Lisky90

Thank you so much to all of you for taking the time to read this...and thank you so much more to all of you who responded, and for some of your encouraging words. I feel so much better this AM after clearing my head and getting some sleep. What scares me however, about my charting is that everything is computerized where I work, so my charting was done in the computer under the pt's notes and that is where I charted every detail of the incident. If anyone chooses to read the notes about the incident...they can. I'm sure the MD will be looking for notes about the incident this AM, as he apparently called the floor as the pt was being tx'd to the ICU. The secretary, who was very aware of what went on, told me he sounded very surprized and nervous that her condition warranted such drastic measures. So, I do feel nervous that he is going to be PO'd and wonder how far he will go to cover himself. But, in many ways I just feel so disappointed in myself for knowing that this pt wasn't OK...and that if RT had not come back to reassess when they did, that I would have given in by giving her a drink. I didn't trust myself and my abilities and if RT had not come back in when they did, it really scares me to think about what may have happened. I owe RT a TON of credit on this one.

I'm so tired after doing 14 hours today...but, I can't get this off my mind and this is the perfect place to get some feedback...so I'll try to be as brief as possible. This was my first day back at work after being off for two days; however, I haven't been on my floor for over a week because over the weekend I was floated to another floor. So, first day back at work, on my floor, I get report on a pt who looked fine a week ago...chronic trach, weaning off the vent, been off for many weeks, on a trach collar, some confusion, always on the callbell, etc. I get report...taped from the off-going shift that she has "4+ BLE, very anxious overnight, given Haldol, Ativan and Benadryl, RT increased her FiO2 to 100%...but, I don't know why, the order is only for 70%, I think she has an EKG ordered but can't find the order...pt in same condition yesterday, but MD wrote in progress note that pt is stable." I first ask RT about her ?EKG...he says "She had an ECHO last night and it is showing Right atrial/vent enlargement with pulm. htn." Seems to correlate with the edema...feel that it is significant. Then the CNA tells me that she is cyanotic. I go in to assess...she is cyanotic, worst edema I have ever seen, O2 sats are in 70s to 80s. RT goes back in...we monitor her for awhile. MD arrives...ECHO on chart, he SEES pt himself, writes orders and leaves. I check the chart, the only new orders were for coumadin and a PRN lotion for her back and that she is essentially stable. I thought WHAT??? Did you even look at this pt??? I asked him if he saw her ECHO results? Did he want to treat that?!? He says "no, this is long standing...meds would only help long term...she has been this way for awhile." I know he saw her so, I thought "OK...he knows her, I haven't seen her for a week...OK?!? Pt starts asking for a drink. She can only have PO if she is capped...she is cyanotic without the cap...I'll kill her if I cap her. I call RT, they tell me to cap her for brief periods, let her sip, then remove cap. I held her off for a few hours...but kept thinking how is she going get nutrition if I withhold PO intake...I didn't know what to do...she kept asking...finally I gave in and sent the CNA for coffee. At the same time, RT comes to reassess...can't get an O2 sat at all, they call for me and my sup...who flips out because pt is in the condition she is...tells me to notify the MD...I explain I have already discussed this with him...he is completely aware of current situation...I explain that she has been this way for a few days...she says "I don't think so" but then admits she hasn't listened to her taped report from the offgoing shift (This is at 2:30 in the afternoon...we start at 7:00am!!! How does a sup do her job if she hasn't listened to her report???) she insists that I need to be "proactive" especially because pt is a full code and if we aren't treating the Right heart enlargement what is the sense of putting her through a code. So, on that, I call. The DR. flips out...he thinks I questioning his judgement, tells me that if I am concerned about her NEW change of condition I should call the House MD...I explain that she has been cyanotic since this AM...this is not a NEW change of condition. He tells me that he is "to stop focusing on the ECHO results" and that he is "seeing pts and I have no right to call him..." and then tells me that he is "ending this conversation" and refuses to discuss her code status. Well, her ABGs were in the toilet, she ended up having her trach changed, going back on the vent...and sent to the ICU per the covering MD's orders. I then sat down with my sup...and we listened to report together at 4:00pm...she still had yet to listen to report herself...we discover that this pt had in fact been this way since Monday...nothing has been done, as MD has continued to write she is stable...but no one has had the sense to question it. So, this mess fell into my lap today and I was so PO'd!!! Everyone said to chart, chart, chart everything. So, I did. Now, I'm worried that all my charting is really going to rub someone the wrong...especially the attending MD. I feel like what I did was right but, I feel in so many ways this situation was so wrong. I don't know what to do next...I've gone to the sup...should I go to the DON? I'm exhausted but, I just can't sleep because of this. Thank you to anyone who has gotten this far in reading this...and even more thank yous to anyone who has any words of wisdom to impart

