cloister

Obama

We can wear whatever, and a lot of our folks wear Charger stuff during football season. My blood runs deep orange, however, and no one in Southern California would get it, so I don't bother. GO VOLS!!!!!!!!

RhiaRN75, That was a GREAT story.......I was howling. Thanks for sharing it in such great detail. And, oh, yes, I agree with you.....when certain surgeons lock horns with administration, things change. FAST.

Perhaps "I Want a New Drug" by Huey Lewis and the News, or "I Want to be Sedated" by the Ramones........ Seriously, congratulations on your upcoming pinning and duet. I don't know if your ceremony will have any religious overtones or not (my nursing school was in upper East Tennessee; everything had religious overtones), but another possible song might be "On Eagles' Wings" which I'm sure you could google. Good luck as you finish nursing school and start your career!

Stop flogging yourself. I don't think you did anything wrong here. With respect to the previous posters, I have to disagree with them. Your patient was a COPD'er admitted with a sat of 84% on 5 liters per NC. Generally speaking, we try to keep these folks in the 88-92% sat range. I think you were correct in what you did to try to elevate her sats to a decent level (90%). Clearly, your patient was hypoxemic and in respiratory distress. Unfortunately, her COPD makes it a dicey thing to correct because of the CO2 narcosis these folks go into when you shove a mask on them. I had a patient like that on a rapid response once. I nailed the diagnosis almost from the door, and sure enough, the CO2 on Bipap was 120. So, we took the bipap off and the patient woke up, and I'm thinking I'm pretty cool until the sats drop to approximately 75%. Back on with more O2, which was clearly indicated, and back to narco-land we go. End result? This guy had a nasty pneumonia that knocked out what little alveolar space he had, and we couldn't win. We called a code, tubed him, and brought him to ICU. Sounds like your physician was behind the 8 ball here. You weren't getting results from the lasix, and he orders more. Not much you can do in these situations except keep calling the MD, stressing the respiratory distress of your patient, and having your intubation tray handy. I've had quite a few patients turn south and need intubation, all while the MD I was calling was insisting that the patient was fine and was not having respiratory issues. It frustrates the hell out of you, but hey, it happens. It still happens to me as a charge nurse in the SICU, and yeah, I usually feel bad afterwards, because I second guess myself and wonder what else I could have done. Frankly, it sounds like you did what you could as a nurse, and your physician wasn't as aggressive as he maybe should have been. Funny how these things seem to happen more in the middle of the night........ Again, stop flogging yourself and move on. The patient was alive when you left, and his getting worse is a function of his disease process, as opposed to a reflection of your nursing care. Don't quit! You'll have other moments like this, but it does get easier with time. Frankly, I think you did the best you could under the circumstances.

You may use my screen name, sure.

I'm not an L&D nurse, butI successfully breastfed three strapping sons, so I'll weigh in with my two cents. Baby #1 wasn't interested in eating (or breathing....or doing much of anything, frankly), and since I brought him home at the 24 hour mark (ah, gotta love the '90s!), he had never breastfed, despite the best efforts of the nurses and myself. I ended up bottle feeding him and seeing a lactation consultant at the 10 day mark, because he just wasn't consistently nursing - he'd scream, and not latch on, and I'd cry and think about what a horrible mother I was. (Hormones - oy vey....) Long story short, with persistence on my part, he was consistently breastfeeding by week 5, and continued to do so for 11 months, despite my working full time nights. Yes, he was supplemented throughout (my husband, although quite handy with babies, couldn't master the breastfeeding thing.....go figure!) He probably was a little nipple confused (the baby, not my husband), but it worked itself out ok in the end. Babies #2 & #3 latched on with steel trap jaws within two hours of birth, and other than the pain, were much easier to get going on the breastfeeding. I did supplement them, though, for the first day or two until my milk came in - my experience was that the colostrum really doesn't cut it with a hungry newborn. Others may have had a different experience. I do think that breastfeeding takes a lot of commitment in the beginning - it never seemed to go like the books said it would, and the pain in the beginning was incredible. Yeah, yeah, I know the book says to make sure the areola is in the mouth and then it won't hurt. Bullfeathers. In the first place, my areola was bigger than the kid's head, making it difficult at best, and in the second, my babies latched on like a cobra going after a rodent. Juxtapose a bear trap with a Kirby vacuum cleaner and you'll get the idea. Pain.......... Hope this helps. Good luck with your teaching!

