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nursbee04's Latest Activity

  1. nursbee04

    What does a nurse manager/charge nurse do?

    Nurse Manager - in charge of running the unit, administrative duties, committee meetings, staffing, budget, evaluations, payroll, policies, day to day issues that come up. Basically managing the unit, hence nurse "manager." Usually not involved in direct patient care but SHOULD be able to pitch in during staffing crunches. Charge Nurse - usually (but not always) an experienced nurse who "runs" the shift. This can vary greatly from facility to facility. Sometimes the charge nurse takes no patients and helps with admissions, IV starts, PRNs, who gets the next patient, dividing up assignments, delegation, problems that arise, assisting physicians, etc. Sometimes they take patients, but less patients than the other nurses so they can still be of assistance. Sometimes they take a full load of patients plus all the added responsibilty, like I did when I was a newish nurse on nightshift. It also depends on where you are a charge nurse, nsg home vs hospital for example.
  2. I have worked night shift for over five years and our dayshift staff would never EVER dare to make such remarks. They know when we leave at 0730, sweaty and tired from a busy shift that we work just as hard as they did, with less resources and in most cases less staff. I probably wouldn't have been able to keep my mouth shut, so kudos to you for taking the high road.
  3. nursbee04

    nonrebreather-how long, and what should be next

    O2 sat alone is not enough to decide if the pt is okay. What were his ABGs? If the pt was groggy its very possible it could have been from elevated CO2 or hypoxia or both. If CO2 is a problem, the NRB only makes it worse, and the worsening decline in LOC/resp drive makes the hypoxemia worse. I would have went from the NRB to a Venti Mask, titrated down the venti mask until I could put on a NC. If I was unable to titrate down from the NRB to a Venti, I would have put the patient on Bipap. If the problem was elevated CO2, I would have went straight to bipap. Then, if the ABG didn't improve after Bipap, we would intubate in my unit.
  4. nursbee04

    Help! How do I stop blowing very good veins?

    Lots of good advice in this thread! You could just be going through a dry spell. It happens to everyone. You'll pick back up Try to feel for veins instead of relying on veins you can see. Good veins have a nice spongy feel. Try to notice where the vein tracks to. Sometimes its best to use the tourniquet to look and find/feel a vein, then remove just prior to sticking, just as earle58 explained. If you use one, as soon as you get a flash remove the tourniquet. As soon as you get a flash, advance the stylet just slightly further then stop and advance your catheter as you retract the stylet a bit at the same time. Most of the time I float the cannula in (flushing with saline gently as you advance after you remove the stylet) especially if I think I am hitting a valve or if the patient's veins are fragile. Finally, if you think you can hit a vein at all, please do your patient and other staff members a favor and try to at least start a 20g. Where I work, in ICU, a 22g is almost useless. (I know sometimes it cannot be helped, access is access, just making a point...)
  5. nursbee04

    News Article about "Nursing Shortage!"

    I apologize, for this is long. But this post struck a chord in me. *note: the quoted sentences in my post are not taken directly from anyone's post. You know, no one would ever look at me where I work (ICU) and question my nursing skills or judgments. The physicians I work with respect my opinion, My nurse manager has said "I don't have to worry when I know you are doing charge." I say this not to make myself sound better (because I have several wonderful coworkers who do just as good of a job), but to prove my point. There were times (when I was a new nurse, before I switched areas) that I would think to myself - This Is Not Safe. This FACILITY is putting MY license at risk. At one point I left work every morning and cried all the way home. The stress and anxiety made me miserable. And yet every single mentor, nurse manager, coworker was telling me what a good job I was doing. (I was skipping all of my breaks to get my work done. If you have eight patients, five of which are incontinent and turns, three of which get pain meds every four hours and one of which is getting multiple units of blood, you have no nursing aids to help, no charge nurse to help because she takes nine patients too, you kinda loose site of "lunch." The workload was insane. Even the experienced nurses I worked with had a hard time getting out before 8.) Everyone thought I was doing "just fine." Like many new nurses the above poster mentioned they know. By July of my 1st year (I graduated in June) They made me charge nurse. And what business does any new grad have being in charge? You can imagine what this did to my stress level. But I plowed through, everyone continued to tell me what a good job I was doing, and I continued to cry all the way home. And I started to have panic attacks. Because it wasn't safe. And the whole time feeling conflicted because I wanted out of a profession that I loved. Then I switched areas. I went from Medsurg to ICU. And it was like I could BREATHE again. Not because I had no stress (on the contrary, a day in ICU can be VERY stressful.) but because the work load was acceptable. Now, somehow I don't think you would look at me and say "You're just not cut out for nursing." Because guess what? I am cut out for it. I am darn good at what I do. Its not as simple as "well, they just weren't cut out for the job." No. We are good nurses, with good skills and gifts to offer this profession, but some of us have standards we refuse to stray from. I expect to be able to practice SAFELY, without putting my license at risk every time I clock in. Granted, there are people out there who are not cut out for the job. Goodness, I've worked with some of them But to chalk it up to "Well, they're just not cut out for it. Sink or swim." That's not the attitude to have. We are loosing many GREAT nurses too. You need to be given the tools to build a good foundation before you are expected to hold the entire building up. How can new nurses build that foundation if we don't give them the tools?
  6. nursbee04

    New Grad as an ICU nurse?

