zamboni

I've looked back and often asked myself this very question (damn middle age!). I've come to the conclusion that, while I could have made many better choices and not had to deal with so many issues of my own doing, I really dig the person I am now. I may not have become that person, had I not dealt with so many bad times. Sure, I might have had a big house or a nice retirement set aside by now...but that is certainly not a guarantee of being truly happy, which I am now (and totally cool! ) One thing my younger self did tell me, through all the dark times, was "You'll be fine. You deserve better and will get it". I was right. :) I do have one regret though. The day I allowed that damn orthodontist to do a plaster mold of my mouth for braces when I was in 7th grade. I started choking, and he and his staff held me down, forcing my mouth to stay closed (until I punched one square in the face to get free). I never got the braces, obviously. And to this day I'm still terrified of dentists and as a result, have terrible teeth. I don't regret not sucking it up, because what he did was wrong. I don't blame my parents, because it was what they could afford. But I guess I wish I had made myself go find someone else when I got older, and gotten things fixed.

I worked with a wonderful ER doc (who isn't THAT old), and sometimes when she would get tired, she would inadvertently write our nitro orders in grains. Always threw someone for a loop...you could almost guess what it was when you would hear a "*****" coming from the Pyxis room. We had free rein to take it back to her and give her heck about it.

A trick I learned a while back to use as an alternative to the sternal rub, when assessing response to pain....take your pen and place it on top of the pt's fingernail (nail bed), then squeeze down hard. Try it on yourself....hurts, doesn't it? :) I was taught this by a paramedic and he had several rationales. First of all, explaining big bruises on a person's chest sucks. Secondly, I've had plenty of pt's that could stay "unresponsive" during a sternal rub (I guess they were veterans of that particular move). Last, doing a rub puts you in a vulnerable position if the pt decides to react violently, where as squeezing a fingernail can be done with you standing almost out of reach. Besides, family members tend to freak if they see you "punching" their beloved in the chest...squeezing the nailbed can be done with them standing next to you and never seeing it. :) I've done lots of sternal rubs, and was a big fan. Now, I'm more of the covert "fingernail rub" kinda gal. It hasn't failed me yet.

I have just discovered what is my new favorite-of-all-time show..."24". We're watching the back seasons on DVD while keeping up with the current (and sadly, last) season. I am so happy to report that in an older episode, Jack Bauer finds an unconscious person (trying not to spoil here), and performs a picture perfect assessment, followed by proper CPR (proper by AHA standards in the early 2000s). When he's trying to keep someone alive that's been shot or stabbed, he uses direct pressure and pressure points (while screaming at them to give up what they know!). It was hysterical, because when he did the CPR, my boyfriend (who always cringes, waiting on my critique) looked over at me...I simply smiled and nodded. They "worked a code" in a clinic that was fairly spot on, although they gave up kinda quickly (in their defense, if I was working that code on someone with that much trauma, I would have bailed out too). I even predicted the intra-cardiac Epi dose before they did it...and given the situation, it's probably exactly what I would have done in real life (should I ever find myself in that ridiculous a situation...). It makes me happy that a show that uses any reality as a loose definition would go to the trouble to do simple little things like that right. And even though Jack survives being shot, stabbed, tortured, electrocuted, beaten, crashes, radiation exposure and bio-weapon exposure...I believe that would probably happen in real life too. Him doing proper CPR was probably the hottest thing I've ever seen on TV. :redbeathe:D

An A+. Last book I read was "Lance Armstrong-It's Not About the Bike: My Journey Back to Life". Fascinating book that I highly recommend to anyone!

In medicine...CT or MRI tech. No muss, no fuss. Get 'em in and out. Outside of medicine...run either a small hotel or a bar in Playa del Carmen, Mexico, or any where along the Mayan Riviera...maybe Tulum or Punta Allen. Live in Pamuul in my palapa, and spend my time living with and meeting interesting and fun people. Help out at the pet shelter in Playa. Maybe learn to weave bracelets and sell them to tourists on the beach for kicks. Guess which one I've put more thought into.

