lorilou22RN

Where do U work???? LOL

AMEN! I am so burnt out lately! I can't stand the regulations enforced upon nursing. Nursing is becoming intolerable and MORE AND MORE nurses are leaving due to the unrealistic demands placed upon our practice. JCAHO/STATE inspections, regulations for patient safety that do NOTHING but place more work on our overloaded shoulders. Gold standard for patient care is a crock! Fall precautions, restraint issues with side rails down in order to PREVENT FALLS??? COWS at each bedside (half don't work), scanning armbands, and meds in order to prevent med errors....yet the scanners may or may not scan. Bringing foreign nurses over WILL do nothing other than decrease pay for American nurses. DO NOT VOTE FOR THIS BILL! :banghead: American nurses MUST unite and stand together for our careers, and for our patients. Managers are little help for us, so busy trying to kiss state butt. Most of our peers are too busy stabbing each other in the back to even become a united front. In the meantime patients are getting sicker their health concerns increasingly complex and the nurses time is spent maintaining compliance with the myriad of details these "patient safety/accreditation organizations" enforce upon us. Patients are no longer patients...they are clients, customers. Families NOW have huge say in the direction of "client" care regardless of the healthcare teams professional advice. Our hands our tied Nurses due to our inability to work together as a UNIFIED team. Now I am not advocating for unionization, but there has to be someway that we within this forum can make a difference in our chosen profession. If this does not occur soon, you will see more foreign nurses at the bedside, and many of us within the ranks now WILL leave. I for one regrettably want out. This is a painful choice because I do want to be a nurse, and I take pride in my profession, yet my body is hurting, and my mind is exhausted. WAKE UP NURSES....

I have never posted a new topic and am hoping for responses regarding: State Inspections/JCAHO/Managers. I work in St. Louis in one of the larger hospitals. JCAHO is going to be inspecting and the entire managerial staff is grilling us re: Questions Joint may ask? Auditing Charts like mad, POLICIES, pt safety etc etc etc. I AM SICK OF IT! They are having us/secretaries etc police the doctors about signing off verbals/telephone orders, and all the BS that goes along with accreditation. Yesterday our manager was freaking out about who was covering a patient while his primary nurse was taking a patient for testing. Now this man was stable, 24 hours post-extubation, full-code, hemodynamically stable. I work in the ICU and we do not have PCA's, NA's. I really had no idea who was covering, but told her that I would cover him. She continued to question everyone about him because his wife had wanted an update on his condition (she had phoned, the secretary told her to call back because his nurse was off the floor with another patient). We were told that if covering another patient, we HAD to accept phone calls re: that patient. That it was unacceptable to put a family member off. Now it turned out that the nurse covering his care was in an isolation room and unavailable. Apparently that did not matter. In effect the impression we all had was we should have DETAILED info re: ALL patients on the floor not just our own. I was fuming! HOW MUCH ARE WE SUPPOSED TO BE RESPONSIBLE FOR????? The next incident happened with our nurse educator, we had just rec'd a code from the floor, (the 2nd in 10 min), as we were stabizing her, the educator came in the room and asked, "What happened to the O2 tank? Was it secured?" Now lets talk about priorities here, do we stabilize the patient? OR do we make certain that our butts are covered for JCAHO??? Now I must know: What direction is nursing going? Is our job to provide care to patients? Or to drown in RULES/Paperwork? To what extent does family dictate care? And how much verbal abuse do we need to take? Recently I was reprimanded for angering a family member. Now this man advanced upon me, was IN MY SPACE shaking his finger at me, telling me that I had a bad attitude etc. To his credit, I had, HAD A ROTTEN DAY! No break, worked from 645-2030, and yes I was fed up. But I wasn't hateful, nor was I unprofessional, I WAS short with answers, and NO I wasn't overly sympathetic to him (his failure to thrive 89 year old wife, alzheimers, 44 kg, broken hip/broken humerus etc.) I told him she needed to go to a nursing home, and he didn't like that. When he got in my face I told him to step back and to get his finger out of my face, because that was RUDE. Of course when called to the office, guess what....Yep I was wrong. Nursing is becoming impossible to perform. It is the only profession where your break time is not given, where others can be abusive towards you, where you have to lift more than your own weight with little help. Where you constantly are put in positions of defending your CAREER. Patient directed/state mandated. Where rules are in place that set you up for failure. :twocents::banghead:

Did you ever work in healthcare before? I'm not saying you cant do it, but if you havent worked in nursing, well I don't see how you will be able to be competant in a clinical setting. Nursing isn't just about passing Nclex, it is a way of thinking/viewing situations. If you haven't been exposed to it for 8 years well you WILL have a tough time. Curious about why one would give up after all the effort put forward in school? Do you have any idea what nursing is like? Nurses are notorious for being a tough crew to work with. You can't be too soft, you have to be strong enuff to defend your position re: patient status/care etc. If you arent...who will trust your judgement? The Docs look at nurses to relay pt status, you will have to be assertive/firm in your oppinion. Addl there isn't a nurse out there that hasn't had their practise questioned, by docs/managers/peers. Are you truly able to defend yourself, or will you give up again? don't mean to sound harsh, I do wish you luck.

