taz628

Maybe I'm just a softy, but in my little more than 2 years as a nurse I have several pt's already cemented into my mind and will never leave my memories. Just this past week I refused to leave my pt's side until he was safe into the OR. Dissected aorta from descending arch all the way down the whole trunk. He said he had recently had a dream where the blessed Mother told him she couldn't save him again. He also had a child due to be married in the short term. I spent an hour dumping labetolol into him (pressures 240/100) and was just about to start a nitro drip when CTVS finally said OR was ready for me to take him. I prayed, HARD, that night for him. Turns out radiology read the initial report wrong, it wasn't a type A dissection but a type B afterall. Thank God for that though. I hear through the grape vine he's doing well enough, I sure as heck hope so. The other pt was a pediatric trauma. 15 months old, fell head first out of a 2nd story window onto a cement patio. It was my first major trauma I helped with off orientation when I transferred to the ED. She was almost lost in CT. She still had perfusion in the base of her brain, but not much else. The story of HOW she managed that fall changed about 3 times... it just didn't make sense. I used to work in ICU step-down, and one pt was end stage ALS. Younger guy, you could tell he was extremely handsome before the ALS started wasting him away. He was on our until some 4 weeks before being transferred to a vent facility (we had him on BiPAP). I took care of him almost every night I worked, myself and one other nurse seemed to be the only two who could effortlessly communicate with him. His personality still managed to shine bright despite only having eye movements, the ability for a weak smile, and being able to contract knees JUUUUUUST enough to use a pancake call bell. A year after I last took him, he was brought into the ER for some respiratory complications. I walked into his room and I was greated with a HUGE smile (for him). His primary nurse said he hadn't smiled once until I came in. :) I talked to him, managed to amuse him, and was honestly surprised he was still alive at that point. :) I miss that guy... he was a real sweetie and his whole story just pulled at my heart strings.

it's the same story no matter where you go. we've got a great new intensivist who believes that ICU pts are to be in the ER for as short of time as possible - which means we often don't have time to do all the little things, just enough to stabilize and make sure they'll survive transport. love that new doc! no more ICU patients in the ER for hours and hours on end... ::crosses fingers::

apparently, so the story is told, we once had one of those nifty fetal heart rate ultrasound thingys in our ED. wellllll... a dad let his kiddo play with it one day without the nurses knowing. they walked out with it! so we no longer have that toy. we have a video camera in our supply room to try to catch would be theives (both patients and docs and nurses from other units....). I, personally, thought the commercial was funny. but knowing it smells of the honest truth? i've sent pt's home with the one time items, with 2 days of dressing changes, but that's really it. I've put my foot down on other requests for things. we hardly keep any supplies in common areas due to this.

I've had my white koi pants for almost 2 years and they are only a teeny bit dingy, nothing a light bleaching (if i weren't so lazy) wouldn't take care of though. :) the fabric seems rather thick, i think they are much less see through than other brands. the cherokee workwear allows a bit more to be "noticed," but i personally think the fabric stays whiter, longer. my white pants in that brand STILL look brand new, and I wear my white bottoms an aweful lot - even though I work in the ED. ;-)

My nursing program did this. We were separated, men in one group, women in another, so that it wasn't overly awkward. As others have stated, it wasn't to teach HOW to give a bed bath, it was so that we UNDERSTOOD and EMPATHIZED with the pt receiving a bed bath. It's very uncomfortable to trust another person to bathe you, and I actually knew the girls in my group fairly well. We also did the occupied bed change and bed making lab... but that was actually kind of fun. (especially when we "trapped" each other in the linens, ha!)

yep - just the other day I was going to use "nursing judgement" on an order. Resident ordered 60mg toradol, IV. Called the doc up, wanted to know if she wanted 60 *IM* or *30* IV. She said she "looked it up" and that 60 IV wouldn't hurt the veins! Uhhhh... I'm not overly concerned about that. I adequately flush and dilute with saline... but what about the kidneys??? Next thing I know, 5 minutes after she insisted it was 60mg IV, the order was changed to 30mg IV. :) Of course, this is the same resident who wanted to d/c a pt who came in with a foot fx, after nursing staff found several empty pill bottles of benzos that had only been filled a week prior. We fought it, went to the attending, shortly after my shift ended the pt went into status and had to be tubed. then there was the time we had a floating IM resident in our ED and the one attending actually told us nurses to check and double check all the orders she wrote and to come to him immediately if we thought anything was off... oi vey. *rolls eyes*

a note in one of my work emails stated that our CNO is watching the movement out of Philadelphia to push for ALL entry level RNs to be BSN prepared. So there is a fairly serious movement for such a thing. I know the philly campus of Thomas Jefferson University dropped their ASN program, soooooo who knows.

