Heartman

Please everyone do protect your back! RN for 21 years and because of improper lifting for all that time,I herniated L4-L5. Surgury last June and just got back to work on "light duty" in September. Nerve damage resulted in Caudal Equina Syndrome (CES). Loss of motor control of lower extremities, bowel and bladder control. Don't risk it, at any age you are to young to be wearing depends and pushing a walker. Remember the body mechanics that you have all been told and do not lift by yourself!

Greetings all, I'm a critical care RN and have been since '81. Last June my chronic low back pain developed into incredible back pain with siatic pain on the R. This resulted in surgery to remove the disc between L4-5 and installing hardware @ L-5/S-1 for stabilization. The good news is that the pain is completly gone. The bad news is that I now walk with a limp, have urinary retension requiring self cath 4 x/day and bow incontinence now controlled with strict bowel program. I am now cleared to go back to work 24 hrs/week and lifting only 20 lbs. I will not be able to lift patients. My question is has anyone else on this board had to go back to work under similar cercumstances? Did you go into administration or case review or what. Any ideas are welcome. Thanks, Walt

Thanks I'll check it out.

In over twenty years of critical care nursing I've seen one blown PA. Nothing you can do unless you have a thorasic/vascular team in the OR standing by. We didn't have this. MSO4 for comfort as pt. bled out. Make sure you get those consents signed and risks explained. Walt

I agree, dopplers are easy to use. Anyone can learn in about 1 minute. I would be interested in getting one for myself. I frequently detect my own pulse in my fingertips when palpating for a pulse. Especially in a pt. with compromised vascular status or hypotention. So far everywhere on line that I have checked, they are $650 and up. I would be willing to pay around $100, maybe I'm dreaming. Anyone know of a source for "cheap" dopplers. Thanx, Walt

Always with Swans. Usually with propofol, NTG and dopamine @ renal dose. Docs pay no attention to PCWP. Swan is usually DC'd by following AM.

Never wind up drunk in the ER telling the Doc to go **** himself repeatedly. This angers the physician. The physician has pavulon and an Ambu bag. He whispers in your ear. " Now I'm breathing for you. Now I'm not." Probably just one of those urban myths.

I'm working in a SICU new to me and they call insulin gtts here "CZI". They've been calling them that for so long that no one can remember what it means. I've done a couple of searches with no luck. Can someone help me out? Just curious.

I'm a guy. Wearing white and have always worn white. In my hospital just about anything goes. There is a dress code but no one seems to enforce it. All the rest of the staff wear colors instead of white. We are all high quality competant nurses so it doesn't seem to make much differance what you wear. However I like to be identified as a nurse. My pt. population is frequently elderly and I like to give them all the clues I can as to who is who and who will be taking care of them. I have my name embroidered in large block letters on my shirts to to help them remember my name and identify me. (frequent poor eyesight and poor memory) Works for me. Just my .02 Walter :redbeathe

I have used a doppler in codes when one is available. I have not seen them generally included on the crash cart as standard equipment but think it would be a good idea. In the PEA algorithm if no pulse is detectable, CPR is initiated. If a pulse is detected it is not PEA and CPR is not initiated. Walter :redbeathe

Dear Steph, I agree with crjnursewarrior. We all have bumps in the road. Dust yourself off and keep trying. You need to shop for a good orientation program. I've neen a nurse since '81 and I'm sure I wouldn't have been comfortable in a hospice situation with my own caseload without a proper orientation. I recently changed from a general MICU/SICU/CCU to a Cardiac SICU. I had never taken care of open heart pts. before and needed orientation. I started in early January and am just getting off orientation this week. The nurses in this unit are very proud of the work that they do and want to make sure that the new guy (me) is up to their standard of care before they let me go it alone. Even though I am presently comfortable taking a post op CABG I know that if I run into trouble I have people around me to back me up. I guess what I'm trying to say is that there are places that have good orientation programs and supportive staff. Keep looking and I'm sure you will find one. Walter :redbeathe

Speculating, So well said. I have always worked in hospitals and make it a point to know the name of everyone I come in contact with. All the ancillary staff, from supply , pharmacy, lab, x-ray, OR, ER etc. etc. It's nice to know the person on the other end of the phone when you need something in a hurry. Makes your job more fun too. Walter :redbeathe

A lesson to us all. Get malpractice insurance, it's less than $100 per year. I don't know how good it is, thankfully never needed to find out. Walter :redbeathe

Wearing a full beard. Must wear a positive pressure hood for airborn bacteria situations but this only happens a couple time a year wear I work. I'd shave if it became a problem. Walter :redbeathe

