Sirapples

Hey all, this is a topic that is a little unusual for me. I enjoy the anonymity of the internet for it. Ive been in the healthcare field for over 15 years. A cna for approx. 5 years before I became an rn, at a lock down dementia unit. My career spans the gambit. I was a ortho/tele nurse, Ive done agency where I was thrown into some absolutely ridiculous circumstances. I then went and became an icu nurse for almost 4 years and got bored of that. Then went to the er where I loved it. Ive been an er nurse for maybe 7 years? But I don't have it anymore. I used to jump into the middle of the **** so to speak if I had downtime. I would grab the busy patients. I loved it. My icu background was invaluable when it came to intubating patients, titrating drips and just generally keeping people alive. Other nurses loved working with me because I always kept my cool and I was always able to help. My charge nurse would slam me and I would beable to just get it done. But I am finding myself increasingly anxious. I left my old ed to work at a one that wasn't as busy and told myself it was because it paid more. And even here... while I work I find myself anxious. I had a little old lady today who fell.. stable as can be.. and I was sweating while I took care of her. It hit me when she said... dear.. am I making you nervous? I wasn't even busy. Ive never been told that in my life. This is a patient I can take care of 100 of. I don't know what it is, why its happening. I find myself now very nervous when a sick patient comes in. And I can take care of these people without any issues. Once I actually take care of them, Im good. My instincts and training and experience kicks in.. and I don't feel that anxiety and I work just like I did when I would as I would say "crush my assignment". Except today. And that was when I had lady who was a fall... that simply slipped on her butt. I think it started when one night I was working and I had a multitude of codes back to back and ended with a 3 year old asthmatic come my way and we had to intubate on the spot (went well too). And since then it has been a slow steady decline since in my own self confidence and ability to stay cool. What are anyones thoughts on this? Has anyone felt this way?

Ive been a nurse for about 8 years, work in icu/ed for 3 years before that medsurg. In the past 6 months I have seen maybe 12 cases of patients requiring intubation from lisinopril reaction. all of these cases the patient came in with angioedema and symptoms related to that and required intubation with 3 day or so stays in icu before exubation. I recently assisted in a very rough intubation after a patient ate stake and rice and then took lisinopril and it turned into a VERY messy situation. I work in eastern mass and Im wondering if any other nurses are noticing a trend lately? What is going on in the lisinopril factory? I dont ever remember taking care of patients with this issue before.

I work 7pm to 7am. I am on the verge of switching my job so I can work days.

2 months? its fat soluble I know that. How much were you smoking?

I dont know why you would smoke prior to taking this drug screen. marijuana stays in your urine about a month fyi. I dont think this would be kept as info by the state. Try again. Whats the worse that could happen? Just this time, avoid smoking a month prior to taking the test.

charting does not save a patients life. appropriate actions to critical situations does. I am also a new icu nurse, Ive been here for a little over a year and a half.. some very tough nurses here as well. Especially I think because I am a male nurse. I use the phrase alpha female because a lot of very strong intelligent women work here with more experience than I thought any nurse could have. Very strong personalities. When I started here, and when a patient crashed, other nurses would come in and help my patient, and I would act as the go get this guy. I was afraid I was in the way and I honestly was scared of these situations. I realized that I would learn nothing doing this and changed how I acted. Any time a patient crumped in the icu I made sure I was there to help and to see and do what I knew how to do. That could mean chest compressions, ambu bagging, starting iv lines, or whatever was needed that I knew how to do, and observe how others acted in each role. I made it an effort to go to every rrt with a seasoned nurse and learned how to react to situations that occured and how to handle the stress of a crashing patient. I asked the charge nurse to let me be open so that I could take the first admission. I let her know that I may need her help but I wanted to learn. Anytime someone was about to be intubated I would make sure I was present. to at least watch and if it was the right group, I would ask questions right away, or would ask questions after. Anytime anyone needs help with a bed change I help, or a call light or bed alarm or a vent alarm or iv beep goes off I check it out. Doing this, I believe I am earning the respect of my coworkers. I do not have the knowledge that everyone here does, but I am trying to learn. when I started the thing that always made me in awe of seasoned icu nurses was a patient that was from ed, crashed here, intubated, assisted with a line placement, and tons of pressors put up. About 4 months ago I went to an rrt by myself and the patient had no iv access at all, no foley nothing and sats kept dropping and bp was in the toilet. I helped the anesthesiologist intubate the patient, I asked someone in the room to page surgical resident for some kind of line and we brought the patient to the icu. It made me very satisfied to of done that. Never would of happened if it was not for me stepping out of my comfort zone and starting to attempt to edge into the world of critical care by actually doing and observing and challenging myself. gluck!