This move is pretty much EXACTLY what I did. we call it "special care" but it's essentially an ICU step-down. I was there for 10 months and then transferred to the ED - where I originally REEEEEEALLY wanted to be but couldn't for various reasons. My step-down experience has been a HUGE plus in the ED. There are certain things that I'm more comfortable with than other ED nurses (i.e. ventriculostomies) because I've had more 1:1 experience. The director of the ER when I *first* interviewed actually told me that starting out in the SCU was preferable to coming direct to the ER anyway. So, YES! They will hire you, and you'll get good experience. You have to very carefully monitor pt's in step-down because they can very easily and very quickly get either better, or worse, very fast. So that sort of experience does help quite a bit when transferring to the ER. Hope this helps a bit. :)

....last week... diet ginger ale... allllllll over my scrubs. but, I got that stubborn tube open! I just the rapid push/pull "agitation" with the plunger. Works for me. :)

we don't bother with finger sticks during a code... the docs usually do some sort of lab draw (fem stick) and we ALWAYS run an iStat for codes (from the few I've actually witnessed anyway). The BS shows up on the iStat, so that's what we tend to go by.

We use EPIC at my facility. Once you learn all the short cuts, it's really easy to navigate and to quickly chart. It's nice - basically looks like an excel flowsheet. Some of the info (like the nurse kardex) can be a bit tedious to access, but I overall like the program. Of course, it's the only I've used. :) A friend of mine works in IT doing training programs for hospitals converting to all sorts of electronic charting and she says that more and more hospitals are choosing EPIC. Dunno how factual that is, but that's her opinion.

my biggest pet peeve about nursing is being stuck inside a single building/unit for hours upon hours. Ideally, I'd find myself in a job that keeps me outdoors. My cousin and her husband are anthropologists/palentologists - so playing in the dirt all day sounds awesome! otherwise, I'd get my pilots license, move to Alaska, and be a bush pilot/tour guide/wildlife photographer living in a small log cabin with at least 100 acres to call my own - hehe. :)

there are actual separate CDUs out there? At my hospital, if a pt is CDU'd (always chest pain/SOB, kept overnight for stress tests in AM, then d/c or admit) they are kept in the ER. Ugh. We have a "holding unit" attached to the ER, staffed by ER nurses, that we can use IF the bed situation warrents it, and the CDU pt's go there. I would totally work in a fulltime CDU though, I generally like the pt's we place into CDU.

Oooo... the Amish. My grandmother was Amish - but then shunned for marrying a heathen. I've taken care of SEVERAL Amish patients. One of my FAVORITE patients ever was an Amish man in his 70's who had suffered a stroke. lovely man, until he ripped out his A-Line. :) Not his fault - we under estimated his overall lack of understanding. Overall, they can be a wonderful group to work with if you have patience. The information above pretty much sums everything up. The ones I've come across have become fairly knowledgeable in their own way when it comes to medications - especially if it's for their children. Other beliefs tend to be a bit antiquated as well. Had one young child brought in for rattle snake bite, father tied a very tight tourniquet on the child's leg and cut open the wound to suck out the poison. The docs were worried the child may lose that leg... but from lack of circulation d/t the tourniquet mostly - it was in place for over an hour as they carried the pt from deep into the woods to the nearest place to phone for help.

I was offered a position in the PACU as a new grad - two of my classmates accepted their offers (I chose another path). So, there is a chance you could still do PACU as a new grad, depends on how the hospital is set up.

