HeySis

Yes, I got a $500 bonus. The company looks at it every year and decides how much they can "afford" based on your PT/FT status. Someone said it's actually about their tax liability and to give us a bonus at the end of the year decreases their tax liability. I really don't care.. anything is better then the nothing I've gotten from other companies.

Critical thinking is definitely a learned skill, and the more overall experience you have the easier it is to apply knowledge from one situation to another. There is a book that I used to study for RN-NCLEX that I think helped me a great deal... it explained each answer which got me into thinking through the ABC's (airway, breathing, circulation) when critical thinking situations came up such as which patient to check on first, who to assign a task and such. I'll put the lin down below if you are interested. But yes you have to study it... it has to become a muscle that you work out and get use to using so often that you are doing it without having to outline each step. The decision about schools is up to you, only you will know what is best for you. https://www.amazon.com/gp/product/0323113435/ref=oh_aui_detailpage_o08_s01?ie=UTF8&psc=1

So this is your first job as an LPN? RN? How much training/orientation did you get? how many people are you responsible for? are there other nurses working the same shift as you? Just looking to see more about the job situation before I offer any advice.

And you most likely didn't give him his first dose of fentanyl... our anesthesiologist use it in the OR all the time. If my pt is awake I always ask if they'd like pain meds in their IV, I only chart when they refuse. I have been told by quality control that if you have a standard practice and can relate that to how you chart, then you are covered. So I always chart the same things in similar ways, so I can look back at it and say... he was having pain and consented to pain meds, if he had not consented I would have charted that as having pain, refused medications.

No this is not fair. The list would be fair if it reset to zero every quarter/year (depending on how many pick ups there are). That way each person would have to do the same amount of pickups each year.

You can take the amount and place it into a a 401k.. that way it's placed in pre-tax and when it comes out during retirement it will do so at your tax rate then.. not some higher tax rate.

If that's your hospitals policy, I would push it. But our hospital doesn't have that policy. You keep seniority as far as benefits (the longer you work there the greater amount of PTO and such you earn) but As far as asking for time off and such, you start at the bottom... but then you climb each year and after you reach the number one spot.. you go back to the end of the line. That way if everyone works there for 10 years or more.. you are not always last in asking for your vacation/holiday preferences.

I work a small PACU with limited staff, we take call about once a week. If someone is sick they send out a group text to see who can cover.. one of two things happen, either someone picks it up with the condition of swapping their next day out, or it's the yes, put you'll owe me one. Since we are so small... you know you'll need the favor some day too, so its best to be flexible. We don't have a mandatory list, have never needed one.

In the first articles it says he was escorted, but later people that were there (including a patient that videoed it on their phone) spoke with Dog MD and he reported that the anesthesiologist just walked away and left... that the admins didn't even find out about it until the next day. I find that disturbing.. that no-one on the unit felt it should be reported... or maybe they didn't think reporting it would make a difference... either way the culture is showing here.

Do people know how many wrong doses of medications I would have given if I didn't question physicians? or how many times the wrong knee may be operated on.. sponges left in a patient?? How about the podcast Dr Death.. in which no-one questioned the credentials of a spine surgeon. He killed a bunch of people, everyone thought he was unsafe, turned out he wasn't even licensed.. but no one questioned him cause he was the physician. We are part of a team... not a dictatorship.

When Doctors Attack! | Incident Report with Dr. Zubin Damania Here is the link. Dog MD went on to say that he has nothing to say off the news report himself without further info... so if you're going to send the article you need to have more info. He did a video segment once he was contacted by other that work there and witnessed it. He goes on to talk about the things he was told lead to this (alarm fatigue and staffing ratios). but does say "we have to have a zero tolerance policy for this kind of thing. He shouldn't have been, it turns out there was some talk that even the higher-ups in the administration didn't even know this had happened until the next day. This needs to be a zero tolerance thing. I think that if you're committing a crime against your fellow human beings in a hospital, there's no level of hell that is hot enough for you, okay? "

For fentanyl, I draw up the full vial in a syringe and give titrated doses from there. That syringe has to be labeled with the drug, concentration (mcg/ml) and the time it was drawn up because it does have a time frame it has to be used in. If I need more then the first 100mcg, I'll get a second vial, if I'm really dosing ever 5 minutes Ill use the same syringe... if it's taking longer I'll use a different syringe and place the new time I drew the second vial. Labetalol comes in a multi dose vial, I only draw what I need for each dose.. again has to be labeled. Morphine and diluadid come in syringes, so I use the doses I need and waste what ever is left... Because the med and concentration are on the syringe I only need a label with date and time.

