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M/S, Onc, PCU, ER, ICU, Nsg Sup., Neuro
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flaerman specializes in M/S, Onc, PCU, ER, ICU, Nsg Sup., Neuro.

Have been hospital based RN for over 23 yrs, worked in multiple states, currently working as travel nurse in San Antonio, Tx in Neuro Telemetry.

flaerman's Latest Activity

  1. flaerman

    so confused!

    I have been in practice for over 23 yrs and went to a Diploma program in Phila, Pa-have never gotten a degree BSN or otherwise. If you can get into the ADN program go for it, get your education, pass boards and start working. There are multiple RN to BSN programs you can do online etc or go to school part-time, there are hospitals out there connected schools that offer BSN programs with as little as one day a week. flaerman PS: I spent a year as an Administrative House Supervisor in an acute care hospital in FL with only my experience and my diploma in nursing!!!! Good Luck!!!!!:)
  2. flaerman

    I can't handle it when kittens die...how can I be a nurse?

    I have been an RN for over 23 yrs, probably some of the hardest deaths were the pediatric pt's who died in my ER when I was doing ER. I also worked almost 7 yrs with Oncology pts(5 in a big teaching hospital on a pure Onc unit) where the majority of our pt's died. In school we are taught not to become emotionally involved but when I did Oncology it was not possible. These were people I cared for, not furniture. We became almost extended family to our pt's, I never let one of my pt's die alone-if I couldn't get family in to the bedside in time, I stayed with them while they passed. I shed many a tear in Oncology, got very good at recognizing when a pt's last hospitaliztion was, esp those I had been caring for-it just became something I could see in them when I'd admit them. I would address death with both my pt's and their family and always encouraged to talk to their towards the end when they were not responsive because they can hear, I've seen that. Had one lady not looking good, called her children to come see her where they argued at her bedside over who would get what when she passed. The next day while bathing her she woke up, first words were "call them" I asked who and she replied, "my ignorant children". I am not an overtly religious person but have come to realize several things, when we are born into this world there is time when when we will go, preset if you will and that time is btwn you and God-nothing will change it. If one codes or crashes and we resuscitate them successfully, then that day was not theirs to die, if not-then infortunately it was. Also early on in my career I would see some my pt's pointing at a spot on the wall/ceiling and after a while of seeing this realized they all died, so I've come to believe that maybe an angel or departed family member/friend has come to cross them. Then my second wife who was a psychic and very much into the spiritual world told me that was exactly what was happening. I left Onc for Cardiac Telemtry and had a lady who was an onc pt that was going to discharged to hospice. The night before I had her she had an almost died experience(SOB etc) and we talked about it, I told her God wasn't ready for her and that when he was she would know. Next night I had her she again had trouble breathing but was DNR(and not wanting intubation), my co-worker wanted to bag her but I put her on O2. Reconizing that she was going to die I went her called her nephew(no other real family and they were close) told him she dying and that he would never get to her in time short of beaming in, asked him if had any last message for her-which he did. When I went back in the room she had a fearful look on her face initially but was started looking at that "spot". I knelt at the bedside to hold her, asked her if someone was there and she could only nod, I then reminded her of our previous conseration. Told her that she had ben "sent for" by someone I couldn't see(because it wasn't for me) and told her I spoke with her nephew, whispered the message from him into her ear and told her I would tell him that she loved him and would see him again. Then I told her it was time for her to go and to take my which she did, put her head on my shoulder, smiled-took a last breath and passed. It freaked out my fellow staff in the room because that said the her face brightened(looking like a scene from "Touched By An Angel) just before she passed. One CNA grabbed me outside the room and asked me what i did, I simply told her that I crossed this lady to the next life. One year, six months, and six days ago my second wife/soul mate and best friend passed into that good night at 11:50 after suffering from a devastating brain attack that would have left her vent dependent with PEG and trach, she was blinded at birth and her greatest fear was of being on a vent at the end. We lived in Florida during that Terri Schiavo digrace when the government(state and federal-aka "the Bush boys") and the religious zealots decided to get involved in what was not their business to, and had decidied that feeding tubes and artificial means of sustaining life long term was not what either of us of us wanted. So with family at the bedside we removed her from life support and stayed til the end. That puts me on both sides of the spectrum now, in ways it has me stronger and better as a nurse, I now work with neuro pt's as well, have had discussions with loved ones regarding end of life decisions and share my own story, letting them know that they know their loved one would want and it's up to them as to how we procede. As nurses we do the best we can as long as we can for our pt's. win or lose. We always want everyone to win and get better but we know realistically that doesn't always happen either. So do what you can for them, take care of their families too, it's ok if we cry over them sometimes because we are always human. If dealing with dying pt's or death is too much of an issue, then try going into something different(school nurse, MD's office, insurance etc) because the reality is that sooner or later we will all lose a patient. Sorry this got into long-winded rant, but it's how I feel flaerman
  3. flaerman

