WWRN

Thanks much for the replies. I was fortunate to run into one of my favorite docs and just asked... He was so gracious it made me wonder what I was worried about in the first place!

Hi all... I recently interviewed for a position and they are asking for an MD reference. I work in an ICU where I deal with many different docs. However, I work an off shift and therefore only see the docs if there is an issue with my patients. I'm unsure how many of them would recognize my name if I called/e-mailed them, but I don't know when I may see them to make a timely request. What do you think would be the best way for me to ask for a reference? Thanks in advance for your help!

Okay all, I have exhausted my internet research abilities and cannot find a reasonable answer to the patient situation I encountered recently. I need your help because I can't stand not knowing what was happening to my patient... Pt had been severely acidotic and was placed on a D5W and Sodium Bicarb gtt at 250ml/hr -- was getting about an amp of bicarb per hour. Glucose levels were in the mid 200s and the acidosis had resolved so the gtt was d/c'd and 1/2 NS started at 75ml/hr. Pt's next glucose (about 3hrs later) was in the 120s. Before the next scheduled CS the pt's BP plummeted requiring the addition of a Levophed gtt. By the time the next CS was due the pt was on 14mcg/min of Levophed and the CS result was 35!!! Pt was given and amp of D50 and the BP immediately improved to the point that I was able to decrease the Levophed to 4mcg/min. Repeat CS 116. Next CS about 45 min later was 82. An hour after that the CS was 63... This pt was in acute renal failure -- about 4L positive with 60cc urine output in 24hrs. My charge nurse said something about the Bicarb being withdrawn so rapidly and the failing kidneys led to the glucose issues, but couldn't really explain why... I'm really curious to know the possible link between the bicarb gtt, hypoglycemia, and hypotension that vastly improved when the glucose was corrected. Any light you can shed on this would be greatly appreciated. Thanks in advance!

It's not just you... I think it's the 'nature of the beast.' You can't predict how a shift will go and there will always be those individuals who follow you and don't feel you did enough with the new admission, etc. At the end of the day you have to be okay with knowing you did the best you could and that you didn't intentionally leave things undone for the next shift to take care of.

Thanks everyone for your support and suggestions. It's much appreciated!

so, i ran to my first code alone last evening.... the adrenaline was flowing and i was feeling pretty good when i was the first one there after the resident and i started cpr, was pushing epi and atropine, and really participating. we intubated, drew a femoral abg, etc... and then it happened... [color=#483d8b]the other icu nurse recognized the patient and said 'he was a dnr on our floor.' she checked the chart and sure enough the man was a full dnr. [color=#483d8b]i feel pretty guilty/angry today. guilty for not checking myself and putting the poor man through all of that. [color=#483d8b]angry that there was a huge communication breakdown in the system so that the bedside nurse's kardex said this man was a full code when the code sheet in the chart said exactly the opposite! :angryfire [color=#483d8b]how do the rest of you identify pt's who are dnr? i think our system needs an overhaul and i'm in the mood to take action. i don't want to ever feel this way again! [color=#483d8b]thanks for listening! :heartbeat

hey all, the sicu i work in is considering learning to do our own crrt. currently, a micu nurse comes over and does it for us so we still have a two patient assignment... if we start doing our own crrt the crrt patients will be 1:1. for those of you that do your own crrt what are the pros and cons? thanks for your feedback!:heartbeat

I didn't read all the earlier posts so this may have already been said... My biggest personal mistake during orientation was to not ask enough questions/not facing my fears. Tell you preceptor what you don't know. Ask for those patients that scare you the most while you're on orientaion, because sooner that you think you'll be off orientation and facing one of those 'scary' patients. But, remember... even once you're off orientation, in the ICU you are NEVER alone... just open your mouth and ask for help... you'll get it! Enjoy!

