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Loxam10

Loxam10

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  1. Loxam10

    The good, the bad, the ugly

    I am seriously considering going into forensic nursing. I know this is kind of broad but can you tell me what do you love about it and what don't you like? I am currently working in a pediatric operating room. Unfortunately, there are many times when we have victims of abuse on our operating table. So I am somewhat familiar with the meticulous documentation and the emotional tribulations that come with abuse. Thanks for any comments!
  2. Loxam10

    Transitioning from med/surg to ambulatory care?

    You may want to also post this in the PACU nursing group. I currently work in a pediatric OR but I can tell you that nursing in the OR or preop/PACU is completely different then any kind of nursing. I'm not sure what exactly is destroying your spirit” but I want to be honest, It is also a tough culture to get used to. I've been in the OR for 2-1/2 years and I am looking at transferring to an ambulatory care clinic.
  3. Loxam10

    Advice needed

    Hello everyone. I have always gotten good advice on here so figured I would go for it again. As you all know working in the OR can be physically demanding. I recently had a DRUJ (wrist) joint replacement. The implants are titanium but I've been told I will have a 20 lb lifting restriction for the rest of my life. Technically per my job description I need to be able to lift 50 lbs. my surgeon was nice enough to write my return to work note that my restriction was 50 lbs but told me under no circumstance am I to lift that much. I work in a pediatric OR but I have seen my fair share of adult size kiddos. Adding to the predicament, I work nights and I am the only circulator after 9pm. I am nervous about returning to work knowing that eventually I will be in a situation that will require me to lift more than I should. So do I need to start looking for something else or do I just stick with it. I work with a good group at night and can usually find someone to help with lifting. Prepping for big ortho leg cases can be tricky but I make it work. I love the OR but I am only 28 and further damage to my wrist could have career ending consequences. Any advice would be nice.❤️
  4. Loxam10

    Pediatric OR nurses here?

    Hello. You have probably already chosen your job opportunity but I figured I could still give you some info for reference. I have been a pediatric OR nurse for two years now and I absolutely love it. OR nursing is completely different than any other kind of nursing. I started out as a new grad so I cannot really compare my experience to an adult OR. But I can give you my two cents. Adults usually have comorbidities, kids usually don't. As previously stated, in peds you have the opportunity to start IVs. In our facility any child under 10 years will get PO versed in preop, anesthesia masks them down with sevo (now they are not a moving target!), then you put in the IV in the OR. I would think prepping and set up would be similar between the two. Even as a pediatric facility we do get adult sized patients. Once you are OR trained you are in the minority of nursing. Nurses from other units cannot float to the OR for obvious reasons. You are a specialty within a specialty and therefore can expect the compensation that goes along with that. Schedule- our nurses work either 8,10, or 12 hr shifts. I do feel fulfilled professionally. I won't lie to you, the OR is a stressful place. Especially a pediatric one. We see kids go thru things that they should never have to deal with. You will probably go home and cry your eyes out at times. But we also see how amazing and resilient kids are. I've watched a child recover from a brain tumor resection when no one thought they could. It's days like that that make all the stress and tears worth it.
  5. Loxam10

    Grounding pad sites

    We place ours on the back too. Sometimes if the baby is fluffy enough you can get it on their thigh but 99% of the time I put it on their back and use a disposable washcloth to pad the cord so it's not touching their skin. The other day it took me a minute to figure out how to put one on a 890 gram NICU baby. It can be tricky!
  6. Loxam10

