Aloe_sky

I completely agree!

Thanks, I actually sold my soul for my daughter's tuition to be covered by the hospital haha.

You're right, they hired a new "charge nurse" last night was her first night. She's been a nurse a little over 1.5 years. It was my third shift in a row and I came back to a new assignment, I asked why? Her response..... she wanted the patients I had because she's familiar with them. I was BEYOND mad! I get it sometimes assignments have to be changed but not for silly reasons! We have a new manager that started this month, will see how it goes.

I agree, I also feel bad for the patients. These nurses are new and I may come off stand offish so they don't ask me questions. The sad part is, they wait till day shift comes in to ask questions when I could have answered it. Although they really should know by now to ask the Physician if they are unsure!

I'm at a new hospital, I love bedside nursing but we are always understaffed, 3 patients in the ICU is the norm which I really hate!! I still don't dread going into work yet, in fact I pick up extra shifts EVERY week. I use to be a helpful nurse but I don't offer any help at all at this hospital. I will however always assist in an emergency situation, that's when I get VERY assertive. Here's the issue, I am the most experienced nurse on the unit and on nights, all of the nurses only have 2 years max experience but talk as if they know EVERYTHING!! They talk down on nurses that just got off orientation, they talk down on newer nurses that don't know how to ex. Set up an EVD. They will smile, laugh and talk bad about the same nurse they go out with and call "bestie", this is every shift, It's annoying and draining. I don't talk to majority of them, not even hi. I've worked a handful of hospitals and this is by far the WORST when it comes to lateral violence and bullying. My old manager flat out warned me they are all know it alls that think they are better then everyone. She wasn't the manager for long unfortunately, only lasted a few months. There's no thought process when they are making assignments, literally they rock, paper, scissors who will admit. No taking into account patient acuity. The nurse that gets floated to another unit depends on who they don't like rather then a pull list. And is this a new thing to trendelenburg a patient in septic shock?!?!? I walk in the room and see intubated patients in trendelenburg and ask why the patient are in that position?They act as if because their blood pressure is low is the answer. I ask why not titrate the pressor up? I don't get it. I had a patient that became obtunded, Map dropped to 50 and the "resource nurse" on the unit put my patient in trendelenburg when I started the levo and acted like it was the position that raised the blood pressure, he started to brag about it on my unit as if I didn't know what to do! I was so irritated he did that and just elevated the patients HOB up. I had a patient with a large stoma from a lary tube that came back from OR where they placed a trach to put him on a vent, A&O x4 on cpap, doing his crossword puzzles and as I was assessing him, the "resource nurse" came in took an obturator and TRIED to shove it into my patients inner cannula because it "looked like it was out". I was very mad and irritated. I had a patient that was in Afib with RVR and was hypotensive, now if I need help I will ask for help but I absolutely don't need help with most tasks! I got the crash cart and put it next to my patients room, put the monitor bedside and was placing the pads on the patient to cardiovert when the "resource nurse" came out of nowhere and asked if I was cardioverting the patient, theDr said yes and he just grabbed the machine. Didn't ask if I needed help, just yelled clear after I put the pads on and cardioverted my patient at 200J!! Then told everyone how he had to shock my patient. They just think they know everything and over step their boundaries. If I can't find a policy on something, I will ask them about it, they will give an opinion when I really don't care about their opinion. I'm asking about a policy and how/where to find it. There's an aide on the unit that's just sitting there but it takes 3 nurses to give a bed bath to a patient. They don't know how to utilize the staff or time. Maybe it's their bonding moment and I honestly don't care but they complain the aide "just sits there" or they will complain they are behind when they could have told the nurse to call them only when they are ready to turn the patient or to ask the aide to help instead. 3 ICU patients is a lot of work, most of the day shift nurses noticed that I always get 3 patients out of the rest of the staff (10bed ICU that should have 5 nurses, only runs with 4 so 2 nurses will be tripled). I don't complain, do my work and go home even though I am highly annoyed. We once were "lucky" to have a nurse stay over to "help out", she quickly gave up her patients to triple me and another nurse. While she sat on the unit with no patients, refused to take patients to MRI or CT because she "didn't feel comfortable" since she's "not familiar with these patients", has the aide go pick up her food from the ED and refused to give baths because she's "not an aide". Nobody had an issue with this but I WAS BEYOND MAD!! I had 3 patients, 2 were q1 neuro checks and 1 had an MRI that I was gone for 2 hours and had to catch up on meds and charting. I really don't like doing unnecessary extra work. Nurses don't ask me to get anything for them but they will have other nurses running around the unit all shift. Standing in a patients room that is not in isolation to get them CHG wipes or a towel. When it probably would have taken them less time to get it themselves. I think it's inconsiderate to have other nurses constantly getting items for them, while they just stand there waiting for things to be handed to them constantly. I know I'm not a team player, I feel they need to bring their issues to management and their staffing ratios, my focus is always on my patients and my tasks. I also really don't like the nurses attitudes on my unit. Maybe I'm burnt out and bitter.

