NurseBatzy

I don't want to argue, or inflame, but I am just offering some perspective. Coags are a different beast. It only takes about 1/10 of 1 ml of plasma to run a coag test. In this case, it's not a matter of having enough specimen, it is having the right ratio of specimen to anticoagulant. Blue tubes have an exact amount of anticoagulant in them, so that if you fill the tube to the line it is a 1:9 ratio. The machine does not know or check the ratio, it checks to see if there is sufficient specimen. The tech is responsible for checking the ratio. Many will run it short, but then the results are skewed. If it is an emergency, or again when the lab techs just can't handle being cursed out one more time, it can be run, but it is not accurate.

I'm not an ER nurse, but I think I can give some perspective here. Before becoming an RN, I was a lab tech. You know, the one who actually runs the tests. I think every hospital has a communication barrier between lab and nursing, and it can be difficult to understand exactly why it is the way it is. First, as for not having enough blood to run a test, it most certainly has nothing to do with the lab staff. Certain machines need certain amounts of blood. If the machine rejects the specimen, it can not be "made" to run the test. Depending on the test, the lab tech might be able to run it manually, which takes a LOT longer, and if there wasn't enough for the machine, you're not likely to get very accurate results manually either. 10mls of blood for a culture provides the most accurate results. If the patient is able to give up that much, they should. Just because other cultures have shown positive with less specimen doesn't mean that all cultures will show up with less. If your lab tech is sick to death of fighting with the nursing staff, or the patient is too young to give up all that blood, they can do the test, but again, less accurate. It would be a pretty twisted lab tech who would treat specimens drawn by nursing any differently than ones the phlebotomist drew. Also, leaving a CBC sit for a few hours will not cause it to hemolyze. CBCs can be done off of blood up to 48 hours old in either a lavender or green tube, depending on the instrument doing it. I've never met a lab tech who really wants to have a patient restuck. Yes, I worked with some nasty people, but no one who ever tried to punish nurses by tormenting patients. We in the lab didn't want to make those phone calls any more than the units wanted to hear from us. Being on the other side, I can see how it is a frustrating system to everyone involved.

Some of our patients are allowed to run high, but not that high. I agree with the previous poster though, this is a time to use nursing measures. In my state you need an order for a cooling blanket, but ice packs are open game. A fan and a wet head works fairly quickly too, just don't let the temp go too low. Fevers are good when controlled.

When I started in my first ICU, I had to take something similar. NCLEX meds are a good start, but you'll likely be asked about drips as well. Know your insulin drips, pressors, propofol and other sedatives. I remember needing to know Cardizem, Amiodarone, NTG, Nitroprusside, and strangely Dopamine. I say strangely because at that hospital we didn't use Dopamine, although at my current facility it's pretty common. Good luck, and relax. It's probably not going to be nearly as hard as you expect.

I can commiserate. I worked at a job where we were mostly all afraid of losing licenses. We had a doc who loved to call the BON and complain about us. Constantly. It's a harsh, stressful environment to work in, and when one is afraid for one's livelihood, it isn't unreasonable to move to a place where one feels safer, no matter if the threat was real or not. A better excuse might be that one is afraid for their patients, or one is afraid for their job, but in the end, it doesn't matter. Each nurse has his or her own personal license, and therefore the right to protect it as he or she sees fit. It belongs to the individual, not to the managers, more experienced nurses, or the co-workers who disapprove.

A wonderful nurse once told me that I should not expect any code to turn out well. She said to remember that if you must do CPR, they are already gone, and you MIGHT be able to bring a handful back. In my time, very few have survived for very long after the code, and I still feel guilty every time, but her words help. They were already gone. It sounded harsh to me at the time, but I realize she was right. Kudos to you for what you did, you brought one back, for however long. That's better than many can do.

"I can respect that you finally put your grandfather on hospice care. Very noble. But why, why, why, did you then bring him to the ER when he stopped breathing, and tell us to maintain his hospice status?"

That's a nice realization. I want to one day go to NP school, but am waiting on some more experience myself. I want to get out of bedside nursing before my back gives out completely, and your post gives me some insight into how it will be different. Good for you for expressing your opinion and thoughts, as no doubt there will be some flames coming your way for it, but I appreciate the point of view!

I think it should be said that did not post this in an effort to be self-righteous, it was more a speaking of my mind for my own benefit. I am grateful for these patients, I understand not everyone is, and I wouldn't want to force my opinions on those who aren't. And yes, I have injured my back, been slapped, punched, kicked, bit, and spit on. And yes, some days I know the burn-out is just around the corner. As much as we try, sometimes we fail to provide the care we want to. Just a thought.

