3fins

I can tell you we had one (now ruled out) and the patient was allowed visitors. I spoke to someone in infection control about this, I was told: "We told the visitor to go straight to their car after every visit." LOL I then stated the obvious about putting the community in danger. "We're in the process of updating our visitor policy." LOL

Cmon people, grow some! You have a RESPONSIBILTY to refuse an assignment, legally, provided you have not received adequate training! Most of us have NOT received any such training! By accepting such an assignment without adequate training you put yourself, not to mention others at risk. Use some common sense - something that obviously was lacking considering the decrepit conditions RNs were working in at Dallas Presbyterian. Duncan wasn't even a 1:1 patient according to details coming to light!!! What good is a job if you lose your life?

Any lawsuit will fall flat. Medical waste piled to the ceiling? Cmon, people - call a spade a spade. RN and other staff knows better than to care for a patient under such conditions. You do have a right, even a responsibility, to refuse an assignment. The CDC was nowhere to be found at the hospital and administration was on their own attempting to manage the problem. Hate to say it, but it looks like everyone involved in care, including the RNs can be labeled "at fault." I'm expecting Tom Frieden's resignation sometime today.

So now we have a second positive - as well as more info coming out about decrepit conditions under which Duncan was cared. First off, Tom Frieden of the CDC should resign. The CDC wasn't monitoring hospital operations in any way, there were no protocols in place, healthcare workers received no hands on training. Workers were using medical tape to rig up ill-fitting PPE. Also reports the trash in Duncan's room was piling up to the ceiling. As an ICU nurse I have to ask, WHY DIDN'T THE ICU STAFF REPORT *** WAS GOING ON, WHEN IT WAS GOING ON??? WERE THEY THAT CLUELESS ABOUT THE RISKS??? An anonymous phone call to a news organization is all it would've taken. You do have the right to refuse an assignment, especially when conditions are unsafe. While I sympathize with the victims, there is an element of stupidity and ignorance here that cannot be denied. I can steadfastly say even before Duncan showed up I would have refused an Ebola assignment on the grounds I do not have the training to care for such a patient. It was something I had considered and even discussed with coworkers. Central lines, intubation, dialysis, diarrhea. blood draws, etc. There's a tremendous amount of bodily fluids you're going to be dealing with, much more than aid workers are being exposed to in Africa. I work at one of the most prominent, well respected hospitals in the country. We still have not received any training in regards to handling Ebola. You can bet if a suspected case rolls into the ICU I'll be walking the other way, guiltless.

CRRT is 1:1 in our ICU. I'm appalled to hear the staffing ratios at other facilities are anything but 1:1. Maybe our dialysis machines are just old, but between changing bags of fluid, titrating drips, drawing labs, calling docs, documentation, managing the machine, etc.etc. it's a full time job. I've never heard of stable patients being on CRRT, they are all on pressors and have multiple other issues to manage. That's why they're on CRRT. Someone mentioned 3:1 or receiving admissions to open beds during CRRT. You do have a right to refuse an assignment; legally, and for the sake of your license, this would likely be a good idea.

Long story short: I've been a MICU nurse for 3 years (my entire nursing career). Recently got my CCRN. My wife and I have been seeking to relocate across the country. Haven't had much of any response from ICU jobs where I've applied. However I've applied for PCU jobs as well and received an offer at a great hospital. Should I take it? Why/why not?

I know this is an old post but I wanted to weigh in. Let me start of by saying I'm opposed to government involvement in anything. Way on the libertarian side of things. Here's why I support mandated nurse staffing ratios. 1) The state requires RNs to practice under a license and the nurse practice act. 2) Unsafe staffing ratios lead to nurses practicing outside the nurse practice act and puts patients and licenses at risk. 3) RNs have no control over the staffing situation in which his/her employer places them. Now the root of the problem here is the state requires you to purchase a nursing license from them. If the state didn't require a state-controlled nursing license, I wouldn't believe in mandated staffing ratios. But because the state ultimately controls YOUR nursing career, they should also provide protections for your license from circumstances beyond your control. But that's a topic for another thread. At the end of the day mandated staffing ratios make no real difference in hospital costs. For example, if you try to run the ICU with a skeleton crew, you're gonna end up with pressure ulcers. With no nurses to help turn patients, it will and does happen. Every so often a patient will sue, the hospital will settle out of court, but still end up paying $$$millions$$$. And that's just the start of how hospitals are financially penalized for poor staffing. Someone mentioned that some assignments end up being "easy" patients that should fall outside mandated ratios. Thus unnecessary staff is used and money "wasted." I invite them to look at the perspective that in life, we often "waste" money "just in case" - health insurance, homeowners insurance, etc. Stuff we might never use but we still buy... because it could cost us a fortune if we didn't. Full staffing should be looked at as an insurance policy. Patient safety is the ultimate concern here, but that concern amazingly enough falls on deaf ears. So I'm just presenting this from a fiscal and philosophical standpoint.

