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PACURN1818

PACURN1818

PACU, ICU
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PACURN1818 has 13 years experience and specializes in PACU, ICU.

PACURN1818's Latest Activity

  1. PACURN1818

    Anti-Intellectualism/Autonomy in nursing

    This is why I like PACU. With time and experience sliding into PACU is one of the few areas left with autonomy. Because of the way our protocols are worded we can go ahead and do things medically needed for the patient which also make sense without waiting until the doc runs to the bedside or calls back (though they are usually right there in a flash) I can fluid bolus, change levels of oxygenation and other things depending on what I see is happening with the patient, and am covered by the protocol that the anesthesiologists sign when they arrive in PACU. Anywhere else you just stand there waiting for the RRT team to show up when the doc doesnt call back. Thats why I stopped floating in house for extra cash. If my patient had chest pain I was calling for a 12 lead, and then getting fried by the charge even though the doc always covered me afterwards. Its a different environment, and it isnt for me anymore.
  2. PACURN1818

    HCAP scores - I can live without them

    I will second the scores getting crazy attention, esp now that it is a funding thing. As in the other post Was has been up more recently where I was frustrated, I feel it gets to the point where it doesnt matter if safety is compromised as long as the patient will mark good things on their survey.
  3. PACURN1818

    Does your OR have to hold til theres a PACU bay??

    LOL, THAT would be fantastic! Its been a huge issue lately, and I think the situation is going to be discussed in practice council. We do utilize the extra transport monitors with O2 on the sides to take extra folks. I have often wondered why in these instances ICU couldnt take their patients straight from the room, it makes sense and is an excellent point
  4. PACURN1818

    PACU RN's- what is your visitor policy?

    We have visitation issues. with HCAHPS starting up our manager is all visitor gun ho, but there are many problems. She feels that privacy isnt an issue since we dont say first and last names, but even if they didnt say my first name, if the staff was talking about my perianal abcess surgery I would be embarassed. We allow 2 parents back, then one stays with kids under 16. Or special needs. Otherwise we do updates. If a patient is there more than 2 hours we allow a short visit. I love that people have no consideration. Its not about the patient, its about them. Or they come back and dont pay attention to their family member and just stare at all the other folks.. Or just wander into PACU and dont want to leave. Or force their way into PACU. It is supposed to be every nurses decision, until someone complains. My favorite is, patient needs attention, having problems, only out of OR for 15 minutes and the sister wants to come back WITH HER FRIEND so they can leave For The Mall. ??!!! I dont really feel that visitation in PACU is appropriate, family members dont understand the things that go on, and as one of my fav anesthesiologists said a while ago when we had an issue.... "Good medicine, especially good anesthesia care often either is brutal or looks brutal. Its the safety that matters."
  5. PACURN1818

    Aldrete Score

    We use the revised one for surgical patients as part of our criteria. A score is done on arrival, after 30 minutes and prior to discharge. A pt cannot leave PACU with a score of less than 10 out of 12 unless they are going to a critical care unit or had a pre-existing issue, (such as having a 0 for being on a vent, but were already vent/trach dependant long standing preop) This works well for us, and yes I believe its an ASPAN standard.
  6. PACURN1818

    Does your OR have to hold til theres a PACU bay??

    wow that sounds nice. For us its pot luck, when the doors open we have no idea which patient it is, or how big a case it was until they slide into a place. Knowing the size and severity would really help us to be better prepared and let the OR know right where to go. It seems like a better way to go. Thanks!!
  7. Ok.... So nearly ALL our patients scheduled today came out in a three hour time span, like stacks of three at a time, killing us. At one point we are out of PACU bays, putting people on the edges with transport monitors. THEN we send total joints over to inhouse holding. THEN three more come out with an ICU at the end, all angry we have no where to put them and crazy impatient as we scramble to put them places. One of our nurses is a long time PACU nurse with experience in other hospitals and said several places she worked the OR had to call and see if they could come out, and had to actually HOLD patients in the OR until their bay was available. Our OR chugs along completely unconscious of our capacity or resources, and we are all getting a bit worried about missing something, or not giving people enough attention. Whats up in your PACUs?
  8. PACURN1818

    You might be a PACU nurse if...