I would be willing to bet by the title that the reader here will think this is a rant, but it is quite the opposite. This came about because the longer I spend here on AN, and the longer I work in a hospital, the more my heart breaks to see how some of our patients are treated. I am grateful for older patients: Some may say it is time to let them go, to stop trying, and give up. If the patient and family do not want to stop, I want to be the nurse that agrees to keep fighting with them. I am grateful for overweight patients: When they are brought to tears by embarrassment, when they spend day after day listening to snide remarks by the staff and turn angry when they have had enough of health care providers complaining about them, I want to be the nurse to give them some dignity. I am grateful for drug-addicted patients: Some don't want to quit, and won't. Some want to quit, and can't. When others see a "junky" or a person who could never amount to anything, I want to be the nurse to see potential in the human being trapped inside an addict's body. I didn't become a nurse to take care of only the patients I deemed worthy of my care. I became a nurse to help people. All people. I'm not here to judge them, and I am lucky to have a job. If it weren't for these patients, imagine how much worse the nursing job market would be. I am lucky to be able to help people who need it most, and make a living doing it. On a side-note, I am also grateful for all of the wonderful, fantastic, and talented nurses!

Wow Jay, thanks for the fantastic information. It surprises me how few of us health care workers know this, and I will be sure to take your post into work with me and educate our staff. It is a time when we are constantly told "no,no,no" about giving out any information on anyone, and this statement really helps. Thanks again!

I usually don't post on the more controversial threads, like this one, but I have a story that might fit as an example. Now, I won't throw age into the post, but physical capacity. I used to work with a nurse who used a walker outside of work, but not when she was working. A fantastic woman. Knowledge like nobody's business, experience the likes of which I won't likely see. Interpersonal skills, the whole nine. The unit was small, the rooms were like closets, with no room to move around, and we were constantly tripping over things just to get in the door. One day there was a patient who fell out of bed. And then he coded. And he landed in front of the door. There were only 2 nurses in the unit. One nurse got the door open and dragged the patient away so this other, less physically capable nurse could get in. The code blue was called, CPR started by the more physically capable nurse. Unfortunately, these two nurses alone were unable to lift the patient back to bed, and less physically capable nurse could not get to the ground to perform CPR. Eventually, more help came and patient was dragged into the hallway to complete the code, which ended poorly. Risk management felt that more physically capable nurse's compressions were inadequate after 2 minutes due to fatigue and no one to relieve her. Interestingly, more physically capable nurse was older than less physically capable nurse. Take from this story what you will, I won't take sides. Old, young, hefty, skinny, short, tall, male, female, or other, we all have good and bad qualities, and we all need to know what we can and can't do. ~ A young(ish), hefty, tall, female nurse

Hello All! I have recently been accepted into the RN to BSN program at DeSales University. Before applying, I researched AN for info on the program, and found very little, so hopefully this thread will help someone else out. A little background on me: I graduated in May '11 from my local community college with an ADN. I work in a small ICU, and obviously I'm going back to get m BSN. As for the Desales program, here is what I know: None of the nursing courses are completely online. Most are a hybrid, containing both an online and in-class component. Many of them are only 2 or 3 meetings per course, however some are weekly. General ed courses can be taken in either format, however they have limited class space for completely online programs (So register early!). For RN to BSN, the sessions are 8 weeks long, year round. As it was explained to me, you are free to take semesters off up to a total amount equaling one year if you so choose, however, nursing classes are each offered one time each year and must be taken sequentially, starting in August. So, if you miss a semester, you wait until the same time next year for the class. You need to take at least 10 courses at DeSales to receive their degree. For me, after reviewing my transcripts, I needed 11. I took a P-Chem course at my community college that I didn't need at the time, but it transferred to DeSales (Taking it at the CC saved a BUNCH of money. Hint.). Most community college grads will need 12 or more courses to meet DeSales requirements. All of the people I encountered during the admission process were fantastic. Everyone is helpful, the campus is beautiful, and the nursing faculty seem to truly enjoy what they do. Good luck to anyone trying to continue on, I hope you find this helpful in your search for the right school!

Thank you all for your great responses! rjflyn - How would you verify that it really is the Red Cross calling? We have caller ID, but it only shows a number, not a name. I wonder if they have a way of proving their identity? Perhaps a reverse phone number lookup might work here. Thanks again everyone, this has been a great learning experience.