I'm curious as to why no scrubs? I mean, you've already got the job, and the job entails wearing scrubs. I wouldn't wear prints or anything like that...when I get hired I always ask what colour scrubs and go buy some. Maybe it's different in a smaller facility, but in larger places, I'm pretty sure the CEO isn't going to remember me, no matter what I'm wearing. Plus every time afterwards any of those orientation people see me, I will be wearing them. If I have to sit through 8 hours of folks droning on about fire exits and late policies, I'm going to be comfy (but in my professional uniform). Maybe it's just me. Heck, the last two jobs I got, I wore scrubs to the interview (after working 12 hours), and got the jobs.

I was wondering if any one had any knowledge of American nurses working in Mexico, even for short stints (like volunteer work). I know Mexico has some employment laws about foreigners doing their jobs and such, and I wonder what their staffing is. I've never even seen agencies placing nurses in Mexico, although I see ads for other places out of the country. Just asking if anybody has any knowledge of whether or not they ever use American nurses, and what may be involved.

This ^^^^^ is the perfect answer.

We're colour coded by job. RNs- royal blue, techs-tan, resp- green, etc...it is the same for all the floors (although it may be different for OR...I hardly ever see them.) I don't think it helps the patients, but I agree with other posters that it helps me. Heck, I ID myself to the pts as an RN, and some of them still don't get it. But in a large hospital where it takes a while to learn people's faces, I like knowing who is doing what. We buy our own, and I'm very ok with that. I buy scrubs that fit me, without being to short or falling off, and in that new soft material that feels so good (Grey's Anatomy scrubs). I don't mind, because I don't know anybody else who has a job where they're supplied clothes for work. Just seems like a weird concept to me. (Besides, what other profession that makes in the range that nurses do gets away with wearing a $20-$40 outfit to work? Even a pair of Dockers and a decent polo shirt is gonna run around $75-$100). And yeah, we wash our own. Been doing my own laundry my entire adult life, can't imagine letting anyone else do it.

As someone earlier pointed out, the job of a nurse is often to speak up and advocate for the patient...even sometimes putting one's butt on the line for that patient's best interest. It's not like a retail job, where you have to put up with unreasonable customers because "the customer is always right". It's possible (since none of us were there) that they were attempting to lessen their patient's pain and suffering. You don't just shut up and accept that when it's your patient, just to pacify a family member's discomfort with grief. Sure, it can be handled in different ways, some good/some bad. But in an emergent situation, you advocate for your patient. Period. One thing that I can't get out of my head. You say the patient's Living Will wasn't found until after her surgery. Since your brother was her caregiver for so long, surely he knew where the document was kept. It's quite sad that it took that long for the document to be found. I'm sorry also that you have been involved in this situation, and that your brother is grieving for his friend. But I am glad that she is no longer suffering. And make no mistake, she was suffering her last days.

Are there any hospitals that are testing for and refusing to hire persons that drink alcohol during their off time? I don't mean coming to work impaired, obviously. But if it's all about making an employee live a healthy lifestyle for our own good, shouldn't drinking be right there next to it?

This is pure genius! I'm so going to use this next time. Might want to swab off the top of the container a bit...but I love this idea.

Nurses are human beings with emotions, not robots. Emotions are funny things in that we aren't always in control of where they lead our minds. Everyone has "that point" emotionally, and to ignore it or expect that it must NEVER happen is dangerous and neglectful to our coworkers and peers. Hell, the Ft Hood shooter was a caregiver. His peers expected him to be able to "provide care and not let it get to him" (and many other thoughts being tossed around in this thread). That didn't work out so well, did it? I work emergency, with an adult and pedi population. I would be alert if a pedi code came in, and the nurse whose room it was being worked had a child the same age. I wouldn't demand they not treat the patient, but I'm watching them to see if they're coping ok. I once worked with a woman who had lost her mother to a drunk driver, and it was her first week back. A drunk driver was brought in, and no one expected the nurse to care for him that soon after her tragedy...we swapped patients. She soon recovered emotionally and was able to provide care for these frequent patients, but we still provided her with a little TLC when she did. The community around Ft Hood is so closely tied to the base and it's military culture. My heart just ached for the staff that had to care for this patient. Yeah...you provide care, not judgement. But for the staff, if they didn't have someone they cared about on base that day, they were likely close to someone who did. To expect that emotions were forbidden to play a role is wrong. Would you assign the shooter to a nurse who's husband was on the base that day? I suspect that is one reason he was transferred to Brooks....military staff there are familiar with the distinct emotions that go along with "caring for the enemy" (similar to corrections nurses). Even so, the staff (civi and military) that provides care to him has demons to deal with that most of us are, thankfully, unfamiliar with. To ignore those emotions and expect staff to treat a patient such as this one without any aftermath is sad and dangerous. We all have our "breaking point". I have never had a patient that I couldn't care for because of my own personal baggage. But I have always been acutely aware of where my point may be lurking during that particular epoch in my life, and I would hope that should I be forced to face that demon one night, my coworkers would help me...and not simply say, "You are a nurse, get over it and provide care and don't let your feelings play a part."