Nurse since '81 Never thought about it. Walter

I've been an RN since 1981. All but six months in Critical Care areas. Nursing has been good to me. I have been able to buy a house, support a family and keep two new or fairly new cars in the driveway. I leave my job at work. I very seldom bring my work problems home with me. I have remained at the bedside by choice. Management has not been something I want to do. A few months ago I changed to a new unit. An SICU that does a lot of CABGs. This is new to me and I enjoy the challange. I am paid well, there is plenty of staff. Phyicians that I deal with seem to be competant. I get job satisfaction when I know that a pt. or family asks for me specifically because they like the way I do my job. Most of the problems that I have run into over the years are the kind of problems that are found at any job no matter what you do. The grumpy employee or boss. The person who doesn't carry their weight. The jerk. The idiot. I find I can usually work around these people and still do my job. Maybe I've just been lucky. But I think that if you are miserable at your job you should leave. There are almost unlimited oportunities for nurses and you should be able to find something that you like. I know that it is not that easy and there are other factors that prevent one from changing but it may be worth it. Just my 2 cents. Walt

Dear Paul, I would have to agree with the previous poster, that ICU nursing is quit variable through out the United States. I can tell you a little about my experiences. I graduated from a 4 year bachelors program in 1981. I have worked in the ICU environment in different units since that time. Almost all of my hospital career has been with the Veterans Administration System. This is the system that our country has set up for the care of all verterans of US military service. So keep in mind that our pt. population is mostly male and all adult, many elderly. I started out in a medical ICU for about ten years. General medical pts. requiring ICU level of care. Lots of pulmonary and cardiac cases often with multiple system involvment like liver and renal failure. Many end stage pts. with end of life issues to be delt with. No trauma pts. May pts. intubated with eventual tracheostomies on vents. Frequent heodynamic monitoring and occasional insertion of temporary pacing wires at the bedside. Some overdoses and some senile dementia. About ten years ago our hospital downsized and combined the medical and surgical ICUs. This brought a different kind of pt. In addition to the medical pts now we had to deal with all types of general surgery pts. Excluding neuro and open heart surgery. Ventilated pts are managed by resp therapists. At the beginning of this year I transfered to a surgical ICU closer to Boston. This unit deals with all general surgical pts. but primarily open heart surgury. The nurses take a more autonomous role in weaning the pts from the ventilator and extubating them. When their PA catheter is no longer needed it may be DC'd by the RN. Pts. are moved along quickly from their cardiac surgery. Usually extubated within hours of their procedure, OOB to chair and maybe ambulating on post-op day 1 and transfered to the general floor on post op day 2. Well thats a brief synopsis of what I do. If you have any more specific questions please let me know, and I will try to answer them for you. Looking forward to hearing from you soon, Walt

Check out the Littmann II SE. Cost is $45 to $50. Available online from multiple venders. This is a quality scope for every thing you will probably need. Lung sounds, bowel sounds, carotid bruits etc. IMHO you only need an ultra sensative, re: expensive, scope if you want to listen to advanced heart sounds. And these days you can look at the echocardiogram to check out wall and valve function. In addition many pts. in isolation have a scope dedicated to their room and you won't be using your scope in that situation anyway. Walt

Over twenty years ago a stethescope salesman told me " It's not the stethecope, it's what you have between the earpieces" One of those thoughts that has always stayed with me. Especially in July when you see all the shiney new scopes around the necks of the shiney new interns. Walt

Don't want to seem heartless but this guy needs a code status. Sounds like a family meeting with the Docs is in order for this pt. What does oncology say? Can they treat his CA? Has the pt. stated his wishes to anyone? Family member? Heathcare provider. Sounds like his prognosis is grim. If it was me and oncology suggested poor survival rate, make me a DNR amd as comfy as possible. And let me go. Walt :stone

Regarding the little old nursing home pt. that upon arrival is confused, disoriented, tachycardic, hypotensive, and not making any urine. After rehydration with about 3 liters normal saline, he wakes up and asks "Hey, where's my cigarettes?" IHBJAW - Instant Human Being Just Add Water :roll :chuckle

Rhode Island winters are typically unpredictable but we do occassionally have significant snow. It seems that it has been a matter of pride to get in to the hospital through the worst that mother nature has thrown at us. And if you get stuck there, a sort of holiday spirt prevails. The work gets done and we have a good time. I guess it's a matter of attitude. Heartman

I've been a Critical Care RN for over twenty yearsand I love to have a student to teach. I like to have someone who is into what we are doing. They are not expected to know everything but I do expect them to try, and be enthusiastic. I usually knowthe instructor well and will ask for another student if the one I have is not interested in learning. I have even recrited students to work in our ICU after they graduate and it has worked out well. As with most things, communication is the key. Let your instuctor know what you want and you are more likely to get it. Good luck and have fun. :) Heartman

Thanks for the hint. I'll check it out. TIA stands for Thanks In Advance. Heartman :)

Greetings, Considering purchase of a PDA (hp iPAQ) for use in the SICU. I like the idea of having all that info at my fingertips. Any suggestions for what kind to get and what software to purchace? I'm not familiar with pocket PCs but hey look good. It would have to be compatible with windows xp as that is the system I use at home. TIA :balloons: