get three nitros every single time, and EKG, and call the Dr. before you get any morphine. Also, in this case we have very little sympathy for nitro headaches and tylenol is the remedy, not demerol. If you point out the vein that you "normally use" and swear its a good one, I refuse to use it, just on principal. If you threaten repeatedly to go AMA, and you are waiting for open heart surgery, I will soon get tired of trying to convince you to stay. Again, AMA paperwork is much simpler. Just because the ER asked you a bunch of questions, this does not mean that I can "call the ER nurse" and get all the answers. I WILL ask them to you again, and I don't have time to listen to your griping. Just because you demand a private room does not mean that we have one. Just because you SEE a private room open, does not mean that its not assigned or that I don't need it for someone really sick (see post one) Just because your roommate is annoying doesn't mean I don't think you are too. If you can't remember your own meds or take them correctly and you are an adult person who is not senile - why do you think that I am psychic and know what your "water pill" and your "blood thinner" are and the exact dose? If I ask the question "so, who wipes you at home?" you know I am getting ticked off and you better do something for yourself if you intend on going home tomorrow. If you want to complain because it took 5 sticks for us to get an IV in you - then why did you pull it out? If your family calls the floor every 5 minutes checking on you, I won't have time to take care of you properly. If you want me to mediate between you and your half-sister's husband, etc. and not allow them in the room - I am not Judge Judy. Work out your own problems. If your refuse meds and procedures but still want to get well, then get out. No, you cannot plug in your cell-phone charger right in front of the "turn your cell phones off, please" sign. If your chest pain is a 10 and you are flipping channels and eating a big mac your family brought in - I am much less sympathetic. If your senile mother in law is in the hospital and you are trying to get her to sign and make you power of attorney, I will not witness it. I do not know how much each pill costs, and I have 500 more to give today. I know what they do, what their side effects are, and why you need them. End of story. No, I will not give you a portable oxygen tank so you can go out and smoke. I know all of this is not stuff anyone is taught in nursing school, and I truly do care about most patients. It is those few patients that you always remember though. Good luck, everyone!

I appreciate your response. I guess my problem is - I'm torn between working my butt off trying to make it better, and taking a stand. I feel like, if I DON'T do this - who will? I work a shift where there is only one other part time nurse who is NOT a new grad within the last year. I accepted the job as charge nurse knowing that it would be a real challenge. However, now i'm whining. :) It's hard to know where to draw the line.......how much is TOO much? So far, even though I stay 2 hours over the end of my shift catching up on charts and stuff every night, and I work too many doubles to count........so far, no major incidents. I feel like we provide good patient care, but I also feel overwhelmed. I guess I just wish that once I could feel like a regular person with a regular job who leaves their job AT their job. I worry about things so much that I often call back to work 2 or 3 hours after I'm off - in the middle of the night - making sure that someone has checked this or that. Is it just me? For example, tonight the entire hospital was full. The units were almost full, two monitored beds left in the entire 800 bed hospital. We couldn't go on divert. I had a patient ON THE NURSING FLOOR on a lidocaine gtt, going into slow VT (rate 105) regularly. The cardiologist would come to the bedside, pace him rapidly to speed up his VT until his AICD fired and shocked him out of VT. This happened 3 times in 8 hours with multiple lido boluses and stuff. Still couldn't get a unit bed for the guy. It seems that a patient not on a vent or a balloon pump can't get a spot in CCU. AND I had 8 other patients. Scary!! But I kind of go into survival mode, we just have to do what we can with what resources we can, because there's nothing better within 200 miles - we are the only level1 trauma center, and we can't divert, and we are full to the brim with not nearly enough staff. What to do? Anyone feel like this?

I work on cardiac telemetry, we get a lot of post-caths. I saw a weird thing with an angioseal once - this guy got up before his bedrest was over and started bleeding (not a gusher, but more than an ooze). Anyway, the nurse responded, got him back in bed, and started holding pressure. As she pressed down with some 4x4's, this large (about 2 inches in diameter) clot came out of his groin site - thing was, it was like a doughnut. It had a hole in the middle and was perfectly round. Weird. Anyway, we called the Dr. and held pressure a little longer, sent the guy home later that day. Anyone seen anything like this? Also, anyone had any experience with a Starclose?

