Oh'Ello

Look up your local Catholic Charities chapter. https://cflcc.org/healthcare/ I was in a bad situation when I started nursing school. I had no insurance, I had absolutely no money, my dad had just died and my student loan distribution didn't happen until AFTER the semester started and I had to prove I was vaccinated prior to the start of school. I actually had met all of the vaccination requirements over the years but could not prove it (I had many done prior to or in undergrad out of state.). Catholic Charities was (no pun intended) a god send. The free health clinic, which is is designed to provide services to the working poor (which is probably you in this case), gave me the vaccines and documentation I needed. For vaccines and titers they could not provide, they gave me a voucher to have them done at the local hospital at reduced cost. Honestly I was embarrassed about using charity services because I wasn't exactly what you'd call an impoverished person, but everyone at the clinic reassured me that that's what the services are for, to help when you are in whatever situation you're in that is limiting your access to healthcare. Its worth a shot (pun intended)

I didn't know this was a thing? Our patients and family members buy us gifts all the time.

How flexible is your living situation. The other side of the state has TONS of acute care opportunities, and I personally know of several practitioners that were hired as RN's (most of them as Casuals and PRNs for supplemental income) because our acute care nurse situation over here is so dire.

A Minnesota tube is a device used for upper GI bleeds. It's a long tube with 2 balloons and 2 drains. The gastric balloon inflates in the stomach to tamponade the bleeding there, and the esophageal balloon can be inflated likewise. The drains connect to suction to remove the blood from the GI tract. And the tube is set up to traction to maintain it's position. That night we transfused 27 units of blood (amongst other fluids)....And the patient had 30 liters of blood/fluid loss. If you do the math on that, you get a fluid balance that's not consistent with life.

RN's change central line dressings where I work. A select group who've received training change PICC's (simply because of the displacement risk). I'm not sure who else is expected to change them.... Physicians? LOL

I'll tell ya this right freakin now. Yellow wristbands DO NOT HELP.

Not required to double check insulin here. Level 1 Trauma, Teaching, Magnet, Pennsylvania.

i was always under the impression that it was a matter of maintaining the catheter. Some JP catheters are kinda teensie and can clog if you don't strip out the clots. I've never had to or even thought about stripping a chest tube... I just don't even know how that would work. The tubing (at least that we use) is fairly large bore and isn't really very flexible or strechy, so I don't even know what stripping would achieve.

Whether or not someone needs and interpreter is like the 4th question on our admission assessment, lol. I promise you, that nurse probably didn't give any kind of ****. She's just asking the questions that the computer prompts her to.

Which is why sometimes (at least on our monitors) you can have a crappy wave form and -/- for sys/dia but still have a map in parentheses that makes sense

Minnesota tube, 27 units in and 30 LITERS out. I think that pretty much sums it all up.

I also reconstitute In flushes. We don't stock saline vials....Because it's stupid. The ISMP assertion is stupid too. If I drew up 10ml of nimbex, and 10 ml diltiazem, how on earth would I know which one is which????? Labels that's freaking how (which is also an ISMP recommendation)

I've been a nurse for about 4 years now. My husband was shocked/irate/confused/disturbed/befuddled/concerned when he recently found out that I frequently encounter male genitalia at work. I don't think it's uncommon for "the others" not to know what we go through at work let alone what we actually even DO. With that said, I don't really have any advice to offer you other than, he'll figure out it eventually....in my experience at least.

There sure as **** is never any toilet paper

Are they all in the same health system? Maybe it's just bad culture. I've worked in places (not in nursing) where all of the management were jerks. And then when I transitioned into a management position, I realized why.

I think it's ironic that your username is "Thank god for ativan" but you're apprehensive about giving prescribed controlled substances per order. You aren't a drug dealer because you aren't personally profiting from the dispense of drugs. She has pain meds ordered and they're indicated.If she is engaging in self-sabotage, self-harm, med-seeking, she will suffer the consequences of those destructive behaviors regardless of whether or not you attempt to control her pain. I think its important here to remember what our job IS and what it is not.

