Nightrn16

Greetings! It's been a while since I posted, mainly because sometimes RL sucks. The last time I posted, I worked on a 39 Telemetry bed unit, taking care of as many as 9 patients at night plus being responsible for the LPN on my hallway. She could have as many as 8 patients as well. We (the nurses, not the LPN's) also started and titrated many types of critical drips. (Insulin, amiodarone, cardiziem, heparin, dopamine, dobutamine, argantroban, levophed, ect ...) I ended up working there for 2 years before burn out and stress got to me. I would have stuck it out longer because I hate quitting, but my grandfather, who raised me, asked me to move home and help take care of him. He was 84 at the time. So from 2006-2011, I stepped away from the 'official nursing positions' and I took care of my grandfather and my step-dad. (I kept my WV License active though.) I kept track of all of their doctor appointments, lab work, any questions that needed to be asked to the doctors, meds, hospital visits, blood pressures, and sugars. Not to mention the fact that I was also the primary driver for both of them. (And they lived 20 minutes apart, so after a while, it got to be a strain on me, but I did it.) My grandpa passed away at 89 this past November, so I've moved to Virginia to spend time with my biological father and to get to know my 10 year brother. My other brother moved in with my step-dad and while he doesn't do the blood pressures checks or the sugar checks or take him to the doctors and stuff, he does keep an eye on him. I go back to WV when he needs to go see the doctor's. Anyway, I digress. I got my VA Nursing License and recently interviewed for a nurses position in a doctor's office and I would deal mostly with the EP doctor's. I don't know if I have it yet, but I'm hoping I do. I felt the interview went well. I was wondering if there were other nurses in a similar setting and what their responsibilities were? The interviewer told me that it was a fairly new position that they were interviewing for and hoped that by adding a nurse that dealt mostly with the 3 EP doctor's in the practice (there are 19 cardiologists at the one practice) it would help out with the load. She told me that it would mostly involve teaching a patient about a procedure and a LOT of follow up. In all honesty, I was practically jumping at the idea. I know a little about them because I have taken care of patients post AICD and post Pacemaker. (If they had an ablation, they went to a step-down unit.) But over all, I'll be learning even more in depth about stuff. To be honest, I've even looked up all kinds of info on the web. I should know later this week if I'll get called in for a second interview. I really hope I do. If I don't, then really, the knowledge won't be lost. No knowledge is ever truly wasted. :) Any other EP doctor office nurses out there, if you could let me know what all you have to do, I would appreciate it. :)

20/hr .. wow .. my base pay wasn't even that when i worked in the hospital for 2 years. I started out at 17 something and when I quit 2 years later I was up to 18.50. Of course, that was my day shift pay, and i worked night shift so I did get the differential, but still. I'm still looking for doctor's office jobs right now. I'm following a couple "leads" I got from a friend and hope they pan out. At this point, if they offered me $15/hr I'd take it.

When we do Tikosyn, or have them on a drip that would affect the HR, we tell the HUC's (the one's that watch the monitor), and they have a clipboard that when they measure each strip out, they record what the qrs interval and stuff on, and they also write down if their on a drip affecting HR, that way when they give report, it get's passed on. It worked the whole time I was working there.

I liked the 11p-7a shift. Sure the patients get cranky when you have to wake them up especially when the 3-11p RN gave a sleeping pill at 9pm, but the way i look at it, they get their vitals taken at midnight anyway, so their gonna get woken up. It had its advantages. I'd scheudle my doc appt's for the first thing in the AM then sleep all day and wake up around 9pm to get ready and stuff. THe sun scares me tho hehe

haha that's hilarious

The tele floor I worked on had a monitor tech that was trained specifically to watch the monitors .. uh .. watch the monitors. They took off doctor's orders and watched the tele's. Not the nurses. The nurses would sit for them when a break was needed, but as part of the orientation an EKG class was given. Frankly, I trust more of the tech's decisions on strips than I do my own and I done cardiac for 2 years. I can calculate .. but they do can do it much quickly .. and normally are more right than me lol.

