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.

Godwin's Law! And it only took 3 pages this time.

A great portion of people I graduated nursing school with were only able to find jobs in home health. I know at least 3 of them weren't able to stick with it and quickly bailed (2 of them left nursing altogether, having never found jobs in the hospital).

I think the term "bedside report" is inherently confusing. I've always taken it to mean that at some point we go into the room together to look at the patient, clarify/discuss some of the physical assessment data, verify gtts/vent settings/CT's/etc, introduce ourselves to family, and just generally give the room a once-over together. I've never interpreted it to mean that the entirety of our report must be given standing next to the patient; rather, we look at the chart and orders together, along with going over any pertinent history or sensitive information, before we enter the room. Having said that, there are some facilities and nurses who interpret bedside report to mean just that: the entire thing, right there in the room. Eh. I think it's a potential landmine of privacy/dignity issues, not to mention the fact that I would certainly forget a lot of things that way. And I'm certainly NOT going to march into a room with an oriented patient and tell the oncoming nurse, "Yeah, he's pooped 2 liters of foul liquid stool today. Been drinking like a fish since he was 15 and now his liver's shot. He's terminal with 2-3 months left, and look at those ascites! No family involved with his care and apparently he's got a history of extreme psych issues. Okay, Mr. Smith, Nancy Nurse here will take great care of you tonight!" :icon_roll

I'm one of those people who absolutely love working nights. Love, love, love being a creature of darkness! I've been orienting to my new facility on days and it's been rough (I'm not cut out to be a daywalker). But it's definitely reminded me that there are always two sides of the coin, and each shift has its benefits and drawbacks. When I first went to nights my boyfriend was very much against it. However, with time, he's come to not mind it at all. At the end of the day (or night!), however, family and personal happiness simply have to come first. If he was genuinely still upset about me being on nights, or I was miserable doing it, I would go back to days. Money is just money, but your family and your personal well-being are priceless. Best of luck to you, and I'm sure you'll transition well.

My stepdad just went through this EXACT situation. And believe me that he got screwed out of every other job he applied for. His former employer even told one of his prospective employers that they were considering reporting him to the board! He hired an attorney and very promptly got not only a written apology, but a written recommendation AND a nice fat settlement. :-) My advice? Don't roll over and play dead. Nurses are used and abused too much as it is.

I D/C central lines and Swans in the ICU/CVICU, but RN's on the floor usually don't. We also don't do a CXR following. I'm not sure I understand what the necessity for that would be, unless there was a question of complete removal.

I had to take a semester of Medical Terminology for my ADN. It was very well worth the time.

If you are an RN I don't understand how you can work as an LPN. You don't hold an LPN license; you hold an RN license. Could it be they're asking you to take a position normally held by an LPN and get paid at that rate, as opposed to RN scale? Sounds confusing.

Had one last night Hgb 3, crit 9. White as a sheet but otherwise completely stable.

ETA: I should probably mention that my single greatest problem with ICU is the patients/families who insist on full-code status, no matter how ridiculous and insane that is. Granny is 95 years-old with complete heart failure? Full code! Dad has end-stage lung cancer with mets to brain, bones, bladder, and liver? Let's keep him a full code AND do a thoracotomy! I literally coded a woman 3 times last week in her late 80's, s/p CVA and full-code 2 weeks before, on the vent, been unresponsive since that time. 3 times in a row! The family is in full-blown denial and the docs won't do the right thing because they're afraid of being sued. But that's a typical night on our unit, lol. It takes a lot of getting used to. Sometimes when people ask me what I do for a living I reply, "Torture people for no reason."