shoelace

How do you manage it? Currently, the nurses in our CCU float out to 3 other departments. One of those departments used to float in to help us out, but the nurses who always got stuck floating to us decided that they didn't want to anymore, so now they just don't have to! It's very frustrating for us to not get days off because we have to float to cover other units. It's especially frustrating because no one ever has to float to help us out! When we're short staffed, we hop on the phone and start calling people in, getting people to stay over, etc. It always ends up working out in the end. We know we have to work a little harder sometimes and help ourselves since no else will. We accept it as part of our job and there are lots of people who are willing to pick up the slack. I feel like the other units rely on us way too much. If they know we'll have extra nurses, they don't try to call their own staff in. I'm tired of having to bail them out. We all are. Some of us want to try to make our unit a closed unit. Since no one floats in to help us out, we don't want to have to float out either. Has anyone's unit gone from a floating to non-floating unit? How did you convince management to allow it? Even if your unit has always been closed, what do you do with extra staff? Do they get the day off? Do nurses just accept that they may be forced to take time off during low census? Do some float anyway just to get hours? Tell me how it works.

Currently at the hospital I work at, we can pretty much wear whatever we want. Most of us wear scrubs, some wear a top with scrub pants and jacket, etc. Very few wear "street clothes." And those that do - it doesn't look that bad. It's not like they come to work wearing jeans and a blouse. A committee is forming to "discuss the option" of going to standardized uniforms for nurses. I'm sure there are good reasons to do this, and the transporters and EVS have already switched. I think they look nice, but I didn't really have a problem with the way they looked before. I don't particularly want to wear something mandated by my hospital, but it's not a deal breaker or anything. Some nurses act like it is... like it threatens their very identity as a nurse to have to wear something that they did not pick out themselves. Has anyone else been in this situation, where nurses were invited to go to a committee to voice their opinions? What were most of the opinions? If nurses were against it, how did they change administration's mind?

If you can get some petri dishes somewhere and can go to the classroom about a week or so before your presentation, pick 3 kids to come with youl. Have one run their finger over a petri dish right away. Have another go rinse their hands with water only and do the same. Have the third wash their hands with soap and water and swab the last dish. Put the dishes in a warm dark place for awhile and see what grows! I did this in college as a project for kindergardeners and they LOVED it!

Has anyone experienced this? I had a flu shot yesterday. Last night, about 9 hours afterwards, the injection site became very sore (which I expected). But soon after and since then, my entire right arm down to the fingers has these flare-ups of pain. Sometimes the pain will originate at the elbow, sometimes at the forearm. Sometimes my upper arm. These areas of my arm will start to hurt, last a few seconds, then it goes away. The soreness is almost gone from the injection site, but although the other pain abated somewhat this morning, now it's back to the way it was last night. I asked some people at work about it today and only one person said that their whole arm ached after a flu shot. I'm not sure that I'd describe this as an "ache." It is pain. My movement is not restricted. Any ideas??

Get in there and do chest compressions! It's not mindless work or anything, but you can at least peripherally observe what else is going on and get more comfortable in a code situation. If you're doing compressions, no one can ask you to do meds, defibrillate, etc. Or, if there is no resp. therapist, you could bag the patient. Just until you become a little more comfortable in an emergency.

I had a guy with priapism once. Urology came in and did the same thing - speared the patient's swollen member. He then just let the blood flow out of the needle onto the bed. Nice. Once he let the patient bleed out a couple hundred cc's, he ASKED FOR A TRANSDUCER SETUP to hook up to this guy's member. Yes, that's right. We obtained a CPP on this patient. Central member Pressure.

This isn't a lab value, but I was amazed... We were detoxing a young man from alcohol... giving him continuous IV Ativan and IV Haldol was given every 2 hours. The dose of Haldol was 5mg at a pop. The dose of Ativan was 40mg. PER HOUR. Groggy, but still awake, pulling at restraints. We triplequadruple checked the dosage... sure enough, 40mg/hr.

I bought a magic fairy wand.. It makes "brrrrrring!" noise when you "flick" it at someone. Sure helps to lighten the mood when that thing comes out. :-)

Thanks for posting the link :-) I maintain the site. To the person who said there was only one "nursing student" entry - I've long forgotten the entertaining moments of nursing school... If you have anything to contribute to be posted, click on the Story Submissions link at the top of the site. I'm always up for a good nursing school story :-) Thanks again, glad you guys like it!

