Nightcrawler

If you still have proof of the positive titres in your files and can produce copies, they may not necessarily draw blood. In the past they have foregone the blood draws when I have been able to provide proof of positive immunity. If you are not able to provide proof of immunity, make sure that you sign whatever forms that you need to to get copies of the blood work for your files so that you don't necessarily need to have to go through the blood work with every new employer.

Positive cardiac enzymes have not been considered critical lab values at either of the hospitals that I have worked at, regardless of how high they rise. I have seen some truly amazing results with no peep from the lab and results that routinely take an hour or more to come back

Best tattoo that I ever saw on a patient was pre- lung transplant. She had a dotted line tattooed for the incision line for her transplant. Very cool individual. Hope that she is doing well.

One item to remember..... when you take the test to prove that you have become an expert in your field, you will be held legally liable for your practice at the expert level as indicated by the CCRN designation. This is something that does not bother me, as I hold certification in my specialty, but it is something to be aware of when you go to take that test.

Ahh, and that is what I am afraid of. I have always been the biggest nightshift cheerleader imaginable, and have turned down dayshift positions numerous times. On the other hand, if there is even the slightest chance that the shift is causing the headaches, then I am outa there

I keep waiting for all of the people to tell me I am crazy to consider it. Didn't anyone read my post? Even I didn't think that I made the move sound very fun! I know that I have probably made the decision, but I can't believe that I am actually going to do it. I have always been the one to try to talk people out of wanting to go to days. I didn't even ask when the move was to happen. I am assuming that it would be with the next schedule, which starts the week after next....no time to back out I guess. I want to thank all of you for your encouragement. I feel as if I am crawling out of my small dark hole into the blinding light...... I wonder what I should change my username to?

I have been having these headaches for years and always thought that they were tension headaches. Of late they have been much worse, more one sided and associated with some facial numbness. Much more indicative of migraine. Also, no meds work.

Nope, 12 hour shifts only. I explored the idea of trying days for a month or two, but my manager wants me to give it at least 6 months to adjust to the change. Yick

Sooo... some of you may remember that I have been having headaches. Several weeks ago I had an MRI and a scare that was thankfully false for tumor. I did have a few very bad days about that one. Anyhoo, the current theory from the neurologist is that I am suffering from the mother of all atypical migraine variants. 6 weeks and counting. I have been started on supression therapy, and am just waiting for it to kick in. I have also been referred to a ENT doc to see if maybe there is a sinus element to the issue, though most of the pain is occipital in nature. In the meantime I am trying to look for things that can be causing or making the headaches worse. In October I took a medical leave to have a minor elective surgery. I was having headaches before I left for the surgery, and the current headache hit me the moment that I came back to the floor. I could come to the conclusion that I am allergic to my job- but I am not yet ready to go that far- or I could come to the conclusion that maybe, just maybe I have hit the wall on night shift. I have always been a tried and true nightshifter- thus the allnurse handle. I like that most of the family has gone home, the doctors have left for the day, and that I can actually find my charts. I may not have the supportive staff that the day shift has, but I don't have to trip over that staff either. The quieter atmosphere allows me the time to actually sit with my patients once in a while and do a little teaching, find out their fears and allay them if I can, and decipher the progress notes so that I can let the next nurse know what the plan is. If all of the above are not good enough reasons to want to stay on night shift, there is the financial incentive, and it is not a small one. When you actually break down what a night shift differential comes to in a month and a year, it is a hard amount of money to give up- the car I bought while in nursing school was less. On top of that I would have to be at work at 7am. Needless to say, I am not, repeat not a morning person. So why am I considering this move? Why would I want to be a tired poor nurse who spends her miserable days tripping over cardiologists for less money? Because. Maybe. The. Headaches. Would. Go. The. %^&%^/. Away. Oh, and maybe I would be able to get a date one of these days. So what do all of you think? I have to let my manager know tomorrow. I mainly wrote it all out so that I could have it all out on paper, but any input is greatly appreciated.

IMO no ICU nurse should ever have more than 2 patients, so if you are full you should have 3 nurses on duty, not 2. But that is not the point of this thread. More to the point, I know that in my state that it is illegal to ever have only one licensed nurse on a unit at one time. You might want to check the regs. What happens if one of your patients codes? Are the M/S nurses ACLS? Our unit recently had to shut down due to a Noro outbreak, and even when we were down to 2 patients they still had to staff us with 2 RN's, and that is in a stepdown unit. If the OB nurse is floating to you for the rest of the shift, then she should get just as "dirty" as the rest of you. Good luck to you.

