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nrsgnerd

nrsgnerd

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  1. nrsgnerd

    Anybody ever see an IABP balloon failure?

    Luckily, our unit is 1:1 for IABP's and thus far no ruptured balloons. I am taking the class in the next month or so to start taking IABP's so it was good to read these posts.
  2. nrsgnerd

    Is this the norm or unfair? thoughts and opinions needed!!

    Woah woah woah! Im on your side here. Lets remember there is more than one way to skin a cat. For instance, we just draw blood from the art line and do our own accucheks....we don't wait on lab results that can take forever in our hospital and its not common practice for us to do stat glucose unless the accuchek reads "high or low" Next, if you don't ask people for help then you can't say that they wont help you. Maybe nurses are on their own (as it sounds from your post) just because no one has taken the iniative to point out that teamwork makes for a better work environment. Since you are a new nurse, be a brave new nurse, don't be afraid to go against the grain. Its how you handle yourself now that will cause the nurses to either respect you or "eat you". But fear, thats only reinforcing them and giving them power to eat their young. As long as you are respectful and reasonable with asking for help then there is no reason for the work environment to be hostile. and if someone is hostile with you, let them know about it in a firm and reasonable way. However, if this environment is making you nuts then perhaps you should do your time to get your experience in and find an easier enviroment to work in. If it were me, I'd try to cling to other nurses that did show teamwork and talk to them about maybe starting a committee that promotes teamwork. Talk to your manager about bringing it up at the next employee meeting and see who wants on board. Make a bulletin with little rules of courtesy such as: No one sits down until everyone can sit down and things like that. You can google to find some good sayings. Adn to those that are resistant or don't seem enthused aobut it, kill em with kindness...go out of your way to show them that teamwork makes the environment better. Just make sure that your manager is enthusiastic about this because if she/he isn't then the older nurses may buck you all the way....I wouldn't waste my time unless i knew the manager would help me to reinforce this because she/he believes in it to be important. I once pulled a nurse into an empty room because she was rude and embarrassed me in front of patient. I told her, "Look, I will give everyone here my respect all day long but if you disrespect me then I will stand up for myself. I don't allow anyone in my life, personal or otherwise to speak to me like i am less than who i am so I am giving you the chance to not treat me that way again but if you do then I will get management involved." She immediately appologized and said she was having a bad day and didn't mean to come across that way. We have never had another problem and I learned alot from her. So see, there is a way to get your point across without creating havoc. Just hang in there and do what you can to make it a better place to work, for you and most especially for patient care.
  3. nrsgnerd

    Is this the norm or unfair? thoughts and opinions needed!!

    Bob has the right to inquire as to why he is getting this new pt. when it seems clear that there are other nurses who are available/underassigned and more capable of being able to accept this pt. My question is what are the accuities of the other two nurses pts. Are they one on one pts? Are the other two nurses trained to take this level of OR pt.? Did Bob state any objection, now or previously, or is Bob such a nice guy he doesn't stand up for himself? I would have delegated a few things such as: asked for someone else to transfer my pt. ( pack him up, take him out, get meds ready...whatever) and ask someone else to get my meds or do accucheks for my remaining pt or whatever else i could have delegated to ensure that i stood up for myself and let Tameka know that she can't bowl me over. In the future, Bob should professionally state his opinion and delegate his needs thru his charge nurse.
  4. nrsgnerd

    I think I'm too slow for Critical Care...

    You are in the same boat as me! I have just graduated and work in CCU/CVICU and as soon as one of my pts start having less than a perfect reaction to care I start to freak....though Im told it doesn't show, my Lord I feel it! I start thinking its me, i didn't do something they needed...what did I forget....am I safe to care for this level of illness...I need to google that...but so far, thank you Lord all my pts have made it thru my shift. I havent' had a code yet but don't take ACLS until FEB. Luckily our unit is a total team nursing unit and we all gravitate towards whoever has the sh*t assignment or the very sick pt and we stick together. Thats the only reason Im making it is because I work with such a great group of nurses and those who aren't on the same page as our main personalities never last in the unit. Just keep trucking as I think you have to do this for years before things just come very natural. And I know what you mean about the cool cucumbers that make it look easy but most of them have been doing this for a while so cut yourself some slack and I will try to take my own advice but you are sooo not alone in how you are feeling. Just give it some time and if nothing else, one day at a time!!
  5. nrsgnerd

