rmprn

Hi everyone, I'm hoping you can help me. I am an adult MICU nurse so my problem is foreign to my knowledge base. I need some pediatric neuro advice! This weekend my healthy 9 year old was diagnosed with Generalized Epileptic Disorder. She had what I believed to be either a seizure or a vagal fainting episode at home. They did a CT and ECG in the ER, both negative. But an EEG showed spike/waves (2) during hyperventilation (AND, she was hyperventilating at home before the episode happened also). So the pedi neurologist wants to put her on Topomax! We are also having an MRI in 2 weeks. I am feeling overwhelmed and wondering if it is the standard of care to put a child on meds with only one seizure. I am also wondering if she has been having absence seizures all along and we didn't notice (but being the astute control freak mom/nurse that I am cannot accept the fact that I wouldn't have noticed something)! Could the EEG be wrong? IT was done in the ER and even though they shut the door, still not the ideal environment in my opinion. I know nothing about EEGs and what they mean. I would hope that an MD would make sure the EEG was of good quality before making a diagnosis, but you never know. I have thought about asking for a repeat EEG, but what I am reading says that another one might be entirely negative, which would further complicate the situation. UPDATE--just got off the phone with my pedi neuro and when I expressed my concerns, she offered a repeat EEG. Makes me feel better! BUT I STILL WANT YOUR OPINIONS! I hate the grey area of neurology! Thanks a bunch Rachel

I don't know about you guys, but I live in the real world where I am a working mom as well as a nurse. I don't have time to sit around reading all the research there is on all the drugs I give!! I DO have a life you know!! If the doctor orders the drug and the pharmacy stocks it and it is part of the hospital formulary (our pharmacy checks all orders for route/dosage to make sure it is ordered correctly), then that is good enough for me. And despite what you say, StevieRae, the fact that you HAVE given a particular drug LOTS OF TIMES with NO PROBLEMS IS ABSOLUTELY RELEVANT!!! It is evidence that this problem with phenergan is rare given the fact that there are plenty of us who have never heard of it and plenty of us who have given it IV "all the time" and not had our patient's limbs amputated. An all the drug books say it's ok to give IV! If I have never given a particular drug I will look it up and/or call my pharmacist about it with questions. I use my resources. We are all in patient care together, the doctor, nurse, pharmacist, hospital administration. You cannot hold a nurse solely responsible for knowing all the latest research on all the drugs out there. Nor can you hold us at fault because we haven't bought a copy of the INS book and memorized it cover to cover. I am a patient advocate and of course I strive to take the best care of the patients I serve. But there is only so much I am responsible for! Do I agree with the use of Demerol? No, I hate it, but if it's ordered by a physician and we still have it as part of our formulary and the pt is not allergic then guess what, they get Demerol (doesnt' happen very often anymore, but you get my drift). Would I suggest an alternative? Depends on the physician. I'm going to spend some time with my husband since I worked a 12 today, while some of you are reading every nursing journal you can get your hands on because you feel you are held liable for knowing all the info contained in them. :chuckle

Tom, you are crackin' me up!!! We also give phenergan IV where I work, and I agree with everything you have said. There are risks associated with every drug, no matter how it's administered. And OUR Phenergan vials say "for IV OR DEEP IM USE" so the drug company can go down with me along with the doctor and the hospital!!

Deathnurse, you are evil. What goes around comes around, just remember that. One day you might not be PREGNANT (because I bet you hate kids) but you may very likely hurt your back and need help turning YOUR patients. OR maybe one of your 400 lb patients will fall on you and squish you, and none of your fellow nurses will come to your aid because they will all be pregnant :chuckle I see no harm in cutting the prego nurses some slack when it comes to isolation (if it can be helped), because I would appreciate the same consideration if I were the prego one. We should try to take care of each other. COMPASSION, Deathnurse. Geez, maybe you neeed to retire.

Krissy, GET OUT OF THERE!! Tuiton reimbursement won't be worth anything if you are dead!! It's not safe for you there and you know it. A good CNA is hard to find and you will get another job pronto.

I am doing something I didn't ever think I would do. I am quitting my job without giving any notice at all. I was planning on giving the standard 2 weeks, but my supervisor has been giving me such a hard time for the past month---I work pool, and had to get another job because I wasn't getting enough hours at this hospital, plus I get floated out of my unit more than I would like. Anyway since I have gained employment elsewhere, I obviously don't work as much at the one hospital anymore. And my sup. has made my life miserable ever since. I have not worked in my unit for over a month, she floats me out of turn whenever I am scheduled. And she has messed up my schedule, putting me down to work days that I didn't sign up for. So today while I was working at my "new" job, they were calling me at home as a no show for my other job!! I feel just awful for the staff who had to work short handed (but then I wonder if I was supposed to work in my unit at all since I am perpetually floated,) I have decided not to go back to work there. If my sup really has it in for me this badly, I am worried about her looking for things to write me up for, report to the board of nursing, etc. IT seems that she has been trying to make me quit, so I guess she will win. And besides I am just miserable there. But still I feel bad about just walking out. Only for the staff, not for her. I have never been the kind of person who leaves a job without notice.

