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Nepenthe Sea

Nepenthe Sea

PICU/Pedi
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Taking the scenic route to pedi - started out in SICU/MICU, went to adult Med-Surg...now working in PICU/Pediatrics.

Nepenthe Sea's Latest Activity

  1. Nepenthe Sea

    Inane scripting

    My hospital a couple of years ago directed us to start saying "My pleasure" as "No problem" or even "You're welcome" were considered rude or not pleasant enough. I guess everybody must have blown this off completely because they haven't said anything about it since. Hello, I don't work for Chick-Fil-A! More recently, at the grocery store in which I shop they had the cashiers and baggers asking us things like "So, do you have any plans for this evening?" or "Is today your day off?" I think that customer service has gone WAY overboard when they sound like they're hitting on you. One time they asked me if I had plans for the night and I told them "Well, my kids are in bed now, so I guess I can start drinking." You could almost hear crickets chirping as they just stared at me. lol
  2. Nepenthe Sea

    Now THAT'S a lab result

    Oh yeah, and recently had a newborn come to our unit in severe CHF, and pulmonary hypertension (I can't remember what heart condition she had - we are a small regional unit and ship cardiac kids off). Her BNP was over 5,000. Don't remember what the cardiac enzyme numbers were, but greatly elevated.
  3. Nepenthe Sea

    Now THAT'S a lab result

    In adults, I saw an ammonia of 300+. The guy had a bad liver and the doctors had been trying to get him on a transplant list forever, and he and his family kept declining. He finally agreed to it, and of course, he was supposed to be transported the next morning to a hospital to begin the process. He had a decline in mentation sometime in the night, so we checked his labs and gave lactulose, and that's when we got the ammonia level. He went off to ICU and after that, I don't know what happened. Also saw a hgb of 4 in a woman who insisted on walking herself to the bathroom even though she felt dizzy. I thought that hgb was low until... ...I went to work in PICU, where I take care of chemo kids. I have seen a 2.9 and most recently, 2.7 hgb. 2.7 was a new diagnosis, the 2.9 was an established ALL. Also saw a new diagnosis AML that had a crazy WBC. I don't remember what the number was, but his blood was almost pink and had a white layer in it. We kept a tube of it in a bio baggie for a bit so all the nurses could see it. He had to have leukapheresis for several days to get it down to a more manageable number. Had a patient in our unit with sodium of 101. She is a young chronic adult who came to us after her sodium dropped while on an adult floor. Also, not a lab, but something of interest. Had a toddler breathing over 100 breaths per minute. I don't remember what his underlying chronic condition was, but his nurse counted it, and asked me to count it. We counted for a full minute, had the charge nurse and RT come in and verify the same. When we called the intensivist, she said it wasn't possible to breathe that fast. Well, I am here to tell you that it is!
  4. Nepenthe Sea

