ICU56

For ICU its at least a liter and its 999 ml/Hr. I don't really care to ask much more than that from the provider about boluses because I don't really need to, I know what to do and what my intensivists want or if its for sepsis or dehydration I have protocols for the unit. Hypotension should be corrected, we are protective of MAP and if the patient is less than 60 and symptomatic it is an emergency, if the patient isn't readily fluid responsive after the first liter or two depending on circumstances than I'm getting a vasopressor.

If I question what the patient is self reporting then I'll administer the medication deemed appropriate based on my observation of the patient. I'll then document that patient reports pain of 4/10, on assessment patient displayed such and such nonverbal indicators of moderate pain, was medicated with Norco per MD order.

Agreed, The way we reduced them in my previous hospital was to pull every line possible prior to the patient leaving the ICU. Laziness and poor line management produces CLABSI.

Clean, tag, bag, call Translife.

I completely understand. I've dealt with this for nearly 2 years. It seems that is always some petty little thing I must account for without being given the opportunity to confront my accusers or even speak to the validity of the claims. My patient satisfaction is impeccable yet I seem to always be in the crosshairs and I don't really understand why. When I float to other units I receive rave reviews for my performance and I have routinely been invited back and even requested on many occasions. However, on my unit, I seem to never be able to do enough to satisfy someone and I always end up hearing about it going on behind my back. I don't know what your situation is but I tried for so long to be nothing but professional and good at my job and it seemed like once I found my way into their sights, I couldn't get out no matter what. I recently left for better opportunities and it was the best thing I could have done. I finally feel I am being treated like a nurse should be treated.

I personally dislike med surg because my background as a medic. I was used to a much more acute setting and I dislike the lower acuity, higher patient load that med surg has. I like my ED/ICU/Stepdown, the acuity of the patients is normally high enough that I get to enjoy "nursing" instead of "tech-ing". I have no other way to say that, I know it sounds bad and is going to rub some the wrong way but I can't think of any other way to describe it. I have no problem bathing a patient, but I just like when the patient needs me medically as well.

I love having students, I plan my day around making it the best clinical experience for them that I can. I try to treat them like they are the nurse, Ill snag an extra vocera and log them in as one of the night shift people and tell the monitor tech to call them for their patients. This last clinical group we had would fight to be placed with me. But there are always the few who don't seem to want to take advantage of the opportunities that clinicals present to them. Personally, the thing that bothers me the most about "lazy" students is that they don't seem to understand that I end up having a ton of extra work, and will end up staying after 15-30mins to finish everything because I've spent the day trying to make sure that they had the opportunities available to them, and that they had ample time to learn and not feel rushed. I don't need a cookie for that, but Id like a little effort since it is the profession they chose to pursue.

Im just going to throw my two cents into the ring here. I am a Paramedic. And now have been an RN for almost 2 years. I was a medic for nearly 8 years. I thought I knew just how ****** nurses were and just how much better I was. I was wrong. Am I a better nurse than most because I am also a medic? Absolutely. But as experienced as I was as a medic I wasn't experienced as a nurse. I came to find that there was much more below the surface of nursing than just what I saw when I was not one. Be humble, if your attitude is coming across here without any body language etc. then you can guess that it is probably coming across to those prospective employers as well.

You know... I had a nice long diatribe written about all the extra things I do, the time spent honing my craft and all the time lost with my family so I can help others by picking up shifts for them, or extra classes and certs to stay ahead and knowledgeable. All of that ending with a nice bit of sarcasm about how wonderful it is to have all my achievements brushed off by others who attribute my success to my genitalia and not my effort. But I’m not going to bother. I will merely say this; only 9% of nursing is male, if you think every bit of our achievement is due to that which dangles betwixt mine or their legs… Well then that’s a shame.

Listen to your preceptor. Learn the rhythms. Learn the drugs. Don't slack on I&Os and Fluid restrictions. Never forget to consider the BP and kidney function in patients you diurese. Above all listen and learn. Every interaction has the potential to teach you something. With experience will come confidence and proficiency, give yourself time.

This site can explain pretty much any question you have about 12L ECG ECG Library and clinical cases in cardiology

House supervisor. Any time a MD (or anyone else) decides to ignore the best interests of the patient, a quick call and something gets done fast. We are pretty much the only game in town, or at least the biggest, I've seen what happens to docs who get on our bad side...They lose privileges or leave the county. Not that they don't still have 1000x more leeway than an RN... Great job advocating for the patient though!

1. FL 2. 1.5yr as RN, 8 as a medic 3. C/V surgical step down 4. $23.40 days 5. Do not recall but its for me it would be close to 5-6$ extra if I worked nights. 6. No. 3/2 house 1350$/mo. (bought when housing was outrageous here) $750-ish per mo. for health insurance for a family $3.65 for gas at the station I passed earlier tonight. Col here is pretty high since its very touristy.