Very sorry. Yes I know what it is like to be fired from a nursing job, and to have people TURN on you. Yes Nursing is cut-throat, it is difficult to do your best for your PATIENTS, when you are constantly pulling the knife out of your back. Good luck.

:yeah::yeah::yeah::yeah::yeah::yeah::yeah::yeah::yeah::yeah:

Sorry if this doesn't sound helpful or understanding, but I agree with the above post. It really sounds like a ridiculous concern. There are so many other things to worry about being a new nurse, and you are worried about how others view your appearance? It just sounds a bit shallow. You really should be more concerned with whether you will be able to assist patients effectively, intervene in emergencies, advocate for your patients needs. Not how you look.

they used to say that because of the side effects associated with high dose Levo. ie: Kidney failure (of course hypotension will cause that too!), necrotic fingers/toes etc. It will completely clamp down the peripheral vasculature in order to raise BP, you can definately sacrifice other body systems with this, or risk amputation of limbs....it all depends on how far the patient/family wants to go in order to "survive"

I too agree that that is a VERY low dose of levo. I think that tho some of the posts are really keying in on the severe sepsis pt. We have run levo obviously wide-open with severe hypotension, while initiating vaso at max dose. This of course is not for long term..just get the patient stabilized. Most patients tho, that have such high doses administered are not going to survive, it doesn't matter what else is initiated. Our usual concentration is 8mg/250cc, but for those that are receiving high doses we will mix 16mg/250. It just depends. We really have no policy that states how high you can go with Levo. It states: "Titrate for pt response/physician parameters."

AHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH do u all hear me screaming at the loudest possible decibel?????? WHAT A JERK!!!!!:angryfire:angryfire:angryfire:angryfire:angryfire:angryfire:angryfire:angryfire:angryfire:angryfire:banghead::banghead::banghead::banghead::argue::argue:

I used to work at a facility that went non-smoking. It was poorly enforced by security, there really is nothing they can do about visitors smoking! They did try to enforce with employees, but have proven unsuccessful. Because of no-smoking policy, they have no ashtrays, and one very hot/dry summer, a lit cigarette did start a fire in the grass/mulch area! My current employer is going non-smoking in November, of course they will try to enforce with employees, yet they too will waste their time. Most workers WILL smoke in their cars. This is not something that the hospital can stop. Most hospitals have signs in their parking garage or lots which state "not responsible for damage to your vehicles while parked on the property". I was told by an attorney/family member that as long as they have that sign, they can not enforce what you do in your vehicle (as long as not illegal). They can threaten, but in the case of potential termination/disciplinary action regarding what you do on your breaks, in your property....well that was violation of civil rights despite the no smoking policy or the unpopularity of smoking at this time. I am a smoker, and no I don't smoke all the time at work, but after I have worked 6 hours non-stop, and I have a bit of downtime to go to the bathroom, get a drink, and run off the floor, believe me my psyche craves that cig break. I will be a raging, .............you know what without 1-2 in a 12-13 hour period! The minute the hospitals get rid of all that fatty, fried, and poor meal choices in the cafeteria, well perhaps I'll take notice a bit more. (hey a smoking smiley...on allnurses heheheheh)

sorry but not alot of help here. I am an ICU RN so no we do not have 15 patients but we have LOTS of now orders, the only thing you can do is do ONE THING AT A TIME. All nursing requires tons of time managements as well as multi-tasking. That is nursing. I personally would HATE having patients walking after me demanding their meds. That is why I like them VENTED and SEDATED! That way there is no demands for items! Good luck

I too have a real issue with too many visitors, this goes double for a semi-private room. I understand the original post and her side of this story. I really don't care about what the other patient had done or what their cultural beliefs are. The fact is that there is another person in that room, it is 1 am, and that is not the time to visit! Yes you do have to speak up and be a patient advocate for your patient, and her/his right to obtain some rest. Next time politely remind them of this, and suggest they stay in a waiting room, this will allow both patients to rest and recover. Unfortunately, if they cop an attitude with you, I have found that if you call your supervisor they will not support your stand, and you'll look like an idiot! That has happened to me, when I let family know that visiting hours were over, and they could NOT stay in a semi-private room. This family really didn't care about the other patient, or that patients right to sleep, right to privacy etc. The supe did nothing to support me, nor my patient. It can be very frustrating, yet it seems that management will do anything to maintain cordial relations with even the most difficult patients/families. Even going so far as violating other patients RIGHTS.

