beckster_01

I'm also in the northeast. I agree with connecting with DDNA, an added bonus is that their offices are in Texas. I went to the San Antonio conference in 2022 and it seemed like there is pretty good networking in Texas.

Scene: Patient is comfortably sleeping while on a trach collar, the ventilator next to him reads "STANDBY" in big, bold letters. Resident walks in and stares intently at the ventilator for a few minutes, then looks at me and asks "so what are his ventilator settings at this morning?" There was also that time when I was peeking over the doctor's shoulder while he was looking at a chest x-ray for line placement, then he looks at me and asks (he was not being facetious), "well, do you think it's in the right spot?" "I'm sorry doc, that's a bit above my paygrade, I just like looking at the pictures."

I talk to my husband about work if I need to. When I first started in the ICU I had a lot of things to talk about. But now I usually give simple indicators of how my day was (good, fine, busy). "Crappy" (or @&!#ty) means that I need to talk. It really is important to vent if there are serious issues going on at work. Otherwise I will talk to him about if a coworker is bothering me or there is a problem I need help solving, but beyond that we don't talk much about work.

8- hour nights sounds like a dream. 8-hour days can be tough since there is generally more going on. If you have a busy day there are generally a lot of loose ends for evenings to tie up. When I work 11p-7a it falls into a nice rhythm. Most of the time, of course

I am curious what your "average" is. I time my work drive so I arrive between 6:50 and 7 (or 7:05). It varies according to traffic and the line for coffee. But I also get out early more often than not. It balances out so that the occasional swipe out a 7:45 means that I had a busy day. I guess if I was consistently coming early and staying late I would get talked to, but I think our policy is a 15 minute guideline. We have overtime ALL the time anyways so I don't think anyone really cares. But when it is a patient safety/staffing issue they need to either fix it or leave you alone.

I totally can embrace C-diff for what it is. Truly most smells don't bother me, my nose is actually a little broken! Good call on your MIL- I can't imagine willingly spreading this stuff on my face of all things! Unfortunately capsules are not an option unless you can think of a way to squeeze one down the dobhoff. I have a few days of so I at least get a break. I'm not sure what families think of this treatment. It permeates their skin, and don't get me started on the poop! Opening the med room door actually helps too, at least there is some ventilation going on!

I'm not in a good state to give advice for levels of snark- I'm feeling a little snarky myself today. But you should definitely clearly communicate that this is a patient safety issue. They are nitpicking. Very annoying!

A little bit yes. There is only one case study that I know of, but it isn't an unheard of recommendation. The idea is that Omega3's are essential for neuro growth and recovery, so lets give huge doses to saturate this person in fish oil. But there have been no clinical trials so therefore no way to say that the improvements we see are related to the omega 3's. But since there is low-to-no risk our doctors just do it in young patients with uncomplicated hospital courses- meaning the only thing wrong with them is their brain. Therapeutic use of omega-3 fatty acids in severe head trauma Many nurses make themselves DNR. One nurse I know declares herself a DNRT (do not rectal trumpet).. me? I am a DNGFO. Do Not Give Fish Oil. Any neurorecovery that I have seen is not what I would call meaningful...

Sorry it has been so long to reply, I haven't logged in for awhile. I think he ended up being 1:1 for the next two shifts so about 24 hours. He was on D30 and still needing amps of bicarb, and I think he was still hemodynamically unstable as well. It was definitely an interesting weekend and I got to see the whole treatment through. The article chare posted is the exact article my toxicologist gave me to learn how it works so I recommend giving that a read. As far as staffing it isn't unusual for 1 nurse to be expected to care for two patients on insulin drips, 2 weeks ago I had one DKA and one that was requiring hourly adjustments for reasons I can't recall. But q15 minute checks with insulin running at 75units an hour was a little much. It was a fun experience though, and it worked really well.

We did just break out the essential oils. So now it smells like a minty fish. Or a fishy mint. I'm not quite sure but it is preferable. We also tried getting a hold of activated charcoal but the pharmacy told us they don't carry it (?!?) and ED told us that pharmacy is lying. LOL. Ill be sure to keep y'all updated on this evolving situation

So we have been treating our anoxic brain injury patients with high doses of Omega 3's- the back story is that we had a patient whose mother found research that it helps with long term recovery. She advocated for the treatment for her son (he was in bad shape- Unknown downtime, central storming, totally unresponsive). So a year later while he definitely wasn't normal he was starting to walk and say some things. So now we are using this stuff on all of our young patients with hypoxic injuries. What's the problem? Liquid fish oil.smells.awful. I'm dying right now, it is literally stinking up the whole unit. We have it double bagged in the fridge and I am going to buy baking soda to put in our fridge (I'm sure that is against a JC regulation somewhere). I am calling on you my nursey friends to help me trouble shoot! Any creative solutions? I guess I could just always use Vicks in my nose for the next 2 months- my estimate for an average stay for these folks :'(

