JSRN81

Thanks for the replies. I am still working on it. I am aware of a few errors already. Luckily they have only been "underdosing" thus far. However, most seem to be getting the hang of it now, which makes it a little more comforting....I think. Still looking though. I spoke with our Biomed and IT depts. and they said if they HAD to, they would put a program together but would be worried about the liability, which is understandable. Our monitor company said "Why don't get the nurses PDAs, then you can get them a drug program for it". Uh....no. JS

Actually, I am too. The new monitors do some calculations, they are just set up differently than our previous monitors/program. I actually had one individual ask me to make her a list(she didn't want to do it herself) about how the drugs are actually dosed (mg/kg, mcg/kg/min, ect). I asked her if she was kidding and asked her if during a code, she would say to the doc "Hold on, I need to go get my list" before she administered a drug. My feeling is that if you do not know that about the drug, either you need to go look it up, or you shouldn't be giving it. I don't know, just my feeling. My problem in telling my nurses this is that right now, it is a serious liability because so many of them are dependent on the drip tables. For some reason instead of mg/hr, the monitors print out in mcg/min, so you have to do a few conversions before you actually know your dosage. I am just worried that they won't recognize this and will fail to dose their patients correctly. Unfortunately, I cannot spend 24 hrs a day babysitting them and making sure they are all doing the correct thing. Anyway, it was worth a shot seeing if anyone knew of a program or book that helps out in this area. JS

I was wondering if any o fyou out there use computer software to do your drug titration tables, and what type of software is it? Recently we had a change over in our monitoring systems and the company failed to provide us with the right titration software and it won't be available for some time. Hence, I am looking for a program that we could use to enter weights, drugs, dosages and concentrations and get a titration table....ASAP!!! Thanks in advance, JS

My shoes don't go into my house...but the rest of my stuff does. Our hospital does not provide scrubs, nor do they provide a place to change and keep your belongings. On the same token...I'm hoping that other hospitals have a protocol in place regarding isolation. Anything that is potentially virulent, or easily spead and can cause infection is generally on some sort of precaution. If you are visabily soiled, then yeah, you need to get out of your scubs at the hospital...but otherwise the chance of you bringing home something contagious is slim. Like I said, my shoes come off before I go into the house, because they DO go into an isolation room without being covered and you don't know what ends up on the floor. However, unless I know I was exposed to something terribly virulent or I got visibly soiled, I go home in my scrubs. I don't crawl in my bed with them on, and I go home and shower, but otherwise, I don't worry about it. Now that I am in a position that I don't wear scrubs everyday, I still do not have any qualms about wearing my dress clothes into a room if I need to. They come home on me too... JS

I didn't ask!!!!! All I know is that that was his official diagnosis!! It was quite a few years ago, so it wasn't recently. JS

We had a guy one time with lead poisoning because he stuck a pencil up his because he couldn't pee....yeah, stick a pencil in there buddy, don't pick anything hollow like a straw...a pencil might help!!! JS

I believe that a person must consent before having a placebo, which means that they could sign a general consent for a treatment that says that may, or may not receive a placebo instead of the actual drug or treatment. They don't necessarily have to be told that they are getting the placebo, but they do need to consent to the possibility of that happening. JS

Okay, I just need some opinions as to what to do about this situation, besides freak out. On Tuesday I went in for surgery to have my submadibular gland removed. In January, my allergist felt a nodule/mass right underneath my jaw....and in February, I had a physical from my PCP, mentioned it to her, and she felt it, sent me to a general surgeon. Anyway, he sent me for an ultrasound and a CT scan which showed uptake of dye in my submadibular gland and the report read mass of submandibular gland. So, the general surgeon said I needed to see an ENT. He palpated it, looked at the scans and decided it needed to come out. On Tuesday I went in for surgery and supposedly had my submandibular gland (and nodule) removed. In PACU, I remember saying to the resident "How did it look? Were you able to get the nodule?". And I remember him saying "No, there was no nodule". Anyway, they made me keep the pressure dressing on until today...so when I took it off, I noticed that the incision was much lower than the doc had said it would be. To top it off, the nodule is STILL there, underneath my jaw!! I'm not quite sure what they heck they did if they didn't take the mass out that THREE other docs palpated and he felt himself!!!! My mom is going to call the MDs office in the AM because I am devistated and every time I think about it, I cry and can barely talk! I cannot believe I went through all of this and he didn't even take it out. He felt it in the office and told me the incision would be right underneath my jaw....well it's halfway down my neck!! I don't understand how this could have happened! I am only 2 days post-op and now I am facing another surgery!!! Any ideas????? JS