Gotta disagree here! Never keep your mouth open during this type of activity! While turning, cleaning etc. sometimes things get flung around (ever wonder how the poopy/mucus/blood etc. got on the wall, or on you? Well it can fly in your open mouth! I have seen this happen, and you think the smell was bad? How about tasting it? EWWWWWWWWWW! I NEVER keep my mouth open during poop cleanup. I would PUKE if that happened!

It is a Neurogenic issue. I started my career in rehab, and dealt with spinal injuries, we used to have TEDs, AND ace wraps on legs during all activity (especially while the patient was somewhat fresh in getting up). I truly do not remember the pathophys on it, but it is an autonomic dysfunction due to the injury/surgery. It will eventually resolve over time, but the compression to the lower extremities DOES help in returning blood flow to the heart for recirc, thus improving BP during movement.

:nurse:My very first clinical in LTC 14 years ago, I'll never forget it. They partnered us up, and I was with another gal, well we had this chronic demented, CVA patient. Non-verbal, incontinent, tube feedings etc. Well she pooped and the smell was horrific, I was gagging, with tears running down my face during the entire experience. We also had to do pretty extreme oral care, and good god the stench and slime in her mouth was equally as bad as the poop. I seriously thought, "Lori, you made a big mistake". Now looking back I laugh, cause you really do get used to it, it becomes part of the job and not so bad. Hang in there, you will be desensitzed eventually.

Several years ago my daughter was eval'ed in the ER (I worked at this hospital). After several hours (10) she was transfered to a local childrens hospital to be seen for a potential acute belly. Well she was taken to surgery at midnite for an appy. Anyhow, I was a bit peeved that this had taken so long to realize that my facility couldn't treat her (no peds), and it took even longer for them to arrange transfer. It was actually kind of a mess getting her CT scans etc. (and I worked there!!!). I was very upset with how the entire situation had been handled and did write a letter to the DON, as well as the Medical Director regarding her care. I DID print up all her labwork, and her CT results to include in my letter. I did not get in trouble for accessing her information, because I was the contact to allow release of info. What were they going to do? Have me sign a Release of info to release to me? You should be allowed to access your childs labs, xrays etc. without repercussions from HIPPAA.....just my

I suppose to answer your question there is not a true max dose for levo, you do titrate for pt response, as well as add other pressors etc. As far as volume depletion, well that should always be suspected first and fluids should be given before pressor support. As far as CVP monitoring, etc. wellll if you have to give that amount of fluids/colloids, or initiate high dose, or multiple pressor support, a CVP, PA cath etc should be in place.

Ditto (prior 2 posts)!!!

Agree with Mark, we go very high if needed, and this is with other pressors on board too. For the most part tho, it is somewhat futile, and the patient expires despite our intervention.

Nope never did this, and wouldn't ever do this. i don't care what the book says, make certain you stay within facility policy. Lots of times facilities have differing policies for certain items of care, those are the guidelines you need to follow.

As with other posters we will go very high with Levo, I've seen upwards to 200 mcg, with vaso etc. Have to change the bag every 2 hours it was infusing so quickly at double strength (reg strength is 8mg in 250 at my facility). Sorry you were so freaked! sounds like a BADDD nite.

I am confused...was the port already accessed? If so then infusions are the same as with any IV therapy, just remember if not a continuous IV infusion, and there are no contraindications Heparinize the port after infusion is completed. Now if you were recanulating the port, it is a sterile procedure after you remove the current huber needle.

I have a question, Perhaps I didn't absorb it from your post but after 4-5 hours of this, and subsequent acidosis etc, did he even have a myocardium left? What about his cognitive status, was there any anoxic brain injury? Would love an update regarding his current condition, cause it seems to me that God was trying to call him home!

I have a question, Perhaps I didn't absorb it from your post but after 4-5 hours of this, and subsequent acidosis etc, did he even have a myocardium left? What about his cognitive status, was there any anoxic brain injury? Would love an update regarding his current condition, cause it seems to me that God was trying to call him home!