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AlabamaBelle

AlabamaBelle

Peds Critical Care, Dialysis, General
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AlabamaBelle specializes in Peds Critical Care, Dialysis, General.

I started my career in 2005 in Pediatric Critical Care. After 5.5years, I transferred to Pediatric Dialysis in an in-hospital setting. I took a break to spend time with my aging dad. Glad I did, as he became acutely ill and died during this time. I explored other non-nursing interests. I recently moved from North Carolina to Alabama (my home state) and now work in a community hospital.

AlabamaBelle's Latest Activity

  1. I have worked for DaVita in Acutes. If you really like working on your own, it's great. It's also very feast/famine. You may to 5 hours one day and the next 20-24. And there's call. This part is very MD dependent. Personally, I am grateful for my experiences, but will not go back. I'm enjoyed nice, set clinic hours.
  2. AlabamaBelle

    Social Media and Doxxing - Your Thoughts???

    I'm more appalled at the pettiness of the nurse who reported Jonathan. This is a petty, vindictive individual. Everyone who works around this person should be wary. I don't do selfies and I don't list who I work for.
  3. AlabamaBelle

    What is your "thing" and how do you deal with it?

    UGH! Ostomies. I will do any other task for any coworker if they will take care of my ostomy patient. I gag at the thought. Just no.
  4. AlabamaBelle

    new nurse advice. screwed up?

    Dear youngling... Accept now that you WILL get yelled at or the MD will be extremely annoyed with you in the field of nursing. Grow a thicker skin. The Charge or Preceptor is just a cog in the wheel. You will chart that you notified your charge nurse. Then you will call the MD, as he is the only one who can give you orders. You will chart this also, as well as his orders (or lack thereof). You will carry out orders and note responses to interventions. Protect your license. Try to group questions to the MD, if at all possible. You can always ask if anyone else needs the particular doctor. This thread has given you valuable information. Use it.
  5. AlabamaBelle

    new nurse advice. screwed up?

    Always, always, follow your gut. Don't listen to a charge nurse or anybody else. I'll take the chewing, which I had recently. The NP and MD (who has standing orders that we call the NP, not him) complained about my call, but my glutes were covered, just in case. And later, a couple hours after the treatment, there was a problem, not a big one, but my considerable hiney was covered as I had charted and filled out some paperwork on the problem with that particular treatment. It's your license, protect it. Nobody else will.
  6. AlabamaBelle

    Acute Inpatient Dialysis Patient-to-Nurse Ratios

    We are 2:1 in our dialysis unit. We have no techs. If we have an unknown Hep B status, that patient has his/her own nurse. Hep B, does of course, complicate staffing. We also do portables 1:1 in our ICUs. We often have more than one patient in a particular ICU, so we load up as much as possible and go from room to room. Our larger sister units in the largest city in the state have techs. Their ratio is 4:1 and there are at least 4 techs at any given time. The techs get all the fistula/grafts on (and these techs are awesome). The RN must put on any PermCaths.
  7. AlabamaBelle

    RN

    Read up on the company for starters. This will give you a great springboard for questions about the company itself. Ask about training, what are career paths with the company. Are they looking at you for acutes or chronics? Your Med/Surg Tele is a good foundation for dialysis nursing.
  8. AlabamaBelle

    How do you handle rude comments?

    This is a touchy subject. I've dealt with some pretty rude and thoughtless remarks about my daughter's congenital heart defect. She's nearly 30 now, which is nothing short of miracle, since she was not expected to live out her first year. The absolute worst was "You've got your own little Frankenstein." This was said in front of other mothers....the mom who uttered this remark quickly realized she had put her foot in the poop pile. We never spoke again, my daughter did not associate with her or her daughter and many of the other children avoided her. Usually, I take the opportunity to educate on her particular defect. Sometimes they just get my "you're too stupid/unfeeling to live" look. Sometimes, what is even more hurtful, is people avoiding you. They don't know what to say or what to do. When I am given the opportunity, I educate folks in the nicest way I know without punching them. She also has to deal with the sequelae of 5 years without adequate oxygen to her brain. I can usually get people to understand she is a bit different, but she is more loving, loyal and forgiving than anyone else I know. I have responded not so nicely to people who have made derogatory remarks about her less than perfect mentation. Educate as best as possible. Don't forget to breathe. Take care of yourself as you are taking care of your family. My parents both died of cancer, so I feel your pain. (((hugs)))
  9. AlabamaBelle

    RVN: Registered Veterinary Nurse, what do you think?

