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carolelainern BSN, RN

Trauma/Neuro ICU
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  1. carolelainern

    Delirium & neuro patients

    Yes! I cannot tell you how many times I've escalated a change, and the response is... "monitor." Ugh. I just had an 18 year old frontal TBI. He's impulsive and irritable as hell. Not a surgical candidate. 5 days of q1 neuros. Did we do them? Uh, no. Basically you end up deciding between fudging some charting and harming your patient
  2. carolelainern

    Delirium & neuro patients

    Something that's been kind of on my mind lately...I work in a trauma/neuro ICU. One of the big pushes lately from the higher-ups at my hospital has been towards delirium detection and prevention. If anything, I think this has arrived to us a little late. As far as nursing interventions in this area go, mobility is obviously a huge one, but another is promoting sleep. We're supposed to chart things we do to promote sleep in our patients...turning down lights at night, minimizing inappropriate alarms, etc. To be clear, I'm completely on board with these things, but one thing that never gets mentioned is the frequency with which we awaken patients to do neuro checks overnight. Obviously these are people who already have a neurological insult of some sort. Of course I know why we do frequent neuro checks, but sometimes I feel like we drastically overdo it, like hourly neuros in patient who has been neurologically stable for days to weeks. I'm curious if anyone works in a neuro ICU where frequent neuro checks are being re-evaluated or decreased in order to promote sleep and possibly help prevent delirium. I'm curious as well if anyone knows of any literature out there that either defends frequent neuros, or the opposite-ties them to increased delirium and possibly worse cognitive outcomes.
  3. carolelainern

    When family fails the patient... it breaks my heart

    One of the hardest things about ICU nursing! I had one such patient who, even when the family had been talked into comfort care, did not actually want the patient medicated to be comfortable-they wanted other family members to come in and "see how he is"-think severely encephalopathic, in a lot of pain, striking out and kicking anything that moved near him. Thankfully the doctor put his foot down and told them in no uncertain terms that they were not going to make decisions that put the nursing staff at risk and made the patient suffer. It's so hard and it sticks with you! I have seen a trend lately towards more education for families on what DNR status means, and why it's a good choice. Ethics committees can help too, if a little too slowly.
  4. carolelainern

    BSN bump in pay?

    In the Minneapolis/St Paul metro area, and least in the hospitals, BSNs make about a dollar or so, maybe two, more an hour than ADNs. BSN is becoming a requirement.
  5. carolelainern

    Do I need a new attitude, a new job, or a new career?

    Thanks for your input, everyone! By "connecting ", I mean those nurses who are able to support the emotional needs of patients and families in crisis; who are able to make a patient feel at ease, make them laugh, make them feel safe and supported, get to know them. I have a lot of trouble shaking the feeling that my patients would generally be better off with someone else as their nurse.
  6. I've been a nurse over 3 years. I worked in inpatient orthopedics; then a cardiovascular stepdown unit; now Trauma/Neuro ICU for the last 9 months. I feel like I'm in a nonstop identity crisis. I realize that ICU takes some getting used to, but I leave work every day so mentally exhausted, and I almost never feel like I've done a good job. I have difficulty truly connecting to my patients and their families, or I feel like I do; I'm not sure how my coworkers see me. I'm not sure if I am in the wrong specialty, or the wrong field altogether, or if I just need to give this job some more time. I'd just like to be happy at work, at least some of the time, and feel like I might maybe be doing a decent job or making some slight difference. I'd like to hear from anyone else who's had similar experiences, who has found their way to a position they enjoy and find rewarding; or who stuck it out, and are glad they did.
  7. carolelainern

    Is this for me?

    Hello, all! I am an RN on an inpatient orthopedic unit in Minnesota. I graduated from nursing school in December 2014 and have been at my job for almost 8 months, and sometimes I really wonder if I want to leave bedside nursing. For the most part, my time as a new nurse has been so much better than I anticipated. In school I was warned constantly about nurses who "eat their young", and in reality, I have rarely encountered anything like this. I have never found my job unmanageably stressful; I don't dread going to work. That being said, I don't know if I am cut out for this kind of work. For example, the rare patient or family complaint about my care really gets to me. Usually these are completely unfounded, or a misunderstanding; I feel like I am definitely being too sensitive, but I also feel like it's possible that I would be happier in a job that didn't put me in a situation where I am constantly being critiqued on my work by people with a poor understanding of it, i.e., many of my patients. I'm not sure that I find the good experiences meaningful enough to make the bad ones worth it. I'm going to stick it out at my job for a year, but I'm not sure what my next step should be or even what direction to head in. I appreciate any and all advice, commiseration, etc!
  8. carolelainern


    I am an RN currently working on an orthopedic floor-we also take plenty of medical overflow. I graduated with my BSN 10 months ago and have been at my current job for 7 months. I knew going in that this isn't my "dream job", but I was and am very grateful for it. However, I've started to think a lot about my next career move. I don't feel ready for a BSN to DNP program-I do enjoy working as an RN and would like to spend some time as an RN in an emergency room before considering becoming a nurse practitioner. However, I am strongly considering WGU's MSN-education option. Basically, what I would like to get out of this degree is, at the very least, a way to enhance my knowledge and practice of nursing; plus the option to teach. I think this degree could open some doors, even if I don't necessarily spend a lot of time working in a nurse educator role. I welcome any and all feedback from current students/graduates of this program-do my expectations seem reasonable? Would you recommend this program to someone who's not exactly sure yet what she wants to be? Or does it seem like I would be wasting my time and money? I appreciate your input! Carol