    A lot of it depends on the individual, but I think mostly on the environment you will be in. Is it a supportive environment with established preceptors/mentors? Will you be with the same preceptor every shift or will it change from shift to shift? Will you have enough orientation? How long will the orientation period be? Is it guaranteed? Will you be taking a Critical Care course or other education such as Rhythm/EKG Interpretation? Will you be expected to learn these things on the job? I am a preceptor at my facility and a firm believer that new grads should get AT LEAST 4 months orientation in ICU. Currently our new grads get three months, then they are evaluated at the end of that period. They are either taken off orientation or they get another month, at the end of which they are evaluated again. I believe a strong orientation period is key. ICU is a fast paced environment where prioritization and critical thinking skills are a must. New grads need time to develop these skills. Wherever you decide to work, ask the questions above. You may get more insight if you post this in the MICU/SICU forum. Good luck!
  7. nursbee04

    Socialized Medicine....WHAT IF?

    Regardless of the "or," I assumed you were presenting both these situations with the idea of government involvement. My mistake :wink2:
  8. nursbee04

    Ok to take Anabolic steroids as RN?

    Psychological effects of steroid use from the Encyclopedia of Sports Medicine and Science http://www.sportsci.org/encyc/anabstereff/anabstereff.html#5 Anything that could potentially affect your logic, temper, ability to critically think and also happens to be illegal you probably shouldn't be taking. They could affect how you handle situations and could also put your patients at risk. Being that they are illegal, could endanger your patient and you are knowingly taking something that could affect patient safety, you could get into trouble. And even if they don't KNOW to test you for them, if you make a mistake or lose your temper around a patient there will still be ramifications. Just as there should be. From the Colorado Nurse Practice Act http://www.dora.state.co.us/nursing/statutes/NursePRacticeAct.pdf Grounds for Discipline (q) Has dispensed, injected, or prescribed an anabolic steroid, as defined in section 12-22-102 (2.5), for the purpose of hormonal manipulation that is intended to increase muscle mass, strength, or weight without a medical necessity to do so or for the intended purpose of improving performance in any form of exercise, sport, or game; ® Has dispensed or injected an anabolic steroid, as defined in section 12-22-102 (2.5), unless such anabolic steroid is dispensed from a pharmacy pursuant to a written prescription or is dispensed by any person licensed to practice medicine in the course of such person's professional practice; (s) Has administered, dispensed, or prescribed any habit-forming drug or any controlled substance as defined in section 12-22-303 (7), other than in the course of legitimate professional practice; I also found a few health care professionals listed online who were busted for purchasing steroids for personal use. I would say yes, you could get into legal trouble.
  9. nursbee04

    Socialized Medicine....WHAT IF?

    Um, this has happened at a hospital I worked at already. No ward clerk, they frequently have to clean rooms and the only person who gets a raise is the CEO. No government involvement there.
  10. nursbee04

    Family members at bedside

    Wow. I have had family members burst into tears and tell me they feel so guilty because they are praying for their loved one to move on so they don't have to suffer anymore... I've had family members who were terrified that their loved one would have to feel ANY pain or discomfort and requested pain meds at the slightest sigh or twitch the pt made...both of which I can absolutely understand...but never have I had a family member outright ASK me to give a lethal dose. I am one hundred percent for pain control and palliative care...Too many times I have seen patients and families hit in the face with EOL issues because no one addressed any of it until it was too late...but my goal is to keep the patient comfortable and pain free. Not to facilitate death, but to make the dying process EASIER on the patient.
  11. nursbee04

    Do you take the MAR into the patient's room with you?

    But what do you check the armband against?
  12. nursbee04

    Do you take the MAR into the patient's room with you?

    For those of you who don't take the MAR in - how do you do you verify that it is the correct patient @ the bedside? I take the MAR and the meds/unopened pills into the room - verify the name and account number, then verify the meds against the MAR as I open them. And this is in ICU - where often I only have one patient, and the same patient several nights in a row. This is policy @ my facility, and also how I was taught in nsg school.
  13. nursbee04

    most enjoyable nursing books for pleasure / films

    ditto on Echo Heron's books. I loved the documentary Vietnam Nurses. It's narrated by Dana Delaney and simultaneously fascinating/heartrending. I would also recommend a book called A Piece of My Heart by Keith Walker, also about Vietnam nurses.
  14. nursbee04

    question about IV push

    1. Never take someone's word for it. ALWAYS look it up. Plus, if you look it up, you will be more likely to remember it next time. 2. Never assume its okay to dilute/that it won't hurt anything. For example, if you were to dilute IV valium with NS, you would probably see your syringe precipitate and turn white. Good Luck!
  15. nursbee04

    Quotes for Success...

    "Nobody made a greater mistake than he who did nothing because he could only do a little." -- Edmund Burke
  16. nursbee04

    Giving bolus Medications via IV port.

    Ditto what calla said - Not everything has to be diluted - always check an IV drug reference if you are unfamiliar with ANY medication. Any good reference source should tell you how much to dilute in or "may be given undiluted." It should also tell you rate of infusion, contraindications, etc. Solumedrol, for example, I don't dilute. I dilute lasix - but if there are IV fluids going compatible with the lasix, sometimes I'll give it undiluted into the IV tubing port, because the fluid running is diluting it for me. This may be what your preceptor is doing. Have you asked your preceptor about this? Also, our facility no longer uses heparin for our PICC lines. They are locked with saline. Always check you facility's policy and procedure manual if you are unsure.