I'm so tired after doing 14 hours today...but, I can't get this off my mind and this is the perfect place to get some feedback...so I'll try to be as brief as possible. This was my first day back at work after being off for two days; however, I haven't been on my floor for over a week because over the weekend I was floated to another floor. So, first day back at work, on my floor, I get report on a pt who looked fine a week ago...chronic trach, weaning off the vent, been off for many weeks, on a trach collar, some confusion, always on the callbell, etc. I get report...taped from the off-going shift that she has "4+ BLE, very anxious overnight, given Haldol, Ativan and Benadryl, RT increased her FiO2 to 100%...but, I don't know why, the order is only for 70%, I think she has an EKG ordered but can't find the order...pt in same condition yesterday, but MD wrote in progress note that pt is stable." I first ask RT about her ?EKG...he says "She had an ECHO last night and it is showing Right atrial/vent enlargement with pulm. htn." Seems to correlate with the edema...feel that it is significant. Then the CNA tells me that she is cyanotic. I go in to assess...she is cyanotic, worst edema I have ever seen, O2 sats are in 70s to 80s. RT goes back in...we monitor her for awhile. MD arrives...ECHO on chart, he SEES pt himself, writes orders and leaves. I check the chart, the only new orders were for coumadin and a PRN lotion for her back and that she is essentially stable. I thought WHAT??? Did you even look at this pt??? I asked him if he saw her ECHO results? Did he want to treat that?!? He says "no, this is long standing...meds would only help long term...she has been this way for awhile." I know he saw her so, I thought "OK...he knows her, I haven't seen her for a week...OK?!? Pt starts asking for a drink. She can only have PO if she is capped...she is cyanotic without the cap...I'll kill her if I cap her. I call RT, they tell me to cap her for brief periods, let her sip, then remove cap. I held her off for a few hours...but kept thinking how is she going get nutrition if I withhold PO intake...I didn't know what to do...she kept asking...finally I gave in and sent the CNA for coffee. At the same time, RT comes to reassess...can't get an O2 sat at all, they call for me and my sup...who flips out because pt is in the condition she is...tells me to notify the MD...I explain I have already discussed this with him...he is completely aware of current situation...I explain that she has been this way for a few days...she says "I don't think so" but then admits she hasn't listened to her taped report from the offgoing shift (This is at 2:30 in the afternoon...we start at 7:00am!!! How does a sup do her job if she hasn't listened to her report???) she insists that I need to be "proactive" especially because pt is a full code and if we aren't treating the Right heart enlargement what is the sense of putting her through a code. So, on that, I call. The DR. flips out...he thinks I questioning his judgement, tells me that if I am concerned about her NEW change of condition I should call the House MD...I explain that she has been cyanotic since this AM...this is not a NEW change of condition. He tells me that he is "to stop focusing on the ECHO results" and that he is "seeing pts and I have no right to call him..." and then tells me that he is "ending this conversation" and refuses to discuss her code status. Well, her ABGs were in the toilet, she ended up having her trach changed, going back on the vent...and sent to the ICU per the covering MD's orders. I then sat down with my sup...and we listened to report together at 4:00pm...she still had yet to listen to report herself...we discover that this pt had in fact been this way since Monday...nothing has been done, as MD has continued to write she is stable...but no one has had the sense to question it. So, this mess fell into my lap today and I was so PO'd!!! Everyone said to chart, chart, chart everything. So, I did. Now, I'm worried that all my charting is really going to rub someone the wrong...especially the attending MD. I feel like what I did was right but, I feel in so many ways this situation was so wrong. I don't know what to do next...I've gone to the sup...should I go to the DON? I'm exhausted but, I just can't sleep because of this. Thank you to anyone who has gotten this far in reading this...and even more thank yous to anyone who has any words of wisdom to impart

