brainnurse

Hi, There's nothing wrong with flashing the skull flap...it does get a little soggy, but like the surgeon said, it hardens up in situ after a few months. No more than 3 minutes, though (3&5) I once put one in for 20 minutes thinking longer would be better, and ended up with a pan full of mush! I scrub it clean, wrap it loosely in a blue towel, and put it in a small flash pan. It's better if infection control doesn't know what's going on in the OR...they don't understand We used to freeze the flaps in sandwich baggies, when the brain was too swollen to re-attach it. Then a few weeks later, we'd reconstitute it in hot saline, and put it back in. They don't do that anymore, they have better materials now for cranioplasty. Infection control only looked in that freezer once, didn't know what to say, so pretended they didn't know about it from then on. You should do some literature searches, and write a policy, so if this comes up again, your neurosurgeon won't have to fight about it. Hope this helps, Brainnurse

I reinforce the recommendation for UCI. The cardiac nurses rule at Hoag, and unless you want to be on that team (which you can't, unless you're young, blonde and white), you'll feel like an ugly stepsister. They are Dr. driven and do lots of electives on call.

This isn't about levels of responsibility, liability, or personal value and worth. Hospitals have very rigidly designed hierarchal pay structures for job description categories or lisencure, and new grads RN's start at the bottom. The years put in as CNA or ST or even CEO do not apply. It's stupid, it sucks, it's been that way for 50 years and will never change....it is what it is. If the hospital has clinical ladders, and the this poster is ambitious, she might get back to where she was financially rather quickly, and then exceed it...which she would never have done, assuming she had hit the ST ceiling. I don't know how it works in other professions...for example, if a paralegal graduates from law school, and passes the boards, do her years with the firm entitle her to a higher starting salary? Or does she start over as a new hire? Anyone know? The nursing shortage is real, and without definitive action, in 15 years it will upgrade to crisis, when the bulk of us 45-55 demographic workforce retire. Brainnurse

Yeah...it is a huge compliment, and a concession on the part of HR. Unfortunately, hospital pay structures are very rigid. You are in a nursing compensation category based on how many years you've held a license. Your years contributed to the organization in another job category are n/a. This happened to me when I transitioned for ST to RN 20 years ago. I had to take a $5/hr pay cut from the top of the range for ST, to the bottom of the food chain for RN. I, too, made the argument about how valuable I was to the organization, required no training time, etc., they understood my points, but couldn't go outside of that box. So, I had to eat it, and now, 20 years later, I've far exceeded that ST pay ceiling. Consider yourself highly complimented by this concession, go forth and kick some circulating butt! Before you know it, you'll be making more than ever. BTW....you'll really miss scrubbing :-( Brainnurse

Watch out for putting scopolamine patches on PD patients. It's an anticholinergic and will worsen rigidity and drooling...may also worsen existing cognitive problems. I would ask to d/c permax and amantadine...they are for earlier stage PD management. He should be taking Sinemet 25/100 3-4 qday for dystonia and rigidity relief. Seroquel might be useful too....but NO Haldol. I still work part time in movement disorders management...in case you hadn't guessed. lol Brainnurse

Please say she didn't really tell you to do that??? If a patient were allergic to PCN, but you already drew it up....I guess by her thinking, you shouldn't have to waste the syringe. Just squirt it out and refill with Vanco, right?

One time I took pity on a surgeon who'd been scrubbed over ten hours and still had a long way to go. I took him in the substerile and held a urinal for him.