I've had a couple thanks yous that stick out in my mind. The hospital where I used to work at had papers thumb-tacked to the bulletin boards in each patients room that said "Thank you to _____" and a big space was left so they could fill in why. Well, a doctor made rounds one evening to tell a patient that he wasn't a candidate for a CABG. With me being a night nurse, I don't get to see but a handful of doctor's that make rounds that late and this was not one of the usual ones, so I listened at the door what all he explained to the patient. The doctor was out of there in about a minute's time. I had the patient's pills in my hands and went in and assessed him and gave him his meds. I then asked the patient what the doctor had said. (I do this b/c it's nice to know what their take on what was said is.) I could tell the patient and his family was upset. I told them that I would come back and talk with them in a few minutes and explain what the doc had said in understandable english if they would give me a few minutes to see my last couple of patients. They agreed. I ended up spending an hour and a half with the patient and the family, explaining, answering questions, and basically saying that the doc would have operated if he felt he would come through it okay, but didn't wanna take that chance. I explained some of the new meds the doc was gonna put him on and looked at the patient and his family and said that he could get better, but there's always that chance that he could get worse. The family thanked me and said that that was all they wanted here. Everyone else had been dancing around the "can my dad die?" answer and I was the only one that was saying he could die ... I then told him that the future is an uncertainty and for all I know I could go around the corner and just plop to the ground. (This brought a laugh from all of them when the patient looked at me and said ... before you do that ... can you help me to the bathroom first?!) lol The next couple nights I had him, I had BP and breathing problems with him, but I would always get him fixed for dayshift (in which of course he dind't have problems then lol). I kept him and the family updated in what I was doing and why. They seemed to appreciate it. I had the patient again a couple days later. We were sending him to cleveland clinic for a second opinion. Just as soon as I got out of report to start the night, they called and said they had a bed for him. I called the doc's and let them know that he was going that night. I walked in the patients room. His eyes and his families eyes lit up when they saw me. I looked and them and said "You just became the luckiest person in the world." He looked at me and asked why. I told him that they just called and said he had a bed, and that meant he didn't have to put up with me all night long. He said "whew! Dodged the bullet on that one!" He laughed so hard he turned purple lol. Now is where those little papers come in, while I was getting his stuff ready for the trip to Cleveland Clinic, the family had went and gotten a bunch of those papers, and every one of the family members had written a tahnk you on it as well as the patient himself. I'd never had one before, and when I read them (they handed them to my charge nurse to give to our nursing supervisor ... but the charge nurse let me read them first) I literally started crying. It made my night. =) Another one is I had a patient who was sick, not keeping meds down, he liked the phenergan better than Zofran b/c that was the only time he'd get some sleep and it was only 30 minutes. The pt's wife called and asked how he was doing .. well at that time, I had just walked past his room and looked at him and he was asleep. Granted he was sleeping with the puke pail, but he was asleep. She was relieved. An hour or so later, he's throwing up again, and it looks blood tinged. I thought it's probably from his throat where he was throwing up so much. 30 min after that his abd started hurting. RED FLAG CITY!!!!! I listened and sure enough where there had been bowel sounds at 8pm that evening, now just after midnight there were none. So, I went and got 3 other nurses to listen (my stethoscope was falling apart so I didnt always trust it) .. they agrreed, one quadrant, no sounds. I called the doc that'd I'd already pestered 3 times before ... I have to suggest to him to get an abd xray, lactic acid, and ask if i can put an NG down him, along with get some various other labs. He lets me. (this doc can not be bright sometimes. o.O) So my co-workers got the stuff out for me. I'd never put an NG tube down at all, not even during nursing school, and they didn't remind me I had to measure it. Well, I was flying blind as I was putting it down. The patient was pale and diaphoretic before I put it down. It was the easiest my co-workers had ever said they've saw one go down. We guessed about how far (an oops in my book for not measuring!), and immediately the pt had color in his cheeks. There was so much air come out of the ng tube when we first put it down that it could have blown up a balloon. X-ray confirms we guess placement right and hooked up to suction. (Ended up getting 1200 out in 5 hours.) I looked at the patient and told him I needed to call his wife and let her know else she'll shoot me in the morning when she comes in and sees all the tubes. He agreed and for the first time that shift, laughed. I could tell he was feeling better. I called the wife. She didn't say "hello". I guess she had caller id. She said, "Oh god, what's wrong?" I reassured her that I fixed him and that he's ok and in the room talking. I explained all I did and she asked if she could come in. The patient was in a semi but I told her if she was quieter than a mouse she could. I also told her that her husband said that if she was to get there in under an hour, I had permission to yell at her. (They lived 45 min away.) SHe laughed and said he must be feeling some better. She got there. I explained the set up to her and her daughter and son (she brought both kids b/c surgery had been consulted .. just not seen yet). FOr once, the patient was sound asleep. I'm talking snoring with the NG tube. For a man that'd not slept in 4 days (he was there all 4 days), he was outcold. ((Side note, I'd never heard anyone snore with an NG before .. but I have now lol.)) The patients wife hugged me and thanked me over and over and said she believed I saved his life. I told her I was just doing my job and I was glad he was able to get some sleep now. When I left that shift, she hugged me again and thanked me again, as well as her kids hugged me. (Grown kids!) That was one of the nights that I can honestly say I saw the fruits of my labor, and the outcome was good, and on top of everything else, I got a thanks you from the man, and his family. =) I know one thing. Those's few thank you's that we do get sure outweight the ones we don't get. Even if we do spend the same amt of time doing something for someone and never hear a peep of thank you. When we do hear them, it does go straight to the heart.

