Sonia,RN

Don't think so. I'm definitely not as sick as I believe I would have been had I gotten the flu outright. No GI symptoms, no fever. Also, I had no symptoms at all until the day of my first vaccination. Still, you're right that I probably was exposed to multiple flus throughout the week. I observed all precautions with patients, though. Sonia

Well, I went against all my initial outrage against the mandatory flu shots, and I got the seasonal live vaccine (nasal spray on Tuesday). This left me with a sore throat and runny nose, and very fatigued for 3-4 days. I understand these are within normal limits for the 10% of the population that is supposed to experience side effects. On Friday, I came back to work, and the H1N1 vaccine had just hit our floors. Only 300 doses were available and they were going fast. We had to decide on the spot, and I decided to get the shot. The shot didn't hurt, though I began to ache as the evening wore on. I was scheduled to work the weekend, and our managers throw a fit if anyone calls out, so I didn't even think about it. I woke up with a strong cough, and a bronchitis-like feeling of inflammation in my lungs, plus I was coughing up yellow stuff. Also there was a severe headache and body aches. That's all, but enough to make one miserable through a 12 hour shift in the ICU/CCU. I could tell that my patient care definitely suffered, as I did not have time for any of the extras. So on Sunday (today) I called out, let the chips fall where they may. I am still in bed as I write this; the aches are mostly gone, but I definitely have bronchitis and will need to stay in for a few days (I tend toward repeat bronchitis with any cold or infection, though I am rarely ill). This seems to me a very severe side effect grouping from a shot that is supposed to prevent the flu. Why then, did I get the first flu vaccines of my life, shots I have spoken out against on this forum, without fighting administration? The answer is what I have seen hit our floors in the past few weeks. Young people in their 30s and 40s are dying of ARDS and necrotizing, mysterious pneumonias, and all of them started with H1N1-like symptoms. These people are very sick and though they have co-morbidities, it is highly unusual to see people like them, without a history of chronic hospitalizations, become so ill, while being so young. We have lost a few already. Others are still fighting for their lives. And it's only October. The probability of being exposed to it in my line of work is very high. And we don't know if the virus will change in any way during the winter. If it did, I imagine those who got the shot would still have partial immunity, just as those in 1918 who got the spring flu never came down with the deadly winter version. More importantly, I don't want to be the one responsible for giving a patient this virus and then watch them deteriorate. So is the vaccine safe? Probably, though not exactly harmless. From those who I've talked to, it seems like the percentage of side effects is closer to 30 than 10. And my personal opinion is that those who have reactions are more likely to be those who, like me, and some of our foreign residents, have 1. never had the flu vaccine and 2. were raised on a diet and in an environment relatively free of additives and chemicals. So our reactions are stronger. Of course I have absolutely no research to back this up with. Thoughts? Opinions? -Sonia

Several nurses and one resident I know at our facility have been stuck with HIV-positive ABG needles in the last year, which have a much higher rate of transmission than insulin needles, and fortunately they were all ok, though they did go through the obvious freakout and drug therapy stage. I myself have stuck myself twice in my nursing career, once an insulin needle and once an ABG needle. It's a horrible feeling but the chances are very small. Both times the patient was a little old man, HIV and Hep C negative. I was lucky. I am sure you will be ok given the circumstances Sonia

Thanks! That's actually pretty helpful. I'm going to do my best to try to do that. Actually, if we just were correctly staffed, the tech issue would not be such a big deal. And we have had a lot of poopy patients lately.

Our ICU/CCU has 17 beds and is divided into two sides, the ICU and the CCU. This makes the secretary situation more difficult, as when we have one, one side is also neglected. But the bottom line seems we are not alone, others are working under tech-less condtions. It is nice to know what is going on with your own patient, (how their backside looks, what their hourly fingersticks are, ect.) It's just been exhausting lately, and I'm fairly speedy and well-organized (not a newbie). Those who are less organized routinely stay 1-2 hours late to chart. (ouch). I used to always get out on time, but lately I have found that I have to stay 15 min.-1/2 hour. Not bad, though, compared with the others. Cardiac rhythms, by the way, we would always monitor ourselves. No tech would be entrusted with that work. There are telemetry techs only on the telemetry floor in our hospital.

Thank you for your comisseration. I agree with you that even one tech would not change matters greatly. How would you suggest writing up matters (incident reports) without creating an atmosphere of blame and harming the reputations of my co-workers and myself? It seems like a good idea, but I have little experience with incident reports as I rarely write up matters except if there was patient harm or good possibility of patient harm.