Shouldn't you have addressed your concern in that moment to this nurse? I don't understand why nurses especially charge nurses see or hear something, sit around, say nothing, do nothing and then tell management. I was always taught the first step is to talk to the nurse directly before taking the next step.

Thank you, the problem is all Drs will give different answers. A patients MAP goal will be 65 with an order for pressors to start, cardiology will come in the morning and say SBP goal to titrate pressors. When you verify with critical care, they say no continue at the MAP goal but cardiology will say NO. DKA patient will have critical care communication order to d/c insulin drip when the bicarb is 12, ignore the anion gap. nephrology will add a bicarb drip when critical care says the insulin will treat the acidosis and doesn't recommend bicarb, endocrine will say no bicarb drip and continue till the gap is 12. These orders are ALL on the SAME patient. Who do I turn to then? They are ALL Drs! they only ADD orders, never d/c because they can't override or don't want to override another Drs orders. so there are orders from all Drs. an open ICU means anyone can admit to the ICU and the critical care team is only consulted but closed ICU must go thru an Intensivist. This is why the patient for hypernatremia had 2 different hypotonic fluids and water flushes, there'sno communication and all Drs put in their own orders. also the Hospitalist is the admitting team and they sometimes butt heads with the critical care team and will remind them they are consulted, not primary. At first I was like huh? Because eg. critical care will want amio for a patient in Afib with RVR but the hospitalist will say no, give metoprolol. Now somewhat understanding this is an open ICU so anybody and everybody gets a say in who is admitted to and how the patients are treated. I just think open ICUs are unsafe.

OK so I just learned something today and have been an ICU/ED nurse for a few years. A coworker that is a travel nurse just told me the reasons why me and her are frustrated is because this is our first job in an open ICU. we use to complain that the critical care team never knew about a patient we were getting, how patients with no drips on room air were admitted to ICU by cardiology or the hospitalist without talking to the pulm/crit team. Then I'm told they are pulmonologist not intensivist. This is knew information to me! I did research that open ICU have a higher mortality rate, I can understand why. I've witnessed, the different specialists don't communicate. At least in the closed ICUs I've worked at, EVERYTHING must go thru the ICU Drs first before any orders are put in place. so all consulting providers must talk to the primary team. here Nephrology, Cardiology, pulmonology can all input 3 different IV fluids. All 3 can order a head CT for a Neuro concern. Endocrinology can manage DKA but pulmonary can also D/C and add the fluids and insulin drip. cardiac arrest patients are consulted to cardiology to determine if therapeutic management should be started. Which they never do because targeted temperature management "doesn't work" or they "don't believe in it" , there is never an input from neurologist, not even for stroke patients. I had a patient admitted for hypernatremia and pulm/crit ordered water flushes, cardiology ordered 0.45% and nephro ordered D5W. No sodium rechecks ordered, day shift had them running 12 hrs and I almost lost my damn mind. I think everyone thought I was a mad woman. I was yelling this is dangerous. The nurses that aren't travelers think this is normal. I am just baffled. I don't know if this is the norm for open ICUs but it is not safe at all.

I'm at a facility where start of shift I'm noticing patients don't have foam wedges under them. The nurses will say they removed it so the patient can lay on their back for 2 hours. I was taught to never leave a patient on their back with exceptions of course but as far as q2 turns for patients that cannot self turn, no. There are a high amount of coccyx pressure ulcers they said develop on the unit. I can see why. we also have heel lift boots and nobody utilizes them, I put them on my patients and they are removed when I come back on shift with pillows instead. The pillows are either flat and their heels still touch the bed or nurses are placing their heel completely on the pillow when it should be floating. I was even questioned twice why the patients that were comatose had heel lift boots on. heel protectors that I place for patients heels are taken off when I come back on shift. as far as the wedge goes, the degree angle these nurses place the foam wedge and the patient, the patients are basically lying on their coccyx. It drives me insane. Anyway, as far as the turns go, I was looking for a policy regarding turns but it doesn't specify. I work in the ICU and I know these patients are high risk but it bothers me that patients are left on their backs. Do you guys also leave patients on their backs for 2 hours?