    I need new shoes

    I wore danskos for almost 2 years and would come home with my legs just killing me. I recently switched to klogs. They are so much more comfortable. They still give you good support but are a lot easier on your feet!
  7. I work in a pediatric OR and we have recently upgraded to a level 2 trauma center (we are also the only pediatric hospital within a 60 mile radius). So we know have 24/7 in house staffing as well as a backup team on call for traumas. Our department has gotten into the habit of allowing surgeons to add on non-urgent/emergent cases on the weekends which ties up our in house team. If several cases are added on then they will call in the backup/trauma team to run a second room. But what happens if a true trauma comes in?? The response I get from management and anesthesia is - you would have to quickly wrap things up in one of the ORs, well that's only happened once in the last 10 years, or the ED should be able to stabilize them enough for us to finish the case currently in the OR. This is crazy to me! This is the only facility that I have worked at, is this normal?? I want to look at them and say what if it's your child in the OR, would you want us to "quickly wrap things up" and possibily make a mistake or even worse what if it was your child that came in as the trauma and needed emergent surgery. I don't understand how people are willing to just roll the dice and hope it doesn't happen. How does other facilities handle situations like this?
  8. Loxam10

    Did I do the right thing??

    Sorry I did not see this reply. I'm not sure why an ENT surgeon was doing this either. The lesion was not prearicular. It was towards the top of his head in the middle.
  9. Loxam10

    Did I do the right thing??

    Thank you for your response (I knew if anyone who reply it would be you!). We are a smaller hospital so we do not have a chair of the department. I realize now that I skipped the the CNO in going to the medical director. However, the medical director has emailed me back and said thank you for reaching out and gave me the contact info I need to be able to schedule an appointment with him. So Tuesday I go into work and after about an hour of being there I get called into my directors office. For the next 20 minutes I get for lack of a better word attacked. She immediately started in on my about how my incident report was inappropriate, that I was intentionally trying to throw her under the bus. She did not understand what i was trying to protect myself from. If there was anything resulting infection it would come back on her because she told me to allow him to continue. I still disagree with this, I was the nurse in the room and I am the one signing that chart. In a court of law I could try to agrue that I was told to let him continue but at the end of the day I allowed him to. She wanted to know why I consulted with the attending anesthesiologist, that I do no answer to him, she is my superior. She wasnt sure why I was questioning her, she has been going this for a long time and brought up the fact that I started there as a new grad. Also if I was going to disagree with her I should not have but it in my incident report. I started to bring up my patients safety, she intrupted me saying "Dont you think I was thinking about his safety too?" She also said that she doesnt think she could trust me anymore. I left her office after what felt like hours crying and feeling completed defeated. I tried as hard as I could to hide it but it was obvious I was upset and I still had about 10 hours left in my shift. The charge nurse that was originally involved pulled me aside to find out why I was upset. After talking to her I felt a little better knowing that I was not the only one confused about the whole situation. She believes there are politics at play in this and my director is mad because I made her look bad. She kept apoligizing for how discouraging this situation is. She doesnt understand the directors reasoning about risk of anesthesia being more of a risk than infection. Especially since this is the same director who allowed another surgeon on Monday to have a patient taken to the OR and put to sleep when the surgeon was not even in the hospital. The kid was asleep and waiting for the surgeon to arrive for 50 minutes. So now im in my next predicament. I obviously am not in a good position with my director. So I could email the medical director back, thanking him for his response but telling him I have spoken with my director and am confident with the outcome. Which would not be true but it would close the situation and keep me from getting in more trouble. Or I could continue to meet with him in hopes that my director would not be allowed to be a bully and do this to any other employee. But i feel like this is a risky move especially being so early in nursing career. Im so confused.
  10. Loxam10

    Did I do the right thing??