    Fired During Orientation

    I know it has been almost a year since you wrote this post. How are things for you now? I hope things are better for you. I have to say, your story could have been MY story, almost exactly. I went to nursing school with the intent of becoming a NICU or PICU nurse. I never really wanted to work with adults. I ended up getting a job as a tech in SICU because there were no NICU or PICU techs at the time. Although I didn't want to work with adults I LOVED working in SICU, and was always told what a great job I did. When I graduated there I wasn't able to get a job in the areas I wanted to I chose to stay in SICU. My supervisor and many of the nurses I worked with were excited and thought I was going to be awesome. Well, first off, I ended up with a preceptor that everybody warned me was not a "good" one. Seriously, I had at least seven people make comments to me, saying "I hope that works out for you", etc. I was so new that I wasn't able to see that she was doing anything wrong. Looking back now, I don't think she WAS doing anything. They just said her orientees came off not knowing how to do anything. This made me nervous, and I needed a schedule change, so I requested another preceptor. Before I sound like I am blaming my receptors, I need to say that it was a VERY high acuity unit to begin with, and then that summer we had a higher acuity level than usual. The patients they started to give me were train wrecks. The charge nurses were like "We normally don't give this kind of patient to a new person, but this is the best we can do". There were patients there that started out as 1:2, that turned into 1:1, and even 3:1 sometimes, trying to stabilize them. There's so much to learn about in that environment - all the numbers you have to memorize, all the equipment you have to learn how to use, all the things about nursing that they don't teach you. There honestly was just too much going on for me to learn. I made some mistakes, and then my preceptor became just awful. I know she had to watch out for me, but when you treat me like I'm stupid, that doesn't help me - it only makes me more stupid. There was less and less support. They would give me patients that had stuff going on that I didn't know how to deal with, but wouldn't tell me how to deal with it. They were just like, "Figure it out!" I was having nightmares all the time. Just about the time I started thinking that ICU wasn't for me, they let me go. They gave me the same spiel: It doesn't mean you're not a good nurse, this just isn't the place for you right now, etc. I had enough money saved up that I went two months without a job trying to get on where I wanted, and trying to figure out if I even wanted to be a nurse after all. I ended up applying for a med-surg job and got it. In fact, my ICU supervisor apparently put in a good word for me. So I did that and hated it for almost two years, but stuck it out so that I could at least build some skills and learn some prioritization and time management skills. I finally left that hospital last year for a PICU job. I'm doing a lot better, but I still sometimes have "flashbacks" to the ICU job, especially when dealing with the same equipment. Since I left that ICU, I have found out that they had a huge meeting with all of those nurses on that unit because they were so awful to the new people and to the nurses in the other ICU units that floated there. A bunch of people ended up leaving because they were told they were going to have to start acting decent or leave. I also found out that my second preceptor was KNOWN for being terrible to the new nurses (and she had only been one for two years herself). I sometimes think they were doing me a favor by letting me go. I had been told that maybe half of the new staff on that unit ever made it off orientation, so there had to be something to it. The place was just too much for me as a new grad. I still feel awful about it, and it was three years ago. I also hated how people there that had been my friends became very cold and aloof after I left. Oh well, I'm in a better place now!
  5. Nepenthe Sea

    Parents required at bedside?

    I think we are trying so hard to be "family friendly" that we try to accommodate people as well as we can. There is only room in our ICU rooms for one fold-out bed, so if both parents are staying, one will stay in the recliner. It does get pretty crowded, but again, our acuity is not as high, so we don't have the tons of equipment that some of you guys do in the room.
  6. Nepenthe Sea

    Parents required at bedside?

    Yes. We sometimes have a unit full of vents/very sick kids, and sometimes we have one sick kid and some floor overflow. Our acuity is not as high as the other hospital here. We also tend to keep our ICU patients there until discharge, unless we need their bed, and then we put them on the floor. We are usually 1:2 or 1:3, so yeah, a little different from your unit.
  7. Nepenthe Sea

    Are there any nurses happy to be a nurse?

    That was an easy trap to get into. The reason I didn't leave the area I was in sooner was because I liked the people I worked with and knew the doctors and what they wanted, for the most part. I was just comfortable enough to be afraid to make the jump somewhere else. Glad I did, finally.
  8. Nepenthe Sea

    Parents required at bedside?

    I understand what you are saying. That is just the policy here. I can see how it makes it hard for the families. I was just wondering if that is the norm. What do you do with the younger kids who have a hard time staying in a room by themselves? We don't have any kind of help at night, in terms of a tech or even a HUC. If you have five or six patients like we do in the busy season, what do you do (I'm talking floor patients, in this case - I get floated to the floor on a fairly regular basis)? No snark intended on this end, either. I am just imagining what we would do when all the nurses are in the treatment rooms, trying to draw a.m./admission labs, and there's not even anyone available to answer the phone or the door, and a kid is alone and trying to get out of bed with an IV.
  9. Nepenthe Sea

    Parents required at bedside?

    I am a relatively new nurse in PICU/pedi (almost one year). We have a 5-bed PICU, and bed pediatric floor. I admitted a 4-year-old to our PICU last week, and mom said something about "I'm going to leave after I get her settled but I will be back in the morning". I informed her that we require an adult to stay with the patients at all times, even in PICU. We occasionally make an exception if the patient is ventilated/sedated, but don't really encourage it. We VERY occasionally will allow a parent to leave if they really can't miss work, if the kid is a certain age and is fairly stable, especially if it is day shift and we have a tech or the Child Life Specialist can help out. This mom freaked out because she knew she was going to have trouble finding someone to watch her two older children, and dad is traveling for work. She got everything worked out in the end, but it made me wonder what the policy is elsewhere. I find that most parents WANT to stay, and sometimes both parents stay, even though it's not necessary. I hear that the other nearby hospital does not make parents stay. I'm not sure how that works out.
  10. Nepenthe Sea

    Nightshifts..how to prepare for them?