    You have been getting all the patients all day because no one else is moving theirs You know by looking at your anesth. doc all your patients will be in PACU two hours because they are slightly overwt your patient who is vomiting is angry that you wont give them water Your NPO x24 hour thoracotomy has a family member bring them 4 mcdoubles, a 20 pc chicken nugget a large fry and a milk shake into recovery (for real) Your 10 hour abd surgical patient comes out on a cart, but your thyroid comes on a bed
  9. There is a thread running in general forum about patient satisfaction, burn out, HCAPS, and patient safety. Someone commented wisely that a management viewpoint would be insiteful... Anyone have time to take a look and join the fray?? https://allnurses.com/general-nursing-discussion/customer-service-any-553651.html Thanks for any time you can give us:yeah:
  10. hmmm, just another good reason to head back to my uk roots! (green with envy):redbeathe
  11. It is SO nice to see that I am not the only one struggling over this. I love the Press ganeys that say things like, "my roommate puked all night" or The nurse wouldnt go down to the lobby and get me a sandwich from McDonalds" Really?! Its just killer how YOU are somehow responsible for all this crap. I give good care. My fellow nurses do as well, but the comments you see have nothing to do with care, they are basically about how they did not get to do whatever they wanted, or how they didnt like what the MD ordered, and then blame the nurse. We chart by exception at my facility, but I have stopped doing that and started writing every time I get the vibe that Mr Smith is angry his pillow is plastic to cover myself and illustrate the patients ridiculousness. Sometimes that helps when my manager pulls and reviews the charts. It is crazy and maddening, makes me want out of nursing, you cant do your job, you cant convince people to do their stuff, and you cant say anything back when getting abused. Comfort in others experiencing the same thing.
  12. PACURN1818

    Inaccurate story on CNN?

    Agree with everyone. Never saw a doc do our burn dressings, nurses and burn techs. They show up to look at the wounds every day or every other day, but that was about it!
  13. SO... Things are more different every day than when I started nursing over ten years ago. The advances and technology I can flow with. Some other things not so well. I have worked ICU, LTAC, Med/Surg, Peds, Oncology, Float, and PACU. No matter what the area, this customer service push follows you every where! I have always understood that the patient is your customer, and you just cant be flat out rude or nasty, however, when did it become routine every day acceptable for the patient, their wife, and their aunts third cousin to be rude, and right out nasty to the nurse?! People more and more feel like they can do or say whatever they want in the hospital. Like basic rules of courtesy do not apply if you are their healthcare professional. My hospital had a big customer service push with classes a few years ago, which basically was all about how to lie and be fake. This is above and beyond keeping your personal troubles at home, and giving your best to your patients. I currently have two jobs, PACU (because i love it), and LTAC for the money. If there is a problem or any type of complaint no matter where you are, you are done for. Recently in our PACU a comment card from a patient angry that he was aroused and told to breath was taken seriously and a discussion was had with the management. At what point does this junk stop? At what point does customer satisfaction overpower safety? At what point will someone understand that the impression this junk is giving nurses is that we dont matter, and if someone spits on me I should thank them for it?? HCAPS = Burnout! I was kicked by an a & o pt last week. I had it, and politely told him i wouldnt go to where he works and kick him, and expected the same level of respect in my work environment. Did not go over well. HCAPS and the government and the Joint stressing the satisfaction issues simply makes this worse. People making decisions about this stuff arent the ones getting screamed at, insulted, and belittled. Politely educating your patient family member who read how to flush a line on the internet and doesnt know what they are talking about will get you fried. Telling an alert pacu patient they cant scream and curse when there is a 3 yr old in the next bay will get you fried. Telling a family member in the waiting room they cant come to recovery while you are extubating their wife will get you in trouble. Following pplicy will get you in trouble as soon as someone decides to complain they dont like the policy. Anyways, can you tell I am frustrated? I like patient education, rights, and good customer service, but how ridiculous will this continue to get? I just need to hurry up and hit the Mega Millions. . . .
  14. PACURN1818

    CPAN exam

    Good info, I am hoping to take it later this year!
  15. PACURN1818

    Narcotics at the bedside in t he PACU

    We use the carpujects so the med is still in its original labed container for anything we can get that way. The meds are labeled with a pt sticker and kept at the bedside, in our immediate supervision. We have been told that with our upcoming survey expected any time, we will need a lock box at each bedside. It is NOT possible to waste after every dose, and a complete waste. Peole making the rules need to understand the situation in order to help make solutions
  16. PACURN1818

    PACU nurse give Ketamine?

    We have 2 anesthesiologists in particular that are fond of ketamine if nothing else is working and the patient is kinda going nuts. I have had several people react well, and several have what they would describe as a "bad trip" It has, howver seemed to break the cycle and help every time. We tend to give 10 to 20 mg ivp times 1
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