kalycat

Oh @KatieMI!! I just had to post and wish you well. I’ve followed your posts for years and remember you mentioning your allergies in a thread where we were discussing restaurant food and epi pens. I am so, so sorry this happened to you! I am glad you are on the mend, and dammm straight you deserve a Chanel belt bag for your O2! I hope that as of this writing you are doing physically better. I am stunned beyond belief that anyone of any age would do this — especially with the emphasis on nut allergies in school nowadays — I am absolutely floored. Wishing you and your family a peaceful December filled with health and love.

It's a loss. A true loss. There will be somewhat of a grief process around it for sure. Try to use this time to regroup and work towards your dreams/goals, particularly ones outside of work. Give yourself some quality time. Major life changes, especially u planned ones, very often bring with them a sense of upheaval. Focus on your goals and be kind to yourself. Take up a new hobby or spend time writing. Even though your time there came to an end, you will go on, and you can take with you all the wonderful experiences and love that you cherished there. Best wishes.

It's actually part of orientation to our CVICU that you observe a CABG or other open heart procedure - you spend two days in the OR. I think it's awesome. I used to work as a circulator and then went to the unit, and the context and breadth of experience has been a tremendous asset. It also has helped give me rapport with some of the surgeons when I wake them up in the middle of the night. I feel we're pretty lucky on our unit - the vast majority of the surgeons, Anesthesiologists, etc treat us as valued members of the same team, and a couple of days in the OR helps solidify that relationship. One of our valve and robotics guys is huge about getting people in to the OR even beyond orientation. He feels it helps us be even more invested in our outcomes by observing first hand the amount of work put in to improve the lives of these patients. Sorry I don't have any funny phone anecdotes to add but wanted to comment on that!

Add me to the list of people who were actually bullied at one time - the time I transferred to my "dream" unit. Believe me, the behavior went far beyond jamming a copier or eye rolling. Think screaming, malicious rumors, personal attacks, being set up, and anonymous hate mail. I am a confident and articulate person most of the time. I give people the benefit of the doubt and roll with strong personalities as I am aware that I have one myself. I believe in the team though - that we don't all have to be best friends to be successful. I'm still not sure, two years later, what I did that caused the initial offense or made me a target. I was aware in advance that the unit was going through a major cultural transition and tried to be reserved, open minded, and an active listener while on orientation. It was frustrating and stressful as I was trying to draw on all my previous knowledge to make the situation better. I only made it worse. Some of the behaviors I experienced may have fallen under hazing, and I rolled with that. But one particular person took it really far. I tried to approach management and my educator to express my concerns in a professional way, but I don't think I advocated for myself strongly enough. I stuck it out as long as I could, but when I started absolutely panicking on my drive to work and dreading every phone call, as well as becoming so distracted in my practice that I *did* make mistakes, I left. My husband thinks I should have fought it with the union. I don't think it would have mattered or helped, honestly. I had mentors that stepped in and tried to fix the situation, but it wasn't enough. I walked away and do not regret it. I love my job and have since advanced to a high acuity CVICU and advanced heart failure program, and it was an excellent fit. I'm learning every day and love that. Perhaps I simply gave up - but putting my practice and patients at risk because I was so anxious and in my head was an untenable consequence for me. It took me awhile to bounce back, but I did. I still reflect on the situation, but haven't had many new answers. Working in high acuity critical care develops a lot of strong personalities. For the record, I think that we overstate the bullying issue (jamming copiers) in some effort to bring it to light and mitigate it. Unfortunately, imho, that does a disservice to the cause just as much as ignoring it does. I worked in business management and then mental health prior to becoming a nurse. There is incivility everywhere. We must find the balance between developing new nurses who critically think and have a thick skin and truly malicious behaviors, which I believe are relatively rare. Being a new nurse is stressful and it can be difficult for some to not take critiques and corrections personally. It's just part of growing as a nurse. Being hyper vigilant to suspected bullying only makes the problem worse and makes it harder to be a "fit" somewhere. Good self care and a good support system can help put things in perspective. I personally do not share my story much, but it stays with me to a degree. I feel that this article did generate some very valuable discussion, even if it somewhat missed the mark.