Hello all :) Today I initiated high dose insulin to treat a beta blocker overdose for the first time. We have done it before on our unit but it is quite rare (1-2 times in the 4 years I've been there). Our toxicologist gave me great literature so I don't have questions about the therapy itself right now but I guess I am interested in hearing from others about how often your docs recommend this treatment, how you write your protocols, and how you manage staffing on the unit. My hospital has a well written guideline to follow but due to the nature of the treatment it is difficult to write a protocol with titration parameters, so I'm curious to see if other facilities have different guidelines than we do. We start with grabbing baseline labs premedicating with 25g D50, then we bolus the patient with 1unit/kg of IV insulin- In my case I administered 75 units of insulin as an Iv push 😱💀. Then we start the drip at 1unit/kg/hr, initiate a D20 gtt, and watch BG's q15 minutes until, and I quote "you get 2 consecutive BG's that are relatively similar," then space checks to q1. I kept an amp of D50 drawn and ready plus a couple extra for good luck. If BGs drop below 150 we give 1 amp, stop insulin, and call HO to change the rate of dextrose, if the insulin needs changed we are supposed to call toxicology. We check K+ q1hr. I think that is the jist of it but this guideline was 3 pages long. My biggest problem is that using the guideline feels so nebulous. How similar do my BG's have to be to be "relatively" similar? My made up number was within 10points, but it obviously depends on what my interventions have been and how my sugars are trending. If my sugar was 280 and my next two checks are 165 and 161, I'm not waiting an hour to recheck. Even though I LOVE using my nursing judgement, And I trust my nursing judgement, I don't trust everyone's nursing judgement. My docs today were great, but what if they weren't? We have some questionable residents that rotate through, and I felt that if my team today had not been as good as it was, we could be in a dangerous situation. I just have to remember that this is why I work in an ICU- to be able to closely monitor my patient, use my brain, and work closely with the team to make the best decision. Finally- our acuity is high right now, so when I told charge that the assignment needs to be split (hello q15minute BG's), she pushed back. I made her come into my room and look at my insulin drip running at 75 units per hour. Unless this patient stayed therapeutic for several hours I do NOT feel safe trying to care for a second patient, but our decisions to make a patient 1:1 is a bedside nurse assessment. Management is always on call if we are unable to safely staff. Do other units mandate that this patient will always have a 1:1 nurse? I guess I need some reassurance that I'm not being greedy and hogging or resources I look forward to reading anyone's experiences!

Goodness, give the OP a break. It is HARD to talk about new job issues without tipping the scales between sounding whiny vs. know-it-all. I can relate with feeling like you've covered the same ground over and over and still being met with the same assumptions, and honestly I think the OP has handled that well. To address your concerns OP, I have encountered a similar situation as you. I was told all of our techs "haze" new hires, and all but one quit after a couple weeks- all it took was for me to demonstrate them basic respect (I don't delegate to them unless a need to, some nurses go out of their way to find a tech to fetch the blanket that is next to their room). As for the tech I had problems with? I kept my guard raised, I made sure that I was faultless and kept myself mentally prepared to confront her if it was an appropriate situation. I also spent a lot of time learning to read her, she is the type of person that will passively aggressively joke with everyone, but I learned that the more she disliked me the more aggressive the joke. Once I figured that out I played into her good side and now we are pals (not proud of the schmoozing but it worked). Some people will appreciate it if you ask them for help in an area that they have more knowledge than you (our EKG machine is on the fritz, do you have any tips on how to get it working again?). It demonstrates that I am trying to be autonomous but I am still ready and willing to learn from everyone on the team. Between that and a couple strategic confrontations we are in a workable place. I still don't trust her, but that is a different issue than respect. I was a step away from building a list of very specific quotes and situations and meeting with her and a manager to discuss our issues. While this is an ideal situation for true conflict resolution I avoided it because word of meetings like that spread and that isn't good for your image either. But the most important thing you can do is continue to be friendly, don't hold grudges, but remain careful and prepared to intelligently stand your ground if the opportunity is right.

Stress: The first year is very stressful. You will second guess yourself, make mistakes, make people mad. But its all worth it when you get to the point where people are asking you questions and you realize that you are actually competent. After that the stress comes mostly from the system, and you either cope with it or you don't and find a new job. Family life: No kids yet, but the upside of nursing is that even though you get crappy hours, it is a flexible job. When I have kids I can ask to go to straight nights (I will sacrifice sleep for being able to see my kids during daylight hours), weekend contract (which would free me up during the week and the husband can do childcare on the weekend), drop to part time, or find a cushy office job and work 9-5 but be bored stiff. As you can see, there are ups and downs to everything, an ideal situation would be if I only had to work when I wanted to (ha!) Mood: Most of the time I am fine. Tired, but fine. Sometimes I come home angry. Sometimes I come home sad. Sometimes I come home happy. Going out? Not my scene. I think people manage to make time for it. Again, good set of questions and I think you are taking the wide variety of answers in stride. Good luck with your decisions!

I feel like the OP is saying the same thing as the objectors, but in a different way. OP is saying "don't ignore the monitors," because a patient might feel ok without actually being ok. If I have a patient with lung Ca with says in the 70's, don't ignore the low saturation just because she doesn't feel short of breath. When my numbers look bad but my patient looks fine, it helps to draw a definable line. "If she takes longer than 5minutes for her sat to come up, I will call the doctor." (Treat the monitor, not the patient). Alternately, I treat a BP of 85/40 differently when it is a little old COPD/CHF lady with an EF of 20%, vs a 32yo with sepsis (treat the patient, not the monitor). We're all saying the same thing. In the words of my favorite nursing professor: THINK!