cab631

I was an ICU nurse for 15 years and have moved on to a happier playground, but in my old wise years I have decided that, although it is frustrating for us to watch and participate in, there are so many reasons we know nothing about which results in families' behavior and refusal to let go. We must provide dignity to both patient and family as best we can, know when to ask for another assignment, and EDUCATE EDUCATE EDUCATE the public at home, in our neighborhoods, in our churches about living wills, healtcare surrogate designees and the reality of death. My brother was 19 when he "died", but he was pronounced 9 1/2 years later. He never thought of death or comas or anything like that. But I guaran-damn tee you now, that everyone I come in contact with, including my own children understand that life is fragile and that things happen which can cause it to end early. And we speak openly in our family about what we want and don't want, and have signed the necessary papers. We must be very vocal about these issues to everyone, and when you can't stand the heat, then move on to another kitchen, knowing that you've done your best to make changes for the one that follow you.

I agree with most everything said here. It seems that the men who come into the nursing profession gravitate towards the more technical areas such as critical care, cardiac cath, OR, ER. Nursing shifts are long, even on an 8 hour shift, it is usually 9-10 hours before you leave, by the time you finish with report and paperwork. I find that other cultures I have worked around (Vietnamese, Native Americans, East Europeans) all look at nurses differently, but a common thread seems to be that a nurse is there to perform certain duties and not interact with the patient on a personal level the way we tend to do in the American culture. In the American culture we like to touch, caress a child perhaps or hold a hand. I like to give back rubs and to tend a patient's more "personal" needs when they are too ill to do it themselves and are uncomfortable having family do it for them. It makes me feel needed on a level that even family can't attain. I would be interested in knowing how different this is from nursing in Japan.

We are in the process of beefing up our PICC abilities hospital-wide. Right now there are a few nurses, hospital certified, who are placing the PICCs at the bedside, confirmed by STAT port CXR with a wet read. If we cannot get it in after two tries, then the patient is sent to radiology and the radiologist/nurse team place it under fluoro. One of our biggest problems right now is educating physicians on appropriately ordering PICCs. If a nurse calls him on a Friday afternoon with the fact that a patient is a "difficult stick"and they havn't been able to give Abtx or draw blood, to avoid being called over the weekend, the MD will order a PICC line. Never mind that it may not really be necessary if a a good IV nurse could get the line in to begin with. We have to IV team here. Any suggestions here?

We have one doc using 3 rooms 5 days a week. Those are essentially "his" rooms. A couple of days of week, one or two other docs share the other 2 rooms. They're good for anywhere from 3-10 additional cases on the days they are there.

We have one doc using 3 rooms 5 days a week. Those are essentially "his" rooms. A couple of days of week, one or two other docs share the other 2 rooms. They're good for anywhere from 3-10 additional cases on the days they are there.

I currently staff my unit with enough nurses to take 5-7 patients per day. We use all RNs. They are responsible for prepping and admission paperwork, the return and post procedure paper work, and discharge of the patient. We have approx. 14 beds dedicated to 20-30 patients. The turnover time is approx. one and a half hours of patient care on our part, and 45 minutes in the procedure and endo recovery area. Our physician spends approx 11 minutes with each patient inclusive of pre and post procedure discussion. The procedure itself takes approx. 2-3 minutes. The patient spends approx 15 minutes in the procedure room and 15-30 minutes in the endo recovery area before returning to the pre/post area. I'm interested in knowing how this works in other institutions. We are part of the Outpatient Department of a 200 bed hospital.

I currently work for an HCA hospital in middle management. I think the bonuses you speak of depend on the location and need of the particular area. We have sign on bonuses here, but they fluctuate, and I don't know of any retention bonuses. It must be regional.

I am in the process of rewriting the pediatric policies for our hospital. In the past, children under 12 required the use of a buretrol and a pump, but the new policy will require a pump always, and buretrol only if the amount of fluid in the IV bag is more than 250cc. You have to consider the outcome if a peds pt. were to get the whole bag of fluid dumped into him, thus the buretrol/small volume bag. Also, as far as weight, the Broselow tape is the standard, as I understand, and any pediatric pt. who exceeds the measure of a Broselow tape, is tx with weight based fluids/meds/tx. Max wt. for peds on the Broselow system is 68 LBs. (34 Kg.) If you have info that differs from this, let's discuss it.

I find floor nursing much more frustrating than ICU nursing. In ICU, yes you have to know EVERYTHING that's going on with your patient. You have to know a lot about a lot of things. You have to be able to confer with the MD on a knowlegeble level. But I find it easier than floor nursing because I want to do too much for patients on the floor and I make myself crazy! You can't possible properly look after 8 patients every day and know everything you're supposed to know, and follow up on everything you're supposed to follow up on, teach, listen and pee when you need to. Argghhhhhhhhhhhhhhhhhhhhhhhhhhhhh! Give me a good old ICU anytime!

At my hospital we have received portable fold up carry-around chairs, great umbrellas, duffle bag totes, lunch bags to name a few. Plus the administration serves the nurses breakfast twice during the week, at our stations, and we have a reception with cake and awards, free pizzas delivered to our nurse's stations, plus drawings for things like Mary Kay, movie tickets, free CEUs, free attendance at seminars of interest. They really treat us pretty well that way. Of course, we still have short staffing, no lunch breaks at times, etc... But overall, they treat us pretty well. I think it has EVERYTHING to do with the nurses who are administrators.

When I was in BFE with that patient, helicopter ambulance wasn't flying due to altitude and weather, ground ambulance wasn't an option either for the same reason. The patient survived BTW, and I had an exciting night. Learned a lot when I realized it was just me and not a lot of technology.

The depth of the slobber puddle was usually and indicator as to how long it would take to wake up.......I did a little throat clearing or chair-leg stumbling sometimes. It's the ones with their head on a book that usually woke up and said they weren't asleep! If they were students....I tended to be a little sympathetic, but if student or not....if it was a repeat offender, they had to go home...even if I paid for their cab!

I know.......the crappy NAs all moved to PA from FLA! Unfortunately, not enough of them have left! I went from staff nurse to night supv. and I LOVED to catch people sleeping! First I would scare the hell out of them by standing there watching them sleep until they sensed me and woke up. Then I would tell them to go home and write them up EVERY time. And believe me...I got writer's cramp. But the situation improved, slowly....VERY slowly. You've got to document, document, document. And when the rest of the crew c/o that now they have to work short because so and so got sent home, I would just tell them that they are responsible too, because they knew "so and so" had disappeared from the floor and never bothered to look for her/him. The directors usually fired the sleepers after being sent home. People quit sleeping while I was on duty.

I have BEEN in BFE with this kind of patient. Four/five nurses in the whole hospital, and me...a traveler! Talk about nursing by the seat of your pants! I would monitor quality of resps, ABGs if possible, o2 sats, heart rate and quality of rhythm and watch for changes. No patches for the first night. I'd probably hold on the anti-anxiety med till I felt comfortable with his reaction to the PCA. Look for changes in skin color, monitor I&O, frequent abd. assessment/neuro checks, then thank the LORD that he is your only patient in a 4 bed ICU!