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That smell is either CDiff and we need to isolate or one of the nurse FINALLY got lunch in the cafeteria and they are serving pork and beans.

I work on a Med/Surg Neuro floor, I usually have 5 patients on a typical dayshift and maybe there are 6 patients scheduled for overnight. I left this floor about 2 1/2 years ago to work on a Med/Surg floor that had everything from Cardiac to GI Bleeds. I have returned to Neuro 6 months ago. It can be challenging every day. Don't think that every patient will be stroke. I deal with brain tumors and crani's, back surgeries, intractable back pain, MS, Parkinsons, Change in Mental Status, amoung other things. I can't at this time imagine going to anything else. Its not for everyone, patients are sometimes long term due to placement and or depending on the area of infarct, talking to familes about ending life due to quality of life over quanity is very difficult, sometimes it is on a daily basis. Just beware that this is not a floor that you will assess your patients and pass meds and then chart and relax. These people are usually neuro checks q 1 hour x 4 then q 2 hours by 4 to 8 then q shift. If there is a change then the whole process starts over. If your floor has Stroke Accreditation, then you will need to be NIH accredited and depending on the floor, we are certified to swallow screening. I love what I do, I feel like I make a difference. God Luck

I am not sure what you mean by signing out all your meds for the shift. Please explain this. I have never worked in a nursing home and don't know the procedure. Would this have been against procedure for the facility? I understand that you would have missed the appointment but was multi tasking the best thing to do? I don't want you to think that I am condeming what you did. I think that you should have been given the opportunity to explain the situation to your supervisor. I can only say that all protocols are put in place to prevent medication errors and so that nurses can not abuse medications. I hope that everything works out for you.

Thanks mudd68, glad to hear all is well with your mom. This is a procedure we are now seeing done again after many years of neurosurgeons declining to do so. Thanks for the feedback.

I would like to get feedback from other Neuro nurses who have taken care of patients that have had aneurysm clippings. I have had two patients over the last two weeks who had similar clippings and I have seen patients who were alert and oriented x 3, and now alert to person only and unable to care for themselves. They both have ended up with Peg tubes and will end up in skilled nursing care. These patients were viable adults prior to surgery and I am struggling to understand if other Neuro nurses have had similar results. One of the patients was slated for a VP shunt as she had fluid build up on the right side of her head but after several days of CT scans the fluid sac decreased and finally dissipated but the patient has remained somewhat lethargic and and disoriented. This is a woman who prior to surgery was walking to the bathroom and holding intelligent conversations. The other patient has been agitated and has slurred speech and on multiple assesement is not even oriented to person. He had some issues prior to surgery but was walking and talking and working a full time job. I would appreciate any feed back from other nurses on their experience with this procedure.

I can't say I am comfortable with death. I work with alot of the older population and deal with strokes and brain injury or tumors. I can say that my opinion on DNR-DNI has changed over the years. I now believe in quality of life over quantity. I talk to families more open about their loved ones and when I have a patient pass, I am sad but I don't feel bad about the fact that this patient was laying in bed and unable to do anything for themselves. I shed tears for the family because they have lost a family member but not for the patient who is now at peace. I don't want to rush them to death but why prolong a life that is now longer viable. I have cried with families and am not ashamed of it. I feel I still have compassion and I can make a difference in a families life by being human.

REALLY? He thinks he can scare me?? I'M A NURSE!!

I have read the different replies & all I can say is, I think this little student came into nursing with stars in her eyes, thoughts of saving the world and wearing cute little scrubs. I work at a teaching hospital & am always happy to help the students when they have clinical on our floor but guess what- I am not being paid to teach, that is the instructors job. I will answer questions when I can but I have so much to do that I can not stop & stroke your ego as a new up and coming nurse. I think my dear you need to grow a tougher skin or you will be crying in a corner ALOT. I don't spend my paycheck on drugs or steal them from disoriented patients. I don't spend my day making sure all the staff around me is happy or likes me, its not high school and I am not worrying if the popular kids like me, but ask any of my patients & their families and they will describe me as a caring, compassionate and loving nurse. So my dear just because a nurse doesn't stop and pat your hand and tell you that you are wonderful, don't judge her or him. Chances are they are patting the hand of a patient or family member who more deserves it or needs. I have learned that nursing students are quick to judge what they do not know. Check back in a few years & give us your opinion & it may be a different perspective.

No you don't always get the assignments with the most difficult patients. No one else seems to struggle with these patients, so give some thought as to why you find them so difficult. ;-)

I was an older grad so I didn't have any unreasonable expectations as to what I was getting myself into when went into nursing. I have since seen alot of new younger grads who went straight into nursing from high school burn out quick. They complain about this not being what they signed on for & the work load is too much. I agree that I have seen more & more responsibilities placed on the RN's. I have spoken up at times when there certain tasks are handed to me, these things are busy work that take time from my patients. Many of these things are Press Ganey related and although I understand it is a business, I also realize that if you want those ratings you need allow me to spend time with the patient & family. We police everyone from the CNA to the doctor but we are the line of defense for the patient. I personally think that new grads don't fully understand that nursing is not cute scrubs, hanging out with cute doctors, and taking home a decent paycheck. If you put in perspective, the amount of time, work and responsibilities they do not equal the pay. I think this pays a hugh part in the new grad turn over. They have unrealistic expections and when reality hits, they bail.

Joe thought he had reached Heaven and then discovered it was just a doctor with a God complex.

Maybe if he was neutered he wouldn't bark out so many orders & it wouldn't be so embarrassing how he greets the patients, cuz we are getting complaints on his cold nose.

Recently moved from telemetry to neuro floor. I agree it is predictable unit. You know what you are going to do before that patient arrives. Frequent neuro checks but you can get a variety of neurological diagnosis. Report paper I made up is pretty much taken from our computer system. Related to push, pulls, grasps bilateral, smile, droop, sensation equal, pupils, drift of arms, and so forth. Look in your nursing books, but I am sure your floor will have standard papers to follow & you can always google the NIHS stroke scale to get some ideas. Good Luck

I agree that if you feel uncomfortable with the dosage of ANY medication, you need to check with the patient, check the computer and see if this is the patients norm, and you can always double the order with the doctor. Always follow the your gut.

I agree that people not following protocol and doing proper flushes before and after is a problem and not crushing meds fine is another. The free water flushes are very important. I get Peg tubes every once and awhile and when these people come from a nursing home you can tell the ones that have been properly maintained. That first flush you do on the tube tells you what has been going on. Most of the people who come in with the peg tubes are dehydrated but it depends on what they are there for, be it diarrhea, emesis, or patient is on a diuretic and hasn't had labs checked for ever.