Gigglesforall

This also bothers me when I see people completely uncovering their patients. I always leave at least half of the patient covered when I'm not washing that half. I'd say the majority of nurses that I've seen totally uncovering their patients had gone to nursing school in other countries, which might have not emphasized the importance of privacy in their programs. I can't say it's ever been brought up in a staff education day or staff meeting or anything.

EXACTLY! Especially in regard to the head. Gets me every time.

The one thing I can't get over is that heavy "thunk" as the body goes into the cadaver transporter. EXACTLY! Mostly in regard to the head. Gets me every time.

I talk to the dying, not the dead. After they've died, I say a a little prayer (inside my head) wishing their spirit well and free from suffering. During post-mortem care though, I move them just as gently as I would had they still been alive. And I always keep a gown on them once they are zipped up, just for dignity purposes. I have been told by a few RNs not to, as we won't get the gowns back from the funeral home, but I still think it's appropriate.

Thanks for all the replies so far. I have 3 years ICU experience, so I have a pretty firm grasp on my assessment skills. I wish I was more confident in my IV skills...but most of my patients either have a central line or are grossly edematous and/or a hard stick. I try not to stick more than twice (per policy) and if I know it will be virtually impossible, I defer to our long-time pro who used to be an IV nurse years ago. I'm good with starting/maintaining drips, intubations, assisting w/ art. line/central line insertions, basically all things "critical care". Are there any things "strictly ER" related, or more-often seen in the ER that I would need to know that I probably wouldn't do regularly in an ICU setting?

I currently work in ICU but am interviewing for an ED position in a level I trauma center. Just wondering what skills you use the most on a daily basis and what I should start practicing! (I hope I get the job!) Thanks!

Thanks for everyone's replies. I know the problems have been addressed at various hospital trainings that eventually turned into an ICU pt. visiting rant in iteself. That was not the appropriate venue to discuss it though. Our unit doesn't have a "coordinator" per se. We just got a new unit manager recently, our previous one wasn't too much of an enforcer. As it is mostly a night shift issue with the visiting and sleeping, the manager is not there to see or intervene. As I said in original post, they just started announcing when visiting hours are over (but that does no good). It's possible that other plans are in the works to control this, but I don't know any yet. Security has been contacted on a few occasions, as well as is the POLICY that they are to call up to the unit of a family member comes after hours, to check if it is ok. I can recall 2 occasions for me, where security has called. Otherwise, they are just allowed up. We have families from other units wandering around too sometimes and need to be "redirected" back to their unit. It is very hard to be enforcing of the policies, when all I hear is "But I've been staying for the last three nights " or "I've stayed overnight every single time he's been in the hospital and didn't have a problem" etc... No one seems to be on the same page with this, even the charge nurses, don't take charge of the situation most of the time. No one wants to make anyone upset and so it's the nurses that bend over backwards to make everyone happy. Ok, enough said for now.

I work pm/nights in ICU and am getting so fed up with pt.'s families. (Not all, of course.) I am talking about those who have 20-30 family members lurking around or lying on the floors and more just keep coming from every corner. I am also talking about those who wander into other patients rooms just because "they speak the same language"!!! It's those who have "never spent a night apart" from the pt. and request cots and recliners to sleep in, despite the lack of space. The ones who have tons of stuff taking up all my valuable counter space and want to keep food in the pt. fridge! The ones who will ask for you to take their blood pressure or get them a Tylenol! (That's what the ER is for...or your own house...sorry!) Our hospital visiting policy is 9a-8p, but no one ever enforces it. Just recently a hospital announcement goes over the loud speaker at 8pm stating that visiting hours are over but no one listens. "Of course they don't mean for ICU, right?" We have had to call security a few times for those with 20+ people at 1 in the morning. Security is supposed to not let people come up in the middle of the night, but somehow they always get in! We do have a Care Partner program, which they get info on at admission which states that ONE family member can stay around the clock, if they assist in some patient needs that are in their scope of abilities, such as helping with turns or a bath or ice chips or something. Most of the families I am describing don't lift a finger though or aren't physically able to help. I can only imagine what it would be like to have a loved one in ICU. I get that and make sure I am supportive to family needs and explain what I am doing and procedures and answer questions about the monitors, etc... I try not to be heartless, but it takes so much of my energy dealing with the families...not the patients! I am tired of working in the dark with my intubated/sedated patient and tip-toeing around the sleeping family member. I would love to know how you all deal with this and any tactful/non-offending statements I can use to get my point across that I need to treat my patient all night long and can't just create a space condusive to your sleep/personal needs!!! Please help! Thanks!

