NurseRatched67

Used as a 15 minute premedication IVPB in chemo patients. I have never seen it as continuous.....

Make sure you document what you saw and what you did (report it to the RN). You did exactly the right thing, just make sure you cover you butt by documenting the blood on the sheets and that you brought it to the nurses attention.

I think most RN's on here will tell you that the pumps beep TOO MUCH! To clarify your situation...yes the pump will be if you are trying to infuse a piggyback without the clamp on that line open. Let's say you have a mainline (line A) of .9NS infusing and you are going to hang another medication as a piggyback (line B). You can program an infusion pump to run a few different ways. One way is to run both lines (A&B) concurrently, another is to program (B) to run, while (A) is on a delay. When you do it this way, then once your piggyback infuses, your mainline (A) will restart on it's own. The third way is to run line (B) only. If you want to infuse line (B), then you have to make sure the clamp is open on your piggyback or else the machine will beep. It will beep if you run line (B) alone and let the line run dry, and the pump "cassette" backs up with air. The machine will not necessarily stop and beep if there is a large amount of air already past the cassette (i.e. you didn't prime line well enough). The pump will also beep if the line is occluded...that is if it is pinched off or there is air backed up in the cassette. If your pump beeps, then stop all lines...check your settings and restart. Take your time on pumps... I see too many new nurses rushing through pump settings and making simple errors in programming. Breathe and slow down. Don't always trust the pump to do ALL the work for you...make sure your lines are primed, right tubing is used, clamps are properly open or closed and the pump is not malfunctioning before you start your infusion.

Here's a little trick I learned. I have a little solid tin of a perfume called "Karma" by a company called LUSH. I keep it in my pocket and if I have to clean some one up..I take a litte and rub it under my nose (then wash my hands of course!). It smells really nice and clean and takes away at least one factor in the poop-phobia! After a few years you will embrace the poop and learn to do things like melt a bag of hersey's kisses on a bedsheet to help initiate the new RN's and CNA's. LOL!

Hi, I live on the north side of Chicago, just north of the Lakeview area. The two area's you mention are different in their proximity to the downtown area. Lincoln Park will be closer to downtown then Lakeview. Both areas are nice and have good transportation north and to downtown. Northwestern is downtown and would be easy to get too from either area you are interested in. Rush and UIC are a bit more challenging and would take you way more time to get to on public transportation. Both of those hospitals are not exactly in the greatest of neighborhoods as well. You have a few more options then those three hospitals...if you are looking for major hospitals then you have Illinois Masonic and St. Joseph's close by, Evanston Hospital and St. Francis just north and community hospitals like Swedish Covenant, Thorek and Mercy close by as well. If you are an ER nurse who loves the adreneline rush, you also have Cook County and Mt. Sinai hospitals south of the city. (Both of those see alot of action!) All the hospitals here have pretty standard and decent benefits, but the salary ranges are big. UIC's nurses are unionized, with better pay, but they are going through some rough times right now with staffing ratio's. Salaries are varied throughout the city and depending on your years of experience. Big question is "will you have a car?". Northwestern is better off being accessed by train, as you will have to pay to park in a remote lot with a shuttle. Most folks working at NW take public transportation. If you have a car, you can also consider a few more close in suburban hospitals that you may find better different pay levels and shifts. As for Critical Care - Mt. Sinai, Cook County, NW, Illinois Masonic and Evanston are all Level 1 trauma ER's. I'm not really sure about the others in terms of levels. You will probably find more critical care positions at these types of hospitals. If you are a childrens nurse, then Children's Memorial Hospital is in Lincoln Park and is world reknown. Hope this helps...let me know if you need anything else!

I work in outpatient Oncology. We change dressings on PICC lines and draw labs using nothing smaller then a 10cc syringe. We flush with NS 5-6ml, then drawback and waste 5ml-6ml, then switch syringe and draw labs. We put vacutainer device on draw syringe, not on PICC port directly. You want to limit pressure on vital, small lines. We put new extensions on for our patients (because they go home and flush their own lines daily!), flush with NS and heparin. The only time we would not draw from a certain lumen of a PICC is if it is being used for TPN. Our patients usually come in with double lumen Hickman lines so we only draw off the lumen not being used for TPN. Again, that is in an outpatient setting. What is done as an inpatient may be different.