I work PACU and BLS, ACLS, and PALS are required, they were not upon hire, but were before orientation was completed and we are required to keep re-certified. Our hospital keeps track of all of our dates and has a page that we log into each quarter to do necessary training and updates, we can see if or certifications are due. let me make sure I understand this. You did not know you needed to keep current in PALS, it was 7 days past due, you took the day off to recert and got paid for it, and upon arrival back had your recertification but still had to sign form stating you know if it ever lapses again you'll be placed on unpaid leave or fired. If there are no other problems with your manager, I would not worry about this. No harm, no foul, keep it updated in the future. Sometimes managers are just following the rules outlined maybe because it's not in the policy book, but now you've signed you can be held accountable.... maybe it was what needed to be done in order to be paid for that day. But if your manager has had other complaints about you, and/or you've had to visit HR more then once, sign written notices or similar, then I'd be looking for a new job. Managers that start reporting everything to HR are compiling a record for a reason, to justify disciplinary actions or termination.

I have seen that a lot, and I've heard doctors tell patient not to let anyone use their ports except the infusion/chemo team. It usually happens because someone has not properly cared for a port after accessing it and had it clot off and it had to be surgically removed and replaced.

Your resignation letter will go into your employee file, if you're ever back that way and you reapply, it'll be looked at. So put it in writing, if you can give more then two weeks, then do so... but give at least two weeks notice. Thank them for the opportunities, say something positive about your manager and/or company, note something you contributed and be clear about the last day you are available to be scheduled.

Congrats on your new job, I'm hoping this was a move that you were hoping for. I love the PACU, The work, the environment, the patients and acuity and the people I work with, I hope it's the same for you. AS for advice. 1. Make sure you get a full and proper orientation, as if you didn't have the three months of NICU experience. 2. Drians' Perianesthesia Nursing (book) is considered to be "the bees knees" when it comes to resources, A lot of certification questions are taken from it if you are ever wanting to get certified. Even before I was interested in certification, I used the book as a reference to study up on airway issues and anesthesia meds. 3. You can go to American Board of Perianesthesia Nursing Certification, Inc website and sign up for weekly email questions. They go back and forth between PACU and for Same Day Surgery questions each week, you get last weeks answer along with the reference of where to find it, with each new question. It is a free service and can keep you thinking. 4. Don't be afraid to ask questions, or ask for help. One benefit of PACU is it's open pit configuration, which means even when taking your own patients, there is normally someone within hailing distance to ask a question or get a second opinion. 5. Don't get so caught up in the charting that you forget the patient. We had one nurse try to cross train.. and she could not do both and her patient would be turning blue while she was standing right next to them charting. I great way not to get sucked into this as a new PACU nurse is to place the patient on your none dominant side.. you can type with one hand and keep the other hand on your patient. And yes I mean on them....before they have roused, if you place a hand on the shoulder or chest... you will be more intune if they start having breathing difficulties and I find will glance at them more often. I'm sure others have different tricks, but this one was taught to me, and I teach it forward. 6. Know your meds (both the anesthesia meds given in the OR, what they do, how long they last and which ones can be reversed and with what) and your narcotics, non-narcotic pain meds, anti-emetics, anti anxiety, beta-blockers and the meds used in a codes. 7. Frame of mind... PACU is not a place to cure drug seekers... the fact is someone who is opioid dependent will require more pain meds, not less, this is not rehab, our job is to safely control pain to the best of our abilities.. leave the judgements behind. 8. On that note, realize that those who use tobacco and/or antidepressants may require more pain management efforts as these drugs compete for opioid receptors so pain meds don't work as well for them. 9. On the other hand safety is first and there has been many times where I have told a patient "I know you are hurting, but right now it's a choice between pain relief and breathing and I always have to choose you breathing". 10. Transport your patient when ever possible, and give the family member s a small status update. They are hurting but you have given pain meds and they haven't peaked yet, or you had to wait for pain meds to wear off so they cold safely hold there own airway. PACU is a big mystery to most people.. and they don't like being out of the loop. If you tell them nothing and the patient goes back to their room complaining the family will think you did nothing.. so take credit for the things you did. 11. Makes sure to develop and good and professional relationship with your anesthesiologist and surgeons, it will make it so much easier to ask questions and get the things you need to do a good job. 12. And the same for your co-workers, be a apart of the team, help each other out, reciprocity os the name of the game here. Good Luck and keep us up to date with how it's going or if you have specific questions.

In cases like that I ask the patient. Have you ever had oxycodone? If so what strength did you take and how many, how often? For your pain level I can give you one or two tabs, would like to start with one and see how it works or have both? I find that most people know if they are opioid naive and choose to start with one, or if they are not, and are use to taking pain meds, they know they'll need the larger dose. Then I round the number appropriately (cause my computer won't except 6.5.... when it did I charted it that way.)

Every hospital nurse as worked a ton of Thanksgivings and Christmases... its part of the job. Black Friday and Halloween aren't considered holiday's. When my kids were little they didn't look at the calendar and know what day it was so if I had the 23rd off I told my kids it was Christmas eve on the 22nd... or we'd do the same a couple days late. I've eaten Thanksgiving dinner at noon when I worked the 3-11 shift that doesn't exists in most places anymore. It is what it is. We make adjustments and enjoy our holidays anyway.

