theantichick

Yep. First time I started CPR on a patient (I'd taken over several times with other patients, but this was my first time to decide to start it)... broke ribs, whole 9 yards... (geriatric patient) Anyway, after about 6-7 compressions, she moans and moves her arms like she's trying to raise them up to stop me. I FREAKED OUT. Started thinking I had missed a pulse (I'd checked at the carotid, but adrenaline had me shaky enough I figured I must have missed her pulse.) Got her 1/2-way down the hall and she stops breathing again, and at the door to the ambulance (I was an EMT back then) I couldnt' find a pulse again. I made one of the firefighters double check me. He couldn't find it either. We fast loaded her, and started CPR again. Once again, after a half dozen or so compressions, she starts moaning again and moving her arms like before. Stopped compressions again, and about 3 minutes later she stops breathing and no pulse again. Started CPR again just before pulling into the ER bay. Gave report, told the nurse everything that happened and that I was scared I'd started CPR and broken her ribs inappropriately, but laid out the timeline for her. ER staff took over and I went to do my paperwork. About 10 minutes later went to hand off my paperwork to the nurse. She wanted to reassure me because I was still freaked out. They'd stabilized the patient, and the indication was that she was having such low output that there was no palpable pulse at the carotid, and once we boosted that with compressions her brain would perfuse and she'd wake up. She wanted me to know that I'd absolutely done the right thing, and while the lady was old enough and frail enough she might not make it out of the hospital, I'd given her her best chance.

I thought I'd offer an update, and emphasize the importance of having backup plans with a midlife career switch. I worked a little over a year in the ICU at the LTAC I mentioned in my previous post. Started my BSN online, and then got an offer for my "dream job" which was at a level 1 trauma ED in my area. I loved the work, but the pace was just too much for me physically. Having 8 or 9 very sick patients without coverage for lunches and breaks made for hellish shifts. It seemed like I would recover on my days off just in time to start it all again. What I didn't know is that I had developed rheumatoid arthritis. I got a new job at a smaller community ED with strict 1:4 ratios, coverage for lunches, and fabulous coworkers. I absolutely loved it, and I would still be working there if the RA hadn't flared up so badly and the resultant treatments (immune suppressing) made it a very bad idea to stay in bedside care. Because I accounted for the possibility of not being able to continue bedside nursing due to physical issues, and had a plan, it's all worked out OK. Not my first choice, but my backup plan wasn't a bad one. I'm now working in Medical Informatics, blending my extensive IT experience with my nursing training and knowledge. I'm pursuing my Masters in Healthcare Informatics so I can advance my career further. It's a desk job with office hours, and I'm not exposed to tons of sick and contagious people on a daily basis. The money is quite good, and I don't feel like my nursing education and short-lived career were wasted. I don't want to say that people in their 40's are necessarily going to have problems physically doing the job. I've worked with 70 year old nurses that run circles around the 20-something new grads. But it is a very physical job, and contingency plans are a must in my opinion. I don't regret my choices. Yes, if this hadn't happened, I would have spent another several years in the ED and then gone on for my NP. My life would look different than it does now. But one of the things I love about a nursing career is that there are many specialties and disciplines in nursing, and you can find what works for you. I won't discourage someone from pursuing nursing, even as a mid-life career change. My original advice, I think, is spot-on. Go into it with as much information as you can get on the profession, and your eyes WIDE OPEN. Have a PLAN for how you're going to get through school while likely needing to work and care for your family. Have plans already in place for your alternatives if you find you don't like bedside nursing or the specialty you got into. Keep those options open. And if you still want it, GO FOR IT.

A little off topic, but wanted to ask you something about UIC. I started that same program this summer, and have been very put off by the way they deliver some of their courses. I've now had two courses out of four where the days in which I had to contribute were dictated. For example, this unit discussion starts on Tuesday and you must post 3 or more researched and cited posts to the discussion board on Tuesday, Wednesday and Thursday. I have done a LOT of online classwork, and I've never had the timing dictated to me. If I'm working 12 hour shifts (especially nights) on Tues, Wed and Thurs, then I have less than 12 hours to commute, shower, eat, and sleep. I do NOT have an extra 3 hours to do research and write posts during that time. I am used to being able to bunch up all of my work on days I'm off. When I raised my concern and asked if this was the standard for course delivery, I was basically told if I can't handle the coursework to drop. I've got student loans taken out and others on deferment and dropping out at this point is nowhere close to an option. I'm very disappointed in UIC as I had a lot of discussion with them prior to choosing them over Walden. I did so based on their reputation and their assurance that the program was flexible around work schedules. This is NOT flexible for anyone working 12's in my opinion. Their delivery method of so tightly dictating discussion is so outdated for online course delivery that it's scary that they are considered one of the top in the field. Anyway, my question to you, being further in the program is: Is this the way most of the classes are delivered/organized? In all of the drah-mah, no one actually answered my question about it.

I have a concealed carry permit. I would never consider carrying while on duty at a hospital. The responsibility of keeping track of my firearm would distract from doing my job as a nurse. Also, while on duty, I don't feel a particular need. Should an armed attack situation occur, it's not likely I'd be able to use my firearm effectively anyway. There is rarely a clear field and line of fire in those situations, and I'm best off finding cover for me and my patients (if possible) and letting security and P.D. handle it. Now, I do NOT like the regulations at most employers (not just hospitals) where you're prohibited from having your weapon in your vehicle. I have a gun safe in my car, and usually have a handgun secured in it. Granted, my employer is unlikely to demand to search my vehicle, but I don't like the policy being there in the first place. FWIW, I don't actually carry on-body often because a) it's a royal PITA; and b) I rarely put myself in a situation where I feel that unsafe. I keep one in my car basically in case of a breakdown where I have to wait for help or walk somewhere at night.

