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LouisVRN is a RN and specializes in Med/Surg.

LouisVRN's Latest Activity

  1. LouisVRN

    Standing up to MDs - consequences?

    i don't think so. Although this has several answers. First of all imo you have to develop a good relationship with the doctors, and also deliver good quality care to their patients. Second you have to be willing to explain your thinking to the doctors, especially when working night shift. Third you have to know when to not take no for an answer. Fourth, it is always ALWAYS important to document your conversations with physicians, but especially so when you disagree with the physician's course of action. Under no circumstances do you tell a patient that their physician is wrong and to seek a second opinion. You i'm sure would be fired. You can however say, I can see you're concerned about xx, it is within your right to request a second opinion if that will help make your decision easier/put your mind at ease, etc. But it has to be the patient's choice, you can only ensure they know that they have that right.
  2. LouisVRN

    Becoming an ICU nurse

    I have worked med-surg for the past 4 years, and have loved it. I am currently a med-surg charge nurse and getting to the point where i need a change. I feel like the unit i have been on, while home, and I are going in different directions. The push is entirely on patient satisfaction, and while i acknowledge its importance i feel there is more emphasis on this than providing safe and quality care which is where my heart lies. So i've decided i want to try to go back to floor nursing in the ICU. I went to school to help sick people, not play concierge. I am getting my ACLS but want to know what else I can do to be a good candidate without having prior ICU experience. i do not have any Tele experience but within the next couple of years we will become a monitored unit. Should I wait it out until I have tele experience or apply now? TIA for any advice.
  3. LouisVRN

    Diagnoses you never thought you'd see?

    SJS, Serotonin Syndrome, and Werncike-Korsakoff's Encephalopathy, as well as 2 cases of Adrenal insufficiency/
  4. LouisVRN

    Need to interview nurse supervisor for scholarship

    You can send it to me, I'm a charge nurse.
  5. LouisVRN

    Where would I be a good fit?

    I've done Med/Surg for almost 4 years and have been a charge nurse for about 6 months. I don't have any intent on leaving my unit for at least another couple of years, we are in that time going to get trained on Telemetry as they are going to start doing remote monitoring. But I like to have a long term goal in mind...and i don't think I want to stay on Med/Surg forever. I'm really leaning towards ICU/ER but don't know how to make a decision like that. So I'm posing the question to you, a little bit of background about me, I've always worked nights, I love nights and don't want to work days, but I miss having any interactions with the doctors because I feel they would provide some additional education/rationales. That being said i like the additional autonomy of working nights. I'm extremely type A personality. I am a very quick learner and have a photographic memory. I've been told I have very good "instincts" for knowing when something is going wrong. I'm not a people person. I can pull it off and have received many pt compliments but I very rarely get any joy from interacting with people. I'm obsessed with charting/paperwork. Everything has to be perfect or it is extremely upsetting for me. I like to be busy. So any ideas where I could put my talents to best use?
  6. LouisVRN

    How did you *know* your specialty and when?

    I always wanted to work OB in school, but was offered a med/surg job and took it out of school. I've been there for 4 years this September and am now a charge nurse and love it. Every now and then I wonder if I'd like anything else as much.
  7. LouisVRN

    Rapid Response - primary RN

    Oh yeah as charge its super annoying to have the icu charge rn, house sup and swat nurse there asking questions about the pt and have to pretty much run after the primary nurse who is trying to leave to go chart or when their questions are met with silence and blank stares. Yesterday had to do a crt after getting like a 30 sec report because when everyone was asking questions neither the primary nurse or day charge answered anything. I just really feel like the ability to advocate for out pts in these situations are extremely lacking.
  8. LouisVRN

    Rapid Response - primary RN

    In a Rapid Response what is the primary RN's responsibility at your facility? I am working on this as a project as during several of our recent RR on the floor the primary RN has left the charge nurse to conduct the RR while they see the rest of their pts, which when this is discussed this is not what the expectation is.
  9. LouisVRN

    Tips for a new nurse going into ICU

    I don't work ICU. I'm a Med/Surg Charge nurse. But we get to see the intensivists/ICU charge nurses whenever there is a rapid response/code. And what I've learned is this...ask a lot of questions. Most of them have been doing it for years and welcome questions, especially when next time you can show them that you've learned from their answers. Ie. during my first code I was asking the intensivist what supplies he would like, obviously the code team had taken over caring for the patient, the next code everything is setup ASAP: suction, a central line kit outside the door, portable O2, the furniture is all moved in the hall.
  10. LouisVRN

