Guest805836

Well since I only walk in the visitor accessible areas in my regular clothes (I don't pass through any inpatient units on my way out), I don't pick up all that much ickies (no poop or projectile vomiting for instance). Of course there are germs all over hospitals, but I use public transport to get there, and I'm pretty sure that is full of germs as well. Also for me, working in the OR, it is just as much about what I bring in to the hospital as what I take away. However, I just did a quick search on pubmed about bacterial contamination of scrubs, and there seems to be no particular risks associated with wearing scrubs to work and home. https://www.ncbi.nlm.nih.gov/pubmed/31358414 https://www.ncbi.nlm.nih.gov/pubmed/29056327 Historically, was this something that was common in hospitals in the US from early on when scrubs became a thing, or was it introduced at a later stage (for instance, as a cost cutting measure, because it is cheaper to not have to launder and deliver all the scrubs) ? Are there any countries other than the US that wear scrubs on their work commute ? This is largely a cultural thing, I think. It just feels really weird. Like I'm still at work when I'm going home.

This is so strange to me, in Europe we don't wear our scrubs to or from work, we change in the locker rooms at our units (and there is a shower available there as well). Our scrubs are provided by the hospital and are washed as needed (typically you get 3 pairs of scrubs at most from the distributor and then as you put in the dirty ones to wash, it scans them as returned and replenishes your scrubs 'credit'). And shoes are washed daily in a sort of a dishwasher thing.

This just makes me think of the episode of Friends where Joey has his face plastered all over NYC in a commercial for a clinic with the caption "What Mario isn't telling you is that he has VD."

While I think it is unprofessionnal (and potentially unsafe) of any member of the team (surgery or anesthesia) to ignore the timeout and any case related communication, most anesthesia trained people are aware of HR and whatnot modifications even if it doesn't look like it. The annoying thing is when the person doesn't set their alarms accordingly and it beeps all the darn time; but in general, if the machine ain't beeping, there is probably nothing dangerous going on.

I had 6 years of experience (first surgical floor, then ICU) when I went back to school. In my class there are people who have been in nursing for quite a while and only one or two who have been nursing for 2 years. I don't really buy the "past 5 years you are too set in your ways" : it is a totally different profession, what ways can I possibly be set in? (I'm not being facetious, I think it would be pretty interesting to do some statistics about how many years of experience & what background people had when they decided to pursue their studies)

I come from Eastern Europe and have an appropriately long and scary last name. People call me by my first name or massacre the last name, I endure. Do whatever feels right, it really doesn't matter much.

And we found out the hard way that seems to not be a great way to do that either (chronic pain epidemic in our waters....). Yep, we're more about that now. Also, non medicated interventions (cold / heat / TENS....).

I worked nights for 8 years and we often played music at a low volume in the nurses station (we agreed on music selection). I now work in the OR and music is often played. It doesn't impede my concentration. In a critical situation we usually turn it all the way down, but otherwise it often helps concentration and soothes. Recently I was in a neuro OR and there was a particularly hot tempered surgeon who got into shouting matches with himself everyday (yes. he would yell at himself for his incompetence when the surgery was a bit complicated... don't ask). We had a patient quite anxious before surgery and they requested jazz music for the anesthetic induction. After the induction, the surgeon asked we keep the music on and it had a soothing effect. No shouting that day. Maybe coincidence (can't remember if the surgery was tricky that day).

I am pretty durn confident withing the margins of my scope of practice in France not permitting me to initiate treatment on my sole decision. However, where there times where I called the guy on call saying "I believe patient X is in afib, would you like me to give amiodarone ? I did an EKG for you to look over" and the EKG would wait until much later, if the doctor on the other side of the phone knew me, knew my experience level and told me to just go ahead and initiate treatment. If I had a weird rythm I wasn't comfortable with (some weird block, or a Wolf Parkinson White re-entry thing... or like an atrial flutter with 1:1 conduction can seem a bit like sinus tachycardia sometimes), I always insisted the EKG be looked at anyway.