I'm in WV. That'd be nice if it was the same payscale, but I don't want to expect high only to get them crushed!

I quit the hospital to move home and help my papaw out, plus it was getting too stressful and too dangerous (see my other threads about that rant lol), so tomorrow I'm going around and gonna hand out my resume to doctor's offices that may or may not be hiring. I know that I won't get paid nearly as much as I was in the hospital, especially since I had the night shift differential lol, but I was wondering what the avg doc office RN makes. I'd ask the nurses around here but I swear there aren't any. Their all MA's. My mom is friends with several doctors and tried to get me an interview, but all 3 doc's said they didn't hire RN's, only MA at their office. So any price range would be great! Thanks in advance :)

Well I have a few, some happened to me, some did not. 1) This was told to me as well as several other orientee's. There was an aide doing post mortem care on a patient. This was evidentally an expected death because all the family was there, I'm talking an entire waiting room full of family. The doctor pronounced, talked to the family about donation and everything. The family then went home while the aide was cleaning him up. She was almost done when suddenly he sat up, grabbed her arm and said "HOW YA DOIN?!" She burst outta the room. Now by this time the patient had been "dead" for about an hour or so. Of course, everyone runs in the room, hook him up the monitors and stuff and he seems fine. They have to call the doctor back AND the family and let them know. He lived another week so I was told. Who knows why he was hanging on because he had all his family there. (I know that sometimes people wait on certain family members.) 2.) This one happened to one of my patients. Actually, the very first code that ever happened to one of my patients. I started out at 7pm a bad shift. Within an hour, I sent someone to the unit because everytime she moved, her HR shot up to 170. THen I went around to all the other patients and checked in on pt "X" because I was told that she was a "dump" from another unit that didn't wanna deal with her. She had an NG tube, came from a NH with abd pain, blind, a Right BKA, and would not stop yelling. I finally got around to her. I went in, introduced myself, which would later result in her yelling my name at the top of her lungs because she didn't like using the call light, and of course, her room was as far away from the nursing station as possible. Yet, I strangely took a liking to her. She reminded me so much of my grandmother. Anyway, lemme back up. While I was trying to get the other sick patient off the floor to the unit, a doctor called and asked the code status of patient "X". First of all, thats NEVER a good sign. (Full code btw) Ok ... all night long she kept saying by morning she was gonna be dead. I sat back there all night we talked and laughed, turned out she didn't wanna be alone, which was fine, but I hadn't even opened a flowsheet on any of my other 5 patients and at 11pm I was gonna have to pick up more. Around midnight, HR went up. Called doc and asked if wanted me to give standing order of lopressor, said he'd be up. Came up, said she was in pain... gave morphine. Didn't help. I asked the patient if she wanted me to call anyone to come sit with her, she said that her family lived 30 min away, not to bother them, they put her in the NH b/c she was too much of a hassle for them to deal with. I told her I'd check on her about every 10 minutes, but I needed to go take care of my other patients as well. She said ok. Every 5 minutes, I'd hear my name. It got to the point that I sat at her door and *tried* to chart. (I couldn't do it inside b/c she was on contact precautions.) Come 5:30, her HR shot up as I was giving contrast down her NG tube. All of a sudden, the monitor tech came over the intercom to the room and told me to get to the desk now. I ran up there, she met me half way and showed me a strip of v-tach. "CRAP!" I run back to the room. I ask pt. X if she's hurting. I swear, she looked dead at me and said "No, for once in my life, I'm not hurting at all." Then she seized. Well, we did end up coding her. After the doctor's finally got a hold of her MPOA, they decided to make her a DNR. Her family said that they would not be in. That made me LIVID b/c during our conversations earlier she was telling me about when her kids were little and her husband. My shift ended at 7:30 that morning. The day shift nurses were pissed because I never left the patients bedside all night