justanurse

Don't take the assignment unless you're trained in caring for the vent patients. You need at least some orientation in what care you should provide these patients with. Some training on the ventilator itself. Not to mention managing the airway if a problem should arise. Surely they can train you. And, if they can't then they should readjust the assignments to allow for patient safety. Should not ever take a balloon pump patient unless you have been trained. Very dangerous to the patient. They are unstable, that is why they are on the balloon pump in the first place. Too many things can go wrong with the slightest miscalculation or oversight. Stick to your guns.

And, so far haven't been burned. I re-read my orders back so I know & the Doc knows I've got it right. Did hear about a very good Critical Care nurse who worked in ER and had a Doc tell her to start TPA on a CVA patient. She re-verified it with him and had consent signed, gave the bolus and then he tried to retract the order. The ER Doc stood up for her, as he had heard the exchange of order & confirmation. Now that is one Doc I will be leary of in the future. But, of course, you have to be careful of all of them. They are the doctor after all and don't make any mistakes. The mistakes are always the nurse's.

I worked 4 years in orthopedics until I went to CCU on the "buddy-plan". I worked 10 years in CCU and then did CN over our CCU/PCU (tele). I loved it (most of the time). It took me 8 or so years to say my worst day in CCU was actually worse than my worst floor day. If your hospital is like my hospital, the telemetry nurses are some of the most over-worked nurses there. Way too many patients, not enough staff, and expected to care for patients that should be in the units. I know all areas are like that now, but I have worked with too many nurses that floated off tele to other floors and had a much better day with less ill patients. Can you float to some of the units to check them out? If you can, you will see which ones are receptive to new staff. I love critical care. I am now in our float pool and go to ICU, CCU, PCU, ER. I started that this summer as I burned out as CN and didn't want to step back into a single unit role yet. Don't get me wrong, I have much respect for nurses who work the floors, (been there, done that) it's just a whole different ball game. Whatever you decide: GOOD LUCK!!!!!!

IABP = Intra-Aortic Balloon Pump This device is a near ventilator size machine attached to an arterial line placed into the patient's femoral artery. On the end of the line is a balloon that is rhythmically inflated and deflated with helium. This is timed just right by the machine to correspond with the patient's heart rhythm. As the balloon inflates it pushes blood back against the aortic valve and into the cardiac arteries (increasing blood flow to the heart) and down the aorta (increasing blood flow to the rest of the body). The balloon has to be positioned just right by the cardiologist (or other specially trained Dr) so that it does not occlude the renal arteries or the left subclavian artery. Hope this helps!

I've just landed my ?dream job. I will go from making $44K to $34K (which is only a grand or two less than I made last year before my big raise), but I will have two months off with pay, and can still take the 7 weeks of vacation/holiday time I earn each year. So, if I plan it right I can have almost 4 months off with my family in a years time. Working 3 days/week, doing bedside nursing care which I love, receiving full-time benefits. I'm going to have to pull in the purse strings, but I'm going to get to enjoy my kids while they're still little.

The physician usually orders a dosage to begin with. You can increase the dosage every 30 - 60 minutes to get the desired effect of pain control that your patient needs. Possibly more often at the beginning, then back off once patient is more comfortable. I usually only go up 1-2 cc/h each time. It depends on the patient. Check your policy at your facility. HTH

No regrets to having gotten "only" an ADN degree. I went straight out of high school, knowing I wanted to be a nurse. I received a full tuition scholarship to our local community college for my ADN. I told myself I would go back to school within 5 years to begin my BSN. It's almost 15 years later and boy am I glad I didn't do it. The degree isn't what is important to me, it's the nursing. I can do whatever *I* want to do with the degree I have. I like patient care, am a Charge Nurse over our CCU and PCU departments and am as high up on the management ladder as I ever want to be: just one rung below it, not on it. Now, don't get me wrong, if you really want the advanced education, GO FOR IT. To each his own. I don't think anyone is better than someone else just because of their degree. I work with some nurses who are going after their masters, God bless them, it's just not what I want in life. May be different one of these days. This degree started out to be a stepping stone to something else, just now I happen to kind of like this stone & maybe even looking for a different path.

Yep, did that too. I took over as one of the Charge Nurses in our CCU 3 years ago. For two years, I wore many hats. Many times I had 3 patients right along with everyone else, praying "please, God, no codes today." As of a year ago, I don't have to take patients. Now I just have to charge over our CCU & 27 bed PCU. Oh, more hats. Assistant manager is what it's like. When I had to take a patient load, some days most of those hats just had to stay on the rack. First things first, the patient. Other staff usually don't like it, but I'm not going to let someone suffer or die because someone else is wanting my attention. They'll just have to wait. I've tried to spread myself too thin, but I just don't spread in the right spots. There are two words that accurately describe any charge nurse positon: IT SUCKS. I'm going to check out the grass over there myself, it's a pretty shade of green from here.