And yet, paracetamol + opioid = synergy (the sum of the two is greater than the effect of one + the effect of the other), so it would probably have been interesting to include it despite you needing the opoids. And that is why an opioid prescription alone isn't great : patient education about pain management is also about managing the side effects of the medications (and if there is one classic one it is constipation from opioids !). So you stopped a prescription before it was due (?) because of side effects and probably were in a great deal of pain, with the risks for chronicisation that entails. I am glad you are pain free now, here's to you making a great recovery :)

In the context of my anesthesia nursing studies I am following a class on pain management this year (in France, nurse anesthesists are specialised in anesthesia, but also pain managment, emergency care and intensive care). One of the things of which I was insufficiently aware during my initial nursing studies (which are.... a bit of a time ago!) was the impact of acute pain on developping chronic pain, neuropathy. So I'd say one of the important things to drive home is how important it is to have good quality pain managment in acutely painful situations (post-op comes to mind), no toughing it out ! Educating patients towards managing their post-op pain, especially if they are going to be out of the hospital very soon is critical. Also, another thing that has been a bit of an eye opener was how little neuropathic pain was accurately diagnosed and treated (I only learned about the DN4 during this class; how come I'd never heard of it before ??).

I am ressurecting this discussion; I am looking into information about the Face Anxiety Scale. [ATTACH=CONFIG]25645[/ATTACH] I have read several articles by McKinley but can not locate the precise intervention threshold, how they categorise (is face 2 moderate anxiety, 3 ? 4 - 5 high anxiety?).... Maybe I've just read so many articles that I can't see what is in front of my eyes...

I am in my last year of studies to become an anesthesia nurse in France, if you want info.

Some line of cooking, possibly pastries and desserts. Something in applied arts, like costume and prop work for plays or TV/film ? I actually did an elective course in art, and it was tough but I loved it :) but not imaginative enough and not talented enough to be an original artist

Except for Isoprenaline, which isn't a typical code blue drug, but can be used for complete AV bloc (which can be so slow and inefficient that no circulation is taking place); it should be titrated until an acceptable rythm is obtained; if you push it fast, you can overshoot into VTach :)

To keep track of medications administered, I suggest not discarding any ampoules or wrappers, keeping them all in a tray for later, when you'll have to write down in some form or another what was done. I suppose most people have heard this one before, but to understand what the speed of compressions should be, do it in rythm with "Staying Alive" by the BeeGees. EtCO2 is interesting because it is an early indicator for return of spontaneous circulation (when it will usually skyrocket) and a consistently low EtCO2 during the rescucitation attempts may be indicative of a poor prognosis. If you can't establish an IV, you can use the endotracheal route (dosage *3 than what would have been used in the IV) - as always, per physician order!

My fb account lists Veridian Dynamics as my workplace (fictional zany company from a funny series). I also listed Xavier's school for gifted youngsters (x-men reference!) as my school. I think a message saying that you got your dream job at an ICU is pretty risk-free.

I'm still back on Europe and have very little interest in moving to the USA. I lived there in my childhood and my mother did her nursing studies there, but I've been in France for a while now and I love my city :) but this forum is very interesting, love the nursing discussions. Wishing you the best of luck in your NP studies, it sounds like it won't be a piece of cake but it should be worth it in the end ! I hope nursing evolves into more autonomous provider areas here, there is a projected medical shortage in the years to come, and I think the government will have no choice but to move with the times. There is a powerful medical order, which pulls much weight, so it's an uphill battle. Anaesthesia is one of the areas with the most autonomous role, but even so, there are a number of limitations, which are a bit frustrating.

Some sort of pyramid scheme selling of beauty products (not Avon but something like that) - I was 15 and didn't know any better. Washing dishes in a restaurant - my hands were all burned from handling the dishes from the dishwashing machine and skin messed up from being in the water a lot (even with gloves). Nurses aid at night in a senior home : 80 patients, no nurse !!, two nurses aids. Half of the patients were senile, several were combative, most were incontinent. Horrible, horrible, both for the patients and us ! Nursing helped by bringing me financial security and independance. And my hospital is paying for my education in anesthesia after 7 years with them :)

What is this 'floating' technique ? Curious. I'm always looking for ways to better my iv-fu (like Kung fu but with needles). One of my favorite techniques, on patients with sclerotic rigid veins, which impede the progress of the IV catheter : I stick em, when I have blood in the chamber and if I have trouble moving the catheter up the vein, I take out the needle, connect my bag of saline and open the drip. The flow of liquid in the vein helps the me make the catheter progress up without friction (less chance of spasms)!

