Mrs.Rollins

Or maybe it was a nurse who doesn't usually work ICU and was already in over his/her head? Some units will pull nurses from stepdown when they're desperate with the intention of only giving them "walkie-talkie" patients, but we've seen how that sometimes works out...

I'm confused: why on earth would you be bolusing someone with propofol unless they were intubated or for the purposes of RSI?

I agree with many of the other posters. Once you've had to break this kind of news to family often enough (I don't work in a Level I with docs at the bedside 'round the clock; I am frequently the one who notifies family of a death), you'll see every reaction under the sun. Some shout, some cry, some laugh and brush you off, some may even call you a liar and turn around and walk out (happened to me last year). While you may feel that you could have done a better job with this family member, you did the best you could. The simple truth is that no matter how you did it, that family member was in a for a huge whalloping dose of pain and heartache. Try not to be so hard on yourself: focus instead on how hard you worked to be supportive for that person, to stand by their side and offer your compassion and acceptance. After all, you're only human, too.

This type of thing happens all the time in my facility, unfortunately. We had a rash of nurses a few years ago who wanted to transfer, were completely blocked by their managers, left for another system for positions in their desired change-of-specialty, and eventually came back to our hospital to work in the units they wanted to transfer into. For more much more money. I've never understood the thought processes of managers and administration. How on earth does it make financial sense to encourage nurses to leave the organization after you've invested so much time and money into them, only to turn around and hire them back later? Wouldn't it be smarter for hospitals to encourage retention through better raises, benefits, and measures to increase employee satisfaction? But, I digress...logic is and never has been a pertinent point when it comes to nursing in the U.S.

I just want to take a moment to congratulate AsystoleRN for a wonderful response. There is so much misinformation about the dying process and hospice care in general within the acute care setting. Morphine isn't given to "hasten" death: it's given to ease the transition to inevitable death. Our focus changes from fixing the problem and "saving" the patient to accepting nature's course and allowing for their passing to be more comfortable. That is a role change that can be extremely hard for some bedside, hospital-based nurses to adapt to.

Ditto the above poster. Never seen the balloon pulled out without the sheath, and NEVER with a heparin gtt running. Yeesh.

My standard practice (and the policy at my current facility) is to document vitals Q15mins any time I'm titrating pressors. If they've been on low dose pressors (like renal dosing dopamine, for example) and there hasn't been any titration for 2 hours, then we can go to 30 mins. If there is still no titration for another hour, then to Q1hr. The above, however, really only applies to MICU, though. I always do Q15mins on post-ops/hearts until the vasoactives are off, but of course we get art lines in those guys, anyway.

With our population it's not uncommon for us to run 50-60mcg propofol, 9-10 midazolam, and Fentanyl or Dilaudid gtts and patients to still be awake and actively pulling at ETT/lines/Foleys. We get a lot of chronic drinkers and druggers.

If you come to the nursing station looking for a patient named "John," and when asked what John's last name is you say, "Well, I don't know. But he's one of my best friends!"

I'm a night-shifter in mid-level acuity ICU with no CNA's. We have to do nightly baths on all our patients, every night. Day shift on my unit is pretty good about cleaning up the patients during the day if they're getting really gnarly, but usually the spa treatments fall to us. While I don't mind doing it because I feel it's an important part of their care (especially our vented/sedated patients), it's still physically very hard on me to do every night. In addition, we have no turn teams or such to help, so every nurse has to help their neighbor when it comes time to turn and change linens. Many of our patients (at least 1/3 to 1/2) are morbidly obese and require multiple people to turn. Factor in these people being on lactulose (we get A LOT of cirrhosis patients), and I'm essentially bathing/turning at least 4 times (twice for my 2 and twice for my neighbor's) a night, usually more if everyone is pooping. No wonder I'm 29 and my back and knees are KILLING me.

...when you arrive for your shift and there are copies of Safe Harbor forms hanging at the time clock. True story, yesterday. Quadruple ICU assignments.

Had one 3 weeks ago with a serum glucose of 1472.

ABG: pH 7.13, pCO2 88, pO2 46, don't remember the HCO3, but it was something equally ridiculous. This patient was not intubated, by the way, and the attending didn't seem to think it was warranted because "she can open her eyes." She did, in fact, open her eyes: once, after 2 minutes of vigorous sternal rubbing. Needless to say I had her tubed mighty quick. The patient spent a few days on the vent and later discharged home in pretty good shape. Very sweet lady.

Actually, only Methodist in The Medical Center requires a BSN; all the other locations will accept ADN. However, Methodist is notorious for almost always choosing BSN over ADN applicants, regardless (frequently) of qualifications. It's just their thing.

If you're planning on working in the Dallas area I'd be a lot more concerned about Group One than about having your BSN. I work in the Houston medical center for one of the big ones (I won't say which) and have an ADN. None of the facilities in the medical center would hire me as a new grad ADN (despite graduating valedictorian and Magna Cum Laude, with various clinical excellence awards, having worked in a cath lab prior to nursing school, and having 120 hours direct care ICU experience prior to graduating). They wouldn't even let me apply. And you know what? That's just fine. I got my experience somewhere else and came back later. I'm happy and you will be, too.