CCRNCCU2008

bard manufacturer (which is who we use) says not to pretest as they test 100% of foleys per quailty controls.

there might be alot of med/surg rn's who disagree but, i would feel the same way as you if i worked med surg, it seems that med surg at most hospitals are very poorly staffed, when cuts need to be made med surg is usually the first on the chopping block. If i were in your shoes i would look at working ICU, CCU, PACU, OR, Cath lab, peds, picu nicu (basically anything but medsurg) those units typically are staffed better. However, as you stated you had a "cry out session/anxiety attack/hyperventilating session" if this is happening often you might think about seeing a doctor for help with panic attacks as nursing is not a typical low stress job.

I think most of us have had horrible days, try to calm down step back, breath, learn and dont let it happen again. My personal worst was about 6 years ago. First week out of new grad orientation on a step down icu, 3 of my fellow staff memeber were new grads also (the charge nurse the only experence on the unit had left the unit for dinner) long story short i gave diazapam 20mg when i was supposed to give diltiazem....pt was intubated for a day then they were fine, i wanted to hide under a rock for about 6 months, almost quit but very glad i didnt. Still i get a pit in my stomach when i think about diltiazem or diazapam. Point of the story, we all are human and make mistakes try not to beat yourself up to much.

we do not wedge (often) at our hosptal do to one of our cabg pt's dying from pa rupture when wedging. Also a wedge doesnt really give you a bigger picture compared to the rest of your numbers

I say go for it. If you dont want to do charge then your not going to like it. I think if your unhappy where your at and you think you will be more happy else where then go for it, dont wait. Atleast thats what i would do.

st elevation is caused by delayed/altered conduction through dying or 02 deprived tissue (the part of the heart that is dying). that's what the ekg is picking up.

You are being way too hard on yourself. Or at least it sounds like it. Hanging an antibiotic a few hours earily or late is no med error in my book. That is low on the priorty list of things to get done... Keep them alive ABC's hanging a antibiotic is down around XYZ. After the epi, neo, levo, vent, ect. dont stress so much... dont sweat the small stuff.

We (RN's) on our unit pull the IABP, the md is not even required to be in house. This has been done like this for many years. It is with in the scope of the RN as long as they have been signed off on it (atleast in the state of NC) We have never had problems. We do not use femstops often (try not to) Best Practice states manual pressure is best, it has the lowest complication rate. When a femstop is place on the RN tends to not watch the site for the entire 20-30min and when they go back after 5 min the patient has had complications. Manual pressure always best. (i have the lit to back this up if you would like it)

I actually have been on this unit for several years. I like how we can do most anything without bothering the MD. It is really others (from other departments) outside looking in who are thinking we are doing way to much (out of our scope). I dont think so, just wanted input from others.

On our ccu we get anything cv related now with our cv surg docs (ie cabg, valves...) for our patients we have about 120 different standing orders. Ie: Draw any labs any xrays, ekg's. Start amio for afib, start lopressor if needed, neo, nipride, mag, k, lasix, albumin, hespain, insulin gtt ntg, we can start/titrate/dc almost 40 different drugs (all without directly talking with the md first) dc aline, place or d/c f/c, d/c swan, d/c central lines, and the list goes on and on. All without talking with the md first the and god forbid you call them for one of these things esp at night unless the patient is dying b/c they will say you have a standing order for this and hang up. Pa's donot round in the ccu only on the step down units, often the cv surg docs make rounds by asking the rn's "how are they doing" then writing a 2 line note in the chart and moving on. I know this is not the best way to practice however we are ranked #1 in are state for overall cv surg outcomes. I just want to know if anyone else is exposed to this type of unit? Is this common?

BEDSIDE RN's (CCU) always pull them without an MD present if its at night the mds that deal with iabp are not even in house... never had a problem (matter of fact pulled one last night)

I work an avg of 48 hrs a week bring home 105k to 110k per year as a little oh bed side RN