Our facilities celebreates nurses week quite well actually. The nurse managers hand out cards and presents (usually a pen, or calculator, note pad or something....last year we got pedometers). They also arrange for a free lunch or BBQ and have theme day one day, I believe tomorrow is "White out day" where you wear your traditional whites and caps (my class didn't have that kind of stuff though). We also arrange to have speakers come (education dept.) and this year we arranged for a humorist and also a nurse laywer whom I've heard speak before, who will come in and give a talk on nursing legalities and charting problems, ect. So, overall I think they do a pretty decent job at celebrating this week! It's just too bad the union and the nurses are in the midst of negotiations and are threatening to strike!!! JS

I've got three stories... The first one about me...when I was two, I stuck a piece of yellow chiclet gum up my nose. When my parents asked me why, I told them "Petey did it!" Mind you, Petey was our german shepard. It bought me a trip to the ER where I sat for a good hour and cried, and finally the chiclet slid on out! To this day (22 yrs later) if I do something stupid and my mom asks why, I usually tell her Petey did it!! And the other 2 are from our ER. I usually work ICU but float to the ER sometimes....after the second time this happened, no one made me go back! And, the security officers tried to nominate me for employee of the month, but they really couldn't post why, as you'll see!! The first guy I had came in in a full arrest, he was probably in his mid-forties....anyway, we cut his clothes off and immediately noticed the fuzzy blue hair scrunchie wrapped around his member. So we laughed, took it off and rolled him, only to find a large piece of tape over his orifice....we took that off only to find a tampon lodged up his rectum. We never got an answer to that one!! Now, as I tell this, please keep in mind that I'm quite petite and I look all of 16 years of age running around with my blond ponytail, which made this all the more funny to the security guards who helped me. Our psych area in the ER is called the POD....so of course, that is where they like to put their floar nurses. So, one night I relieved another nurse from my unit and took over her assignment....I read over my charts and found nothing out of the ordinary...a couple of depressions, a drunk guy and one agitation, possible manic. Soon, one of the guys who as obviously the agitation one stumbles out of his room and asks if he could go to the bathroom. Since its the psych area, they are all put in hospital garb and in special rooms when they are admitted...so I told him sure and let him go to the psych bathroom. Now, mind you, our psych POD is watched by 2 security guards and 6 cameras, including one in each room, at all times. So a couple of minutes later, he stumbles out of the bathroom and his hospital pants fall down, only to reveal a Suave (Lavender) shampoo bottle stuck on his friend. Now, it had OBVIOUSLY been there awhile, because he was VERY swollen and had cut the end off so that he could urinate through it!! The security guys and I just stood there! We had no idea what to do. I put him back in his room and went to go get the charge nurse and told her what was going on....and her response was to hand me a pair of trauma shears and say "Go for it!" . When I explained to the guy what I needed to do, he freaked out and it took 4 security guys to hold him down while I cut the shampoo bottle off. Then, when I walked out of the room, there was a small crowd of ER staff who applauded me....and then I finally figured out that they had all watched me through the camera!! To this day when we have floats come back to our unit after going there, they always say "Hey, did you know that once someone floated down to the POD and had to cut a shampoo bottle off of a guys, you know what??". The security guys to this day will remind me that I was the cute young blond that they got a kick out of!! Needless to say, when they tried to nominate me for employee of the month, I didn't get it because they couldn't post why I deserved it, in a public place!!!! JS

At our facility, holidays are worked on a rotational basis. You have a "holiday partner" for which you work one holiday, they work the other (on one, off one). The following year, it is switched around. You can offer to switch or work two holidays in a row. Sometimes we even have too many nurses on and so we take offers to have nurses come off the holiday. Our vacations and other things are done by seniority, but working holidays, everyone does their fair share. JS

tjsmom123: I'm glad that you found confidence in what I said. I truly hope that your experience is a great one, and remember, its what you make of it too!! I haven't had a chance to work very much with this particular nurse....for one reason and one reason only: I was promoted to Nurse Educator/CNS for the entire ICU (we recently combined all of our units under one new roof and see them as one ICU with different subdivisions). With this new job, I will be responsible for creating a mentoring program, which I hope will keep some of the newer people on track. I just started my new job about 2 weeks ago and already love it and have not even thought about the amount of hours I spend at the hospital working because I really do enjoy it that much. Hopefully I can continue to help people (patients AND staff) and make a difference. Thanks for the reponse.... Jen

