mskate

I have been fired from a handful or two of rooms. I consider it a wonderful thing! I don't have to deal with you, even better! :) One time I was coming on shift with 2 patients. Separate rooms, you couldn't see one patient from the other room. Patient A was a new admit from the OR that the other nurse had just settled in and barely started on propofol. Patient B was actively desaturating. I started my shift off in Patient B's room. Patient's A's daughter (who was a nurse, supposedly) was IRATE that Patient A was restrained. I wasn't about to go in and d/c restraints on an intubated patient, who I haven't assessed, who JUST started on the propofol. No way. And I also was not going to pay attention to Patient A's daughter when Patient B was having an emergency. The daughter was standing there yelling that she wanted me to print out the policy immediately. I explained (between runs to the supply room for the other patient) that at this point, it was my judgement call and I would remove the restraints when I able to determine it was safe. Patient A's wife fired me from the room for not unrestraining her mother when I felt it was unsafe to do so. ..... Patient A extubated herself a few hours later when the new nurse removed the restraints per the daughters request and have to be emergently reintubated. .... That being said - the new hospital I work with does not allow nurses to be "fired" from rooms unless there is a serious, major, major issue. The rationale is that the family does not get to determine ICU staffing. The charge nurse decides who has the best skill set for each patient and that is that.

A bunch of people I work with rub their fingers on their foreheads or on the skin behind their ears to pick up skin oil. I think it is *disgusting* and I alcohol gel my hands after using the machine because I am so grossed out. No one else wants to touch your gross face sweat, people!!

It depends on how urgent the intubation is... sometimes we will use an alcohol swab over the teeth - but most people don't like to use anything because if it moves, it is risky for an airway obstruction...

Every time I have had to work a code in an MRI scanner. No access to your aline, too much artifact to read the EKG properly, shoddy MRI compatible IV pumps that don't program drugs into them... Having to pull the patient out of the scanner and code in the hallway NEXT to the scanner... It's just a nightmare.

Phone, Android Tablet and their respective chargers, wallet, stethescope, water bottle, granola bars, make up and other toiletries including floss, mouthwash, toothpaste, mini-deodorant (everything I would need if a disaster were to happen and I would get stranded at the hospital for a few days), hair brush, hair ties and lotion.

a 19 year old girl who was in the wrong place at the wrong time... she was shot 19 times.

No, just squeezing a bag that it is attached to tubing in a pump will not do anything at all to fix air in the line. However, if your coworker took the tubing out of the pump and THEN squeezed the bag, they would be squeezing the air into the patient. Side note - please, please let your supervisor know. Many times, its not just saline hanging and if this person squeezed heparin or another drug - the patient could die because a transporter thinks they are smart stuff. Please - for the safety of the patient - talk to your supervisor.

So, this is about a friend of mine who is a relatively new, new grad. She worked as a nanny before nursing school and couldn't find a hospital job, so she started doing pediatric home care as a new grad RN, no orientation with another nurse, etc.. - just here is your assignment - GO. This has had mixed results, I get lots of text messages "I have a kid who is on a versed medicine at home. What is it? How much should I give?" types of questions throughout the day which, for me - is a scary thing and I don't think she is particularly safe or adequately trained/prepared to be a home care nurse. Anyways, she gets very attached to her patients. One patient, she started taking pictures of him, uploading them to her facebook, talking to people in the community about him, etc... and I called her out about how its inappropriate, HIPAA, etc... and she eventually said she "got permission" to do it. Whatever. Ultimately, the child's disease got worse over the course of the 3 weeks she was watching him and he died. She stayed in his house, without pay, for 28 hours while he died. Leaving her parents to watch her own child, neglecting her own well being, not sleeping.... I should add that she did have a relief nurse come in to take over care, but she felt it was "too much to leave to 1 nurse, that it would take 2:1 nursing care." It is not as if the patient would have been left alone... and coming from an adult ICU background - it takes A LOT to need 2:1 nursing care... let alone for an at-home death with controlled symptoms and family care. I question the appropriateness of the situation. I know in the adult world, that really isn't something that you do, and it is important to, although always be invested and caring - to maintain professional boundaries. She insists that it is different with kids and that's the way peds works. Not trying to start a he said/she said battle, not looking for an "i'm right/you're wrong" discussion, but I am genuinely curious if that would be considered normal and acceptable to the pediatric nursing world.

Its not a JACHO thing, nor is it an OSHA thing. Its generally considered to be an infection control issue - which is why some places don't care about it being in the nurses station, but still regulate against it being at the bedside.

We always have snacks, chips, cookies, etc... set out on the counter at the nurses station for us to grab as we go by. We also have a little snack closet to that we drop some coins in and it is stocked with energy bars, chips, oatmeal, soup, candy, soda, juices, etc... and we also keep drinks at the bedside in the ICU. We will wheel out extra bedside stands to set up crockpots full of goodies into the nurses station too... Our managers help us. :)

I have been made to cry by MDs too when I was a new grad... it sucks. I feel your pain.

When a patient loses cardiac activity and dies, coded and all, - actually pronounced dead... What does your hospital do about their pacemaker? Do you allow it to keep firing and send the patient to the morgue or do you deactivate it and THEN send the patient?

