TemperStripe

Yes, I am. Feel free to PM me.

Great, I feel totally vindicated. :) I've set up some additional orientations at these places and feel totally solid that it's the right thing, not just for me but for my patients. Thank you everyone!

I'm with the RFP and I love it. Can't say enough good things about the managers, educator, and schedulers. It's a great fit for me because I hate unit politics and am very protective of my schedule. I float to 6 Centura hospitals and quite a few more with a backup agency when the work dries up (which, because I do ICU, pre-op, and PACU, is very rare.) Many people think I'm insane. :) Floating is not for everyone...it is very hard in a lot of ways I didn't expect but I do feel like the RFP will advocate for me if necessary, and that is a huge deal! PM me if you want more info.

I have been agency/float full time for almost a year now and have floated to probably 30 different units, but wanted to bounce something off everyone. I just finished paperwork for a large multi-hospital system and also completed a single 4 hour orientation at one of their hospitals. I am now eligible to float to ALL of their hospitals without any more orientation anywhere. Would you be comfortable with it? Here's my thing...I'm an ICU nurse, and never knowing what kind of assignment I might end up with, this just feels really unsafe to me. Yes, I am flexible and good at figuring things out on my own, but what if I walk into a critical patient situation and haven't had time to get Pyxis access, know where the code carts are, etc...? Even stable ICU patients are still ICU patients for a reason. I don't think I should be expected to come in early on my own time to learn all this, either, even though orientation pay is lower. My agency is very willing to sign me up with more orientations. I feel like I want a couple of hours at each new hospital just to knock out the basics. Or am I being overly cautious? Your thoughts are appreciated.

I started taking mine to work to use it during breaks and charting and 5 or 6 other nurses ended up buying their own lights. :) I use it mostly during the winter and also take a massive dose of supplemental Vitamin D. Does it help? I dunno...I did feel like I slept better but I struggled with a depressed mood most of the winter. Where I live, you could go weeks on night shift and never see the sun, at least during the winter. However, the depressed mood could have been caused by a lot of other contributing factors. I felt like it was a worthwhile purchase, all in all, and I'll definitely be pulling it out again this winter. It's better than nothing!

I have twice made the mistake of NOT calling in sick...thinking I'd be fine and it would pass. I was having sore throat/cold-like symptoms. MISTAKE. Both of those days ended up being some of the worst.days.ever. If in doubt, call in sick. Your physical health and your mental health can ALWAYS use it. It's usually painfully obvious who abuses sick time. If you know in your heart you're not one of those people, then who cares what people think. Take care of yourself first. If you're no good to yourself, you'll be no good to your patients. :)

I have heard it can already be done but who can afford it? Not sure. As economics allow, I definitely think it's the future of the ICU.

Side-Back-Side I posted a few weeks ago about a patient I couldn't turn at all so I just moved his arms and legs whenever possible. Miraculously he didn't have any skin breakdown when I checked him the one time that I could. I've never had a patient develop a pressure ulcer from the side-back-side method. I agree with a previous posted that there are some patients who need more frequent turning but I have found this to be the exception. That being said, even if I don't physically turn the patient, I try to "reposition" the bed at least 1x/hour (HOB up, chair position, etc.)

I had used melatonin and also found it to be useless. However, I was taking 3-9mg at a time before going to bed. I've been reading that this is way more than the pineal gland ever secretes, and sometimes taking a lower dose (1-2mg) in the sustained release version, and 5-6 hours before you go to sleep, is better at mimicking a natural release and can improve your sleep. Additionally, it's cheap! I may try that in addition to my light box.

Any night shifters use light therapy and/or sustained release melatonin? Just curious about your experiences with it, especially if you switch back and forth or live in a darkened climate.

This particular case was an incredibly unstable pelvic fracture so the wedge wouldn't have worked because the patient needed to be 100% flat, but I will definitely keep that in mind for the future. I agree with the above poster who mentioned feeling like a bad nurse...I felt the same way! Turning and skin breakdown is 100% nurse-owned and its' always been drilled into my head from day 1...so yes, leaving them flat goes against EVERYTHING I know. But yes, life is more important than skin...no life= no skin, right? Airway, breathing, circulation......skin.

Does anyone have any suggestions for preventing skin breakdown on a patient that is too unstable to turn? I was moving his arms and legs and tilting the bed hourly at least. And of course, he pooped 3x...of all the patients that you don't want pooping...so he did get turned two times on my shift. When we turned him for his chest xray I was amazed that there wasn't any breakdown yet (after 2 days of laying totally flat) but I'm wondering if you guys have any other suggestions. Logistically, we were not able to get him on a specialized mattress either. Caroline

It's because the OSA makes them "high risk." However, many of them don't even have their own CPAPs. They're on room air all night long.

Obstructive sleep apnea.

We've had a rash of elective surgeries that have had to stay overnight in the ICU because the patients have OSA. The policy states they have to be in ICU even though they have q shift vitals! I'm talking about tonsillectomies and vasectomies. Anyone else experience this, and any suggestions on what to do about it? (Ha...yeah right.)