PT and INR come on the same lab work. They are usually a measure of anticoagulation related to coumadin (warfarin). PTT is a measure of anticoagulation related to heparin (usually). I would say that your unit has coumadin and heparin protocols to go by for dosing and adjustments. These labs will tell you how to administer these medications. This is a simplified explanation, there is much more, but this will help your understanding of how these labs relate to your practice. Basically, pts with high PT/INR or high PTT's need to be observed for bleeding. Don't make the newbie mistake of letting them shave with a razor! :)

I work on a 31 bed cardiac telemetry unit, but at any given time we do have some respiratory patients and neuro with telemetry. Our unit has recently hired 5 new grads for my 3-11 shift. I am charge nurse. One night last week I had this situation - I was precepting a new grad, so I took report on her team of 8 patients (the normal load) and after following her a little, I didn't feel like she was ready to be left alone for any amount of time. She didn't know her meds yet, very green overall. At the same time, I had 2 LPN's on the floor, each with 8 patients, and one more experienced RN with 8 patients. As charge, I have to sign off care plans for the LPN's, do all of their IV pushes, administer any blood products, etc. Technically I had 3 other nurses working under my license, with 24 patients. I have to do staffing for the next shift, and sign off all Dr.'s orders. Whew! Anyone else experienced this? I just felt like that night was the perfect storm - if anyhting had went wrong it all would come crashing down. I was just praying that we wouldn't have a code or something. Oh, and also - we discharged 8 or so patients and admitted about 8 more. Sheesh.

If he has a component of cardiomyopathy/CHF, it is also a core measure for the patient to be on a beta-blocker. I think many docs do it with any patient with history of coronary artery disease, because it minimizes many risks. My two cents.

Practice is the key! Have no fear. :) Even if the person is a "hard stick" (and don't always believe that) try once! Look for veins in places that are often overlooked - back of forearms, thumb/wrist area, under watches and name bands, upper arms if necessary. Spend three times as long looking as you do starting the IV. Think of things like "how straight is the vein? How large is the vein? Does it bifurcate? Does it feel like it has a lot of valves?" You will gain valuable experience by feeling a lot of veins. Always walk into the room thinking you can do it. Don't tell the patient "I'm going to try to start an IV" Say instead "I'm going to start your IV so we can give you fluid/medicine". Distract your patient by talking about other things while you work. Explain that you like to spend a lot of time picking out the best possible vein. Many times on elderly patients with fragile veins, a BP cuff pumped to about 40 or 50 is more effective than a tourniquet - less pressure and less apt to blow the vein. Or no tourniquet at all! If you have the catheter in the vein but can't thread it - don't try to "force" it at all - gently hook your flush to it and try to gently "float" the catheter into the vein - sometimes this will open a valve or carry the catheter with the flow of blood through a fork in the vein. Try to visualize in your mind what is going on under the skin with your needle. I know in nursing school they tell you that you will feel a "popping" sensation when you enter the vein - often this is faint or non-existent. Watch that flash chamber - if you get a flash, make sure it continues to fill before you try to thread. Practice makes perfect, and even people with lots of experience will have a bad IV day occasionally. It just happens. Oh, and make sure your not hungry/shaky or having to go pee - nothing to blow your concentration or steadiness! My crowning moment was the night I got an IV that anesthesia missed! It was just because I had the courage to try and I took my time! Good luck to you - starting IV's is one of my favorite things, because I love the feeling when I get one easily and the patient says "I'm going to ask for you next time, that wasn't bad at all!" Don't be afraid to ask good IV starters what their secrets are - most will share!