Not going to happen...unless they want the largest population of nurses in the field currently (45 years of age and up with ADN's) to all leave nursing? The ANA has pushed this agenda for years, claiming that a BSN will give more credibility to the nursing industry. I know that obtaining Magnet status in Illinois hospitals does not mean that LPN's get the axe. I will agree that sometimes it means that an LPN get's converted in his/her duties to more of an advanced CNA type. It really depends on the hopsital and their staffing needs. There is no way they will mandate a BSN by 2010, 2/3 of their RN's would leave the field.

I agree with the poster above that you need to look at this as a learning experience. I would write down in a journal everything that transpired that day....from your overload of patients, to the lack of CNA assistance to the doctors response. Find a co-worker who you trust or a manager in the same light. Ask for some time with them and go over one to one what happened. Examine what was happening and in what order and if anything could have been changed. Don't be scared of feeling "blamed"...we've all been there and felt that no matter how great the care was we provided, it still wasn't good enough. Have someone to work with to answer you questions. Some times when we are busy, we fail to realize that the floor and other staff members might just be as busy as we are. Don't feel that asking for help in examining that day is an indication that you did anything wrong. We all that hindsight is 20/20, but it's good to purge this from your brain and see if there are some ways that you didn't think about at the time to help you in the future. Talk it out with your manager...you'll feel better.

I'm sorry...the appropriate response from the nurse you asked should have been more along the lines of... "That level is not usually compatible with life"..followed by..."Let's go look at his labs" and see what's going on. Or..."maybe it's an error (seeing as your patient was still alive and fine!!), why don't you look up his labs and make sure that it's not just human error. You don't chide or critize someone who is asking for your help or opinion. You help them. In the end..only kindness matters.

We need to have a more open, constructive dialogue on how this problem can be solved as a whole. RN's that say new grads are cocky? That's a double standard really. We want new grads to come in confident and rarr'in to go if you know what I mean. Most of the time what appears to be "cockiness" is just a defense mechanism that new grads have to help them keep their confidence level up. Established RN's have to step back and look at their experience as a new nurse. I'm sure we have all felt horrible at times, either as the bully or the picked on kid. What's the real problem here? Do we have two groups of RN's that won't admit that they are intimidated by each other? LOL. New grads...what you learn in school is only 1/100th of what you will learn as a nurse on the job. I know that the excitiment and pride of becoming an RN makes you feel like you are going to burst sometimes. You must learn to find a balance between the book world of a student and the chaotic world of a practicing RN. I think we need solutions. Ideas from both sides on how we can make this better. What do we all want? Not just a "be nicer" attitude. We all know there are misconceptions behind all of our attitudes on this subject. What are the real day to day, operational problems for why this is occuring? One suggestion I had for my manager was that all orientees meet with their preceptors and managers for lunch before they even hit the floor. I think watching the interaction of both parties prior to training will provide valuable information on if this is a good fit for both. Should'nt the goal be that BOTH parties have a good experience? That will only help retention of staff and the ability to put this horrible "eat their young" phrase in it's grave once and for all. I would love to hear ideas from both sides on some ways we can make this better...without blame or name calling.:redbeathe I say that we get an idea thread together. I would love to see the information complied be sent to somewhere like nursing spectrum or to the ANA for publishing. Maybe, just maybe...if we work together...we can start making a change...

This may help clear things up for you.. Oncology is oncology. The differentiating factors are if you are looking at "sub specialties" in oncology. For instance...if a patient is diagnosed with an abdominal "mass", then they may be referred to a "surgical oncologist", who may perform surgery and if adjuvant therapy is needed after surgery either follow that patient themselves OR refer them to a "medical oncologist". A medical oncologist is usually a doctor who specializes in treating patients with regimens of chemotherapy. There are many specialites within the medical oncology field. i.e. Heme, Neuro, Breast, GI, Gyne etc. There are also Radiation Oncologists who strictly deal with patients needing radiation, either before, after or in conjuction with surgery and/or chemo. Think of a medical oncologist like you would a specialist, one who you would see in their office for your visits. They would follow your care and order tests, labs and regimens of treatment. Most cancer patients see their doctors at least once a month if not more. Then the next confusing part is where all of this physically takes place. Radiation therapy is done in the Nuclear Medcine or Radiation departments at hospitals and even some outpatient centers. Patients can sometimes have radiation while being an impatient (one who is admitted to a hospital unit/floor) or can sometimes have radiation on an outpatient (they go home after treatment) basis. This is the same for chemotherapy. Some patients will be required to be hospitalized for some treatments depending on their disease and regimen of drugs. Chemotherapy is also given on an "outpatient" basis at cancer care centers all over the USA. These centers are usually affiliated with the hospital that the patients doctor is affliated with, but not always. So in a nutshell...Oncology is oncology, but within the "oncology" tree there are many branches of sub specialities. If you are an RN, you can work on a hospital "floor" which is an inpatient unit. You would typically be caring for oncology patients who need to stay a certain length for whatever reason. They may be there because they are reacting to medications, they are in pain, they are having cancer related problems (ie. bowel obstructions requiring surgery), or they are dying. The inpatient floors may even get patients who have had a reaction during outpatient chemo infusions. Outpatient chemo infusions are done at a center where a patient comes in and is hooked up to their medications for the necessary amount of time and then they go home after. Blood & platelet transfusions, hydration, electrolyte riders and bone marrow transplants or biopsies are also sometimes done on an outpatient basis depending on the situation and patient. It would be good for you to ask which RN's here work inpatient or outpatient. That could probably give you a better idea of what is happening in their world!