I've used both the DOS based meditech and the windows based "upgrade" one. Both were absolutely terrible and the second took 75 clicks to locate a simple lab result. I love epic as much as it's possoble to love the endless charting. At least it's fast and laid out in a way that makes sense, in my opinion.

I'm sorry to hear this. I've worked at facilities that had fatigue guidelines before - but they seem to be few and far between. Unless her work hours were in direct violation of policy, I personally would avoid that topic in your appeal. Management may have even asked this preceptor to work different/extra days/shifts so that you would have consistency in orientation with a primary preceptor and to expedite the process of getting you on your own; you may not have the whole story. I know it seems cruel to say this, but to clear your name it is going to be critically important that you focus on *your* actions and your subsequent reflection. You could possibly work in contributing "system" factors that you thought about as contributors during your reflection on the incident, but even that is risky. Anything that will be perceived as you being on the defensive or not owning up to your role will cause them to rule against you. They don't have a lot of motivation to rule in your favor, from a purely strategic business standpoint. For what it's worth, it seems your preceptor was ill suited to her role at best, and possibly completely out of touch with modern nursing practice at worst. But you have to focus on you - be humble, contrite and reiterate how seriously you took this and how it has changed your practice. Punitive culture like this should be a thing of the past. This is the ethical equivalent of putting sugar in OJ for hypoglycemia, so maybe this facility's culture is just *that* out of whack. No matter the outcome I do wish you well. Not trying to add insult to injury in any way, but trying to give you some tools to change the overarching outcome. I wish you well.

This is a very interesting discussion. I don't work for MultiCare, but this may be applicable in my region. When I used to work the floor, we had "break buddies" at night with no resource nurse, and it could be an utter nightmare. Even on stepdown where we only took 3-4 patients, these were post open heart, post arrest, VADs and transplants. It was totally possible that more than one patient would crump at a time. Also, if you were partnered with someone who took a very long break, went late in the shift, etc, it could be truly awful for workflow. Now I'm CVICU full time and we have a free charge as well as at least one, and often two depending on census, resource nurses. If you are in a one to one assignment because you have a device patent, fresh open, or arrest, usually the resource nurse breaks you. I personally like to stay nearby and keep my phone. I feel that I get breaks during my shift and that my down time is adequate - I'm just more comfortable maintaining the primary role for my patients. (If that makes sense). Our acuity varies wildly but is typically quite high - I don't take an uninterrupted hour break. (Which some night staff do). My work flow just doesn't support that - I prefer small breaks when my patient's status allows. Not trying to be a martyr but I definitely am a control freak! I take 30 minutes and eat, recharge, was some laps, and then head back. I don't expect that everyone would do this. I just think it would be weird to be told I would have to leave for a full hour (how things are done at night) and at a specific time. I agree with the others who have stated that implementation of this may be a train wreck. Thanks for posting this, Klone!

I read through this whole thing and was hoping someone would mention this. I've only been a nurse for 4 years and was told numerous times in nursing school to never do this. OP: I'm a CICU nurse in a high acuity facility. Everyone here has given you excellent information. We too have a standardized hypoglycemia protocol. It doesn't matter if you're treating labile BGs or BPs or anything in between, if you do an intervention to address an issue, CHECK YOUR WORK. Re-assess, and document that you re-assesssd. We do primary nursing care, but I've worked with techs/PCAs in the past... my rule of thumb is that the minute the pt has a concerning abnormal, I take over that task until I am reassured that the pt is stable. I don't think much of your preceptor or the culture at your facility. I'm not sure why she was bringing up a skin assessment when you clearly had other issues going on. Also, I have a hard time imagining a tele floor that can't do dextrose or insulin drips. Our open heart patients are sometimes on insulin gtts for 2-3 days post op and on a tele unit for most of that time. I wish you the best and I agree with the others - your facility's actions do not reflect "just culture". Know your protocols and know where your resources are. I like to pick the brain of my colleagues as well, but until you know who to trust for advice, look it up on whatever standardized resource your facility uses. In my State, one of the few things RNs can do without an order is a blood sugar check. Use your tools, and check your work. You will bounce back from this.