    Pay Scale

    GA. new grads start from $18-22/hr base pay depending on what kind of hospital you work in, obviously the bigger hospital ICU/CCU's pay more. With shift differentials...weekends....nights... you can make up to 27/hr. I was a tech and just graduated in May, worked in a CCU for 6 years and made 15.43 by the time I graduated. 13/hr is quite shocking to me. It must be a smaller hospital I assume. As far as skills, it is mandatory in my dept to have certain training completed within a year of hire. The hospital provides the training. We have to complete ACLS for adults and IABP training and then by the end of the year they begin to train you on CRRT and eventually Open heart recovery. And then yearly you do your recertification on all these. They provide us with a skills day in which we are overseen by the education dept and we show competency at the bedside with certain skills. They give us like 4 months to get them completed. Then we have skill levels 1-2-3-4 and the higher the skill the more money you are paid and the more that is expected from you to give back such as being on committees and things like that. Other money we make is from a system called bidshift, we no longer take call days mandatory but sign up for them voluntarily on bidshift....if you are not called in and are on call the entire 12hrs then you make 4/h while you sit around at home. If you are called in then it is an automatic time and a half plus any differentials. Hope this gives you a glimpse of what we do in Georgia and by the way my hospital is 50 miles from Atlanta and we have over 5,000 employees total. Its a good size hospital and we just added a tower. Our CVICU has 17 beds with 18 overflow beds (eventually to be remodeled and all open hearts will be there with the other 17 strictly CCU) and our ICU has 38 beds.
  6. nrsgnerd

    How visible are your patients in your ICU?

    Boy, I understand your concern. Our unit has glass doors and the nrsg station is in the middle with desks inbetween each room. Our of 17 beds there are only two rooms that are not very visible and so we try to keep confused or unstable pts away from those rooms. I think you need to make sure you are documenting extremely well and bring this concern to the attention of someone other than your manager as his comment, "My manager says that in most hospitals you can not see your ICU pts" is false. You may want to bring up the fact that the hospital may have a lawsuit on their hands if a pt. falls/dies because they were not being appropriately monitored. If all else fails, I would find another job....your license could be at stake because they are not providing conditions that you can do what any prudent nurse would do to ensure safety....and lets face it....in any lawsuit safety of the pt. will always be the number one goal they are trying to disprove in order to win the suit. My best to you!
  7. nrsgnerd

    Switching to Critical Care

    Utter persistence and try to get to know some of the people that work in the ICU if possible. Alot of times in nursing, networking can get you further than experience can. Start asking people you work with if they know anyone that works ICU, or call the HR dept of the institution you are applying and talk to someone there and explain your position. Keep an eye for job postings on the institutions website. My best to you.
  8. I work as an RN in CCU/CVICU. I had a pt last night that has had a permanent stoma for years. The stoma is open with no type of appliance to hold it open. You can look straight down into it with a flashlight. At the top of the stoma, still inside the stoma, there is a small puncture hole that goes into the esophagus and the pt. had a Blom Singer voice prosthesis which is thIS little white plastic appliance that has a plastic tag that sticks out AND sits in the stoma. the very small maybe 1cm round piece fits into the hole and so he can speaK. He just occludes his stoma to do so. Okay, so heres the problem. 1. None of us have worked with this type of stoma before, or seen this little appliance or even understand the anatomy regarding how it was installed so its hard to picture exactly what was done, we can only go on what we have been told (very little). 2. After the pt had open heart surgery, POD 1, the pt began to expel green bile from the small puncture hole 3. The pt and spouse stated that the pt. has always coughed things up into the mouth and spit them out....now, nothing makes it as far as the mouth and only expels from the hole. Does anyone have any experience with this? The pt is still in our unit, and if there is anything I can learn to troubleshoot this prob. I would like to. I researched the net and can't find anything about bile coming out of the puncture hole. Obviously, something has happened from the time of surgery to now....for all we know anesthesia tried somehtng...who knows? And his ENT here in GA. gave the okay to change out the appliance, allowing the pt. to do it themself. We had Resp and myself at bedside and when the pt took out the old voice prosthesis the pt began coughing and green bile, copius amounts, shot out of the small puncture and it took several minutes to get it back in. The pt. sat was already not great 90-93 (which doc gave the green light to) and then desat'd during this, we had to ambu bag the stoma....scared the hell out of me. I hope someone can shed some light fast....the worst danger in this is if it continues, bile will travel down his stoma into his lungs that already look like crap, sound like crap...its one of those shifts where you know your just not going to be able to let it go. Thanks all who read.
  9. nrsgnerd

    stressed already.. highscshooler.

