murph

In the ER we had a Max Cart and it was the policy that any cardiac arrest from the street went on this cart. It weighed a ton, was a huge box shapped thing that had a thumper and a ventillator built in and IF the patient made it we would have to transport to the ICU on it. It was very painful when it ran over your toes. I got in trouble one time for not putting a baby in arrest on it. I wish I could draw it for you!!!!!!!!!

I moved from a teaching hospital to a rural hospital in the early 80's. We had a spinal cord patient come in. (of course we didn't transfer to a trauma center, there were only a few designated in the country) It took me three days to convince the physician to let me get a circle-electric bed. He wanted us to use the stryker frame that had been in the back of a storage room for years. It wobbled when you touched it. When the patient was not improving he came to me to ask for the "new" bed, because it could be the patient's only chance. The patient made it. Even before my time they used metal needles for IVs.

We would give it PO in orange juice in a glass.

After abdominal surgery the patient would get a binder that provided support. It was a piece of cotton with looked like tenticles, the patient would lay on the fabric and the tenticles were braided on over the other to form support. Thank God we have velcreo now.

Before pleurovacs we used a series of glass bottles on the floor with the same principle that water would create negative pressure, the same thing with GI suction. For decubutis ulcers we used maalox and methiolate and the ulcer diet was for the patient to ingest alternating maalox and cream every hour. I was told that before cardiac monitors the critical care nurse would tape a cotton swap on a fulcrum (folder 4x4)on the chest with the non-cotton end at the PMI, the nurse could watch the cotton tip moving to watch for dysrythmias. I did this one night in the ER in the 70's when we ran out of monitors and the CCU was full. What are you going to do, have a nurse stand a the bedside with a finger on the patient's pulse all night? It worked OK but you still had to see the patient. No alarms. Back then we did not have pulse ox.

Managers may be personally upset (more work for them to replace you) when you are thinking of leaving but if they are worth their salt they should be happy that they have managed your growth well enough to prepare you for something else or figure out what the problem is that makes you want to leave. Nurses are worth their weight in gold. I don't know the political situation there but your manager should just be happy that you are staying.

When calling report to the floor: "I'm sorry you are going to have to hold the patient, we are too busy to take report and no one has had dinner yet!" Our hospital NEVER went on divert because we were the only trauma/teaching hospital around. I can't imagine saying to a paramedic crew, "you will have to keep that patient in your rig, we have to get dinner!" :angryfire

I have been following the thread about new grads in the ICU. I was skimming articles that are out this month. I only read the abstract but you may want toget the article. Hiring and Mentoring Graduate Nurses in the Intensive Care Unit. Dimensions of Critical Care Nursing. 24(4):175-178, July/August 2005. Ihlenfeld, Janet T. PhD, RN

I just saw "the sixth sense" again recently. Sounds like you have a gift.

You need to stop thinking about this as something that is a barrier and more that it is good experience and there is a reason why there are policies about experience. There is such a thing as setting you up for success and the more experience you have the more successful you will be. I guess it is hard for you to imagine why experience is necessary that is because you don't know what you don't know! The only analogy that I can think of is riding a bike. It is safer to learn with training wheels (experience) for you and your patients.

I am not sure if a seasoned nurse could get into a program, they are hospital specific and all of them are different. There is usually a requirement to work at the hospital for so many years after completing the program. I wish that I could be more specific but really all of the hospitals are different.

No, it is just the philosephy of the hospital. Some hospitals have strong "internship" programs for ICU and some are really desperate there is no such thing as a track. But on the 2 years of med surg I say at least. Going straight into the ICU with no formal support system would be a major mistake and hospitals know that. They worry about patient safety and a new nurse without significant backup has no place in an ICU. I know that is not what you want to hear but experience is the key to sucess.

See if the company has an option for redundancy, some systems are dupicated so that if one goes down the other takes over.

Does it have to be on the internet or can it be real life? Help can come from more senior nurses on the floor and sometimes there is a psyc nurse practitioner in the hospital. I worked in one hospital where the hospital chaplin was on the code team for the patient, family and staff.

Not just for this case but for every possible case, get and keep up your malpractice insurance! I see the need for malpractice insurance as a positive thing, the public knows that we do have a major impact on care and that nursing is separatre from medicine.

I miss the times that I know I made a difference for the patient even if no one else does.

First lets look at education, yes it is specific information and skills but it is also the ability to think. Don't mix up education and training (or skills) I agree that it would be nice to pop out nurses who could hit the road running (and not to compare, what can medical students do on July 1? ) If you have the background information and problem solving skills you can learn the nuts and bolts quickly (the training part, yes training we are now training patient families to complete technical skills that were once reserved for nurses) . Nursing is not about how you start an IV it is all of the background information that is important to take care of it, it's use what can go wrong etc. Starting an IV is a skill,( just the tip of the iceberg) that I learned or was trained to do . I was a Critical care coordinator, on our prehospital unit we ran 2 paramedics and a nurse. The paramedics had the skills but the nurse had the assessment and assimilation skills. The patients saw unconcious patient, the nurse could look in the medicine cabnet and probably figure out why. I have taught technical skills (like IVs)to sea captains (before some of the new regulations) so that if there was a problem at sea they could do what they were told to do. Let's stop confusing the "technical" with education. Let's not confuse how to do it with what needs to be done. I am an OLD BSN graduate and yes I started with diploma grads and ADs, it WAS HELL FOR ALL OF US. None of us had ever put in a foley. What was missing and what is still missing is the education of assimilation skills, problem solving, decision making and a reality course on what it really is like to be a nurse. I think that I may have an idea for a new reality show! Perhaps we should encourage hospitals to do more nursing internship programs where nurses could be trained to do the technical stuff. I hope everything is spelled right. And one more thing, I have an MSN and I didn't learn allot of material that I could not have gotten by reading on my own, I learned new ways to think about things and put principles into practice.