Hey, it takes time. We've got a real big crop of brand new ICU nurses working with us now as we prepare to move to a bigger unit. The majority of them are struggling with the same issue you're struggling with. I can see the frustration behind their eyes when I talk to them as a preceptor or mentor. They're all smart, hard-working, conscientious people, and they're going to make great nurses. Most of them haven't been nurses for very long, however, so how can I expect them to think like seasoned veterans? That being said, I'll offer my two cents on what worked for me as a new ICU nurse: 1) Ask questions. Ask lots of questions. Ask questions even when you think you know the answer. I was always amazed at the extra info I was able to pick up and squirrel away for future reference. 2) Find a mentor. Look for someone who's clinically excellent and approachable. Ask them to take you under his/her wing. Many experienced nurses are honored to be asked, and it also serves the purpose of making you somewhat off limits to those who would put you down. I know I tend to be a little territorial about my preceptees and mentor buddies. 3) Play "Worst Case Scenario, Patient Care Edition", when you have a spare moment or two at work. Pause from the mundacity of the bath or flowsheet to ask yourself, "What will I do if this patient goes into V-tach?" "Drops in front of me?" "Has a seizure?" "Blows her aortic graft on a wound vac?" (Actual situation in my ICU. Luckily, I had thought about it a few days before!) It kind of makes me stop and think of what steps I need to know to be prepared later. Of course, I always emerge as the cool thinking heroine in these mind trips......... 4) Read. No, I don't mean textbooks - you've read enough of those for now, I'll wager. Read the $6.99 paperbacks you find with names like "Critical Care - The Story of a Nurse", or "Intern", or "Tales from the ICU". Stories are a great learning aid. Let's face it, you learn far more from hearing about somebody's screw-up than you do from a treatise in a journal. It's also way more fun as you think to yourself, "Well, at least I haven't done THAT." 5) Go easy on yourself. It takes time, observation, and experience, both good and bad, to develop the judgment that leads to critical thinking. The fact that you acknowledge your preceptor's comments without being defensive shows that you're open to learning and hearing what others have to say. That alone makes you more intelligent than a lot of folks. Frankly, nursing needs more folks like you. Hope some of these ideas help, or at least make you laugh a little! Good luck to you. :wink2:

I would think that working as a CNA, even after passing your NCLEX, would be a great way to keep your foot in the future-empoyment-as-an-RN-door, so to speak. We have a young man working with us now as a nursing student. He failed last semester's term and is having to more or less start over. Regardless, I still want him to come work with us when he's through with nursing school. Why? Because he has a great personality and work ethic, and he's eager to take on any task. Nothing in patient care is beneath him. That's the person I want as a colleague. It is certainly disheartening to have to defer your dreams of being an RN for the present due to this lousy economy, and I wish you luck with your job search. In the meantime, however, I'd take the CNA/PCT position and run like hell with it. You never know who you're going to impress with your professionalism and patient care, and it might just open some doors for you. At the outside, you're making some money and learning new skills. I say go for it.

