canned_bread

I think prompt attention to their psych help is needed. They should not have to wait until 8am - chances are they can't sleep anyway. So yes, getting them help ASAP is indeed good. I can't see why we should wait? I would be outraged to hear that voluntary patients had to wait to be seen and to speak to someone. This is something I would try and reduce!

The best thing you can do is ignore him and act professionally. In surgery this is 100% guaranteed. Doctors can be arrogant. Watch how others handle it, or ask how others have handled it. Blowing up and being upset about it is pointless and it will just hurt you more in the future. It is so so so so so annoying and seriously he is at a disadvantage.

Hey - as everyone as stated, during a code with the ACLS protocol its rapid. BUT more importantly is you should be trained to know this, and know how to handle this. You should be ACLS trained and thus know the algorithm and what not. So push for that training! :)

Most of us, especially after working in healthcare, have MRSA in our groins and arm pits etc. It's a community bacteria. We did a test when I was at university and swabbed each other. A good 60% of us had it in our nose, groins, armpits. It's susceptible patients that are at risk and it's just unfortunate. It doesn't mean you have to not work.

I was really bad at maths in high school, I did "general maths" for my year 12 certificate, and basically struggled through it! Then at uni, I had to focus, but it was mainly learning the algorithms and I somehow managed to get through. They started from the basics so that was good.

Hey - basically experience in scrub, scout, anaesthetics or recovery is what they would want. Any experience in endoscopy is often a bonus too. It's quite an easy area to get in to I have found

What debbieuk said I most certainly agree with. It's also viewed as a form of "career death". With the experience in community nursing, you will be fantastic - you will have the skills, both with communication and knowing what you are doing. However the pay is appalling.

No there isn't, it's on the job training. Most cath labs will view experience in cardiac (ecg interpretation, caring for cardiac pts), surgery, ICU/HDU and neuro to be a bonus. Then from there they will take you on ALS courses, or ECG courses as required. Radiology likes experience with radiology. But that really depends on what applicants they receive. Are you an Australian resident? If you are thinking of joining a cath lab, feel free to private message me.

I think you need to have a sit down with either your preceptor, or educator at the hospital. I am quite shocked that this wasn't brought up prior, as part of the new grad process is that you are precepted. I do feel that they failed. When I was a new grad, I had constant feedback. You need it! You need to ascertain where you went wrong, and how. The fact that AHPRA was informed means the situation was rather quite serious I should think. So you need to ascertain what went wrong. Once you ascertain what was wrong, you need to work on it further. You shouldn't graduate without the skills, so I would think you need furtehr education or to work in a less intense enivronment

Gastric motility decreases whilst we sleep, so I don't blame him. I've found reducing the speed of feeds or stopping them entirely is the only way to go. I would chart that he refused them, and leave it for the AM. Unless it's critical, nothing can be done. Can't force it on the patient!

It sounds like the key issue is that a division has been created. To rectify this issue, the team leader or manager needs to help the team understand that EP is just like angio's and everything else, that it's all part of the days work, that there is no division. Perhaps the team leader (or manager, however your day is structured) needs to start with a prioritisation of the EP side, and then when they are relieved get someone to relieve angio. Or put a responsible team member in the "angio side" in charge of the breaks and set up for the EP side...somehow make the division less. Or, alternatively, train more people for EP so everyone gets a go. Or, perhaps, identify what seperates the two, and remove that. If all else fails, perhaps in departmental meeting state the issue.

A friend of mine has epidermolysis bullosa - a disorder where basically the skin falls off, nothing holds it on. Anyway, her whole life she has been covered in open sores. It's basically the worse disease you've never heard of. Anyway, she started using medicinal honey a few years ago, and was one of the first patients in a trial for it. They noticed wound improvement with healing. It's amazing - nature delivers for us, yet again!

I need some career advice and ideas... I am 28 years old, and have been working in the cardiac cath suite/angiography suite for most of my career. I've done my back in (permanently). I love patients, I love nursing. I loved the angio suite, but now I can't wear lead and so can't work in there! So now I have to look at other career options that are not "dead ends" so early on in my career. Can anyone give me some guidance as to where I could go from here? I don't particularly like ward nursing, I loved surgery and the conveyor belt. I love chatting to patients and making them feel good. I know if I saw this post here I would think "well it depends on what you like, it depends on the person, it depends on so much...". But if someone could give me some advice as to what career options to look at that is low impact on the back, and involves no career suicide, stays clinical, avenues, ANYTHING, I would be highly appreciative. So lost and confused right now!

Great question - yes, they do show up. In fact, I have noticed I can tell "really deep effective compression" by whether it shows up on the ECG or not and how it shows up! If it's consistent and deep it shows up in perfect big wave forms. And, it does register a beep on some machines. Even when someone has a heart monitor on, and moves around erratically, it still shows up. They can "fake the monitor"into thinking its VT or something! It's not electrical activity it just picks up, it's a movement too for some reason!