Okay, here's the scenario: I had a 39 year old patient with viral cardiomyopathy, new onset CHF, EF of 10% on telemetry floor. He was on dobutamine at 4mcg/kg/min. Fairly stable, but as you know, EF of 10% is pretty touchy. He was already not perfusing to extremities as well, and his creatinine had gone up over the last 24 hrs. Tolerating the drip okay, and adequate urine output. VS stable. Few crackles in the bases, but nothing new or worse. I was to transfer him to a larger university hospital for, hopefully, a transplant. Our hospital is 800 bed and does everything but heart transplants. It was a fairly urgent situation, and the transfer was arranged quickly. This would involve about a 4 hour ambulance ride. I called report to the receiving RN and notified her when EMS showed up as to what time to expect the patient. The problem was - I felt that the EMS guys who picked him up were borderline incompetent. I explained the dobutamine gtt - 1000mcg per ml concentration, dose was 4 mcg, patients weight, etc. - drip rate was 21 ml per hour. They acted totally baffled. They didn't even bring plum pump tubing with them. (they were informed of the drip and cardiac monitoring before coming to get the patient) They were asking me things like "what do I need to watch for with this stuff?" etc. I realize that their training is more ACLS/emergent type protocols - but I really didn't feel comfortable entrusting my patient to these guys. However, I spent the time patiently explaining etc. I called the receiving hospital several hours later to make sure he was stable and okay. I gave EMS our number to call if they had questions. Has anyone had any experience with this? Is it even an option to refuse to hand off care to someone like this? Just wondering, and questioning myself.

We use Cardizem frequently, including boluses and drips with and without parameters. I work on cardiac telemetry. The only instance in which they are transferred to ICU is if the drip needs to be monitored frequently for heartrate AND BP. If the person's BP is unstable on Cardizem, then we don't have time, and I transfer. Or if the doc gives complicated parameters involving HR and BP, then i have to stick to my guns, we just don't have the time. We always have someone watching the monitors, but we don't have the staff to do BP's every 10 minutes.

I get so frustrated sometimes at work. I work cardiac telemetry, and we have a lot of high acuity patients and frequent codes sometimes. I consider myself good under pressure, and I like the feeling of using my brain and skills to the max during a code. I get so mad when some nurse freezes up and leaves the room or someone else has to go code their patient. Not just new nurses, either. One nurse has been there for 30+ years and still I have yet to see her slap that code button on one of her patients. She hovers and flits around until someone runs in there and starts compressions and yells for help. To me, this is just simple incompetency. I precept and mentor a lot of new nurses - how can I teach this? It seems an elusive quality. I try to look at it like this - the patient would be dead if they were at home, so basically everything you do at that point is helping. There will be one of two outcomes - and it seems to be about 50-50, although we have been lucky this month and I think every one of our codes has lived and done well afterward. I hate to say that I "like" a code - but I do like the adrenaline rush and the feeling of accomplishment when someone survives. We get a lot of sudden VT and VF - it's just the nature of our floor and the types of patients we care for. We are all required to certify in ACLS protocol every year - so why the lame nurses that run from it? The way I look at it, if a nurse is going to be that indecisive and harmful to the patient, then get the heck out of cardiac nursing! Sorry for the rant, just had a bad couple of weeks - tired of working with people who won't get up and haul a$$ and do their best when needed.

Same thing happened to me this weekend. I had worked 7 days straight, then one day off, and five more days. FINALLY had my weekend off. Sure enough, Saturday I get a call at noon that 3 night nurses had called in - this left a 9-month pregnant nurse and a brand new grad on night shift. I am assistant nurse manager on evenings, so I go on in. Called in another LPN who agreed to work. However, I didn't feel comfortable leaving my unit with one pregnant nurse, one new grad, and an LPN (fairly new grad). We have 30 cardiac patients to take care of. Where are your nurse managers? I LOVE my family time and off time also, but I knew when I took this job that I am essentially on-call 24/7. I will call and call and call people to come in on short shifts, offer bonuses, overtime, whatever - but if that fails, then its ME. It makes my staff work better together also - they know I'm not asking them to do anything that I won't do myself. I ask this question when I interview nurses - how willing are you to come in when the floor is short? We all have to pull together to provide safe care. I am not going to leave a new grad hanging out there with no one to help her. I WILL answer my phone anytime and answer questions if need be. If the facility is that bad and unconcerned about patient care, then GET THE HECK OUT OF DODGE! However, if you can encourage teamwork and pull together to provide care, then do it. I have had to do some creative staffing sometimes - Trade a floor that's short a CNA for an RN, Call other floors and offer bonus and overtime if anyone wants to work an extra half-shift. Sometimes I get an 8 hour evening person to stay and work a 12, then an 8 hour day person to come in early and work a 12, just so I can cover night shift. But I can and do refuse patients. I don't abuse it, though. We take as many as 14 admits on a 3-11 shift when we are staffed. But I have used the words "We cannot safely admit any more patients for at least 2 hours" or something to that effect. Lo and behold, the supervisor magically pulled a nurse out of SICU to work for us. Just have to stick to your guns! Anyway, this is my experience.