Today I learned that there is at least one nurse manager, one director of critical care (MD), and at least 3 committees full of people who reviewed a policy and not one of them can spell the word dysrhythmia. I was looking over some material to teach a CTS class and ran across a policy (that I don't use much) that was changed over the past few months...and the 3rd line of the policy refers to "disrhythmias"....apparently these are MUCH worse than DYSrhythmias. JS

The other night (at 1am mind you)....I was helping another nurse bring her patient to CT Scan and as we were going down, her I-Med kept beeping. Anyway, I saw her keep pushing a few buttons and then it would stop for a few min, then beep again. Well...since it was her patient, I thought she had control of things. Anyway, it CONTINUED to do this t/o the entire scan. So finally, I went in there to see why and if the line had infiltrated or something and wasn't running properly. So...I go in and it was a double pump. On one side, she had labeled "KCL" for a mini-bag and the other side was IVF. So I look at the pump, and the KCL mini was set at 100ml per hour, running and beeping occulsion, and the IVF pump was off. Since it had beeped a couple of times already, I looked at the site, then followed the line up thinking maybe it was clamped or something. Nope, not clamped. Kept following the line up, and then ;aughed and said to the nurse "I'm not even going to tell you what is wrong here!!!" and made her come fix it... she had the KCL (which was on and running at 100ml) going through the pump and then hanging up on the IV pole with a cap on the end (not even connected to the patient) and had the IVF connected to the patient and not even running. I just laughed again and promised not to tell anyone when we got back upstairs! Don't worry - it happens to all of us! JS

A couple of weeks ago we had a kid who almost died because of a fentanyl patch. He didn't freeze it, but he did scrape the gel off and chew on it. After we saved his life and discharged him, the narc guys were in and it was all over the news that a pharmacy about an hour south of our hospital had a few boxes of fentanyl patches stolen and then they reported that one kid almost died from chewing on the patch (the kid in our ICU). Go figure. Also, I went to a legal conference last week and there were reports of people extracting the liquid fentanyl from the back of a patch with a needle before applying it to the person. I always check location and integrity of the patch, guess I never thought to check for pinholes or to make sure the med was actually there. As for what I learned today, is that sometimes you just have to go with the flow and let other people help you out...and its okay to say "I defer to you, I don't know what to do"...(regarding how to tell my boss that I thought it was ridiculous for him to ask me to teach an open heart class on MONDAY....good thing HIS boss told him it was ridiculous for me to do...and I didn't have to do it!). JS

Yea....I'm 4'11"...my steps aren't that big! Plus....I acted as the gopher, not giving patient care....but when the PA is standing there with sterile gloves waiting to put his chest tube in and I have to go to another floor...I think it's justified. JS

Today I went to a Code Blue on a medical / oncology floor. Turns out that the doc did a pleural tap and according to him he pulled off 3.5 liters of fluid and then the patient coded (v-fib arrest). Anyway, I was there and a few other nurse mangers and the rest of the team. One of the cardiothoracic PAs decided to put in a chest tube, so I went out to the stock room to find NOTHING. All they had was an atrium, not a chest tube insertion kit OR a an actual chest tube (which according to the NM, they are supposed to have stocked). So, I said I'd be right back and ran down the hallway, down a flight of stairs to the floor below to get a setup. Well, I asked one of the critical care NPS where they kept their chest tube setups on the floor (she works their all the time) and she said she would check...so in the mean time, I went to the stock room and looked. Finally someone got one for me, and I ran back down the hallway and up the stairs...but as I was running down the hallway (mind you, I as running politely, I didn't run into anyone, said excuse me, ect)...the NP said "Well you don't have to run and quit panicking". I know for a fact, I wasn't panicking...had I been panicking, I wouldn't have thought to run down to get another chest tube, and secondly...I don't think that running to a code and/or running to get emergent supplies is a problem...am I completely wrong? I wanted to say to the NP..."Fine, when it is your family member, I'll walk". I just think people deserve more. Am I completely off base here? JS

