txdude35

No, I didn't. One of them and I have a profound and mutual dislike of each other, and have had for some time now. I can put my personal feelings aside and work with her though, because business is business. I have _everything_ to learn about collective bargaining. I'm an absolute neophyte and freely admit it. I'm reading, researching, and talking to people with experience though in order to have some sense of where this is going to go.

We'll see what happens. Everyone votes on these positions and unfortunately for them neither has much respect on the unit.

Cool, thanks for the info.

I hadn't seen that either, learn something new every day. A couple observations though. 1. the efficacy of reverse trendelenberg has been pretty much dismissed in all the literature I've seen and in my clinical practice so I really don't use it. 2. the conclusions state that there was a difference but not statistically significant in the trendelenberg position but then goes on to say "significant errors occur when subjects are in nonsupine positions." So... which is it? 3. Is the slight difference between the position of the aortic root and the phlebo axis going to be clinically significant?

Got blasted last night from a couple people who supported the union from the beginning. Said I was jumping on the bandwagon and in their opinion couldn't hold any position of responsibility since I wasn't in it from the beginning. Tried to tell them that I was adapting to a new situation but they couldn't understand that. Ignorance like that is hard to combat. Neither one of them had any idea that 2 positions will be decided, 1 for bargaining council and 1 for union rep. Neither one had any idea what the responsibilities of _either_ position entail. And they tell me they're "going to run for something because we deserve it." This is going to be fun. :)

vlynnieg- it was a Filipino guy named Erik. Smug and arrogant as hell, didn't get too far with him without getting pretty uptight. Some of my colleagues reported the "home visit" as well. Too bad they didn't come knocking on my door.

Thanks, I appreciate it. One of the things that cracked me up when I was duking it out with the organizers was, when asked how the unit rep would be chosen the reply was "sounds like you'd be a pretty good one." If chosen I plan to try my best to keep everyone honest.

I voted "no," but as I said, they're here now and have to be dealt with. Many of my fellow staffers aren't going to join but I can't do that. The only way to have a voice, IMHO, is to be involved. I'm not going to let someone else make crucial decisions about the course of my professional life without input from me so not only am I joining the union I'm running for shop steward for my unit/shift. Going to another hospital is out of the question. I may not be too keen on the union but I'd rather stay where I am and see where it goes than go back to Tenet any day of the week.

Great info here but not one mention of where the transducer needs to be. Curious. Can't tell you how many times I've been called in to a room by a new nurse in a panic over a pressure reading just to find the transducer hanging off the bed. The answer, of course, is the phlebostatic axis-mid axillary line, 4th intercostal space (ie, in line with the heart). Many folks use armbands to hold the transducer and that's fine but keep in mind that if you turn the patient the reading is false- if the transducer is lower than the heart the reading is falsely high, higher than the heart reads falsely low.

The union got voted into my facility a few weeks ago. Most people I spoke with hadn't done any homework at all- they ate up everything the union was shoveling without hesitation. Of course, the union reps made everything look fantastic and most people didn't take the time to do some fact checking of their own. I did. When confronted with specific examples of union misconduct, financial irregularities, and questions that required an answer that went beyond the script reps tended to raise their voices and dance around the questions as quickly as possible. When I asked about why 47% of the Cypress/Fairbanks staff wanted them gone one of the reps said "it doesn't matter what they think- this is a democracy and we won." Arrogance such as this is offensive to me. The night before the vote a RN from Cyfair was at the facility and told me what a great contract they had negotiated. Soooo..... do they have a contract or not? Healthy debate is one thing, flat out lieing to me is quite another. The hospitals here in TX are in a very strong bargaining position because of the right to work status- they know many people don't support the union or won't pay dues. I expect a protracted contract negotiation that may or may not benefit the staff. Like it or not, they're here and we have to deal with them.

My hospital is about to vote on unionization. The story they tell is of course pretty rosy so I've been looking around for potential negative consequences to unionization and have naturally been reading your posts. I've got to tell you, your credibility with me took a good hit with this drivel. " I like to work steady." Seems to me unionization protects staffing ratios and provides compensation for cancellations. "I've got too much self respect." Are you kidding me? I have too much self respect to blindly follow anyone without finding out the facts for myself but this is just plain insulting.

Thanks for the replies. At our facility charge nurses are considered management and therefore not part of the bargaining unit. We'll just have to see what happens.

I work in an HCA facility that has union reps on site now in prep for a vote by staff to unionize or not. The question is for charge nurses in unionized facilities. It seems to me that the hospital wouldn't be able to deny most of the salary, PTO etc gains made by the union to charge nurses or there would be a large scale revolt by the charges. Do any of you have experience with this? If you're a charge have you also been given salary increases to keep par with staff RNs? I just don't see a scenario where staff RNs are making more than charge RNs.

How much time did I spend sitting in the last week? lol, ummm... not much at work, that's for sure.

I wouldn't honor those orders. If you do, you're placing your license and liability right on the line with hers. I also feel as if I would have an ethical obligation to call the state board and put a stop to it. Of course, both she and the surgeon are exposing themselves to millions of dollars in malpractice suits not mention loss of license, etc. If your facility is aware of it, they risk losing accreditation. JCAHO would have a field day with this one.

