sandyteele

Geez,... how rude of those individuals calling you at all hours. I would talk to those people for calling you for inane reasons and let them know... in a kind and respectful way... that you don't appreciate their calls. I say, "in a kind and respectful way", because you'll still have to work with them as a team in the future. Going off and exchanging angry conversation (not that you would do that) with those individuals will just break down bridges of communication you'll want to maintain in the long run. "With care and compassion, a warm heart and determination, difficult things can change and healthy, happy people can talk through their differences, reaching a compromise that all can live with." The Dalai Lama

Sounds like you had a busy day and that you were pulled in all directions. Sorry, that you felt that way. Know that we all go through these trying days as nurses. There was a time we had an ongoing nursing shortage, with stress and exhaustion being the primary reasons nurses left the profession in droves. Many nurses considered themselves "crispy" after ten years of being a nurse. Burnout is a reality for all nurses. Recently, more people are choosing the nursing profession because of the higher salaries, but the work requirements still remains the same and will only increase in the years to come. Our population of hospitalized patients are increasing because baby boomers are getting older, and they (we) are a very large population of people. The stressful conditions that caused nurses to leave did not go away, they're still there, and will only increase in the future. Will the stresses of our profession ever go away? Probably not. The one suggestion I can give you is to prioritize what you need to do first. You can only be in one place at one time. Take a deep breath, and know what you need to do next and do the task at hand with a positive attitude. Staying positive is always a good frame of mind to be in. Choose not to be stressed. By the way, going to the ICU will not lower your stress level, you will be responsible for keeping your patients alive minute to minute. I hope your days in the future will be happier!

An addendum to my previous post would also include any pain medication (prn or boluses) that were given for dressing changes, turns, etc. and how effective were these meds? It seems that there is so much information being given to the oncoming nurse, but these details are necessary for our patient's sake, so that they can continue to receive excellent care.

Congratulations on your new position! Welcome to the world of SICU nursing! Actually, shift reports are the end product of what you did and accomplished for the past 8-16 hrs. with a brief history of how and why your patient got to the ICU. I found it helpful to write down the following at the beginning of my shift, and added on info throughout my day. This ended up as my shift report: -Med hx. of patient. Physical findings. i.e, Head to toe assessment ..heart, lungs, etc. -Labs (past, present, and future labs to be done) their values, and what you did to correct them. -IV drips, and if you titrated up or down and why? (Its always nice to have another drip mixed up and ready to go for the oncoming shift if you are running low.) -Vent mode and settings, and any changes throughout your shift. -Blood gasses (ABGs) and what you did to correct them. -Lines- art lines, PA caths, cordis, bladder pressures, TLCs, peripheral IVs sites, etc. - where they are located, the condition of them, and when the dressings were last changed. -Tubes and drainage from JP bulbs, hemovacs, foley caths, penrose drains, colostomies, iliostomies, wound vacs, chest tubes, rectal bags/tubes, etc. And their drainage amount and complications, clots?. -I&Os .. any abnormal values? Are we on the right track with fluid balances? -Sedation- what titration worked? Was a daily awakening done? How did that go? -What are the CVPs, PA pressures, BPs , ICPs ..What are the goals? -Skin condition- especially in trauma patients..rashes, incisional sites, trach sites, road rashes, stab sites, gunshot wounds etc. and the dressing changes you have done and what time you did them. -Family- Who is the primary decision maker, any issues? -CRRT? What are the replacement fluids, settings, dialysate, any issues with the machine clotting off? -Surgeries- When they last had surgery, when are they due to do again. SICU pts may have surgeries every day or every other day. -Road trips- CT scans, MRIs, Nuclear med scans, xrays, angiograms, ultrasounds, etc. Let the oncoming nurse know what the results were, when they were done, and when they are due to do again. -Supplies- If your patient has an open abdomen, or any complicated wound with a washout due every day or every other day, your room will need plenty of supplies. I always let the oncoming shift know what supplies I have on hand and what I ordered. Its difficult to go scrambling for stuff when you are in a hurry. -Fluids, blood products given, how much and why? -What is the plan? What was discussed at rounds? This is a lot of info, but I hope it helps. Good luck!

Your feelings of being a new nurse is very common. I see first, you have to adapt to just being a nurse. Its a lot of responsibility, ...overwhelming to most new nurses. The fact you have to work nights, literally turns your life upside down. Your whole circadian rhythm is thrown off. You are also floating, which is a lot to ask for a new nurse, too. You have to learn the to adapt very quickly to other floors and their idiosyncrasies. Congratulations for sticking with it so far! These are common feelings for new nurses. In some new nurses minds, they envision their job like a Johnson & Johnson commercial .. "you're a nurse , you make a difference." Which is warm and fuzzy, but the reality of what we actually do in, in-the-trenches-nursing, is nothing like a new nurse ideally sees their first nursing job. Give yourself some time to adapt. Surround yourself with caring, supportive individuals, and talk about your experiences. Do something that you really like to do every day for yourself... bubble bath, going out to eat, seeing friends. Try not to be too hard on yourself, you're still learning. See yourself five years from now, ten years from now and what you would like to be doing, and work toward that goal. Keep a positive attitude, ...that is one thing you have control over. Shadow someone for an hour in a different sector of nursing or a another career you were thinking would be right for you, ..to see if you would prefer it than what you are doing now. If you really feel that nursing is a wrong career move, then recognize it, accept it, and find out what you would enjoy doing besides nursing. Life is too short to be miserable in a career you are unhappy about. Strive for happiness. Best of luck to you!