Ty-yen-ol...my preceptor for OB used to say that all the time...didn't feel that it was my place to correct her but, pts used to look at her funny when she offered it that way and she never noticed.

Love 12s...Where I work, there is still the same amount of pt care that needs to be squeezed in to 8 hours vs 12 but, at 3p I still have 4 more hours to complete things...charting, dressings, etc. Sometimes at 3p I can kind of sit for a bit and regroup after a crazy morning vs trying to get everything done and charted by 3p and more days at the hospital. Between 3p and 7p there are sometimes 16:00 meds and then 18:00 meds...definately no where near as heavy as a 9am med pass. So, I'm getting 4 more hours of pay, more time to finish up day stuff and 4 days off per week.

I just busted a gut out loud all alone in my kitchen after reading (my kids who were in bed had to come out and see what I thought was so funny)...OMG!!! That must have been awful...it was bad enough having it on my gloved hand and plastic gown...but on your head?!? you poor thing!! This is why I come to this site...no one who is not a nurse would ever understand why we CHOOSE to do what we do. So sorry to hear you had to go through that. Some lessons are learned to hard way but, that is just too much...I really feel for you!

I had a confused pt that had a capped trach. I took the cap off for trach care and put it down on his tray in front of him but, then thought better of doing that as he was confused so I said, out loud "better not put that there...he'll probably end up with it in his mouth." I was just kind of thinking out loud but, his wife took offense and said "oh come on he will not!" I apologized and finished what I was doing. I returned awhile later to do a fingerstick, and then left the room again. Upon returning to give insulin a few minutes later, I looked at this man and did a double take...his wife was sitting by his side...calm as could be...but he appeared to be chewing gum. A confused man with a capped trach...I said to the wife "did you give your husband gum?" She said "no, of course not." We fished out what he appeared to be chewing like gum...it was the alcohol prep pad from his fingerstick that was left within his reach.He had put it in his mouth and started chewing on it. Hmmmm...and I was the crazy one to suggest he might swallow the cap to his trach?!? He was found on other various occassion trying to eat his call bell, lick it like an ice cream cone...how can you not laugh sometimes?

This may sound like a silly question but, what makes an ICU nurse different than a tele nurse? I am still a pretty new nurse (one year since graduation)so, I really don't know what I would/should say if the small hospital that I work at asked me to float to the ICU. I've had orientation to the three depts in this hospital...the two regular floors with vented pts and no tele and the ICU. We just opened a tele floor this past week and I was one of the first nurses to staff it. I have taken tele training, and been ACLS certified and the pts I had all ran normal sinus rythyms but, I will admit I was still pretty nervous to have an actual assignment on this floor. I am now wondering if there is other training and/or certification that I should have to agree to float. Now that I have started on tele, I'm sure it's just a matter of time before this comes up.