I like to use my fingers rather than my fist- easier to control exactly where the pressure is. Put the bed down so you can use your body weight rather than your arm/hand, and watch for mottling in the leg. Much easier to use a fem-stop _if_ you've placed it correctly, above the insertion site for art sheath. Most of the docs here write for fentanyl prior to pulling the sheath but if you don't have it use whatever you've got to relax the pt. Explain what you're going to do and that it's going to be uncomfortable. Also be very clear that they won't be able to bend that leg or sit up for several hours. I _always_ let other staff know when I'm pulling a sheath so they can come running at a moment's notice, and I always have an amp of atropine handy in case they vagal down. Once you get the hang of it it's really not that complicated, you'll be fine.

Ah, thanks. Haven't been around much and a quick search didn't turn it up for me.

2 nurses in Midland TX has been fired and arrested after contacting the Texas Medical Board about a physician they felt was giving substandard care. The medical board informed the physician, who then filed a harassment complaint with the local sheriff. The anonymous letter to the board contained 6 medical record numbers as examples of the doc's poor care, and the letter contained enough clues to their identity that the sheriff was able to identify the 2 nurses during his investigation and they were promptly arrested for misuse of personal information. The hospital fired them for violating a policy that stated the hospital must be informed prior to reporting anyone to the board. If this can happen in Texas, it can happen to you! I urge you to contact your state's board of nursing and nurse's association to express your outrage over this. I also suggest you find out if your facility has a similar policy in place.

There are 2 pressure gradients in the circulatory system, a high and a low. The right side of the heart is a low pressure system, the left a high one (right side pumps into the pulmonary system, the left systemically). The left side should ALWAYS be higher than the right to pump effectively against SVR and effectively perfuse the entire system. If the CVP is higher than the PAD, I would first check your swan because the problem is most likely in the setup or placement. If your swan placement is good, there's an adequate waveform and it's properly zeroed and transduced and your PAD is still lower than your CVP, you've got a fairly serious cardiovascular compromise going on.

Hmmm... I think I work with you...

Roger that on the docs, montie. I still can't believe how many people with an advance directive we code because one person in the family doesn't agree with it and how many docs tell the family there's hope when the patient is rotting away in the bed. I love what I do, but some mornings I go home feeling dirty because of the torture we put some of these poor people through.

Roger that on the docs, montie. I still can't believe how many people with an advance directive we code because one person in the family doesn't agree with it and how many docs tell the family there's hope when the patient is rotting away in the bed. I love what I do, but some mornings I go home feeling dirty because of the torture we put some of these poor people through.

Just make sure the bradycardia is asymptomatic. If they get _too_ beta-blocked you've bought yourself a whole new set of problems. Watch your urine output, changes in mental status, or a drop in bp. Never hurts to have a little atropine handy, just in case.

Thanks for your input. I agree that the docs many times aren't as straightforward as they could be and and have witnessed occasions where the doctor has given the family hope where, in reality, there was none. In the case I'm referring to, all the docs on the case have been consistent in telling the family that the prognosis was very poor since day one. After the code the primary and the intensivist met with the family and laid out the entire picture in a way that left no question that it was over. After listening politely the wife said "Ok, but when is he going to get better, because I'm going to keep him alive as long as I can. I'm not disconnecting ANYTHING." In the first one I saw there was telemetry nurse in the family who kept loudly questioning the nephrologist and the nurses on the case why we weren't treating his uncle's renal failure with Mucomyst (the guy had a creatinine of 8 at one point, never less than 4, on daily dialysis and the CRRT). He, of all people, should have known better and despite all the promptings he got to research multi system failure never acknowledged that his uncle was cooked. I'm trying to wrap my head around this dilemma, and have been since the first one. Where does my primary responsibility lie? As a patient advocate, it is my responsibility to protect the patient from situations within the healthcare system but how is it unethical to protect them against the family? At what point do I do what's right for the patient and put a misguided family's wishes second? How do I go home knowing that I did the right thing, whether it be rescucitating a patient whose EEG is basically a flat line because the family doesn't get it or allowing that person to die in peace?

Thanks for your input. I agree that the docs many times aren't as straightforward as they could be and and have witnessed occasions where the doctor has given the family hope where, in reality, there was none. In the case I'm referring to, all the docs on the case have been consistent in telling the family that the prognosis was very poor since day one. After the code the primary and the intensivist met with the family and laid out the entire picture in a way that left no question that it was over. After listening politely the wife said "Ok, but when is he going to get better, because I'm going to keep him alive as long as I can. I'm not disconnecting ANYTHING." In the first one I saw there was telemetry nurse in the family who kept loudly questioning the nephrologist and the nurses on the case why we weren't treating his uncle's renal failure with Mucomyst (the guy had a creatinine of 8 at one point, never less than 4, on daily dialysis and the CRRT). He, of all people, should have known better and despite all the promptings he got to research multi system failure never acknowledged that his uncle was cooked. I'm trying to wrap my head around this dilemma, and have been since the first one. Where does my primary responsibility lie? As a patient advocate, it is my responsibility to protect the patient from situations within the healthcare system but how is it unethical to protect them against the family? At what point do I do what's right for the patient and put a misguided family's wishes second? How do I go home knowing that I did the right thing, whether it be rescucitating a patient whose EEG is basically a flat line because the family doesn't get it or allowing that person to die in peace?