vic_rn

What are your rules for floating? My unit has a large amount of per diem nurses and in addition, hired a group of travelers for the busy season. The travelers are not allowed to float per their contract. The rest of us are floated on rotation. With all the staff, and many of the per diem working part time hours, I find myself floating more often than not, despite the fact that I am one of few full time staff nurses on the unit. I don't mind the occasional float and understand the need. I do feel however, these rules are unfair to the dedicated unit staff. Is your policy similar?

Always amuses me that there is so much concern for a capped water bottle at the nurses' station, but complete disregard for the fact that the nurses have 7 patients each with no free charge or uc. Priorities...

I have never worked for hospice, but have provided end of life care for hospital patients. Feel free to correct me if I'm wrong, but 1 mg of dilaudid and ativan, while a large dose in a general patient population, does not seem out of line in an end of life situation. When I've worked with these patients, we always use continuous infusions of narcotics and benzos to ensure comfort, with additional PRN doses if needed. Is it possible the doctor was concerned for the patient's discomfort if not receiving these doses? Has he watched other patients suffer due to a failure to provide appropriate medication? Was he trying to prevent an onset of discomfort that may be difficult to overcome once it has begun? As for the comment, I have said and heard many statements in moments of frustration. Things you would never say to a family member or patient, but say to a colleague to vent. It does not make it right, the comment you mentioned is way out of line, just something to consider. If in fact, he truly wanted to speed death and not assure that the patient encounters a peaceful end... scary!

I agree. I was highly disappointed in my RN-BSN program. Pharm and Patho were the exact same courses I took for my ASN. The rest of the classes were a joke as well. The only one I feel I actually benefited from was Research, something not covered at my community college. I'm not saying I didn't learn new things. However, I could have easily learned them on my own for much cheaper. UGH. Wish I had gone straight for BSN the first time. It would be nice to see specialty RN-BSN programs for experienced nurses. Where you could learn something actually applicable to your career. Maybe a choice of ICU, Cardiac, Community, Pediatric, or Geriatric pathways. Maybe some universities already offer this. Definitely feel I paid for a degree and not an education!

"I don't want to seem rude, or come off as though I am telling you that metabolic acidosis isn't the correct diagnosis for this patient, because that is not how I feel at all. I am just slightly confused, and would love to use this situation as a learning opportunity. " Not at all, this is exactly what I'm here for. I appreciate all the answers and it has given me a lot to think about. Thank you, too, for the links. I am glad to receive so much input. I am learning a lot and hope to one day be the person who is able to help educate others!

A patient was found down after an unknown, but believed prolonged over 3-6 hrs, unconscious. EMSd to hospital, intubated. Severe metabolic acidosis, with initial pH of 7.1, CO2 70s, pO2 60s on 100% FiO2. Obvious aspiration pneumonia. Sedated with propofol, PRVC rate of 24. Despite adequate comfort sedation, patient respirations averaging 30-45 BPM. Low dose bicarb gtt in use. It was suggested to increase patient sedation to the point of overcoming respiratory drive. Just wondering if this is common practice. I thought allowing the patient to remain tachypnic would reduce CO2. Also thinking that oxygenation would not be responsive to reduced resp rate as the patient was not 'bucking' or fighting the ventilator breaths. Do you generally allow the patient to breath instinctively, or block spontaneous respirations in initial recovery? I am new in dealing with Med ICU patients and would appreciate any education and insight!

I have several years experience at a respected hospital with excellent references and it took over 2 months for a call back and 3 months for a job offer (at the same salary I was given as a new grad). It is hard to be rejected, especially when you feel interviews have gone really well. I am excited and feeling blessed to be working in my new position!!! Best of luck with your job search!

How long after sheath removal can a vasovagal response occur? Situation: I picked up a stable patient post exploratory neuro angio (no cardiac history). This patient had walked into the hospital for the angio, pre-elective surgery for aneurysm clipping the following day. She had gone straight to angio/cath lab on admission. When I went to retrieve her, the sheath had already been pulled (sheaths are not pulled in my unit), the patient was reported as stable, and had already been transferred to a stretcher. I hooked up my travel monitor, BP and HR were normal, assessed the site and noted no hematoma or excessive bleeding to the bandage, also a strong pedal pulse. Once I was in the elevator, the patient reported feeling "funny". Never what you want to hear in the elevator. In the second I spent assessing the site, I watched her HR plummet into the low 30s, quickly followed by a dropping blood pressure, and decreased LOC as I prepared a dose of Atropine. With the Atropine and the initiation of a ns fluid bolus, she was rebounding as we made it back to the unit. Note: there was no change to the site and the patient was flat in bed. :yeah:Finally, to my question.... I have not trained for sheath removal, however, it was my understanding that the vasovagal response is caused by pressure and site pain during removal. So why did this occur 15 minutes after pressure held and dressing applied in a pt with no complaint of site pain??? I checked the cath report and did not note any previous incident or Atropine administration while in the lab. How long following removal should one be concerned for this? Thank you for reading my very lengthy story!

Thank you for all the replies!!!

Good luck to all of you still job hunting!

Not exactly sure what I was basing "successful" on myself. I suppose just how you answered. Employee response and participation to the program. At my last hospital we had a large participation level hospital-wide and on my unit, I really felt the c.l. nurses made a huge contribution and many positive changes through task forces, education, program development, etc. It really was a big part of creating unity and working together on many projects gave us a sense of accomplishment and increased job satisfaction. With around 70% unit participation (in a 30 bed ICU), most of our nurses were BSN or working towards it, as well as nationally certified. Our manager was extremely helpful and supportive. We were also happy with the compensation at 4, 8, 12, and 16% of base pay! I am hoping to develop an interest at my current job (which does not offer a c.l. program), but curious how the response would be with a smaller employee base. Also, we received a lot of our credit by precepting the many students and new nurses, working on hospital based community volunteer products, and joining the numerous committees available at the large hospital. Curious this is feasible in a smaller environment, where less opportunities are available for participation. Thank you for responding!!!

A process that grants increased pay based on program participation. It involves several categories: experience, education, research, volunteer, and such. By completing tasks like national certifications, additional education, participation in task forces and hospital committees, precepting... you reach certain levels which correlate with an advanced pay grade or bonus.

Hello everyone! I have recently transitioned from a large, level 1 trauma hospital to a small 120 bed community hospital. I was actively involved in and very happy with the clinical ladder program at my past job. I am curious if anyone currently works for a small hospital that has a successful program or if this is something only to be expected at a larger facility. Thanks for any feedback!

I hope the newer nurses can keep in mind that questioning you about your patient isn't always questioning your abilities as a nurse. Sometimes (at least with me) it is your own fear of having performed poorly that makes you view questions and comments as an attack. I often question about certain labs or situations during report. It is because listening to the reporting nurse has made me consider certain things. I have never looked down on someone who didn't know the answer, but I do make a note to remind myself to check on it! :) I know there are some nurses out there who do carry mal intent, but try to ignore them. If it is the majority of nurses you are dealing with, try to find a new unit! I now appreciate when people question me and use it as an opportunity to learn. If it is truly an important and applicable question to the needs of my patient, I will remember to regard it the next time around! Even the most experienced nurses are learning something new on a regular basis!