traumalover

everytime I've received an order for a gtt it states start levo gtt and titrate for sbp>90 or map>60. They've also said occasionally start at a certain rate but never titrate by so much, only titrate for desired effect. Could you possibly shadow in ICU for a few shifts and spend some time titrating vasoactive gtts with an experienced ICU nurse?

As a new grad with LPN experience I was hired into ICU and given 3 months orientation. have never looked back. Great reviews, prn'd in the ER after six months, did open hearts, balloon pumps and CRRT in my first year. Three months is a long time. And they if you work in a team orented unit, you'll never be "on your own."

Had a patient's daughter complain to director nurse "ignored her mother's cries of pain all night while she sat on the Internet all night and only checked on her twice." Thankfully we wear Big Brother tags that you can run a report on....SHOCKINGLY I was in her room evey hour for at least fifteen minutes, had placed four pages to the anesthesia on call managing her epidural, two calls to the surgeon, had multiple coworkes who had assisted turning her every hour and who had observed said pt sleeping while daughter cried about how much pain she was in.

everyone is entitled to their opinion. I have seen a lot and been around the block a few times. Perception is reality. What's real to you as a person in one room in pain and afraid may not be the same perception of the people involved. I have witnessed two people involved in the exact same incident describe it two totally different ways. So, yeah, you want to know point blank? I think much was exaggerated. An outright lie? No, again, a different perception from someone who was undergoing pain and anxiety. And you can believe what you want. Either way, good luck to you in your future endeavors. Same to the OP.

Your circulating blood volume consists of components. Hemoglobin and hematocrit are only indicative of the part of the rbc count that binds to oxygen, and not reflective of total blood volume. After a traumatic injury or blood loss, you produce new immature RBC's that weigh less and are smaller, so while your hgb and hct counts may be low, as long as you are producing them many docs esp trauma prefer not to transfuse, as your RBCs mature your hgb and hct will go up on their own. There are risks with transfusion. Not trying to make anyone mad, just stating facts.

Mmmmm....something about this is just not adding up. don't want to fight or debate but as a ER/ICU vet in three major hospitals, remember, perception is not always reality.

had four interviews before I got hired, two panel. never knew there would be another until they called to set up the next one. First with a recruiter, second with a panel, third with the hiring manager, follow up/fourth with her again.

To the frequent flier OD drugseeker repeatedly pushing their call light while we are emergently intubating and putting lines in/starting pressors on my two day post partum septic patient (very sick) to tell me over and over again she can't sleep and needs me to call MD for benzos. "I am busy trying to save someone's life. I am not coming back in here until i am done next door and you're are not getting any more pain meds or downers, so stop bothering us while we do our real work." Two minutes later hear code blue paged overhead. Patient had gotten out of bed and pushed her own code blue button in room because she knew a doctor would show up. And then she asked him for meds. And then the charge nurse spent five minutes in there and we didn't hear a peep out of her until shift change. Don't know what she said but it worked. Said but not by me, to a frequent flier who had extubated himself and was leaving AMA while telling us all what a bunch of jerks we were "You're lucky nurse can't carry guns."

Click if you're lucky. If he's still on the phone after that you better hold that baby away from your ear about a foot.

Can you ask to shadow a day to see exactly how the patients are assigned? Acuity in our hospital depends a lot on whether drips are titrated or not...stable amio/cardizem gtts and low dose Dopmaine/Dobutamine are on our stepdown units. All our open hearts are extubated, lines pulled, and have been up to the chair prior to transferring from our ICU. I think the stepdown's patient ratio is 4:1. They take all post cath lab patients as well unless they are really sick.

Don't agree. It's the same everywhere. I started as a new grad in a competitve ICU and had a great experience there before I moved and started a new ICU job. I don't even remember seeing instances of bullying and "eating the young" and if they happened it was rarely. I find a lot of the times I hear people say that they are the ones creating drama in the unit. In my experience if you work hard and care about your patients and are a team player, people accept you with open arms. Especially with the fact we are short staffed all the time. Prinicples before personalities my boss says, you ain't got to like them just work with them. My best friend is a teacher and she has drama at her workplace, as do all my friends with their respective jobs.

no flipping idea which patients have insurance or not. Doesn't affect my care one whit. From a ICU nurse viewpoint. Not saying it doesn't affect others.

if you plan on having them insert an appendage in you or vice versa. Or show up when ur hubby's had a massive MI is on a IABP and scream "where are the god!@# drugs?"

