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TemperStripe

TemperStripe

ICU
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TemperStripe has 5 years experience and specializes in ICU.

Outspoken.

TemperStripe's Latest Activity

  1. TemperStripe

    New hospital with agency...no orientation?

    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!
  2. TemperStripe

    Light therapy for night shifters?

    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!
  3. TemperStripe

    Future of wireless monitoring?

    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.
  4. TemperStripe

    Is turning to supine considered a turn?

    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.)
  5. TemperStripe

    Light therapy for night shifters?

    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.
  6. TemperStripe

    Light therapy for night shifters?

    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.
  7. TemperStripe

    Patients who are too unstable to turn

    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.
  8. TemperStripe

    Patients who are too unstable to turn

    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
  9. TemperStripe

    collagenase for healed burns?

    I took care of a gentleman with some recent but healed facial burns (burns were about a month old.) Even though I don't know anything about burn care, I was hesitant to use the collagenase that they had written for. My understanding is that it's an enzymatic debridement, but this guy's burns were perfectly pink with no eschar, and were on the way to being well-healed. My question is, how long do you use collagenase for, normally?
  10. TemperStripe

    Army/DOD RN's working abroad?

    I have some questions for anyone who's working abroad right now (or has, in the recent past,) specifically in Europe. PM me, please! Thanks. Caroline
  11. Dec' 08 grad here. We rarely see 3:1 assignments, even when our acuity is low (which does happen...our hospital has no step-down unit so they tend to hang out in ICU longer.) Hope you're able to find a unit that cares enough about your license to be VERY careful with this practice.
  12. TemperStripe

    Are swans going "out of style?"

    Just heard from a coworker who returned from a conference that there are a bunch of new, really cool, much less invasive way to measure cardiac output and such, and that we are going to be swanning people less and less in the very near future. Anyone have any experience with any of these? Are you actually seeing fewer swans?
  13. TemperStripe

    What does an ICU nurse do exactly?

    The answers to these questions tend to be very unit-specific. As a new grad, you should ONLY work on a unit with great, supportive team members. I would say that is the number 1 thing to look for when you interview. There is no quicker way to sink when you're new in ICU then working with nurses who are not 100% on your side and looking out for you. No if's, and's, or but's about it. As for the rest, sometimes there are aides and sometimes not. 99% of time on my unit, there is no aide, we do it ourselves, but we do have an awesome team that will help you whenever they can. In the last year, I can only think of 1 or 2 instances where I needed immediate help and had to manage on my own, and that was only because there were multiple other patients crashing all at the same time. Even still, we made it work. No one can teach you have to prioritize; you have to learn it yourself, and it really depends on the patient's situation. ICU nurses tend to be picky about things looking neat and clean, but when you're patient's losing their airway or their blood pressure, it doesn't matter that their pajamas are from yesterday and the bed linens haven't been changed. Be prepared to make a plan, then change it immediately. But make the plan anyway, because occasionally things go the way you expect! :) (And it's very exciting when that happens...a cause for celebration, really!) Also in terms of prioritizing, learn to think of yourself, too. YOU are a priority. Your charting is a priority, for example, so that you can go home on time. Fit it into your day. MAKE time for the things YOU need to do to get your job done and done well. And as for time management, you have to learn that one for yourself, too. I think a lot of the pressure on new grads is self-imposed. (At least it was for me.) Remember: this is a 24 hour job and it IS okay to pass things on to the next shift, even if they whine. You simply cannot do it all in 12 hours, end of story. Of course, people will sniff you out quickly if you are being lazy. :) Technical skills like IV starts, suctioning, etc, will be slow at first, but soon you will be amazed at how quickly you can accomplish these things. It just takes time and patience with yourself. Good luck!
  14. TemperStripe

    Adjusting to being an RN

    I graduated in December, '08. Switching days and nights in the same week is extremely difficult, even without all the pressure of just being a nurse, let alone being new! It's no surprise that you are exhausted all the time! When can you talk to your manager about doing one shift or the other? That kind of horrible schedule is one reason why nurses are leaving the bedside, if you ask me. Don't be a martyr any longer...tell you manager you need a change! Now that you have one year under your belt, you ought to have at least a LITTLE bit of seniority, right? As far as outings with friends, I set up a google calendar with my work schedule, and gave my friends access to it. Most of them work a regular 40 hour week (M-F, 8-5) and I'm the only one that really needs to be "scheduled around." It's a bit of a pain for them, but they do understand that this is just one of the downsides of my job. I think it's really important to hang out with both nursing AND non-nursing friends; gives me some balance in my life. Also, many of our outings are planned 1-2 months in advance so I can request the time off if necessary. All this being said, even after a year, I still feel like I'm "adjusting" my life, and constantly having to be flexible and make sacrifices for my job. I think once you get on a set day or night schedule, it will be much easier for you to enjoy your time off, rather than having to spend it all sleeping and recovering! Good luck.
  15. TemperStripe

    Antibiotics and blood cultures

    I hadn't heard this and it doesn't make a lot of sense to me...if you have a source, I'd be interested in reading it. My only thought is that antibiotics take long enough to kill bugs that you could administer the first abx and THEN draw cultures without too much change in what might grow out? Let me know what you find out.
  16. TemperStripe

    I/O Access in hospital-Code Blue or RRT Protocol?

    We are just getting these in our hospital. The reps demonstrated 2 different devices and they are VERY cool...surprised it's taken this long for hospitals to pick up on these things! Looking forward to hearing about what you come up with.