An emerging trend we're discussing in our ICU right now is family centered care. Other topics with lots in the litereature include nurse mentoring, family presence during resuscitation and open visitation. You might also look at the new nursing drama TV shows for their effects on the general public's perception of nursing. Hope this helps. Good luck! :typing

amen, and amen. precepting, good or bad, will only take you so far. i've done a lot of precepting in our icu, and i've been told that i do a good job. i like having new staff come aboard, and i remember my own days as a new grad. kindness is always warranted in any of our interactions. that being said, some folks do not make it through our icu orientation. sometimes, i'm the one who has gone running to the nurse educator to demand that the person in question not be turned loose on the night shift. ususally, i've sat through report with them and realized, to my horror, that they don't know enough to safely take care of a patient. we had one poor soul who kept reminding us that she "was a slow learner", and that she needed more time. i feel for you, darlin', but you don't need to be taking care of people with multi organ failure if you can't distiguish levophed from nipride. not on my watch. it's a steep learning curve, and getting steeper all the time. i've been pushing for extended orientation time for our new staff, because i don't think they can reasonably be expected to perform at the level we expect in the time frame we are currently allotting for orientation. the flipside to this is that we need to expect basic competency as a nurse of anyone off orientation without having to watch them like a hawk. not everyone can do the job. those that can't should be reassigned out of the icu.

I agree with this poster. The insecurity among some nurses is HUGE, and sometimes intimidation of the newbie is their only defense. I also agree that what goes 'round, comes round. My philosophy on new staff? Be nice to them. I never know who might be my future boss. Follow policy and don't take shortcuts. Everyone else may be doing it, but that won't help you one iota if you get singled out. Find a mentor - someone whose nursing style you'd like to emulate, who has the respect of other staff, and who will help guide you as you're beginning your career. It might even be someone from a different area of the hospital. It helps to have someone who will act as a sounding board and advisor at work. Good luck to you. Hope things get better.

I wanted oncology too, fresh out of school. I drove up to Nashville to interview on winter break my senior year, hoping that's where they'd place me. It wasn't. "We'd like to hire you for 11 South, the neurology and neurosurgery floor", said the nice recruiter. I don't remember what I said, but I wasn't doing cartwheels at the prospect. He then pointed out that it was medical AND surgical - a selling point, I guess. To which I, naive 21 year old that I was, said, "OK". Fast forward 6 months, and I am off orientation, in charge, and hating the stupid floor, because I don't have a clue about how to determine a neuro change from say, a stubborn old man who is feigning sleep. The residents are already tired of me, and it's only July. As time went on, though, it got better, I got better, and you know what? Neuro is everywhere in nursing. That first assignment has stood me in good stead over the years. I finally did oncology, about 5 years later. Really liked it, but no full time positions available and left after 3 months for telemetry, and eventually SICU, where I think I'll stay. I imagine that ortho will be the same for you. There's a lot of basic med surg there, and frankly, most of those folks are going to get better and leave the hospital fairly soon. In the meantime, you're learning all about mobilizing patients, how NOT to screw up a hip or knee replacement, and oh boy, will you know a thing or two about pain control. Probably never going to be your dream job, but hey! Fake it till you make it. At least for the interview. Good luck! I hope you get where you want to be. Keep us posted.

Sats in the 40s? Hell, I'd be calling a code too, and I'm an ICU nurse. You don't screw around with that, and the misinformed folks who told you that it "looks bad for the floor" might want to consider that it looks much worse when no help is called and folks subsequently get hauled to the morgue. I've never berated a floor nurse for calling a code in the middle of the night, and I've reeducated a few of my super nurse colleagues who had the temerity to sneer over what they considered "inappropriate codes". It's never inappropriate to call for help, and frankly, the rapid response guys would have done the same thing. Been there, done that. The day charge needs a reality check. Hell, at least you stayed over to do the charting. Did the night charge take some of the load off you? Does your floor have a resource nurse? No? Well, then, short of cloning yourself or ignoring your other patients, sounds like you did all that was humanly possible. Two unstable patients? Some nights, I'm overwhelmed with ONE unstable patient. All of your patients still had pulses at the end of your shift, and baby, some nights, that's the only goal in mind. Quit flogging yourself. Sounds like you did a great job!