raskol

My unit takes hearts post op day 2. We rely on percocet 5 or 7.5 q4 (1 tablet) or q6 (2 tablet). If that is not adquate, we get IV morphine, dilaudid, toradol, or talwin depending on the surgeon. We get our patients to the chair on day of transfer and walking by day 3, ideally. The RNs pull our own chest tubes usually when they put out less than 100cc in 8 hours when not walking or surgeon preference.

I had a vascular resident ask me what VICU was. I must have made a look because he went, "It's vascular icu isn't it?"

Just came home from another shift. Nurses who are already scheduled overtime this week will be mandated to stay past their eight hour shift because we have TWO NURSES for 28 beds. Because we were only scheduled three (due to severe staffing issues) and one called in. You bet, I love overtime but not forced and not in the 50 hour range every single week on shifts with only four nurses when we are suppose to have 6-7

On average I work 48-52 hours a week. My status is full time 40 hours, however my unit is at mandated overtime and has been since January.

I've been in health care for about 5 years both EMS/hospital. Up until last summer, all the places I worked had nitrile gloves. However, since the summer I've been using non-powdered latex. Well, now I am awaiting my blood work for a suspected latex allergy. (I think it might be contact irritant dermatitis from my internet investigations). The alternative at my facility are vinyl gloves. Since looking up allergies, I'd learned that vinyl gloves have an increased failure and transmission rate. When I asked employee health, I was told nitrile are way too expensive. But now I'm getting mad that I'll be stuck were substandard gloves. What gloves are used at your facility? Any recent changes to nitrile and how did it happen. I'm the floor representative for the research council and I'm thinking about proposing this as a topic and using it as my clinical packet.

I was getting a telephone order to test for possible HIT. The surgeon said to order HIPA.. well, I was tired and said, "HIPAA? Test for privacY?" He just laughed and told me I needed a day off.

I find it helps to know why they are on each medication. Is the EF low? Am I trying to increase cardiac output or coronary perfusion? How have they tolerated the meds in the past? Am I trying to keep them in sinus rhythm?

You asked what you could do differently. And now you know where to find stupid buried old labs. no big deal.

my floor gets a lot of post-op CABG patients.. they often come with a cordis...that I love for selfish reasons.. mainly I have great access and I don't have to worry about nurse collect draws in the AM.

Yeah, we don't have L&D. The hospital had different campus and mother&baby is on the other side of town. We did try the ED, waited half hour to borrow their doppler...they won't loan it for whatever reason. When I took report from the ED, the nurse stated she got heart tones but not a rate, because she would lose it before she finished counting. They also had abdominal/pelvic ultrasound ordered. AGAIN my hospital, for whatever reason, won't do pelvis u/s on pregnant women... and by the time I got that cancelled, her abdominal u/s got moved to the morning. The mother kept stating she could feel the baby kick.. so I pretty much went on that.

I had a question regarding fetal heart tones. I work on a cardiac step-down floor (our population is most commonly cardiovascular surgical patients) however the other day I had a 30 y/o female patient admitted with chest pain. However, she was 22 weeks pregnant. The only real treatment I was giving (all her cardiac workup was negative) was dilaudid 0.5mg IV q4. I called the resident.. as I was concerned at this choice of pain medication, as well as the fact her OBGYN had not been consulted and I could not monitor heart tones. (I have a vascular doppler. but it stated not for fetal heart tones.. and I think I only picked up mother's heart rate (100s)). After jumping the ladder, I finally got them to switch to stadol and they said it wasn't a big deal if I don't get heart tones. The attending the next morning said at 22 weeks monitoring heart tones is unnecessary since the fetus is non-viable at this time.. ANYWAYS.. my question is, as the experts in maternity,.. is it appropriate to not monitor heart tones, and was I right to be concerned about the dilaudid? I just want some guidance since at my dedicated heart hospital none of us nurses have experience with this population and we were at a loss at what to do with this patient. Thanks.

The order you call the physicians is dependent on your hospital and shift. You'll learn it on the job.

Hello fellow nurses, I'm a cardiac step-down nurse and my floor has all their nurses observe a CAGB due to the large amount of open-heart patients we get. I'm scheduled to go in the morning, and I'm wondering if anyone had any last-minute online resources so I can brush up on the actual procedure (like what a med student would study). I work a major academic teaching hospital, so the surgeons are used to quizzing the med students and I want to have a little bit better knowledge if I get asked (and the CV surgeons I know will). Thanks!

I'm mostly bummed because that wasn't even a good story.

Thanks guys you have been so helpful

I am at a new facility and had a few questions regarding PICC lines. I have consulted with my fellow nurses and looked at my policies, but still wanted some other opinions. Where I am now, the lumens of the PICC (only single/double lumen, boo), have a t-port adapter on them. I am used to the clave adaptor like on a saline lock. Are these t-port type connectors considered positive pressure caps and does that mean I should not be clamping them? The brief search I did on the research left me with conflicting information. Some said if it has a clamp on it, use it, and others said if it's positive pressure caps then do not use the clamps. I am coming from a facility that was very stick about clamping and here the nurses don't at all "for fear of clotting." I was told, if I am flushing regularly, I don't need to clamp. That didn't sit right with me so I questioned and asked. Thanks!

Quick mention... even though the EMT has less training than a paramedic, they deserve a good report. They are still responsible for that patient during transport and need to know whats going on. Just like a paramedic (where you don't know their background), the EMT may be in nursing or medic school. When I was an EMT, one of my partners (an EMT) was a Physician Assistant as well. Soo.. my point being.. EMTs are still part of the health care team and deserve some respect.

