diddoms

In my experience Patients cope well with Nurse's foibles. Being open and honest with them is often an ivitation to them to open up to you and tell you things they have never told anyone else. One of my favourite sayings is that" If you don't laugh you cry". If that doesn't work try an apology. That usually works. Patients start getting upset and mistrustful when you stop being open with them. I think that's one big reason why a lot more Dr's get sued compared with nurses. It''s got to do with being open with your patients and not too defensive.

I live in Australia and our winters are pretty short compared to you guys. I once met a woman from USA travellin g in Australia . She was the first person who I had met with SAD. She used to get quite manic in summer and severly depressed in winter when she lived in Maine. She successfully managed her SAD by moving to Hawaii. She said it made hwe feel like a new person. I know it's a bit further south than AZ, but it's still the USA. I wish you well.

CVP measures pressure in the Vena Cava which sits in the Thoracic Cavity. During inspiration we create a negative chest pressure in order for air to fill our lungs, and then a positive pressure to expell air.( Boyle's LAw) CVP should always be taken at END EXPIRATION. This is when the air pressure in the chest equals the air pressure outside. Since at end expiration there is no difference in air pressure what you are reading is purely the CVP. It is actually quite a skill to read a CVP accurately. Patients with any respiratory condition can have abnormally high or low chest pressures, and these thoracic pressures are all reflected in the CVP. If you want more info I'd recommend you read "Hemodynamic Monitoring" by Gloria Darovic( Saunders) Q1 Are you reading the CVP frm the wave or just the number? Whilst the number is often accurate, it only gives an average or mean pressure. Q2 I think you mentioned you checked the equipment,I'm assuming that included a re zero. ? In my exerience transducers often wander. If you had a faulty transducer that may have accounted for the problem. If all these things had been checked try another cable. A faulty cable will lead to loss of zero. YOu can get sucked in because you've just rezerod and the numbers are going wild. Wiggle the cable around and see if that makes a difference. After the cabl;e I'd then try a new transducer. Hope this helps. Regards

Definately Invasive. If they have an art line that is an invasive line and can be very painful even when local is used. ABG's via a an arterial stab are also invasive, and as the earlier post suggests, very painful. Oxygen Sat can be accurately read from a non invasive finger probe if there is good circulation, but when the numbers aren't looking good most peopel will want a gas before changing management, eg intubating.

I'm male and I've had that experince too .Only once in 18 years, but it was hell at the time. What you are experiencing (isolation) is a covert form of bullying. Conversations suddenly stopping when you walk in the staff room, not being acknowleged etc, being left out of coversations, being ignored.eg Having to listen to 'why women need men as much as fish need bicycles'.( when was the last time you saw a fish putting out the rubbish bin? is what i usually reply) Having a quick retort can help, but don't get upset , because that's what they want. If you get angry and rash and are provoked into saying something they can use against you it will only reward their bad behaviour.:) Having said all that Discrimation and bullying is something women have had to deal with for years in male dominated workplaces. Males can do it to other males and females likewise to each other. I worked in an all male culture once and hated it. What's the answer?? I think work places that have a good gender mix are best. Ying and Yang and all that. A few women in an all male envirinment are jsut as important as a few males in an all female environment. In my experience the culture of bullying is rife in nursing. We take great care of patients but treat each other cruelly at times. Bulling usually occurs when soemone is a bit different, and being a different gender is but one exapmle of this. The up side is that most women I workl with really enjoy having a male about to break up the all female work place. Being different people remember you name and if you do something good it usually egts noticed.The one rule I adhere to I think was alluded to by This is perhaps one reason men do generally get promoted ahead of women.They get noticed more for doing exactly the same work. Because nurturing and caring are not traditionally seen as male traits I do IMHO think most ( not all) guys also choose nuring because they really want to do it. I'd either try and get some more males in to your work place. If there are 3 or 4 of you I think the problem will stop by itself. If you an't get more males to join consider leaving and finding another ER to work in. Try confronting the ring leaders. eg " I notice every time I walk in the room the converation stops. " Revealing 'The Game' might take the fun out of it for them. The best way to really **** these bullys is as someone else said to be really good at what you do, keep a clean slate eg never take longer than you are entitled to for breaks, and keep being reasonable and nice. Eventaully they'll give up when they realise that it's not working and they'll move onto someone else. That's my observatin of bullies. Generally I love working with women. I have always had one rule..Don't dip your pen in the company ink... One of the other women mentioned fear as a possible motibvation. There may be something in this. Once women know you are happily married or gay and not a sexual threat they tend to really open up a lot quicker. I think the fact I never had a sister is the reason I went into nursing and that's the best way to relate in the work place. Good luck and let us know how you get on. Hope this is of some use. Regards Diddoms