    I love nights and plan to never work days. I don't live on a night schedule at home, though, because it would be too hard with my young children. So I keep a regular schedule like most people when I am off, then the night before I go back to work, I stay up a little later (until around 1-3). Then I go to sleep. If I have my kids and have to feed them or take them to school, then I get up to do that (but don't drink coffee or get fully dressed or anything), and then go back to bed until 12 or 1. I usually get a good amount of sleep, and wake up, drink my coffee, and take my time getting ready for work. I pretty much have to be up by 2:45 at the latest on any given work day because I pick my kids up from school at 3, so you could adjust your schedule accordingly. I always feel pretty good that first night, at least. If you don't have to get up for kids or anything, then it would be even better. I don't generally get tired at night but if I do, I go in the bathroom and do some jumping jacks or squats to get the blood pumping again.
  11. Nepenthe Sea

    Are there any nurses happy to be a nurse?

    I think it just depends on where you work and what you expect from your career. Anybody who goes into nursing thinking that they are going to make a lot of money is delusional. The money is decent, but you earn every penny, that's for sure. The area in which you work makes a huge difference. You may be in your dream area of nursing, but if there is no support and you can't trust your co-workers, then it will suck. Personally, I wanted to work with kids all along. It didn't work out for me that way, so I started out in adult ICU - hated life, wanted to go wait tables. Then I went to med-surg - hated life even more, wanted to do anything BUT nursing. I decided to stick it out until I could get my foot in the door of a pedi/NICU area. Finally got into PICU last year. There are nights that aren't that great but the difference between this nursing job and the others is like night and day. It makes SUCH a difference when you are in the area you want. Now I love being a nurse, and I love all the education and things that go with it.
  12. Nepenthe Sea

    Kids Say the Darndest Things...

    I know this is an old thread, but I had to add something funny I aw from one of our patients. She drew a picture of a horse for the nurses (currently on display at our nurses station), and after signing her name, she added in parenthesis "The appendix victim". So funny!
  13. Nepenthe Sea

    Advice for a new peds nurse?

    I agree with all the previous posters. I will say, however, that some of my teenagers remind me of the adults I used to take care of, in regard to not wanting to ambulate, not wanting to go use the bathroom, or eat, drink, whatever. I have especially see this in my post-spinal fusion patients. Sometimes we really have to get after them. A lot of the parents are good about encouraging (or making) them do things, but sometimes they are useless, so we have to be the "bad guys". I still love it, though. You can definitely tell when the kids are feeling better - they are climbing the walls!
  14. Nepenthe Sea

    Advice, tips, knowledge..

    The previous posters are correct in that you will be spending a lot of time with these kids. Obviously, with the infants and very young kids, you will be dealing more with the parents (which can be a whole other issue in itself), but you will be educating the older kids. Sometimes they listen and are compliant, and other times you wonder if they even WANT to ever go home again because they will not do anything they need to do (ambulate, eat, increase their fluid intake, etc.). The parents will often help by "making" their kids do what they need to do, but sometimes they are just as bad as the kids. Sometimes, we get kids with behavioral issues that are all over the place, taking off their oxygen, climbing the furniture, etc (with the parents sitting right there, watching). Sometimes the patients will hit, kick, bite, etc. It can be frustrating at times. I can say, though, after working with adults for two years that many kids are more well-behaved than the grown-ups. You may not consider yourself a patient person, but this may improve with time. I learned a great deal about patience while in nursing school (those old people take their time with EVERYTHING!). I loooooove pediatrics, and don't plan on ever doing anything else.
  15. Nepenthe Sea

    New Grad trying to get into PICU

    I went to school with the goal of working in NICU or PICU, but there were few jobs available, so I worked with adults, mostly in Med-Surg. I did that for almost two years before I decided to move on with my original plan, and applied for a job in PICU at a different hospital. The director that interviewed me (and hired me) told me that she PREFERS nurses with ADULT med-surg experience. All this is just to say that if it doesn't work out for you to start out in PICU (hopefully it will), the just get some experience SOMEWHERE. It will help you in the long run.
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