    Ive been a nurse in a pediatric OR for two years now. Friday was one of the most difficult days I have ever had, not because of a difficult case but because a situation arouse and I did not feel supported by my management. I am sorry this is so long but I feel like you need all the details. We were doing an excision of a scalp lesion on an otherwise healthy teenager with an ENT doc. Prior to me coming into the room the surgeon told the orientee scrub tech that this was just a clean case and he could use wall gloves to set up. This was brought to the attention of our charge nurse who spoke with the surgeon. The surgeons arguement was that this was not a big belly case or joint replacement, it did not need to be sterile. Charge nurse tells him she is making an executiive decision, the set up needs to be scrapped and start over for a sterile case. I picked up the patient and now the orientee has been relieved by a very good/veteran scrub tech. The case is set up in a sterile manner. I prepped the patient with hibiclens and the surgeon is scrubbed/gowned. He asked me to lift the head so that he can place a sterile towel underneath. He then begins to place the split drape and in the process grabs the anesthesia circut and places it on top of the drape. The scrub tech and I look at each other in confusion and she says "Sir your glove is now contaminated". He responds "I know. This is not a sterile case, its ok." I immediately call my charge nurse back into the room. I tell her what happened and she leaves to go get the director of our department. A minute later she calls into the room and says "Do not let him proceed, do not hand him anything, we are coming." Surgeon asks for the local and we inform him of what we have been told, you can see the confusion and irritation on his face. Less than two minutes later my charge nurse calls back into the room, "Per the director - Continue with the case but make sure you document his refusal to fix the contamination. We are going to report him." At this point the scrub tech and I are extremely uncomfortable with this situation and I think the surgeon could tell. Thankfully he says "if it will make everyone happy we will start over and do everything sterile." Everyone agrees to this and we completed the case without further contamination. Here comes my issue. The scrub tech and I have now been placed in a position we should never have to be in. After the case we went to the director and asked why in less than two minutes was the decision made to allow him to do a surgery knowing he was contaminated. We were told that sometimes you have to pick and choose your battles. She felt like the risk of the child being under anesthesia was greater than the risk of infection. That if the child came back with a wound dehisence or infection it would be on the surgeon not on us because we documented our disapproval. Two things: This was an otherwise healthy teenager who had an uneventful intubation. For the director/charge nurse to come into the room and talk to the surgeon we are talking about adding less than 30 minutes onto the anesthesia time NOT hours. I spoke with the attending anesthesiologist in the room. He agreed with me that the risk of infection far exceeded the risk of anesthesia. This child was already asleep and stable. Second thing, in a court of law I would be liable too because I knowingly allowed the surgeon to continue after he was contaminated. So our management team, the people who are always preaching patient safety over all else and saying they will always have our backs when we stand up to surgeons, were not there for us. They put us between a rock and a hard place. Yes it all ended ok and the patient was not harmed in any way. But we were put in a position where we would have had to decide to step away from the case (oh wait the patient abandonment and illegal) or knowingly allow a surgeon to put a patient at risk (also not good!). Being asked to be relieved/removed from the case was not an option since this was later in the day and the only other team was already in another OR (but that would put them in the same hard spot we were in). I filled out an incident report like my director said to. I stated all the facts and noted my discussion with the anesthesiologist. Only problem is that those reports go directly to our management team. So I felt like I had to reach out to the medical director of the hospital and request a meeting. But now I am completely stressed out and know that I am really putting my neck on the line with going over their heads. It just feels so wrong to me that they put us in that position and did not even have the decency to come into the room. Maybe its my lack of experience but I also cannot understand why they were ok with putting my patient at risk.. I know I did the right thing for my patient but did I do the right thing for me by escalating this?
  11. Loxam10

    Organ Procurement

    Thank you all for the advice. My hospital hasnt offered any type of debriefing but I will ask about it. I think it is some of both that is bothering me (the procurement itself and the accident). The act of organ donation is a beautiful thing. So the actual act of watching the organ be removed isnt what bothered me. My mind just kind of summed it up to another case. Last time I was able to separate myself until after the case. This is what keeps replaying in my head.. During the time out the representative from life connection read a letter that the little boys mom wrote to the procurement team. It talked about his personality and asked us to please tell him mommy loves him. So from the start of the case I was already emotional. This was not a coroners case so at the end we had to take all of his lines out and clean him up. I was towards his head so I ended up taking out his ET tube and the EVD catheter that was sutured in. The feeling of pulling those lines out sticks with you. I know I need to continue going to work and I have. But it makes you wonder if you are really strong enough to continue being a pediatric nurse... If my hospital doesnt offer any type of debriefing then I will seek it on my own. It is nice to know that I am not alone and that it is somewhat "normal" to feel this way. Thanks again for the advice and any more would be much appreciated.
  12. Loxam10

    Organ Procurement

    I am having trouble coping with an organ procurement I had to do this week. This is the second one I have had to do but for some reason this one is hitting me harder. He was a 6 year old boy who was hit by a car. Every time I close my eyes I can see his face. I haven't been able to really sleep since the case, I've had nightmares when I do fall asleep. The last time I was able to make myself some what "okay" with it by telling myself he was living a better life thru other children now (2 year old abuse case). Does anyone have suggestions on how to deal with the heart ache of procurements? I know we have to try to separate ourselves and do our job but we are also human...
  13. Loxam10

    1st nursing job, Do I disclose condition?