I used to work in a hyperbaric facility where we treated amoungst other things scuba divers with the Bends or decompression illness( DCI). Every once and a while we would get some one who had relatively severe symptoms given the nitrogen load they were exposed to. We would send them off dor testing and usually they still had a patent forame ovale, which is supposed to close over after birth. Sometimes the opening occurs with straining( valsalva manoever). Small bubbles of nitrogen return to the pulmonary circulation and are usually filtered by the lungs, but when a R>L shunyt occurs the bubble are free to move out into the circulaton where they cause all the problems.

I'm ambidextrous. Does that count? I do some things with the Left hand and some with the right.

I've worked in 3 teaching hospitals in Melbourne Australia. It is our custom to have what you would call open visiting. We limit to 2 visitors per patient, but people can visit 24/7. Having said that we stingly encourage relatives to go home and get some rest. We encourage 1 contact person per family who is the spokesperson for the family. They are the only person to be put through to ICU telephone, however soemtimes this doesn't always work. A big part of our job is talking and reassuring family. We have a holistic approach that whilst our duty of care is to the patient, so long as this is not compromosided by visitors we will let them in. Do we keep them waiting?. Yes often, but people are pretty understanding on the whole. Because they see us working so much they can see how busy we are. Regards

This sounds like a complex case. I think this kid needs a bit of "tough love". This kid has used food as a way to control his parents . Being a poor eater obviously gets him a lot of attention form the parents, albeit in the form of anguish, frustration , despair. Nothing is going to happen until the parents give him some very clear boundaries. Consistancy is the key in my opinion. They seem more the indulging types. If they have trouble managing him at 3 this kid is going to be uncontollable in his teens. Kids being human are always wanting to exercise some control over their environment. The way I've always managed the food issue with my daughter is to give her a choice of 2 things that I think she should have. Would you like apple or orange? She will usually reply chocolate, but I then introduce the third choice which is nothing. Then she ususally choses something on offer. I'm happy because she eats something healthy. She's happy because it's not a control issue and her hunger is satisfied; I'm not telling her what to eat, she is exercising soem control. Another thing a MAternal Chiuld nurse told me is that kids will eat when they are hungry. If the kid throws a tantrum and refuses to eat they will usually eat if they are hungry.My guess with this kid is that he might hold out for a few days, but eventaully he'll give in. Sometimes if my daughter is a bit ferral I just leave food out on the bench and give her a bit of space. As long as I don't make an issue of it and remain out of sight she will go and eat when she thinks I'm not looking. She's happy, I'm happy. It sounds like this kids eating habits are pretty ingrained, and I think it's going to take a lot of resolve from the parents to crash on through some major behavioural modification with this kid. They are going to need a lot off reasurance, but until they stop denyiing that there is a problem this kid is going to keep l;earing that he can hold his parents to ransom. I get my daughter to help me prepare the food, then she is more interested in eating it. We make bread( occaisionally) or use vegtables form the garden. Home grown vegetables taste so much better and the broccoli and couliflower we harvest from our veggie patch taste sweet. I get my daughter to help harvest things from the garden and I'm sure that has helped her to eat healthy food. Good luck. Hope this is useful.

My wife is also a nurse. We met over a hot resus in ER. :rotfl:

There is no such thing as a stupid question, just dumb answers.

It looks to me that you've been set up, and you've been a victim of BAD management. Any manager worth their salt would have aske d for your side of the story, and then at least councelled you. It looks like it was premeditated adn someone wants you out. The fact you have 7 years experience compared to the LPN 1 yr the motive may perhaps habve been either jealousy, or a controll issue. Bad managers feel they have to control everyone and everything all the time. I 've met quite a few in my time. I think you're better out of that environment. If you fight and stay it could get ugly. Your next workplace can only be better. Goodluck.