" All major religious traditions carry the same message, that is love, compassion and forgiveness, the important thing is they should be part of our daily lives." Dalai Lama

Good question. ICU skills are necessary to work in the PACU. You'll never know what drips, PA caths, artlines a patient will come out of the OR with. And a PACU nurse must be competent to handle all critical patients if need be. Pretty much any situation you will encounter in the ICU, you will see in the PACU. In our PACU, only ICU experienced nurses who are who are ACLS , PALS and BLS certified are allowed to work there. I would first get a few years experience in a busy surgical ICU before going to the PACU. Med-surg nursing is probably the best place to start off initially. There, you get your basic nursing and organizational skills down. Building up to advanced nursing skills from med-surg will help you in ICU and PACU. To become a CRNA, you definitely need to be experienced in ICU nursing. I hope this helps in your decision.

I appreciate patients opening up to me about their viewpoints, feelings and anxieties about medical and non- medical issues. It almost seems as a nurse, people feel an increased comfort level with us, ..a trusted professional who truly cares about your wellbeing. While I routinely take this opportunity to create a calming, and reassuring environment for the patient, it gives us a golden window of opportunity to really reach out to patients and perhaps make a difference in their lives through the art of conversation. Talking about uncomfortable subjects, such as politics may be looked upon as impolite in the non-health care sector... You wouldn't go up to a bank teller and start talking about politics, would you? But, you can use this opportunity as a segway for teaching, and trust building. Silence is never a good practice, it doesn't accomplish anything. It tells them "I'm ignoring you." Not very therapeutic. Turn around this need to communicate from patients and steer the conversation to their educational needs. If they just want to vent due to anxiety, by just listening to them may help them to feel important in a sometimes cold and impersonal health care system. Of course you shouldn't tolerate any verbal/physical abusiveness, know your own boundaries. Communication, is a very human need that can help the patient in the long run. Your comfort level in practicing communication in different circumstances will increase with time. Good luck!

Central pressures are more reliable for sure. A cuff pressure would be part of the picture, but the femoral art line pressures would be the one I would go with. Levophed could likely be the culprit in the lower cuff pressures, but the picture still doesn't look very pretty. I would still take both values very seriously. Sounds like this patient is in total septic shock. In our SICU, this patient would probably be on 10 IV drips , (including Xigris), be swaned and have CRRT going around the clock because her kidneys have probably have shut down by now. An O2 sat monitor placed on the bridge of the nose could pick up a value if all else fails.

I am very sorry that you experienced such a nightmare work experience while going through such tough personal challenges. You may think you have failed, but you actually succeeded in showing that you had a lot courage under terrible circumstances. I am impressed you forged ahead at work while going through a divorce and chemo. Two already very emotionally draining situations! You are to be admired! As a great human being and as a nurse trying to get her bearings. Good job! You can only do the best you can do, ...and that's all you can do. When all hell is breaking loose, and you feel overwhelmed. You can start by prioritizing the most important thing , do your ABC's (airway breathing, circulation), check! Next, move to patient safety,... everyone safe...check! Next, ...meds,... dressing changes, check. Its easy to get distracted by so much going on. If you feel you need more practice with nursing skills, let your manager know. You are not expected to know everything immediately as a new nurse, but asking for help is a good first step. And it looked like you did ask for help, and you were being ignored, unfortunately. That is never acceptable. Realize this situation is ridiculous for any nurse, experienced or new, and realize your power as a nurse and take stand for patient safety. (Ears perk up when you mention unsafe conditions). On a happy note, congratulate yourself, and be kind to yourself. For you sound like a kind and caring person who was tossed into an impossible situation, and you survived! Please don't be discouraged. Surround yourself with loving, supporting, positive people, and veer away from negative, judgmental people. I wish you the best of everything in life! Good Luck!

Diprivan and FFP (blood products) should never run together in a peripheral line. A central line cath/ or cordis is the standard practice when administering these two products. Preferably, two central lines should be saved, one only for Diprivan and one only for all blood products. In a trauma/ critical situation where you have only a peripheral line, I would use the peripheral line only for FFP, and start another peripheral line or two on the other extremity at the antecubital region using a 16 g or 20 guage needle. The primary reason for the central line is to have a line in a large vein where you have more control of the med, and to prevent burning/infiltration of a small peripheral vein. With a central line, you can also stop the med/ blood product quickly and take action if a reaction were to occur and fluid resuscitate the patient if the blood pressure gets too low. Having a central line close to the heart in case you need to give fluid/ Levophed isn't a bad idea either . Another reason not to use a peripheral line for blood products (includes FFP) and Diprivan has a high potential for fast bacteria growth from both of these products. Diprivan is a high lipid solution, where standards of practice dictate total line changes every 12 hrs. Blood products, too, can cultivate bacteria at fast rate, hence, the practice of not keeping blood products/lines up for more than 4 hrs. If you were to combine these two products in a peripheral line, it would be difficult to pinpoint the source of contamination if you were to culture the line. If the patient is trauma patient or sick enough to need FFP/blood or Diprivan for continuous intubation, or a surgical procedure, and you can't get a central line/ cordis /PA cath in I would definitely call the next surgeon on call to get a central line in asap. In some ICUs, the tendency is to hold off inserting central lines to prevent sepsis down the road. If you feel more I.V. drips are being added on by the hour , or your patient is in critical and unstable condition , I would persevere in asking for central lines.