Nellie Nurse

It's like you are me. I have been working in an ICU for almost a year now. I find myself more bothered with the things that go on here than in any other place I have worked. Having to participate in caring for patients who are rotting away in the bed because the family cannot let go is so stressful for me. I have the suspicion that at times the motivation to keep grandma alive for a little longer is to continue to collect their checks. That makes it extra disturbing. I also find it really upsetting that a family member can disregard a patient's signed DNR just because they can no longer speak for themselves. It seems like we do more and more and more tests, procedures, etc with the same outcome at the end but adding extra pain and distress. Like you, I don't think that I can do this work for much longer. I feel not quite depressed but definitely more melancholy after working and it takes me several days to feels more like myself. I took some much needed PTO over the holiday just to get away from work. I have learned a lot from this job and for that I am grateful but I really do not want to participate in this aspect of medicine anymore.

Thanks for the reply. The hematoma was too large to mark; extending into the groin and thigh. It was a critical situation. Unfortunately the SWAT nurse present, the one that we look to as a guide for interventions in these situations, gave poor advice and did not recommend continuation of holding pressure. Now that I have had several days to process the scenario, I realize how bad that advice was. At the time I felt like we should be holding pressure but when you have someone with more experience telling you different it makes one question themselves. This event has been a great learning opportunity for me and in the future I will not be so hesitant of what should be done.

Not my pt but an event that happened the other night has me wanting to refresh my education and I can't find much info with a general web search. Pt developed rapidly expanding hematoma shortly after tx from cath lab. It was eventually discovered that pt had laceration of femoral artery and pseudoaneurysm. Pt was taken to surgery for repair and hematoma evacuation. So the question is... when in this situation, is continuous manual pressure held until pt is tx to OR? Where exactly would you hold pressure if the pt has no external bleeding? We didn't know exactly where the site of bleeding was so pressure was held over the puncture site. What other nursing considerations would be expected? A second IV was placed and IV bolus started. I personally have not had a pt with this degree of bleeding before so I did not feel 100% confident. As one of the most experienced nurses on this unit many of the others turn to me with questions. They were looking to me to help with interventions. I just want to make sure if this ever happens again that I will be very confident and intervene without question of if I am doing the right thing.

That's surprising. Prior to moving out here I was working just south of the MI border, in Indiana and I figured their wages would be similar. Hoping to someday go to possibly the GR area.

So I have been living out here in the Phoenix area. I would love to someday move back to West MI which will always be home to me. I feel as though that will not be possible due to the huge difference in pay. My base is 33 with 18% shift diff. If I move back I'm looking to go down at least $10 per hr with similar cost of living. Are there any areas in the Midwestern area that do not have such a huge pay difference? It is really ridiculous that nurses get paid such crap wages after 10+ of experience. On top of that, now the hospitals in Mind are requiring BSN's. So I would have to shell out thousands to take a pay cut.

Sometimes when a family member would ask me more questions than I could answer about the patient's plan of care by the physician who usually did not share that information with me I would give the family member the phone number to the doctor's office and let them contact them directly.

Is it just my idealistic view of what a nurse should be or does this bother other nurses? I have heard several times lately and have read articles of people who are going to nursing school, not because they want to be a nurse but because they want the paycheck and a stable job. My sister in law is one of these people. She said to me, " I really don't want to be a nurse but I figure that I can work as a nurse while I go back to school." I find that mentality very frustrating. I worked very hard to become a nurse. I worked as a nursing assistant before I became a nurse so I could make sure that I knew what I was getting myself into, I shadowed nurses when I was in high school. I really feel that this is what I was put on this earth to do and to hear people talk like this who have absolutely no concept of what they are getting themselves into and who have no respect for the profession just boils my blood. I feel like these people, who have no intention of staying in nursing for an extended period of time just make it harder for the nursing student who actually wants to make a career of nursing because they take up spaces on the wait list for getting into nursing school. Maybe some of these people will be excellent nurses and will contribute well to the profession but I personally would not want a nurse to take care of me who only got into the field because they wanted a stable paycheck. Don't you agree that to do well in nursing you have to have some desire to be here in the first place? These are people's health and lives that we are dealing with. This field isn't just about a paycheck!!! I know I'm probably being naieve and idealistic when I say this but I really feel that nursing is a calling, not a JOB!!! I've been doing this type of work for going on 10 years now and I have felt that way about it from day 1. What do you think? Does it bother you that people are getting into nursing who have no desire to actually be a nurse? Just wanting to hear other people's perspectives on the issue.