    Arizona question...

    With your experience you will not see the kind of money you currently making, I lived out in Phoenix and have over 20 yrs of experience in nursing and wasn't making that kind of money. If you do go out there stay away from Good Samaritan Hospitals, was treated very badly by them, much as they claim they care about their employees, they really don't.
  4. flaerman

    CHF and HTN

    Lasix can lower BP so maybe they wanted to see how the pressure responded to the Lasix dose, then decide on anti-hypertensive therapy. As far as NTG- was the pt having chest pain/pressure? That would be more an indication for NTG. Lasix and O2 use are more first line tx's for CHF. flaerman
  5. flaerman

    Can I get opinions please?

    Unfortunately some of my older nurse compatriots will always believe that GN's don't belong in specialty areas, however they forget that they too were once brand new nurses as well(none of us are born with RN after our names). Do well in school and continue on as a tech in your unit, you are gaining invaluable experience and insight. Start asking other nurses questions, "why are we doing this?" or "how does this help?" etc. I was working ER a few years ago with a bright young man as a tech who went onto nursing school came out of school to the ER and did just fine, matter of fact much better than the GN we hired because of his years as a tech. So don't be disheartened, unless your maanager/director tells you they can't use GN's, let whatever this other nurse not bother you. Welcome to the wonderful world of nursing.:cheers: flaerman
  6. flaerman

    Most stressful moment as a nurse?

    Right now is my most stressful moment as a nurse. All my wife wanted for Xmas was to go and visit her mom(she has Alheimer's and lives her older who relocated to SC within the last 18 months or so) so I sent her there. My wife is blind and has multiple medical problems including being the world's worst migraine sufferer. She had the usual H/A's etc but either late Xmas eve.early Xmas day she had a really bad one(all of her H/A's were always bad to her) with N/V which is not out of character sometimes(she was sick in bed and never got to spend Xmas with mom anyway). US Air wanted $600-700 to fly her home early so we had to crash some low level credit cards to get airfare and was due to fly home on Friday. Unfortunately she collapsed and was rushed to ER, and is now on a vent in a neuro ICU. In 22 yrs it has never bothered me looking at a sick pt, but then again there was no emotional attachment as my wife and I have. This is absolutely killing me and is moving me towards wanting to seriously give up on nursing as a career. I work in an intense med/surg ICU and am sure I would not melt down taking care of my next vent pt. Sorry for the long winded message but I am just so lost right now and trying to hang to whatever I can that we(she and I) will get over this and continue to be together(as I always tell her, "we will grow old, and fat together baby"). Flaerman
  7. flaerman

    Is Nursing your Passion

    I have been a nurse for going on 22yrs now, all of it hospital based and everything from M/S to ER and now soon to be ICU again. When I started out in school in 1982 and first did patient care it became my passion, I thought that once I got paid for it, then it would even better. That feeling has lasted throughout most of my career. But of late I can't say that remains to be true anymore. I have been a nurse in 4 different states and always as a staff nurse. Right now all nursing is to me is a paycheck because I've done this so long there is nothing else that will pay me what I make. This never comes through to my pt's because I am a professional and my pt's care is number one. I think it is time to go back to school to find something new that I want to do and feel passionate about. When my pt's are truly sick and in pain I do feel for them and try and make a difference for them, but I have seen so much abuse of the system and have had to be nice to so many people who were not worth my time or effort. Maybe ICU will help change this for me. I guess I'll just have to wait and see. flaerman:o
  8. flaerman

    Med/Surg - Case Study Help!