    Stopping patient care for another patient

    I agree with this. Pt A wanted pain medication. Once they received that they probably would not have minded if you reassessed their vitals, repositioned them, etc when you went back to reassess your pain after medicating patient B. I have had one patient complaint in 4 years of nursing - which I think is pretty good. It was a lap appy pt that requested two Tylenol for pain and he had to wait 20 minutes. However I was with a pt who had aspirated her dentures.
  11. LouisVRN

    What NOT to do as a new RN.

    On a related note, as a new grad I once was taking care of a pt with an AKA and on a heparin gtt. My shift was over, pt and I had a good night and developed a good relationship, so when he said he'd like to get back to bed during bedside report i told him I'd go ahead and help him so he wouldn't have to wait for his day nurse to come back. So promptly grab some gloves, help him out of his wheelchair and pivot at the bedside. Of course he pivots the wrong way, wrapping his IV line behind him and despite my, "Hold on just a second so I can get the line out from behind you" he proceeded to sit on it and I have no idea how, broke the tubing in half rather than just pulling it out. Being on heparin the blood was pouring out. Thankfully was able to clamp it off and the patient helped apply pressure while I ran to get new tubing. The patient profusely thanked me for providing him some excitement - he had been hospitalized a long time - but I was mortified.
  12. LouisVRN

    A question to nurses with children

    Having 2 young children, I work nights so I can spend all the holidays at home. Even if sometimes it means staying up 36+ hours. We all sacrifice somewhere. But nights works well for me. The only nights I try to get off are Halloween, usually not a problem as a lot of people don't care about working Halloween and Christmas Eve. But even Christmas Eve all we usually do is go look at Christmas lights so we can really do that any day.
  13. LouisVRN

    Eating on the Night Shift

    My usual eating schedule on days I work: drink coffee when I get up around 9am, eat a light lunch around 2pm, take a nap around 330pm, snack before work at 530 with another coffee, dinner at 1-2 am, then light breakfast around 8 when I get off, if I'm working consecutive nights, I'll repeat the snack and coffee at 530 and go from there, otherwise will have a snack around 2 and dinner around 7.
  14. A lot of it will be ambulating/helping pt's with ADLs. Regardless of the type of ortho surgery few of them are independent post-op whether it be due to inability to move, pain, or fear. So expect a lot of helping set up trays, helping pt's turn in bed - high risk of HAPUs in this dept, ambulate safely, get to the chair, get cleaned up, etc. However while sometimes its easier to do all of these things for the patient, its equally important to reassure and encourage the patient to do what they are capable of on their own as the goal is usually rehabilitation.
  15. LouisVRN

    Is this considered patient abandonment?

    I'm assuming that would depend on the policy at the facility where you work. Are you required to get a verbal/written SBAR of the patient, or is that information available in the computer and you are supposed to see it when you are assigned the patient? You knew you were getting the patient so it wasn't like the patient didn't have a nurse. Either way it is bad practice not to ensure that the receiving nurse is aware of the patient's presence on the unit.
  16. LouisVRN

    Grossest thing that you've experienced?

    Bostonterrier - having delivered a baby and a placenta, I can say the placenta was pretty gross from that aspect too. With my second child, who was 9.5lbs and natural I dreaded the placenta more than anything else. The eye story would have to be the one that got to me - i hate anything having to do with eyes. My grossest story as a new grad would have to have been packing a pilonidal cyst post-surgery. I did not see what it looked like before surgery but afterwards it was cut like a jackolatern ragged smile vertically about 8" long. The cavity was HUGE - you could have easily have fit a basketball in it. I remember having to reach in and hold it open while my preceptor packed it with rolls and rolls and rolls and rolls of kerlix. Also having to change a wound vac that went down to the intestines - I didn't know the patient, diagnosis, etc. I was just there because I knew how to change a wound vac. The pt had no abdominal skin, muscle, fascia... trying to change the vac all I remember is how she had open areas on her intestines and they kept stooling liquid green stool almost constantly and having to try to clean it off while trying to get the foam ready, the smell was horrendous and I think it took over an hour to complete the vac change.