BlueEyedRN

I came onto a shift once where a lady had an IJ infusing propofol and fluids. The nurse said the doctor okayed it. Her neck was swollen, she was out of control, and increasing the propofol did nothing. I was suspicious and asked the intensivist to please check the x-ray again. He said that it was fine and I could use it. Half hour later, her neck was more swollen. I started some peripherals and switched the drips over and she immediately calmed down. When I pressed on her swollen neck, propofol oozed out of the insertion site. I was so mad. I dragged the intensivist into the room and he admitted that he hadn't really looked at the x-ray, but just went with what the night intensivist had said. The poor lady had been getting all this stuff infusing into her neck for hours. Anyway, a little different from your dilemma, but I'm just saying that docs don't always look closely when they should. Grrr.

If you can tell from outside the room that you are going to gag, wear a mask, spray something in it or use mentholatum, and breathe through your mouth. I've gagged in front of patients before, but it was pretty bad and honestly, they knew it and were embarrassed, but understood. A lot of times, I just get into a zone when I'm in there working with it, but then outside the room I have to lay my head down for a minute to keep from throwing up. Just try to focus on what you have to do and try not to think about what you've got your (well-gloved) hands in.

It really depends on the patient. I had a verbal patient with a huge stage 4 sacral decub the other day who didn't feel a thing when I changed the dressing. I've also had the same type of decub on a patient who screamed and hollered even after getting tons of pain meds and versed. If you feel like the patient is in pain, ask for meds. It is very hard with nonverbal patients, but we usually go by blood pressure and heart rate and grimaces. You just do the best you can.

I had an assistant call me with orders. I told her I didn't think I could take them from her, and she immediately handed the phone to the doc who was apparently standing right there. Why couldn't he have just given them in the first place? My impression was that they knew that it wasn't the right way to do things, but that plenty of nurses didn't question it.

Not since I was brand new, but it was expected I wouldn't be that good at time-management then. I have been told I need to give more organized reports. Okay miss only-work-one-8-hour-shift-a-week, lets see how organized your brain is at the end of three night shifts in a row.

I would say I don't like that I don't always have enough hours on the shift to spend as much time talking to my patients and doing those extra little things like relaxation techniques and back rubs. Ooh, don't I sound like a good little nurse? And be sure and mention that you do try to fit those things in during routine patient care.

I don't think that any of the nursing theories do include giving religious advice, but rather that the spiritual needs of the patient are being met, including religious needs. We always ask patients if they would like us to contact a spiritual or religious leader for them. I have had patients who were facing their mortality ask me if I believed in life after death and I would tell them yes. I've had some patients ask me what my religion was and I would tell them. A couple of times, the patient has also been a member of that religion and it was a comfort to them. I have never brought up religion, only asked to make sure that any needs they had were met. I always follow the patient's lead in this and only participate in a way that would benefit the patient. I never give advice, but am always willing to listen to what they have to say about God and beliefs. A lot of people who are scared need a listening ear. You don't have to be professionally trained to do that. I love our chaplains, but they are the busiest people in the hospital and if I have time to meet spiritual needs, I'm going to do it. If they ask for advice, I do my best to contact their spiritual leaders. This is a major part of many people's lives and absolutely should be addressed by nurses in total respect. When I was a patient, I had a doctor who would always ask if he could leave with a prayer. I thought it showed compassion that he would not only care for me physically, but want to ask whatever god he believed in to bless me as well. Not that I would do that, but I'm just saying, it isn't wrong.

If possible, try to find an externship in an ICU. Actual experience, even as a student is very helpful.

Oh my, students got me steamed this morning. The nurse I was giving report to was running late and both of my patients were getting 2 students each. I don't function well past 7 am and was getting antsy. The nurse finally gets there, we go over to the nurse's desk outside the rooms and the students are sitting in the chairs, taking up all the table, looking through the charts and the flowsheets. I asked politely if I could have them. I got a dirty look, "Um, I guess. We're kind of using it so why do you need it?" Excuse me? Oh, I was bored and wanted to doodle in the margins. I was going to be nice and let them sit down so they could write during report, but when I got attitude, I made them get their tails out of the chairs so the real nurses could do their jobs. And then they kept interrupting me to ask questions about every little thing. I love helping students learn, but when I am already 30 minutes beyond when I should have left and have an hour commute through traffic ahead of me, I don't have time to tell you what every little lab value and med means. I said, "Look, I don't have time for you guys to keep interrupting me. Write down your questions and look it up later, but right now you need to be quiet and just listen." The secretary told me that after report while I was packing up my stuff, they went and found their teacher and complained about me. I was tempted to find their teacher and complain about them. :angryfire Sorry, I really like students in general and don't mean to be a jerk. I was just really irritated by their rudeness and needed to vent. Thanks. I love you students!

I hated rounds my first year because our intensivists loved making everything a learning experiences and would ask these complicated questions that I couldn't possibly know that answer to. I eventually learned to say sweetly, "I have no idea." And of course, the more I learned, the harder the questions they would ask. I sort of appreciate it because I did learn a lot, but you could tell they just delighted in knowing so much more than me. (Oooh, big ego boost, a doctor with 12 years experience knows more than a brand new nursing grad. Ugh). I learned to really not sweat that stuff and get the focus on what I needed from them. I don't know exactly how your rounds are done, but it seems to me that the best way to stay involved is to not look up stuff on the computer because then your focus is there instead of on the discussion. Let someone who knows the answer pitch in, but if you have questions yourself, ask them. Most people I know love to teach and you aren't expected to know everything when you are new. Have your list of concerns and make sure that you get what you need before they move on to the next person.

Hold very very still. :) I have the same problem and found that if I hold the endpiece between my 2nd and third fingers, I am able to limit movement in my hand.

Yay! What an awesome outcome. Congrats on the raise.

I don't know anything about goodpasture's so I don't know if anything is contraindication or whatever, but when you have a patient that is difficult to sedate, you have to try about everything. Ativan drips or prn pushes, Versed, Haldol, dialudid.

There are so many different areas of nursing that you can totally find a place where you feel comfortable. Operating room nursing is a specialty and there are a lot of other options. I thought I wanted to be a labor and delivery nurse, but then I took that clinical in school and I hated it so much. I'm sure if I had stuck with it I would have gotten over it, but instead I went to ICU and was much happier there. I never even saw anyone get cut open until I was actually working and got to go with one of my patients for a craniotomy. If you go to the specialty forums, you can see how many different areas there are and find something you might be more interested in.

There is a big emphasis on leadership in BSN programs. Not necessarily going into management, but getting the skills to be a charge nurse, or team leader and mentor, learning how to work with other people, how to give advice, etc. So you could say you wanted to get better leadership skills. They also focus more on community nursing, going beyond the hospital, understanding local needs.