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Mr. Murse

Mr. Murse

critical care
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Mr. Murse has 7 years experience and specializes in critical care.

Mr. Murse's Latest Activity

  1. Mr. Murse

    Playing Cards

    I don't know much about critical access facilities, but I do think there's often a misperception of nurses having a lot of downtime because it often appears that way when you don't know what's going on. Our work ebs and flows very quickly, and if I get caught up charting and am waiting for my next med pass or task then I may sit and chat with a coworker or I may do something on my phone. Then things will get busy again for a while and then slow down for a while, depending on the day and where you're working. I think non-nurses really don't get this, including administration who may walk around and see a couple of nurses chatting or doing something not directly work related and assume they have plenty of free time, when in fact those nurses are waiting on critical patient to arrive, or a lab value to administer a medication, or CT results before taking a patient to surgery, etc etc etc......we wait a lot for things as nurses, but that is not free time. There's a lot of "hurry up and wait" in our field, and trying to fill the perceived "wait" times by cutting staff or adding responsibilities only jeopardizes the critical "hurry up" time when it soon comes. Also, chances are that if you're caught up and actually do have free time, then someone else doesn't and your availability to help out coworkers is valuable. Even on those luxurious days when you're not terribly busy, most people would rather have a couple of nurses at the desk available to answer call lights, help eachother, and respond quickly to emergencies than have everyone stretched so thin they're always stressed and unavailable. Lastly, non-healthcare people seriously underestimate the dynamics and toll of working with people in a healthcare setting. Most of them are in some of the worst times of their lives, dealing with health, financial, and social hardships and part of the nurses job is to help carry that burden with them. Is it really that terrible when we can afford a few minutes to take our mind off the job? I may be slightly off topic here, but anyway......
  2. Mr. Murse

    Can I get Fired?

    This response is right, they COULD technically fire you for it, but most likely won't, unless you have given them other reasons to do so. Let this be an important lesson though: think through potential repercussions of your actions BEFORE you do them. ha.
  3. Mr. Murse

    What constitutes a bad nurse?

    I think what defines a good/bad nurse should probably be divided into two main categories: clinical and social. I've known a lot of nurses over the years who were not very clinically savvy nurses. In other words, they had poor critical thinking skills, often made questionable decisions and sometimes were just downright scary. Yet often these same nurses have a great bedside manner and patients love them. So clinically, while I hate to call someone a bad nurse, they were at the very least not the most competent and confidence inspiring nurses, but the patients may have loved them and thought they were great nurses, being blind to the risks the nurse may have been posing to them. On the other hand, I've known super smart nurses who had terrible rapport with patients and other staff. These were the kinds you might want around during a code or complicated situation, but they might say something inappropriate or embarrassing while cleaning up a patient. Often they might have run ins with patients and other staff, but you would rarely question their clinical judgement. In the first example, said nurse might be a bad nurse clinically, but a good nurse socially. In the second, they're a bad nurse socially but a good nurse clinically. Then, of course, you have those occasional nurses that are good at both or bad at both too. Either way, there's a large degree of subjectivity in defining this kind of thing, but I personally worry most about clinically lacking nurses. It doesn't matter if Granny in room 12 loves you if you don't understand how to keep her alive or why she's even in the hospital.
  4. Mr. Murse

    When Faith Creates False Hope

    This is an old thread but still a relevant topic. I've never had a patient who was declared brain dead and the family insisted on keeping them on life support, but I've had quite a few patients who were actively and painfully dying and the family insisted we continue to treat them aggressively because they believed god was going to heal them. To me, this is almost worse because we know the patient is, at least to some degree, still "in there" even though they may be too sick and/or sedated to be acknowledging it fully. One patient in particular always stick out in my mind when this topic comes up. A few years ago my ICU had a patient who was, through a long series of unfortunate situations, in multi-system failure. Multiple doctors and surgeons had seen the patient and there was nothing more we could do for them. Palliative care was on board, and the patient was declining slowly and steadily every day, yet one of the children who was POA was convinced that god was going to heal them. It came to the point that some of us nurses literally were feeling guilty because it felt like we were torturing the patient. They were emaciated and severely jaundiced with skin sloughing off, intubated and on multiple drips. Every time you were assigned this patient it was like playing hot potato, hoping to get through the shift without them finally coding on you, because we knew coding this poor shell of a person would be gruesome. For weeks we kept this poor person alive because "god". Finally their body gave up, and the POA mercifully stopped the code before we destroyed the patient's poor body with compressions. It still haunts me a little bit, seeing that sad yellow wasting human suffering because their kid was too delusional to let them go with dignity. I've had a few other similar cases, but that one always sticks out.
  5. Mr. Murse

