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Sounds the the M. Jackson thearpy of Dipravan as a sleeping aide. Since Ketamine is an analog of LSD I would wait for awhile to judge this. The dreams and halucinations may increase the depression and lack of control.

I have been an RN for several decades, and have been up and down the pecking order of positions in large metropolitan hospitals. I have always had my heart in ICU. Currently I am working in a small rural hospital as staff ICU. Our hospital, and 3 others (plus a pharmacy to cover after hours orders) have just linked electronically with a computer system (MediTech). Now all four hospitals can exchange medical and financial information to make transferring between institutions smoother. I am very uncomfortable with the set up; not the day to day use. Though it's not nurse friendly I can work with it. (No choice) I have several concerns: (1.) Accuracy, narrative is not encouraged (2.) time delays inherent in the system though in a court of law I'm sure all entities would cover themselves. Culpability of an off campus, 3rd party pharmacy hasn't been explained. They are a stand in pharmacy for 48 hospitals. The next step in the modernization is that the MD's will have access to clinical test results and be able to put in orders from any computer anywhere. For the first time in my career I have purchased professional liability insurance (AACN -$114 with 2 million / 4 Million in coverage). Am I just paranoid or is computer charting a positive. I know that if I were an "ambulance chasing medical lawyer" I would look hard at hospitals using computers. We have already been told that capturing charges is more difficult in a computer system. An aside questions: Do MD malpractice insurance rates increase with a computer system

I just renewed my California license. On the back of the form was a box to be checked "if you have completed 30 CEU's". WELL, DUH YA. I checked the box and mailed the money. Just like that I r a Nurz agin. Previously when we renewed we would have to document date, class, provider number and number of units awarded. Actually, in the past not only did the curriculum have to be approved by the board but also the physical setting had to be up to standards, including the number of doors and desks. Now all I have to do is check a box? And its gets better. I also have an Idaho license, and that state doesn't require any CEU's. Idaho is a Compact State, which means I can practice in six other states without any transfer of a license. They also must have no CEU requirement. Now I know that NTI will disseminate a large volume of good information. Conventions such as these keep nurses, and MD's, updated with the latest theory, practices, and procedures. And that those CEU's will definitively be for continuing education. Recently I received a booklet from my professional organization. It was written on cheap newspaper quality paper. The contents were the text of several courses, along with the answers to the posttest for so that I could evaluate my answers. There was that little box again 'check if you read the course'. All that was left was to mail the money. The CEU market has become very diluted. I, and probably you, receive information frequently about 30 unit classes for $29 - $59. The worst part of the situation is that these texts are written at a Jr. High to High School level, and accepted as professional education by the Board of Nursing.

Also during the Viet Nam era, I worked with a guy that was a USN/USMC Corpsman. He came out, challenged California RN boards, and got his license, all without ever going to school. He was also a member of M.E.N.S.A.

I have just completed a home study course for 30 ceu's. The subject was Substance Abuse. Even with multiple decades in Adult ICU several factors have intervened and I am now working in a drug rehab center for L.A. County. (No, I didn't use.) The first statement was interesting,"It is likely you will become a co-dependent if you work in the health care field". In a later section, the explanation followed. The healthcare worker takes on the role of co-dependent at work because the patient is in a dependent situation, and subject to your control of their world. In the ICU theater the nurse is definitely in control, but I have never thought of myself as co-dependent! One of the ways to save one's self is to be able to walk out and leave work there. I may bask for a while with the nice feeling that I did a good job but that doesn't last long. At home our life is give and take and my wife is definitely NOT "barefoot, pregnant, and in the kitchen". Are you, or do you work with people, who are co-dependent?

As someone else said, Arterial line position is toward the heart. The catheter does not occlude the vessel, it merely rests in it. The arterial set up has a pressure bag, which should be at 300 mm pressure, is used to force the solution (either 0.9 Saline or Heparinized saline) through the catheter, which in addition to stopping it from clotting off also helps to keep the catheter straight. One thing to learn is that there are no stupid questions, especially in nursing. One of the things I like about ICU is because nurses frequently ask questions of each other. They know what the consequences are if there is an error. BEWARE OF THE NURSE WHO KNOWS EVERYTHING!!!

A while back we had a married couple of Jehovah Witnesses. They wanted to have their first child the “old fashion way”, and they did work for it! They decided to deliver in their home with a mid-wife present. There were complication and the mother started to bleed. We received her in the ICU still bleeding. Over several hours of saline and volume expanders, she continued to deteriorate. Her husband was with her most of the time. It was like watching a textbook death as her HGB dropped below 4. First came the arrhythmias, and then the chest pain because of poor perfusion. Her pressure continued to drop and the SOB increased. The cyanosis crept through her body. She became decreasingly coherent. With each new worsening her husband would go to the phone and call his leader in the church and then come back and tell her the same thing, It is in God’s hands, and they continued the refusal of blood products and intubation. (I firmly believe that since she was the one dying that she would have accepted the blood, but with her husband continuously there she would not.) The situation continued downhill. We had not seen our MD for and hour or so, he came back in and requested a transfer to a local burn center. The couple came back about six months later (without infant) to say “Thank You”. What had happened was the burn center had a new hyperbaric chamber. They had used the pressure/oxygen to super-saturate the HGB with oxygen. Shad had stayed in that hospital 3 months.