I've looked out of state to no avail, and I'm not interested in peds. I think the bottom line is no one has the interest or financial resources to train people anymore - and that goes for any specialty. The nurses will continue to age within their specialities (45% of nurses are over the age of 50, with an average age of 45 y/o) and new hires will be imported from developing countries overseas to the overall detriment of patient care. I can imagine it's only going to get worse with ACA and Medicaid/care cuts.

I started my career in the ICU as a new grad and am going into my 4th year. Also have my CCRN. I've always really wanted to do NICU but can NEVER seem to find a hospital that hires anyone who doesn't already have NICU experience. So how the heck does someone get into NICU when it seems hospitals only hire experienced NICU nurses?

I've been an ICU nurse for a year and half, and had an issue come up during foley insertion on an elderly male at the end of shift yesterday who was agitated and going through DTs. The insertion - 18 french - went rather smoothly. Plenty of lube jelly. Slight bump around the prostate and then plenty of normal urine output further in. No problems inflating the balloon. Light tug felt normal. Came back about 15 minutes later to see hematuria and a few clots with slight leakage of urine around the meatus. Patient didn't seem to be experiencing any pain and was actually less agitated than prior to insertion. Nothing about the patient, labs or history, or procedure indicated anything like this should have happened. And nothing was forced (I know better). Not sure if the patient may have tugged on the catheter somehow. Aside from the patient tugging on the catheter, is there anything else that could have caused this?

Simply put, it is because most nurses are women. Women have a tendency not to stand up for themselves. Therefore management allows the abuse in the name of patient/family satisfaction. If the majority of nurses were male, it wouldn't be that way. I guarantee it.

I used to get annoyed when I have a BP med to give that's "Hold for systolic less than or equal to 100." and a systolic of 102. What I do is look at the patient's vital's history and trend (how did he previously handle the drug?) and consider the big picture. Then think about the actual order - if the parameters are low, they're low, and that's how the doc set them, and if you give the medication you're 100% in the clear. Not sure, call the doc and ask if he wants to keep the same parameters.

I'm a new night nurse, 3 weeks in, starting off in the ICU and had this situation arise yesterday . Patient was transferred to ICU from telemetry and nurse knew barely anything about the the patient except he was admitted for exacerbation of a pulmonary issue. I took report and it was mentioned in passing that approx 4 days ago (prior to admission), he had experienced some unilateral weakness with trouble breathing, had been to see his pulmonologist, and was sent home with a bronchodilator after the doctor said he "didn't think the patient had a stroke" and should just work on the respiratory issue. A day later the patient came to the ER with worsening SOB and was admitted tele. I didn't see any signs of the said weakness (patient was in no real condition to effectively assess for weakness anyway) but relayed this info to the day Nurse A. during report. At the time it was mentioned, I wasn't sure I had Nurse A's full attention, but she's very difficult to read and somewhat moody . I cared for the patient the following night. The doctors had been to see the patient during the day but no new orders were given. The following morning when the Nurse A arrived I told her in report that I still hadn't really noticed the unilateral weakness that had been reported to the pulmonologist, but documented the pulmonologist was aware of the problem days earlier. Make a long story short, Nurse A insisted I never relayed any such information about weakness to her during first report wanted to why I hadn't already notified the attending physician of the problem. "Nurse A." then contacted the attending who called neuro for the case, but I was later told by "Nurse A" the patient indeed had a stroke days earlier and was declining, and that the decline was basically my fault because I hadn't made anyone aware of a potential neuro issue. Being a new nurse, I learned three lessons through it: 1) Attitude significantly effects how effective communication is - the message obviously didn't make it to the receiving day nurse. 2) Everyone will always claim they had no responsibility - docs, nurses, whoever - and it's often your word against another's. 3) There will always be something you don't know, simply because of lack of experience with the situation, and you will learn these things the hard way. Today and 20 years from now. It's the nature of the game, and as a nurse your expected to know EVERYTHING but you really can't. In my case, I wasn't aware there is ZERO communication between docs, they will allow a potentially major issue to go unaddressed (like what happened before the patient was admitted to the hospital), and that an attending physician is the only doc who can write a for a consult. Therefore it's always best to call the attending when you're transferred a patient from any part of the hospital and give a full rundown of the situation, because things get missed or not addressed. Even if your thought, like in my case, that they had been. You will get stuck with the blame.

one of these http://www.amazon.com/General-Tools-6-Inch-Flat-Divider/dp/B00004T7S4/ref=sr_1_1?ie=UTF8&qid=1311722245&sr=8-1 and I'm good to go?

Any suggestions for a place other than a scrubs supply store where I can buy EKG calipers? I need some by Thursday and everywhere around here either doesn't carry them or is sold out...