Our hospital got rid of sitters, then found that we actually do need them for psych holds and the like things that are 1:1 for reasons other than being critical. They brought them back but instead of making them CNA's they are nothing, no cert required. So the powers that be said since they are not CNAs they should do any "patient care" and it seems "patient care" has come to include everything but pressing the call light.

Judging by some of the comments here I doubt my contribution is going to be well received...But sitters we have are generally lazy and do nothing. We have to cover for them because we are normally down techs and their 15s take 30 and their 30s take 60. Its always a pita. Now, please understand at my hospital sitters do nothing. Unless they want to. They are not required to do anymore than press the nurse light and call for help. They don't clean, they don't assist the patients, nothing. They sit on their phones or watch tv. Calling for me for every single thing. Few, very few are sitters who used to be techs and are worth their weight in gold, those sitters actually do something all day and never take extra long breaks. Those sitters I will cover and give extra breaks for.

If I am reading your question right, you are talking about a stable patient with no acute s/s of anything, that happens to have LE edema that was previously noted and hasn't changed. If that is the correct reading then I wouldn't do anything.. Why? there isn't anything going on. An MD could order some tests and make a ddx, but in the absence of ANYTHING to spur action why bother?

Agree with the general consensus being put forth by the other comments. Call bell, absolutely. Prioritization issues are a major concern. If you come into the hall and grab me, its taking away from something else, or Im going to have to finish something more urgent and get back to you, which may take much more time. Its better for both of us if you use the call light and the task gets delegated appropriately. Obviously, if your family member is in distress then you are more than welcome to grab me, but understand that for other things...You are not bothering the person on the other end of the call light. Their job is to answer it and delegate the response.

Setting up suction is going to depend on the brand of suction but the basics are suction unit that connects to the connector on the wall, tube to connect to canister, suction canister, and tube to connect to patient. NPA is an airway adjunct that is pretty much designed to be used with an ambu bag... You can connect the ambu bag to o2.

Yes and no. Previously, I was a Firemedic and can be considered at least proficient at it. I can offer a lot in my area of nursing that comes from that experience. There are a lot of new nurses and nursing students who clearly act a bit too arrogant for the level of skill and experience they possess but we cant forget when dealing with them that nurses come from all walks of life and a new nurse might be an expert in a similar or related field. The median age of my nursing class was about 35, almost everyone had a prior career. We should guide new nurses and help them to understand that school doesn't make one an expert and that they need to be open to learning more but we need to be open to learning from what they may have to offer as well.

I second some of the others. I use a belt clip. Easier to clean.

I don't really see too much sexism, maybe I don't pay enough attention. I do understand about the lifting part though. Normally being the only male in my unit I get called and asked to help all day long. Which is fine, provided I'm helping... I'll lift 99% of the load happily. I just don't like being called to do other peoples work rather then helping them. We may be stronger as men but we still have the same job to do, which can be much more difficult if we are doing others work as well. Hell, I'll even be ok if they stand there and just move things out of the way but ive had female nurses call me for help moving a patient and then leave once they tell me where they want the patient moved to. That's a bit much.

I agree with this. This whole concept makes me think of a story about my wife who is not in medicine at all. She was in a store and witnessed a man have, from what she described, some sort of seizure activity, fall and hit his head. it cause a laceration which, per her description, sounded more superficial than anything. Maybe a few stitches from description. She, however, was horrified and it bothered her for several days even though by her own account the patient was fairly fine by the time EMS cleaned and bandaged his lac and loaded him on the stretcher for transport. I think it is difficult for us as professionals to understand the fear that those not in this field have about medical things, particularly death. It would be pretty easy for most of us to say patient has xyz and death would be something quite capable of being done at home and without traumatizing the family, but that isn't what the family knows. For them they could be terrified of the thought. In that type of situation, the patient may benefit far more from a hospice house, or facility rather than being in a home were their last bit of time is spent with people terrified of them. Another story this brings to mind is family friends who wanted help administering their fathers narcotics. They could not do it, even though he was terminal cancer and projected to die within days, they felt that if he died after they had given him meds that they would have "killed" him. They were smart people, understood everything I told them. But they still couldn't, it may have been irrational but it was just too much for them. The family is our patient too, and while we always need to advocate for the patient's needs and desires, we have to temper that with the totality of the circumstances. A patient may desire to die at home, but the family may be resistant even after every bit of education and support. That is just how it is, we cannot judge them. We can only support both the patient and the family and try to provide an answer that satisfies the needs of both. We often think we know what the right answer is, but sometimes there are no right answers just answers that are amicable to both parties. The dying patient will always be our focus but the family has to live after the patient passes. They deserve support too, even when we disagree. This family in the op may grow to regret this decision but even then its not our place to say "I told you so" it is just to continue to support and care. As NicuGal wrote above, families often have a great deal of guilt over decisions that they believed were correct at the time. We shouldn't exaggerate this by pushing our POV on them, just provide them as much education and support as we can to support the best interest of the patient. Ok, finished. Sorry, that was far longer then I intended.

Business casual / interview attire.