She is absolutely beautiful. Make sure you visit the NICU with her... nurses like to see the fruits of their labor :-)

I started out as a new grad on med-surg, working nights. The morning I put in my transfer to ICU came after a night where I had 3 admissions, making 10 patients. It was the night from hell; very sick patients. I did med-surg for 6 months and have done ICU for the last 6 years. I have never looked back.

Wow!!! What an excellent thread!! So much of what I've just read resonates very strongly with me. I was dx with depression in high school, was put on and off Prozac during first few years of college, then totally hit the bottom junior year and was started on Wellbutrin. While that helped, my grades were still awful (even though I am a smart gal!) and during one appt with the psych doc, he noticed that I simply did not stop fidgeting. He went through a checklist, and put me on Ritalin. I hated it; one pill did squat, but two pills zoned me out big time for a few hours, then wore off completely. There was no "medium" setting to it :) Tried Adderall and Dexadrine, and I could tell they helped on some level, but had too many weird side effects. Finally we tried Cylert, and that stuff has been amazing! By the next semester, I was on the Dean's list until I graduated. I, too, kept forgetting to take my 2nd Wellbutrin and recently switched to XL and it's working out better than I would have ever imagined it could! As for symptoms of ADD/ADHD, I am very fidgety, and if I forget to take the Cylert and go to work, I can pretty much guarantee a miserable day. Usually, I can't wait to go home. I can't concentrate, I can't sit still, I can't quiet my head. The auditory overstimulation is unbearable (for an ICU especially). When I take the Cylert, I can remain focused and I'm not so antsy to flit from one thing to the next. I also have trouble telling my right from my left (always thought that was due to having to chart according to the patient's right/left, so I get confused when it's MY right/left!) and my boredom level is extremely high. My brain constantly has to be working on something, thinking about something, but then again, I can easily spend HOURS playing stupid computer games that are practically mindless, but somehow they're enough to keep the background noise at bay. The auditory overstimulation is the worst, though. Before anti-d's, loud noises would send me into a rage. I remember in HS, I was in band, and before we started practicing, everyone would sort of play their instruments randomly. It would literally hurt. The drums were the worst for some reason. I would get so angry (but never show it of course; that would have been freakish). Now, with all the sirens/intercom announcements/alarms, etc in ICU, I make the perfect nurse... I simply canNOT let an alarm continue on without making it go AWAY. I can't understand for the life of me why someone can just stand at an IV pump while it's beeping and not want to silence it! I often go into rooms where a nurse is already fixing an alarm (but hasn't silenced it) to reach over and hit the "silence" button while he/she is working on it. It's intolerable. Not to the point of job dissatisfaction... more of an annoying quirk. Most nurses silence the alarms now :-)

Well, I have much the same situation. I think the admins are asking for suggestions on a broader scale, like hospital-wide. I work in CCU, never have more than 2 patients, and our charge is almost always free to help out, co-ordinate admissions/transfers, AND we have a "break nurse" from 11a-3p (usually picks up patients at 3) to help out and give breaks. I'm not sure that our particular unit is having problems, but I think it's a problem on med/surg floors. As for teamwork, I simply could not work in a better unit! We help each other out splendidly. Maybe other units are missing the teamwork... hmmm... and I know for a fact that other units give their charge nurses patients to take care of, in addition to staffing, etc. Interesting thought.

ICU and ER at my hospital gets along fairly well, but there is bad blood related to a few things. Awhile back, several nurses offered to cross-train to ER to float there when our census was low. Almost all of those nurses now refuse to go to ER because some nurses there are so rude and unpleasant to work with. They keep trying to give our floats pedi patients, etc... when we don't routinely ever work with kids and aren't familiar with dosages, etc. (for example) ER is chronically understaffed (probably influencing their attitude) and seem very unappreciative when we help them out. Furthermore, they never help us out and you know how that whole one-sided float thing goes. But as for transferring patients... there's rarely any problems at all. We overall have great communication and they certainly pull their weight and get a lot done before sending the patient over.

Ok, so I was kidding about the cheese part. Sorry. I'm looking for input. My hospital is looking for ways to reduce medication errors, specifically errors of omission and "late" meds. We have a computer-entry system that prints out orders for us. Our care plans are all printed out and have the meds highlighted for the shift. Couldn't get much easier, but for some reason, we're still not giving the meds on time. We have a Pyxis. The wait time to get meds doesn't seem excessive. I've been racking my brain here. I'm good at thinking outside the box, but am not having any luck coming up with solutions. I was wondering if anyone out there had some special ways of reducing med errors at their institutions. Thanks!