We use cerner, when the medication is scanned and rate adjusted and documented, it calculates the volume infused that hour. These nurses "unchart" or clear the computer calculated volume infused. I spoke to my manager about this because I'm honestly irritated, the fluid balances are always way off, the I&O aren't accurate and yes, pTT are affected. My manager said he has tried to talk to the staff and they are very resistant to change. Therefore nothing will be done, I will continue to chart the way I do and try not to get irritated. Thanks for the response!

I am at a new facility where the nurses clear pumps q1 and document continuous fluid intake instead of clicking in the prescribed volume in the computer. They say it's "not accurate" but this is really frustrating. I get it if a patient for example is on a bicarb drip and pharmacy hasn't delivered the medication yet and it runs dry and is off for a bit BUT for the most part that is rare. Management says they are supposed to click in the intake but the nurses don't agree. The manager is young and new, these nurses are new to computer charting and very resistant to change. I have told the nurses that if they change the rate of a drip and document it in actual time in the computer and click the volume infused at the end of the hour it IS accurate. They don't agree. Another problem I told the nurses is that they are not programming the pumps to the pharmacy dosing weight so if pharmacy has the clinical weight as 100kg the pumps need to be programmed to that weight for the volume to be accurate. These nurses are changing the patient's weight daily in the pumps and it is driving me crazy! My patient has been admitted to the ICU for 2-days and it is documented that the patient had OVER 600 THOUSAND mls of Norepinephrine in less than 48hrs, I told the nurse when she came back that she documented the patient was getting 11000mls of Levo an hour and it needed to be fixed. The next day a nurse documented she gave 2200mls of Levo, 1200 of bicarb in ONE hour because I didn't clear the pump. Even if we had to go by pump infused clearing intake hourly, I would think common sense would tell her that should not be documented. We also have THREE patients in our ICU so the calculated dose of eg. Levo going in on the pump is 75ml/hr, that correlates with pharmacy dosing in the computer, they will document 200ml 1 hour and 25ml the next hour because they can't clear it at the exact top of the hour. A bicarb gtt ordered to run at 100ml/hr ranges in their charting. 1 time scanned meds are a fixed rate in the computer, they can't adjust the intake on BUT they will add an "other" column and document the IVPB intake, even tho it is clearly documented already. I was curious if this is done in your ICU because this is honestly bizarre to me. I don't want to be that new nurse that think she knows it all, I'm honestly trying to understand. Any answer from them is "that's how I was taught", it's a small hospital, these nurses have been there forever, I need help wrapping my head around this.

I definitely agree, my manager admits the staff are resistant to learning new things despite the access to education. Thanks for the response.

I have a question regarding dialysis catheter’s. At the facility I work at they call non tunneled triple lumen dialysis catheter a “Shiley with a pigtail” I’m use to calling this a trialysis catheter, or a doublelumen dialysis cath I call a Quinton, they call a shiley…. they always ask me what a Quinton or trialysis catheters are when I’m giving report. When a patient has a tunneled cath, I call it a permacath, they also don’t know what that is as they call it shiley, or one person called it a Niagara catheter. I’m also use to permacaths being inserted in the chest wall but placed in the IJ, I read IRs notes to confirm. The nurses tell me that’s a subclavian and will inactivate my charting for that IJ Central line and chart it as a SC. They will say the PAs insert tunneled caths at the bedside but I thought you have to go to IR for tunneled caths? These are ICU nurses with experience and they all act like I’m crazy, it’s always “I’ve never heard of that”. Not 1 nurse knows what I’m talking about. They call every dialysis catheter a shiley, when I Google it, a shiley catheter is temporary line. Shiley, Quinton and Niagra are name brands? I tried to Google the differences but didn’t see anything. I will admit my ignorance to “shiley” and didn’t know what that was because I was only used to that being a trach tube.

For our charting it says at the beginning of the hour document the I&Os from the previous hour (then the computer calculates what to program the CRRT machine to). Then in the next column it says at the end of the hour document the actual fluid removed (then it calculates how much was unremoved/removed) and then that gets carried over to the next hour in the calculation of what to program the machine to.

OK thank you! I’m just trying to wrap my head around why it’s not documented on the actual hour the fluid removal and pressures were measured. Did they ever explain?