stellina615

Hi guys! Thanks for all the replies. Reviewed the sloshing again today with the neurosurgeon, who directed the day nurse to the CT scan of the pt's brain. I took a peek at it myself. About 40% of the space in his head is abnormal fluid collection.....it basically looked like the majority of the L hemisphere was missing and there was a collection of fluid instead. I wish I could share it with you! Unbelievable! The pt is still doing well, and having seen the diagnostics, I have an increased appreciation for how well he is able to function.

To clarify, I heard the sloshing as the pt was quickly putting his head back onto the pillow from an upright sitting position, not when he was sitting still. Thanks for any input!

Hi guys, Today I had a pt come up from the PACU who was s/p VP shunt revision. Apparently his previous VP shunt had had a crack in it, and was leaking CSF fluid. For the pt, this manifested as increasingly painful headaches. He came to me, VSS, neuros WNL (with the exception of being disoriented to date), PERRLA, everything looking good. After he had been on the floor for a few hours, I was getting ready to leave his room, and he said "come here. Listen to this." Having no idea what he was talking about, I put my head near the head of the bed. What I heard was an audible sloshing noise coming from this guy's head, clear as day, just as if there were a pair of tiny boots walking through a puddle. I called the neurosurgical PA immediately, who mentioned that there had been a large amount of fluid built up due to the broken VP shunt, but she also said that it was unusual. No new orders. My question to everyone is, have you ever been able to hear fluid in a patient's head? We rarely deal with shunts on our floor and it just rattled me a bit. I had to clarify to the PA that it was me, the RN, who heard the sloshing, not just the pt. The pt is still fine, VSS, neuros intact. Anyone have any experience with this? Thanks! -Erin

I find that I'm more invested in my nursing care when I'm doing a good job of taking care of myself. When I work hard to make sure I have enough time to sleep enough, eat properly, spend time with people I love, and have alone time to relax, that's when I feel most capable and willing to give 110% of myself to my work. I wish you lots of luck!

I apologize for asking such a strange question, but I'm wondering what different facilities use for body bags or other post-mortem shrouding supplies. I recently had to pronounce time of death for the first time. My patient was very sick before she passed away, and the whole situation was very sad, but the thing that saddened me the most was the post-mortem care. I promised my patient's family that I would take good care of her, and having to put her body in the body bag (my hospital uses white zippered bags made of heavy plastic that have that new plastic shower curtain-type of smell) felt almost like breaking that promise. My patient still had her gown on as well as a clean sheet, but something about zipping a person up in that bag was so impersonal and, to me, almost disrespectful to her. Even though the essence of my patient wasn't in that body anymore, I felt really sad having to zip her body up in a bag. I understand that plastic is helpful in preventing spillage of any fluids that may leave the body after post-mortem care, and that they're probably the least costly option for the healthcare facility, but I want to know if there are other facilities out there that use something less cold and stark than white zippered body bags. I guess I'm having difficulty accepting the whole thing. Thanks, Erin

Thanks to everyone for their responses! I'd love to hear more stories of what people are doing with their MSNs. I've attached the description of the program of study. I also emailed my advisor to ask for some specific examples of what students have done with the evidence-based track after graduation. The evidence based nursing track focuses on developing advanced generalist nursing practice in a focused area of study, promoting interdisciplinary collaboration, fostering life-long learning, and prepares students for the leading edge of health care knowledge and delivery. Students strengthen knowledge and skills in clinical decision-making, application of nursing interventions, and ability to critique and appropriately use evidence as a foundation for practice. In this graduate track, students study nursing as an applied discipline advancing their knowledge of theoretical perspectives for clinical practice, with an emphasis on leadership, the cultural, social and political context of health and illness, and quality improvement methodologies. Students are mentored in the enactment of leadership strategies to improve quality care in nursing practice through an intensive clinical practicum.