long, long enough to chart anything, actually, most of my patients never even had a new flow sheet started. (Night shift starts the new flowsheets.) I told my nurse manager I wasn't leaving her. I told the patient I was there for her and wouldn't leave her and I wasn't going to. I held her hand until she died around 8:30 that morning. By that time contact precautions were out the window. I didn't have any gloves on, I was holding her bare hand. I didn't get out of work until 11am b/c of all the charting I had to do. My nurse manager was wonderful and took care of talking to the family over the phone and arrangements and stuff. (Good thing b/c I was still pissed at them lol.) Word of advice: If a patient tells you their going to die, then they will. And when she told me that she wasn't hurting, I really did not want to shock her because I knew she was going somewhere much more peaceful. Of course, I did, several times as it turned out, but still. I bet I was out of her room for a total of 40 min's that entire 12 hour shift. My coworkers were really great in helping me out in that situation, helping me pass meds and everything. 3.) This one happened to a co-worker. She said that she was charting at the desk one night and all of a sudden the tv turned on and turned up really loud in an empty room across from the nurses station. Co-worker got up, turned the tv off and sat back down. By this time she was a little unnerved but didn't pay too much attention to it. About 5 min later it did it again, and this time got louder. She said she walked in there and said "I'll leave it on, but it's gotta stay low, other people are sleeping!" She turned the tv down and it didn't get any louder the rest of the night lol. 4.) I was a witness to this one. I came out of room 15. Room 14 is a semi, but it was completly empty. We'd taken a critical pt that was in there earlier to the unit. Anyway, I was coming out of room 15 and a call light came on. I looked down the hall and it was room 14. I had a urine specimin in my hand so I didn't quite think I should go into 14 with it in my hand, so I stopped at the desk where the tech answered the call light. "Can I help you?" "Can I help you?" She asked twice. She then looked over at the heart monitor to see the patients name that was in there so that she could call the patient by that name. She went white as a ghost because she looked at me and said there's no one in 14. I guess that's when it donned on me that no, there wasn't anyone in 14. So we went together to look, and everything was as it should be, empty and clean. It rang twice that night. Very scary lol 5.) Happened to another nurse but I was around the corner when it happened. She went to go open a door to room 17 (a semi) to answer a call light and the door wouldn't open. She said she pushed on it door several times as if someone was on the other end holding it shut. She said that when it did open, both patients were white as a ghost b/c she couldn't get in. The window was closed, so there wasn't any air blowing in the room. Both patients were assists, so neither could really hold the door then HOP into bed as if nothing happened, and there was no family members in there. Kinda freaky. I have more, but that's all for now! =)

The floor I work on, I've taken care of insulin drips before with a 9 patient load. I work night shift (and I don't care what anyone says, no one sleeps at night) and on the telemetry floor I work on, we titrate cardiziem, heparin, nitro, dopamine, dobutamine, insulin drips, argantroban, amniodarone, ect. I gotta say that it's annoying to just finally sit down from doing like 5 things and then realize it's time for your hourly blood glucose test. So I get up, go do it, on the way back to the desk, 2 other people call out wanting stuff, or I gotta fix someone else's heparin, or someone is having chest pain that I gotta take care of. I get them fixed, sit down, write all of 2 words then realize that it's time to check the blood sugar again. On the floor I work on, the patient care people can't take the blood glucoses, only the extern II's can, and at night we only have 1 of those working occasionally. Most of the time we don't even get an aide, so even if the girl is working that can do them, she's not on the hallway I work on. I think since I've been there (almost 2 yrs .. still a fairly new nurse) I've taken care of about 5 or 6 insulin drips, all in this situation. Insulin drips sadly do not count as two people in our classification system. I'd give anything to just have a 4 or 5 patient load with an insulin drip lol.