Pm me and I will give you more information.

Why, thank you. I have to say that we have really grown and improved. Really invested in teamwork, improving pt outcomes, and are almost finished with a complete remodel of all cardiac inpatient care areas. Great place to work, but because of that, not many openings right at the moment. We hired a bunch, but haven't had much turnover. Keep your eyes open, and good luck no matter where you land.

The contract that I signed for my new grad training WAS in California. That being said, the program was comprehensive and thorough. I stayed my 18 months and didn't begrudge them one minute of the time. I left after my time was up because I wanted to move back home. Others did leave before their contracts were up, and paid the portion of the training that was remaining.

You are thinking about this backwards. They giving you training that you will take advantage of for the rest of your career. If you want to work in this specialty it is every bit as valuable as your student loans. There is an old complaint from those that are just out of school-- They won't hire you because you don't have experience; you don't have experience because no one will hire you. These hospitals are the ones that are willing to go out on the limb to train a new grad, starting them on the road to their entire career. What is wrong with them looking for some assurance that the new grad will stick around for them to get some return on their investment? The person can leave the day after their training is complete if they don't like the environment, but they will be asked to pay back a portion of the training that they have received. Sounds fair to me.

And this is why they are asking you to sign a contract. A good ICU training program costs a hospital TENS of THOUSANDS of dollars per nurse. This is a major investment for hospitals, especially small ones. Many new grads over the years have done anything they could to get a job in a ICU somewhere, got a year or so of training and then used the experience that their first hospital paid for to get a more desireable and lucrative job elsewhere. This leaves the hospital that put out the time and effort to train a new ICU nurse out in the cold having to start over again. Requiring nurses new to the specialty to sign a contract promising to pay back a PORTION of their training if they leave before the hospital would have seen some benefit from their investment is only fair. Areas that have a large nursing shortage have a large number of opportunities to enter specialties right out of school. This leads to people thinking that hospitals should be happy to have anyone who is willing to work for them, regardless of their long term plans. Areas like ICU, ED, OB etc are specialties that require a great deal of additional training after nursing school to be able to function independently. When I graduated from nursing school 4 years ago I signed a 18 month contract for my new grad program in Cardiac Progressive care in a unit that cared for patients pre and post heart and lung transplant. Had I left my program early I would have had to pay a pro-rated amount from $5000. Had I continued at my hospital and moved to ICU, I would have been asked to sign another contract for an additional 2 years for that training. I didn't begrudge this time at all. I paid for the education that I received in school, had I left the hospital before they could have received some true return for their investment, then I would have expected to pay for the training that I received. It is not fair to compare signing a contract to indentured servitude, because you are still being paid for your services. I don't mean to sound harsh, and it can be scary to sign a document with such a financial incentive to stay somewhere where you are not sure that you will be happy. Think of it as signing a loan document for your additional training, where the hospital will pay the loan if you stay with them for long enough. Believe me, they are paying far more than they will ask you to repay.

As a lifelong asthma patient, I can tell you that inhaled steroids are highly unlikely to lead to increased serum glucose. The reason for this is both in the low dosage and the fact that it is not taken systemically. Those who take oral steroids for their asthma are at risk for DMII, but those who take the inhaled form are not considered at risk

I don't know. The one patient that I saw that died of a ruptured AAA was in a huge amount of pain and very, very anxious for the 5 or so minutes that it took for him to lose consciousness. Granted, he was out of it for the end, but I would not discount the experience leading up to that. I was not even taking care of that patient and I will never forget him

unfortunately what they saw was posterior to the pons, underneath the cerebellum. Essentially in the 4th ventricle, an unlikely place for a tooth abcess. My doc never called me back last night, and no neurologist will see me without a physician referral even though my insurance does not require one. So I left another message for my doc, and I wait.