1. 18 years 2. Acute. ICU 3. Major city hospital - Australia 4. BSN with Post Grad Cert 5. NO! No and NO. I used to have to wear cotton scrubs when I worked in a hyperbaric facility. That was for safety reasons. They were comfotable but any time i stepped out of the unit I always felt like I was waering pyjamas Scrubs are OK if yu work in theatre. There is a good reason to there. Elsewhere I find uniforms stifling. I think sometimes people in ER (or ED as we call it here) like to create a 'team uniform' for all medical and nursiung staff. It is also a away of creating an us and them distiction between patients and staff. In the time i worked in ED I found that a lot of objectification occurred. The uniform can be a barrier to hide behind. Having said that I was greatful to be wearing a uniform that I could readily change the night a patient vomited a bag a of charcoal all over me. The argument that uniforms help the patients identify nurses from other staff doesn't work in my experience. Even in the days when I wore a uniform patients frequently assumed I was a doctor. I attribute this to the fact that I'm male. As a male I have learnt that the best way to communicate the fact you are a nurse to patients is not by relying on uniforms. They don't work. I introduce myself at the start of the shift with something like.."Hi I'm Rob and I'm your nurse for the next shift." I find that introduction more than any other 'visual communication' is both more effective, as well as being more professional. Historically nurses uniforms have been oppressive in my opinion. When I started training 18years ago the girls had to wear an old fashioned chambermaids uniform complete with starch collars and cuffs. For the mature age students they found the uniforms both uncomfortable, impracticle and humilliating. The efforts the girls had to go to get even a modern uniform was immense but in the endthe end the hospital had to give in and let the girls wear pants and tops like the males,so as not to be discriminating. Not long after that the hospital moved away from uniforms alltogether when it realised that it could save all the money on laundering uniforms. But some nurses don't dress professionally I hear soem argue.You will always get some nurses who won't dress professionally I agree. I believe this is an issue that any unit manager worth their salt can handle at a ward level. The whole notion of uniforms I find oppressive, and there are always soem in the hospital hierachy who like to keep nurses in their places. 6. Smart casual clothes with a namebadge clearly visible, clean shoes, and a friendly face. Nothing too overtly sexual. Low hipster pants with a thong ( G string) showing when you bend over is not going to do anything for your male patient's acute angina. For guys without beards I think it's important to be cleanly shaven when at work, as much as I hate shaving. That's my 10 cents worth. Hope it's what yo wanted.Interesting topic.

Here is an excerpt from the The Journal of Clinical Nursing which throws some light on this discussion. Hope you find it useful.>> >> Volume 10(5) September 2001 pp 682-696>> An evaluation of a teaching intervention to improve the practice of endotracheal suctioning in intensive care units>> [Articles: Issues in Research Utilisation]>> > > SUCTIONING

I've seen Droperidol used in ICU as a sedative with confused patients. Like Haloperidol one of the side effects are alpha receptor site suppression. The most common side effect that I have witnessed therefore is hypotension. As most of our patients have arterial lines we can monitor BP very closely, and so we see if there is a sudden drop in BP.

I'm sorry to hear about the loss of your father.I've been here.In my experience it is really hard to make decisions at such a devestating time. I suggest you just need to take one day at a time and make your decisions accordingly. Take as much time as you feel you need. My father died 12 years ago when I was 1 month into a 12 month ICU course. I was entitled to 4 days Compassionate leave which I took. When I did return to work I felt like I was going through the motions, and in retrospect I probably was dangerous as I was so vague and unable to concentrate. When my Dad died what hurt me deeply was the fact that none of the people in my class were told by the teachers what had happened until after the funeral. In fact not one person from the hospital came. I had been working there for over 5 &1/2 years.I told one of my friends in the course what had happened and when she asked if she go to the funeral as a class representative she was refused permission to miss study block for the few hours to come to my Dad's funeral. My fahers death was obviously an inconvenience to the hospital.It's 12 years and I'm still angry about that. I think the amount of time off required is a very individual thing. Follow your heart. It has always struck me as ironic/perverse that we are so caring, compassionate, and tollerant of our patients, yet there is a tacit expectation that somehow nurses should need less time to grieve. Take the time to deal with your grief before you rush back to work and find that you have to deal with someone elses grief. Take care, my thoughts are with you.

I don't know why the bully with the bomb hoax wasn't sacked. It certainly wasn't because i didn't say anything about it.It was a saga that I have loast a lot of sleep over. Being further down the food chain I wasn't my decision. It ( sacking) was something I recommended to my manager though. I still regret not taking it further at the time.

