Ashley_RN

Sorry just seeing this.... Do you mean staffing ratios? Like nurse to patient(s)?

I work at Brigham..... Weekends $9/hr Nights $4.70/hr Evenings $3.20/hr

2 nights before this past Christmas, I took care of a woman who had end-stage IPF... she was originally admitted for a lung transplant workup & deteriorated very quickly, never able to leave the hospital.... She was ready to transition her care to CMO but wanted to wait for her young daughters to get there & stay 'awake' for them as long as she could (She was only 50yrs old, with 2 girls aged 19 & 21). She did not want to be intubated & was 'tolerating' continuous bipap at its highest settings and by tolerating, I mean any change in position, even shifting to get comfortable, caused her sats to plummet anywhere from the mid-teens to the 30's... It would then take her ATLEAST 10 minutes to recover them back to the low 70's. These episodes would come on at random as well so I spent my whole shift at her bedside, catering to her every need to keep her & her family comfortable in anyway I could. Each time, I held her hand tight & prayed outloud (her request of me) while she got through these episodes. I also spent most of my shift crying, hiding it from her & her girls, as I watched them cry & hug eachother tightly all night. She was placed on a morphine gtt & passed away the following day on Christmas Eve She was the loveliest woman, I think of her & her girls often... I hope they are doing okay. The lowest her O2 sat read on the monitor that night was 15%. (It was her request to keep the oximeter on, she said it provided her the strength to keep going after each 'recovery')

My apologies OP, when I couldn't read it forwards my brain figured out something else! Haha I literally did not see therapist, too many Law & Order's for this lady I guess... :)

The OP's username is 'the rapist' spelled backwards.

1. Boston, MA 2. September will be 3 years 3. Thoracic Surgery ICU 4. $34/hr 5. Extra $3.20/hr for evenings, $4.70/hr for nights and $9/hr for weekends 6. Yes, Massachusetts Nurses Association

Yup & love it! :)

I work in MA and anything over 12hrs is DOUBLE TIME :D

Stumbled upon AllNurses frequently throughout nursing school, more so during my final years.. Think I joined somewhere in that time frame. I am on it everyday, multiple times just browsing, enjoying, learning :) I dont post often but I am here alot, sooo I guess I'm just a lurking member

[0.2mg each dose/7min interval /3mg lockout in 4 hours] is our typical Dilaudid PCA orders; however, everyone is individualized. What is the pain for? Any option for bolus doses? I second the pain specialist, if available. They are wonderful & creative as the poster above stated. If Dilaudid isnt working, what about a changing the med in the PCA? Fentanyl? Morphine? Although in my experience (which isnt saying much, Ive just passed my year ), I'm usually switching from Fentanyl to Dilaudid for better pain control. Does his meds need to be IV? Can he be changed over to something longer acting, ex. Oxycontin with breakthrough PRN? What's his HCT & renal situation, can Toradol be of some additional help if IV is the only way? I absolutely feel terrible for patients in pain; has your MD SEEN the patient? When I'm working with a "stingy on the pain meds" doc, I tell them to get their butts in to see the patient so THEY can be the ones to explain why they will not order anything further. Sometimes after seeing the pain on the poor patient's face, they come around :)

just wanted to say thank you ruby vee. i was a little sad/upset to find out i was working all 3 winter holidays this year and although being the newbie i expected it, it still felt crappy. but your view on the situation has really made me feel so much better about this year & years to come when i have a family of my own! so seriously, thank you and happy holidays! (on whichever day they may be)!! ?

I had a walking 4x/day, completely independent with ADL's, no mobility issues patient throw a PE on me before; turns out, he hated the shots and since he was so active, some nurses were letting doses slide. Well, sure learned the hard way. Since then, I never hold any Heparin/Lovenox, etc... just offering some advice after our mistake

I work 1900-700 so I'm able get to know my patients very well within the 1st 2 hours of my shift since they're up; however, if I do come in at 2300 & they were already sleeping here's what I do: knock politely, lights on and speaking softly "Hi Mr/Mrs So&So, I'm Ashley_RN and I'll be here with you til the morning; I know its late and you're trying to sleep so I'll try to make this as quick as I can, but I do need to get a good look & listen about everything that's going on with you so I can ensure I'm watching you safely overnight." I am also on a acute surgical stepdown floor so I'm constantly saying "I'll be keeping an eye on you and checking in periodically throughout the night; I want you to get your sleep but if I feel I need to wake you, I am going to." For the most part, people are usually receptive. There will be the occasionally cranky ones but who cares, I don't let them bother me cause knowing they're safe is more important. And as far as family members as concerned, I'm not worried about them, it's my patient who I'm there for.

It honestly shocked me at how "whiney" and RUDE people can be when I began nursing. I'm empathetic, I really am.. You're sick, you feel crappy/tired/scared, etc so I understand why you're in a terrible mood.. So I'm always pleasant & let things roll off my back.. But they do nottt make it easy.

We are required to report temps of 101 or above, and oral is the preferred route.. However, working in a large teaching hospital, I have the advantage of a resident who is always awake & routinely rounding at night. AD is definitely a concern but it sounds like that patient could've benefitted from a breathing treatment & some good old chest PT :) Ignore the grumpy resident & move on.... I'm sure they'll be plenty more to come :)