As a new grad, you need to learn many skills. You shouldn't worrying about being competitive. Learn from experienced nurses. Ask questions. Read up on things you don't know. Never do something without knowing why. Watch procedures. If you simply focus on being the best nurse you can be for your patients rather than the best nurse compared to everyone else you will be the best nurse. Nursing, especially where I work, is a team effort. Somedays you get the really sick septic shock pt on CRRT, and have schloads of fun, and sometimes you get the detoxing alcoholic in 4 points and spend the night giving Haldol and Ativan and being verbally (and sometimes physically) abused. That's nursing. Take care of both those patients like you would your family and you'll be all right.

Got my GED in 1998. Got into the first nursing program I applied to after taking comuterized test and have been an ICU RN for seven years. Good luck.

I agree that healthcare is a right but there should be limits, just like everything else. I have a right to free speech but I cannot walk down the street screaming obscenities, because this is a public disturbance. LIMITS! also, I am a liberal before the liberals start chewing my butt:lol2:

I freakin love these threads!!! Also, on the bank note, if you cuss, spit, punch, or hurt a bank worker, you will not be going there anymore. If you steal from Wal-Mart, you don't get to go there anymore. When a drug seeking pt stands on the bed screaming the c word, and trying to whip people with EKG leads, and then breaks into a code cart to steal drugs (nothing of which is fun in there), I feel they do not have a right to healthcare and if we booted them out on their butt til they acted like a human being and charged them at the door, took their pocket money, yeah things would be a little different. Eat yourself to 600 lbs? great but you shouldn't get disability if it's not a glandular issue. Healthcare is widely abused. Go to you tube and watch er-pt fakes a seizure.

It's permanent. After AV node ablation it is implanted in the node to function as a pacemaker rather than having wires extend into atrium/ventricles.

When they talk about chambers they are talking about where the pacemaker fires and senses. Your atrial is one chamber, your ventricles are another. All pacers. It is completely different from the type of pacer. One is a type (temp, or permanent) the other is the mode to which it is set.

Morphed, Thank you! My malpractice is $400/yr. Lots of my coworkers have it but not all. If something does happen hospitals coverage is often inadequate and you can lose everything. better safe than sorry! I have never been sanctioned or disciplined at work, but mine is a little high because of ICU. Apparently a lot of lawsuits come from there. There are different kinds you can carry. i would look into your hospitals coverage and hunt on the net if it is as inadequate as most hospitals!!!!

red tote bag hosp gave us. Stethoscope, locator badge (gotta love big brother) name tag, magazines, novel, none of which I ever read, pens, lotion, hot tamales (candy), iPhone and charger, and in locker, assorted snacks that keep, sugar free red bull, extra report sheets, spare scrubs, and shoes as well. Also a brush and toothbrush plus toothepaste stay in my locker. oh and tampons. Spare drawers and bra, sometimes getting splashed soaks through. also shower stuff in case I get blizzarded in. Although the road would have to be impassable. not snow like tornado upheaval.

Maybe he needs a high bp to perfuse renally since he already has issues with his kidneys. They may be worried anything long acting could drop his pressure for a period of time, and push him over the edge to complete failure requiring vascath and dialysis. Also, some triple AAA's are in a spot that is not operable. if he is already in renal failure, going on pump for an extended period of time could be disastrous. Obviously I don't know the patient, soo....just a few things to think about! Also, next time maybe get with a senior nurse or charge nurse and perhaps outline what they think needs to be done. That way if he doesn't seem worried, you can ask about a BNP, or X-ray, or CT. If he says no, simply say You are not sure why not, could he explain it. He will either explain himself, get annoyed and hang up, in which case he was probably annoyed at being called in the first place, or just order it. I have learned a lot from asking, but I also have half a butt since it's been chewed so many times

P.S. also carry my own malpractice insurance.

PAY ME MORE!!!!! We didn't get a raise last year thanks to the recession. Working in the ICU where I'm at you have a lot of autonomy, and respond to rapid responses and codes where you act as a team leader. You can be at a code without a doctor for several minutes. Also, I have 7 years ICU experience. My hospital does not pay extra for specialty. I have to charge and not get paid differential when they decide they want me too. In low census times I'm forced to take call and use PTO. I spend a crapload of time home reading new procedures, keeping certifications up to date, etc. Do I get paid well? Yes. Should I be paid more considering the knowledge and responsibility I have? Yes. Did I get in it for the money? Yes. That doesn't mean I'm not a good nurse, or that I don't like patients or what I do. It was simply what attracted me. Just saying.

Tell your manager. It may very well be that she was sanctioned. It's either diversion or some kind of sanction, and it probably is the sanction and she's embarrassed to talk about. One of my coworkers was sanctioned and back to work in the ICU and we had to do it for him for 2 years. So don't judge too harshly until you find out. I don't understand why no one just asked her. That seems the easiest thing to do. and by the way, my coworker has been clean for five years and does an excellent job and I wouldn't trade him for the world.