crazyearrings

We're currently having a debate at work about pediatric patients under the age of 8. The nurses feel that general anesthesia is the kindest, safest way to go with young children. Two of the docs are resistant to this. We recently had a bad experience with moderate sedation on a one-month old which has brought the issue to the attention of risk management. They are asking what is the standard of care for sedation on young pediatric patients. So tell me, how do other places sedate little ones?

I agree with all the posters that said - we love nursing, it's just the politics we hate. I used to tell my husband, "I love my job, I just hate where I work." For example, the powers-that-be have decided everyone in the hospital will start wearing solid colored scrubs with each department identified by its own color. I work on Peds, the area that first went to fun scrubs, and we aren't thrilled with this prospect. I wonder if anyone who decided on this even has to wear scrubs! So much for nurse governance! (We're applying for magnet status) I'm sorry - this is supposed to be a positive post. What I love about being a nurse; 1. Being home 4 days a week 2. Good pay/job security 3. Making a difference 4. Watching the way kids bounce back 5. Getting to know the families 6. Having the honor of watching someone peacefully leave this world. 7. Patient teaching 8. Hearing that the docs know when I say a child isn't doing very well, they better listen.

Has anyone else noticed that? The year I lived in Indiana, we had blizzards 3 out of 4 weekends one January. Every Friday, the grocery stores were emptied as people prepared for spending a weekend stranded inside (my pre-nursing days). I live in Oklahoma now, where 2 inches can paralyze the city. Blizzards are still on the weekends (which I work), but tornadoes come mid-week (which I don't work). Pick your poison.

I'm one of those who call in once a year or less. But if I feel sick, like I don't think I'll be able to function for the next 12 hours, I call in and don't feel the least bit guilty for it. We are allowed 6 call-ins a year (used to be 8), but I come nowhere near that. So if I say I'm sick, I expect them to believe me. I do agree that we should get mental health days. I'm a peds oncology nurse. Last May, a very dear patient of mine (we shaved our heads together, she crocheted me a doily, I made her a quilt) died. I was so upset/heartbroken, I wasn't sure I ever wanted to come back. But I did, and I was numb for a long time. Other patients' families assured me that I was making a difference so I continue on. But I believe a mental health break would have been very appropriate - I have over 400 extended sick leave hours I will probably never use unless I have to have a major surgery.

Never dismiss a parent who says their child is not acting right. Always trust the opinion of a parent (unless you can prove it wrong), especially for a chronic patient. Along the same line, never let a physician/charge nurse dismiss your gut feeling that something is not right. As a float nurse, I once had a pt with a head injury in PICU. All night long, I went to my charge nurse and an experienced PI nurse, telling them the child was very agitated, trying to pull out lines, vomited, etc. What can I do? They told me it was normal for a head patient. To make a long story short, the kid coded at 6:30 am, and the charge nurse made a comment to the doctor that he had been showing signs of increased intracranial pressure all night long. The kid had herniated and died within the next 24 hrs. I still wonder if things would have been different if that charge nurse had recognized the increased ICP when I kept asking her what to do about the agitation. We could have gotten a CT scan, called a neurosurgeon, done something! Hindsight is always better than current sight.

When my daughter was in 2nd grade, she had a friend who sucked her thumb - okay, so far not so unusual. In third grade, my daughter started having problems in school. In September, her teacher told my husband that my daughter would fail third grade because the teacher didn't have the time to give my daughter the individualized attention she needed. A little while later, I call the teacher to discuss my daughter's schedule and she tells me, "I'm concerned about M's social-emotional development. Do you realize she still sucks her thumb?" "What do you mean she STILL sucks her thumb?" I replied, "She never sucked her thumb, even as an infant!" This teacher had my child so stressed that she started sucking her thumb. Soon after, I pulled my daughter out of school to homeschool her. She is now in middle school back in public school and doing well after three years of homeschool. And you know what - I still have never seen her suck her thumb!

Meat cutter for Golden Corral (all-you can eat buffet type restaurant), but has only one semester left in rad tech school. He already has an ECB student tech position at the same hospital I work at. We are never here the same shift, so someone is available for the little munchkins at home.

If you don't mind one more opinion on the topic: I work peds hem/onc, and our practice is this. When a patient comes in with fever, we draw lab immediately and give the Tylenol almost simultaneously (most of our patients have lines, so we aren't waiting on phlebotomy). We only hold antibiotics until after cultures. Then we usually have an order for blood cultures daily for fevers. If it has been almost 24 hours since the last blood culture, we hold any more tylenol until the next fever. We don't want a doc to think a patient is afebrile and not needing blood cultures when really we are keeping the kid medicated every 4 hours. As far as antibiotics and blood cultures, our blood culture bottles have some special ingredient which is supposed to filter antibiotics out of the specimen. That is how we can draw daily blood cultures after starting antibiotics.