    Also would want to check his PT/PTT and D-Dimer(if elvated could have PE which could explain SOB and CP)-then would need CT chest /angio study, and did he have a CT of head/brain, the BP (150's/90's) although sl elevated would not always cause a H/A(the initial presenting BP would be more a cause for H/A)-need to R/O CVA especially with H/A, disoreientation and drowsiness(and H/O fall as well). flaerman
  9. flaerman

    Banner Healthcare???

    I live in the state of Florida and am applying to work at Good Sam Med Ctr, I am currently in ICU and have over 8 yrs ER experience prior to that(20+ yrs of hospital based nursing experience). Any info I could get about Good Sam or the other Banner facilities would be a great help. Thanks in advance..... flaerman
  10. flaerman

    Guess I do okay.....

    I am an RN with 20 yrs of hospital based experience in a variety of settings and have worked every shift there has ever been. I currently work 7P-7A in a 15 bed ICU at a community hospital in Central Florida(I started out as a Nursing Supervisor for the first 8 months but realized I am nurse and not an "administrator"). My background prior to that had been over 8 yrs of ER nursing in 2 different states, I had always wanted to try ICU but didn't think I'd like it. Anyway the other night a man I had taken care of several times in the past (with a very long cardiac hx and bad heart) started going south on me at 5:20 AM. His wife was staying in the sleeping room of our waiting area so I sent someone for her first. He had been sinus rhythm 70-90's all shift and all of a sudden now he is sinus tach vs atrial fib 130's and SOB. I immediately increased his O2 to 6L/NC, turned off his Dopamine drip and hung Neosynephrine to boost the BP I was losing too, changed his O2 to NRB 100% after a few minutes. I annoyed his MD by waking him up just before 6AM and told him Mr. M is trying to die(Mr. M had made himself a DNR the day before) and got orders for resp treatments, Morphine IV and to cover the Neo too. Resp tx may or may not have helped but the family knew I was doing what I could. Monitor was saying V-Tach but didn't look like it(pt had an AICD that hadn't fired yet) and I considered Lidocaine but didn't want to lose the pulse if I relaxed the heart too much. When the rate increased and looked more SVT vs A-fib I considered Lopressor but the Neo was still working to bring up his BP and that would have tanked his pressure. The Morphine helped him to breathe better and for a little while he was quite gray and seeing dead relatives(which is never good), but I held his hand and continued talking to him throughout this. Next thing I knew the dayshift RN was behind me for report, we got the cardiologist involved but Mr M just kind of pinked up and HR went back to sinus 80's. When I left the room Patti (one of recent grad nurses on nights was sitting with our unit secretary(Teresa) and smiling at saying "she was right". Apparently the secretary had told Patti to watch me telling her "if there is anyway or anything that can be done to keep Mr M here then Paul will do it". I was a little taken aback by that and almost embarassed by it but since I have gone into ICU back in April I have pulled all stops to do whatever is necessary to keep my patients going on my watch and hadn't realized until then that apparently someone had taken notice of this. I may not be the best ICU nurse but I use my critical thinking skills, ER experience and general nursing experience and knowledge to the best I can for my patients and consult with my colleagues and docs as well because they're why we are here in the first place. So I guess I do okay...... Paul
  11. flaerman

    New to site--Question 4 school

    This something I have to agree with, I have been an RN for over 20 yrs and before pyxsis and accudose was the old reliable "narc" drawer but whatever it's still stealing first of all and violation of nursing accountibility. If I get injured which just recently happened to me, I went first to employee health, and when what they prescribed was ineffective I went to my PMD who changed my meds and have since gotten over the injury and pain. I have lost friends over the years who got into trouble with drugs from above named sources and have been fired over it, come whining to me and get no sympathy whatsoever(sorry). Unless they start putting Margarita's in these machines I have nothing to worry about myself tapping the machine for a med or anyone else(my wife has chronic migraines and other maladies and when she needs something, we call her doc, I hate to see her in pain, but I'm not risking my career and professionalism to grab something to help her pain). flaerman
  12. flaerman