    Thank you all for your replies. Rose Queen - I am not positive of all the specifics for PTO. I do know what my friend is only in her 8th month of orientation and has been getting and has used some of her PTO. I will find out more of the specifics when I talk to HR this week. Depending on when orientation would start I should be able to get my ketamine infusion right before, at least that's my hope. As far as the environment.. I'm not sure. They seemed like an understanding group of people but the manager was a little hard to read. InklingBooks- thank you for the encouragement. The YouTube videos touched my heart. I know what a lot of these kids are going thru and I want to be there for them like I had people for me. Graduatenurse14- unfortunately my doc is the only one that does them in my area. He is one of only three places in Ohio that offers this treatment. Heathermaizey- that's what I am afraid of. My last two semesters in nursing school I had a clinical instructor who found out and made my life miserable. She basically told me I was wasting my time and I would never make it as a nurse. I think I am gun shy about talking to management because of it. You would think people in the medical field would understand people having medical conditions but unfortunately not . Hppygr8ful -as far as I know ketamine would not show up on the drug test. I plan on asking my doc when I see him next week. (Hopefully before I do the pre-employment testing). If it will show up I will have no other option but to explain. Cricket183 - it is nice to know that I am not alone in this. I too had a spinal cord stimulator but had it removed within a year after the leads malfunctioned. I am so glad the ketamine treatments have been helping you. They have been a miracle for me. I get one large bolus dose one day a month. I wish you luck this fall and hope the ketamine continues to work for you. I really appreciate everyone's response and advice. I plan on talking to my pain doc next Tuesday about it but it seems like I would be better off disclosing (and letting them know its under control) then not disclosing and them finding out later and think I tried to cover it up. Now I just need to figure out when to disclose, during pre-employment testing or after I am hired?
  14. Hello all. Hoping someone could give me a little bit of advice. I graduated in December and recently passed my boards. I am over the moon thrilled that my first nursing jobs looks like it will be in a pediatric OR. This is the job I have been dreaming of! I shadowed yesterday and everything looks like I will get the job (the manager said I will hear from HR next week.) So heres my dilemma.. I have had CRPS in my arm for 13 years now (I am 25), I have learned ways to deal with the pain and be able to get my work done. A year ago I found a treatment that has kept me off of pain medications. I get a ketamine treatment once a month and everything is good in the world. The position I will get getting is 11a-2330p but I will be on orientation from 7a-1530p five days a week for almost a year. Which leaves me no time to get my treatment.. According to my friend that works there we get 8 hours of PTO every two weeks. But would it look bad if in my first months of employment I was using PTO once a month? Do I be honest and talk to the manager, explain the situation, and hope she understands? Or do I just take the PTO once a month and not explain why? If I do disclose my CRPS do I do it in the pre-employment testing or do I wait until I actually have the job? Any advice would be great! Thank you..
  15. Hello all! I could really use some advice.. I graduated nursing school last week (). Graduation comes with a sigh of relief that school is over but also fear of the nclex and a lot of decisions. I have been approached by the manager of the med-surg unit I precepted on and by an individual at a pediatric doctors office for employment. I am really torn right now. I loved the med surg unit but because of my own health issues I am not sure if a full time 12 hr shift schedule wold be a potential problem for me. But I am afraid that if I go straight into the pediatric office that I will close the door of ever working in a hospital setting. So do I go into a hospital and hope that my health issues will not interfere or do I potentially close the door to only working in doctors offices for the rest of my career? Any advice would be great!
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