Just this year, we separated from the rest of peds. So now we have a floor for peds surgery/cardiology/oncology. Peds oncology takes the back half of the floor. I made two quilts to decorate the walls. One of them has the name of every child that was diagnosed or relapsed with cancer over a year and a half time period. This way we remember the ones who made it as well as the ones who moved on to a better world. Due to the reponse of the patients and families, I may have to make this a yearly thing.

Football players? You put football players in the same category as other life-saving professions? Oh, you're talking about the uniform. Well, pay me a couple hundred thousand a year and I will wear a uniform. Until then, you'll have to rely on my ID badge, stethoscope, and knowledge how to handle the situation. I work peds where uniforms and stethoscopes identify the people most likely to hurt you, so we like to keep it light-hearted. I just had to prove to a 2 year old that listening with a stethoscope does not hurt - I had him tickling me before I left. Oh, and I'm sorry for the stressful situation your family is having to go through. It's not easy being on the other side of the care continuum.

We're a "chi;dren's hospital within a hospital." We have an active Peds hem/onc service. I believe there are only two peds oncology centers in my state, and I work at one of them. I do agree it is better to re-draw than to treat based on a false lab. That's why I always assume the first bad result is my error (although that hasn't been the case yet). It's when they want the lab drawn a THIRD time that I object. With this particular case, looking at the child, you could tell he needed a transfusion. Even if I had the specimen diluted to half strength, his hgb of 2.7 would really be 5.4 - still in dire need of a transfusion. That's why I feel they should have accepted the hgb as "low" even if they didn't believe it was Enough venting for today - at least about this topic.

I once had an oncology patient admitted for bloody stools. I have known this particular patient for about a year. When I saw him that night, I immediately drew a CBC & type & screen on him - he was the color of vanilla ice cream. He had a Hickman so drawing lab was no problem. About an hour later, hematology called me and said my specimen was obviously contaminated. I needed to re-draw it. Okay, I always assume the first time is my fault. Although I have been doing lab draws for over 10 years, it's possible for me to make a mistake. So I re-drew the CBC. An hour later, I get the same call. Now, I can't make the same mistake twice in a row so I asked what the results were showing. They said the hemoglobin was less than 3 which is incompatible with life. I told them that's why I drew a type & screen, so now I wanted to transfuse. They said I couldn't without a valid CBC. that the specimen was obviously diluted as the platelets were only 10,000. Could we get a peripheral stick (since they obviously thought I didn't know how to do a line draw)? I said no way if his platelets were only 10.000. I had to get the attending physician to call the pathologist in blood bank to release a unit of blood without another CBC. It took me a total of 3 1/2 hours to get that transfusion started and ended transfering him to the unit during the transfusion with bp of 43/22. All because hematology wouldn't believe my lab results. This isn't the first time I have re-drawn lab because the results are so bad the lab wouldn't believe them, even though their clinical presentation supports the results. It delays treatment and endangers the patient. Has anyone else had this problem?

A lovely 15 yr old girl with AML. When she started to lose her hair from chemo, her friends were supposed to all get their hair cut with her. Her stepdad showed up with the clippers and her friends did not show up. I got my hair cut with her (1/4 inch all over) and told her, if her nurse who only knew her for three weeks was willing to cut her hair, her friends had no excuse. This girl told everyone I was her favorite nurse and crocheted a doily for me. She went to Houston for a BM transplant. Six months later, she died of TTP with her family and I at bedside. Her dad actually thaked me for loving her. My heart broke. My hair has grown back, but a piece of my heart never will.

The day before my mom died in 1992, she was calling out for her daddy who died in 1965. My mom did that, too. My aunt spent the night with her in the hospital, but had to leave at 6:00 a.m. to take my uncle to work. At 6:15, we got a phone call from the doctor to come to the hospital immediately. I told my dad that Mom was gone but he didn't want to tell us over the phone. Sure enough, that is what happened. Mom knew Aunt Sherry would freak out if Mom died while she was there, so she waited for her to leave.

What I hate about work: 1) going to work - there are so many more fun things to do at home. 2) rude hateful doctors. 3) rude hateful families. 4) rude hateful anyone else. 5) short-staffing. 6) doing anything painful to a child too young to understand (anyone under 21) 7) not having the meds/supplies available to provide the care needed/ordered. Actually, I love my job. I love patient care. I just feel frustrated when I feel I can't do a GOOD job due to staffing, lack of supplies, inadequate orders with docs who can't be bothered, etc. That's why my doc doubled my bp med last year, then when I was still getting hypertensive at work, he put me on a beta-blocker so my body couldn't respond to stress with a 185/115 bp.