Anyone using heparin anti-Xa labs now instead of PTT? Our heparin protocol still uses PTT, but some orders say "pharmacy to manage" and whatever their protocol goes by uses the anti-Xa result.

I moved to Chicago 3 days after I took the NCLEX in my hometown in MN. That was 2 1/2 years ago. It was the best thing I've EVER done! It's been amazing to pick up and move to a city where I didn't know anyone and start a new life with a new career. I've never been happier than here. If some place is calling your name and you feel that excitement just thinking about moving to that city, JUST DO IT! Sure, it may not work out, but it might be the best thing you've ever done and you won't have the regret you'd have your whole life by not doing it. Especially if you're young and unattached! I've met the love of my life here in Chicago and can't imagine what my life would be if I hadn't made this move. Good luck and have fun!!!

Hi~ St. Joseph is part of the Resurrection Health Care system, one of about 10? hospitals now. It's the largest Catholic hospital system in Chicago. My first job two years ago was with another Res hospital. I left after a year, it wasn't for me. They're not among the top hospitals in Chicago. St. Joseph though is probably one of the better ones, I'd say, along with Resurrection Medical Center, which is pretty far north. Last I heard, St. Joe's still does paper charting. Some people like that though. That's really all I know. Good luck with your decision!

Hi everyone~ Just looking for some input from experienced SANEs. I've been an ICU RN for two years and will hopefully be transferring to the ER by the end of this year. I worked for law enforcement part time in college and have volunteered as a rape crisis hotline counselor. I've posted here before regarding my goal to get my MSN in Forensic Nursing either through Duquesne or Quinnipiac. I am interesting in taking SANE training in February, despite my lack of experience in the ER (other than a semester-long internship my senior year in nursing school). Is this a realistic option or should I gain more experience with ER and encountering assault victims in general? Ideally, I'd like to expedite this career path, because I'm confident it's the right specialty for me. I was hopefully going to start my masters classes within the next two years. I want to get the "theory" out of the way now while I'm young (I'm 24) so that I can have a long career in this specialty and get married/have kids(?) after school. I feel like I have all my goals in line and can achieve them, but are they realistic? Am I going to be out of place because of my lack of experience or be set back because I haven't seen enough? I feel like by reading the posts that most of you experienced ones are so much "wiser" and have had more extensive backgrounds. I have all the confidence in the world that I can learn the theory and will gain the experience eventually, but what do you all think? Thanks in advance!

How often do you change the filter for say, mannitol or dilantin?

Our ED does not fax report, gladly. At another hospital I was working at I got a chicken scratch of a "report" that I could not discern anything and could not even fine out what the patient's diagnosis was, lab values, IVs, etc. I like getting report first so I can be prepared to get an NG suction set up, or have the IV pumps on the right side, large adule BP cuff instead of standard, etc. Being prepared with the specific equipment the patient will need before he gets there and is possibly too unstable and I can't leave the room really helps!

A few people on nights in ICU would wear them when it was slow and they were just charting or during a.m. care with a sedated/vented patient, but they were "outlawed" when someone told the manager. It's not the most professional thing to do, but sure did pass the time and I don't think the sedated patients minded!

Hi all~ I work in ICU and often times am running Regular insulin drips on DKA or post-surgical pt.'s. Our hospital doesnot have an insulin drip protocol, it is up to the ICU nurse's discretion on titrating the dose, which works out fine if the nurse is attentive enough and has enough critical thinking skills, but I have seen pt.'s bottoming out or sugars being all over the place with frequent titrations. Just wondering if there's a good protocol out there that can be used as a "guideline" for insulin drips, or if anyone has any input. At my previous hospital we used to have one that worked pretty well, with 4 different algorhythms and slow titrations, but I don't have a copy. Any examples would be greatly appreciated. Take care, Jackie

(So I guess this is turning into my own thread!) I just wanted to update in case anyone is interested. I purchased "Forensic Nursing" by Virginia Lynch and I am sooo glad I did. It is such a great resource for me to learn the basics and the very thorough details of this specialty. I am learning so much from it! Definitely reccommend this book! Take care, Jackie

Thanks 4n608, I will be checking those out. I just want to get a good background of knowledge now before I start school because I am so excited about this specialty and want to start as soon as I can! Any other beneficial websites would be helpful, I've Googled it plenty, but I could be missing good ones. Thanks.

