fiveofpeep

A better preceptor would have explained that stroke response time is kept track of and published and also factors in to the hospital's ability to be stroke certified and be a stroke receiving center. For example, a patient needs to be called a code stroke within a certain amount of time, get a CT in x amt of time, and start TPA within a specified time from the ER door to injection. Given that you have only been there four weeks, I would be peeved that you didnt come get me straight away or get someone to double check because even if you're NIH certified, I wouldn't necessarily trust it. I worked in a neuro ICU and now I work in a mixed medical surgical ICU and you'd be surprised how completely different one person's NIH score compared to the other (for the same patient). It's not something you lose a license over but it's something to learn a lesson over. Make sure you are familiar with the policies of your facility, like how soon should a patient who could potentially be a code stroke be seen by the ER MD. They also follow MI to cath lab response time closely as well so you may want to check that out. There are also some key sepsis core measures that need to be followed too (like BCx in ER, ABX started in ER after cultures sent.) Good luck to you.

Was the patient sleeping? What was the rhythm?

Yeah we have a chart but LR is not on it. It's just not realistic for me to look up each drug each time. Our internet is too slow and my patience is too short I guess as a last resort, I'll make my own chart with our common drips and drugs, but something like what I'm looking for must exist somewhere out there on the internet.

Hey Everyone, I have been doing some extensive internet searching but can't seem to find a reputable source that details IV solution compatibility with IVPBs and drips. Specifically, I want to know about LR's compatibility with other drugs. I work in ICU and the docs love it for our septic patients and we often run it for the main IVF as well as for bolusing. Just to err on the side of caution, I always run the LR alone through it's own dedicated lumen, but there are times when I need to be able to combine stuff in there if possible. I've always heard LR is incompatible with many things and unfortunately on micromedix LR doesnt show up as an option when you run the IV Compatibility tool. Any ideas? Thanks!

If you aren't ready then don't go. A good supervisor wouldn't push you into something like that if you don't feel ready. You sound genuinely scared about it and if it made you hate nursing before, going into it now when you are already so apprehensive will probably make you feel just the same.

Thanks everyone. Now that I have thought about it and distanced myself emotionally I totally agree with the need to hang back.

Friend

we give mag IVP during codes and emergencies. I don't understand though, was the Mag not programmed into the pump at all?

My new unit is like this too. I feel like every time I turn around, they're gossiping. It drives me crazy. It makes me feel really isolated and paranoid. I just keep to myself and don't socialize with anyone if I can help it, but it sure makes the hours drag by.

Yeah that's what I figured. Maybe he refused follow up care. It sounds like he wanted to get out of the SNF at all costs--not that I blame him--so maybe he had to sign out AMA? I dont know.

Oh and according to the friend, he can't even transfer out of the chair without assistance. When the friend left him, he was sitting in the couch and refused help to get back to his chair. That's more why I am concerned, because according to the friend he isn't able to transfer to and from the WC without assistance.

Thanks everyone. Yeah I dont know if I made it clear. Although I am worried for him, I have no idea what his level of functioning is and I definitely don't think it would be appropriate for myself to intervene unless in an emergency. Independence is very important for patients. I just want to know if I can refer him to someone who deals with this regularly and can follow up with him to make sure he is well taken care of. It really isn't my place. I like the idea about meals on wheels. I was wondering more though is there like an agency for the county that follows cases like this? I really don't want to involve myself much more than to just build a neighborly rapport and refer him to other services or get them in contact with him. Thanks :)

I am so upset. A neighbor moved in and one of his friends was telling me that he is wheelchair bound and just got out of a SNF and has no family resources in the community or health care professionals following up. I went over and introduced myself to him and he was very withdrawn. Apparently, he won't let his friend help him. I don't even know how he will get out of the couch to his WC, but I don't know how much function he really has as the friend of his is a lay person. He has no one from the county or home health coming to follow up on him. How did this guy slip through the cracks? How can I help him? I plan on establishing a rapport with him and I already told him to come and ask for help anytime. I plan to check on him every couple days to make sure he is alive and has everything he needs but I am so worried he is going to suffer a complication because of lack of help. I understand that I don't know his level of function. All I know is what the friend told me. I also understand I don't even know if he wants help. How can I help him? Shouldn't he qualify for some sort of follow up care? Can I contact the public health department? What can I do? As an acute care nurse, I've never seen what happens when discharge planning fails. It is shocking to me and breaks my heart.

