vashtee

I should add that the patient was experiencing heart pauses throughout the day, 2-3 seconds long.

I am wondering if anyone can offer guidance about how to choose which PRN blood pressure medication to give when there have been multiple types ordered. For example, when might you choose a calcium channel blocker over a beta blocker? Patient (in the 80s) has had a hemorrhagic stroke and now comatose and DNR, SBP in the 160s, A-Fib/A-flutter with a HR to 110, RR irregular (20-40 throughout the day). A hospice eval was already done, but I still felt bad when the patient passed, and wonder if I chose the wrong medication to treat her HTN with. Thanks in advance for your advice.

I hope your patients are low acuity! 6 neuro patients can be a lot if they are all stroke patients!

I hadn't worked (for money) in many years when I applied for my current position, so I listed all my volunteer work on my resume so they wouldn't think I did nothing during all that time. It seems to have worked for me...

I couldn't possibly care less if someone calls in sick. We have patient ratios, and my workload is the same, regardless of who else shows up.

I hate those surveys, too. Our nurse manager insists on having meetings to go over them as a group (this after 12.5 hour days), and they really only ever cover the complaints. It's so demoralizing. Also, based on these stupid surveys, they are actually giving us a SCRIPT about how to speak to patients (thanks to one or two surly nurses), and they intend to shadow us on rounds to see how well we do. It's so insulting. I wish management would just grow some testicles and speak directly to the one or two nurses with attitude issues.

I work in a community hospital, and we definitely treat tons of these. In fact, I work on a floor that takes all the stroke patients. We get lots of "ordinary" diagnoses where I work. The thing we DON'T get are *unusual* chronic diagnoses or pediatrics. When we get these kinds of patients, we stabilize them, and transfer them out. We also transfer out when insurance (or lack thereof) require it, but only after the patients are stable.

I made up a day planning grid when I was in nursing school, and I still use it every day. There is a column for each patient, and each hour of the day is listed in rows. Before I start working, I just list all the tasks I need to do throughout the shift for each patient in their column, and then cross them off as they are done (or add things in as needed). I write abnormal labs and procedures at the bottom, as well as anything else I might want to mention to the doctor. It's VERY effective, and very helpful in getting yourself organized, and I share it with all the students who pass my way. I tried to attach a copy of it, but it didn't work, but it's sort of like this (imagine there being multiple columns): _______pt #1____________ pt#2_____________ _______Room 100A________Room 101B________ dx_____GI bleed___________ PNA_____________ 8-9_____________________ IV abx/turn pt_____ 9-10__med_______________med______________ 10-11____________________turn pt___________ 11-12_ blood sugars_________RT tx_____________ 12-13_IV abx______________IV abx/turn pt______ 13-14_____________________________________ 14-15_med________________turn pt___________ 15-16_____________________________________ 16-17_____________________IV abx/turn pt____ 17-18__blood sugar__________coumadin________ 18-19___IV abx_____________turn pt__________ IVF ____HL________________D5NS @100_______ tele____SR________________A-fib_____________ diet____CCU/CCD___________low Na+__________ .......... wound care [_].............. high fall risk ........... PT [_] OT [_]...............soc svc consult [_] .......... 2D echo [_]..................CXR [_] .......... WBC ^ 16.1................ INR 3.1 ......... Hgb 8.8.......................crush meds ......... constipated..................stage 1 coccyx

edited - just in case it could be construed as a privacy violation. Too bad, too. It's a great story.

I think if this happens again, you should simply hand a pair of gloves to the phlebotomist and say, "trust me: you should wear these".

Leslie - Thanks for clarifying! Also, I wanna work with wooh! :)

I just wanted to thank you for noticing the difference between days and nights. I agree that day shifts (at least on MY floor) are crazy, but I could never stay awake all night. To each their own...

I hated nursing school, but really admired how smart my fellow classmates were (after the 2nd semester, anyway). I was very happy to graduate. The best thing about being a nurse is that you are never bored, though honestly, I think it would be very hard for a young person to understand exactly HOW boring a job can be unless they have worked one. I also happen to love and respect the people I work on the floor with... And of course, though I like most of my patients, every now and then, you get someone special...

Lack of moralities? I don't know what kind of people you work with, but none of the nurses or CNAs I work with are "immoral". They are just really busy.

I truly wish there was some way to diplomatically tell family members they should be participating in their loved one's care if they want them to be shaved or have their hair fixed if they are a patient anywhere besides ICU, and that I have as many as seven other patients who believe they are more deserving of my attention than your parent. Of course, the hospital would fire me if I gave the impression that we are understaffed. :/ I don't mean this to be sarcastic... I wish this with genuine concern for my patients. My own child was a brain surgery patient, and there is no way I would rely on overburdened hospital staff to take care of her basic needs... because I have no idea what her nurse's other patients needed. Caring for the sick should be a collaborative effort between staff and family members.