Hi, telemetryrn. Here are the sites I have found helpful with my palm: www.rnpalm.com/software.htm www.pdamd.com This one will probably have more options for you, since your software probably differs from mine. If you can find and download epocrates drug book, I highly recommend it. It is very up to date and I enjoy having the information right in my pocket without having to carry around a big book. www.memoware.com/Category=Medicine_ResultSet=0.htm This one has a lot of programs. For many of them you have to download/buy a special reader. If you are careful and determine which types of files you can download, you can pick and choose what you want. www.pdabookstore.com This one has many little stories, etc that can be downloaded for reading during your spare time on the job. Good luck and I hope these help you out. [This message has been edited by justanurse (edited February 21, 2001).]

Be very careful. Check out your policy. At the hospital I work, we had a state review last summer. A nurse received an order to give Haldol to a patient who was very uncooperative & combative in an attempt to sedate the patient. The nurse did not chart any s/s of psychotic behavior and we had to defend why the anti-psychotic medication was ordered/given & not a sedative. Yes, the nurse should have charted a little better, but hind-sight is 20/20. Haldol is an anti-psychotic. At our facility we use Versed for sedation, along with a little MS or Demerol for pain control. Both of these are reversable quickly if needed. Good luck!

I am so sorry for what you are going through. My own personal feelings are that that patient should be held accountable for her actions. As we all should. Should she be allowed to hurt others just because she is ill? No. Unless she is declared incompetent, that attorney should press charges. Unfortunately, she would probably say, "poor me, I'm sick, no one wants to help me, and now I'm being punished for being ill." Which is probably a big hold up for him in pressing them. I'd keep after that gentleman to press charges. If it were me, I wouldn't give up without a fight of my own. But, then I don't seem to be having much luck with my own little fight. Good luck to you, & God bless you.

This is a hot topic in the CCU I work. Our policy is 30 minutes visiting 5 times a day. Our staff would like it to stay that way, but it never does. It is very difficult to enforce strict visiting times. I have a difficult time myself enforcing the policy, and usually do not for the simple matter of personal experience. I spent several days with my husband in a large hospital, 2 hours from home, worried that he was going to die following an MVA. Their visiting policy was visit for 5-10 minutes then leave, no one was supposed to stay at bedside for long periods, and the unit was locked down (no visitors, no exceptions) for 4 hours in AM & 2.5 in PM. It was locked down during those times, for personal care, and the Drs to make rounds, change of shift, etc. The nurses were very nice to me, though, I stayed at his side 90% of the time there was not a lock-down, only leaving long enough to sleep. Didn't need to drink, that would mean I'd have to leave and go to the bathroom. I have told the staff I work with what I feel is fair to all. The patient comes first. I feel that one family member may stay at the patient's side with the following exceptions: when a procedure is to be done, at assessment time, at bathing, BRP, etc. The families should not trek back and forth down the hallway, changing out every 30 minutes. The family member needs to stay in the room, not looking out down the hallway, or in another room. By all means, I would like the family member to be able to talk with the physician, ask them the questions, and then I would be able to re-iterate what the physician has told them and help them to understand it. The family member should be supportive of the patient, not argumentative or disruptive to their rest. There should not be several family members in the room constantly, just the one. At visiting times, I would understand 2-3 visitors, for patients who are stable. Unstable patients, those with lines, on vents, post-op, should be allowed to rest without disruptions of visitors trying to talk with them, and the visiting times should be enforced. Patients who are DNR's & are not expected to live long should be allowed to have family to visit as they wish, as long as the nurses are allowed to care for the patient appropriately. And, families should not be allowed to sleep in the unit, they should return to the waiting room for rest, or go home, no exceptions to that rule. Every family thinks that their situation is unique and is as critical as the next, your staff will need to be strong in enforcing the rules as you set them out. There is another thing that you should consider if you are contemplating a strict visiting policy: will your manager be supportive and enforce the policy when a family complains? Ours was never enforced by a manager, they always seemed to break under the complaint and tell us to let a family visit as they wish. If that happens, then you can never seem to get it going again. Good luck!!!

I got a palm handheld for christmas. It's very nice, the one I got has 8M of memory and cost $250. You can get a handheld computer for ~$600, that has 32M memory, even. I've downloaded a lot of info onto it for free from different websites (2 drug books, a ABG decoder, drip doser, Pediatric emergency dosage calculator, etc). There are lots of other info you can put on it for purchase. Pretty cool. If you're interested, I'll be glad to post the websites for the downloads.

Ours is paying a $50 bonus for a shift (either staying over 4 hours, or working an extra day), when it's deemed "critical need". On extra days, that are listed as needing help at the beginning of the schedule, if you sign up in advance, you will get 1 1/2 time for the whole shift, even if you're not into overtime. And, if you ask for it, you can get a sick day removed. That's what it is right now, who knows what it'll be in two months.

I'm with Jenny P. As of last spring, I am cargiver to my husband. Let me tell you, just because you know what's going on, doesn't mean anyone thinks you do. Doctors and nurses start to explain things to you and then when you tell them that you're a critical care nurse, they start to back-pedal pretty quick.