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Grumpy's Girl

Grumpy's Girl

Critical Care
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Grumpy's Girl has 34 years experience and specializes in Critical Care.

Grumpy's Girl's Latest Activity

  1. Grumpy's Girl

    What would cause Hgb to plummet?

    One more tidbit for the truck analogy: Less trucks, though with a full load, must work faster to deliver the goal amount, even faster if they are carrying less load on less trucks. Hence tachycardia. Hence increase RR to fill those less trucks that are running faster with O2. As RRT members we encourage - esp new RNs- to call with questions if their senior nurses can't answer. One of the "triggers" to call RRT is the RN is "worried" about how their pt is doing. I guess "worried" is that developing nurse sixth sense that this patient has the potential to crash whether you can get the MD to feel it or not. The RRT will help you put together the pieces to see what has developed and what is probably coming and how to nip it in the bud or d/w MD. Those are good calls - nipping it in the bud. Each call is a learning experience. We teach and think out loud with the RN (and the family). It has been neat, now, to see that many times, by the time we get to the room, the nurses who called us have already started our routine. Talk about nipping it in the bud. We are a team. We have more pts getting over the crisis and staying in the room. This is just a RRT aside. So keep in touch with your RRT resources. Glad your pt is doing better, hope her mystery is solved soon.
  2. Grumpy's Girl

    How long did you stay at your 1st job?

    I stayed at my first job 6 yrs and was downsized out b/c I was PRN by then (working FT). At this first job I had expressed a real desire and love of ICU in my interview. I struggled thru a rough year on a busy low staffed mostly med, surg floor. Learned a lot. Cried on the way to work on days I new was going to be awful. Then I was surprised to find I was assigned to the ICU class & transfer to critical care! They remembered, I felt I didn't dare ask. There I bloomed. as PRN, it overlapped 2nd job. Loved my 2nd ICU job for 3 short yrs then we moved out of state. Thought I started my dream ICU job, but lasted only 6 mos d/t crazy A/P rotation killed me and scary staffing issues in a highly critical unit (they lost a bunch of treasures over that). Now I have been in this job 24 years !! (as staff and charge) Times get tough but I look at the "Frying pan into the Fire" issue. Take a good look at that green grass, it could be fire. Try to figure a way to be on the improving end. Getting involved in projects gets you out of a rut. Or try a different unit. We have a no switching units for 6mos after a change. We have brought our hospital a long way, going for Magnet.
  3. Grumpy's Girl

    ACLS Experienced Provider Course

    Our nurses enjoy (if you can "enjoy" testing) the Experienced Provider Course better than the ACLS or ACLS recert. Though our recerts are run more like the EP class now. It's geared more for those who have had ACLS at least once and have had experience with codes and critical care. It seems to take ACLS a step further. More understanding whys and application. We enjoy it because there is a lot of group discussion and shared real life experiences. Gives reality to the algorhythms. The doctor leader that has worked with us and the nurses instructing have bent over backwards to make it interesting and a relaxed learning experience so it sinks in. HodgieRN gave good suggestions. You should teach it.
  4. Grumpy's Girl

    Colonoscopy: A patients perspective...

    Say, YES to Propofol ! I had a great colonoscopy nap. You just wake up with gas.
  5. Grumpy's Girl

    I fainted today in the ICU!

    As you can see you are not alone. We all have a war story. LOL. I had a few close calls. There is the fear of leaving your assignment and being accused of golbricking. But sometimes you have too. In nursing school Benzoin always did me in. The stress of holding a screaming 18 mo old, in isolation garb, for a spinal tap by a resident was more than I could handle. (now that would be done with sedation) Tried to be tough, but the room was going black. Switched out and left the room just in time. I was sat down on the floor before I hit it. I was really embarrassed. Though the instructor was supportive, way back then a nurse was supposed to be tough, and heavens never cry with a pt or family. Now we are a bunch of mother hens. I work in ICU and and freq am the one who gets the CNA and RN students. I have had several hit the deck during difficult situations. Oops. I guess that was a little too much experience for one day. The last time I got faint in nursing school was the day the instructor asked the newly wed nurse (me), could I be pregnant? Of course not, I hadn't been married very long! HA! Surprise! That WAS the reason that time! I was just helping a little old guy shave behind a closed curtain. So follow the helpful hints, they do help. You may be the one helping a fellow student/nurse slide gently to the floor.
  6. Grumpy's Girl