Here's one I had to google the other day because even in context I couldn't figure it out... MAE = Moves All Extremities Just when you think you know the lingo you find something else you didn't know! =)

Recently my unit has been experiencing this d/t the trauma docs not feeling comfortable with the care pt's are getting on the floor. We have a pt who is completely stable that trauma has said we aren't allowed to transfer to the floor only to d/c to rehab when he's ready. It makes for a very difficult situation especially when you're running so low on beds your 'bumping' people to MICU so you can immediately turn around and admit a new trauma. Frustrating and scary practice when you think about it...

babs and zoe: thanks for the replies and words of encouragement. i've been fighting with the insurance company for the last few days to try and get them to ok the program my doc recommended with no luck (unless i can pay for half of the apprx $20k)... so i'm waiting for a call from the intake coordinator of the partial program at the hospital i work at. i'm not too thrilled about the situation, but am being assured that other employees have gone thru the program and confidentiality is strictly maintained. regretfully when i told my manager i'd be out on leave i told her it was for mental health reasons so i am concerned that this will be held against me down the road, but i can't take the words back so i'll have to deal with whatever comes my way. this program i'm waiting on is all group therapy with individual med checks twice a week. any idea what real value hours of group therapy will have w/o any individual therapy mixed in?? i need this to work and work quickly as my husband is unwilling to allow me to miss more work than i have pto to cover. thanks again for your support - it means a lot. :redpinkhe

My understanding is you can just run them in "full strength". I'm interested in what others do...

hello all... i'm an rn in pennsylvania and my doctor has decided i need to be placed in a partial hospital program and out of work for a month or so due to a severe exacerbation of my depression. do any of you know if i'm at risk for loosing my rn lic due to mental illness requiring this level of care? thanks in advance for any and all replies

Thank you all for your words of encouragement and advice it's greatly appreciated. I am in counseling, but not as regularly as I probably should because of my schedule. I recently had an adjustment made to my meds and it is helping somewhat. I'm getting ready to head back to work after a week off and am anxious to see if I feel better at work too. I think a large part of my problem is not feeling like I have a life outside of work because with working 12hr nights and trying to maintain the same sleep schedule on my days off it's very isolating. Therefore, I'm considering a full time 3p-11p shift in the same unit. Yes, I'd have to go to work 5 days a week which scares me. I'd have to deal with families more which is also scary. The leadership on that shift is less consistent and there are other negatives, but I feel like the only way to fairly gauge if CC nursing is for me is to do it with adequate sleep... What do you guys think?? Thanks again for all the replies!:redpinkhe

Warning: This is long and will likely be hard to follow as I've got many thoughts swirling in my head... I am a newer RN (graduated about a year ago) who works in a critical care unit that sees a wide variety of patients. My orientation was less than ideal and I've been 'on my own' for a couple of months. I dread every shift I work. I have a hx of depression and it's rearing it's ugly head again. I'm on meds and they help a bit, but I still dread going to work and being at work. Before work I worry what will happen at work, while I'm at work I worry that I won't know what to do/will do something wrong, and after work I worry that I did do something wrong or missed something important. I work 12hr nights and I don't think that's helping my mental health any. I'd like to work 3-11p, but worry that I wouldn't be able to handle the traveling and inconsistent leadership on that shift. I did well in nursing school but now feel like I know absolutely nothing. I'd like to possibly look into a different unit, but have zero confidence in my ability to interview effectively right now and I'd hate to go to an interview, humiliate myself and burn a bridge... A co-worker of mine (who graduated with me) said my problem is that I 'care too much' and that the rest of the people who started with me feel the same dread I do, but they don't let it bother them. They just go with the flow... I can't seem to do that. I have a terrible time trying to prioritize/organize my shift. I worry that I'm not documenting the correct things or in the correct way. Someone suggested to me that I look into a less 'intense' area of nursing, but the thought of having upwards of 5 patients that I can't see at all times scares me more that my two 'critical' patients... Okay, I've completely rambled on and ultimately none of you will have a magic wand to wave and make this all better for me... My only hope is that some of you will have 'been there, done that' or will have some sort of advice to help me sort this all out. Thanks for taking the time to read this and I appreciate any and all feedback, questions, or comments.