"We hear your concerns, and we will address them at our next -----meeting." After which, of course, things go on as before. Also, "That's not in our budget for this year, but we'll look at next year."

Have any of you ever worked in an ICU without techs. I do, and I can assure you it is no picnic. Apparently, techs were abolished by management before my time; I am not sure of the original reasons, and we have never been successful in bringing them back, although we bring up the issue at each staff meeting. I have worked in this small city ICU/CCU for two years. Our patients are mostly medical, and some of them are very sick. We have two patients per nurse. And we do everything--hourly vital signs, fingersticks, daily weights, clean poo poo poo, wound care, regular critical care nursing care duties, obviously, linen changes, feeding patients, bringing drinks for family members, (of course) and often, physical therapy and swallowing evals (while we are waiting for these departments to come, sometimes days--or the intern/resident forgets to order these consults until we, or the intensivist, remind him to). Sometimes, there is so much poo to clean that meds get given very late and tests get delayed. Often, one patient has to lie in poo while his nurse cleans her other patient. It is exhausting. Most of the time, we are short staffed, as our managers will not hire new staff due to the economy. If a patient refuses their bath on night shift, or the night nurses do not have time to get to it, the day nurses are simply not able to get to it, either. We are not assured of a secretary, either, and some of the ones we have don't do their job at a correct pace, either. We are expected to assume secretary duties if the secretary is absent or neglectful. This includes answering phones, showing visitors back, taking off orders, putting them in the computer, and updating kardexes. It would be nice to hear if we are alone in this, or if there are other ICU/CCUs without techs. Any suggestions for accomplishing change? Thoughts? Ideas? The only possible advantage I can see is that we sure know what's going on with our patients--if we get into both their rooms often enough.

Towson U has a good nursing program. I found it fairly easy (I graduated 8 years ago) too easy in my opinion...I believe (from speaking with the faculty) it has gotten a little more strict since then. I like the flexibilty of the faculty. Some of them are really fine professors. I am in Towson right now for my master's in nursing education, so maybe I'll see you around campus!

My facility has also mandated flu shots and H1N1 shots this year. I am deeply disturbed, because, for many personal reasons, I have never wanted a flu shot and have always refused one, even writing letters to management when necessary. This year we are not being given a choice. What I do not understand is, given that fact, why we still will be giving our patients a choice. If, as Duluth Mike says, unvaccinate people KILL, then, shouldn't we mandate vaccines for everyone, including all of our patients? I have not had the flu since the spring of '04, and it was the Asian strain that that year's flu shot missed.

One field which prepares you for many different fields is telemetry. I recommend telemetry to any new nurse because you get enough patients to practice time management, but not so many they overwhelm you (med-surg has in some places 7-8 patients), sick enough they challenge your skills, not so sick they are unstable, fast-paced, but not so fast you lose the ability to be organized (like in some E.Rs) There is usually a lot of need in tele, too, and most units at a non-open-heart hospital will accept new grads. 6 months to a year in tele, and you can go anywhere. . . Of course I practice in the U.S., I never had a residency.

House. He says all the things I wish I could say.

Sorry . . . what is a residency? Does a legal commitment keep you where you are? If it does not, I have some general suggestions. But I need to know a little more about your situation. Do you have your degree free and clear? Can you leave one position for another? Is work easily available where you are located? Let me know and I will reply.

I have been a nurse for 8 years, I can say unequivocally that I get sick much less often than my husband of two years, who is also very healthy. I work with very sick (from an infectious disease perspective) patients in the ICU/CCU. The good thing about an ER nurse is that you may be exposed to a lot, but not for any extended period of time as we are in the ICU/CCU. I actually think that constant small exposures to bugs RAISE immunity over time, perhaps that is why I just don't catch things easily. Even my first year, I was sick no more than normal. If a nurse sticks to the prescribed standard/contact/airborne precautions, there is no reason he or she should even be exposed to what's out there. Few contagious diseases in this country are dangerous, except for tuberculosis, and that, one is constantly checked for (yearly PPDs). I work with nurses who have lupus and other autoimmune diseases which requrie immunosuppressive therapy, and they are just fine. I hope this alleviates your concerns. There is truly not much to worry about. -Sonia

In some telemetry units, and cardiac cath units, there are lower rates of transfusions. Why? Sonia