At one place I worked, I counted what I considered X5 documentation for a med.. 1) scanning in Emar 2) nurses notes (written) 3) signing off on the ER orders 4) signing off on the CP pathway sheet 5) signing off on the admit orders (as "first dose given in ER") All for a dang aspirin....gah! Ironically, it took as long to scan it as it did to write it in the four other places. Total madness.

I work ER, and I started cutting them off of DC'd patients after a good friend and mentor pointed out that it was a security risk to let them leave with them. Her rationale was that it was much easier for a person to come back to the hospital, even days later, and wander around without being questioned if they had an armband. With our high homeless population that made perfect sense to me. So now I snip them off in the room after they sign DC papers before I walk them out. I also don't have the attention span or motivation to track down the HIPAA box, so I drop the band in the sharps container in the room.

I can sorta see what you're saying. But one of my buddies was recently readmitted for a post-op infection and was in for 6 days. He wasn't critical or unresponsive. A usually very active guy (one of my geocaching friends). What is a patient supposed to do for 6 days, waiting for the ABX to do their thing?

One facility around here has said that you're not required to get a flu show HOWEVER if you decline, you will be required to wear a mask during your entire shift from now until March. Bah. So, if these facilities are so worried about protecting patients from us, why are they not swabbing all the nurses, docs, rad techs, phlebs, etc... for MRSA? Is it because some studies claim that 1 in 2 healthcare providers have colonized MRSA in their nares? I mean, that's testing for an active presence, not a vaccine that may or may not work against the current flu bug, so you would think it would be a higher priority. Of course, with 1 in 2 having to stay home for a few days on ABX, that would cost gobs of money...can't have that now, can we?

Heh...not me. I can have a patient with decent veins lock-and-labbed in the time it takes me to just get the port supplies all pulled together. Port supplies are scattered in two different supply rooms (don't ask!). PIV trays are right there. I do many PIVs a shift, where as I do maybe 2-3 ports a month. I can do PIVs in my sleep vs having to stop and roll through the port procedure in my head before I start.

I'm ED, and I'll explain why I don't always access the port. The ED is a filthy place. The nurses are filthy. This is just because of the number of patients that role through a shift. Even when we clean, in my mind it's still gross. We don't have housekeeping come in every time we turn over a room, we do it in a few minutes typically. Yeah, I do have high standards for keeping my rooms clean, but it's still a five minute-wipe down the mattress/counters/call light-and throw a clean sheet down-kinda clean. The trash may have trash from previous patients, as does the linen cart in the room. I've had contact with 30 or so patients straight in from the world, carrying God only knows what...hand washing can only do so much. Now, accessing a port is a sterile procedure. An infected port is a nightmare for a patient (and most patients with ports are compromised anyway). Yes, we do maintain sterile technique when we access, but the environment itself is less than optimal. If I can throw in a quick PIV without causing stress to the patient, I'll leave the port for the nurses upstairs in their clean rooms that access several ports on a daily basis (I access ports maybe 2-3 times a month). I won't torture a patient with multi sticks, and I'm not scared of accessing a port (I actually kinda enjoy the procedure). But I prefer not to fool with it if I have any other quick, easy options, and the patient is ok with it. I'll explain my rationale when I give report, and every floor nurse I've handed off to appreciates it.