    Rapid Response Team and Families

    That's a thought, the operator paging the Service Director (manager) - on Days (might interrupt some meetings) with her Charge Nurse her back up, and Supervisor on PM shifts. There is not a Nursing Supervisor on 7-3. We still haven't put the family call in place. I'm glad so far, though I'm very family supportive, I keep going back and forth about this. I'd love to be able to drop and investigate any call. The concern is mainly because the ICU Charge Nurse/RRT Nurse now has a full pt load. (budget) Granted it should be the lightest load, but that sets you up for transfers out and crash ins. Not to mention, are the other staff able to handle your load too while you're gone for at least an hour at a time. We aren't getting very many calls lately but we can't even attend all the RRT calls now, then add Family calls. As it is we've had to add the ED staff to our RRT staff if we can't go. On days there isn't a nursing supervisor so we have to attend the RRT calls. So, do any of you have a Family Call system P&P to share? One pro-thought for family calls: during night shift, a family member runs to the nurse's sta with an emegency situation and all the nurses are in pt rooms the family member would have a back up plan by calling the operrator with the family emergency code.
  7. Grumpy's Girl

    Rapid Response Team and Families

    Thanks for everyones thoughts. We haven't started this part of the program yet but I think doing it like you are sounds logical. We are a 150 bed hospital, 8 bed ICU and the RRT ICU nurse has a patient assignment also. So having the supervisor check things out initially for a FAMILY call will help - with the pt's RN in tow. One look at the patient as she walks in the room will tell her whether to call the RRT. We would have the heads up and be expecting the call. If she was tied up then it would fall to RRT to go immediately. We and RT and pt's MD are called first by the RNs on the floor and the supervisors next. We need to work on our brochure, signs. Can you share yours? :typing
  8. Grumpy's Girl

    Rapid Response Team and Families

    Our Rapid Response Team (RRT) is about one year old. It has been a success. The nurses on the med surg units have appreciated the assist. Part of the JACHO requirements for the Rapid Response Team is to involve the pt/families, allowing them to call the RRT themselves. Has anyone started this aspect of the team function? I don't want this to be a taddling on their nurse or underminding the pt's nurse. I want it to be part of the pt's orientation to the room/unit. Given positively and part of encouraging the pt's participation in their care. Ex: do your I.S. DB/C and call the RRT if you feel like you are in a crisis and your nurse hasn't been able to help. Talk with your nurse first. We have the Joint Commission "Speak Up" posters everywhere and it would play into that theme. Do you have a family handout? Who receives the call from the pt/family? The team itself? A "screener" like the nursing supervisor - to screen out irritation calls? (no one is answering the call bell fast enough).
  9. Grumpy's Girl

    Consent for albumin?

    Yep, blood product and we have to get consent. And "they" want it on the IV pump with the preprogramed albumin mode, which doesn't really work well. Good grief. We just hang it as usual - free flow.
  10. Grumpy's Girl

    Rapid Response Team and Families

    Our Rapid Response Team (RRT) is about one year old. It has been a success. The nurses on the med surg units have appreciated the assist. Part of the JACHO requirements for the Rapid Response Team is to involve the pt/families, allowing them to call the RRT themselves. Has anyone started this aspect of the team function? I don't want this to be a taddling on their nurse or underminding the pt's nurse. I want it to be part of the pt's orientation to the room/unit. Given positively and part of encouraging the pt's participation in their care. Ex: do your I.S. DB/C and call the RRT if you feel like you are in a crisis and your nurse hasn't been able to help. Talk with your nurse first. We have the Joint Commission "Speak Up" posters everywhere and it would play into that theme. Do you have a family handout? Who receives the call from the pt/family? The team itself? A "screener" like the nursing supervisor - to screen out irritation calls? (no one is answering the call bell fast enough).