If you expect to go into a specialty right out of school (ie: critical care, L&D, OR, ER, etc.) then you can expect ANY hospital to require a time commitment from you--anywhere from one to two years. The fact is, it does cost the hospitals a lot of money and TIME to train you in that area, and it's only fair to expect you to stick around for a while. Besides that, it will take you AT LEAST ONE YEAR before you feel competent working independently. Not so long ago, a new grad RN had NO CHOICE but to go to med-surg for a year before even thinking about specializing. New grads today are lucky to have so many opportunities. I went right into critical care out of school and thank my stars for it everyday-----------and I had no problem working for the hospital for the required time committment. I am grateful for the opportunity and EDUCATION that was given to me by them. To get back on the subject, I currently work for ORHS and love it. Once you work there you can work anywhere. You will see things at a Level One Trauma Center and teaching facility that you won't see anywhere else,and that experience alone goes a long way on your resume. I have never worked for the FL Hospitals so I can't tell you about the differences. But I can tell you that I am excited to go to work everyday, and even though my other job pays more money, the one at ORHS is my favorite.

I used to work for a hospital that achieved "Magnet Status." To be honest, I think it's a bunch of crap. The application for Magnet Status is HUGE, there are lots of meetings and hoops to jump through, paperwork to be filled out. That must be how you get it, because the reality I worked in was not consistent with "magnet" guidelines. I can tell you that in working there for 2 years, I had 3 patients in ICU/CCU about 75% of the time. At times I would be tripled and one of my patients really should have been a 1:1 (they almost NEVER allowed pts to be 1:1 because they didn't have the staff for it). Our charge nurses always had an assignment, in additon to being responsible for staffing both units for the next shift. No aides and lots of times no secretary/monitor tech either. The ratio on tele there is 7-8pts on days and 10 on nights. Way too many!! So for me, hearing a facility has "magnet status" does not impress me. If anyone else has different experience, I would love to hear it. :)

OK, I am totally impressed with him, not just for what he has to say about the nursing shortage and the healthcare sysytem, but for his stance on ALL the issues! I have to tell you that I always vote, but I am never what one would consider an activist. Never impressed my political opinons on others. NEVER campaigned or even wanted to. But I just typed a long email with a link to the Dean for America website and sent it to everyone in my address book! I signed on as a Dean supporter, ordered bumper stickers and plan to attend whatever rallies in my area that I can to get this man elected. He has a proven track record (Vermont), and I love that along with his views on the issues, he lists the actual plans he has for carrying out his intentions. When have we EVER seen that before??????? DEAN IS THE MAN!!!!!!!!!!!!

Now you have made me want a better quality camera! Your photos are great, thanks for sharing!

My creative outlet is my Scrapbooking! Turning my family photo albums into works of art. I bet there are a lot of other "cropping nurses" out there. It gives you such a sense of accomlishment, and you know you are leaving a legacy for your family. I also like to write, and have always been interested in journalism. I was very impressed with your articles. I would love to be a magazine columnist, or one of those "investigative reporters" doing expose's. I would also love to write funny editorials like the ones from 60 minutes (John Stocil---or is he on 20/20? Anyway he's a hoot!). But, alas, I am stuck charting nurses notes instead! Although documentation in our line of work could be considered an art form unto itself-----"tenacious, thick, creamy yellow secretions"----oh how we love our adjectives!!

I need some advice here and maybe some reassurance from my fellow RNs. I spoke to a reporter who was asking my opinion about proposed legislation in our state that would make it "harder to sue doctors for FOLLOWING the living will of a patient." I said that I would support such legislation because I have seen many cases where a patient's living will is NOT FOLLOWED because the family pressures the doctors to "do everything." So the reporter wrote an article and quoted me, butchered my words and such to make it look like I said that I see advanced directives (living wills) being ignored on a regular basis (which I do, but still, the quote sounds very harsh). The article did not state my place of employment, but it did state my name and the city where I live, and my specialy (ICU). Despite the fact that I don't like the context in which my words were used, the statements I made were true. I read many of your posts in the "Witholding of treatment in Elderly patients" thread where you expressed your heartbreak at seeing living wills ignored because the family cannot let go. We all know it happens every day. I for one think something should be done about it, and we should follow a patients wishes ESPECIALLY when they do everything "right" by having it "in writing" as they are told to do. But I am scared that my employers may read the article and I may get in trouble. My last name is common and I can deny that it was me at all, but I don't know if they will believe me. IF they even read the article. Or I could say I was misquoted (which Iwas). didn't name names or say anything specific. Still, I am having second thoughts about talking to this reporter. Too late though! It's done. Have any of you ever talked to the press and been reprimanded? CAN you be reprimanded? I mean, we do live in America. That doesn't mean I'm safe though. Just wondering if any of you have ever been quoted on TV or in the paper and faced any consequences. Should I change my name and start job hunting? Please guys, try not to scare me too much!

I live in the South, where children are taught to address their elders my Mr. or Ms. "first name." They also use ma'am and sir. I was not raised here, so this took some time for me to get used to (the first name part). Still, I am not offended by it and I think it is respectful. There are quite a few youngsters who call me by just my first name, but you have to look at the parents, they raised them to think it's okay to do that. When I am at work I use Mr. or Mrs. "last name" unless asked to do otherwise by the patient. I agree that in cases where the patient is confused, they usually respond more readily to their first names.

At least you get a buck an hour! In my M/S ICU, we all take turns being charge for free (there is no charge nurse on nights right now, hasn't been for at least 6 months)! AND, if there is no charge nurse for either CCU or ICU, we have to do staffing for BOTH units. Plus take a patient assignment.