I work in a cardiac cath lab, which basically means I wear lead aprons all day. I wish I had worn a back brace because I now have a torn vertebrae and disc problems (at the age of 28!!!). The thing is, if you wera a back brace incorrectly or for to long the msucles in that area, essentially your core muscles, can become weak and disused - essentially giving you the opposite of what you want. The best thing to do, according to my physio (who specialises in backs) is to go to a physio, learn core strength exercises, stay a good weight, and get fitted with a brace for only long shifts or sore back days.

A few things concern me in this, aside from the obvious lack of "care" the staff have apparently provided. Firstly, midazolam can CAUSE agitation. Nearly all my patients that receive midaz want to scratch their nose, and wiggle. And combined with fentanyl they will fall asleep and wiggle. Giving more makes the situation worse, it's one of those catch-22's! They should know this. I know that the cath lab is like a production line, and is very very fast paced, however a patient in pain should not leave the recovery room. It's best practice that prior to transfer have the pain at a manageable level. They could have easily ordered a stat dose of something because they have the doctor or ICU RMO available. Thing is, it sounds like they were having a bad day , and I do feel for the cath lab team as I have been in that situation before, but it does sound like the time constraints they had on them compromised the patients care.

Do you have an NICU educator? Could you ask her about studies and kind of quietly mention it? If not your manager? Be prepared with backed up studies, and don't get to forceful as this can irritate some people. But it's great you have thought of a best practice and are being an advocates for your babies.

This is a truly tough position, and I feel for you. If you aren't quite liking it, it's very hard to stay on top of everything. You know how when you like doing something, it becomes easier? Maybe it's just not your niche, it's not everyones. Do you have a good educator or facilitator that you could sit down with and discuss, without whinging, your feelings? And discuss why you feel like you are falling behind?

THIS. I COMPLETELY AGREE. To often the processes of hospitals are changed and it's damaging. Only with that risk paperwork does something get done. It annoys them, but it's pure legal evidence that the practice isn't working, and why. It's tedious for us, so it often doesn't happen. But it should. We had a ridiculous major change in our hospital approximately a year ago, and this meant less time for patients, more chance of critical incidents. I started entering the "risks" and "near-misses" in religiously until a change was made. And I encouraged others to do the same. Eventually a meeting was called, and an echo throughout the room from the nurses was that they were scared for the patients, and the patients were noticing the inattention that was occurring.

Yup, you sure can in most cases. And its good to, as even though they have the PPM, they may still experience infarcts etc that you can pick up this way. Depending on lead position of the PPM, you may or may not see a P-wave. You will only see a P wave if the lead is up high enough that the whole atrium does the P. If you do see a P wave, calculate it ignoring the pacing spike. The QRS should still be seen, as this is ventricular, and should be conducted down still if the PPM is just an atrial lead.

Yes - we often set the defib to attempt to pace the VT out prior to the shock. The defib records the rhythm - ascertains its rate and type (VT and under 200 bpm say) and then if that fits the criteria of pacing set by the Dr, it will pace it out. If it is to fast or a VF then it may have criteria to shock instead. It also will only pace and then stop maybe twice and then will shock as backup. The "looking" for R waves is not visible, as no electrical activity is outputted at this time, it's simply read. Very impressed that you saw it and thought of different things it could be - good thinking!

Yes, you still give medications so need competency in maths. In Australia, some "serious" medications cannot be given by an EN at all, or an EN alone. They need an RN to do it or to sign off on it, depending on what the drug is.

There is no pad that will hold the amount of urine without spilling. The urine will also make contact with the skin and harm the skin, and decrease the skin integrity. It's hard to shower the person properly as well, so the urine will burn burn burn that skin. Furthermore, it's demeaning and embarrassing to pee in bed, on a pad.

A lot of nurses finish their careers with back problems. Despite correct manual handling technique, there is a risk of back injuries as it is a physically tiring job. Some hospitals will not employ nurses if they disclose a history of back issues. If you are very keen on nursing, I suggest you get fit, especially with core body muscles. Tone up, loose fat, get fit and give your back a chance to support itself. Core body muscles make a huge difference. Also, a lot of nurses seek help from physiotherapists or chiropractors. This requires regular sessions, not one or two. Depending on your back injury, it could be a life-long committment. I would see a neurologist for an accurate assessment of your back and to ensure that the chiropractor is correct, and then start treatment. Personally I work in a field that requires me to wear kgs of lead each day. It has ruined my back because my posture was bad initially and I was not given this information. Now I have a chronic back injury that has required chiro and physio and daily medications. I like nursing, so I stick with it, but it's good to have a good start. Also, your body somewhat gets used to the new ways its moving. After a while, after your injury has healed, you may find you get used to it.

Depends on the drug and the potential for side effects. If its an anti-emetic, then sure, maybe up to 30 minutes early. Low side effects risk for most patients. If it's pain I evaluate why are they having "break through" pain? I may give it to the patient a little early (15 minutes), but if it's intense or doesn't seem enough for them, I will also call for a medication review. After you have developed some skills in medication administration, in judging patients, in knowing when a patient is drug-demanding, and what things can go wrong with what meds etc, you can then use your own judgement. But until then, as a new grad, if the med is due every 4 hours PRN then give it right then at that 4 hours :)