Oh my...I hope I didn't totally gross everyone out with my Foley story. That all happened to have happened the day that I had posted it. I think my grossest medical story however, was when I was an EMT and we responded to a fight to find a man sitting on the side of the road holding his ear. When asked what happened he said, pointing..."that guy bit off my ear!" My stomach still turns thinking about that one...12 years later. Why would anyone ever bite the ear off of someone's head...cartilage, earwax...eeeewww!!! I think if I ever shared half of my stories with family and friends they would question my sanity in wondering why I would have ever CHOOSEN such a career...lol!!!

pseudomonas is a good one...there are now many strains that are becoming multi drug resistant...which warrants a "critical value" phone call from the lab, when sensitivities are finished. Also ESBL...got a call from the lab the other day that a pt had Kleb pneumo (a common bug) in his urine but it was found to be ESBL positive...I believe this is something that is being seen more frequently, and something to do with common bugs now becoming resistant to antibiotics.

I have a good one...from today as a matter of fact. One of my patients, who is a parapalegic called me in to tell me he thinks his Foley is clogged and needs to be flushed. His urine cx just came back with >100,000 Proteus and the urine in the bag looks like eggnog...sorry, for lack of a better description. Very purulent and sludgy...very gross!!! I checked the puter to see when the Foley was last changed and saw that it was changed on 6/3. So, I decide to just flush it. I tried and tried and couldn't get it unclogged, so I said "unfortunately, I'm going to need to change this again." So, I get set up to put in a new Foley, everything is within my reach, I deflate the balloon...and then thought about grabbing some extra chucks...only 3 feet away. I step away to get the chux, and I hear him go "OOOOHHHH!!!" There was so much pressure in his bladder, that it blew the Foley out of his member, sending sludgy, smelly urine EVERYWHERE!!!

The last time I did one, the sponge went directly onto the wound...I believe there was one once that I did that had orders to put gauze and then the sponge on the wound. You are right though, if there is a Tegaderm over the wound it will contain any drainage that the wound vac is supposed to draining. It should be the sponge, the tubing and then there are clear, plastic dressings, like Tegaderm but, made by KCI that go over the whole thing, to create a seal...they are usually much bigger than a Tegaderm.

Good morning...thank you to everyone who posted. I really needed some honest answers...to know if this is this crazy or if I am just new and slow...or whiney...lol. After I reflected back on the day...what seemed the most crazy to me was the timing...why would a supervisor want to tx pts from floor to floor while we're all getting ready to change shifts??? Why would she try to take report at the same time??? I get the impression that she waits until the last minute to take care of her responsibilities so that it appears to the oncoming shift that she did something all day...all the while wrecking havoc on the staff...leaving things feeling insane but so unsafe...I hated the feeling of getting a pt at the end of my shift, who I was now responsible for that I knew nothing about...thank God nothing happened. But complaining about it falls on deaf ears which leaves me feeling new and whiney, and wondering if this is the norm or not. So, thank you to all for your input. Re: vents and monitors...I agree that many of these pts belong on tele...but many of them are chronic, and no longer need it...they are alert, watching tv, do PT/OT while vented. Think of Christopher Reeves...he was vented. PMV: Passy muir valve PSV: pressure support ventilation...like CPAP, a weaning mode on the vent, where the pt does more of the work than with AC, which is full vent support PNA: pneumonia Sorry...I just start tossing in abbreviations when I start "nurse talk"...good to always ask for clarification, though...what might be an abbreviation in one area of nursing can mean something completely different in another area.