We have a special sign with a dove on it that's kept with our other iso precaution signs. It's just our way of letting others know what is going on -- lab, other nurses, etc. With 72 beds, we can have a ton of staff around and things can get hectic.

I am so sorry for your loss. I suffered the loss of my first daughter in the mid second trimester due to a variety of complications. My experiences are what, in part, inspired me to become a nurse (almost 20 years later!). My experience was a very, very traumatic emergency c-section delivery, and the surrounding situation was traumatic as well. I do not work OB. However, in the years following my loss, I served as a parent advocate for families who had kiddos in the nicu or who were going through a demise. I also became very involved as a volunteer with perinatal palliative care programs. I can say that time helped with compartmentalization. I actually attended some complicated deliveries with various outcomes while in nursing school, and while I had much to think about on my way home, I did not feel triggered and did not have recurrent PTSD-like symptoms. For me, my drive in the early years following my loss was to use my experience to try to help others. For whatever reason, these experiences helped me heal, and as a nurse a professional detachment was relatively easy to develop. I'm not sure if that's because I'm in denial, or if because my first instinct was to become wholly focused on the family and situation at hand. Everyone is different, and some of us have greater tendencies toward maladaptive coping -- mine might be that I am an adrenaline junky and always sought out ways to test myself and emotional limits; that may have not been healthy, but it is who I am. There were a few deliveries in our main OR when I was a circulator that were quite sad, and honestly, because we often crash sedated the patient and I wasn't in "nurse support mode" talking to the family and fully engaged with a conscious mom, I actually felt more of the physical signs of anxiety than when I was face to face working with a family. Not sure if that makes sense. When I was circulating, the patient was out, father not present, and I was more focused on technical tasks, there was more room for my mind to wander back to my own experiences. Never set a timeline on your healing -- be gentle with yourself and take it one step at a time. Check in with yourself often and use your resources -- your support system. best wishes to you, your family, and moving forward with your education. ❤️

While I agree that we need to put our own perspectives aside since it's about the patient and their goals, I feel very strongly about being an advocate for mitigation of suffering. Very strongly. I have seen strong, healthy men of 90+ lose all semblance of dignity in a very short period of time secondary to a sudden cardiac diagnosis. In the old days, these patients would pass in their sleep at home, etc. I have seen sharp, beautiful elderly ladies, passionate about their modesty and philosophical about their end of life, end up with every terrible intervention under the sun; even knowing them only a short time, I knew we were going against their wishes. I have seen a wonderful former military and law enforcement officer go from walking independently in from the ED gurney to his patient room reduced to a pegged, trached, screaming and incontinent soul, crying out for days on end for us to kill him or for Jesus to save him. He had suffered a v-fib arrest on the way back to the floor following a normal stress test. The family could not agree on a plan of care. He lingered on our unit for weeks before going on comfort care/inpatient hospice. He died within hours of tube feeds being halted. I'm sorry, but these are examples of doing harm. We need to advocate for our patient's dignity. I believe this. We cannot force our viewpoint, but we can educate, listen, try to assuage fears. Involve a multidisciplinary team to help make these tough decisions; transparency and realism can go a long way with an indecisive family. I recently cared for a patient with late stage Alzheimer's, tube fed, bipap dependent, who was approved for open heart surgery. I was absolutely shocked. I have no idea what went in to the decision making process here -- I can only make judgments from the outside looking in. Our surgeons usually don't go in for something like that; we have a very solid team in the ethics department. Nonetheless, it happened. I have suffered multiple losses in my life; some would say a statistically improbable amount of loss. I've been the person making the decision to withdraw care. But I agree with Nutella -- it's a multi-faceted problem; families are divided and fear "killing" their loved one and don't want to live with guilt. In the examples listed above, the patients DID make their wishes known during the admission process, both to staff and to their family. However, in the absence of the official documentation, a family divided can do a lot of damage. I know that in at least 3 recent cases (including the police officer) the patient verbalized their wishes to at least one family member before things turned bad - often in a casual "in passing" but sincere style. The family were just unable to support their loved one's wishes one last time, for a myriad of reasons. I've also had a couple of cases where the patient just as clearly stated "don't ever give up on me" to their family members. In those cases, I have no problem parking my personal opinion about futile interventions at the door and doing what the patient wants, even if the consequences are terrible -- they made their wishes known. Bottom line - The system *is* broken -- and the results are tragic more often than not. Quality over quantity to be sure; or, if you prefer, more elegantly stated: "It is not length of life, but depth of life." "Is immortality only an intellectual quality, or, shall I say, only an energy, there being no passive? He has it, and he alone, who gives life to all names, persons, things, where he comes. No religion, not the wildest mythology, dies for him; no art is lost. He vivifies what he touches. Future state is an illusion for the ever-present state. It is not length of life, but depth of life. It is not duration, but a taking of the soul out of time, as all high action of the mind does: when we are living in the sentiments we ask no questions about time." Ralph Waldo Emerson, Immortality

