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TLCinCICU

TLCinCICU

cardiac ICU
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TLCinCICU has 8 years experience and specializes in cardiac ICU.

gay male RN

TLCinCICU's Latest Activity

  1. TLCinCICU

    Please Take Our Men in Nursing Survey

    What is your age? 44 Are you currently working as a nurse? yes How long have you been a nurse? 8 years Did you graduate from a nursing program outside of the U.S.? no What area do you work in now? (e.g. - ER, teach, etc.) Cardiac ICU What nursing-related degree or certification(s) do you have? What nursing-related degree or certification(s) do you intend to pursue? Possibly CNS Are you currently a nursing student? no Is nursing a second career? yes If YES, briefly describe previous career(s). (e.g. - butcher, baker, candle maker) medical laboratory technician (nearly 15 years) Were you in a management position in your previous career? no Do you believe that people expect you to become a nurse manager because of your gender? yes Do you intend to become a nurse manager? (MAYBE & DON'T KNOW also acceptable) unsure. they always tell me in my evals that i would be great. Are/were you a paramedic? no Were you a medic in the military? no Do you have a previous college degree? yes If YES, how many years prior to nursing school? 13 Were you a pre-med student? initially, then went for med lab tech Have you experienced NEGATIVE discrimination as a nurse or nursing student? no Have you experienced POSITIVE discrimination as a nurse or nursing student? only in the sense that doctors seem to have more of that "one of the guys" attitude with me and can be more aloof with females.
  2. TLCinCICU

    Reasoning against pushing meds through a-line?

    The reason is simply anatomic. Arteries flow outward from the heart. Vein flow toward it. You get systemic distribution of the drug using a vein. Using an a-line will send the medication away from the heart. There would be quite a significant delay in therapeutic effect, taking into account that the return route from medication entry point to the heart and then out to the body is longer.
  3. TLCinCICU

    Central + Peripheral IV Care

    I've always been told that a small amount of heparin actually adheres to the CVC or PICC lumens. If it's true, then any sample drawn could potentially contain a small (incredibly small) amount of heparin that comes back with the negative pressure of aspiration and be contained in your sample. That would falsely prolong any PTT results. So I typically discard more than policy requires if I have to draw from the lumen where heparin has been instilled.
  4. Between my prior position as a lab tech and my first few years as a nurse, I worked night shift for 12 years. I thought I had always handled the night hours well both physically and emotionally. I did, however, spend much of the first day off asleep - or just stay awake for over 24 hours and go to bed at night. I really, REALLY dreaded the loss of shift differential upon going to days. It was a significant amount, when you thought of it as a yearly sum. So I timed my change just as we got a raise. It didn't "hurt" as bad that way. Having a more "normal" life and circadian rhythm has made a tremendous difference. It's affected everything about me - social, physical, and emotional aspects, positively. And unless you have already "capped out" and are at your top wage for your position, you will eventually regain that loss of shift differential.
  5. TLCinCICU

    Do you accept tips?

    It's wrong to accept any kind of monetary gift/tip for our care from patients or families. Just think of how it could be if tips were allowed. Those who could afford to tip generously would receive the most devoted attention and "service" while the poor would get the minimal attention required by law. An economic bias (worse than what already exists in places) would then become built-in to healthcare. I had one patient send a card to me, care of my unit. Enclosed with the card was a personal check for $500. I just couldn't even think of accepting it. She then figured a way around my own personal ethics and donated to a nursing fund through the hospital. It will reimburse me for attending a future conference. The fact that she WANTED to make such a gift actually meant more to me than the amount of the gift...
  6. TLCinCICU

    do any of you like codes??

    Codes do give me a bit of an adrenaline rush, but I am much more pleased with myself after a day where I've felt like I've spent the shift about 15 minutes away from a code at any given point. I prefer being proactive - somewhat aggressive - and taking initiatives (getting them intubated, getting lines placed and drips started, etc.) and being part of the team effort to AVOID a code. After all, less than 15% of those who reach a code blue situation (in hospitals) survive to discharge - which includes those in vegetative states.
  7. TLCinCICU

    Nurse fired for calling police

    There's a little rehearsed tirade I've had in my mind for years that I've never had the guts to actually say: "You are NOT on public property. You do NOT have the right to act however you want. You are here as a COURTESY to your loved one that is in our bed and you CAN be escorted out our doors if you don't behave in a civilized manner." Perhaps I'll work up the nerve to say it one day... Sometimes I wonder if we haven't been too effective in pushing the patient's "bill of rights" over the years. They hit our doors feeling they have a right to everything under the sun...and rarely express appreciation for it.
  8. TLCinCICU

    Not allowed to say "I was busy w/ another pt"

    It's all in semantics. I usually say something to the effect of "I'm sorry for the delay. I have another patient who has been requiring much of my time. But at the moment, you have my undivided attention. What can I do for you?" The tension level usually drops quickly. If the coworkers on my pod work well together, it's not so much of an issue. Many of us will answer a call light that isn't our own assigned patient, if it has been on for a longer time than usual. We can then go to the assigned RN and ask what he/she would want us to do if it's a med need.
  9. TLCinCICU

    Do i settle or do i wait?

