EDValerieRN

I think that as an L&D nurse, it would be important that you don't push your beliefs onto others. Not that I think you would, but I'm just speaking from personal experience. I got an epi and my nurse made me feel bad about it. That's not cool. I do know that at my hospital, there are nurses who are particularly good at NCB, and patients who want to go natural often request these ladies. Sorry, not an OB nurse so I can't offer much guidance, I just thought I would throw my 2 cents in.

I figure a nurse could get into a whole lot of problems administering meds w/o an order... plus, why would you want to paralyze someone when you don't have anyone there to manage an advanced airway? Paralyzing someone before an airway can be managed seems like trouble to me.. order or no order.

So being that I'm in a neuro-focused ER, we give lotsa the tPA. Here are a few points. ~ Our window is six hours from time of onset. However, I have never seen it given more than four hours out. ~tPA can only be given for an ischemic stroke. The patient will have a stat CT-Head (we strive for a door to CT time of 20 minutes) ~IF the CT is negative, but the patient is experiencing symptoms, we will screen the pt for eligibility, get permission, and give the juice. If you see an ischemic stroke on the scan, then it's too late to give tPA. Reason being that if you see the stroke, the stroke has been there too long to benefit from clot-busters. ~tPA has a six percent mortality rate due to head bleeds. ~Often, you'll see marked improvement in only a few minutes after giving it. Truly is a miracle drug. However, a large scale study just came out that shows tPA to be no more effective than an aspirin. More research really needs to be done, and other studies have shown it to be tremendously effective if used correctly. ~ You'll need to do more neuro checks in the next few hours than you've probably done in your life... unless you give tPA a lot. It is REALLY important to get a great baseline assessment of your patients neuro status. Without it, you won't have anything to go on. ~The very first sign that there may be a bleed is a subtle change in LOC. The patient will seem tired.... will stutter, or not recall certain things... may get agitated, combative, or just sit up in bed and have a wild look. Pupillary changes are a late sign of a bleed. While helpful to assess, it won't be the first thing you see. You may also see bleeding at IV sites, tachycardia (early) and bradycardia (late), blood pressure changes, etc. None of this is good. When you see it STOP THE TPA and do a stat head CT. tPA patients can herniate fast. ~When we give tPA I'll often sit in the room and just visit with the patient/family for about 30 minutes. I can do that because I don't have a patient assignment as charge, but a lot of nurses don't have that luxury. tPA pts should be 1:1, due to the high risk for bleed/death. I've caught a bleeds before, and it's scary. I've also seen a lot of fab outcomes from it as well. Lemme know if you need anything else.

Mr. Poopboots. He's got these wide boots on, and wears them with shorts... and poops... poop falls into boots, hence Poopboots. He also had some Cheetos in there.

I had the priviledge of taking care of a holocaust survivor. Such an interesting man, I found it hard to take care of my other patients because I enjoyed listening to his stories so much.

In three years, I've had one physician talk to me in a less than respectful manner, and he promptly apologized the same day. I think it depends on the culture where you work. Where I am, yelling and berating are not accepted, period.

If your fiance plans on retiring at 48 or up, your child should be out of the house by that time. Regardless of if you adopt or not, you're always gonna have a kid around. I'm not sure what difference two years would really make. I had a daughter in nursing school, and I never got to really spend time with her when she was a baby. It was hard, but worth it. Good luck with whichever you choose.

I have a cheap band I wear to work, and I keep my platinum and diamonds at home. The last thing I need is to lose my stone, or cover it with bacteria...

I think it's a good idea. Sure, it'll be abused and mistreated, but it will also catch a few things that could have been prevented. A patient one time on a floor was complaining of SOB and palpitations. The nurse blew them off. The family member ended up calling the operator and speaking with the house sup, who went to the room. Patient had a Saddle PE, transported to the ICU, and nearly died. Because she was only in her early 30's, the nurse thought it was anxiety. Didn't check to ask if she was a smoker or on birth control (the patch). If it wasn't for this woman's family, she would have died, and the hospital would have had a really big lawsuit on their hands. I think this one case alone justifies the use of RRT for families.

Easy, even cheaper way: "You leave now, you don't get a voucher, here is security to escort you out."

A nurse that I work with put it this way: People don't go to the grocery store and demand the clerk give them a ride... why would they think they can do it in a hospital? We give them out, and I HATE it. People abuse it sooo much. We had one guy who lived across town, and would call EMS to bring him to us, get discharged, and get a cab to his girlfriend's house a few blocks away. He got away with it for about a year before someone noticed his home address wasn't the voucher address. Ugh. Another guy was homeless, and got a cab to go to the Circle K two miles away... he lived behind it. Seriously. I'm really stingy with them, and try to only give them to people who were traumas, or who came in for a legitimate reason and really don't have a ride home. Otherwise, they can hang in the waiting room until the busses run.

I just delivered my second daughter on July 19th. I thought I would share my birth plan with you ladies: Dear Nurses, Please do all you can to make sure my baby and I remain healthy. Also, I would like food ASAP after delivery. Thanks, Valerie They got a kick out of it.

My favorite: Dude who had rectal itching, and figured what better to scratch it than a steak knife? Ended up with a colostomy.

Squirt an amp of bicarb over stinky feet (1/2 amp each foot), and it neutralizes the smell. This is how we wash our homeless people's feet, works every time.

See, this frustrates me so much. You are a grown woman, with a career. There is no way you should have to bring in brownies to be respected on the team. Do you think your coworkers would expect a new male nurse to do so? Never. I see your frustration for not fitting in, but I'm a firm believer that work is not a place for socialization. Granted, it took me about a year to really fit in with my coworkers, but they knew I was a good nurse, and they trusted me on the patient-care aspect of things. Just let your nursing speak for you, and don't worry about making friends. Easier said than done I guess....