felineRN

It's not like the woman titrated up her propofol and turned down her precedex... If this is what we are nit picking over these days, I need to find a new line of work. Seriously?!

You will develop a flow to things. I'm the bad nurse who would unpackage/draw up, scan, and then give. That way I can get in and get out. If I'm in that room for more than 5 minutes, there better be a very good reason. If you take meds in, scan, then open the packages/draw up, and give, you will increase your length of time in my opinion. That's probably how your hospital system wants you to do it to prevent errors. I think that its probably going to be a learned muscle memory thing. The more you do it, the faster you'll get. As I said before, if you have your ducks in a row before you get in that room, you'll save yourself a lot of time. I would also pre-spike fluids/piggybacks and scan them at the desk near the computer and then hang.

I have used these in an Emergency Dept setting with mixed success. (Negatives) If your patient moves in any way, the machine will result in an error. It requires your patient to be flat (with legs elevated) and completely still. This might be more feasible on an intubated patient, but on an awake/alert patient, it can get complicated. The other issues I have seen are the time requirements to obtain your readings. While the actual test might be 5 minutes, you are often in there for 15+ troubleshooting the machine. (Positives) I've seen this machine help us make an educated clinical decision and thus avoided invasive interventions/monitoring. Often times this can be utilized as an 'I told you so' tool when working with physicians. If you choose to opt for the fluid challenge option (500cc) and you KNOW your patient just needs a bolus, this is an intervention to suggest to get your patient that bolus and prove they are responsive to it :). I think there can be much improvement on this device. Do yourself a favor and use regular pillows instead of the pillow provided (unless you keep it inflated all the time.)

Ha! I know this thread is quite old. However, hilarious!

I found a case study and an article. The case study refers more to this as a lung irritant (in an infant in this case.): http://www.emedmag.com/PDF/043010017.pdf The second study just states it is no longer recommended as a drying agent for skin in terms of fecal/urinary incontinence: An overview of skin care and faecal incontinence | Practice | Nursing Times There are many articles describing possible risk for ovarian cancer in women who have been exposed as well as talcum powder poisoning. I hope this helps you somewhat. :)

Hello Everyone, I posted this is a state specific forum with no bites but am interested to see what the common practice is. I was offered a position in a General ICU. However, the hiring manager is asking for a two year minimum contract. I am not a new grad, nor am I getting a sign on bonus. I am being told by nurse recruitment that if I leave prior to this time I will not receive a written reference but will not be penalized. Has anyone encountered this? Has anyone left prior to the two year mark and gone to a different position within their health system successfully? I ask these questions because I despise being mandated to stay in one place. I am not a job hopper and have held employment successfully for multiple years. However, I'm afraid that I will have no recourse if I don't gel with the management/culture of the unit. Any thoughts would be greatly appreciated.

First and foremost, let me state I am NOT a new grad. I was just given a job offer from Duke's health system. However, the hiring manager is requiring a 2 year minimum contract. I think this is a bit excessive. I don't have plans to jump ship, however, I would really prefer not to be locked into a contractual agreement. As I am sure most of you know, sometimes you don't always gel with the culture/management of a unit. My question is: Is this standard? (They are not giving me a sign on bonus etc...) Am I unable to transfer prior to two years time? I have asked nurse recruitment and they stated I would not be penalized, but would not receive a written reference from my manager. If there is anyone who has experience with this I would love to hear from you. You can also PM me if you prefer. Thanks!

Oh, and I've been deemed eligible by AACN at this point anyway.

\Laurie52. Just a heads up. (Taken directly from AACN): Who is eligible to sit for the CCRN certification exam?The CCRN exam is for nurses who work at the bedside of acutely and/or critically ill patients in areas such as ICUs, CCUs, respiratory ICUs, surgical ICUs, medical/surgical ICUs, cardiac/surgical ICUs, neuro/neurosurgical ICUs, PICUs, NICUs, critical care transport/flight, trauma units, emergency departments and in nurse anesthesia — or in other units as appropriate. Final determination of eligibility is not based on unit type but on patient acuity, as patient placement varies by facility and bed availability. Keep in mind, where was your ICU patient prior to their arrival to your unit? The Emergency Dept. I get that ICU nurses are far more competent in the long term management of the critically ill. No one is debating that fact. That is the reason why I'd like to move into that specialty. Please give your ER nurses a little credit.

Good Evening Ladies and Gents! I've seen a lot of threads about ER/ED to ICU. I get that it's an entirely different discipline etc... My question to you is, what would you as a nurse manager like to see on the resume of a former ED nurse who like to go ICU? A little Background: I have about 3 years experience at a level 1 Trauma Center. I am triage competent, TNCC (Trauma) certified, and precept new nurses in the ED. I am going to test for my CEN and CCRN in the next month. In our ED we get very high acuities and are holding ICU patients for several hours (7-8) due to continual bed flow issues and high census within our ICUs. Therefore, we are tasked with titration of gtts, management of vents, ventrics, art lines, etc... My question is, would it be prudent to list all gtts I'm familiar with? I feel like my resume could get far too lengthy trying to "prove" I take care of acutely ill individuals. In your opinion, what should/could I add to make myself a more desirable candidate? TL;DR- ED RN needs a resume spruce up to land an ICU job. Thanks in advance Ciao!

