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ninja-nurse

ninja-nurse

3 years MS/Tele, 2 years Neuro ICU/CCU
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ninja-nurse has 5 years experience and specializes in 3 years MS/Tele, 2 years Neuro ICU/CCU.

ninja-nurse's Latest Activity

  1. ninja-nurse

    That nagging feeling...

    I was working med/surg on nights. Had the same patient for 2 nights in a row - young male with crohn's, post resection. He was doing GREAT! Was off the PCA, up walking, one of 2 JP drains out. They were going to pull the other JP in the morning and were talking about sending him home a day or two after. The last 2 hours of the shift, I got THAT feeling. No idea why, he seemed fine. VS stable, labs okay, incision fine, A&O, denied pain, everything. One last quick check before morning report and the patient was laughing b/c I just kept checking on him. I passed on to the day nurse: "keep watch on him, something just isn't right." Went home worried about the guy. When I came back that night, the day nurse rushed up to me as soon as I got off the elevator. "You were right" she said. Turns out not an hour after I left, the patient's remaining JP drain went from empty to full of stool. His anastomosis had come completely apart and he had to be rushed to emergency surgery! I still don't know what I picked up on, but I just KNEW something was wrong. And I was right.
  2. ninja-nurse

    O2 sat monitor question

    Pulse ox machines are notoriously unreliable. SO many things can interfere with the reading - nail polish, callused fingers, cool fingers, diaphoresis, gripping something tightly, the list goes on and on. As everyone else has said, watch your patient. If he's breathing 6 times a minute no matter how deeply, he's not getting enough air. If he's breathing in the 30's, he won't BE getting enough for long. Is he drowsier than you would expect for whatever meds he's had? Or unusually agitated/confused? How's his color? Cap refill? There's a few big clues and a dozen little ones that will tell you if you need to worry about oxygen. If some of them are there, then an ABG is appropriate, if not, continue to monitor. Lastly, I haven't done it myself, but a class I recently attended suggested that an adhesive finger probe can be placed inside the cheek. Not sure how you'd get it to stay, but... might be worth a try if you really need a number.
  3. ninja-nurse

    Only African American Nurse on Staff

    OP, good luck! I hope you find a place where they'll treat you right, you seem like a wonderful person.
  4. ninja-nurse

    ICU Acuity - Advise?

    Thank you, everyone! I had thought that I was about ready, but then I started reading those skills checksheets. Halo's, IABP's, open heart recovery, PA caths, trauma.. I read all of that on the list and freaked. This is the only ICU I've worked at, so I wasn't sure how it would compare to anywhere else. It was my nightmare to think that I'd take an assignment only to arrive and find out that EVERY patient on the unit was one of these high-skill/rare machine. You've all made me feel SO much better! Hugs!
  5. ninja-nurse

    Only African American Nurse on Staff

    OP, I may not have the right to respond to this, as I am not African American (or any other minority). But coming from a Caucasian point of view: some of your coworkers might not be trying to be offensive. I personally TRY to be sensitive and understand where my minority coworkers are coming from, but there have been a few times I've said something jokingly that I was told was a bit offensive. I was honestly shocked and fell all over myself to apologize, then make sure that I didn't say anything like it again, but it had to be pointed out to me because I truly didn't think it was anything beyond a casual comment or joke. And in regards to the "Angry Black Female" stereotype... I have noticed that a fair percent of black females seem to have naturally louder voices than their other ethnic counterparts. Not that they are trying to be loud, just that it seems to be the natural timbre of their voice. It's not something that they can help, much less intentionally do, but it can make otherwise innocuous comments come across as irritated or even angry. Anyone who actually bothers to get to know you even a little should quickly learn the difference, but unfortunately... lots of people won't bother, and even more will listen to their comrades first and come into meeting you with prejudiced expectations. If you are that uncomfortable, by all means leave. No one should have to stay in a hostile workplace, no matter the reason. Hugs to you, and I hope something changes for the better. Good luck!
  6. ninja-nurse

    ICU Acuity - Advise?