If you have been a health care provider for 4 years is it possible you are already burned out? (A combination of school, working and life) Nursing scenarios and EMT scenarios are different. In addition to the emergencies nurses deal a lot with just activities of daily living. The relationship of nurse to patient can be over an extended period. If, as advertised, the response time for an EMT is 5 - 10 minutes then you patient involvement may not be more than an hour at a time. ER Sound the most reasonable, especially as a radio nurse. No knowledge is a waste! Since you were a paramedic for 4 years and soon you will be a nurse with 4 years field experience, why not consider teaching paramedics?

Happened once to a friend of mine starting an IV, in ICU. She did the logical thing; hooked it up to a pressure line and explained to the MD that he didn't need to start an A-line. No problem.

I am in the "September "of my career. (Well maybe mid-August.) When I began, it was a "given" that teaching hospitals were the forefront of modern medicine. At least in this area that doesn't seem to be the case. USC & UCLA are linked at the hip with the Los Angeles County Hospitals. This is probably a simplified view, but it seems that the cost of health care equipment and service has risen so dramatically that the only way to support county hospitals is to raise taxes, and probably substantially. The L.A. County Board of supervisors can't/won't do that. Consequently, what we are left with is partial service teaching hospitals. UCLA/Olive View does have a cardiac cath lab. But they are unable to perform any heart surgeries. The hospital is not even in the trauma network, there is no Neuro-Surgery service. Recently, King/Drew, with its 530 beds, was shut down by JCAHO... for incompetence at all levels. Some one died in their waiting room after being triaged for treatment Harbor/UCLA is now being looked at. A patient died in their parking lot. He could not stay for the 16 hours, which is the average wait in their ER. High Desert Hospital was one of the smaller hospitals, in northern L.A. County. It was closed because it would have been too expensive to retrofit the building to bring it up to current building codes. Initially licensed for 170 beds it served not only the county clients but also prisoners from adjacent Ca State Prison. A clinic building does not require the same physical stability as a hospital so the main building is now a few clinical services and the primary clinics Adult Urgent Care, Peds are now in temporary buildings that are 10 - 20 - 30 years old. Now we have learned, in order to save money, that at least eleven clinics spread throughout LA County may be closed and their services either contracted out or shunted to the reaming county hospitals. I realize that this may be just in this area, and that some of the Ivy League schools or the better-known schools must have their endowment programs to keep them at the top of the field. Are City/County/Federal hospitals across the country in the same situation?

My brother just bulit a chopper from an original Triumph twin & frame. Looks great. I'll stick to my GolWing, that way I can bring the beer & pizza. Farts & Stories are extra added attractions

We have a girl in our primary care clinic that has just passed boards for RN. She has been a clinic LVN for several years, starting out as a CNA from So. America. We are in a county system so that the county does not have a slot for her at the clinic where she is currently. She will be transferred to a teaching facility into their Neo-Natal ICU. (Her other option was ER.) The director's logic was that she won't have to unlearn anything Is this safe or even sane?

I like to use he same technique that CardioTrans uses except that all tubes and drains are mentioned at the end with the I&O. Don't even think about not doing at least one bed bath, but do it before the end of the shift so that you can organize your assessment of the systems for report The world of ICU is the most enjoyable place in the hospital to work. Both responsibility and rewards are very high Since you are new to the field, you might look at some of the posts about "nurses eating their young". :angryfire

I have worked in both union and non-union hospitals. I have found that on a day-to-day basis that non-union hospitals are easier to function in. Example given: If you have a bed that needs to be cleaned for an emergency admission, you don't have to wait around for someone to come who has that particular task in their job description. I am aware of one hospital in the area (I'm sure that the pattern is duplicated.) where the staff felt unjustly subjugated by administration. They contacted appropriate Union which did come in. If you had listened to their spiel you would believe that the union could solve all of their problems. One thing that the Union rep said that was never quite explained is that "This is your union." Well, the signatures were obtained, the staff vote happened and the Union was voted in. Eighteen months after the election nothing had changed, and the union reps were very scarce. You see the union now belonged to the employees. The only thing that changed was now on each of the RNs pay stub was the charge for Union dues. The staff returned to its prior feelings of apathy, such that there was not enough enthusiasm to vote the union out. One thing that the Union will never tell you is that a Union, regardless how strong...or weak... cannot dictate how a business is run.