LouRN92

I just finished the GENE course. It was 17 modules and took me over a week to finish. I thought it was very useful. My PNCC funds covered it.

Please always check for blood return as well as thoroughly assessing the site. i had a patient years ago who had the needle come out of the port and had actual infiltration into the tissues around the port. She complained of pain and the blood product she received was stopped but because she was a young, fragile peds patient the amount that infiltrated caused her problems and reaccessing the site was a night mare.

It has been a long time since I commented on Allnurses but this post really struck a chord with me because I was a Dialysis nurse for 3 years in 1994-1997 and it was hands down my favorite job ever. Yes,it was sometimes repetitive... but sometimes that was comforting. Let me tell you why. It allowed me to get a real sense for patient's, their lives, and nursing in general. In my work on the floor I often wondered about the patients that I cared for... what happened to them? Did my care make a difference? In Dialysis, I saw the same patients 3 days a week for years and I learned that sometimes I really could make a difference and sometimes people just died... no matter what we did. The patient's and staff were my second family. I also learned excellant assessment skills in dialysis. Of course I was an RN, not an LPN. I also learned alot about patient teaching. I used my ACLS in Dialysis..... got to defibrillate a patient one day!! I became more familiar with labs.. especially potassium!!! As a Dialysis RN I got the respect of the ICU nurses... they would scatter when I came to dialyze a patient in the unit. I became expert at accessing grafts and fistulas with needles... I drew blood on patients...gave immunizations.. And about the noncompliant patients... yes it was frustrating.. but I can't imagine what it would be like to have to monitor everything so closely... your fluids, every bite of food....and to have your life restricted by your treatments...lasting 4-5 hours a time 3 days a week... So it wasn't as hard to not be judgemental... I can hardly restrict myself from my 32 oz soda each day. Anyway... I loved learning the technical aspects of the machines... So dialysis may not be for everyone.. but for some it really is a great fit. I wish I lived closer to a dialysis unit... Now I work in a really rural setting and get to do lots of things: ER, OB, ICU, Med surg... but I do miss the specialization in dialysis. Thank goodness nursing is varied and there is something to appeal to everyone.

I have been an RN for over 15 years and I am pretty good with IV's because we do alot of them in our little hospital. But everyone has spurts where they just miss a vein once in a while. I make it my practice to only stick twice. Then I will go get someone else. I hardly ever have to get help, but every once in a while I do and I try not to sweat it.. So just remember that even when you have more experience... there are still times when it just doesn't happen Don't be too hard on yourself. You will aquire this skill over time. Good luck.

I was reading through this thread tonight at work and several comments from last year were very derrogatory (did I spell that right?) towards rural outlying hospitals. As a nurse who does OB at an outlying hospital, I would like to say that all of our RN's are trained in NRP and that we, at least at our facility, give excellent care and can easily keep a baby stabilized until transport. One of the best shifts I ever worked a mom came in and delivered a 28 weeker, breech, stat C -section, that our team resuscitated, bagged, CPR, umbilical line, intubation, and smooth transition to the NICU team that flew in to get him. This little guy is 4 now and I see him all the time. I just recertified in STABLE an educational offering designed to help RN's and MD's at outlying hospitals keep these infants safe prior to transport. I had both of my babies at a rural hospital... I got so much attention I had to go home to get rest!! I know this thread is about homebirthing vs level III NICU hospital..but I would like to point out that not all hospitals that don't have NICU are bad. I think researching the hospitals in your area is important. Just a thought. I would never have an unassisted homebirth.

Well he was 37 weeks and they took him c-section only because he was breech. So almost term. :monkeydance:

It's been probably 12 years since I worked Dialysis (one of my absolute favorite jobs). But I'll never forget using a K free bath for a high potassium and after 30-45 minutes having the patient complain of severe leg cramps and putting him on the cardiac monitor and seeing the widened QRS and sweating it out. i think he had dropped in the low 2's and then we switched him to a 3K. my memory may be fuzzy about the details, but I do remember the fear. i think i would be hesitant to use K free.