    I have met some wonderful LPN's, however, alot of hospitals are getting very technologically advanced these days and do want to hire RN's over LPN's. You can also call and talk to the nurse recruiter at a hospital you'd like to work at and ask them if they hire LPN's in the ER so you know where you stand. RN's make quite a bit more money and the schooling can be from 3-4 years depending on if you get your Associates Degree-RN (3yrs) or your Bachelors Degree-RN (4yrs). there are some programs that let you become an LPN and then you go to work while doing additional classes to get your Associates or Bachelors (some schools offer a majority of the classes online as well). LPN's are hired quite often in Nursing Homes or Home Health and they are needed. My suggestion to you would be to set your ultimate goal as becoming an RN after you get your LPN or looking into a program that you can go straight to becoming an RN. You'll be restricted on what you can do with an LPN is my point but it is a great place to start if you just want to get done as quickly as possible with school so you can go to work. As far as stress, school will be stressful and there is no sense in doing it so fast that you barely absorb the material. Nursing gives you the power to heal or kill a person so its very important that when you do begin your program that you give it your all and not overextend yourself to the point you make yourself sick and miserable. Not to mention alot of surviving nursing school is having good coping skills so if you go into it already freaked out, its gonna be twice as hard for you. So relax, take a deep breath and tackle things one at a time. Read a good book on optimism or positive coping skills and above all else, pray. My best to you!!
  10. nrsgnerd

    Nursing Me Black

    I did not grow up in a family that was colorblind but early into my adulthood I soon learned that people are people. I had all sorts of misconceptions, false beliefs told to me by family and when you get to a certain age you realize that so many things you were taught are just simply false. You learn this by life experience and by developing your own perception of the world around you and the people in it. At our core, we are all the same. We need, love, support, grieve, get mad, sad, happy, get sick, get tired and need affection. One of the reasons I love nursing is becasue it reinforces to me that we are all the same at our core. We may have differences in our belief systems personally but our goal is common when we work and that is to take care of the patient to the best of our ability. I am proud to live in a multi-cultural society and look forward to a time where the places we come from just don't matter because we are all here together now no matter how we got here. I feel its ok to look back at where we came from, IF, we learn from it and keep moving forward. We can't change yesterday but we can change tomorrow. Thanks for provoking some thought, loved your post!
  11. nrsgnerd

    Did I Miss Something?

    Well, my brother once said to me that he answered an online survey and it asked him who he admired more than anyone else and he said, "Doctors, because they sacrifice so much for their patients and they are like the smartest people on the planet." Now, I agree Doctors are extremely intelligent but as his sister, I thought well I guess I'll just go fluff some pillows for 12 hours now since that seems to be what nurses do! People just don't realize what nurses do.
  12. nrsgnerd

    Nurses: Remember The Calling?