When enough rooms have closed that they can go down a nurse. I have done a 26 hour call day (got called in at 6:30am on Saturday and my relief person wanted to take a shower when I called her on Sunday at 6:30am so didn't get there until sometime after 8am. We had a nurse that just did her 12 hour shift.. (started at 7:30am) but was on call and need up being there until 1:30am, went home and got called back after an hours sleep... was there when I came back the next day at 8 am... she was scheduled that day too... we tried to get her out as soon as we could , but they kept on adding on cases and so she ended up working until 4pm. (started 7:30am on Monday.... worked until 4pm Tuesday on one hour of sleep). It's pretty rare, but it happens... and no... not one of us thinks it's safe for the patient, or us (especially on that drive home).

We rarely do C-sections in our OR... if we do, its because something is going terribly wrong. They are done up on L&D (some of our anesthesiologist don't like it, they don't feel the nurses have the experience needed in a crisis and because the baby is allowed to stay in recovery and family is invited in... and they feel it's just too much for one person to monitor. In the end I think the rationale was the patient experience.

I agree with the pressures being a bit low, I know most of our anesthesiologists would respond until they were at least 80/40's, but we normally get patients with 80/40's and know they normally come up as they wake. In our PACU who manages the airway would really depend on the anesthesiologist... Some leave it to us do do the head tilt or jaw thrust, some will hold it while your hooking the patient up... some will just start on report while we are managing it.. unless we ask for help, we always get help if we ask for it. And we have a couple of exceptional docs that continue to manage the airway until the patient is sating and breathing well (but breathing well doesn't mean a certain number of resp/min.. it's more about the quality of breaths and oxygenation). How did the patient look?? Was his color pale? blue? purple? Was he exchanging good air? Did you hook up capnography, and if so how were those readings? We can't give 100% O2 in our PACU, you need a vent to be able to do that, did you hook him up to a vent?? Even a non-rebreather doesn't do 100% O2. I ask these questions not to dismiss your frustration, but to honestly answer the things that have been taught to me. SpO2 readings can be off, not a good wave form, not good circulation in fingers, and the readings are normally a bit behind... so not uncommon to have them low when you first place them. I have had patients that the anesthesiologist has said they had a hard time keeping at 89-90% on the vent in the OR, so I don't expect them to be above 90% in the PACU on 10L simple mask... or when they first come in. So I'll ask what parameters the Doc wants them managed in. How much narcotics did the pt get and how soon before leaving the OR, the effects of anesthesia meds and gases aren't reversed with narcan, so without that info I don't know if narcan would have helped? What other co-morbidities did the patient have? Was this an otherwise healthy person? Neck size? BMI? STOP-BANG score? uses a CPAP at home or home O2? Final question... patient that stabilized in 15 minutes doesn't sound like they OD'd and if they stabilized in 15 minutes and stayed that way, why keep them 3 hours?? Once my patient is stable (one criteria is a Modified Aldrete of 9 or greater, with no category scoring a 0, twice at least 15 minutes apart) I send them on to the next unit. 5L O2 per NC (cause you can't give less then 6L for a simple mask) would not have prevented an aldrete of >9. Again, I'm not saying you are wrong to be concerned, I just would not have enough info, based on what you said to know if there was more that should have been done.

What I have been told was that you never should should suddenly stop taking beta blockers or miss a dose, it can lead to dangerous rhythms, extremely high BP's and runs the risk of a MI. It is one of the very few medications that we have pts take the morning of surgery (if that is their normal time to take it.) Even those not having surgery should not abruptly stop taking beta blockers. I have had one or two patient that did not take their beta blockers and the spent abnormally long times in the PACU dealing with elevated BPs.

And a full bladder can set it off too... so can bowel issues.... Other symptoms you can notice are anxiety, increased heart rate, pounding headache.... sometimes those are very hard in PACU because they are common... but if your patient has a spinal cord injury at or above T6, then these symptoms need extra attention.

We have an electronic MAR, but we can override and get a lot of meds before the pharmacy has reviewed... but any controlled medication given to a pediatric patient has to be double checked and double signed by another RN.

Breath sounds can be hard on patients that are still under the effects of anesthesia and narcotics... there is a lot of diaphramic breathing, and the lungs don't expand well. When that happens I do two things. First, If I have question regarding respirations I will take the stethoscope and listen right over the trachea.. I find this especially helpful with children that are in the rescue position and facing away from me. This way I can hear the breath... I always have students listen over the trachea when a patient needs the airway helped manually (jaw thrust, chin tilt) and I let them listen to the difference between being held and not being held. Second, I'll listen to lungs after the patient is more awake and is taking deeper breath. I agree with others, I would need more info to give you suggestions regarding response time to respiratory situations.