    Aspiring Christian & Nursing student

    As with life in general, what you experience in the world of nursing will affect you subjectively and no one else's experiences will define what yours will be. I'm a missionary kid and had a great, loving family who are exemplary Christians, but I left religion in my early 20s for more reasons than I can get into right here. I went into nursing in my late 20s/early 30s and now, almost 8 years later, nothing I have seen has changed my mind about god or life or religion. If anything, all the death and sickness and humanity I have been around has further solidified my lack of belief in a personal, Judeo-Christian God or an after life and spiritual realm outside this one. On the other hand, I've talked to other people in the medical field who feel like it has proven their beliefs and strengthened their faith. The point is, it's all personal, and you will usually see what you're looking for. If, like me, you are not looking at things as magic/spiritual, then you probably won't see any evidence for it. If you're actively trying to see god intervening and evidence of "his hand" then you will interpret the same situations differently. Nursing within itself will likely neither make or break your faith, it will be what you make of it. Also, it won't make you a good or bad nurse. There are great, compassionate atheist nurses out there and cold, angry atheist nurses. There are great, compassionate Christian and Muslim nurses out there and there are cold, angry ones too.
  6. Mr. Murse

    How do you handle female patients your age or younger?

    I almost always get a female chaperone for anything like foleys, enemas, certain exams, etc. Especially if they're confused or they seem like a problematic patient. If I have sensed any discomfort with having a male caregiver I will usually offer to find a female coworker to do certain things.
  7. Mr. Murse

    bedside report

    So maybe this is just a rant, but oh well. I'm tired of going into report every morning and seeing that clearly not a single nurse actually wants to do report in the patient's room, but as soon as management comes along they all scurry into the doorway quickly to avoid being chastised. Don't get me wrong, I totally agree that the oncoming and offgoing nurses should see the patient together at shift change before or after report, but the big push for a full "bedside report" in the past few years, while well-intentioned, is nothing but another nuisance for management to make their nurses resent them just a little bit more. It's time consuming and unnecessary. Half the time the patient and families don't even want to be woken up anyway. Am I the only one that thinks bedside report is a flop and a burden and completely fails at what it's intended to accomplish? Let us report how we're comfortable reporting.
  8. Mr. Murse

    What does your username mean?

    I kind of hate my username, but made it up quickly when I first signed up thinking I wouldn't be on here much, but here I am a few years later wishing I had used a different name but not wanting to delete all my history on this one. oh well.
  9. Mr. Murse

    heparin drips and lab draws

    My question was more or less rhetorical, but yes I do understand how quickly the blood flows through the body which is part of why waiting 15 min to draw a lab is ridiculous.
  10. Mr. Murse

    heparin drips and lab draws

    I've had the conversation with 2 or 3 different pharmacists lately who have all agreed that it is unnecessary to pause a heparin drip for 10 or 15 minutes before drawing a ptt, yet I still see nurses doing it. Does anyone still do this and if so, why? A 15 minute stop in the heparin is also enough to potentially alter the ptt, so you'd be adjusting the drip to an inaccurate result. Even if you're drawing from a PICC/central line where the heparin is running, pausing the drip and using a thorough flush is still sufficient. I'm just wondering how this little habit got so widespread without evidence prompting it, or is it just around the facility I'm at?
  11. Mr. Murse

    IV Drip Rates

    I've noticed this is different in the various facilities I've worked at also. What constitutes KVO is quite different from facility to facility and I've seen everything from 5 ml/hr to 15 ml/hr considered KVO. I'm curious what the consensus here is.
  12. Mr. Murse