Hey to fellow French colleague :) what area are you based in ? I have left the bedside and I'm in my first semester for my anaesthesia speciality ! Tough but really interesting.

It partly went away for me. Depends on the unit, the shift... Part of the problem is that there will always be more work to be done, it's not like a desk job where you, say, analyse a group of documents, write a report on those and your assignment is done. People will continually have needs that we will continue to fulfill for the duration of the shift and they will carry over to next shift, etc. This is continuity of care and it is just the nature of the beast. The rest, for me was 70â„… prioritizing / 30â„… becoming more laid back. I work in a cardiac ICU and our patients go from 'had chest pain, nothing was found, perfectly fine' to 'in septic/cariogenic shock'.. My current priorities go : 1) patient will die if this is not done OR patient will negatively progress if this is not done ; I.e. addressing immediate emergent issues (breathing/circulation/neuro) 1a) if necessary, assisting physician during procedures although if said procedure isn't urgent, I ask if it can wait until my other tasks are done 2) patients basic needs are met : clean, fed (if applicable), safe (adequate positioning, turning...) 3) the routine : giving out non emergent meds on time, during routine dressing changes per protocol, addressing family questions, rounds... 4) me! Drinking enough water, having time to go to the bathroom, taking a lunch break 5) over and beyond call of duty : doing something when I have the time either for a patient or getting stuff done for the unit (sorting, organising..)

Hey :) Interesting point of inquiry, hope these help.. I've been a nurse for 7 years, during my studies I also worked as a nurses aide for 2 years. I worked on a surgical floor (cardio-thoracic and vascular) and now work in a cardiac ICU. 1. Stressful but not overly so. Working the floor was more stressful, the patients were sometimes ICU worthy but I had a big patient load; the ICU is high acuity but I feel I have more time to devote to each patient, so that works out ok. Also, if there is no new admit and no acute change in patient's condition, nothing particularly stressful is happening... 2. I have a SO and a daughter. I work night shifts (9 pm to 7 am), they have classical day-time school/job. On my work days, I don't see them that much, especially my SO, who comes from work pretty late usually, on my days off we see each other plenty. I actually like having a different schedule, gives me plenty of alone time at home (which I need). 3. Usually sleepy ! Occasionnally pissed off if we had a really lousy shift,.... or a lousy attending doctor ! I always browse the net for about 20 minutes before going to bed, I read something funny to de-stress. 4. I'm not much into partying, but on my days off, I could. I just prefer binge-watching netflix at home instead !

I know the type. I admit, my favourite patients are sedated, on paralytics and have no family or friends... But, the patients are not there for our convenience! I'm glad to read that you're through with that colleague of yours, hope she doesn't give you too much grief now.

I sympathise with your situation - very difficult to learn in hostile environments such as these. If it helps, keep in mind that this is a valuable learning experience of the type of preceptor you do not want to be. Btw, no one has mentioned this on this thread (I think), but your preceptors sedation approach is currently proven to be detrimental to patients. We no longer deeply sedate patients for "peace of mind" or whatever bogus reason (seriously, to not have to go see your patients every so often??... That sounds... Slacker-ish.) There is a study in the New England journal of Medicine about sedation and delirium in ICU patients. It is interesting and if you have time, read it. The conclusion is simply that : "Currently available data suggest that the best outcomes are achieved with the use of a protocol in which the depth of sedation and the presence of pain and delirium are routinely monitored, pain is treated promptly and effectively, the administration of sedatives is kept to the minimum necessary for the comfort and safety of the patient, and early mobilization is achieved whenever possible."