LonghornChic

Sounds like you did the best you could. In the past 6 years, I’ve had 2 of my patients actually code - both were during hemodialysis. Having recently switched to ICU nursing, I’ve helped code at least a dozen patients within the last 6 months. You become more proficient with ACLS after the first few. Anytime I help with a code, I take over whatever ACLS task the primary nurse is doing (pads, CPR, meds, etc.) so they can focus strictly on providing info to the team. Codes are never easy but a good team can literally be the difference between life and death.

I worked in IMC full time 4-5 yrs ago before going back PRN last year. I filled the other years with outpatient nursing (street medicine and school nursing). I got a full time ICU job this year, received 8 weeks of orientation and have been on my own for the last 4 months. it’s been an eye opener for sure. I’m finally stating to feel a little comfortable with most procedures and learn something new everyday. I’m always afraid of what I don’t know but rely on my colleagues to continue to help guide me in this aspect.

I worked IMC for 2 years then left for a “Street Nursing” position. I left street medicine because finding ran out so I became a middle school nurse for 1 1/2 yrs. I have never felt so unappreciated and alone (professionally atleast) in my life. Despite having set hours of 0730-4 pm M-F, I still stayed late everyday to catch up on paperwork. Hardly ever got lunch. Took care of many medically fragile children with very little support. I was the only medical professional in a sea of 1000 people (students and staff). You are in an educators world so are often left out of everything. I took a very large pay cut because I wanted better hours and time off. It really wasn’t worth it in my opinion. Benefits were similar to the hospital. I left the school after 1 1/2 yrs and have now been in the ICU for 6 months. the ICU is crazy busy and not adequately staffed but atleast I can clock out and not have to worry about it. I work 3 on and 4 off. I don’t regret leaving the school.

Thank you all for your advice and support!! I’m definitely going to look into more hobbies. I feel so exhausted but I know I need to keep my mind occupied on my days off. Sadly, this poor patient ended up herniating a few days later and the family decided to withdraw care. I am reminded of our mortality and fragility every day at work. I try to cling to the very few miracle moments that present themselves.

I’m in awe of your flight nursing experience!! I am totally on board with having RN’s help RRT’s with manageable tasks when they are busy but what kind of threw me off is having someone else come assess my patient and then make the determination that vent settings needed to be made. I had previously given all of this info and requested their assistance in my original page to the RRT. I am not too sure what all the training involves but it makes me question what if the covering RN didn’t agree with vent settings? Or say if my patient was not an ICU patient but a Med-Surg patient? I could always insist on the RRT or doctor to asses if it did come to that but just seems like another unnecessary hurdle. I am fully aware that some nurses have extended understating and experience with vents and airway management but I don’t believe the crew being trained with the RT’s has that type of exposure. I just feel like the RN’s covering should stick to the manageable tasks and leave the actual pulmonary assessing/decision making to the RRT’s. I am probably just overthinking this but I’ve seen this situation play out more and more, especially since we’ve lost 2 more RRT’s to traveling.

At my current HCA hospital, we have an extreme shortage of Registered Respiratory Therapists. To help with that shortage, several nurses have been trained to assist the one RRT with things such as neb treatments, vent checks, suctioning, preparing for intubation, ABG’s, assisting with bronchoscopy, etc. Yesterday I overheard one RRT telling another RRT that he’s afraid that they will soon be replaced by RN’s and LVN’s (he was supposed to be training an LVN that day). I will say that if this is the case, I am concerned. A few days ago, I paged the RRT to come asses my vented adult ICU patient who kept desating into the 80’s despite suctioning and adjusting sedation/paralytics for vent synchrony. I increase O2 to maintain >92% while I waited on RRT. The RRT was occupied in ER assisting with an intubation so they sent an RN (whose specialty is mother/baby) to come asses my patient before he turned around and called RRT to come make vent adjustments. The reason I had called RRT in the first place is because I sensed that vent settings needed to be adjusted but I wanted to make sure the correct ones were adjusted such as O2, PEEP or TV. Sending another nurse was just a waste of valuable time. I am a new ICU nurse (not new to nursing) and feel that I rely on the special skills of RRT to help me stabilize my critical patients. But now I am worried that resource will be incredibly limited or not available at all. I will have to do my best in learning what I can in terms of vent/airway management. Is anything like this happening in your areas?

I did want to add that I had asked the MD about possibly changing to another pressor, such as Levo, that might help increase BP as well as HR but he decided that we should try what we had hanging already.