The funny genie is awesome. :) I also found that site about the chicken dance and sex in the city theme, one of my co-workers and I are sitting here trying to find new cue words to make other things happen!! No luck though. We've tried several Star Trek type phrases since 3/4 are Star Trek related, but again - no luck. *sigh*

"Shut up" does the same as swearing at it then, lol. The "good-bye" command gives you Leonard Nimoy saying "Live Long and Prosper." Funny stuff. =D

I looked up an older post about this, but there were very few responses, so I decided to start a new post! My ED started using the Vocera units recently. This past week we've all had fun learning the funny genie and the Easter eggs (Beam Me Up, Beam Me Down, Good-Bye, Shut Up). Has anyone heard of any others? I've read some people have accidentally stumbled upon some, but they can't remember the cue words. So if you know others... post 'em!

from what i've heard - $8/hr at my hospital I believe. they are the lowest paid employees and some of the most overworked. it's RIDICULOUS what admin expects such a small crew to do (night shift = less than 6 house keepers for a 450+ bed hospital, or some other slightly higher, but still crazy low number). we have permanent house keeping in the ED, and boy oh boy, do we EVER run those poor girls (and guy..) ragged.

the peds intensivists at my hospital are all generally WONDERFUL to have come around! there have numerous times in a peds trauma when they show up and are all, "I've already called my charge nurse, PICU bed xyz is open, let's just get them over there now, I've already given the nurse report." --I just stand there and say thanks for doing my job, and *Poof!* off to PICU we go with the doc pushing some form of equipment. I had another trauma pt (adult) in MRI and the attending trauma surgeon stopped by with his PA to see how things were going and I was just getting on the phone to request help transporting the pt back to the ER and he was all, "Oh, no worry, we'll help transport." and that surgeon pushed the bed all the way back for me. :) His PA lent me her jacket too 'cause MRI is FREEEEEEZING lol And one of the ER attendings was a nurse in a former life, she's just flat out awesome. She'll do little things for the nurses when we're busy and sticks up for us and teaches us all kinds of good stuff that other docs don't bother with. I have the craziest amount of respect for her. I've had the pleasure of working with some truly amazing doctors at my facility - for every bad experience, I can name AT LEAST two good ones.

-chest pain/palpitations -SOB -abdominal pain -kidney stones/UTI symptoms -migraine headache -syncope/near syncope -GI bleed I think that sums up the majority of our frequent complaints. We'll have several of each every day, I swear. Some days there will be a whole hall filled with abd pain/GI bleeders!

We've had our magnet status for a bit more than a year now... meh, i really don't see any difference - except that they've taken away our staffing incentive bonus! part of magnet is cutting costs, etc, which has had a negative effect on our paychecks. they went on a hiring binge to be "fully staffed" so there is no OT, no bonuses, etc etc. overall, we - the lowly staff nurses - don't see much of an advantage as of yet. I *still* hold out hope that I'll understand it all some day...

Pennsylvania is one of those states that have that sort of law. Actually, there was recently an incident in the ER I work at where a vistor tossed her soiled shorts at our front desk registration lady (and they landed on her FACE...ugh)... and could not be arrested because she didn't assault a licensed medical professional. If it had been the TRIAGE NURSE... the lady would have been taken away in cuffs. Instead, our desk worker had to go out of her way to press charges against the visitor. Not really the fairest law when you look at it in that context, but I'd wager I'd be happy as a clam if I should *unfortunately* find MYSELF in a similar situation and get to see the assailant taken away by the police.

I had the same issue as the OP when I transferred to the ER. I was trained to start IVs on my old unit, but working nights I rarely had a reason to start them. I'm not waking a pt in the middle of the night to rotate an IV (dayshift usually did it before I got in, anyway). So I was crud at them when I came to the ER. During my orientation they sent me for half a day with the IV team for a refresher course, is that an option for you, OP? It helped a lot, and one of the flex ER nurses works full time in PACU so she gave me some awesome tips. It took me a good 2 1/2 MONTHS to finally hit my stride with IV starts, and I've now been known to hit some crazy hard veins with success. :) Everyone around you had their own tips of the trade, find out what they are and make them your own!! Soon enough you'll lose that feeling of insecurity and do a happy dance every time you start an awesome line - I know I do. :)

Living in and working in a (large) hospital in rural NE Pennsylvania, I've heard that nurse managers will send hospital security in their 4x4 SUVs to pick people up. We were talking about it at work yesterday and some of my co-workers have stories from years past about local ambulances going around to pick up nurses to get them to work. We kinda got jipped in this storm... only 6 inches! I drive an AWD that's really decent in snow, *IF* I had to work this weekend (which I don't!!) I would have no problem getting through this bit of white fluff =P