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ICU_floater

ICU_floater

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  1. ICU_floater

    I'm so disappointed. My hospital FIRED ME!!

    damn! So help me understand, to teach my coworkers and self.... yes, you should have paid for short term disability, 20/20 sucks... try to add it on, once hired, it's impossible. then you had family medical leave act, which only covers you for 30 missed days, not allot with what you're dealing with. My understanding was that after that 30 days, the hospital was not required to hold your specific unit and shift for you, but would retain you as a full time employee to return to any comparable position upon returning.... and they chose not to do this and terminated you???:angryfire Well, without health, we've nothing, so you're right to put that first, recover and see how you are later able to return.... disability sucks like 2/3 of pay, but maxed out after a certain pay off... look, I'm recently sick myself with chest pain and GI stuff... the co-pays for all the labs, docs and tests is pulling us under, with me only taking 2 weeks off and working sick... I can't imagine those bills with the loss of pay:devil: If we can do anything to help, aside from well wishes and prayers, let us know.. thinking about you and wishing you a speedy recovery to full health..... I hope this is a small bump in the road of life for you which makes you stronger. thanks for sharing, and please help those of us not in your shoes understand a bit more so we can take any protections available to us. wish you the best
  2. ICU_floater

    Why be a CCU/ICU RN?

    I choose it because the patient is MINE... I know every last bit of their history, I know all their labs, I understand our current treatment... where we're headed and how we need to get there.... I know what to monitor for, what to call for, what to question... what to put on my "laundry" list of things to add to treatment for the doc. I know every time I turn a patient and suction them and give oral care I prevent complications... I spend endless hours educating non medical families on multi-system failure , where we are-what we're doing... what I hope to see over the next 12 hours. I go head to head with any doc fighting for any new order that can improve outcomes... I read at work, at home and I study all the time to take better care of them. On a floor, I do spot assessments, I know the important history, don't have a clear picture, am torn between many other patients, lack time to teach, rarely know labs, except if on anticoagulation or med therapy. Rarely have time to read through the chart, all the progress notes and the consults to see the true state the patient is in ... and frequently play catch up on labs, meds and tests without a concise knowledge of where were going.. this can't be done with 6-12 patients. If my floor pt. codes, I have to pull out the chart to give the coding doc the info needed. Not trashing floor nurses in any way, they will always be in awe to me.... for me, I need to know it all, do it all and manage it all with the MD. Can't do this on the floor. so, I'm a control freak, live and thrive in the ICU and it works best for me, on the floor, floating... I can't do less than I know... it makes for one hell of a night.
  3. ICU_floater

    iabp

    in our ccu, IABP's once dropped are sick enough to be a 1:1 for 8-12 hours, then we play it by ear... are we still playing with afterload reduction and pressers? if you've a wall of drips... equals a 1:1 CVSU, post open heart, these guys are 1:1 for 8 hours unless off pump done and extubated and stable comming out of OR with the IABP for afterload reduction or a BP kick to get off pump, then paired up with a post op day 2 for nights. we never uniformly make an IABP a 1:1 for the sake of equiptment.... Non IABP's are frequently sicker, on many more titrating drips and qualify for the 1:1. so every assignment is due to acuity, and you certainly can take an anterior MI with little drip titration on IABP with and ACS pt. going for cath in the am. A blind 1:1, only increases facility costs as many of our patients routinely are pumped due to high risk and what not and they're the most stable on the unit. Blanket 1:1's are not the answer, you want management to respond to acuity, NOT the EQUIPTMENT. Writing numbers, checking urine output and pulse, with experience takes only moments...... Make my crashing septic vent on 3 plus pressers, dropping lines a 1:1. I'd take two same day fresh stable hearts on pumps any day, rather than the mutlisystem one. The color here is gray and the staffing needs to flex as such. There is nothing wrong with pairing a stable post mi pump with another fitting assignment. 12 years in and yep, I'd offer to take another pt. rather than sit there for formalities sake.... I'm sure I'm in the manority here.... (I could argue to keep the 1:1, but we know, many times it's not warrented and this will lead the number crunchers to decide for us, I'd rather just speak up when I think I can handle more..... if it changes, we make the adjustments. IMHO.... I know people feel very strongly against it, I just don't see all the hoopla with the pumps.... you know, you're skilled, you can pick when you can do more and you do it. not a favorable response, but i's mine anyway.
  4. ICU_floater