    Ok, all, please forgive the long post, but I want to lay the situation out properly. I managed to get into a Neuro/Cardiac ICU. Yay, me! Loved the area, so I got a little house. Figured I'd get a few years experience, then I'd have my tax home and a place to come back to in the winter (Florida ALWAYS needs nurses in winter). Fast forward 2 years, and... I may have a problem. What I had thought was great and exciting now seems fairly low acuity for an ICU. I almost never see much cardiac equipment. We get an Arctic Sun or balloon pump MAYBE once every 6-8 months. I've seen a rotation therapy bed ONCE, and CRRT maybe twice in 2 years. We don't get external pacers or cardioversions all that much. And I've never even seen a PA catheter. We mostly seem to get STEMI/NSTEMI, HTN crisis, CHF, COPD, strokes, tumors and the occasional sepsis. I can do drips and vents. I can pull lines post-cath. I'm comfortable with monitoring EVD's (not setting one up - our docs take the pt down to OR for that), I'm NIHSS certified, and I think I could do neuro checks in my sleep. I really want to travel, but looking at some of the skills checksheets on different sites, I'm a little concerned that my ICU experience may not be as "Intensive" as I'd originally thought. I am planning to sign on with a local temp. agency to do some per diem at other places, but the only hospitals within a halfway reasonable driving distance from home are just as small and have about the same acuity as mine. Some of my co-workers who came from traveling have said I'd be fine in smaller towns/hospitals, and I was thinking maybe stepdown/IMC units on larger ones. Does this sound feasible? ARE there a decent amount of stepdown units or small hospitals needing travelers? I just don't want to get out there and hurt my patients or my license by jumping in if I'm not reasonably ready. Thank you to anyone who takes the time to read this, and virtual hugs for any advice. ~N. Nurse
  7. ninja-nurse

    Pet health cert.

    Ok, thank you everyone! That's very good to know.
  8. ninja-nurse

    Hospitals Firing Seasoned Nurses: Nurses FIGHT Back!

    Loved this!
  9. ninja-nurse

    No failure to communicate

    Depending on the night, either vent alarms or call bells. I could SWEAR some days that there are alarms in my car.
  10. ninja-nurse

    Healthcare Facilities running out of medications + supplies

    Drug wise, hydralizine (on a neuro/cardiac ICU - that was fun) and protonix. Linens during the night. And frequently - in a crummy little rural place I will never, EVER return to - formula for the babies management kept putting on our ADULT med-surg unit.
  11. ninja-nurse

    Anatomy of a Code

    Well written. In my facility, respiratory does the intubation, and nurses give the meds (no pharmacy for us - at least on nights. Don't know about days) but otherwise this is spot on.
  12. ninja-nurse

    Pet health cert.

    Good day, all. I am considering starting to travel come spring and therefore doing some research. My question today is this: I have read that in order to move/vacation with pets, one is supposed to have a vet do an exam and issue a health certification. But in most places that cert. is only good for about 30 days. So do you have to get a new vet and new certificate with every assignment, or is this one of those things that "should" be done but never actually is? How do experienced travelers handle this? Thank you in advance for your time.
  13. ninja-nurse

    Occular Oddity

    Thank you! None of us nurses were sure what to call it.
  14. ninja-nurse

    Neuro ICU patient population?

    My facility mostly sees SDH's, SAH's, CVA's and the occasional tumor. Of course, we ARE in Florida, so the majority of our patients are "grandma/grandpa fell and hit their head". In the 2 years I've worked here I think I've seen 3 Myasthenia Gravis, 1 Guillain Barret and 1 MS.
  15. ninja-nurse

    Occular Oddity

    I just recently had a GI bleeding patient come in, but he was admitted to us because his ammonia level was sky-high and he was showing neuro symptoms. Totally unresponsive to stimulus, but a bit of an oddity in his assessment. At least to me. In 2 years I hadn't seen this, and none of the other nurses on the unit had either. Pupils were equal, VERY sluggish and he wasn't tracking anything, but his eyes were roaming. Didn't matter if his eyelids were held open or allowed to close. Didn't matter if his head was midline, turned left or turned right. His eyes were traveling back and forth. Slow, steady, all the way left, all the way right and then back to the left. It was like watching a metronome. I've always seen nystagmus as jerky/twitchy, this was slow and steady and involved both eyes equally and in synch. Maybe a form of seizure activity? He came in at the end of my shift, so while I reported my findings to the neurologist I didn't have the opportunity to really talk to him. Does anyone know what this would be considered? I charted it as a nurses note b/c I had no idea what it should be called. Have you seen this, and if so, what was it? Thanks in advance.
  16. ninja-nurse

    Transfer advice please

    I am definitely looking for a higher acuity, and am located between and fairly close to two major metro areas. I don't know about ECMO, but NICU is absolutely out of the question. They are entirely too small. I just DON'T do babies. Which is 2/3 of the reason I'm not looking into ER. Once they can point to what hurts, I can handle it. May not LIKE it, but I can handle it. I do have a BSN, and am regularly searching through our CE courses for anything interesting. I actually just got ACLS even though my job doesn't require it, just because I wanted to know what was going on the rare times we call codes. I'm not technically allowed to precept yet - they said you have to have at least 5 years total experience - but I do love to help, and while I can't formally take orientee's, I'm usually the one watching out for travel nurses who don't know our system. I definitely prefer the hands-on clinical work - management would drive me insane. I haven't though about CRNA, though that's why I posted this. To get ideas to look into from those of you with more/broader experience than me. So thank you, very much.
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