nursbee04

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.

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.

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.

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...)

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?

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!

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

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.

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.

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.

But what do you check the armband against?

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.

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.

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!

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

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.

I'd quit without notice. You have to protect your license. It is up to you to practice safe nursing - a job is a job, you can always find another one. Places like this set people up for failure. If I can't practice safely, its not a place I'm willing to work. There are too many other opportunities out there.

my thoughts exactly, luvschoolnursing. Can you imagine recruiting physicians with this kindergarten crap? How about wearing professional clothing, giving a solid presentation on why your hospital is the best choice to work at and not insulting the intelligence of a group of EDUCATED individuals who all HOLD DEGREES/LICENSES in nursing. Only touring one unit? That would be a red flag for me. The whole presentation would be a red flag for me.

I am by no means an expert, but I'll tell you what I know... Breathing treatments - this depends on the trach and whether or not the patient is vent dependent - for example, my sister doesn't require 02, so she gets blow by treatments or a trach mask. Replacing the trach - again, this depends on the type of trach. There are different kinds: cuffed, uncuffed, one piece disposable with no inner cannula and "permanent" trachs with inner cannulas. My sister has a one piece disposable uncuffed trach, so the whole trach is removed and a new trach put in with a new trach collar. Other patients may just require a new trach collar and cleaning the inner cannula (sterile technique). To be honest, if you are going into peds, the parents can be a valuable source of the patient's routine and what works best for them, and probably are the best source to learn about trach care from (as long as they do it correctly), because they do it every day in most cases. Will you be orienting with an experienced nurse? pictures of several uncuffed trachs and a cuffed trach (the skinny thing by the trach is the obturator, used to put in the trach and then immediately removed.) adult trach with inner cannulas

I think we could definitely take an example from the nurses in California. We are having almost the exact same thing happen in our hospital, but instead of being professional and bringing concerns forward, most of our staff has taken the stress and converted it into increased backbiting and pettiness. Probably because they are afraid to be added to that list of troublemakers. (Which I am probably already on...) I love my job, and I used to feel like the hospital cared about me, as corny as that sounds... Now I dread going in and hearing about the newest policy change or staffing cuts. Power in numbers has no meaning if we can't work together with a degree of professionalism, which is a problem where I work. I truly wish nursing had a stronger voice. Life is too short to go to a job that makes you miserable. The sad part is that its not the actual nursing that is making you miserable. There are just too many other jobs/options out there in nursing to put yourself through it. I'm sure there's a job out there you would love, it just takes a bit of looking. Which is what I'm starting to do. I send you hope and good thoughts

I love propofol. Works well with most patients. It is a huge pet peeve of mine to come in and get report on a vent patient who is practically coming off the bed and when I ask what they are getting for sedation the dayshift nurse replies "Ativan 2mg Q4 hours PRN." As if that counts or something.

I think the point is that you cannot obtain an ASN in two years, not that an ASN should be considered a four year degree. It took me three. To say it is a two year degree is misleading to some, especially laypersons. Just as it is equally misleading to say that you have a four year degree if it took you that long to complete your ASN, just as you pointed out. The argument here is that someone would say "just a two year degree" reducing several years of hard work for most of us to a "just a..." statement.

I was in composition II and we were discussing possible topics for our next research paper. Terrorism was actually one of the topics to choose from. Next I went to A&P class and our prof told us "there is no more world trade center." We didn't know what to think. I get chills thinking about it right now. For days we watched news footage and just cried. I know of a social worker who went to ground zero to help debrief and she says it was probably on of the most important things she has ever done in her life. She cried just describing it to us.

I took over a full load per sememster. It took me exactly three years. Two semesters for prereqs, then the nsg program was two years. Most of the people in my program that went part time took 4-5 years. Good luck and hang in there! :)

Dear Administration - It has come to my attention that you have no idea what goes on in your facility and are completely out of touch with what is feasible to expect from your staff. Please get a clue, leave your plush new renovated offices and speak a civil word to the people who keep your facility going 24/7 - 365. PS - have lost "ask me if I've washed my hands" button again. Am willing to do without a replacement for the sake of the budget. Also am willing to volunteer to filter all ideas stemming from administrators with too much time on their hands. Free of charge, for the sake of the budget, of course.