NickiLaughs

OK thanks. Most of our patients who just had another procedure the day before are alert and oriented but some nurses say since it hasn't been 24 hours since last dose of sedation, we shouldn't be consenting them. All I can find is on anesthesias webpage that it isn't recommended. But how can you rule out a GI bleed in a timely manner post cath or choley etc? It seems to me if they are oriented/alert and can verbalize the procedure and what it's for, risks/benefits that should be sufficient.

Hello all! We've recently had some arguments about informed consent for endoscopy procedures mainly in the inpatient setting. Sometimes our patients are poor prep & we need to rescope them the next day. Because it's often less than 24 hours there's a debate of whether or not we can consent them again. Additionally we've had patients who went to cath lab or IR the night before and it's also been less than 24 hours for that. We tried to look through policies and we can't find anything that addresses this. How does your facility handle these situations where they have multiple procedures over their hospital stay that all require informed consent but sedation is occurring with each of these?

Depends on your RN union's contract. The one we have every 3 years of LVN experience they give you credit for a year or RN. So you'd have 4 years of RN seniority I believe.

Hey all! So our protocol for endoscopies has always been NPO after mn & clear liquids morning of. Our medical director heard I rescheduled someone for drinking an ensure 4 hours prior. (I always double check with doc & he wanted patient rescheduled) Med Director thinks we should have done procedure and it's only NPO for ANY liquids 4 hours before. We use fent/versed Is this a change a lot of people are doing? What's your guys rules? A couple docs are already gathering information to refute this and aren't comfortable with the change. Thanks!

Update: More people have quit/transferred. He went to another unit and told the manager he needed to offer one of our open positions to someone on her staff. The nurse was so furious he told her boss about it she declined the position on the spot. Now we have a bad rep spreading even further about his lack of professionalism. I stopped doing charge and coming in early because we don’t have the staff to support it. I am currently much happier even though I’m getting off work late every day.

I did finally talk to him. I don’t think he knows what to do and basically came out with a “I feel like you are all taking out your frustrations on me and things I can’t control.” I basically stated “we are working with 60% staffing on any given day and you said a month ago we would reduce case loads temporarily.” We’ve lost 3 RNs of our 22 on staff since he started. Many of us are looking but unfortunately we do work at the highest paying hospital in the region and the salary difference is a LOT. We basically have to wait for opportunities in other departments to open up. My seniority isn’t great and I’m our sole income due to a special needs child. I know eventually I’m going to have to just say “I can’t do this position anymore, I’m a staff nurse fulfilling a role I can’t successfully do.” And just let him figure it out on his own.

So I frequently fill the charge nurse role at my endoscopy unit. We got a new manager about 5 months ago who unfortunately has no nursing experience. It sounds as though he got his license a couple years ago and he was very vague about his experience which eventually was discovered to be limited to helping a new clinic get started. He seemed enthusiastic but was supposed to follow me a few shifts, train how to do the schedule with me. Be present on the floor etc. None of that had happened. Ultimately he still doesn’t know how to do anything I do. He’s uncomfortable talking with angry patients. I can handle most things but when I need him he isn’t available. The main issues I have are: His inability to understand our workflows His inability to hold staff accountable with frequent sick calls, His inability to respond appropriately with issues such as short staffing including not being able to provide me with accurate staffing counts of who is actually working what days His inability to communicate effectively. Yesterday he had a meeting with two of our nurses during shift. They told me about it but he never communicated. I needed them to relieve other staff members by a certain time and my phone calls and texts to him were left unanswered leaving me scrambling including telling a physician in the hospital I didn’t have the staff I needed available for another case. Now apparently my director is off for two months. I’m going to attempt to have a conversation with him today about what I need from him but at what point do I just give up and say good luck you need to find someone else in the department willing to do charge?

Our docs “hop” between two rooms. So they have time to get the next patient out to recover flip the room and have it ready by the time the doctor is done next door. 5 minutes is phenomenal. We had a 15 min turnover expectation if we were only using one room. Our policy also requires vitals at the 5 minute mark before the patient can leave the room to go to recovery.