I am so torn!! No, I am not currently pregnant. I want to do as much research as possible so I can make an informed choice. I am not taking this lightly. It's very important to me that I do the right thing. I will certainly talk to my OB before deciding. I want to stay happy and functional during prenancy, but not at the cost of birth defects or disability caused by my lack of, I dunno, willpower. To stick it out 10 months or so. Before I started the meds, my thoughts and life inside my head was fairly miserable, but I was functional, going to school full-time and holding down 2 part-time jobs. After starting them, my outlook improved dramatically, all didn't seem for naught anymore, and with Cylert, I made Dean's list and my concentration was so much better. While I don't consider Cylert to be essential for a happy existence, it does help noticeably, especially at work. It really "tames" all of the thoughts that go through my head at warp-speed. Regardless, the one that worries me the most is the Wellbutrin. Not taking Cylert will be inconvenient. Not taking Wellbutrin is potentially disasterous. I guess I could go off it and just go back on if it gets really bad. At least I would have tried, and maybe I could even make it through the 1st trimester (I know the most crucial development happens then). Thanks, everyone, for responding.

In addition to doing other research, I thought I'd ask you all if anyone has had a patient who has taken Wellbutrin throughout their pregnancy. I found a Wellbutrin Pregnancy Registry, but the info is hard to interpret. Cylert (for ADD) isn't prescribed very often and so there is next to no information about it. Anyway, I'm figuring you will all tell me that it's a decision that I have to make on my own, and I know this. Maybe I just need to throw all of my questions/concerns out there into cyberspace and see if anyone has any experiences/ideas. My pysch doc wasn't very helpful when I asked him about it. I have not yet asked an OB doc, but I would, of course. But nurses are easier to talk with sometimes. I've been on Wellbutrin/Cylert for 8 years, after trying numerous other meds. These meds changed my life. I have had "drug holidays" since, and always revert right back to the old feelings. I feel that I would not want to continue these meds during pregnancy, though. My ideal plan would be to "abstain" from my meds during pregnancy, and start taking them again after delivery (thereby forgoing bf'ing) if I needed to. Am I fooling myself that I could go this long? Others that I've talked to kind of brush my concerns off, saying that with all the hormone changes during pregnancy, they're just sure I'll be fine. I'm not so sure. On the flip side, if I were to take them for all or part of my pregnancy, and something were to happen (birth defects, etc), I know I'd blame myself for not holding out.... even if I didn't know for sure that meds were the cause. I've been pondering this for months and am not really any closer to a decision. Anyway, thanks for reading.

Our CNA's do typically CNA stuff: finger sticks, foleys, baths, answering lights, helping us turn and clean up patients. However, if you want to someday work in ICU, being an aide would be a great experience. You'll learn how to move patients that are covered in tubes and hooked up to a ventilator, arterial and venous lines, etc. You'll also be exposed to emergencies and be able to watch how to handle them. You can start looking at EKG's. There is some structure and routine, but not what there is in long-term care. You have to be flexible and learn to prioritize (We had one CNA who practically insisted on stocking rooms before he'd help us turn/clean our patients... he didn't last long.) Hope that helped. :-)

Ah, this all sounds very familiar. I work at the same place. Don't forget about the new pumps we just got. I wonder if there is a size limit on the learning curve... :-)

I have to agree somewhat with YogaCRNA. I work in ICU and give Propofol ONLY to intubated patients who are continuously monitored. I don't think it's appropriate for concious sedation. An 85yo 85lb patient can possibly have just as hard of a time clearing Propofol as anything else. I'm all for expanding our expertise, but opening ourselves up to liability is not cool. I do NOT mean to imply that I don't think that appropriately trained RN's shouldn't give Propofol. I've used it for years, but you would not EVER catch me giving it to a patient for concious sedation who was not intubated.

healingtouchRN- Taking the hard assignments and "doing it all" just robs other nurses of getting the experience needed to do the job themselves. Why not go ahead and spend the extra time helping someone out, so that next time, they're able to take the harder assignment themselves (er... or the next time or the next time :-). Unless you have a very high turnover rate, spending time exposing the less experienced staff to complicated patients can help you in the long run.

Not an OB RN here - what is a "fourth degree?"

"vomiting bright red blood, and complaining heartily about how thirsty he was. The GI doc walked into his room only to find him drinking his own bloody vomit. " Okay, I got through the full on body poop story, the ejaculate story, the roach story (being a huge bug-o-phobe, that took some effort), the lady parts contents stories, the phlegm-landing-on-face story, and the earwax story without my esophagus clinching in disgust. I think to myself, "Hey, self... maybe you're actually immune to disgusting stories now!" And then I read this one... This one takes the cake. Bleaaaaah.