I am still waiting to hear back from my primary doc. I am sure that she is going to shunt me over to a neurologist, which is just fine with me. One other idea I had was to go get a head CT done. I know that they are not as specific as MRI, but if the CT shows a growth, then I am pretty sure that we have our answer. Part of the problem is that the two studies were done at different studies since I was not willing to wait till Thursday for the contrast scan. Who knows what differences that would cause. Also, no neurologist has looked at either scan, just radiologists, and they were the ones to recommend a repeat scan in 3 months. I am going to pick up copies of both scans tomorrow, and will have a neurologist look at them, hopefully soon. I actually was able to see the film myself- it was there on one film, and not on the other. Don't get me wrong, I would LOVE to NOT have a brain tumor, but I am actually worse off now than I was before the first scan. Having the tumor out there as a possible diagnosis limits the treatment options for the headache. No Imitrex for me- I might have a brain tumor..... etc. In the meantime, I still have a nonstop headache that is refractory to everything that I have tried which includes various NSAIDS, muscle relaxants, percocet, caffeine, extra water in case I am dehydrated, etc. On top of everything else, today was the day that I was supposed to have the surgery to place the dental implant that I have been doing the prepatory work for over the course of the last year. Now that surgery is off indefinitely- No MRI allowed with dental implant. Thank all of you for the opportunity to tell my story- I will keep you all posted.

I want to preface this by saying that I am in no way looking for medical advise. That said, I have been having these headaches for years. When I get them, it is either the same headache that lasts for up to 2 weeks, or different headaches every day. Recently these marathon headaches, which I have always assumed were tension headaches, have gotten worse; more pressure and with some facial paresthesias. So I go back to my doctor. She thinks that perhaps they are atypical migraines and wants to prescribe Imitrex as a trial. Because I have a history of HTN she wants to get an MRI first just to be sure that there isn't something pathological going on So I go to the MRI, feeling foolish the whole way about what I feel is a wholly unnecessary test. Then I get the call last night. Apparently there is a >2 cm mass that they think might be a Schwanoma or a meningioma in the region of my cerebellum. Oh, and there are signs of a old occipital stroke. WHAT!!! I am 38 years old! So the radiologist wants me to go back for another MRI today with contrast, which I did. And the mass, which even I can identify on the study from yesterday....is not there on the contrast study. AND he now thinks that what he identified as an old stroke was just normal variation The radiologist doesn't know what to say, other than that I need to repeat the study in 3 months to follow up...... So, I still have a headache, am nauseous, lightheaded, and have left sided facial paresthesias. I may have a brain tumor, and these may be symptoms of increased ICP, OR I have a 2.5 week long migraine, OR I have a marathon tension headache. I am now waiting for my primary care doc to call me back with a plan.

My understanding is that there is a requirement that any unit has to have at least 2 nurses on duty. One of our units was quarantined for Noro recently, and the night before we reopened we were down to 2 long term patients. And yes, there were 2 nurses on the floor. I don't think that they can get around it by saying that the med surg unit is just around the corner. They are separate units, so I think that they are required to have 2 nurses available, even if there is only one patient

While CT's are not used very much- after all cardiologists do get paid for doing a cath- and the radiologist gets paid to read the CT, I have seen them used a few times prior to EP studies for ablations. EP studies and ablations are understandably higher risk in those who have CAD, so often times the doc with do a heart cath one day and the EP study the next. In certain situations I have seen the doc write for the CT scans for those people who are in that grey zone age wise for CAD. In their 40-55's, with no symptoms and no pre-existing history- the doc may try for the CT scan to check for CAD when they feel that the actual chances of hemodynamically significant disease are low.

I agree with the other suggestions posted. I think the two most important ones are whether charge is required to take patients and why no one is stepping up from inside the unit I always see red flags when a unit is trying to hire from without. Either everyone is too green, or there are a lot of problems. I also think that 40 beds is waaaay too many for the charge to take patients. there is just too much to keep track of to have to manage your own patient load. With that many beds the charge should not have to take ANY patients, but be a resource for those on the floor.

My thought as well was that a nitro gtt would be a good choice. My worry for the OP would be the long lasting nature of so much beta blocker over the course of the previous shift. I hate it when doc's keep trying increasing dosages of the same meds with poor results. As you said, this patient was probably under significant beta blockade already, so even if metoprolol would be a good choice for infusion,(and it wasn't) it wouldn't be effective for this patient.

This is not necessarily true. While the RN does have a higher level of responsibility, anyone at any level of licensure can do all of the tasks of those of all of the other levels. This is how many companies eliminate supportive personnel altogether. It is merely a matter of dividing the duties that would normally be performed by the CNA. If there are 6 patients the RN can do the total care duties for 3 and the LPN can do the total care for the others. They can even team up to do all of the turns together. That said, you need to make sure that the company if following their own guidelines for staffing. If the staffing grid says that 6 patients calls for a CNA, then I would hold them to that.