Im glad Im not the only one that feels this way. I tell you what... when I get in my 60-70 Im putting in my will that the first person that forces the dr to remove a dnr and signs that paper that removes dnr status shall at that point forfit anything in my will.

So I was out the other night with my girlfreind who is charge nurse at boston medical center on a surgical floor. I work in an icu, I have been here for almost 2 years. Discussion comes up about work and someone listens in on us and says to me.. you work in the icu? you do gods work. I cant say this is true unfortunatly. I feel like I am stopping god from allowing the death with dignity part to happen. I dont know what its like for the rest of you, but I find a lot of chronic cases. These patients come in that are like 85, long histories, and you know that if they really had a choice in the matter they would rather die with dignity,... but instead end up trach, peg, with a picc, and just keep coming back untill they code for the 3rd time in 2 days and finally its stopped after being maxed out on 3 pressors and they code again. (I saw this happen once.) I often ask myself why? I look at it like this... that I have learned a lot keeping patients alive that should not be and have been able to apply that to patients who are acutly ill and turn them around.. but I think this is like 1 out of every 50 patients Ive seen, and its a bit much. IT seems like sometimes our purpose is to just see how far we can keep people alive no matter what the concept of life is. Also after I got over the initial... holy **** a vent, and wow 10 iv lines at once, and how pressors work, Im finding a lot of routine to this job. Yes often we are busy as hell, but the other half the time its... enter the vitals every hour, document document document until your fingers hurt. Draw the blood, reposition, do the bedbath, do the suction. I like being an icu nurse. I was a nurse for 7 years before. Tele, medsurg, agency, and as soon as I started my first day of orientation in the icu, it was a humbling experience. It was like starting nursing school all over again where I knew nothing, where I used to be one of the strong nurses on the floor. Ive learned so much more than I ever thought... But I will be honest, this job is not what I thought it would be.

I work icu now and I loved med/surg. I still float sometimes to med/surg because I enjoy it. Now with my icu background I have a bit more knowledge and can help out more when a med/surg patient goes bad. I do not miss the powerstrugles with cnas. I also dont miss when some nurses think that cnas are slaves. Yes, you can change a bedpan as an rn. Dont expect cna's to and yes you can answer a call light on the nighshift when you are not busy. Besides that though... med/surg gives you the background to deal with just about any issue, and gives you assesement skills that are insanly fine tuned. You run accross all kinds of patients and that experience will help you wherever you go. Some of the best nurses I have ever worked with were medsurg nurses.

I think down the road Ill look into teaching. I know I will be doing tons of papers, but I think Ill actually enjoy that. I dont really look foward to seeing what nursing will be in 5 more years. Computers were susposed to make our life easier in medicine. It certainly has not. And this is coming from a computer geek.

Ive been a nurse for 7 years, almost 8.. Before that I was a CNA for 3 years. IVe worked med/surg, tele, been a float nurse, done agency, and now I work in an icu. Ive worked at a multitude of facilites and dealt with all kinds of charting. Before nursing I obtained an associates in computer information systems, was an A+ certified computer tech, and was well on my way to obtaining my microsoft network engineering certificate. I know my way around a charting system, and I know my way around computers.... But I see a trend. And I dont like it. More and more it seems like people who have absolutly no concept or background in bedside nursing are creating programs and dictating charting on us who live, breath and sweat bedside nursing. either that or they worked bedside in the days of 20 patients and blanket warmers for blood. Im also seeing a "customer" approach to patient care, which is complete pc bullcrap. No customer in the world is allowed to spit, ****, assault, or cause chaos in any business in the world. No customer has the potential of dying at any moment in any business (except planes of course, but people dont fly planes because they are sick as hell) Add this together and you have more and more charting taking away more and more from patient care. We had a new system come online today in our hospital and I had an admission. Fairly stable, came to the icu for initial bipap support until lasix and antibiotics get her better. It took me 2 and a half hours to do her admission assessment, and her regular assesment. If she was busy, it would of been a nightmare. Mind you... I know how to chart. This was a system problem. It should of taken me no more than a half hour. I am finding more and more as time goes on, we have more and more charting added on to us... expectations that far exceed reality when it comes to charting.. especially in the presence where no overtime is allowed. I am finding that I have to rush true nursing care like a bed bath, or repositioning a patient because of the amount of charting. I love my job, but I can not see myself continueing as a bedside nurse much longer if this continues. I dont know how ethicaly I will beable to when my job is turning into 75% charting, 25% patient contact. Im rambling now, Im tired, and I worked a 12 hour shift then went to the gym before venting this... but I am getting very frustrated with the way nursing is going.

ah sorry just read that wrong that you werent scared. my bad:)