This is so true but it's also disheartening. In my state it's supposedly punishable by fining to not have lift help, but they can obviously get around it somehow. There needs to be enforceable laws.

So you're the one I see leaving notes in the chart that say "Dr. So and So please change your charting to reflect blah blah blah?" I always wondered who that was. This sounds very interesting and a great way to use my knowledge and critical thinking. Do you need to go to school for it?

This is very good advice and I you are right. Once I just admit to myself that bedside nursing is not the best option for me and I can start to grieve that loss of the idea I had in my head of being in the ICU for decades, I can start to see why other fields of nursing are better for me. I guess I'm just not there yet. I keep holding on to this idea that I wanted to be an ICU nurse since before nursing school and I worked hard and I should be able to do what I want to do as a consequence of that hard work, but life doesn't work that way. Edit: And I'm very sorry you are injured too. I wouldn't even wish it upon my worst enemy

holy barnacles! that is insane! see this is what i always try to remind myself: no matter how bad i may feel, i know that there are people out there who have been through so much more and are dealing with much more but are able to go through life with more grace than i. i need to be like that. thank god you survived such an aerial assault!

I was an avid yogi for years before my injury but now I lack the strength to hold my body up and it just frustrates me, so I've picked up swimming which works miracles for me. I can actually swim to make my pain go away and increase my ROM. The chiropracter helped alot but my back spontaneously healed when I had a break from the chiro so now I am superstitious about it. It's silly, but I'm just so terrified that any little thing could bring on the full blown pain I had initially so I just avoid most things. I do get massages with cervical tension and that seems to help.

thank you so much for the support :) i agree that we need to unite together about this. i think it is a very important issue. nurses are faced with the threat of violence every day. and you're right, that's on top of everything else we have to deal with. some states have harsh laws about assaulting nurses (protecting them much like they do when you assault a cop) but i don't know how well they are enforced. i have actually always been interested in education. i wanted to be a teacher as a kid and in nursing school and pre reqs i would make practice tests for every exam and hosted wildly popular study groups each week. i love preceptoring nursing students. it really helps you to learn yourself. i am definitely passionate about teaching other nurses. i suppose the only thing holding me back from that has been that i've always been told you make even less than a staff nurse. i guess i could always keep my license active and pick up perdiem shifts here and there to augment my income. there's also the fact that i just don't feel qualified with my measly 2+ years of experience. how much experience do you think is enough experience? i would definitely love to do education though. do you have more thoughts about this?

I'm still in ICU but it's a much lower acuity hospital. Many of the patients would be like a tele patient at my old place so the running around is definitely decreased but the lack of resources make it more physical labor. That's true and honestly I don't really want to go to grad school. I just feel as if I have to so that I don't get injured. I love love love bedside nursing which is why I am pushing through the pain instead of choosing a different job. I was just telling my BF yesterday that if I could just find a specialty that is good on my back and my heart, I could do that forever. I also worry though when I hear stories about old timer nurses with 30+ years of experience getting screwed over because they are too expensive. Those are all good points. I think that's my problem. None of the APN options agree with me for one reason or another (probably because I'm not ready) so I am trying to choose the most tolerable option which isn't the right way to go about things.

That is a great idea that I had not thought of. Now I just need to figure out what type of MSN I'd want I did have a PHN course but didn't get certed but maybe I could look into them doing it retroactively. Thank you so much! The patient was not arrested. I didn't even think to press charges but now that I have gone through everything I would never hesitate to call the police if it happened again. Although I still can't hold the patient accountable I still feel that if we don't stand up for ourselves and show there are real consequences for assaulting nurses, there will never be any change.