While I understand where you're coming from, I think it would be best for you to give your two weeks notice, unless you feel the situation is too unsafe and you are risking your life, your patient's life or your licence. If that is the case...talk to your manager and tell them why you are leaving and that you won't be back. One time on our unit there was a nurse who had to bring her patient to the Cath-lab for a procedure....and she did....and then continued right out the door and left for good! THAT I don't recommend! But you do have to do what you feel is best and what you are the most comfortable with. Good luck with your decision. JS

At our facility, at least 6 months of critical care or other acute care experience is recommended before working in the ER. We have two "internships" available for new grads every year, and they undergo over a year of training under a preceptor in the ER. Otherwise, they do not take new grads. The poster above was right about codes being second nature when you have worked in an intensive care before the ER. I have worked ICU for over 3 years now, and when I float to the ER, I'm always pulled into a code, whether or not its my patient because the ER staff know that I have that experience. You have a better understanding of how to titrate drips and different medications when you work ICU before ER. Often times we have ER staff call up to the unit asking about meds because they aren't terribly familiar with them. If you want to feel comfortable and transition in easy, I would recommend some ICU experience first. JS

We recently had one that weight upwards of 700lbs. We had to order all special equiptment for him and he ended up being trached because we could not intubate him when we needed to because of his neck and inability to position him properly. His wife weight 83lbs and insisted that when he was better, she was going to bring him home and take care of him herself. When he finally passed his swallowing eval, he refused to eat the hospital food because it tasted badly. Then, he decided that he would no longer let female nurses take care of him. Well seeing as it took over 6 people to safetly turn him, he really didn't have a choice. I spoke with the case manager recently only to find out that he refused to let his visiting nurse in his home because she was a female. I understand that he has a lack of control in his life because of his size...but that doesn't give him the right to be rude and talk to people in the way in which he did. I found it unbelievable. He got that way in about 2 years too, because he lost his job and became depressed, so all he did was eat. Obviously some underlying issues there!! Furthermore, our hospital and case managers tried to arrange for him to go to a bariatric care facility a few hours away, and he refused. My empathy for some people, and situations only extends so far. JS

Sheri!!!! I too had a CT scan last week (r/o enlarged lymph node vs. parotid gland mass) with contrast. Needless to say, I felt terrible the rest of the day and into the night. I am so glad you mentioned the hearing loss though....I was doing the dishes after dinner that night and all of a sudden couldn't hear out of one of my ears (I can't remember which it was). I mentioned it to my mother (who is also a nurse) and she said maybe it was a reaction to the contrast as I have a lot of other allergies. The hearing loss lasted most of the evening, but was better and completely gone by the next morning. I also ended up with muscle cramps for about 2-3 days following the CT scan. I'm not sure whether it was from the IV contrast or not, but I can say for sure that if I never have to do that again, I won't!!! Jen

Our Chief of Cardio-Thoracic Surgery ruptured a PA about a year ago when he was attempting a PCWP. At our facility, we do not wedge following an open-heart, whether it be a valve or bypass unless we are specifically told to do so. Luckily for the nurses, it was the doc himself who wedged her. He could tell immediately what happened, so he opened her chest in the room and stabilized her before bringing her to the OR. Amazingly she survived it! She later died of sepsis, but not until almost 6 weeks later. Needless to say, now we REALLY don't wedge after surgery...nor will he. JS

This is a totally new concept to me. How does one exercise the 5 (or 6, depending on where you are) Rights of medication adminstration with this? I have never heard of it, and I am supposing you use it in a certain patient population (one where you can be trusting of your patient), but how does one know the patient actually took the pill and didn't give it to their room mate or family member? Not that I'm questioning those who use this practice, but what are the legal aspects of this? JS

I agree with calling to the specific unit, just not the EXACT room number. They used to call just wing and floor, say E5 or A6 south, but now they actually all it to A607b or something like that. Jen

We have the general code blue, red, assist, ect at our hospital. One thing they changed recently is the fact that they called a room number when they call a Code Blue. I do understand the point behind it (allowing the team to know where the patient is...) but I think it can cause more panic and anxiety than is needed, especially if a family is present in house somewhere. I understand that families should know that their family member is very ill, but they don't deserve to find out like that! I would rather have someone standing at the end of a hallway or stairs or something directing people where to go, or like someone else mentioned, follow the crowd...for the most part, unless you are in some secluded spot, you'll find it as long as you get to the right floor or unit. I think just hearing a code blue doesn't alarm families in the hospital as much as if all of a sudden they hear their families room number called over the speaker! Jen