Thank you all for your replies. After some quick googling (yeah, it's a verb now) I found this: For Health Care Practitioners! HIPAA Exemption for American Red Cross The American Red Cross is charged with providing emergency communication services for military families and servicemen and women in the line of duty. With many emergency messages involving health issues (deaths, births, surgeries, etc), we need to verify a patient's condition, cause of illness/death and obtain a "Doctor's Information Statement" including condition, prognosis, life expectancy, and diagnosis. This information can be obtained from any medical personnel involved in the care of a patient (doctor, nurse, or office manager). This information is vital to the sending of an emergency message by the American Red Cross. In any case we are working on, the information we gather is strictly used only for the purpose of sending an emergency communication and is kept confidential otherwise. Recognizing such, the Department of Health and Human Services created an exemption to the HIPAA regulations allowing doctors, or their representative, to share information about a patient with the American Red Cross for the purposes of providing emergency communications. This exemption is provided under 45 CFR 164.510(b)(1)(ii) and 45 CFR 164.510(b)(3). This information is also provided on the H&HS website at http://answers.hhs.gov. The exemption reads as follows: The HIPAA Privacy Rule permits a covered doctor or hospital to disclose protected health information to a person or entity that will assist in notifying a patient's family member of the patient's location, general condition, or death. See 45 CFR 164.510(b)(1)(ii). The patient's written authorization is not required to make disclosures to notify, identify, or locate the patient's family members, his or her personal representatives, or other persons responsible for the patient's care. Rather, where the patient is present, or is otherwise available prior to the disclosure, and has capacity to make health care decisions, the covered entity may disclose protected health information for notification purposes if the patient agrees or, when given the opportunity, does not object. The covered entity may also make the disclosure if it can reasonably infer from the circumstances, based on professional judgment that the patient does not object. See 45 CFR 164.510(b)(2). Even when the patient is not present or it is impracticable because of emergency or incapacity to ask the patient about notifying someone, a covered entity can still disclose a patient's location, general condition, or death for notification purposes when, in exercising professional judgment, it determines that doing so would be in the best interest of the patient. See 45 CFR 164.510(b)(3). Under these circumstances, for example, a doctor may share information about a patient's condition with the American Red Cross for the Red Cross to provide emergency communications services for members of the U.S. military, such as notifying service members of family illness or death, including verifying such illnesses for emergency leave requests. I still feel a little strange about giving out this info on the phone, however. I think you are all correct, next time let the supervisor deal with it.

Just curious if anyone else has experienced this: A nurse in my unit received a phone call at work from a person identifying herself as being from the American Red Cross, and was calling to inquire about a patient in the unit. She stated that the patient's son was deployed overseas, and as a service to American military members, they will contact the son with an update on his condition. She wanted to know the patient's prognosis, if they were currently stable, and if the nurse felt that the family member should be present at the bedside. I believe they also wanted a diagnosis, but I'm not positive about this. Has anyone else experienced this? What are your thoughts? I know in my facility we can acknowledge the patient's presence and condition if they do not specify otherwise, but would you give out a prognosis or diagnosis? My thought is that the family can contact the serviceman themselves, and I would be very cautious about giving out any further information over the phone.

I don't know of any reason it would be used, maybe someone else has a better answer for you, but I can tell you this: In my hospital, adults do not get ketamine. Period. It's too hard on the limbic system in adults, and has the potential to cause flashbacks and psychosis long after its use. I know during my schooling at a different hospital, I saw it used along with propofol, but only for induction, no drip. I'd like to hear from someone who has experience with this, you've piqued my interest!

I see, and sometimes post, some vents and frustrations here on AllNurses, and I think it's time for a positive story. I'm a recent grad RN, working in a small ICU. I've had many bad days, and have been about to quit quite a few times, especially in the last two weeks. I don't feel that my 6 weeks of pseudo-orientation were adequate, and I'm getting tired of being reprimanded for not knowing enough about the unit. One day last week, however, I had a patient that changed my point of view. This patient was very kind, very sweet, and fairly healthy, a rarity in the ICU. He continued to say "thank you" to all the nurses and doctors that saw him, he was truly grateful for our care. I was lucky enough to have him one night, and in true ICU-form, I had to wake him almost every hour for some kind of treatment, medication, or IVF replacement. He never complained. Not once. About anything. He just kept thanking me for being there for him. Unfortunately, he had the opportunity to hear another nurse berate me for an easily fixed documentation error. (I forgot to initial a note. oops.) That morning, I went in to finish my care and say good-bye, and I told him I hoped he went home that day so he could get some rest. He told me he hoped so too, but that it was ok if he had to stay. He said that he was lucky to be there and get to experience an ICU without being a "real patient." He said that he and myself were blessed, and to know that for a fact, all we had to do was look around at all the other patients in the unit. Before I left, he also told me that he knew my job was hard, but to keep remembering that as long as I am on my side of the desk, my day hasn't really been all that bad. I can't even remember his name, but his words will stick with me for a long time. It was because of him that I didn't give my 2 weeks notice that morning. He was absolutely right. After seeing my other patients, with dementia, renal failure, and end-stage diseases of various types, I did realize that when I put it all in perspective, my day wasn't all that bad at all. I hope this helps someone else to take a step back, take a deep breath, and be glad for what you DO have, rather than what you don't.

