CelticNurse

I might be out on a limb here but I think a more succint answer is that some are.......and some are not! Discuss.

That's what I thought it meant. We utilise the same practice with many drugs over here too, such as Gabapentin, Nortriptyline etc. for the use of treating neuropathic pain whaich was not what they were originally designed or commonly prescribed for. It is more commonly known as "use outside the terms of their licence" within the UK but, having more recently looked into some official websites over here, I have noticed that they are beginning to use the the term 'off-licence' more and more....usually in brackets. Typical. We do have a tendency to utilise different terms from the rest of the world when it comes to things medical. We have only recently officially changed to norepinepherine from noradrenaline! I still call it norad myself... Now I am more clear on the phraseology I have to say that yours is not an isolated situation nor would it be considered specific to practice solely within the US. I have been in situations that are nigh on carbon copies of that which you have described. I have worked in a hospital that had both a cardiac and a seperate neuro trauma ICU unit and we used to have to work in either depending on skill mix, workload etc. This type of thing was not an uncommon problem. Neuros wouldn't converse with their Cardiac colleagues and vice versa. They seemed happier to offload on the nurse who happened to be unlucky enough to be allocated to the patient at the time! The trouble is, I find, that doctors tend to prioritize their specialities as the prime factor driving all the care of a patient, regardless of the current presentation of the patient at any given time (which we all know can change for the worse in a New York minute!). It sounds like your neuro doc was merely playing to type and working on the basis that the only factor important to the patient's care was located from the neck up! The mere fact that the patient, certainly from your history and the subsequent orders given by your critical care doctor, appeared to be in a general terminal decline seems to have eluded his own clinical assessment! Like I said, not an uncommon problem.... Having had many years in the field and having used Diprivan for a wide spectrum of critically ill patients, I have never seen it used as a primary drug for the management of seizures. Indeed, I have seen people go full grand mal on me whilst well under the very same drug! Moreover, there is an argument that can be put forward that a patient can still be suffering from seizures and the actual incident can be hidden by being well sedated. Just because the patient is still and compliant in all other aspects doesn't mean that their synapses aren't being scrambled at the same time! Might I ask, was the patient actually on any specific anti convulsant medication, I wonder? Either way, to my knowledge their isn't a specific protocol for high dose Diprivan for the use you described over here.....and I have worked in quite a number of large volume ICU's all over the UK. Generally, as far as I have been made aware by my foreign colleagues this seems to be a universal situation. What can I say? Sounds like you got a dose of your neuro chap when he was at least two coffees behind the rest of the waking world!! Still, nil desperandum, eh?

Indeed they do. However, they always ending up doing unearthly hours into the bargain! There is only so much that a body can take. Before you ask, yes the hours are worse than nursing. Trust me on this.... Besides, I always wanted to be a nurse. The reason why escapes me still but there you are..... The chef gig actually was never planned. More of a happy accident of profession that I just happened to have an apptitude for. Go figure!!

I am sorry to sound a bit obtuse but it is probably because I do my ICU nursing in the UK. Can you explain to me what exactly using a medication "off-label" refers to. I am sure we have an equivalent phrase for it over here but I am in the dark here. Not for the first time either. I work with some nurses from the US, Canada and Australia and we all have differing phrases for the same thing! Just thought I would add to my ever expanding education. Many thanks....

I would have to say that I agree in general terms with the previous post. If you have a position to come to and this includes the Bsc. as part of the deal, then fine. If, however, you are self-funding then there are other seats of higher learning in other large metropolitian cities that would be equal to the task without the crippling cost that would go with funding both your education and general day-to-day living. It may even come to pass that living in London by funding yourself would become a matter of merely existing! This is not to put you off by any means. This is merely a matter of plain fact. Besides, in todays era modern technology, a lot of the resources that once were only to be found in large and prestigious London universties can now be easily accessed wherever you may find yourself. I speak from experience having done my training in a major London trust and doing post grad in whilst living and working in Bristol some years later. Either way, I would say don't be put off but certainly do your research quite thoroughly before you decide. Good luck with whichever path you take.

I was 27 when I started after leaving a career as a head chef. I qualified at the age of the 30. Haven't regretted it once. Believe it or not......

Why did I become a nurse? Three reasons. 1) The money 2) The glamour 3) The uniform

Hey there, I read your story quite by accident but I felt that must say something. Your reaction, whilst ovbiously very upsetting to you, sounds like it was entirely appropriate for the family and, for that, they will never forget you and your kindness. It may not seem like much now but it will, hopefully, put things into perspective later down the line. The job that we do is one of the hardest imaginable things from an emotional angle and we would be sad and sorry individuals if we didn't take on board some of our charges worries and woes! I, personally, have been doing this job for quite a number of years and I work primarily in trauma ICU so I have, unfortunately, been witness to more than my share of similar situations. I can honestly say that I have absolutely no problem with showing my emotions in these situations. I found that it works for me. I will do what I can for my people and, if the need arises, I get myself out the back and cry like a baby! Trust me, it is good for the soul! On one level I think you are right. No-one ever truly understands this unless they go through it. If you have some good people in your workplace don't be afraid to let them help you through this stuff. It is a sign of a normal person to be upset by this. A previous respondent said that it never gets any easier. They are right. It doesn't. I think that it is a good thing that it doesn't, 'cos if I felt nothing it would be time to get my coat and head for the door! You'll be fine, 'cos it sounds like you are doing all the right things. Just keep on keepin' on and remember........there is ALWAYS ice-cream for the bad days!! Keep the faith!

Interesting the variations of using that same drug across the world, I find... I am a freelance ICU nurse working in London and and, even in one city there is no one specific guideline on mixing and administration! Generally, I have found (through my own experience only) that the most regularly used mix was 4mg of 1:1000 into a total of 100mls of 5% dextrose and titrate for effect against weight. Generally, I have also found that it helps with a slightly stronger solution than those I have seen posted because you are not overloading fluid-sensitive aptiens and you are not chasing your own tail to keep changing the bags on your pump! Like I say, just mine own observations as a jobbing ICU nurse...

Okay, not quite lightbulb material but here goes. What is the difference between God and a doctor? God doesn't think he is a doctor.....