    I did my nursing capstone on Postive Socialization in nursing and this, your message, is the message that young nurses need to hear. I see nurses who do their job, and do it well, however, its the nurse that takes that one moment to touch the hand of her patient and look them in the eyes as they speak to her/him that truly make a lasting impression on the patient. I have learned so much about myself just by being around and talking with my patients. Things I learned that I feel I may not have learned about myself if not in this profession. It is a calling, not just a job. Thank you for sharing.
  13. So, just to give a little background, I'm a very type B personality EXCEPT when it comes to work. There I thrive on being the best, very Type A and for the past 12 years I have worked as a CNA/TECH. I got the name Super Tech several years back from Peers and I am 100% about patient care. I graduated nursing school where I also excelled and so when it comes to nursing I hold high expectations for myself. OMGOODNESS, I am sooo a novice and had no idea what the world of being a nurse really was. I work in CCU/CVICU and I run like a chicken wiht my head cut off. I'm still developing a routine, and I forget things because of my lack of experience in the RN role. From a techs perspective it always looked like RN's had down time and for me, I've yet to have any. I don't even recognize my bladder calling me until my shift is over or if I'm at lunch....I don't drink anything practically all day and all I can think about is "What do I have to do now....what am I forgetting....oh crap I had meds due an hour ago.....theres the doctor, what was my K+ this morning...can I run this gtt with whatever other drip...did I remember to do this or that. Basically, my brain is in overdrive and I feel like I'm swimming against the tide all day long. And then today, I had my first interaction with a difficult situation in which I had a patient that came in 12 days ago after v-fib arrest and had emergent open heart surgery. The patient is ventillated, having myoclonic jerks, no purposeful movement but alas had brainstem function so his HR, BP are fairly stable. We had a doc tell the family to not let anyone tell them that their loved one was brain dead....and then another doc tell them the prognosis was poor. So ofcourse the family only wants to talk to the first Doc who was basically shooting psuedo-rainbows out of his butt. The pt has had two EEG's, with no changes and its undetermined how long the pt was down in vfib. Because the pt had a 100% blockage to the Left main, he was rushed emergently that first night to open heart surgery, no hypothermia treatment was given. So heres this pt, jerking....lungs coarse/rhonchi and the children do not know who to believe about the prognosis. One grown child is having anxiety attacks and has visited our ER 3 times now for anxiety and the other is just annoyed and ******. There are 2 other children who we are told don't agree with how to proceed with care and the pt has a sister that the daughters want us to withhold information from. They want no one coming to visit except for them and it seems that in all their grief they are just not seeing the ramifications of letting this saga drag out. So far, no skin breakdown (but were getting close) but there is fever of an unknown origin, WBC's 12.1 which could just be neuro but we drew blood cultures today. Anemia ofcourse, so we infuse a unit of PRBC's and the anxious daughter makes another trip to the ER. We finally get rainbow doctor to come back and talk to the two sisters and he skirts telling them what we see as healthcare professionals (perhaps fear of a lawsuit...who knows) and it takes about 20 mins for him to finally say it...."poor prognosis....1% chance of a "meaningful" recovery. In the meantime, we are waiting on Insurance to clear him to go to a longterm vent facility (limited resources) and it seems that everyone except for the patient is being thought of. We have our intensivist doc, cardiothoracic surgeon, cardiologist, neurologists all either saying something different or just not rounding on the patient. We tried CPAP and the pt had long apneic periods. His muscles are atrophied, his EF before surgery was 10% and I feel like we are just sitting and waiting for his kidneys to shut down,nephrology to get involved and start dialysis. I suppose today was the beginning of me growing a new skin but I get so broken hearted for the pt because I know how this could progress. I love being a nurse, I guess I just have to get used to and learn how to deal with this situation. How do I let this not keep me awake at night? Do I just need time or will I become another jaded RN? I don't cry outwardly very often at all, but inside I weep for this pt.? Why is it that I have a hard time feeling for the family? I know its their parent, I know they just aren't ready to let go but it is so sad watching and just waiting. For all I know, the patient is in pain......or maybe he doesn't feel a thing. I hope its the latter. Any profound wisdom from experienced RN's in this field would be much appreciated. Thanks for reading my rant!
  14. It seems to me its the type of employees you have there meaning they either truly don't give enough or they are too overwhelmed to get it all done. Some employees are completely comfortable with doing the bare minimum and without the support of your DON, your fighting a war by yourself. If you are empowered with writing up those not doing their job, then you may have to take the stance as the "bad guy" to get your point across. Again, you need to be backed by your DON in doing so and you should discuss how he/she would feel/support if you did write employees up before you decide to do the first write up. Employees can be like children, if all you ever do is talk....wheres the consequence to what they are doing wrong. And you also want consistency so perhaps enlisting other charge nurses and asking what they are seeing will give you more leverage with your DON. Collaberation will help you gauge and pinpoint where the problems lie. It takes a team to make things happen but more than that it takes people who care enough to go the extra effort. If you do find that something is not done, take the person responsible to the scene of the crime and show them thats its not done so they can't come back with, "I always do that, or it wasn't me". For example, if Susan is responsible for stocking gloves in rooms 200-220 and the gloves aren't stocked, take Susan around to the rooms at the end of the shift and show her it wasn't done and ask why she feels it wasn't done. Explain to her that without gloves in the room, there is no way for a person to protect themself from being exposed and its takes time away from patient care when one person has to make 10 trips a night to the stock room so they can stock gloves in their room (give a rationale why it is important she stock the gloves). You may have to do some close observation and go behind people to see what was and was not done. A benefit to this is that they see that you are watching and that may be motivation enough for them to get the work done. If this works and you see that employees are doing better, you could try instituting a reward program, maybe a gift certificate to the person who goes the extra mile and use this to try and motivate the staff and show appreication for their hardwork. i would not try this first but perhaps if you see an improvement that warrants keeping morale high. Just don't give up, you are there to advocate for the patients and if that means you have to go the extra mile to be creative in an attmept to motivate people or you have to be the bad guy and write them up, then so be it. In my unit, we have gone thru 3 managers and our current manager, when he first started, seemed like a total butt! in our first employee meeting one of the nurses had said that it would be nice to hear a thank you once in a while or get a pat on the back. My manager replied, " your paycheck is your thank you"....the whole room got quiet and there were many scowling faces at the table. I know now that he meant that you were hired to do a job and if you want to keep that job....THEN DO YOUR JOB! I still think his choice of words were poor, and he did come in and start writing a bunch of people up but after that, attendance improved, tardiness got better and it was all because he let us know that if we want to be told thank you then we need to do our jobs consistently and give him a special reason to say thank you and take care of the current problems we had first. Now, he rewards us, jokes with us and above all has our respect. i wish you the best of luck, sorry so long....guess I'm full of it tonight...LOL! Good Luck to you!
  15. nrsgnerd

