Lisa Jane RN

I find this post fascinating. I'm an RN with over 17 years experience and I still have some level of anxiety and nervousness about what might happen on shift. I work in an acute care paeds inpatient unit and we also respond to paediatric codes in the ED. I can't imagine that I will ever feel so secure that I would be providing this kind of advice....no matter how well intentioned. It should be normal to have some anxiety...I'm sure we have all been involved in situations where there wasn't a good outcome. Guess the OP can call this a learning opportunity. Good luck to you 😶

I work on a general paediatric floor in a community hospital that does not have a PICU. We have bedside cardio-respiratory monitors. They are used for certain patient populations ie. eating disorders, but we also use them for procedures requiring conscious sedation. As well, monitoring may be included in certain order sets such as ALTE. If at any time a patient becomes unstable we would initiate continuos monitoring. We use a lot of spo2 monitoring as well for the respiratory kids. Hope this helps :)

Well here is the thing. I think it's important to document ANY intervention, you would chart the vitals but stipulate the patient was uncooperative, asleep, wrong size cuff etc. As far as calling a physician, in terms of critical thinking, you use your judgement. The is no need to automatically call an MD for an off vital unless you are absolutely sure the reading is accurate. I am an acute care nurse and it's baffling to me when I check back on my patients and see vitals recorded that are clearly abnormal with no explanation! If you get a low BP, consider orthostatic vs or a manual. It's also possible there just isn't the time to search for equipment or reassess, and that is unfortunate but true. I'd be lying if I said my hourly assessments didn't drift into the hour and a half or two hour mark. Sometimes it's just impossible.

As a new nurse you may find it a better learning experience to work days. Also, there is a lot more support and it's generally better staffed so you can focus on learning your skills and fine tuning your assessments without being totally rushed. I prefer eight hour days and twelve hour nights. But when I started nursing I did day and night 12 hours and it was great. I've tried an eight hour line and I hated it. It felt like I was there all the time. I would probably try the 12s and see how it goes :)Good luck!!

Right, I hear what you are saying. How did you find out about the initial VS? We recently laid off RNs and replaced them with RPNs. It's been a very difficult transition and I really preferred an all RN floor. So, I hear your frustration because I have felt it myself.Another question, if a patient was unstable and say desatting in the 70's, can a CNA put O2 on then? I'm from Ontario and we have RPNs (registered practical nurses) who it seems have a much wider scope of practice. If a patient became unstable they would intervene but then a RN would assume care.Was it a positive outcome for the patient?

I'm a paeds nurse, last night we admitted a 9yr old head injury and the ER faxed up report with a bp of 90/29. Wow.....really? It ended up being fine but if documenting a bp that low how could you not reassess it?????!!!!

Wow. Scary, I mean you don't mention a temp with the first assessment but clearly the patient was sick. I'm shocked the first concern wasn't sepsis....

I rarely blind stick. And like everything, it comes with experience.

For me, neonates are much easier than the older chubby babes. My first choice is usually the hands and wrists rather than the saphenous. But thats just a personal thing. Definitely helps to have lots of prep on and if you can get your hands on a transilluminator they are worth their weight in gold!!!I also spend more time looking than poking, unless it's an emergent situation I spend a lot of time searching, I try to take my time rather then rush. If I'm going to poke, I just want to do it once :)And heat! Heat helps too!!!Good luck!!!

Had a nine year old patient in the hospital for GI issues. He has a history of Asberger's. Had been in and out a few times and on the last admission said to me "I don't mind it here, it's kind of like a hotel, but only a one star".Out of the mouths of babes :)

Totally agree. If you ever get a wonky BP reading you have to attempt a manual :)