When I was in nursing school I did not take the scholarship for the reasons mentioned by the previous poster but the hospital I worked for also had an option for tuition reimbursement. Unlike the scholarship program they did not pay for the full load, if I remember right it was like 75% or up to $1000 per semester (which for community college is pretty good). The good thing about that program was that I didn't have to promise to work there after graduation. Your neice should first look to start working at a hospital just to get the experience and then once she has started working there she can find out what is offered and talk to other employees to see if there is a better deal elsewhere.

- I wish that there was a headset device that you could talk into while doing the head to toe assessment of the patient that would automatically enter your assessment into the computer so I wouldn't have to do all of this darn charting. I could just review the info and verify it and be on my way. -It would be cool to have I&O scanners so when the pt pees in the toilet or you dump a foley the toilet scanner would read the total and automatically enter it into the computer.

So the hospital I work at recently instituted these DVT prophylaxis orders where each pt upon admission has a form placed on their chart for the doctor to review and sign. The form has boxes to check for increased risk of DVT such as hx of DVT, recent trauma, ortho surgery, etc. Now I'm all for preventing DVT but they have made it the nurse's responsibility that if the pt is not on an anticoagulant and the doc has not signed the form then we are supposed to call then to find out if the pt is to be on an anticoag. I feel like we are constantly picking up after the doc. This is their responsibility. Same with the med rec form. I feel like a baby sitter. I don't have time for this. And they wonder why we don't leave until 1 1/2 to 2 hrs after our shift is over. Do any of you guys have these forms? Is it the RN's responsibility to track down the doc on this issue?

I work on an ortho/neuro unit where the doctors are babied. Our med reconciliation forms used to be order sheets that the doctors could check mark DC or continue but none of them used the order form the right way. So now the med rec form is put in the progress notes for review and then the doctor is supposed to write an order for which meds to start. The hospitalists and internal med docs are usually pretty good about writing out which meds to start but the darn ortho/neuro docs will write, "Continue home meds." Well we can't write out a clarification order and list the meds as listed on the med rec form so we must then call the doctor and read the list to them and get approval for each med. Half the time these guys don't even know what the medication is!! Then we have to listen to them ranting and raving about being paged blah, blah, blah. Then when the pt is discharged we have to do the same thing all over again and write out all of the meds to be DC'd on. It is a lot of work and is really frustrating.

I have had experience with a level 1 trauma teaching hospital as well as a level 2 hospital. I am most concerned about the drive and safety. Both facilities are about the same distance from where I will be staying but I have heard that the traffic will be crazier going to downtown phoenix vs Glendale? I am leaning more towards the Glendale campus only because this is my 1st travel assignment and the pts won't be quite as sick as in Phoenix but I don't know. These are just some of the concerns swirling around my brain!

I have 2 offers for travel positions, one for Banner Good Sam on the Ortho/Neuro, med-surg unit, and the other on a med-surg/oncology unit at Banner Thunderbird. I have never been to either of these facilities. I am wondering what to choose. Help. Any insight would be most appreciated. Thanks

From a fellow Michigander I want to congraulate you on passing the NCLEX!! I myself was raised and currently live in Berrien county. I have worked at Lakeland, Butterworth in Grand Rapids, and Memorial hospital so if you have any questions feel free to ask. I'm so sorry that you have lost your precious baby. We had a girl where I work who lost her son to SIDs in January. It was so sad. Everyone on the unit was depressed for weeks. We still talk about her and think about her even though she moved right after it happened. God Bless you. Best wishes as you start your new career...and welcome back.

Our hospital just switched to Cerner. We had started out with using computerized MAR but we just went back to the paper MAR because pharmacy was totally unprepared for the change and a lot of scary things were happening- meds were being put in twice, insulin was listed under PRN section and was being missed. One of our patients didn't get their coumadin for 5 days because the nomogram orders were being overlooked. I'm really glad we went back to the paper MARs. I do like the computerized assessments but it also seems as though the paper work has doubled. For instance when a patient is admitted you have to not only document all of their home meds in the computer but also write is out on paper for the chart. Also the aides have to chart blood sugars on a paper flow sheet, on their assignment sheets, and in the computer. There is too much double and triple charting involved at this time. Management has also not told us which paper forms we are no longer using and which ones are still to be used so every other day they change their minds about how to chart. One example of this is there is a place to chart restraints in the computer but the paper form is still on the unit so some people are using the computer and others are using the paper because it is still available. There is still a lot of confusion. We have had this system for a month now.