    recent colonoscopy experience

    They were supposed to do a fluid push to raise your bp to sedate you, YES, they were to stop, PAIN is the 6th vital sign and pain is an unacceptable response to diagnosis and treatment. They were to stop, give you fluids, then meds then schedule you under anesthesia..... like you had with diprovan/propofol. THAT is what a good doc does and should do. I never would have gone back.... but at least NOW you know what works and NEVER settle for less. The nurse there to care for you needed to speak up.... that whole group IMHO is lacking.... twice is a crime.
  5. ICU_floater

    recent colonoscopy experience

    I agree, and I think you're looking at this out of context. Meds cannot be administered until the doc is present and ready to go. This does NOT mean he will start before you are comfortable. trust me here, as a NURSE, not a tech, (no offense intended), that he will not advance the scope until the meds kick in... you just can't have "hits" of versed in some waiting room prior without proper monitoring to dispel anxiety.
  6. ICU_floater

    recent colonoscopy experience

    the propofol without an experienced nurse IS dangerous, it can rapidly drop heart rate and blood pressure plus you never know how someone will respond and it can depress respirations to the point of not breathing in moments. Propofol is an EXCELLENT rapid acting drug that does cause amnesia and does NOT treat pain. Additional drugs are used like fentanyl for pain. Our area has outlawed demerol due to the nasty side effects and fentanyl is used. I don't think any GI who does scopes in their office use propofol, this really should be CRNA, or done in the hospital with an ICU criteria ACLS nurse whos SOLE job is conscious sedation, not assisting the doc. Versed and fentanyl are a great combo too, versed is just longer acting than propofol and needs small increment increases for comfort when done in an outpatient type setting. If you wake and are aware, you're not down enough... don't just put up with it, say you're uncomfortable. My 0.02, with my experience in administering, but tomorrow I'm on the other end of things, so it remains scary to me:uhoh21: and no, no propofol available... but as I previously posted, I'm begging for syringes generously emptied into my IV.
  7. ICU_floater

    recent colonoscopy experience

    jewelcutt- wanted to say thanks, having my first upper and lower tomorrow. As an ICU nurse, I've watched and seen easy exams and some horrific ones where I'm begging the doc to push more meds... even stating "I don't think we should continue until the patient is more comfortable", and even "no I won't hold the patient down, thats what the meds you won't order are for!" So I'm quite afraid not to have someone to speak up if I'm too groggy but in pain to do it myself. I know and love my GI doc, yes I trust him, but the fear remains as it will. I plan to beg the nurses ahead of time to snow me until oblivion, they can always bag me for a bit until the meds wear off;) I want down and out!!!!! I don't CARE what my colon looks like. thanks again
  8. ICU_floater

    Amiodarone and Cardizem drip??

    Well, you mix them and the line clots off, now you're really in a mess. Personally I don' know your protocols, but I would have called the MD to order the line and explain current therapy wasn't working,pt. deteriorating and the two meds can't be run together (the doc's don't know compatability). and at that point I would have firmly requested the central line. The INR may have been out of wack, but as mentioned, the ED doc could have dropped an EJ. Many times afib is exacerbated by conditions like sepsis, chf, dehydration... treating the HR is not the priority as alleivating the condition that caused it. I cringe at ER docs and nurses wanting to drop a HR of 140 in a septic patient. Can you say "cardiac output?? " Medic. Adenosine is NOT used to treat, it's used to diagnose the underlying rhythm in a tachycardia... it slows down the rate to see whats under there... if you're really lucky the rhythm breaks but it's rare.
  9. ICU_floater

    propofol infusion syndrome

    I have yet to see this but we don't use more than 50 mg/hr, with an order 100 mg/hr. If in the usual unit vented scenerio, 50 mg/hr isn't working, you need a second agent, versed, fentanyl, morphine, dilaudid prn or scheduled. My pt. last night just off paralytics was writing his needs on paper on 50 mg/hr of Diprovan. He wasn't sedated, just wasn't trying to stand in the bed while intubated like a few days ago.
  10. ICU_floater

    Nursing, not as rewarding as I thought...