Good points, thanks! This particular position doesn't require me to retain my RN, but future ones might.

For those of you in informatics jobs, have you kept your license up? How do you address the CE requirements? Does your employer want you to keep it up, and will they help by either paying you to take CE classes or paying for the classes themselves? I am currently awaiting an offer for an informatics job, and I don't anticipate going back to bedside care after this, mostly due to health issues. My current license expires next month, and I already have my CE's so I'll renew this time, but I am starting to think about what I'll need to do in the next cycle to maintain it, and if that's something I want to do.

1)__ Do you take the flu vaccine yearly? If you do not, what is the reason you do not participate (if you don't mind answering this question)? Yes, always. 2)__ Does your employer have a mandatory influenza vaccination policy as a condition of employment? If yes, where do you work? Yes. Large health network in North Central Texas. 3)__ What concerns do you have about the flu vaccine? None, but I don't take the live vaccine because of auto-immune issues. 4)__ Do you know if anyone who has been released from their job because they did not get the flu vaccine? No.

I am incredibly lucky with my current ER. We have a ratio of 4:1 to start with. They staff for someone to cover lunches. We also have the ability to go pee when needed, or go get something to drink. On rare occasions if too many people call in, or things are just too insane to free someone to cover lunch, we don't get our full 30 minutes and then we fill in a sheet to have our deduction for that shift to be cancelled. ETA: We also are supposed to get 2 15 min breaks, but those are not covered. We don't track those and most people just take 5 min here and there as they can. But overall, we don't feel put upon over it. The ER I came from was a nightmare in comparison. Ratio 8:1, including high acuity, sometimes more. No one to cover lunches, so you're asking someone else who's equally in the weeds to watch double the patients so you can try to slip away to eat. Management hassling you if you cancel your lunch deduction too often - so lots of nurses there don't cancel the deduction even if they couldn't even get away to pee until they were going to burst. Needless to say, I'm much happier at my current place. I believe we can give better care because we're not in the weeds all the time, and can stay hydrated (and pee) and well fed. We are also more able to help each other out when needed.

I'm in the same boat... 15 years' data warehouse/integration then became an RN. Now a RA diagnosis is pushing me back to the tech side of the healthcare world. Feel free to PM me if you want to keep in touch, share tips, critique each others resumes, etc.

That's really great. I would imagine that if you needed two extra people to keep your patient positioned to ensure a sterile insertion, that happens too. Places I've worked didn't make it possible to get extra help for placement, and we couldn't ensure sterility. Always bugged me.

Probably TMI, but I had to have a cardiac cath for an ablation, and during my 6 hours flat, I could not make myself pee in the bedpan to save my life. I don't know if I could have made myself go in a pad of some sort or not, but nothing we tried could get me to let loose in the bedpan. I finally was hurting so bad I begged the nurse to get a catheter order from the doc. He approved an in and out for less chance of infection, and it got me through the 6 hour period until I could get up. I 100% agree with involving the patient in the conversation. If I had multiple fractures and couldn't get up to a bedside at least, I personally would rather have an in and out every time I had to pee (though long term I'd prefer an indwelling frankly) than to have bedpans. Fully understanding the infection risk, I'd choose a catheter. Not everyone would. I'd like to see us have more options to present, and the cleaner the better.

I find bedpans to be more mess than they catch. The patient's bottom is almost always wet, and if we're using a bedpan then usually they don't have the strength to stay "lifted up" for both the pan removal and drying/cleaning. And that's *IF* all of the urine actually stayed in the pan. More often than not I have to put a towel so the urine doesn't spray "up", and leakage to the sacral area usually ends up being a pool that missed the urinal. I agree a better option needs to be available, and I appreciate the OP's query. The product someone linked to at Amazon looks promising, I wonder if it's been used in a hospital setting at all? Also, addressing the side note... 25 years ago in EMS, they gave us those "emesis basins" ... you know, the kidney shaped ones that function as no more than a deflector. Even the wash basins are messy for emesis. In our ER we use something that looks like an airsick bag, and I think those are a THOUSAND times better. Wish I had a sleeve of them at home for when we get the stomach bug or food poisoning.

Thanks for the encouragement. Health issues are pushing me back into the I.T. world. Wish I could move to Illinois, I'd jump at it, but alas my husband is in love with Texas. :)

Yeah, I ended up talking to a couple of people in passing who work in Healthcare IT, and they both had one burning question: could I write SQL. I only ate, drank, and breathed SQL for 15+ years, so I had to laugh. They were both convinced I'd do very well if I made the jump back. I'm going ahead with my masters program, but I'm not waiting for that to try for a HIT job. I'm putting my resume out there and networking.

I've updated my resume, updated my LinkedIn, and started applying for analyst/informatics jobs in the area. I'm in the process of applying for the online program at University of Illinois at Chicago, which seems like a really good program. No nibbles on the job front yet, but it's only been 2 weeks, and I suspect it's a niche where there's more "wait and see" than other IT fields.