I agree, it's not only possible, it's likely. A word of advice though: do your research! I was hired as a new grad into an ICU not too long ago. It was easy! It was the first job I applied to, and my interview took all of 10 minutes. I was hired on the spot! Unfortunately, I should have seen those red flags. I was hired onto a unit that was so desperate for RNs, they didn't care who they hired. They can't keep anyone around except for a few of the older/experienced nurses who will never leave, and they don't like new grads! The doctors don't like new grads either, which exacerbates the problem of nurses leaving, which leads to more brand new RNs being hired who are being trained by new RNs, and the cycle continues. I won't tell you not to try for the ICU, it's fantastic, and it's what I want to do as well. Just be careful! Look around the unit, get a feel for the experience level, find out who will train you, and ask about turn-over rate. ICU nursing is wonderful, but not so great when the unit is crumbling around you, or when you were kicked off orientation early because they need you to work overtime. Then it is your fault when you don't know something that they never taught you. Good Luck!

1:1? What's that? Granted, I work in a small community hospital, our "critical" may be another hospitals "step-down", but in my ICU there is no 1:1, usually no 1:2. I almost always have at least 3, sometimes 4, and one of the more experienced nurses had 5 the other day. That likely won't happen again, as she followed her chain of command right up to the CEO who nixed it. We don't have CNAs either, just a unit secretary sometimes. Am I working in the wrong place?

Heh heh, you are correct, a crap hole it is. Thanks for all the advice. Just a side note, I AM glad that I have a job, and I don't want to complain too much in this terrible job market. There are many new grads who have it worse off than I do. Thanks everyone!

Thanks guys and gals, you gave some great advice and some things to think about. I'll be sure to be very, very careful, and look for other opportunities. Hope everyone has a great weekend!

Thanks to everyone for the advice. ICUenthusiast, in answer to your question, no, we don't have a union. I am considering speaking to my director about it all. She seems like a friendly and caring person so far, and she is relatively new to the hospital. I am just a little afraid of the consequences if she feels I'm making a big deal out of nothing. I moved myself and my family 2 hours from home to take this job, and am doing everything I can to keep it since I am our families bread-winner. So, what do you all think? Talk to the director, or just wait until I am off orientation and on another shift? Thanks again!

This might be considered a gripe, a rant, or whatever you want to call it, but I need to get it out. I'm a brand new RN, just passed my boards last week. I've been working as a GN and now RN at a small community hospital in the ICU. There are only a few full-time nurses on day shift where I am orienting, the rest are per diem, part-time, and med-surg nurses pulled from other units in a desperate attempt to staff a unit that recently had 6 of their 12 nursing staff quit. One of the nurses is fantastic. She's friendly, loves to teach, can handle everything from tanking patients to yelling doctors. She is not my preceptor. My preceptor I won't comment on. The last nurse is quite simply burned out. She yells all the time. At me, at her patients, at the other nurses, you name it, she yells. I can handle her, because I won't need to work with her once orientation is over. She treats me like her personal CNA, and I spend most of my day bathing and changing her patients. (There are no aides on our unit) But that is not my gripe/rant. We had a patient who had a drug addiction. Not uncommon, but this one was very ill for various reasons. During my free time, I tried to help out with her care as much as possible because she needed so much care. I talked to her often. I explained what was happening when we touched her. She could not respond, but could hear. All three of my co-workers told me, in the patients presence, that I shouldn't be nice to her, she did this to herself. I heard from them that she isn't worth their time, she's just going to kill herself later, etc. I kept at it. I talked to her whenever I could, after I was done with my own patients, until yesterday. What happened yesterday you ask? Yesterday, as I bathed her, I was screamed at from across our small unit to get the "f" out of her room and take care of the real patients. Again, I spent the day bathing and changing the other nurses' patients, while they sat in the breakroom gossiping and playing cards. So, any advice? Should I stick this out? I think that this is just a part of critical care nursing and it will get better when I gain experience or change shifts. Did anyone else have this problem? Does it get better? Thanks for reading my complaint. I really want to see a time when nurses don't need to blow off steam at home like this. Hope everyone had a good rest of the week! Nurse Batzy

Thanks for the informative reply! I will remember your advice when I start next Monday, although I'm sure no one will leave me alone with patients for some time.