Today I started off my 7a-7p shift with 5 pts: 1. Pt on a trach collar tolerating PMV, with unsuccessful attempts to cap...very anxious and crying...high maintenance but, not too complex 2. unresponsive pt with hx of spiking temps, and a new PNA 3. Pt weaning from vent on PSV, who had chest pain tx to ICU 4. Pt with capped trach, with new onset seizures, hx of spina bifida 5. stable pt, hx of sepsis on 5week IV vanco...d/c to nursing home at the same time pt #3 is being transported to ICU...who got stuck in the elevator while being bagged. After losing these two pts, it was now 2pm...sat down to chart on all five of these pts...find out that at 3p, we have one nurse going home and the remaining three of us are going to split her assignment. So, I pick up a fourth pt...but now the 6th I've taking report on. But, things were still in control...it was 4pm, trying to finish up all my lose ends. At 5pm, supervisor starts shifting pts all over the building...I'm sure there was some rationale behind her madness but, had no time to figure it out. I ended up with a 5th pt at 6p...now the 7th of the day to take report on with no notice...while trying to wind up the day. While this is all taking place, she has CNAs cleaning up precaution rooms (no housekeeping available)...furniture and equipment going up and down the halls...CNAs not not available to do their own pt care. While trying to get report on my 7th pt and make sense of his orders and hx...my supervisor walks into one of my pts rooms and says that I need stop what I'm doing to give her a report. Is this crazy? or is it me? I have been working as a nurse for 9 months...so, I am still considered new. I have nothing to compare this to. Is this the way things are everywhere or is this crazy? BTW, while my vented pt was having chest pain, our doc on call was not available and when I called this same supervisor for help...she acted so annoyed that I needed help and kept saying "do you still need me???" We do not have tele on this floor; I put him on our portable monitor...he was having multiple PVCs...bigeminal, trigeminal...a run of 5...prolonged QT interval on his EKG and was a full code...I was scared that he would code at any moment and she was trying so hard to get back to whatever she was up to. Again is this crazy or is this me? I just need feedback.

I agree with you that it is an honor to be in the presence of someone in their dying moments and that it is indeed a profound and unsettling experience. I have sadly, had the honor, in the field of nursing that I have chosen, to experience this several times. I have never been able to express in words what the experience is like; your words describe the experience perfectly. It is truly a blessing for someone pass peacefully, if death is a certain outcome. I am sorry for your loss. In regards to the breathing. I think, and I could be mistaken that Kussmaul respirations are deep and rapid, with no real repeating pattern...regular or irregular, but with no distinct pattern. I believe that it occurs when someone is in ketoacidosis, a type of metabolic acidosis. The breathing that you describe I believe is called Cheyne-Stokes. Where there is a pattern of shallow breaths, that speed up, stop and then start again. It is also an imminent sign of death, from brain injury. I could be mistaken; without getting out the med-surg books...this is just from memory.

Thank you to all of you for all of your kind words. Today was a really hard for everyone involved in this pts care. The whole atmosphere at the hospital was very sad; it is a very small hospital. Tomorrow there will be a hospice debriefing regarding the whole experience. Today was sad...but the days to come will be also, as this patient has been in our facility since July...it will be very hard when they fill what has been "her" room. I know this is a hospital, and I am a nurse and this is life. I try to empathize with all of my patients; imagine what it's like to walk a day in their shoes when they are ringing for the millionth time...even if it is because they are just lonely. But, to try to empathize with this patient and imagine walking a day in her shoes is just unbearable...she was so young, her children are so young, and the disease progressed so rapidly. And through it all this pt remained so positive, and said many times how blessed she was. One of the doctors today...who sat with her through the entire process...sedating her, turning off the ventilator, and waiting with her while she passed on said that for as unfortuanate a situation she has been in for the past year, she was in some ways fortuanate to be able to say goodbye to everyone...some don't ever get the chance to do so. For now I am holding on to that thought, and that she is now at peace with no more pain. I am hoping that she is somehow comforting her children...as they are right now learning of their mother's passing. Please pray for them and her husband...they have lost someone truly amazing. And again thank you to all of you for your kind words and thoughts and prayers today.