    ICU or Step down

    I recently made the post about new grads in the ICU, and in general I think it's a good idea to get some experience outside of the units first. Stepdown sounds like an awesome way to get some well rounded skills and a taste of critical care without jumping all in. Also, if critical care is your goal, having experience outside of the ICU gives you a better rounded perspective of the whole patient experience and the process, not to mention time management. Many nurses that have only ICU experience have a very narrow perspective of what any other nurses do. On the other hand, if the opportunity to work at a level 1 trauma center ICU is hard to come by where you're from then it might be good to take the opportunity. Finally, a lot of this comes down to you individually. Some nurses go into the ICU out of school and excel. Some really need the less acute setting to get their feet wet. I, for one, am really glad I got 3 years of med/surg before jumping into critical care. As someone else suggested, see if you can go spend a day or at least part of one on the units to get a feel for it. Too many choices in jobs is a good problem to have though, congrats and good luck.
  13. Mr. Murse

    New Grads in the ICU

    yes, I didn't even mention this part. The experienced nurses on the units are constantly training and having to pick up the slack. Our night shift is made up of probably at least 80% of nurses with a year or two experience, so the minority with substantial experience is carrying a lot on their shoulders, especially during codes and truly critical situations where textbook knowledge alone just isn't enough. As Pheebz777 said though, new grads do have an eagerness to learn that gives them an advantage. I still can't ignore the fact that there has been a noticeable increase in errors and dangerous situations since we've been hiring primarily new grads.
  14. Mr. Murse

    New Grads in the ICU

    I'm just curious about the general thoughts on new grads in the ICU. The units I work in have been seeing a huge influx over the last 2-3 years, mostly out of necessity. For the most part, they have been doing well, and we all know there are nurses of 30 years out there who can be more scary than a new grad. We are a medium acuity ICU and it's probably a good place for new grads interested in critical care to get into. On the downside, there has definitely seemed to be an increase in rookie mistakes, some of which have been potentially deadly to patients (pneumos from badly dropped dobhoffs, extubation without turning off sedation, missing critical changes in condition, etc). Part of me feels like we've dumbed down the nursing process to the point that even in critical care any average nurse can do it. ICU used to be a respected nursing position and they were considered the "best of the best" (I've even heard patients say that a time or two). We were called on to start IVs and answer tough questions and handle difficult situations, but now we have a bunch of one year old nurses who have barely put in a foley running around the units. Again, most are doing well, and I don't intend this to be a condescending post, but I find myself skeptical of the decision I've seen in at least 2 or 3 hospitals to allow a lot of new grads into staffing. We need the staffing, yes, but when a rookie mistake is putting patient's lives at risk, is it worth it?
  15. Mr. Murse

    Post-Extubation Policy

    Similar to the above post, we stop sedation and check alertness and command following and put them on spontaneous/pressure support for at least an hour. Sometimes an hour is all an agitated, non-sedated patient who's eager to get the tube out can stand, but usually we go longer if tolerated. Then RT does a few tests involving NIF, tidal volumes, cuff leak, etc. Then if physician is okay with it we go ahead and extubate. We will go straight to nasal cannula and increase oxygen delivery if need be.
  16. Mr. Murse

    Normal Saline as a flush for PEG

    I think missmollie's comment is probably on the right track. I've worked in neuro ICU quite a bit and never seen saline flushes through a feeding tube, but my guess would be that it has to do with cerebral edema/ICP. I'm not sure how taking it through the GI tract would be advantageous, but we often have people with various crani's and potentially elevated ICPs on high sodium drips like 3% NaCl or others like Mannitol, which affects the pressure by altering osmolarity/osmolality (and I don't really remember the specifics of those). If I were you I would ask. In part because it's possible that it was a mistaken order, but moreso just to learn. When the ordering provider rounds, present the question along the lines of "I'm just curious why we're giving saline through the PEG", not accusing them of a mistaken order but just wanting to learn more about what you're doing.
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