    The hospital where I worked prior to and just after gaining my license usually did not even hire new grads onto specific units. You had to hire into a float pool and then apply for specific unit positions as they opened. The experience you gained floating was a benefit to whichever unit became your "home". Experience only benefits you in the end, regardless of whether or not it is in the area where you eventually want to be.
  10. TLCinCICU

    Ethical and moral dilemma

    I agree with others, report it to the ethics committee. They will reconcile the situation with your facility's "mission statement" and policies, as well as state and feceral regulations. Protecting the maker of the device doesn't even enter the equation. The fractured leads have been happening with Medtronic AICDs. They have issued a recall and patients with these leads are told of the "recall" and brought in for more frequent device interrogations to try and avert what you described. I've had a few patients who were lucky enough to come in as soon as their devices started acting up and their leads were quickly replaced. We even have a local malpractice attorney advertising on television for client with Medtronic ICDs and fractured leads. I had a similar case in where an elderly woman had renal insufficiency and an outlying hospital MD had placed bilateral renal artery stents. She had greatly improved renal function after the arteries had been opened and even felt in better health. However, the docs there didn't even put her on any kind of anticoagulant therapy, much less plavix or a daily aspirin. She completely thrombosed both renal artery stents and wound up with infarcted kidneys and on chronic dialysis.
  11. TLCinCICU

    Please help, orientation problems

    Keep plugging away at it Pup. Skills do take repetition to go from novice to expert. In fact, I work beside a nurse or two who would have benefited from taking things a bit more slowly and grasping rationales behind what they do in addition to the how to do it. If the critical thinking skills are there, the rest eventually falls into place.
  12. TLCinCICU

    Golytely for constipation

    I hope all worked out well for your patient. I would have been making certain the MD was knew of the belly assessment findings and only having liquid stool. I'm thinking that they must have been trying to avoid some complication by being that aggressive trying to get him/her to have a BM. I kept thinking about other options. We have an NP that works with the intensivists on my unit. We tease her a bit about her emphasis on BMs, but she is correct in making it important. She starts many of our patients on Dulcolax and Senna PO BID. If it doesn't work, she doubles the "starter" dose. At 3 days of it not working (God forbid), she adds a daily Dulcolax suppository. What we occasionally get on the "unusual" side is when erythromycin is written in order to jumpstart someone's bowels. It's a lower dose than when treating infections, but it works like a charm. After all, have you ever seen anyone take erythromycin and NOT get diarrhea?
  13. TLCinCICU

    Medicine vs. ER

    What is the size of your hospital? Is it a teaching facility? I'm an idealist among nurses. I'm actually one who wants to get the patient as soon as you have appropriate written orders that tell me what to do. Whether or not that makes it close to my shift change shouldn't even be a factor. Our medical director for ER/Triage has set a standard that all ER admissions are to be in a bed 45 minutes after the order to admit is written. Does it get met often? No. However, it does encourage us to shoot for the quickest we can accomplish. Do you have a centralized department for bed admissions/transfers or does it just go through a house supervisor? Our Triage/Beds staff have the ability to page the housekeepers directly to change whether a bed is a "routine clean", "next clean", or "stat clean". And they are all nurses - not lay people. They contact doctors whenever the patient may be going to an inappropriate level of care.
  14. TLCinCICU

    Good Body Mechanics

    I was very lucky as a new grad. During the orientation for new nurses, we had a 1 or 2 hour period (can't really remember how long) in a class with a physical therapist. He took everyone one of us through the importance of bed heights, leverage, getting help, etc. He showed us how to use our body weights - not muscle - with a draw sheet/pad to do lifts without increasing risk of injury to ourselves. That little session was as valuable as any course I'd had preparing for my new career and I try to pass those same tips on to new orientees. And by the end of my 12 hours, I've usually helped with at least a "boost" with every patient on the pod at least once. However, the patient may not always cooperate with YOUR good body mechanics. A combative, disoriented, or stubborn (after all, they don't always believe they're weak as kittens) patient can send you looking for your heating pad the moment you get home. This type of jewel is the only reason why I've had a couple of strains over the last 8 years.
  15. TLCinCICU

    What are your ICU visitation hours???

    I envy you guys who work units with locked access a tiny bit. Our floorplan doesn't allow for that. The only access/exit to our visitors lobby is via elevator. Due to fire codes, the doors between the lobby and our unit cannot be locked because they would then not have access to stairs should there be a fire. For those of you with tightly restricted visitation, I do have a question: Do your physicians avoid the unit during visiting hours? I can think of several we have on staff that would do just that, leaving the RNs (and the charts) as the only source of info for the visitors' questions.
  16. TLCinCICU

    Please help, orientation problems

    We have a maximum orientation period of 12 weeks for new CICU employees. New grads go into our critical care fellowship (without an assigned unit), which gives them classes and rotates them through the various critical care areas and takes roughly 12 weeks. They get to sample each unit to see what might be their "best fit" and then apply there. So new grad RNs in our ICUs/ER get up to a total of 6 months of orientation before being released for independent bedside care. However, I have seen RNs complete the fellowship and come onto our unit only to be assigned to a preceptor that is a poor match for their temperaments/skill sets. At the end of their orientation period, they're still a little baffled and insecure. So by all means, try a different preceptor. You may luck into one that thoroughly enjoys teaching and will adapt his/her teaching methods to your learning methods. A former ANM told me when I transferred into CICU "It takes about a year to become comfortable with what you're doing. It takes close to two before you are truly a critical care nurse." So don't criticize yourself too much just yet....
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