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Dempather RN

Emergency Room, Cardiology, Medicine
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Dempather is a RN and specializes in Emergency Room, Cardiology, Medicine.

Dempather's Latest Activity

  1. Dempather

    Difficulty finding contract

    Hi all, Just wanted some advice from y'all about the difficulty I've had finding a new position in the ER. I have a couple assignments already under my belt + 5 yrs nursing experience (almost 4 in the ED). Is anyone else having difficulty finding positions, particularly in that field? I'm working with a couple agents that are saying the same thing -- there are less positions now than before -- but other RNs I've talked to on my current assignment are set up in their next spots. I know assignments are definitely there, but the ones I'm putting myself out to just aren't calling back. I have several certs including CEN, great references. I was a little pickier before, but I feel like I've been very open to all shifts, different places, etc. There are a couple places in the country I really want to go-- I wonder if it would be a good idea to apply for local agencies around there and work through them? Should I look for more agencies? Thanks!
  2. Dempather

    Feeling terrible, first med error... (long)

    ::sigh:: Five years into nursing and I found that we have plenty things to blame ourselves for (i.e.: our OWN mistakes, how we respond to certain things, etc) and we work hard to control how often they happen and how we can do better next time (often I find this comes from just slowing down and thinking about what I'm doing -- which can be difficult when the time we're allotted is just enough for us to work on auto-pilot... no questions, just do do do !) However, somewhere along the way, we've decided to carry the burden of feeling responsible for the mistakes of everybody else. I understand where you're coming from... you missed seeing that the patient should have been tapered off Decadron. But, in all honesty, where in the heck was the person who wrote the order? I'm going to try to keep in check here, but did the MD/NP/PA decide to write the order and then take three weeks off?? If a day went by, ok. But a week? As important as it is to write an order for a medication, isn't it just as important to follow-up with these things? We're held accountable for the things we ask others to do, right? Delegation, delegation they tell us!! And if we don't, we feel bad. But look, if somebody else doesn't, we feel bad, also! Right, right... so it got through the MD, and got through the Pharmacy, and got through you... and you feel the guiltiest because you were supposed to be that final checkpoint (I used to be a soccer goalie and felt plain awful when somebody scored on me until I realized it passed by every other person on the field, as well). This, by the way, doesn't make mistakes acceptable-- I'm not saying that. But they happen, and we're human. Healthcare is a team sport (bear with the corniness)... and just like soccer, I'm coming around to learning this myself now (I still write posts for support ). I've been in your spot, and I'm sorry it happened to you, and the patient, and the whole crew but you can't carry all that responsibility. BUT, you can learn from the error, try not to drag yourself down about it too long, and do better next time. I thought the post that mentioned to "Be part of the solution" is very helpful. Having a clinical educator on the floor was something else I've learned can make a big difference. Make yourself better so you can avoid this, and maybe catch it for somebody else. We do the best we can with what we have and what we know. I read this over and I feel like I sound like a ramblin' woman. Ohh well...
  3. Dempather

    Two companies offering same position

    Hello! I've got two different companies offering me a position in the same hospital. I already got the process started with one when the second called me today with the information. Both are offering nearly the same amount. Should I try to negotiate a higher price from one? In the event that the company that called me today would be willing to raise their rate, can I back out of the process I've already started with the other (my instinct says that would be poor judgment), but it's worth asking. Thanks!
  4. Dempather

    CEN exam question

    Thank you again, Gila!
  5. Dempather

    Sedation and Hypotension

    "The fact that a lot of us have to do our learning on the job, in the moment, is unfortunately the nature of the beast. Better clinical education would help immensely! " I agree with this! I spoke with a couple nurses from the hospital regarding Fentanyl gtts-- which they state do happen, but with less frequency in this ER d/t a specialized pump that's used for controlled substances (that you have to be trained in to use?). Fantastico. As a traveler, I'm not sure if I'll be seeing one before my assignment is up. Thanks for your knowledge!
  6. Dempather

    CEN exam question

    Are we responsible to know/calculate drip formulas for the CEN?
  7. Dempather

    Sedation and Hypotension

    This forum is a great educational tool for the person presenting the case, as well as the people contributing to the discussion. I feel compelled to add that identifying what's "wrong" serves absolutely no purpose, and is quite frankly, irritating. It neither changes what has happened or promotes openness in others when they want to share their cases. In addition to what I mentioned before: I work in the Emergency Room and was waiting for an ICU bed when the patient went into failure. He had arrived and the dopamine was started on the previous shift. There was no CVP monitor at that point, UOP was approx 300cc from when the foley was placed during the arrest and transfer to the ICU approx 2-3 hrs later. The patient was also incontinent of a large amount of urine during the arrest, ? seizure activity which led to it?. ABG showed pt. was in respiratory acidosis. Appropriate changes to the ventilator was made to accommodate for that (change in tV and RR). Lactic Acid was elevated, and with the concurrent hypotension, I'm suspecting the patient was suffering from a later form of septic shock, which (to my understanding) increases SVR? If I'm wrong, please correct me. In regards to the atracurium, this drug could very well be outdated. This hospital is outdated (no computer charting yet). I've worked for other hospitals where this isn't on formulary. While the patient was restless and out of synch with the vent, my thoughts were on improvement of ventilation and CO2 clearance. I found it interesting that you mentioned "the medical directors hanging on to personal preferences" because the ordering doctor was a previous medical director who, I strongly believe, was hanging on to his personal preference. With all the hubdub, his repeat ABG was normal prior to transfer to ICU. Thank you for your feedback, guys.
  8. Dempather