    I see both sides of this argument, primarily because my husband is a veterinarian. He has techs that are trained in the clinic, by him or his primary tech. There are licensed techs, but not all clinics have these. Unfortunately, it comes down to $$. LVTs are worth way more than they are paid and their education bills are not cheap. Sound familiar? There are Emergency/Specialty Veterinary Hospitals, with the emphasis being on hospital. This implies that care is available to your pet 24/7, with a DVM available at all times. These particular settings do have ICUs, because we have had pets in their ICU. There are doctors there 24/7 and probably spend more time with their patients that human docs do. These hospitals are staffed 24/7. My understanding is that they are all licensed veterinary technicians - a requirement. We visited our pets in ICU and it was quite similar to a regular ICU. All those beeps and whistles going off. It is only in this setting would I see the necessity for a "nurse."
  10. AlabamaBelle

    Many nurses do not chart?

    If I chart something in one place, I don't chart anywhere else. Too easy, even for the most diligent of us, to make that one slip that makes the whole thing look bad.
  11. AlabamaBelle

    Low Diastolic Pressure - I mean REALLy Low

    Thank you both for your comments. Yes, patient does have CHF. He considers me to be, in this instance, very stupid and told me to find another job. My run with this patient kept said patient within the more "normal" values, SBP >90, MAP > 65. He said I was just pushing fluid into this patient. I followed protocols. I just could not see having to stand in front of the BON and try to justify anything else ie, "the doctor said so." Reviewing her treatments showed that she continued to go up on BNP with the lower pressures with more and more fluid being pulled off. He dialyzes patients based on BNP, which means most patients get daily dialysis when he is on. BTW, I just saw in our hospital's warehouse, 3 big boxes with pictures of the Prismaflex! Dare I hope that we are adding CRRT??
  12. AlabamaBelle

    Ethics: "Every minute counts..." or not?

    The only time(s) to take a patient off early is: a) there is a medically indicated reason and MD notified; and b) patient ACTUALLY requests to come off early and MD is notified. I also note that patient was educated about risks of coming off early (30 minutes or more) and patient verbalized understanding. MD is also notified. Treatment times are a prescription, a doctor's order. Don't contravene the order. I might run from that facility.
  13. AlabamaBelle

    Many nurses do not chart?

    How about watching nurses chart an assessment on a patient they have not even seen yet?
  14. AlabamaBelle

    Low Diastolic Pressure - I mean REALLy Low

    Both! I usually do both when I get a pressure that is questionable. This nephrologist is only concerned with systolics and MAPs and BNP (he is the only one who routinely follows the BNP and dialyzes on that basis).
  15. AlabamaBelle

    Anyone working or have worked for Davita

    I left acute dialysis at the first of the year for several reasons, two being the insane hours (20+) and bullying (one subtle, one very open). The company could not keep RNs. I was vigorously pursued after I left by upper management. I had taken a significant pay cut to go back to our local community hospital doing night shift. Got the attention of the PTB and was offered a great salary, M-F, no weekend, no call, doing 4-MN. I am enjoying it more this time around. Since I don't mind working solo, this is good for me. And it lets the call person go home and get some rest.
  16. So, I have returned to Acute Dialysis after very heavy recruitment. I love it and got great hours...now for my problem. Had a really unpleasant conversation with one of our nephrologists in regard to a specific patient. His basic complaint was that we (the Acute Dialysis Team) are stupid and incompetent. A patient' s BNP has continued to rise (except for a couple of days) despite daily dialysis. The patient came to us from a larger facility d/t problems with AVF. When pt arrived to our hospital, said patient coded, K was 6.6. Compressions and defibrillation were done and ROSC obtained in 3-4 minutes. I have run this patient once...during treatment her SBPs were fine; however, her DBPs were in the toilet 24-32. Patient looked awful. The mean pressures didn't meet any criteria. I have just never seen such low DBPs before. The nephrologist very clearly stated DBPs did not matter, patient was in heart failure and diastolics were not an issue, that we were only to use SBP as our guide, since we were obviously pumping patient full of fluid. Again, another rant of our incompetence and need to find another job. I learned in nursing school that diastole allowed for perfusion of the coronary vasculature. He did mention one person he wanted to run this patient. A review of treatment showed that a BP of 118/11 was recorded. The patient's BNP has climbed steadily even with his preferred nurse running the treatments. In an effort to improve this patient's treatment, I asked some questions. I formerly worked in teaching hospital where questions were expected and welcome. Again, another unprofessional rant of the team's incompetence and stupidity. I would love your input. BTW, the patient's BNP decreased a good bit after my one run. The patient needs CRRT, but we don't do that and I got the distinct impression the MD will not transfer patient to an appropriate facility.