Have you ever considered Botox injections for excessive sweating? I know they do them under the arms, and for palm sweating as well.

The "westside" of the city is actually quite rough. However, if you are really talking "western" suburbs of Chicago, that is totally different. Apartments in the city itself, can range from 1000 a month or more on the Northside to 2000+ in the downtown area. (you have to pay for your view of Lake Michigan sometimes!) The Northside has many neighborhoods that are safe, moderately priced for housing (rentals) and close to transportation and hospitals. For example a one bedroom apartment in Lincoln park in a "3 flat type of situation" may cost you 1500+ vs. a multi unit apartment building in that same area for 1000.00 a month. Further north you have areas like Wrigleyville, Lincoln Square, Wicker Park, Andersonville etc. Areas get a little less expensive the futher north in the city you go. You also have the North Shore suburb of Evanston, were Northwestern University's main campus is located as well as two hospitals, Evanston and St. Francis. Evanston has very "divided" neighborhoods. Some are cheap, but a bit rough and others can be as pricey as the best parts of Chicago or even more. There are alot more single family homes in Evanston, but the average price there is about $325,000 (median price range). It really depends on what your lifestyle is like as well. Are you looking for a house vs. renting? Will you have a car? How long would you like your commute to work be? Do you prefer to commute by car or public transportation? Do you think you want to work in a major hospital vs. community hospital, VA hosptial or public aid clinic? For instance, the southside has some major hospitals and lots of opportunity for work. There is public transporation, but certain areas of the southside would probably require you to have a car to get around for your travel besides work related commute. The southside is a bit more "spread out". My suggestion would be making sure you are close to public transportation if you move to the southside. Also make sure you know the "neighborhood". The southside has a reputation of being "racially divided" in most areas. I can say this with confidence as I grew up on the southside. While it's improved in the diversity of neighborhoods somewhat, there are still very divided lines and neighborhoods. There are also a lot of "up and comming" areas in CHicago. My friends bought a place in the "Ukranian Village" area about 4 years ago and it's booming there now. I've lived on the southside, northside and in the south suburbs. There is so much to choose from, it just really depends on what type of lifestyle you are looking for here.

Two doctors and an HMO manager died and lined up at the pearly gates for admission to heaven. St. Peter asked them to identify themselves. One doctor stepped forward and said, "I was a pediatric spine surgeon and helped kids overcome their deformities." St. Peter said, "You can enter." The second doctor said, "I was a psychiatrist. I helped people rehabilitate themselves." St. Peter also invited him in.The third applicant stepped forward and said, "I was an HMO manager. I helped people get cost-effective health care." St. Peter said, "You can come in, too." But as the HMO manager walked by, St. Peter added, "You can stay three days. After that, you can go to Hell."

I think actually asking them to clarify, in front of the whole staff and nursing students, exactly what they meant by their conversation (since you are obviously a student and would need clarification.:icon_roll) would have been an interesting approach as well. I would also praise them for offering to do the jobs of the RN's on the floor, and that you would be happy to let the charge nurse know that they will take care of a few patients. That way the RN's could go to lunch. Thank them alot for their gracious offer to help, and tell them you are impressed as a student to find doctors willing to go out of their way to help nurses get "prioritized". :rotfl::rotfl::rotfl::rotfl: