opossum

Original poster here....it's been 4 years since I wrote that post. And I can say with confidence that it DOES get better. It gets easier. I've learned to accept that I will never be perfect, nor should I be: if that were the case, I would never learn. Which would be calamitous for a nurse, right? I'm still in ICU, but at a different hospital. I love ICU - I've learned what my strengths and weaknesses are. I know what I don't know and I'm never afraid to ask, no matter how "stupid" I feel. I think it gets better because confidence in my own competencies, as well as a trusty team of other nurses around me continues to help me provide great care. Thanks, everyone, for all the wise words!

I've been a nurse for 4 yrs now and have both ICU and M/S experience. I've run across several nurses (almost all from M/S) who tend to downplay their knowledge and skills, as if they're not 'good enough' to work in critical care. What's up with that?? M/S is hard work and you do use your critical thinking skills, just in a different way. Never, ever underestimate what it takes to work in a less acute/subacute setting. As a full-time ICU nurse I get sick to my stomach at the thought of floating to the floor. 6 patients?! What if I miss something?? Anyway, it sounds like there is a high turnover in your M/S if they're paying a $3/hr differential.

You are quite possibly the Worst. Supervisor. Ever. And....your scrubs are hideous.

Just stumbled upon this thread. I love courage wolf, too! My favorite is this: Not *exactly* courage wolf, but similar. Like his cousin.

My stock answer is "I have a boyfriend and a cat". The other night, I had an elderly woman w/mild dementia who asked me the marriage question, to which I gave her my stock answer. She then said, "Well, what're you waitin' for, Christmas?" I think most people are just making conversation - they're scared, hurting, lonely, etc. and just want to connect sometimes while in the hospital. I get more annoyed by my coworkers (and family) who keep asking me why my bf and I are not yet married!

That's true, there always will be "those" families that impede your workflow. Then again, I really would expect parents to hover around their children...it's the adult ICU patient's sister's boyfriend's cousin's dog's brother-in-law bombarding me with questions that really irks me and sets a bad tone for the shift. I guess I just need to get out of this negative mindset I have about visitors in general. And, of course, giving a thorough bedside report without violating HIPAA, etc.

Love this. Thank you, CheesePotato.

Sorry you have to work with these people...sounds like your coworkers need to 1) lighten the &*^% up and 2) get over themselves. It was good of you to get out there and try stuff! Don't let immature folks dictate how you feel.

Well, it looks like we've revised the policy to basically reflect what the AACN recommends: http://www.aacn.org/WD/practice/docs/practicealerts/family-visitation-adult-icu-practicealert.pdf We agreed that it should be flexible enough to allow nurses who want to keep the doors locked to be able to do so, but I'm worried about the inconsistency. I don't know...we'll see how this works! Thanks again for all your input!

Thanks for all your replies; it's good to get a sense of what policies other ICUs have. Ours is pretty generous, as we let basically anyone in, however many want to come in as long as it doesn't interfere with patient care. We have a locked unit with a camera so we can see who is buzzing in. If there is an entourage waiting to be let in, I'll usually go to the door myself and request 2 or 3 at a time. We also restrict children under 12. Interestingly, when reviewing the literature, I found that there is no evidence to support restricting children based on fear of infection to either the child or patient (Knutsson and Bergbom, 2007). They actually refer to previous studies that support this...Nurses' and physicians' viewpoints re... [Nurs Crit Care. 2007 Mar-Apr] - PubMed - NCBI My main issue at this point is whether or not we should pursue this idea of doing away with shift change restrictions altogether. I'm going to see if HIPAA requires it. I would feel it would be in both the patients' and nurses' interests to have adequate time to do report and assess the patient.

Hi everyone, I'm currently looking at various policies re: visitation in the ICU and it got me thinking about issues with shift change. At our 10-bed ICU/stepdown, we restrict visitors from 0700-0730 and 1900-1930; my personal feeling is that we should extend it to 0800 so that each nurse has enough time to at the very least give the patient a once-over after receiving report. A coworker suggested doing away with visitor/call restrictions during shift change altogether, in the name of family centered care...I did a cursory web search for any studies focusing on visitation and shift change, but came up with nothing. (I plan to research more extensively on EBSCO or other scholarly database in the near future). There is, however, plenty of anecdotal evidence abound. My question to you all is: have you heard of open visitation during shift change? If so, do you know how well it has/has not worked for that unit?

Everything you've described sounds like a "good" patient to me; I'm glad you've recovered. It must be tough being in the hospital, feeling miserable and worrying about stressing out the nurses...but I think that empathy you have for others is what makes you a good patient and, likely, a good person. Sounds like you were on your call light for completely appropriate reasons. If anything, the nurses may have sound harried around you because they feel bad for their one "normal" A&Ox4 patient with legitimate needs for pain meds and toileting, who is being neglected due to the 5 other patients and family members throwing tantrums over a forgotten diet coke or other perceived injustice. As far as insurance goes, it has no impact on the care I'm providing. I can easily find out that info just looking at the facesheet but I just don't care and can't be bothered.

I think I know this guy...

I work in ICU, but also oriented to the ED a few times...I thought I'd like it but I learned that indeed, I am simply not cut out for ED nursing. I lack the patience and wherewithal to deal with the nonsense described above AND drop everything to attend to true emergencies. I get too confused, frustrated and overwhelmed...maybe it's just our ED (which is overwrought with structural problems as it is), I don't know. Anyway, I remember one night I was orienting over there and a 20-something perfectly healthy young woman comes in, c/o shoulder pain after washing her kitchen floor all day. I just could not understand what she wanted us to do about it. I think she got an X-ray or something and some pain meds to take home. Diagnosis of "shoulder strain". Just weird.

Sign-on bonus...isn't that the nursing world's unicorn? In all seriousness, I think I've only seen them offered by travel agencies.

I remember first learning about this at an AACN conference last year and was blown away by it - it truly does lead to faster extubations. However, I think it requires a dedicated team approach of MDs, RNs, RT and PT to make this all happen; in my hospital, that's simply not an option. We're a small, rural hospital and do not have enough staff around to just even get the pt UP. It's sad, because it's something from which a lot of intubated pts could benefit.

Welcome to the hospital...sorry you're sick. Section I Here's what I care about while you're here: Blood going round and round Air going in and out* *Not necessarily in that order Section II Here's what I don't care about while you're here: Ingrown toenails Vague rashes you've had on and off for 50 yrs Boredom Chapped lips Fetching snacks for your girlfriend's sister's dog's cousin's best friend who heard you were in the hospital Nail clipping (okay, ANYTHING involving your toenails) Hair curling (in the ICU...true story!) Us not having your preferred sweetener Removing stitches from your mom's (not a patient) hand (true story!) Removing the juice container top foil seals juuuust the right way If you're not sure I'm going to care about a particular complaint you don't see listed, please see section I. Thank you!

Yes!! I work both ICU/CCU and Med Surg...I've learned that it largely depends on acuity of pts and staffing ratios (which are almost always stretched to the limit).

I agree...I just don't know how to approach this. It seems overwhelming. Strength in numbers, perhaps? Regarding the fact that "nursing care" is included in the charge of the room...I'm still floored by that. I remember a preceptor in nursing school telling me that was the case and just not wanting to believe it.

I love grumpy old folks. I also love watching any patient make a big recovery when their prognosis was grim from the start. Anyone who uses humor to cope - it's how I deal w/stress and uncertainty, so I feel more connected to these pts

I have a hard time with anyone presenting with vague pain. I feel helpless as it is and if there is indeed something psychosomatic going on, I feel even more at a loss. I'll take the DT pts...

It sounds like for you, this is not really an issue of nurses speaking ill of patients, but one of *people in general* not speaking ill of one another. If that's the case...if you've never said a bad word about anyone - ever - then you are a better person than I am. As for myself, I'm human and will admit to badmouthing other people when I feel they are acting entitled, rude or abusive. And no, it should never happen within earshot of patients...sometimes it does and that's unfortunate. Just curious...why do you think that it is "presumptuous and false" to think you'll never become "one of those nurses"? Do you mean you'll never say anything bad about another person? I'm not trying to antagonize you here...I guess I just want to know what you mean by that.

To a pt's family member: I seriously doubt you'd pass "the nursing test" just because you've "been in and out of hospitals so much." Also, please DO NOT touch the ventilator settings. (I actually did say this loud and clear...This same family member offered to "mess around" with the vent whenever it beeped.

I call the SOMA bed "mosquito netting". I also had a pt (WWII navy vet) refer to using the urinal in bed as "pumping the bilges"