rnsusan

I hope everything is going well for you. I have been a pediatric nurse for 25 years. I was born with TOF. I now have decreased energy so a work part time on an easier floor. I have very few restrictions. I could not lift the heavy patients because I simply was not strong enough.

It is so sad to see a case like this. I have seen a few examples myself where DHR needed to take custody but didn't. I suspect that the reason the state has not taken custody is that they are worried that they have no place for the child. I couple of kids finally were taken by the state and placed in a nursing home. Every once in a while there are wonderful foster parents that will take the super complicated kids and love them as if they were there own, but those couples are hard to come by.

I work on a general peds floor. The hospital has decided to start giving continuous albuterol aerosol treatments on the floor for asthma exacerbation. Anyone else work in a hospital that does continuous aerosols on the floor. BTW where my unit is located it is a minimum of 8 - 10 minute trip to the ICU or step down unit.

Where I work almost all the continuing education is done on the computer. The problem that I have with that is that there is no one to ask any questions. I have gone to the nursing education department for specific questions and rarely get any answers. What percentage for continuing education do you get that is computer based and how much is in person classes?

We do not get adults very often. The adults we get usually have a diagnosis in which we have had trouble finding care in the adult world for them. A few of them have chosen to go out of state to be seen by an adult physician at an adult hospital.

How do pediatric nurses feel when they have to take care of an adult patient? We do not get that many, but we do get a few when there is no one to transition them to. Many of my co workers get upset and think they need to go up the street to the "adult" hospital.

I do not consider myself a hard stick if a 22g is used instead of a 20g. The last time I went for an MRI, I let the nurse know that the 2 previous MRIs were completed with a 22g instead of a 20g and the physician did not complain about the results of the test. When she looked for herself she recognized that I had small veins. She thanked me and got a 22g in after the first attempt. The last time I had surgery the anesthesiologist had to put an IV in my ankle. I also can not have art lines in either radial artery and the last two times they tried to put CVLs in my right jugular it took multiple attempts. Luckily I was in surgery and did not feel a thing.

I live in a state that occasionally gets snow. If we get winter weather it is more likely to be ice. The are many hills and bridges. The city has minimal equipment to clear the roads. A large percentage of staff live 30 minutes or more from work. Our policy states that if you are on call you have to be able to get to work in 30 minutes. We are to bring clothes, toiletries, linens (sheets, blankets, pillows) and food. And of course we are going to get paid only for the time that we will be doing patient care. Last year our unit was full so no arrangements were made for our nurses to sleep. Some of the nurses were able to unlock the PT gym and sleep on the hard exercise tables. Is this going a little far?

I dread my patient's parents who are already stressed out and then told they have to go cold turkey from nicotine if our campus goes smoke free. Security will be very busy.

I have heard that it is not uncommon for adult patients to be admitted to children's if they have a pediatric or congenital diagnosis. As a pediatric nurse I understand not wanting to kick patients out the door simply because they age out, but how do you feel about taking care of adult patients? If they have other medical problems other than what they were admitted for, is the nursing and/or medical staff prepared? Do the nurses enjoy the variety or do they wish they did not have to take care of adults? Do adults sometimes have to have kids for roomates? Do they have adult friendly environment along with a kid friendly environment? Every time we get even an 20 year old on our unit, most the nurses complain. What are your experiences? Susan

I know that it is going to be very difficult. The peds GI office is not being helpful at this point. I personally know how difficult it is to find an adult cardiologist that is trained in adult congenital heart disease. In the US there are over a million adults that were born with CHD. I also know multiple TGAs in there 40s, a couple HLHS adults in there 20s and TOFs in there 50s and 60s. In many states adults must see peds cardios. The only problem is that I can not find a peds GI that is willing to see her within a days drive. The peds GI won't see her and the adult GIs have no experience. I also know adults with spina bifida and severe CP that are having difficulty finding health care as an adult. There was this huge medical team for us as a child and now that we have grown up there is limited care.

Does anyone know an adult GI doc that takes care of adult patients with SBS related to NEC early in life? Where do your peds GI docs refer there patients to when they reach adulthood?

This is one of my pet peeves. I work on a surgical floor with many patients on continuous pulse oximeters. There is no central monitoring station. I can't here the alarms all the way down the hall. I heard of one patient where the family member turned off the alarm. The staff did not realize the patient was decompensating until they had to call a code. Another time the parents were sleeping and did not hear the alarm. Neither did the staff because the door was closed. The patient was decompensating badly when the nurse went in for a routine check. In this case everything turned out ok. One night my husband was on a pulse ox with the door open and close to the nurses station. The nurses had to hear the alarms. No one ever came in. I sat up the entire night monitoring him because the staff did not bother to. He would self correct and bring his sats up to his baseline after 1-2 minutes. I get so frustrated when nurses do not respond to alarms because they are waiting for the parents to call out. Parents should be allowed to be parents, not forced to be medically responsible for there kids.

Does anyone know if there have been studies regarding the accuracy of pulse oximetry in the polycythemic cyanotic CHD patient? I had a patient in which the pulse ox readings varied from high 50s to low 70s in just a few minutes without clinical changes. The waveform looked good the entire time. I got to the point that I did not know when to believe the machine. I changed out probes, machines, and what extremity was used. Nothing seemed to make a difference. rnsusan

Zoeboboey, I did go into nursing because of the wonderful nurses that I had as a child. As a 6 year old, I new who was a good nurse and who wasn't. All but just a couple of nurses were wonderful. I had my first heart surgery in '65 and my second in '72.