Ill be honest, I dont work in CCU, but I do have some tele experience. One thing that is an issue is fear of doctors at night. Its our patients lives that are in our hands and if you have a clinical question like... do I hold this medication without peremiters in the face of this.... and you act on your medical interpretation of the reason why you would hold said medication, you are practicing medicine and not nursing. I would of called the MD. Reason is this... If something had of happened to this patient and it went to court, a lawyer would of asked... Why did you hold the metoprolol? Did you have guidlines set to hold that medication? If you held it, and the answer was you had no guidlines... then his next question would be what md school did you graduate from to dictate medical decisions without perimiters. An answer of, I didnt want to wake the doctor because I was scared... will not cut it. You do ask a good question, but honestly the bigger picture is that you work at a facility where you feel fearful to call a doctor about witholding a cardiac medication on an icu floor. I would of called the doctor, asked if he wanted an additional bolus of fluid, and asked if he wanted me to hold the metoprolol. Then again I dont know if this blood pressure is her baseline and when her last pain medication was.

nice!

Whoever thought of this ingenius idea was not a nurse. I am a very honest and forthright nurse and I would be tempted not to report if this was the drama I had to go threw. You guys have like 40 patients on a nightshift. I can only imagine what it would be like if you had to do all that crap plus all the other documentation you had.

lol fits me to a tee. I have a shaved head, tattoes, scars and about 225lbs at 6'0 powerlifter. But my patients love me and the little old ladies always try to throw thier granddaughters at me. its funny!

Always. Be very upfront about it. I think honesty in these cases is a lot better then them finding out about it with a cori check. I have found that managers respect that and so does human resource.

No offense, but If I was a manager I wouldnt hire you. Seems our society is breeding entitled people that think that because they are having a bad day or because they live far away from a job, they can come and go without fear of losing that job. Sounds like you are getting it though. When you were hired you have a responsability to work as scheduled, on time, and with minimal absenses. You owe it to your coworkers to be on time and as scheduled because when you dont, your coworkers now are overloaded with your patients, and the previous shift may now be mandated to cover your patients because you were out "worried to death". Gluck and I hope that your work ethic continues to grow.

great post

No, its actually pretty common with her. I can be frazzled at times too, but I dont forget too include things like the fact that my patient has a recent 2 day right hip replacement. Ill give an example. Another patient was in a MVA report sheet said multiple trauma. I asked her if he had any injurys and she looked at me like I just asked her why snakes are coming out of her mouth. I had to ask her again, and she replied.. well he was restrained. I had no idea what that meant. I had to ask her 3 times before she finally said he was fine. Then I assessed him right away and he was satting 88% on 5 liters with rib pain. He had multiple rib fractures. I came back out and asked if he has always been 86% on 5 liters and she had no idea. NO idea he was on oxygen, no idea of nothing. I can be very diplomatic. How Ill play it is if I follow her again, chances are she will have the same patients, and Ill figure out a way to include those details she missed... like the fact that my mva patient had fractured ribs, and the fact that the little old confused lady had a left hip replacement.

ya thats right. Just got report on a 88 year old lady. report stated that she was in with confusion and vitamin b 12 deficiency. lung sounds clear, not attempting to get oob. After assessing the patient and reading the h/p patient actually had a right hip replacement 2 days ago, with a dressing to the right hip that was saturated. Report from other patients from her were just about as bad. She has been a nurse for a few years to so its not a case of a new nurse being frazzled. I think the approach I will take is direct conversation to her tomarrow and tell her what was missed. what would you do?

ha well 2 more months I can do internal transfers. Im already doing searches now.

Ive been a nurse for 5 years, and never seena doctor "open someone up". its nothing like on tv. My advice is after you get your ged, go and get a cna liscense and apply at a local hospital. After you see first hand on a medsurg floor what its like then decide what you want to do. Good luck. And why did you drop out? Nursing school is tough as nails.

I also think what I dont like is that most of the nurses I work with ignore the call bells, ignore the iv pumps that go off, and we have only 1 cna on the floor. And since I was a cna for 5 years prior to being a nurse, I feel obligated to get thier stuff. I think if I stay here this unsatisfaction will increase

Ive been a nurse for about 5 years, floated, done agency, rehab, tele, medsurg. But about 4 months ago I got a job on an ortho-medsurg floor. I honestly dont like it much. Not very critical and mostly manuel labor. Push meds, remove the pca's, get patients out of bed with a walker and that takes about 5 minutes. Then get them to the comode, then back to bed then pain med after. And since its a 4 bed ward, the other 3 ortho patients realize one after another they want the same. I have no problem with the patients and Im very pleasant and curtious. I just miss telemetry and more critical med surg complications. More of a rant.