    Lessons from a blind man

    Thank you for sharing. It is so true of the calluses we grow. Thank you for sharing.
  16. nrsgnerd

    How to give a thorough report?

    Hello all. I am a newer nurse and just learning how to give change of shift report. I have tried to do so and found that I leave out information and was wondering if anyone, seasoned nurses, can help me with this. this is what I know to say and would appreciate any help or advice you can offer (what I'm leaving out). I'll just use the best case scenario for my example. I work in a cardiac unit so my example may be geared towards what I see there. Perhaps i just get nervous but i feel like I'm all over the place when I try to give report. Example: Mrs. Patient 55 yo F Dr. Ducky Surgeon, Dr. Lucky Cardiologist Allergies: Bananas/latex full code status Admitted 8/22 thru ER with c/o CP, taken to cath lab, cath found multi vessel disease and consulted for Open heart surgery OHS Surgery on 8/23 with triple vessel bypass with LIMA no complications, extubated evening of 8/23, pt now on pathway neuro) A+O, afebrile, PEARLA-pupils 2+, moves all extremities Cardiac) SR 80's, no rubs or clicks, CO 6, negative enzymes, no CP, no edema, upper and lower extremities pulses 2+, BP 110's/70's. RR 15, Sat is 93-95% on 2 L NC Resp) clear and equal bilaterally, CT output 100 mL this 12 hr shift with total of 200 over last 24 hrs, serosanguineous and draining well, no airleaks, no SOB, CXR report clear GI) BS in all quads, passing gas, tolerating cardiac diet, no N/V, no distention or complaints GU) foley in place with 1200 UOP this shift, urine is yellow/clear MS) pt is weak, muscles are symetric, no C/O of pain, full ROM, 1 person assist OOB or to bathroom Skin) Sternal wound is approximated, closed with skin glue, pink and scab had formed, tender, no pus/oozing. all other skin is in tact, bottom looks fine, heels are fine Pscych) Pt has supportive family, wife is in waiting room, pt seems motivated to get better and is cooperative. Home Meds synthroid 5 mcg daily ASA 325 mg Gtts Heparin 12 units/hr theres a new bag of heparin in the med room if needed NS at 20 mL/h carrier Ancef 2g q 8 hrs next Ancef is due at 2000, IV tubing is saved and on IV pole in pt. room PO meds Lopressor 25 mg bid lopressor is in med room and due again at 2000 Lortab q 6 hrs, last dose at 1400 IV access 20 ga in L FA, 20 ga in R wrist, CVL in R SC...all patent and flushing. Heparin is infusing in CVL along with NS. No redness or signs of infiltration Labs K+ 4.0 H/H 10/35 WBC's 8000 AntiXa therapeutic Pt. has ambulated X2 today, IS reads at 1000, is now up in chair since 1500, one person assist to help with lines. pt was bathed and likes to have graham crackers and skim milk at bedtime. See, this sounds good to me but I just know Im missing something so help me out if you don't mind and thank you so much in advance Abbs