I work at a small rural hospital and all the RN's take NRP. I had to resuscitate a newborn about 2 years ago and I was scared to death. But really using the steps from NRP everyone has talked about made it ok. My biggest fear was giving the baby a pneumo. But that is fixable. The doc handed me the limp blue baby and I immediately began PPV. It only took about 15-30 seconds and the babe pinked up and began breathing. It seemed like forever. I always check my equipment if I am the baby nurse at a delivery. Make sure you are comfortable with the BVM set up that you have. Our RT's have two kinds on each warmer. I like the traditional and not the anesthesia bag. So I always switch and make sure my oxygen and suction are all ready to go. The baby did ok, no pneumo had low blood sugar but pretty uneventful... anticipation is always worse than the real thing. Knowledge is power. NRP is awesome. I really like the disk you can watch of resuscitation showing intubations and PPV. I am a visual person. Good Luck.

Hello all. I'm proud to report my nephew was born this week and he is healthy and at 5 lbs 11 ounces and he went home yesterday. Thanks for all your great info and support.

Thank you all so much. This made me feel alot better. I'll let you know how things turn out!

I have a question. I do a little OB, in my small rural hospital, but I have a family member who is 34 weeks and experiencing low amniotic fluid. Her number is 4.5? Anyway, she is being followed very closely and having ultrasounds, NST's and I assume biophysical profiles biweekly. I really don't have much experience with low amniotic fluid, but googling it made me very scare... Do any of you have any reassuring stories of patient's with low anmiotic fluid and good outcomes. Everything else looks ok except for his estimated weight.. about 3.5 pounds. Thanks for any reassurance.

I just quickly skimmed this post, but for me, having taken care of lots of diabetics with low blood sugar, they do have altered level of consciousness, and become so out of it that you cannot give them sugar orally but have to give an amp of d50. This is because without enough sugar the brain doesn't function right!!If I ever awaken a diabetic that is suddenly unable to talk with me or is losing consciousness, I check their sugar right away. MAny of my ER patients that come in with a decreased LOC get an automatic, do not pass go Chem BG.MAybe this doesn't fit a NANDA diagnosis... but I bet with the right tweaking it could.. and clinically... definitely... a low sugar causes decreased level of consiousness or can lead to NO LEVEL OF CONSIOUSNESS....

One of the really beautiful things about nursing is the flexibility. I work casual. In our hospital that means that I am fill in. Because we are a small rural hospital and I have experience in many areas through the years..I fill in each week... sometimes one night, sometimes two. It allows me to be there for my kids after school and for their sports activities. Plus the day care isn't as spendy. I have 5 children aged 2-14 and for the last 16 years I've worked part time or casual. It hasn't hurt my career at all. I feel like I am doing the best for both. I don't have insurance, but my husband does. I empathize with you about changing areas, but I have done that and stayed full time through orientation then gone back to the part time. Many hospitals are glad to get the help and will work with you. Good luck.

I have taken care of nurses or nurses family members and I have found that they appreciate explainations just like other people and often don't have experience in that particular area. I was a patient 2 years ago for kidney stones. I found it a really interesting experience! I found myself not focusing on how technically competent my caregivers were, but on how compassionate they were. To be really honest I had so much medication that I don't remember much. BUT the nurses that went the extra mile and really cared are the ones that I appreciated. I say this because when I get something really technically perfect I feel like I've really done a bang up job but that might not be something the patient even cares about. (Being technically competent is critical)... Just some food for thought. And I was a rotten patient.

I'd have to agree that nursing can be unhealthy. i work night shift about 2 nights a week. Because I have a large family, I don't get much sleep on my days off. One of the MD's I used to work with is a sleep specialist and he was always saying how night shift work takes years off of your life. Combine this with the unhealthy eating we do at work: grazing, drinking soda all night. Minimal potty breaks.....The stresses of dealing with life and death issues...Many of the nurses I work with smoke.. I don't but I don't exercise.. because quite frankly I am too tired. But.. Our hospital is taking an interest in employee wellness and is paying for part of our gym memberships, and last year encouraged pedometer usage. I don't know if it is so much nursing as it is modern life!?