If you put enough Vick's under your nose you can't smell anything but the Vicks! And it is OK to gag everyone has. My trick in the ER was to concentrate on ABC patient's airway, breathing etc. Thinking about process and procedure always helped me get over the "person" part" until I was somewhere that I could handle it.

Back in the 70's when paramedics were in their infancy the local Community collage would have ER nurses work with paramedic students on IV's, assessment, reading monitors etc. One night on 3-11 I had a group of paramedics to work with, I put two in ICU, one in CCU, one in Step-down and 2 in the ER. The night was going on just fine except for a code in the ICU. I continuously made rounds and carried a beeper. Around 9PM I was on my way to the ICU and came accross one of my students standing in the hall. I asked her the problem, she said that she could not go back into the ICU (now this was a really bright and talented individual). I asked why, she said that I would think that she was crazy and I did. She said that she could not look at all of the auras leaving the patients. She had seen one earlier and the patient coded and now she saw 3 more. OOOOOOOKKKKKKKKKK I said how about you go over to step down, before she went I asked which beds the three patient's were in. The next morning I was at work in the ER at 7. Just for a chuckle I went up to the ICU. All three patient's that she told me about had died during the night. She was a great paramedic but when she brought patients in I never asked about their aura!!!

I would want to comfort someone in any way that I could. I would talk to her, find out about her beliefs. Ask her if she believes John Edward (the guy that talks to dead people), does she believe in psychics, that kind of stuff. Tell her about a story that you read on this web site, in other words assess her. I believe in all kinds of things in other realms, it is absurd to assume that we know everything. We are limited by our 5 senses, everyone has a 6th sense they just need to develope it. Now you think that I am a nut! I had a fiance die in a helicopter crash 1 month before our wedding. My cousin saw him sitting on her bed one night. I was comforted. Lots of other things happened too but not for this thread. I'd say assess her and if she is open tell her.

I wanted to make things change, back then we did not have triage, there were no trauma centers except University of Maryland and only burn patients went by helicopter. There was so much that we could do better but who was I, why should anyone listen to me? Credentials! I didn't learn allot of information, pathophysiology was more in depth and I really improved my clinical assessment skills but more than that it taught me how to think differently. In undergrad they give it to you and you give it back, in a Master's program you decide what direction that you want to take and you learn to integrate information and implement. You learn how to do research too. (I only did 1 project for school, too detail oriented for me). I really didn't need the information that I got from the program, if you are an avid reader and interested you can get that yourself but it got me in the door of places that I may not have had a chance to get in without it.

My master's degree is in Burns Emergency and Trauma. The ED is the most challenging because you have to know the acute phase of everything from MI to preterm labor and what to do about it. But my blood always pounded a little more when we would get a trauma. Let me tell you a funny storry from many years ago. It was Christmas Eve about 10:30. The ambulance rolled in with a patient who had been putting packages into the trunk of his car and was hit. I was just about off but volunteered to stay to take the patient to arteriogram (this was the late seventies). I stayed with the guy until 4 AM. He had 2 broken legs and maybe a pelvis (ican't remember) I got him to the ICU and all was well. At the beginning of Jan. I had to have my gallbladder out. A few days after my surgery I decided to ambulate to the lounge. There sitting and looking out the window was a guy in a wheelchair. I sat down next to him and asked what happened. He said that on Christmas Eve.... He was my patient from Christmas, of course he didn't remember his ER stay or the hours that I spent calming him medicating him etc. But WOW what a day! He lived and I got to speak with him. To answer your question trauma!

I still see my roommate from college, she is a diabetic educator, very different from my choice but we are still close, You don't have to let go of all of your family. And if you are smart you will always be a student learning as much as you can. The new family that I found in nursing 30 years ago are still my family. Every month I have dinner with a group of nurses. We all started in the emergency department at the same time. The things that we saw and had to do there drew us closer than my friends from college. Many of us have moved on to different specialities (The ER is a little demanding for those of us around 50!) These people are the ones who sustain me. Think about your friends from HS and how you feel about them now. (Yes I still have dinner with them too but that is not the issue) You will find your place. If you are anything like me you will not feel like a real nurse, capable of handling everything for about 2-3 years so give yourself a break in those first few months. Don't be afraid to ask questions, it is not the kind of job that you can "fake it". Do you know what speciality you have interest in? You will probably have to put in a year in Med-Surg (I hated that but it is the best thing, there you learn to know who is really sick and who can wait. That is important in any speciality) You also practice those skills that you learned or saw once but never perfected. In that first year find a buddy that you can comisurate with and identify a mentor to build a relationship with so that it is easier to ask questions. That first year is hard, learn EVERYTHING, do EVERYTHING that you can. Volunteer for the worst patient. That is where the learning and professional growth really takes place. You have all of rthe background now use it. Sorry if I sound a little idealist but even though I have been through allot I am still idealistic about nursing. (PS I have been to some parties as a young nurse with folks from the hospital that will rival any college party, if that is what you are into.) Cheerup the best is yet to come, I promise!!! Murph RN,BSN,MSN

That was a good one, I worked in a hospital where it was part of a post code to open the window a crack. As a new manager I had never heard of it but there was no changing it!

I give very high marks to my nurse who became a Dr. She sits down with the patient's at the bed side, she speaks gently to them and talks about how this will affect their life. She is able to combine both worlds and she gives nurses the repect that they deserve. When I first met her I didn't know her history and mentioned to one of her partners her bedside skill in dealing with patients and staff, she is just different. He was the one who told me of this hibred Drnurse. The best of both worlds!!!!