    Nursing is very stressful

    THis kinda sounds like something a lot more serious was going with this nurse than just a stress reaction(ie CVA, med reaction etc) but yes there is stress in nursing. There is stress in life from raising a family to paying bills, to career choices to living in our modern world itself. The beauty of nursing is there many things you can do within the profession, some more stressful, some less. You just have to decide on how much stress you want in your life, learn ways to deal with it and de-stress yourself and nursing can work out for you. I have been an RN over 20 yrs all of it in hospitals and have done everything except dialysis and OR. Something gets too intense, move on(I look for something good or fun in everything I do, if that doesn't work than my cynical sarcastic takes over). Tried being a Nursing Supervisor which can be stressful(never wanted to take my clothes off in the bathroom though) in and of itself because I found it a no-win situation job, and found I am a RN(real nurse) and not adminstration's "boy". :wakeneo: flaerman
  13. flaerman

    So..You're going to be a MALE nurse?

    Hey guys, Way back when I was school I had met a lady who I told her what I in school for and she asked me, "so, when you graduate will you be "Male" nurse??" I merely looked her in the eye, smiled and said, "nope, at graduation we get a complimentary sex change with the diploma and personally I can't wait since I tired of lugging testicles around all day". With that turned on my heel and walked away leaving to think about that answer. Paul :angryfire
  14. I fought this question for the 8 yrs that I was doing ER and never received what I felt was an appropriate answer. During my time in the ER I had ICU nurses work in my unit that had total meltdowns by the end of the shift. I have even sent emails to our moderators asking why Emergency Nursing was never included in with the other Critical care specialties and just lumped in with all the rest of Nursing areas but never really got an answer to my liking, was usually it was just an oversight(one that was never corrected yet....GRR) I left the ER over a year and a half ago. But good ER nurses are every bit as much of a critical care nurse as those who work in ICU, CCU PACU etc and should be recognized as such. I now work 7P-7A in a 15 bed ICU but my mind still functions like that of an experienced ER nurse when things happen to my pt's, or maybe that's just the critical thinking skills that all of us(ER,ICU/CCU,PACU,PICU etc) nurses use on a daily in the delivery of care to our pt's doing everything we can to keep our folks alive and well. flaerman
  15. flaerman

    Religion Needed to be a Good Nurse?

    Kinda sounds like your instructor is taking a little liberty there. Have been an RN for over 20 yrs, am spiritual to believing in god/supreme being because mankind sure isn't smart enought to figure it out. Have taken care of all sorts of pt's from christians,jewish,muslim,and even buddhists. All we have is to respect their religious beliefs. My buddhist pt who passed the family asked me if he could be kept in the room(and not refridgerated) for 8 hrs and could their priest/holy man come, which i complied with. Ultra-orthodox jews if they die after sundown on Friday can not be touched til the sabbath is over, plus any removal of life-support, IV's etc must be done by someone of their faith only(we used to stand and instruct family what to do for removal). 7 yrs of Oncology made me question God sometimes as to why good people can die so horribly vs scumbags that go on forever. When I first became a nurse my older pt's would say "God bless you" while thanking me for something I did, made me think "hey, I didn't sneeze"- but realized that religion and God were important to them. A nun wanted to pray for once and asked what parrish I was with, told her I was protestant, she said"you'd still let me pray for you?", told her yes indeed(a good word with God or whomever my people believe in has to be a good thing. Sometimes you will learn things from people of different faiths, respect their faith(ask questions if there is something you don't understand;ie Jehovah witness refusal to accept blood etc), your own, and avoid deep seated religious debates unless you got lots of time on your hands(have gotten this from born-again people). Always treat your pt's with dignity, respect, and exactly the way you'd want to be treated if it were you in that bed. flaerman:wink2:
  16. flaerman

    Recrutiment and Retention Incentives

    Hi, One thing our hospital does is to offer a $100.00 shift bonus in addition to overtime paid for working extra shifts. Our nurses currently work 12 hour shifts and 3 days week. In our ER which has had a staffing issue any shift where there are 4 or less nurses working picking up a shift then results in being double time as well as the bonus. However the shift bonus is only offered to to full or part tim staff, not PRN or pool). Works well.... flaerman