She sounds amazing. ❤️

About a week after getting the second dose of Pfizer I started having moderate shortness of breath/light headed/palpitations. I ended up in the ER twice; my coworkers hooked me up to take me down I was in bigeminy. My only abnormal lab was my d dimer. Chest CT was inconclusive but they didn’t think a VQ scan was warranted. All this bought me a two week holter which showed: bigeminy, short runs of v tach and SVT. I also had second degree heart block a couple times but that wasn’t concerning. Im on metoprolol which has been controlling it well. I’m hoping it’s a short term problem. I know I won’t know for sure if it was related to an rare vaccine reaction or it’s just coincidental. I did report it to VAERs to let them figure it out. I don’t regret getting the vaccine because covid can be far worse then that. Hope everyone is staying safe. ❤️

Hey everyone! What do you do to combat back pain? I’m 37 and it seems over the last few years it’s gotten worse. I do have a special needs son who we have to lift sometimes for his care. I think also being tall (5’11”) as a woman and in nursing many things aren’t adjusted to my height. Appreciate any and all suggestions. ☺️

We use fentanyl/versed/Benadryl. Our discharge time is 30 min from last dose and 15 min from scope out. I do VS every 5 min during the procedure or when a med dose is given. Then post procedure we do VS in scope out, 5 min after and then 10 min after that (discharge).

You should always directly inform you boss of any shift missed regardless of it’s a class or not. That was truly your only mistake but a big one.

We’ve done that on critical hypotensive bleeding patients. Have you ever used a level 1 transfuser or a Belmont? You basically spike blood on both tubing ends to save time to get it in them as fast as possible. Our MTP (massive transfusion protocol) standardly does this. But we still check every unit of blood as we hang it. That would be my only concern with the other RN.

Every place is different. Where I work we are asked to do a 6 hour call shift on Saturday’s or sundays about once every 10 weeks. I usually refuse and let other people pick up. We have plenty of part timers and I’m already there 5 days a week pulling ot. We only have lvns ok call on nights. I know our sister hospitals do 12 hour night call for the rns plus weekends but it’s all voluntary.

My system never has people exempt from floating depending on their unit. I worked ER they don’t float. I know IiCU could get floated to tele but went by travelers first, then per firm, then part time (all seniority based) then finally full time. Your policy is probably rare and likely won’t have too many systems with similar rules.

I’ve been a RN for 10 years and an LVN for 5 prior to that. I was I see you trained and couldn’t handle one shift on the telemetry floor with four patients. Just because you don’t succeed in one department doesn’t mean you aren’t meant for nursing. Ironically I could handle four patients in trauma ER just fine even if they were unstable.... did it for years. Floor patients aren’t easy. Don’t be too hard on yourself.

I did ICU for 5 years and don’t know why it took me so long to realize it wasn’t the right fit for me. I was good at it but emotionally drained. I switched to ER and was much happier. People still died but you didn’t get to bond with them or know families and you were so busy trying to either save them or deal with everything you didn’t have time to thing about it. Night shift can make your emotions even harder especially if you are rotating. I don’t know why some hospitals still try to do that. It isn’t healthy. I’d look for a different department and a consistent shift.

Dirty hippie was the persons screen name. ?. See dirtyhippiegirl above. I think options provided for all is reasonable. I however would probably still order DoorDash in the hospital because hospital food barely passes for digestible.

Dude.... several problems here: She put something deadly for you in your food.... to prove herself right. Sociopath at a minimum. I’m assuming she owned up to the concoction as some point? Her one saving grace... But then she basically tells your story to help her further along. Then pathologically lies about her involvement. Doesn't have the guts to apologize and her father makes her suffer no repercussions. All of these are major personality flaws and she’s working her way up to be the next dahmer.

This is an excellent answer

Certain parts of Elk Grove, mid town are nice. If you want to live in the country with acreage look at Wilton. Traffic can be a beast so I wouldn’t recommend going much further than that. I commute from fair oaks area to south sac and spent an average of almost two hours round trip on the roads. Welcome to our area!

Potentially, but I would wait til closer to your graduation date since these classes are only good for 2 years.More sought after is having some sort of healthcare experience. Also look st the more rural hospitals outside of stockton and marysville increase your chances.

I live in northern California and we get by on one income. We live in Sacramento area though. My mortgage is 1800 a month for a 4 bedroom in a nice suburb and wages are competitive with bay area. I'm expecting to make 170k this year. We bought a house 5 years ago before housing costs went up. I'm very lucky.

There is specialties for a reason. Nurses DO learn ACLS etc of their specialty demands it. I worked ER for 10 years and have passed several accidents/potential emergencies where my husband asked if we should stop. My answer is always NO. I have no equipment not am I an independent practicioner, beyond basic CPR and calling 911 there is nothing I can do. Obviously I'd stop if safe as first on scene. There is no scenario I can think of where I'd be able to do anything beyond that. Don't let your family get you down. I also don't give medical advice and tell everyone to see their doc. If they want help that bad they should go to the person they pay for. Reality is they should go to the person who can help them long term.