    Sedation and Hypotension

    Hi, I had a large male patient (~120kg) with a dx. of PNA/sepsis who went into respiratory failure. He was on a dopamine drip prior to this episode for hypotension. Normal RSI took place and he was intubated. Once his respiratory status was stabilized on the vent, it was difficult to sedate him with propofol and atracurium without dropping his pressure drop further. The Dopamine gtt was changed to Levophed because Dopamine was making him tachycardic, and his heart rate went back to SR after the switch. I titrated both the Levophed and Propofol accordingly, but I found myself balancing out his blood pressure and sedation levels the whole morning until I could get him to the ICU. He had also received a total of 2L NS in the ED. I'd like to get some of your thoughts on maintaining sedation in agitated patients who have been intubated. Especially those who struggle with hypotension. Prior to transfer, his blood pressure dropped and I had to hold the propofol. While I delivered him to the ICU with a stable blood pressure (which I'd prefer over perfect sedation and unstable vital signs), the sedation had begun to wear off and the ICU nurse was shooting me glares (we're not talking severe agitation, but becoming restless). I feel like I couldn't get the right balance prior to transfer. In my attempts to do this better next time, I'd appreciate some feedback from some of you guys -- what are your thoughts/what would you have done differently? Thanks a lot.
  9. Dempather

    ER and strange phenomena

    Somethings just have to go unexplained... we went three months without one motorcycle accident off I-95 and then separate incidents three show up in one shift. For the full moon theory, I had a well-seasoned ER doc explain it to me in such a matter-of-fact way. Full moon changes the ocean tides, why wouldn't it change our body if so much of it is composed of water? I can't argue that...
  10. You know what? Once you're a nurse, your patients and colleagues won't respect you less for it. You sound solid, so do whatever you have to do to finish with little worry about what you need to do to get it done -- as long as you feel confidant in your education wherever you go.
  11. Dempather

    What your mind does when you let it wander.

    Great-- thanks for the advice and laughs! :)
  12. In the most impressive show of verbal diarrhea that I can recall in recent history, I thought I'd share this-- So I was trying to fuzz up my cover letter and was brain-storming things to throw in. I asked myself what the heck I've learned in the ED in the past three years. So I just let go and typed out every thought that came into my mind. Here's what I found I've learned when I let my mind go-- - how to move as quickly as possible - how to not make mistakes - how to stop saying i'll be back in five minutes when we all know there's no way i'll be back in five minutes - how to deal with a--holes - how to deal with people when i'm being unreasonable and now i'm too far in - how to be professional (sort of) - how to not cry when a patient dies and i'm dealing with the family (work in progress) - how to say i'm wrong - how to say i'm right (work in progress) - how to not freak out when i'm stressed - how to prioritize (ABCs,ABCs,ABCs). - ivs, ng tubes, foleys, moderate sedation, traumas, codes, cardioversions, drips, blood tranfusions, transfers, admissions, discharges, comforting, vital signs, fluid boluses, meds, meds, meds, shots, iv pushes, crowd control, priorities, following my gut, FOLLOWING MY GUT, learning colleagues are not always my friends but they're still my colleagues, continuous bladder irrigations, recognizing bullsh-t from actual DTs, learning to sound confidant even when i don't feel confidant, how not to cry in public, ekgs, rapid fluid infusions, wound care, blocking punches, biting tongue, letting tongue go, triage, triage WELL, restraints, vents, trachs, respiratory txs, suction, delegate, supervise, not yell......... Let your mind go a little crazy and add something... then we can be a little crazy together
  13. Dempather

    Assessments of an OR Nurse

    I'm currently an ER nurse with some experience on tele. I'm considering a shadow experience in the OR or an eventual change over. Can somebody explain some of the tasks one would experience throughout the day? Do you perform assessments (lung sounds, heart sounds, bowel sounds) as a scrub nurse or circulating nurse like you would on the floor? I'm assuming in a sterile env't, you wouldn't carry stethoscopes... yes? no? My understanding is that you assist the surgeons with instruments, count supplies.... but I could be missing a lot ( I have a feeling that I am ) :) Thanks!
  14. A GI doctor once told me to place an NG tube in warm water for a couple minutes before inserting it. Simple enough, reduced patient discomfort, and made the whole process a whole lot easier. What's yours?
  15. Dempather

    NS through peg?

    When I used to work on the floors, it was free water flush q 6 hrs to lower sodium, like Suzanne said. The amount doesn't seem so concerning - usually they would say 200cc or something of that sort. Think about it. Would you drink normal saline (or salt water)? It's all going to the same place. :)
  16. Dempather

    Coping with a wide-scale trauma..

    We had a patient come to us a while ago who was injured after a particularly gruesome accident. After the incident, word got out and people have called me about it, including well-intentioned family members of mine. What makes this wider-scale for me was that it made it's way out of the hospital and into the community. Even a close friend called in a mild hysteria stating she knew the patient well and wanted to know if I was there and if the patient was okay. I was able to handle the situation well and maintain the patient's privacy.. but I think my friend knew I was holding back information she knew I couldn't share (which hurt more). I think I can handle a lot, and I'm proud to be an emergency room nurse, but this floored me. I've been a little hazy since it happened. Can I call myself a good ER nurse if I don't let this brush off my shoulders and forget about it? Are we all supposed to be indestructible? I don't necessarily want to talk to co-workers because I don't want them to think I can't handle tough situations. An example here: One of my co-workers afterwards cried out, "WOW, I wish I was there.. that would've been AWESOME.. what a great learning experience!!!". I felt like reaching over and smacking her. But I caught myself wondering whether that "I'm hardcore" enthusiasm makes a person a better ER nurse? Or better ER doctor? Is that how we're supposed to be wired? Traumas are exciting. And it rushes the adrenaline. Mine was definitely rushing during the whole event, but I would never call myself enthusiastic. I would never leave a situation like this and call it COOL. I did well .... I know that's what matters. But is it enough?