Working agency nursing (I'm assuming you mean a registry set up and not a traveler) is hit or miss. It pays SIGNIFICANTLY less than the standard pay of the staff nurses. When I occasionally pick up a shift for quick cash, I make HALF the hourly wage as staff nurses do. The hospital options that you get sent to aren't great, theres really only about 2 hospitals that use agency nurses on the regular enough to get all of your shifts and its not a situation where your license is terribly safe. I would use it to make ends meet if absolutely needed, if not - its not worth it.

I do not allow people in the bed. I have IV lines, medications, foleys, etc... even on the "healthy" patients and obviously for my sick ones, its an even bigger no-no. The ONLY time I let someone cuddle was a guy that was pronounced brain dead and they were saying their goodbyes. This is a hospital, I have things I need to be doing and you taking a nap isn't OK. This isn't a hotel. Need a nap? - Go home. We have very strict no over-night policies and no sleeping at the bedside. If you are sleepy, clearly you need a nap and in my ICU bed is NOT one of those places where you get to catch some Zzzzs.

Come work in the San Francisco area!! :)

I have never even heard of that before, but that sounds hilarious!

I would lose 18% of my yearly income if I switched from nights to days. Not worth it. If I moved back home closer to my family, I'd lose over 50 dollars an hour, not counting my 18% shift differential. With the money I keep, I can fly to see them and have money left over. LOL Honestly, if it came to losing that much money and just working elsewhere, I'd chose a change career paths. I feel quite strongly that what we do is worth much, much, much more than most areas of the country are willing to pay.

Having worked both, I will gladly stick to my 12 hour shifts. Albeit, I don't have children to try to wrangle childcare around, etc... for me - work is stressful. The trade off is 4 days off in a week! If I had to show up to the unit 5 days a week, I'd trade in my ICU job for a desk job.

- Anticipate their issues as much as possible. When I walk into a room for the first time I have a pitcher of ice, a pitcher of water, a juice, a few cups, a few straws, a fresh warm blanket, etc... so they have fresh water and ice chips. If they drop a cup, theres another, if they lose a straw, theres another. - Before I leave the room I say "I am going into see MY OTHER PATIENTS now. Is there anything else that you will need in the next hour before I go into their rooms and take care of them? its important to me that all of my patients get the help that they need so I am not going to be able to come in here again for an hour. (unless there is a huge emergency.) I will come in and check on you at 9pm. (Specify the time). So what can I get you NOW that you will be settled until THEN?" - When they inevitably push the button 5 minutes after you walked out having the above speech, I usually will have another nurse co-hort go in and say "I know your nurse JUST LEFT THE ROOM and she told me she made a point to get you everything you needed. She isn't going to be back in here until 9. Whats wrong that she wasn't able to do 5 minutes ago?" or something to that effect. It reminds him, again, that you are busy - and its not YOU that comes back when you said you wouldn't and reinforces the limit setting. - I have no problem telling people that I have other patients too. Their concerns matter to me and I will take care of them, but that they need to group their needs together because I have to be able to help other people as well. - Document it all. All of it. - Let a supervisor know about the problem and if you work charge, try to make sure the same nurse doesn't have that room 2 nights in a row.

I don't consider the treatment terribly rude, nor do I believe they deliberately decided to say these things to mean, as other posters suggested. I *have* been in this womans position and coming from a woman that had a good career that crumbled and I was subsequently homeless and living out of my car - I have been there and done that and anyone so concerned about what someone else is saying about their insurance company to the point of being too upset to speak about it needs to get a grip. People are *rarely* deliberately jerks to patients but they do have opinions (whether or not they are appropriate, they exist and are not going to go away). Should they have talked about it out of earshot? Sure. Is it a debilitating insult? Hardly.

Personally, I wouldn't bother. I dont care what people say about my particular insurance company and if she thinks for half a second that she is the only person who utilizes the clinic with her insurance company, she is insane. Secondly, as far as an MD telling someone else to do his dirty work is also NOT something to flip about unless she specifically wanted to see that MD. Of course the staff will say something to smooth things over for the doc and "busy with an emergency", etc... I can't count the number of times I've been asked to do something for them and end up saying "Oh, he had an emergency to attend to... " or something when I know damn well he is in line in the cafeteria. I don't see that as being a big deal at all. No one was rude to her face, her exam went well, her examiner was polite... but she is upset because she heard people talking about her insurance company?... When I opened this thread I assumed people were going to be rude to her face, overtly mean, lacking attention to detail, making huge errors, etc... but "they were outside my door and talked about my insurance and the doc asked someone else to do the exam" hardly seems like something worthy of letter writing. Just my 2 cents, clearly - but really? "RUDE" staff? Too upset to talk? ... Nope. Take a deep breath and move on with your life. Not worth calling the DON certified letters, etc... Sigh.

Yup. I work a full time job at one hospital and a per diem job at another hospital. The other hospital has a mandatory 4 shifts per month and pays significantly higher than my full-time job. I like having 2 jobs, it just feels more secure to me.

I didn't learn it in nursing school, but was expected to know it when I started working. I learned on the job on patients.

What do you want to know?

I'm really really really bad at them. I'm going on 9 years of ICU and I have started MAYBE 3 successfully, and that is if I use a 22g on people with sewer pipes for veins. I blame it on all of our patients coming with access already there. They either come in via EMS (who place the lines), ED (who place the lines) and the OR (who place the lines) - and if I lose periph. access, I'll usually have a resident who needs to get signed off on central lines ready to toss a triple lumen in.... I'm really good at drawing blood but threading an IV is a whole different story....