We use intravenous lidocaine perioperatively pretty often and the results are mixed but typically successful. We have specific programming surrounding its use and we're all quite familiar with the protocols. With that said, I've probably seen close to fifty patients with IV lidocaine infusions, and every single one of them was a GI / abdominal surgery patient. We implemented the use of IV lidocaine (in conjunction with ketamine) to reduce opiate requirements in this population because of the heightened risk of complications from decreased bowel motility that come with post op immobility and opiate use. This care bundle is apparently having a measurable positive effect on early recovery after gi surgery in our facilities. BUT Lidocaine has a very VERY narrow therapeutic index. Serial lidocaine levels MUST be drawn to assess for toxicity. And as we all know, tox labs take forevahhhh to result. Its also specified in our protocol that if the patient's pain is not adequately controlled with the ketamine/lidocaine infusion, and they are requiring more opiates (the opiate requirements are patient specific), the lidocaine must be discontinued and the plan of care can be reverted to a more common pain control regimen. The reason for this is that concurrent opiate use can obscure the early symptoms of lidocaine toxicity which are often very patient subjective (blurred vision, metallic taste, peripheral neuropathy, etc). These patients are also receiving the benefit of sedation for some time post-operatively, which is ultimately aiding pain control by lack of awareness. Long story short, we're giving this to bridge the gi-surg patients from the OR until their bowels start showing signs of movement and then converting them to lower dose opiates if necessary. with all that said none of that **** makes any sense for use in an ER. More (interesting and totally readable) info on ERAS here

Complain. Because "half press" is a stupid, unscientific, and subjective way to pressurize something going into your brain.

The ARDS actually isn't always immediately apparent, it can manifest to the point of emergency 4-5 days post operatively. At which point that particular patient would likely be far far away from anyone that could intubate them.

Because she had massive spontaneous pneumos and resisted mechanical ventilation (understandably) without the propofol.

Zero minutes. Unless I get an admit or am coding a patient in the last hour of my shift.

No ****, last month I had a patient awake and sitting in a bedside chair, communicating by typing on an iPad... INTUBATED on A/C and running 60mcg of propofol. So maxes are relative. Anywho, I'm kinda surprised in an ER they don't have drips available in the accudose and that you have to wait for them to come from pharmacy

1. It's interesting you'd like to have that time with patients before rounds because I WOULD NOT. I would be pretty pissed if I spent 4 hours caring for my patients and then like a third of the way though my shift the plan of care was upended. As far as 11-11's go, I think having to deal with rounds at the END OF A NIGHT SHIFT would be possibly the worst thing that has ever happened to me. 2. I did a brief stint in a CTICU where there were three different start times with 8s and 12's. 7, 11 and 3. That was necessitous because 11 and 3 are when most open hearts came out of the OR and needed to be singled for a few hours until they could be doubled In the ICU where I work now Our patients come out of the OR at all times of day (Transplants mostly), that would be an absolute nightmare because our nurse to patient ratio can never exceed 1:2, managing all of those potential 4 hours gaps would put us in dangerous situations. While having multiple shifts in some places might make employees happier and better adjusted, I don't see it panning out that way, at least where I work. Having multiple shift options really just creates scheduling nightmares in my experience, and inadequate staffing doesn't exactly lead to better retention.

How many drugs are you looking for here? Honestly... if you're a student or new to nursing, the best way to learn them is to just make one for yourself. By the time you're done making it you may find you don't even really need to use it.

So you only have one year or so left of your BSN program...I'd say its not really worth the hassle. You'll have to pay to take the LPN boards, PASS THEM, pay for your background checks and licensure as an LPN, find a job, buy uniforms etc. Then have your employer foot the cost of on boarding you, orienting you and then bear the burden of you being a weaker staff member for a couple of months, just to turn around and have to have the LPN position again when you graduate. I don't know if being an LPN in an office first will help you get your foot in the door as a BSN unless you were an LPN somewhere for quite some time. The roles of many RN's in office include the oversight LPN's and techs. So if you come in with 0 experience as an RN and limited experience as an LPN its not likely they'll give you the additional pay and responsibility. I personally think you should just focus on crushing your senior year (since the work load and clinical are a lot more intense) instead of focusing on orienting to a role that is of a lower credential than what you will have when you graduate.