    You've been given great advice. let me add mine. 5 months is NOT enough time to be comfortable. It really takes a year med surg and 18 months ICU. I think that when the next batch of new grads rolls onto the floors, the "older" nurses have too high expectations of the recently "new hires" and then those 6 monthers take on too much pressure and even act as resources for the newbies when they're "still growing" themselves. It's like asking the 8 yr. old to mind the 4 yr. old (sure the baby may be quiet but at what expense?). Nursing is versatile, you can do L&D, ICU, ER neruo, LTC, education, teaching, home health, research, call center, school nursing.... get the picture:idea: You've just begun your career, in only one place. There are WAY to many choices you've yet to experience until you can say it's not for you. 6 months is a very fair trial for the unit you're on. Have you been assigned a mentor? If not, ask a skilled nurse to be yours, you don't just want nice, you need some one to push you, give honest feedback but support you on bad days. If you can't find this where you are, you have a tougher road ahead. Nurses are in demand and the possibilities too endless for you to be wanting to quit this early..... Why don't we help grow our young? You may stay in the same setting and pick a different unit- talk to people. Any change will add a bit of stress since this is the only place you know, it may be the best stress you've ever worked through.... or gives you the stamina to try something new. Each change REALLY makes adjusting to changes easier.... take it from a float nurse and contract nurse.... I was going to 5 different hospitals on ANY ICU or ER.... but it took a bit to get to that comfort level.... now I HATE being stagnant stuck in one unit, want to see 'em all. You'll find it, and it's OK to move on
  11. ICU_floater

    ACL/MCL/menisci tears

    yes. Had an old undiagnosed knee injury years ago. Last sept. decided to pick up jogging:uhoh3: swell-hurt, swell-hurt. Still jogged, still worked until the knee was hurting at rest. post op month 6 now.... you've GOT to do the rehab post op for full ROM after.
  12. ICU_floater

    NEUTROPENIC PRECAUTIONS and H2O

    When I worked organ transplant, only bottled water never any ice as the ice machines we assumed to be contaminated. We've had a rash of neutropenic cancer patients and our policy does not call for bottled water, no ice. Can anyone give me some feedback or point me to some great sites for standards of care/ evidenced based nursing with this? thank you
  13. ICU_floater

    Not easy being a nurse - Victorville Daily Press

    Although valuable and insightful, we all know that until you begin the process and work it every day, you can't get anyone to understand, TRULY the stressers and challenges that lay ahead...... ... We learned the 52 steps to make a bed, but never how to manage 10 patients, 2 of which are too acute to be there, one other crashing... Two other docs that won't give adequate pain meds, another that won't call you back, three irate different families... all at the same time during visiting, one frequent call bell patient who insists on the RN to raise and lower her head... stat meds and labs left from day or night shift and charting requirements that take up a full 12 hours which leave no time for care, but the facility concern is that it IS CHARTED, not that it is done. I fear our students are well aware of what we face, they're smart enough to get out sooner than later as they learn this quickly. I feel that the intrinsic problem is in the profession, our lack of support and lack of back up that turns away promising qualified individuals into the profession... we're not building fighters into our every day lives in the schools and this ill prepares them for the "war" that takes place to provide quality care. Our young are now leaving way before our burnt out attitudes "eat them"..... We don't teach our young survival skills to fight back and sustain as we have. Here is WHERE we have failed. But we need to find the stamina in ourselves first. The wheel is round... I swear it.
  14. ICU_floater

    Immigration bill could jeopardize nurse recruiting

    As I read this with you yes, but this does not mention the loop hole of experience vrs. degree... which most hospitals value most. Give me an ADN with 10 years over a BSN with 2 is my theory, Or a BSN with 10 over an MSN with 2 yrs. You are aways more valuable with a higher degree but the experience at bedside is the tie breaker.
  15. ICU_floater

    staffing issues

    Our unit tripples. This is because there isn't enough staff period. Management DOES try very hard to find people but there isn't always someone extra to work. We only have a secretary, no assistant. Two nights of the week we work without the secretary. Asside from myself, 14 months is the most experience of the night staff. so I'm trippled, in charge with no secretary serving as preceptor for 3 other nurses who are new. Now THAT is bad. Long story short. I'm not saying it's right the way your staffing is, I'm just commenting that it's common where I work. Because it's so exhausting, our turn over is VERY high, hence the newbies... the older staff knows better;)
  16. ICU_floater

    Oops:(

    This is terrible advice. I've worked CICU for 12 years. we start all MI's and ACS at this dose with ACE inhibitors and NTG q6hr. too.... so a normal HR is 40's, a SBP is 90... lopressor peaks in 2-4 hrs. this med was re-dosed while it was peaking. By dropping the HR even lower in a fresh MI, you can seriously drop the CO and cause coronary artery ischemia and extend the MI. It is a VERY delicate balancing act that is monitored closely.:angryfire THAT is way such a LOW dose is ordered. GEEZE. OP, I'm not making excuses for you. you caught it, owned up to it and monitored. THAT is professionalism. My concern, even though you are about to graduate, we don't let our graduate administer meds on orientation without monitoring until MANY med passes later.... HOW were you allowed to give meds as a student without supervision?? ps. we all have done this, we still make mistakes, we all get upset... we tell everyone so they won't do the same.... then we make a new one:uhoh21: Keep learning, be villigent... be you.
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