Hi everyone! Just got the good news this week that I was accepted into the MSN program I've been hoping for. The university I was accepted into offers 3 tracks within the Masters of Science in Nursing Program: NP, clinical nurse leader, and evidence-based nursing. I'm thinking that I'm most interested in the evidence-based nursing track, because I think I'd like to go into research/clinical trials. This post, however, is intended to get some feedback from all of the Masters-prepared nurses out there. What are you doing with your graduate degree in nursing? What types of opportunities opened up to you when you finished your graduate studies? Where has your nursing career taken you, and what does your typical work day look like? I love floor nursing, but I know that I don't want to work med-surg forever, and I'd like to know what options are out there for Masters-prepared nurses outside of becoming an NP. Thanks for any and all feedback!

Hi guys! I realize that this post was last updated about a year ago, but I'm wondering if either of you (or anyone else) have further thoughts or opinions on the graduate nursing program at UNH. I'm thinking about starting there in 2011. Thanks a bunch! Best, -Erin

If you're trying a make some kind of valid point, then perhaps you should cut the snarkiness and use a little more respect when addressing other nurses, especially nurses who are going out of their way to learn about how to treat their patients well. Checking your spelling and grammar wouldn't hurt, either.

Michigangirl, Thanks for this post. You make a really good point. I do see what other posters mean about not being too hard on yourself, but recently I've had a couple incidences where family members and friends have been on the patient side of the equation. As a nurse, it can be easy to forget what it feels like to be a patient. And you're right, the way something is phrased can make a big difference, especially given that really sick patients and their families typically have a less thorough understanding of what's going on (be it an IV pump, a disease process, a procedure, whatever). Illness can make an otherwise calm and sane person feel worried/afraid/confused/irritable/vulnerable. Thanks for reminding us that as healthcare providers, it's part of our job to be compassionate and sensitive, and a big part of that is being aware of what we say.

I don't want to get the discussion off track too much, but I live in New England and I'm not familiar with the border towns in Texas that some of the posters have described. I'm sorry if this is an ignorant question, but what exactly makes these areas so dangerous that nurses worry about their licenses?

From what I can tell, things haven't improved much. We haven't had layoffs at our hospitals since the summer, but there's nothing in the way of increased job availability, either. Hospitals definitely aren't creating new positions, and it seems to me that the older nurses in our workforce are holding off on retirement, probably for financial reasons. After 2 years of working at the same hospital, I am still working part time on one unit and per diem on another unit because there's nothing full-time available. Good luck with whatever you choose to do.

One of the important lessons I've learned from more seasoned nurses is to go with my gut feelings. It seems like you're already leaning towards trying to get yourself out of this negative environment. If you're feeling a bad vibe and you've only just finished orientation, maybe you should get while the getting is good! Best of luck with whatever you decide to do.

Where I work, taking care of someone you know isn't really an option...if administration finds out that you've been in the medical record of someone you know outside of the hospital context, then that's the end of your job. Being someone's friend or family member as well as their nurse seems to me like a pretty strong conflict of interest. I always thought of that as a HIPAA thing. I'm sure there are exceptions to the rule, like emergencies and such, but in a normal case scenario I it just doesn't seem like the right thing to do.

Last week, we had a patient on my unit (a locked psych facility), who began to appear sedated to a degree that wasn't consistent with her prescribed meds. We suspected that one of her visitors had snuck in some additional meds to her, and we obtained a urine sample for a DAU. It came back negative for EVERYTHING, including the methadone she's receiving (we dilute it in water before administering it, so I know she's not cheeking it), as well as the clonazepam we suspected she was taking on the sly. One of the nurses I work with who's been around for ages told me that methadone doesn't show up as an opiate on the DAU, and also told me that clonazepam doesn't show up on the benzo part of the DAU. My reaction was: huh? I know that methadone is a synthetic opiate, but I figured it should show up on a DAU. And how is Klonopin any different from any other benzo we'd test for? I called the lab and no one knew what the heck I was talking about. Can anyone help clear this up? Thanks!