I've been a nurse for almost 2 years, and while I agree a manual BP would be ideal, but when you have 9 other patients (in which the ones that aren't sick are needy) it's hard. I do try to eyeball the patient. When there is an abnormal BP, I do check it manually. Normally from 7-11, we have a patient care person, and I try to let them know about the BP, and most are good about keeping an eye on it for me (even doing it manually) if they know I've been busy. When I start cardiziem, I do like I do with blood, for the first 15 minutes, the patient has someone stareing at them. I don't leave their side. When titrating, I try to stay near the room, but that doesn't always happen. As for titrating, when the patient's HR is starting to be affected by the drip, the HUC's let us know and we adjust accordingly. In a perfect world, I would keep my eyes on the patient, but it's not perfect, and I often have 8 other patients on their call lights wanting one thing or another. And while I agree it's not safe, there's nothing I can do. The program that determines how many nurses vs patients we have has the final say. When we do have the staff, the program won't let us keep everyone. It sucks, but we deal. (This is why I'm currently looking for another job, 9 patients is too stressful on me, but that's in another thread lol.)

The floor I work on, a tele floor, we hang, titrate, and manage a cardieziem drip, all while looking after normally 9 patients total. We have our HUC's watch the monitor's. It's never left unattended. Normally we tell them when we start them on a drip, or give anything that could affect a heart rate (like pushing lopressor), and they let us know if something happens. If for whatever reason, we need to put them on a frequent BP's, we throw a dynamap on them, and try to check in on them when it should be going off. Cardiziem is actually one of our very frequent drugs, so I guess we tend not to think too much about it. (We also do dopamine, dobutamine, nitro, heparin, integrillin, amniodarone, and various other critical drips.)

I agree with the above poster about the needlesticks. Our hospital too uses the needless system. With the exception of putting in an IV or giving insulin, (or occasionally drawing up meds which i do away from others), I hardly ever come into contact with needles. Just remember to wear gloves. As for infections, on my floor (which is a telemetry floor) we run into MERSA, VRE, flu, adenovirus .. all kinds of things like that. You can't really get around those in the hospital. Our pregnant nurses take care of all but the VRE patients. Just make sure your employer knows about the type of infections you can't be around. As for white .. our hospital just recently implemented a color policy. Nurses wear royal blue and or white , LPNs wear wine color , and the patient care and HUC's wear hunter green. Just ask about the clothing policy you all have there when you interview. As for breaks. There are times during a 12 hours shift when I don't even get to pee, let alone eat. Then there are times when i can actually sit down for 20 minutes and eat and not have to worry about anying pestering me. Just depends on the day and how sick and needy your patients are. Good luck if this is what you decide to do. :)

Well, I really do want out of the hosptial. I'm dreading it. My migraines have started coming back and last week while tugging on a patient (I should have known better to tug on), I think I pulled something in my lower back. The problem I keep running into while looking for a doctor's office job is that they all use MA's around here. I'd like to work for a cardiologist in his / her office, since that is the type of work that I know. But at this point, I'm not picky any more. I'd love to ask some of them but with me working nights, I never see anyone. Last week I decided that this up coming week, I'd turn in my two weeks notice after mailing out a ton of resumes. Then, the boss pulls me into the office and tells me what a great job im doing and my eval is great (and i got a raise of 50 cent an hour), and that she wants to orient me to temporary charge eventually. (I said .. as if I'm not stressed out enough .. you want me to keep track of the charge stuff too, in which she just laughed o.O) So all that is making me feel bad about leaving. Plus I'm still working on my resume, so that's not even been done yet. And I don't really want to give my 2 weeks notice without already having a job lined up. (My apt is expensive >. I'm still no closer to making a decision that I was two weeks ago really. Bleh, I need sleep. It was a long night last night. *pulls out all hair*