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BeatsPerMinute BSN, RN

Cardiac RN

Critical Care, Cardiopulmonary, PACU


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  1. I will try to make this as concise as possible: 2years on the ICU & in trouble with the supervisor who started at the beginning of the year. The new boss frequently pulls me into her office to talk about "concerns". She said other nurses have witnessed me doing things incorrectly, that my charting is wrong, the MD's are becoming less confident/trusting in me, and that I keep making mistakes. She drills me on why I did this or that on a patient I took care of 2-3 weeks ago (as if I could remember...). She has shouted at me in her office and in the hallways a few times. When I ask her why she is concerned, for more details on the situation she's concerned about, or when I ask to look at my charting with her (so I can see what this problem is, and fix it) her response is that she "does not have time" .. or she just changes the subject. She has told me that I had better fix my faults, however, or we were going to head down the disciplinary action road, and if things do not change: termination. I was shocked... My previous boss gave me positive reviews, commenting that I was consistently "cool, calm, and collected." He corrected me / pointed out my weaknesses when warranted, but with full explanation, and was always supportive & encouraging. I am certified / trained to care for any patient who walked into the ICU. I precept students and new nurses. I get along with my peers, even go out with the crew after work sometimes. I am on two different ICU unit committees. I am a focused worker. I do not understand what I am doing so terribly wrong. I tried to handle this on my own for awhile, (stayed late to chart every shift, triple checked everything, pushed myself harder and harder to ensure everything was 100% correct)... but the complaints from my supervisor continued and got worse, and now a couple of the charge nurses are following her lead... I eventually confided to 2 nurse friends I trusted. I asked them to review my charting and even "nit-pick" at my nursing practice / patient care and to help me discover these "faults" ...but they said that they had no concerns, as I am always critcally thinking, asking questions when uncertain. They even chuckled with how I practice things in a very "OCD" like fashion - constantly rechecking everything. One of the girls recommended going to HR. Nurse friend #2 disagreed, arguing that they saying on the side of the hospital, not the nurses, and that these things rarely work out well for the nurse. Fast forward: its been 4 months. I work tomorrow early morning, but am up @ 0130, unable to sleep again because I am dreading work, am anxious about work, and cannot stop thinking about work. I started applying to other positions...which breaks my heart as I loved this job until now and was good at it. I fear getting fired, and my confidence as a critical care nurse is dwindling. I have nightmares about me accidentally killing patients and wake up in the middle of the night in panic. Work never leaves my mind... it consumes me every single day.. Maybe I am placing too much importance on this - it just a job - I tend to be a worst case scenario thinker.. i would hate to lose this position.. I moved over 1000 miles away from home for this job. I started going to counseling last week. I am exhausted, sleep deprived.... I feel demoralized and torn down. My counselor actually recommended that I go to HR for this situation... I am afraid (never done it... I hear "HR" and think -> "HR is on company side, not on your side" -> "you're just gonna shoot yourself in the foot or get fired if you go to HR") I need advice... and would appreciate personal examples / stories, if you have them. I am naive, and something like this has never happened to me. Would you recommend HR? Were you afraid of going to them? Have you had experiences going to HR about something similar? What do I even say / where do I start? How else would you address the situation? Thank you much
  2. BeatsPerMinute

    Atrial kick and A-flutter

    Hm, I see. It is difficult for me to explain concisely and via online messaging (I teach better while drawing and pointing to pictures / videos). I also tend to pull a lot of information from experience. I am going to recommend youtube videos for more specific explanations on how it works - I learn a lot from viewing these myself - as they walk you through the pathophysiology of these things with images to complement their explanations.
  3. BeatsPerMinute

    Atrial kick and A-flutter

    The body can adapt, and the ability to compensate varies greatly from person to person. A younger individual with no prior personal or familial past medical history of Afib/Aflutter will not struggle as much as the older patient who smoked for 30+ years and has both a personal and familial medical history of obstructive sleep apnea, hypertension, hyperlipidemia, pulmonary hypertension, congestive heart failure, stroke, congenital conditions / heart anomalies, diabetic, etc.. (sometimes they have all of the above and more). For example: I have had patient recently who were diagnosed with Atrial Fibrillation (he was a 30-something year old, non-smoking, athletic male) and his cardiac output was better than the 70-something year old female diagnosed with Atrial Flutter, who was bed bound, and had an extensive past medical history of various cardiac and pulmonary conditions. It just depends. There are usually more factors involved when talking about Afib/Aflutter and the effect of cardiac output on the individual.
  4. BeatsPerMinute

    Atrial kick and A-flutter

    Normal sinus rhythm = a p wave with every QRS and T wave - every single beat. Both Afib and Aflutter lack a p-wave. Remember that only Sinus Rhythms (examples: Sinus Brady, Normal Sinus Rhythm, and Sinus Tachycardia) have P waves. If Sinus is not in the name there is no p-wave and proper conduction is not occurring. Atrial Flutter and Atrial Fibrillation do not have "Sinus" in the name as there is not proper conduction occurring in either of these two rhythms. They are both inefficient. Both lack good forward blood flow through the heart (atrial kick) and both can lead to consequences to the body. A fib is just a little bit worse. This is simplified explanation but I hope that it helps As for identifying on tele: both are irregular (the distance between each QRS can vary). Atrial Flutter as a "saw tooth appearance." It looks "prettier" than Atrial Fibrillation link to tele examples: http://www.theblondepharmacist.com/blog/2014/10/11/atrial-fibrillation-and-anticoagulation
  5. I am a new nurse and start my residency on Monday. Thank you for this article. It gives me a little insight on what to expect, a preceptor's point of view, and what I can do to be a good orientee.
  6. BeatsPerMinute

    Nurses Eating Their Young- A Different Perspective

    I personally respond better to this "style" of training. The nurse who trains me is very Type A. She questions me on my every move. With her as my teacher I'm forced to develop effective communication skills and remain calm under stress. I work harder, think more critically, and grow faster. But I agree that this is NOT how you want to train every nurse. A nursing team needs to encompass different personalities, and different personalities respond better to different methods of training. I can think of several friends who, despite being very smart, hard-working, and adapatable, would crash and burn with my mentor.