I was assaulted by my patient approximately one year ago and now that it has been the anniversary of my injury, I wanted to share how my life is now and how I am still affected. Summary--original post for further reading One year ago I was attacked by my patient, suffering a back injury and resulting in debilitating chronic pain. My patient had no organic cause for his agitation. My hospital turned it's back on me and said it was all in my head. I was off work for months. I sunk into a deep depression. I had to sue the hospital because they denied my worker's comp claim and I had to settle for a much lower sum of money because I was destitute and SDI was taking months. I never received a dime of SDI despite having paid into it each paycheck. One Year Later Finally I was able to get off all my medications and return to work at a new job because as a condition of my settlement I had to forfeit my job. I have been working there for a few months now. The unit is much lower acuity. Even though it is bad for my career to go down in acuity, I chose it because I thought I owed it to myself to be less challenged after the year I'd had. Things were good for a few months. I was in pain every day but it was manageable and I resigned myself to the fact that I would be working through pain. I was happy and able to get active again and enjoy my days off. The unit appeared like a great fit initially, but I've already suffered a reinjury because they never staff our CNA and we have no lift team. In my interview I was told there would always be a CNA to assist with turning, but they are only staffed three days each week and the other nurses are all so busy that it's difficult to find help. I had to miss two days of work last week but I didn't want to let anyone know why, because I don't want them to know about my stigmatized back injury. I feel better after resting and swimming, but my ROM in my neck is diminished and I am still in increased pain. I had to take a couple percocet this week and I'm all out and I'm leaving it this way. I don't want to get back into that cycle of treating my pain because I'm always in pain and the medication is only a temporary fix that comes with the setback of tolerance, dependency, change in personality, etc. And you can't take it at work anyways. But the problem is that I am miserable and irritable when I am in pain. I am just not myself and not as good of a nurse to my patients either. I have realized that even though my last unit was hell, every unit is going to have it's problems and nothing is really much of an upgrade. I don't want to switch somewhere else because it could be worse. My Dilemma At this point, I feel like I have to go back to grad school even though I don't want to because I can't risk being at the bedside any longer to get abused and reinjured. It's only a matter of time before I am rendered debilitated again and workers comp was already impossible without having a recent injury to cast doubt on my claim. I really don't want to go back to school yet because my dogs are my life and I can't imagine leaving them home alone for 40hrs/week. I can't afford to switch to a non-bedside position because of the decreased pay and it's very difficult to switch specialties in this economy. I would love to go to NICU because it's still critical care but it would be easier on my back although I think this would greatly reduce my chances of becoming a CRNA one day. I feel stuck. Trust me, I am grateful I can get off the couch and work through the pain and I know things are better than they have been, but I am still so affected by this injury. I am so young and I have my whole life ahead of me and here I am with the back of an eighty year old. When the one-year anniversary of my injury passed it was a surreal moment. I remember how bad it was, how it seemed as if there was no light at the end of the tunnel, how I thought my life was over completely. Now I see how far I have come but there is still so far for me to go and so much potential to fall right back down to where I started. Thank you for listening. Any advice is welcome and appreciated. I have always found strength in the support I have received here. Random Aside: In my OP, people worried that I would be anxious when faced with agitated patients. I don't necessarily feel anxious and I am calm when I handle them, but the entire time I am just thinking "Is this it? Am I going to get injured again? One wrong move and it's back to where I began."

I have noticed the same thing. I actually went down in acuity and the nurses here are so much more detailed. Everyone comes in early to look up patient information off the clock and thus you don't really need to give an excessively thorough report, but I find myself doing it habitually. I have really enjoyed these habits I've picked up here. I did want to warn you to try not to compare this place with the old place at work. I made that mistake of making a lot of comparisons and it was taken the wrong way as if I was being critical of their hospital. I don't know though. The culture here is quite hostile and gossipy though so that could just be it. Good luck to you. I saw your other post and I am feeling the same way. I hope we both get in :)

Good advice :)

try melatonin when you get off work to help you sleep. I have that problem too sometimes. Like I'm not tired enough but then that night, boy am I tired.