I work in a hospital that specializes in vent pts. One of my patients since July is a 40 year old woman who was dx'd with ALS last November. She rapidly progressed from a young, vibrant mother of three young kids to completely paralyzed and on a vent this past July. I was off for four days and when I went back in today I found out that she has decided to turn off the vent tomorrow. The sedation will start at 8a, and the vent will be turned off at 11am. She can no longer endure the pain, she can't move and the last function she had...mouthing words, is no longer there. She can barely move her mouth, now...she exhausts herself trying to mouth just a couple of words. She said goodbye to her kids, ages 9, 12, and 15 last night; she knows that it was goodbye but they don't. Today there was a constant influx of people coming in to say goodbye. There was a group of her friends making collages of her with her husband and her kids. She wants these collages to surround her as the sedation is taking effect, tomorrow. I went in to say my own good bye...it was just heartbreaking. She told me she would watch over me, and be an angel to my children. I held her hand and then spent the rest of my day in tears. I know that she has no quality of life and that this really is for the best. It's just so incredibly sad. Her mind is still fully functioning...I can't imagine what she will think about tonight...or tomorrow as this starts. I just needed to get this off my chest.

I love your idea of the master copy. I have now been an RN for almost 4 months...when I started this post it was the night before my first shift. I have since tried numerous things to stay organize...some have worked,some have not. Right now, I have one sheet for all pts...with space to write something about all systems, VS, new issues/orders, and time slots, etc. It can get very crowded...and then I can't read my own writing. The master copy sheet might help with that. Thanks

As a student, I worked as a CNA on a postpartum floor, spending a majority of my time in the well baby nursery. I did not do newborn assessments, however because I was a student, many times nurses would point out interesting things they would see during their assessments. I remember seeing some, not alot of babies whose cords would have only two vessels. They were usually normal, and there was usually not alot of concern over this...from what I remember, I think I may now be wrong. I am currently taking an ACLS class with some girls I graduated with...one works in a newborn nursery, and came across this situation the other day. She mentioned the baby had a full renal workup and was sent to the special care nursery. I just don't remember this situation ever being a big deal...while it was not common, it always seemed sort of benign. However, after looking this up, I have read several times that this anomaly is frequently associated with renal, GI, issues. But, this information keeps repeating itself with nothing further. Does anyone have more experience with this issue...we're both too new at nursing to know how frequently this occurs and if it is worth worrying about

OH...you have no idea how encouraging your words are to me right now. A. to know that I'm not alone and B. to know that I'm not crazy!!! I try to tell my friends and family how crazy this job is...and they just can't fully understand like all of you can. A toast to those of us who feel like we're on the sinking ship...a fine glass of wine would be perfect right now...as would a pizza...as I'm sooooooo hungry after this shift as the Doritos and the ice cream just haven't done the trick

MEEEEE!!! Chicken with my head cut off is the perfect description. I spend the day trying to remember sooooooo much...that half the time I don't even hear people talking to me...or that if what they are saying is not more important than what is already up in my brain, it just doesn't register. I am up to 4 pts...all on vents...one with funky cardiac rhythms, one with no urine output, a BS of 49, whose tubefeed I held due to 110cc of residual and no BMX2 days, the third had a fever and was pulling on his trach...and the fourth with neuro issues and is unresponsive. My preceptor has taught me a ton...but as I run around like a lunatic...she runs around behind me saying "did you do this???" "did you do that???" and telling me that I really can't get behind...and that once I'm on my own that I'll have 5 or 6 pts...and that I really need to chart as I go. While I completely agree with her on the charting, and I really appreciate her keeping such close tabs on me, I also feel like this assignment is unrealistic. I have been an RN for 5 weeks!!! There are experienced nurses that float to this unit and sink...swearing for 12 hours straight about how ridiculous a 4pt assignment is with pts at these acuity levels. I feel like it is crazy to have assignments such as this...but that is the norm in this unit. Just when I think "Wow...I can't believe I'm handling this" for the maybe 5 seconds that that occurs throughout the day...my preceptor is telling me what I forgot. And then after working for 12, 13, 14 hours a day...I spend my days off obsessing over what I should've/could've done different. I CAN'T WAIT to have my nursing legs under me!!!