Hi all, I've been an RN going on 5 years. My first 2 years were at the bedside in IMC and the last 2 1/2 were outpatient. I recently returned to the bedside but to a 40 bed ICU unit. I had an 8 week orientation (most was COVID related) and this last week was the first week on my own. My first week was what I like to call baptism by fire. I don't really have anyone to vent to so I thought that you all might understand. Sorry for the long vent. My first assignment was a trauma patient that had 2 crani's in the last 3 weeks. She was on precedex and fent to help keep her from fighting the vent, mostly due to the large amount of secretions that caused alot of coughing. She had a fresh trache as well. Her BP was soft with SBP in the 90's and HR in the 50's. No pressors. Yesterday she spiked a fever of 103 and had increased serous drainage from her crani site. A head CT was ordered. Given this patient's vitals and inability to lay flat, I was asked to try a combination of sedatives and add on Neo for BP support as additional sedatives will bottom out her BP (she was already soft to begin with). I added a low dose of propofol, increased fentanyl, and kept precedex the same. She was still unable to lay flat without coughing and her HR actually went down and maintained in the high 40's. I believe this is due to the reflex bradycardic effects from Neo and the precedex as well. I tried suctioning her before laying her flat. I felt that increasing or adding more sedatives would make her dangerously bradycardic. I consulted with the MD about what else he would like me to do as I did not feel I was able to adequately sedate this patient and maintain her in a somewhat safe range. The MD went to the room, messed with the sedatives (increased propofol, turned off precedex, increased the Neo, maxed out the Fent). The patients HR dropped to the 30's but she was able to lay flat without coughing. He then administered Ephedrine and increased her HR to the high 40's. He asked me to leave STAT to CT. The patient was packed in less than 5 minutes and a team arranged to help with transport (RT for vent, 2 techs, charge nurse, myself). The MD gave me a syringe labeled with the remaining ephedrine and asked me to give 1 CC every 5 minutes if she dropped under 45. The team flew to the elevator, down to CT, and back in less than 20 minutes without incident. I thankfully did not have to administer any ephedrine or increase her sedation. I was so incredibly nervous during this entire time! This was my second time ever having to manage anything other than propofol or versed (my orientation was pretty limited). The critical care MD was very patient during this whole event and tried to teach me why he was doing what he was doing during every step of his actions. He even offered to go down with us to CT but we already had enough people going so he stayed and texted me while I was in CT to check in. Earlier that day I assisted this same MD with a bronchoscopy at the bedside (something I had never done either). My charge nurse, RT, and techs were also wonderful in helping me. In talking with the other unit nurses, they felt that this situation was risky but thankfully worked out. Despite the support, I can't help but feel that this was a baptism by fire and I have not even really experienced what it's like to have an unstable patient. Anyway, just needed an outlet to vent. Any recommendations for keeping a journal during your nursing career? Or do y'all just find a colleague/friend to talk to? My current friends would not understand.

It’s a relatively new area of public health. There’s very few programs like this and I feel incredibly lucky to be part of it. I’m hoping to be able to assist in expanding it. It’s a little scary stepping into this role knowing that future program funding depends on how much of an impact it has on the community.

Hi! I’m not sure where to post this but here it goes. I’ve been in nursing for a little over two years with a background in critical care. Recently moved into the public health spectrum. I’ve been working with the homeless and mentally ill at temp brick and mortar sites but will be transitioning into a supervisory position for street/mobile clinic nursing. It will be me, an MA, and a provider. Some days will be spent in a makeshift site inside a facility (church, halfway house, rehab, etc) where we haul in all of our supplies in duffle bags. Some days with community health paramedics providing care in the streets and community fairs. Some days in a large clinic RV. I’ve worked with this group before but never in a management position. We do a lot of wound care, lab draws, care packs, DME stuff, referrals, suboxone management, etc. There’s is a lot of autonomy, critical thinking, and decision making that goes along with this position. Does anyone have any experience in this? Any pointers?

Hi! I’ve been in nursing for a little over two years with a background in critical care. Recently moved into the public health spectrum. I’ve been working with the homeless and mentally ill at temp brick and mortar sites but will be transitioning into a supervisory position for street/mobile clinic nursing. It will be me, an MA, and a provider. Some days will be spent in a makeshift site inside a facility (church, halfway house, rehab, etc) where we haul in all of our supplies in duffle bags. Some days with community health paramedics providing care in the streets and community fairs. Some days in a large clinic RV. I’ve worked with this group before but never in a management position. There’s is a lot of autonomy, critical thinking, and decision making that goes along with this position. Does anyone have any experience in this? Any pointers?

Thanks! I felt some pity towards the intensivist at the end because I had a sense that this delay was due to another reason and not the one he told me about. Maybe something had recently happened that caused him to be hesitant in transferring patients to higher levels of care? Either way we both learned lessons that day.

Thanks! I felt some pity towards the intensivist at the end because I had a sense that this delay was due to another reason and not the one he told me about. Maybe something had recently happened that caused him to be hesitant in transferring patients to higher levels of care? Either way we both learned lessons that day.

Thank you! This was the first time in my career that I've ever had to go through this much stress to get someone transferred. It was definately an eye opener!

In this particular step down we can do certain pressors and very limited use of BiPap. This patient became MICU appropriate due to her rapidly declining respiratory status. The MD held off on putting her on Bipap (despite the confirming ABG's) because he was aware of the step downs limitations on BiPap. From what I know this patient was intubated within an hour of the transfer. As far as pressors go, I was trying to manage the downward trending BP's with very limited nonpressor BP support. I was basically implementing the highest non-MICU interventions allowed for this particular case. The MD was finding ways to delay the transfer while still keeping this patient "stable" despite the obvious. He straight out told me this.