I've been in the ED now for about 1.5 years. In the recent months, I've experience what I would call as "loss of confidence." I won't say that any particular incident occurred to cause this, rather a grouping of small incidents. I think I'll attribute it to "the more you know...the more you realize you don't know anything." Firstly, I have had a few patient's recently that have opened my eyes. A frequent flyer with complaints of "pain" (pain every day all the time it seems) who actually ended up with a 90% blockage to the RCA. Another patient who was drunk and sitting up in his c-collar for the previous shift began to tell me he couldn't move his arms. He also was telling me how much of a ******* I was for making him lie down and keeping the collar on. When I came on shift and assessed him, he could move his arms initially. I did tell the physician, but thought he was partially full of it due to his affect...sure enough: central cord syndrome. Of course, both instances made me feel like crap/like I was incompetent. Also, in recent months I made it a personal goal to improve my documentation/assessment skills. I put a lot of pressure on myself to complete at least 99% of the "required" documentation on each patient and lift myself up to a higher standard. In doing "what is required", I find myself drowning. I realize that prior to my attempt at stellar documentation/reassessments, I cut corners for a reason. Now that I'm attempting to "do things the right way" I find it near impossible to be an efficient nurse. I'm referring to things like: real time documentation (instead of doing everything after the fact.), finishing a med reconciliation, sepsis screen, suicide risk, belongings, linking gtts to I/O flowsheets, scanning all medications, women's health screen, etc... Conceivably there are about 12 different things in our navigator to complete for a patient. If I get a nursing home patient qith 40 medications, who is altered (q 1 neuro assessment), and has increased wbcs, decreased MAP, and arrives with 3 decub ulcers I want to curl up in a corner and die. For said patient I have to: -Complete a full assessment. -Complete a neuro assessment: pupils, speech, mentation, musle strength grading -Complete a skin assessment and add a LDA for each ulcer with details of each ulcer -Complete a seperate report for risk management stating said ulcers were evident on arrival -Complete a sepsis screen (8 different parts referring to Increased WBC (or decreased), MAP, source of infection, febrile?, AMS?, doc notified?, interventions?) -Update all medications (doses/frequency) Prior to my recent attempts at stellar documentation, I would get the patient on the monitor, assess, and treat my patient accordingly (IV, fluids, abx....you know...ACTUAL nursing). THEN I would try to find a computer to finish documentation and only update important medications such as anticoagulants, current abx, and medications that could cause alteration in mentation/VS. I would always being documentation with LE (late entry) 10:00-Assumed care etc.... 10:22- PIV (20g) placed to RAC. NS bolus infusing as ordered. Full rainbow in the lab... 10:46 Notified MD of map of 49 etc... How does the loss of confidence come in to play you ask? It seems that my coworkers are much better/more efficient documentation than I. I've asked, I've looked, I feel like they can adequately care for their patients and write volumes of free text notes without batting an eyelash. When I get the train wrecks or seriously ill, I feel like I should be ensuring their airway/circulatory stability before running to a computer to type "assumed care." Forgive me if this is TL:DR and/or recently discussed. Any advice would be appreciated. Has anyone had any similar situations? Please share. I just want to make sure I'm not alone in this.

There again, I just wouldn't give it. I'd then take it to my charge rn and up the chain. Playing with orders just to be an ass is a bit unprofessional. I will say we don't have that issue where I work. I'll add that im sorry providers react that way to you when you ask for something.

The chief of emergency medicine at my facility said it best when he stated, "In the ED, orders are more like 'suggestions' ." Some of you people are very uptight. In my facility, we NEVER get specified rates for fluids. Many of us initiate fluids prior to anyone being seen by a provider. Where I'm at, were trusted with knowing if someone is renal/chf. We generally have an istat to get a good feel for BUN/Cr and electrolytes. Anywho, on a side note: I had to laugh the other day. I had a woman with an ectopic (who was very stable). I get a call from her OB/gyn that he will be there to save the day. He tells me he wants rapid fluid resuscitation and writes an order for ns @ 125/hr. We had a good laugh over that one. And the 0.5 of dilaudid. (Again, maybe we are rebels where I work.) I wouldve immediately gone to the MD and asked the rationale/ made a joke about giving an elephant a baby aspirin. I Would have also suggested morphine at this point. If you work in a place where you can't question orders, well Jesus, I pity you.

This! I think I'm more annoyed by the countless number of new threads entitled "How hard is nursing school?"..."Am I cut out for ____ specialty?" ...."Can a new grad get hired into the ICU?" No offense to anyone, but I feel as though I have to "weed" through said threads in order to get to the real content. (i.e. Nurse bullying, rn vs bsn, hospital vs ltc...) JK!!!!!:clown::clown:

(I work in the ED) When I was on orientation, I was thrust into critical care rooms. I had never managed multiple drips during my med-surg years. In my ED, we have a lot of autonomy in terms of gtt management. The one tip I'll give is what my preceptor told me: Be able to stand behind and back up any decision to bolus x drip or change a drip rate. Meaning: Levophed titrated up (Document BP, pertinent assessment, or that you called pharmacy to make sure x dosing was correct) This is just another tidbit: Always take a second look at lines, your patient, and your patient environment before deciding to titrate. Maybe your propofol isn't getting to the hub for whatever reason and that is why your patient isn't adequately sedated. BP is rising, cardene is not working...but you notice pt urinary output suddenly is 0. I guess these things are all "duh." But for someone like me who was entirely new to managing multiple drips, this really helped! I fully agree with the above poster about looking up your meds and doing some research. Also: Pharmacy is your friend!!! Good Luck! I can tell you're on the road to being an excellent nurse just by being inquisitive :)