When my daughter was two she stuck a peice of modeling dough up her nose. It was the kind that felt like playdoh when it was squishy but dried into hard styrofoam - my older daughter was using it to build a dinosaur for a school project. I was putting the kids to bed on the last night of a weeklong school vacation. On the way to bed she started complaining that her nose hurt. I looked up and saw nothing. I asked her if she needed to blow and she said yes and as I held the tissue on the bridge of her nose she yelled "OWWW." With a flashlight I could see waaaaay up into her nose that there was a ball of flourescent pick dough. I laid her down on the kitchen island, as if I were about to perform major surgery - how and why she laid still while I stuck tweezers up there I'll never understand. After an hour of sticking these things up there with no luck (while sweating with an aching back...and thinking I really want to put you to bed so I can read), I called the pedi...they mentioned ER. Once I said "the doctor will have to get it out" she started crying, which made her sneeze which blew this thing down to the opening of her nare. I thought "great, I'll just grab it and we'll be done." You would have thought she was giving birth...with forceps. As she was screaming "OWWWW" and I was yelling "BLOW" I was pulling on this peice of dough - now styrofoam...didn't want to let go because I didn't want her to aspirate it. I ended pulling out this huge chunk of hardened dough. I have no idea how this thing made it through the passage of her nare, how she could breath with this thing up there, and how her nostril didn't tear when this thing came out.That is just one of the many crazy/hilarious/heart stopping moments that she's had since...she turned 5 yesterday!!!

I worked per diem in Postpartum as a CNA/student nurse; this happened to me ALL the time. It was called recall, and it was something that occurred with all positions. When I graduated in May that was something I made sure I asked about when interviewing for RN positions. I was told by one L&D nurse mgr "no, we don't do that...the nurses are union...they would never stand for that." It was very frustrating to plan for a shift, hire a babysitter, and then get a call with two hours notice that I was put on recall. Which meant that I had an hour to get to work if they decided they were busy enough to call me in. I had to either cancel my babysitter...or put her on recall. There were times that they would put me on recall for the first four hours of my shift and tell me to call back to check in for the last 4 hours. There were times that the charge nurse would get too busy, and not realize that there was a need for recall due to low census, staff would show up only to be told they were recalled. If the charge nurse didn't figure things correctly the wrong person would be recalled; this created constant tension, arguments and accusations that those in charge were playing favorites. It was soooooo frustrating and yes it definately destroyed my budget. Why did I do it and not complain? A. I was per diem and could not commit to anything but per diem and per diem staff is the first to be recalled and B. Because I felt that as a student I had landed my dream job in Maternity and didn't want to make waves. Did they hire me when I finished school and take me on as an RN? No...due to an anticipated low census they couldn't justify putting me through a novice nurse training program. I would be very aware of this issue and if your facility uses any type of recall/on call...or whatever they choose to call it...I would definatley find out all the details, how it is tracked and who keeps track. As a student, I tried not to let it bother me...there were things that came up with school, unexpectedly that made me grateful to have an unplanned night off. However, now that I am working as a permanent, full time RN...with accrued time off...I don't know how that system would work with budgeting or with planning time off.

thank you for all of your input. I wonder if the banana smell was high blood sugar - that was the only pt yesterday that didn't have BSs needed. She is also on a vent and was receiving Ativan for rapid HR and RR...both s/s of ketoacidosis. Hmmmm....now I'm starting to wonder. I will be paying much more attention to what I smell...thank you all so much. Penny, so sorry about your dog...how sad.

Can anyone identify pt problems/issues by smell? I am precepting right now; while assessing a pt yesterday my preceptor said "her sputum has that pseudomonas smell"...she smelled like gauze to me. Another time someone said "oh yeah...you can definately smell the Cdiff"...I couldn't differentiate that BM from any other. Today, I thought my pt who is NPO smelled like bananas. Just wondering if that smell is significant for anything??? Anyone care to share any other smells that relate to pt issues/problems?