Nurseinlimbo........ I finally got out after 25 years, but I don't know how badly my soul was damaged by the abuse. Fer Chrissake, who else in your circle of friends goes to work every day and get's yelled at, demeaned, belittled, maybe something thrown at them, and then has to go listen to an anonymous litany of complaints from the manager. And we keep going back everyday for this? For what?? Okay....it's because the work is fascinating. The skills are special and the achievements are rewarding. I loved the work, and if I never had to leave the Mayo stand.....But, you do, and the people are mean, and competetive, and respond to stress by abusing each other. Someone else said she can't stand to eat in the breakroom, because it is so unpleasant. I do hospice admissions now. It is a different world. I drive around and visit a couple of patients a day. No managers, no cow-workers. Nobody ever yells or pressures me....they are happy to see me. They actually smile!! Not as much $$, but 99% less stress. I am learning to value myself by a different currency now. Feeling sick about going to work is not okay, and the only way you will be able to do it is to destroy that part of yourself that cares what happens to you. The damage to your self esteem will be immeasurable. I hope it doesn't take you 25 years to figure this out. Ro

You won't forget those things once you get them into an automatic sequence. Every case, no matter what discipline, starts in a certain sequence....turn on the lights, plug in the bovie, plug in the suction, etc. If you do it in the same order every time, you'll find the groove, and it will be as mindless as getting in the car, putting on the seatbelt, putting in the key, etc. I've taught lot's of people in the OR, and it's a huge volume of information to take in, so I always kept in mind that they would probably only retain about 10% of what I told them, getting impatient is not constructive. If you ever learned how to read music, this is a good way to think about OR work. When you are playing music, you are always reading two notes ahead of the note you are actually playing. In a case, you are always thinking at least one task ahead of the task you are performing. Go girl....you can do this. Watch out for the vipers. Don't use the word stupid in the same sentence as I, ever again. Ro

Corvette Guy, Will you tell us your OR story?

I accepted an admissions nurse position with Vitas, here in So. Cal. It's a bit less $$ than I was offered at other agencies doing case mngmt, including admits, but there is no call requirement, and that was meaningful to me. I really do not want to be on night call. I did it practically all my adult life in the OR...now I'm 52, and want to sleep all night. So, any tips or insights about how to survive admissions would be most welcome and appreciated. Thanks, Ro

I'm sorry that happened to you. It's pretty healthy of you to think of a way to turn those experiences and feelings into a vehicle to help someone else. Do you think it will be hard for you to take a peds case? Or perhaps it would be exciting, because you would know precisely how to relate to the parents. My dad received hospice care too, and had a very peaceful passing. It was peaceful for all of us, and we were very appreciative. Ro

And do you like it? I am leaning towards admission nurse instead of case manager. I think I would do pretty well at managing these discussions, and would probably enjoy assessment more than actual management. Pro's and con's of both? Thanks, Ro I sure appreciate this forum! There's someone to ask!:bowingpur

Those are great questions to ask. Photorn, it sounds really good. What made you decide to pursue hospice? It seems like many OB nurses gravitate to it.....must be something about the life/death continuum. It would be an interesting research project. I am heading in this direction myself, and am in the interview process. I'm learning a lot of the questions to ask from reading the archives on this site. The call really doesn't sound bad at all. One agency told me they rotate call for a week at a time. That's right.....7 days on call. Yipes! The $ cut is hard to take, but so are the headaches of hospital systems (yech) and the long commute. Going on a ride along is a really good idea, I might ask about that too. Best of luck with the new business! Ro

Thanks for listening to me rant and vent. My husband and friends are sympathetic, but don't really "get" it, having never been in that world. I should add that even though it sounded like I lumped all OR nurses together as meanies....of course they're not. Some are the most wonderful people I've ever had the privilege to know. If I did label them all that way, I would have to include myself, and I'm sure I have earned the title on more than one occasion. But I can say that I've never stepped on anyone elses face to get where I wanted to go. I'm not leaving OR work because of this one experience. I have to confess that this time around, I'm finding the work harder....the physical labor (those spinal fusion trays are darn heavy!), the pressure and the call. Somehow, it was all easier when I was (stop!....don't say it!....) younger. I'm interested in trying hospice. It sounds more gentle, and perhaps a little slower pace, and I can use my interpersonal skills, and my mind instead of my back for a change. Thanks for responding, Ro