Hi everyone~ I have been an RN for 2 years now, currently working in ICU, but plan on transferring to ER within the year and then on to grad school for Forensic Nursing. I worked for a police department as a college job and absolutely loved it, but knew above all I was interested in nursing, which excited me to explore this amazing field which seems perfect for me. I also recently underwent training for rape crisis counseling and am volunteering for the local YWCA doing that. Today I finally joined IAFN, so I will be interested to be reading the Journal and info that comes with membership. I am interested in any other texts or journals that you all think is beneficial to getting the latest research/news/or maybe a great overview of the field so I can learn as much as I can before I apply for grad school. I saw Lynch's book Forensic Nursing, which is about $90, I am almost tempted to get it, but I wanted to see if there's any resources people who actually work in the field think would be more beneficial and possibly less expensive. Any recommendations appreciated! Thanks for your time reading my post.

This list is hilarious, I forget all these things! My pt.'s name (last name) in the pyxis is frequent, my 4 passwords for each program (they're changed q 90 days!) all the supplies...red dots, duoderms, sterile gloves, foley leg strap, blood bank orders, restraing orders, EKG strip sheets, gosh...I practically forget my own name some nights when it's crazy!

I have to agree that there isn't a single definition for a "step-down unit" because I work in a hospital where there is one 14-bed ICU and next door is a 16-unit "Intermediate Care Unit" where the ratio is 1:3, but often the patients are still as serious or worse, but often maybe the care is not going to be as aggressive, so there's more DNRs or nursing home patients, but still as heavy or more to take care of. Vitals are done q2, there's sometimes a. lines, insulin drips, and vasopressors, hopefully with less titration than in ICU, but not necessarily. If a pt. codes there, they often keep them instead of transferring, if it's doable with a 1:3 ratio. It's a lot of work...personally, ICU is a lot less stressful most of the time!!

I completely understand the frustration, as I'm in the same boat! I started as a new grad in an SICU last July and am STILL not ACLS certified. I did EKG about 90 days into orientation and they wanted to wait about six months for us new grads to do ACLS, which would have been in January. Apparently classes have been "all full" and here it is a full year later and I am not ACLS certified! I feel incompetent as an ICU nurse! It's disconcerting to be transporting an unstable patient to Radiology, etc. and not know what to do if they code right there in the elevator. This is only the beginning of quality problems at my hospital, which is why I'm scoping out new hospitals. Ugh.

Hi everyone! My dad is age 61, had an MI this past July. He has no other medical conditions and his physician told him his only dietary restrictions should be to cut saturated fat and calories, but didn't give him a sodium restriction. He has been doing a great job in keeping to his diet. My mom, who is ten years younger, is having difficulties in keeping their new diet interesting. I am wondering if anyone knows of any really great recipe collections or websites that have heart healthy and tasty recipes that don't take too much work, as my mom works full time and doesn't have all day to cook. Especially holiday recipes would be appreciated, since she basically can't make her usual holiday favorites due to the high fat/calories. I am looking for a website that may have a bunch of ideas, rather than just a couple, so that I can reference it to my mom whenever she needs dinner ideas. Thanks!

I'm a lefty too! I do a couple things right-handed though...batting and bowling. Sometimes it's just easier to use my right hand when things aren't lefty-friendly, like scissors and knives.

I'm a new grad starting in ICU in Chicago. I've been on the unit for about 3 weeks now and my orientation is 90 days. There is no internship and no contract, as well as no formal critical care course either. We do have mini courses each week specific to critical care such as assessments, vents, EKG, ACLS, IVs, etc. The majority is strictly on the job training with a preceptor, which I must admit I'm learning a TON and already feel pretty comfortable considering I'm only 3 weeks into it! Time management is my biggest concern at the moment, as well as trusting my assessment skills. Good luck with your internship and have a blast in ER! I'm so jealous, ER is my passion and I hopefully will be there in a year or so!