In regards to your first question, EMS is so specific to the state office. In my EMS experience (in New England), they make it incredibly difficult to not bring a code into the hospital. First you have EMTs... who cannot really do much. They can call medical control.. but unless the patient's head is cut off or they have obviously been dead for hours.. the MD will err on the side of safety and instruct to continue CPR. Depending on the service, EMS may have first responders (fire fighters, police).. and if those guys start CPR, EMTs cannot stop until they are at the hospital. Paramedics have more resources (monitors, more leeway with pronouncements etc) but they are not always available or by the time an intercept with ALS occurs, they are so close to the hospital, there is no point in stoping. Also..even if the patient went down relatively recent (where EMS would have no reason to stop CPR).. it is hard to have a code save. Think of it. Say the patient has been down for 5 minutes before someone calls EMS. It will take about 3 minutes to dispatch them. Most services have 10 minutes to respond to a priority call. There is 18 minutes gone. You are going to be dead but they have to work it.. and 10 minutes on scene. 10 minute transport time.. there is almost an hour gone. I don't think EMS is trying to pass the buck. They are the ones who have to go into the homes of panicking families and show they are doing everything in their power to help the patient. In addition, they need to keep their licenses (or certifications) safe. They don't work in a controlled setting, and have little team/support, so be nice to them when they roll in. It really isn't their idea of fun doing CPR for 30 minutes knowing they are pumping a dead body that will be called the minute they walk in.

I hated being a tech. Absolutely never wanted to go to work. Not because I had to do turns, and incontinence care, and sitting, etc. But because that was all I did. I knew I could be doing more (as in... in addition to these basic nursing skills). I also was a float too, so I never had the chance to really establish relationships with staff so I was often working by myself with few help. Also, because I wasn't consistent with my presence (varied shifts, floors, days, etc), nurses didn't know me and had the tendency to talk down to me. Or blow me off if I had a concern about a patient. My patients were often impressed I pulled them up by myself because I didn't want them to have to wait forever while I tried to find help and my callbells were never answered if I was tied up in a room. The worse is when I was a sitter for up to 12 hours and the nurses would walk into the room and pretend I wasn't there. There is no respect given to being a tech. You are often overworked, underpaid, and non-appreciated. It is not fun. However, it did help me become a nurse and I learned a lot from the experience. I hated being a tech but I love being a nurse. I am challenged and (somewhat) respected in this role. I feel as part of a team and feel I can actually maybe do something on my shift. An abbreviated explanation but it works. See how you like clinicals as a student nurse (don't being utlitized as a tech, but using your critical thinking, giving meds, looking up patho, doing assessments).. it's different and that's what motivated me.

At my old hospital, as a way to cut expenses, we were not to stock the room. This included linens, alcohol swabs, gauze, anything. It pretty much sucked. Especially as a float, as some floors were more compliant that others with this policy. Hourly rounding was suppose to make my day easier, but I was too busy running around getting basic supplies and becoming off-balanced by how much stuff I was cramming into my pockets. I'm surprised my pants don't fall down. Gotta love a budget.

I have a echo this sentiment as a new nurse. I moved out of my state, even region, for my first nursing job. Where I am from, LPNs are completely phased out of the hospitals. The only time I ever experienced an LPN was doing EMS at the nursing homes. I am having a hard time trying to incorporate LPNs into my practice. I didn't even have a glimmer of understanding of their scope until my interview! One floor at my hospital utilizes the LPN as their med tech. Mine is more with the LPN having your 5th patient. But.. I struggle. I don't want to come off condescending or untrusting of the LPNs, but I don't really know their role, especially as I'm adjusting in my own new position. It is difficult to pass off an assessment (ongoing, not initial) to a LPN yet still be responsible for so much of the patient. While I was in school, the most I learned was from the other LPNS in my program who were shocked that they weren't breezing through the material and the instructors saying it is isn't important to know since we don't seem them in our region anymore (acute setting).

I took TNCC free from my hospital. I don't even work in the ED, I'm on a cardiac step-down floor. My hospital has many faults but they do strongly advocate for nursing education.

I have to question the type of students coming into nursing as perhaps part of the problem. Are they compelled by a strong desire to "help" people. Perhaps the reality of documentation and medication administration bog them down. Are they motivated by the idea of job security? Has the economy decreased their ability to find a desirable job and the tough environment hit them unexpectedly? Are nursing schools accepting students who have no business being nurses, and furthermore not kicking students out after serious violations? Do students find nursing research to be a boring class and not understand the implication to practice? I don't really know. But I feel as though students go through nursing school with no true appreciation of how the profession is run and are throughly disappointed with reality.

I would suggest working towards TNCC first. I want to get CEN, CTRN, CFRN certification and all the nurses I highly respect encouraged me to wait until I have more experience in those specialities. I did get TNCC a week after I passed my boards and made some good impressions/connections through that.

My feet never really hurt wearing them. Only because the girl I bought them from was great at explaining them to me. She told me.. these were shoes that took time and I had to break because they were handmade and needed to form to my foot. They don't have foam like sneakers, which is why they last and help you stand and walk in a better position. I wore them for about a week because I took them for work. I work them for an hour one day. Then two hours the next. The third day I wore them on a flight. Etc etc, progressively increasing the time until I braved an entire 12 hour shift. Because they are hand-made and every foot is different, my left foot was initially tight at the top. I wore a bandaid for a few days there and now they are perfect. Give it time. They are so so worth it. And I held off getting them for the longest time because I thought they were ugly.