I was on an immune suppressing med in nursing school - only time I ever got sick that I could directly tie to the hospital; it was norovirus. I changed my meds and lifestyle, don't take that med anymore, and I've been fine. I have pretty severe asthma and I can definitively state that I was WAY sicker when my kids were little than I've ever been as a nurse, and I had an exposure incident where a patient coughed bloody sputum in my face and ended up having something communicable. I don't shower when I get home unless I've gotten something really icky on myself -- I use great hand hygiene, keep my skin in good shape so I don't have fissures, etc, sleep/eat/hydrate/exercise regularly, and keep my shoes clean. I have "hospital only" shoes that I don't wear around in the community and that I sani wipe as needed. No issues whatsoever. I wash my scrubs in warm, hot dryer. I do wash them separately, but it's because lint is evil.

A couple of thoughts to add to the great info you've received... If you think that resources are a major component of your stress, perhaps dayshift on your unit would be a better fit? We staff very lean at night on my busy cardiac transplant and mechanical heart unit, and several of our new grads have gone to days as soon as possible -- reporting much less stress -- even though the shift is busier. You have multiple disciplines around during day shift, leadership, attendings, etc. But you can get orders when you need them, additional specialists are around, and our day crew even has a helper nurse. Just something to consider if you have day shifts opening up with any regularity. I love nightshift because I love the challenge and the autonomy... and I'm a natural night owl. The unpredictability of a sick cardiac patient or an evolving stemi is what makes me fire on all cylinders, so it's a good fit for me. I work at a large teaching hospital and am supplemental at a well respected/established critical access hospital. I feel like small community hospitals are occasionally overlooked. While it can be busy, the stress is much different, the patients are no where near as sick, and the staffing ratios are better. I work med-surg and ED there. I wouldn't recommend ED at a critical access facility if you're not very comfortable with your skills, but med-surg can be very nice and the patient contact is wonderful. You see some variety, you invest in your community. If you like cardiac and are in a metro area, perhaps look at clinic nursing for your heart institute, mechanical heart program, or in pre/post cath lab areas. (We have a dedicated pre-op and pacu for our cath lab and EP patients during the day). While it can be busy, these patients are typically there for a scheduled, pre-planned procedure and are stable outpatients -- Not the same as working in the cath lab itself. I have several friends who work with our mechanical heart program and love it. You truly get to know your patients well and the skills tend to be more technical in nature. Pre/post cath lab and EP can be busy but as I said, stable outpatients and your cardiologists and cath lab team is right there. Can't get much better in the resource department! Good luck!

I've had adults do it - not as often as kids though. Just happens sometimes. Nothing to do but drop a new one.

This is a great little website that I used when I initially took acls. It really helped with rhythm recognition - I wasn't a new grad but hadn't worked on the floor yet; I went straight to the OR and then transferred to cardiac and became a code team member. So, anyway -- great prep. Quick, concise, affordable and very very pertinent to both the written test and mega code. I paid for the membership because I didn't feel like reading a ton of chapters before hand, and thought this was a great resource. Good luck - you've received great advice from other posters as well. We have a really fun group at most of our classes and the collaborative learning environment is really nice. https://acls-algorithms.com