I have to say, I just don't get it. I work on a 31 bed cardiac stepdown unit, We have 4, sometimes 3 nurses on nights, with 2 NA's. No secretary, no monitor techs. We are all dysrhythmia and code-blue, ACLS trained. We monitor our own rhythms, pass all meds, etc. I have had as many as 11 patients on nights. The mix is usually like this - maybe 2 A-fib on cardizem drips, 2 or 3 CHF on dobutrex and lasix, 2 chest pain waiting for an angio or stress test, 2 post-angio/stents, etc. We also have patients waiting on pacers, EP studies, etc. Patients waiting on CABG and valve replacements. If we have a code, a nurse from the unit on the other side runs down and watches our monitors and call lights. We do the same for them. It works fine. No beepers, no telemetry techs, and we don't use our overhead paging system at night except in a code. Am I just used to a lot of hard work? I would think 5 or 6 patients was heaven! On any given morning we might have 8 accuchecks to do, all the 6:00 meds to pass, a first-case angio to get ready and a 1st-case CABG. this is normal. Comments?

Hey, I am in almost the exact same situation! I graduated in dec. 03 also, and accepted a position as assistant director of nursing on my cardiac floor 6 months ago. Has it been rocky! My first week I had to pull a nurse in the office for cussing a coworker - and I had previously been friends with her. It is hard knowing that everyone's eyes are upon you. I have to try to set a good example no matter how I am feeling or what mood I am in. I have to do the right thing, no matter how I may feel about the employee. I have to be fair. This is the hardest thing I have ever done! I face pressure from my director and complaints from the rest of the floor - I am stuck in the middle. I try to view this as a stepping stone. I am going to learn everything i can and do this job to the best of my ability until something better comes along. This keeps me going. It seems like I get one thing fixed and 10 more things go wrong - every day. It is a thankless job. However, after 6 months - it is gratifying to hear the "I'm glad your here!" from a nurse after I have been gone for my day off. I have heard the occasional "thank god your back, it was a mess yesterday!" I take this as the ultimate compliment right now. I have often had to "fake" my way through things! I rely on the unit secretary who has 20 years of experience more than she knows! I have to "pretend" calmness all the time - I had to walk up to the CCU director and defend one of my nurses the other day, and I know my hands were shaking. But if I let an ICU nurse treat one of my nurses like crap, I stand to lose a lot more. Same situation when I stand up to a doctor - it is hard, and I worry about it at night after I go home - but I have to advocate for patients and my staff. It is the hardest, best job I have ever had. One thing I have learned - what I lack in experience, I can make up for with enthusiasm and hard work. I set the "tone" for the shift - they all follow my lead. If I stay calm in the midst of a 14-admit in 8 hours night, they can all do it too.

I am a nurse manager on a cardiac telemetry floor. My hospital implemented a RRT about 6 months ago. I was kind of hesitant about the program, I feel that my nurse;s skills are pretty up to par and didn't want ICU nurses "swooping in and taking over" so to speak. However, I have utilized the RRT on a few occasions and found it very helpful. First of all, we on the floor don't have the authority to automatically order a chest xray or ABG's, etc. without a Dr.'s order. If the Dr. is ignoring calls, this is a great alternative to get something done in a hurry! For example, the other night we had a patient with decreased LOC and a history of COPD. Sats were falling into the low 80's, extremely labored breathing, wheezing, high anxiety levels. The nurse caring for this patient and I both knew she was "swirling the drain" so to speak, and she was still a full code. The Dr. just told us to support her with more oxygen - which we felt was just raising her CO2 levels, probably. He didn't want ABG's and didn't want to deal with it. I called the RRT. Her CO2 level was 98! We had her to the unit on BiPAP, THEN called the Dr. and informed him. It was great! The nurses were very attentive to our input, and I felt like we all worked together to get done what was best for the patient. My night shift has called the RRT several times - with our staffing problems, night nurses sometimes have 10 cardiac telemetry patients. If one starts going bad, they don't have time to spend all night working on that one patient. It is a good way to get some extra hands in the room before the patient gets more critical or ends up in a code situation. In my opinion, properly implemented, the RRT is a great program!