There is an old joke that goes something like....What do you call 2 orthopaedic surgeons reading an ECG? A double blinded trial... boom boom! Here's a couple more. How do you hide a $ 5 note from an Orthopaedic Surgeon? Put it in the Medical notes? How do you hide the same note from a radiologist? Pin it to the patient. How do you hide the $5 from a plastic surgeon? You can't!!! Why do they put nails in coffins? to keep the Intensivists out.... :rotfl:

Good on you. I am constantly saying to the students who I support that the academic content of their course is only a fraction of what they learn. Communication and personal development is the biggest part , and yes you are right, it's not on the curriculum. Reagards

I tend to agree with Triage 34 and redservo. I'm an educator and I agree that you are not going to learn anything from her if you fear her. There are good and bad in all professions, Educators included. Saying nothing just perpetuates the problem, and also doesn't give your educator the opportunity to develop. She quite possibly has no insight into her behavior. There is definately a rostering issue here too. I would raise the issue with someone you trust and get some help to appraoch the issue. Goodluck.

I picked up a really good line form an ED Reg years ago. The reply to the cadiologist would have been. "if you treat me like a dog, I might just bite you". Retort #2 would have been...." It's obvious monkeys could never be Cardiologists; they have too much personality!!" Little boys in long pants. There are a lot of Doctors who think that they can denigrate others in oprder to make themselves feel good.It's a form of sport that is right up there with bear baiting. I tend to tell them what I think these days. I used to be intimidated, but as I get older it gets easier to stand up to them to get stuffed... in the nicest possible way. Once they know they can't get away with it they tend to show a lot more respect.

Why is bullying so rife in nursing compared to other professions? Rats and nurses eat their young! I work in an Australian ICu, and have really gone through a steep learning curve regarding bullying. Several of our post grad students have experienced bullying. Some of them even are unaware of it. We have one malicious senior nurse who will allocate staff she likes to the more interesting patients, whilst for those she dislikes she will actually limit their exposure to ventilated patients and give them heavy patient loads, to the point where she sets them up for failure. This is usually accompanied by a whispering campaign where critisisms concerning the individual are made to everybody except the peson concerned. The effect of this is that it denies the person the opportunity to grow whilst eroding their confidence and isolating them. She is so good at covering her tracks that she will even be really nice to their face so that they don't suspect a thing. To someone who has been on the end of her treatment I can see it happening to others. What I find so frustrating is that she is so good at covering her tracks. I've tried to raise this with my boss, but she can't see her maliciousness, and tends to back the bully's suspect allocations. How much does bullying cost? I've spent hours and hours councelling people who have falledn victim to this one bully, just convincing them to believe in their own ablilty, and not to throw in the towel. It is interesting that 2 bullies I have encountered over the last 2 years have claimed to be bullied themselves, gaining a lot of support form HR and mamgement. One of these RN's actually phoned a vulnerable member of staff at work and pretended that there was a bomb hoax. Did she get the sack? WHat do you think? Of course she didn't. I persoanlly think she should have been deregistered for that.

Off and on over the last 20 years here are soem of the tips I've got on offer. Keep off the junk food. I try and eat fruit maybe yoghurt overnight. Try and keep your normal; diurnal rhythmn as much as possible. I have breakfast at 0600 whilst still at work, go home and try to get straight ot bed. I have lunch when I wake up about 1400 and then normal dinner before leaving for work. Light: Blackout your bedroom . Black plastic or silver foil work quite well. When you are awake get outside and let some daylight hit your pineal gland. I like to get out in the garden for a few hours. Keep the lighting up at work if possible. This will help you stay awake. As a caffeine junkie, I have a rule, no coffee after midnight, otherwise I don't sleep as well the next day. I drink a lot of herbal tea or H2O on Nights. Invest in an answering machine for the phone, and put the phone at the other end of the house. Put a sign on the front dooe warning people of the perils of waking a night dury worker. I had a run when the Jehovahs always seemed to wait until I was on nights before they called. Exercise helps you sleep. I find swimming quite good. Night duty isn't all doom and gloom. I've had some great conversations on nights. You really get to know yourfellow workers. I find people open up al lot more on nights, and it makes for a better appreaciation of your fellow colleagues. Try and keep off drugs. I used to do 5 week blocks of ND, and out of desperation for a good sleep would smoke a joint in the morning to get me off to sleep. The only problem was I found my concentration was really ....what was I talking about:rotfl: I would councel against Temazepam and other benzos as these are quite habit forming. One colleague of mine got really hooked to the point where she used to take IV Midazolam. I try and do short 2 week blocks of nights which I'd rather do very often rather than doing long rotations less frequently. I find I can still keep my normal sleep cycle on nights off and revert to normal much more quickly. Yes long term night duty does take years off your life, there are studies to prove it, so try to limit your exposure. I hope this is helpful. goodluck.