LOL! When I was reading the OP, I had to go back and look to see if I had started this thread and forgot (even though I didn't know about AN when I NCLEX'd)! When I NCLEX'd, I went in feeling pretty good. I'd never failed a test in my life, did my Sandersons, felt comfy with the vague way the reviews did questions, and really felt that I knew my material inside and out. I sat down, and the first question was something about rickets! I had a serious "***" moment! In peds, we had studied over all the pedi cancers, heart conditions, congenital issues, growth and development, etc....I mean, I guess I knew there are cases of rickets out there today, and it may have been mentioned in a sentence in a textbook somewhere along the way...but as far as I knew, it was a disease that pirates got. I almost just quit right then and walked out to go get a job at Starbucks and forget the whole nursing thing. But then I decided that I had just seen all three Pirates of the Caribbean movies, and that Jack Sparrow wouldn't let me down (yes, this thought did go through my mind...sue me, I was at a loss!). I took a guess, and moved to the next question... ...and the whole test went downhill from there. Diseases and meds I had never heard of, questions with four right answers, questions with no right answers, yadda, yadda, yadda. I like someone's description of "entering the cornfield", it was very Stephen King-esque. 75 questions later, I leave in tears, grab an app at Starbucks on the way home (yes, for real!), and contemplated my next move. Two days later, I was an RN. ( Even though I didn't know the difference between rickets and scurvy! LOL!) You'll be fine, it's done. Go find something fun and mindless to do (maybe a Pirates of the Caribbean marathon?), and laugh about the bizzaro experience with peeps that love you. Know that pretty much every single person who has danced this dance before you had the same experience, and the odds are greatly in your favour. Here's sending you hugs, best wishes, smiles...and lots of sunlight so your bones don't get all soft and bendy. (Don't forget to let us know how you did!)

...of smelly, nasty UTI pee on the (expensive) shoes of the next person who brings up my ED's "census" when planning staffing! :angryfire We don't have a census, or grid, or count or any other fancy management words for our patient loads. A very wise friend once stood up to supervisor and told her, "Our census is the entire city that is outside our doors!" Sorry...just had to rant for a second. That is all.

Yeah, we just started too. And I have to say it was highly entertaining to watch a nurse try to scan meds during a code a few weeks ago. Or when RT refused to start an updraft on a crumping patient because his Albuterol wouldn't scan. Personally, I'm a huge fan of the amount of work required when we pull meds for a critical that rolls in without ID, then we have to save the bottles of Etomidate and Sux (and all the other goodies that go along with it), and then go back and reconfigure the name in the Pyxxis once we get an ID, and then finally scan meds. Oh, and if we pull a med and don't scan it within 30 minutes, it gets bumped out of the computer MAR since it's not "scheduled". Awesome. Of course, we still have to chart it on the paper chart too, since the docs aren't being forced to the computers but we are....weeeeeeee...double charting! :icon_roll Yeah, not a fan of our system....I'm trying, I really am. I would much prefer we go to all computers. But our system has so many bugs and flaws...

I use one of those clip thingys that goes on your waistband, and the scope hangs in. I thought it would catch on everything, but my old Littman Classic II (that they don't make anymore) has the short tubing, and it's never hung up. Might want to consider trying one out...it's something like $6. And yeah, Littman will do a total refurb for about $70 bucks. New tubing, rings, diaphragm, took the head apart and cleaned and lubed it. I was very pleased. I also have zero problem telling someone, "No" when they want to borrow it. Unless I really like you, and even then, I'll stop what I'm doing and follow you to wherever you use it and stand next to you, staring at you till you hand it back (always with a smile). Yeah, it's kinda rude...but I've had the same scope for years now, so I win.

We have a prep protocol for allergic pts that need contrast...even for "urgent" but not "now" situations. It involves multi doses of Benadryl and SoluMedrol over a period of (I think) 8 hours. For the life of me, I can't remember the doses or time increments right now...but the theory is to really knock down the inflammatory response in over time, in phases. God, I'm so brain dead right now. I had to do it just a few weeks ago for a patient...I really should remember it. But I do know that it worked very well for a highly allergic patient, and he had zero reaction to the contrast. Maybe I'll have more synapses firing here in a few when I wake up...