Kastiara

7pm Friday to 7am Monday

Thanks for all the replies and suggestions. Just a quick update. I had plans to call the house supervisor if/when I found her sleeping again but, for the past two weeks, she hasn't slept while on duty. In fact, last week, she worked harder than I have ever seen her work. I was truly surprised. I've worked with her for a few years now and she has always been very lazy and has always slept while on duty. I don't know if our manager said something to her or if she realized she was putting her job and license at risk. Maybe a bit of both. I really hope it lasts. If it doesn't I will escalate the issue up the chain of command.

I work as a charge nurse in an ICU. I am having a problem with a nurse sleeping while on duty. I'm not talking about sleeping while on her 30 minute, unpaid break but rather, sleeping for hours at a time, every single shift. She doesn't let anyone know, she just disappears into the computer room at the back of the unit or into the family conference room and sleeps. Her patient's end up being horribly neglected all night as a result and the other nurses on the unit end up picking up her slack by having to answer her call lights or silencing her pumps. Not too long ago, one of her patient's coded and, while I have no proof of this, I strongly suspect she was sleeping just before it happened. I have spoken directly to her about. I wake her up every time I find her sleeping. I have went to management about it. Nothing works. It seems like management couldn't care less about the situation and, since she keeps getting away with it, the behavior continues. I have no idea what to do about it now. I just feel like eventually a patient is going to be harmed and/or will die as a result of her sleeping. What would you do in this situation?

It's going to depend on how Epic is set up at your facility, but I do the following: 1. Orders tab to review the patient's current orders. 2. I read over the doctor's notes to see what the plan is for the patient. 3. I go to the Chart Review tab and look at any imaging/procedures/tests the patient has had. 4. I go into my flowsheets to look at the patient's vitals to see what their trend has been. 5. Finally, I go into the MAR to take a look at their current medications and to double check that I got an accurate report on what drips/fluids are currently running.

We have to pick up 6 weekend shift in a 6 week period regardless of how long you have worked here. We self schedule, so people pick and chose what weekend they want to work. Some will work one weekend day/night each week. Some will do every other weekend. I personally prefer working weekends for the higher differential.

I'm in kind of the same boat; sick but had a negative test. However, my facility isn't pushing for me to come back. They told me to take as much time as I need to recover. I'm sorry your facility isn't being supportive. Hope you feel better soon.

Gloves and gowns are one time use only. N95s are used for up to 12 hours of continuous use then we get another one. Face shields are wiped down with Sani-Cloth in between uses. Compared to some places, my hospital is doing a pretty good job at protecting their workers.

I'm in GA. My unit has a couple r/o Covid patients and several confirmed Covid. The patient's that are confirmed aren't doing very well. All of them are on ventilators and pressure support and we'll more than likely be proning them soon. We've had a couple nurses and doctors end up testing positive. All employees are screened for fever or SOB when coming on shift. Our PPE has been locked up and is being rationed out. We use N95 masks, face shield, and gowns for all r/o or confirmed patients. We also have to change into a set of hospital issued scrubs if we are taking care of these patients. Our census has been pretty low. Before this my unit was full. They were begging nurses to come work OT last week; this week, they're calling people off. The ED has been seeing fewer patients as well. It's eerie.

The titration parameters are in the order. The order will read something like: titrate by 1 mcg every 5 minutes to keep the MAP greater than 65. If we go up or down by more or less than the order states, we are supposed to fill out a form with how we titrated and why and then have the physician sign it. A lot of the nurses don't want to do that so instead they'll modify the order to reflect how they titrated the drip. I had a patient not too long ago where the physician had me turn off their propofol due to low BP (they were on two pressors). At that point, all I had for sedation was fentanyl that I had orders to titrate up on by 25 mcg every hour. I had five nurses in there holding this patient down to keep them from pulling out the ETT. I went up on the fentanyl by 100 mcg every 30 minutes or so until the patient settled down a bit. I filled out one of those forms for the physician to sign and got a lot of crap from some of the other nurses. They told me to just modify the order which I refused to do since I had not actually got an order from the physician to do so.

No, not standing orders. My unit doesn't really have many standing orders. They'll put in labs (not routine morning labs) if they think something is off. They'll modify the titration orders on critical drips to match how they went up or down on the drip. Things like that. There are quite a few physicians that round on our unit, most of them I have never met in person. Some of them don't seem to mind when a nurse puts in an order under them but others have thrown fits over it. It just makes me really nervous.

Do you ever or have you ever put in orders without actually getting an order from the doctor? The other nurses on my unit do it all the time. Lab orders, restraints, modifying medication orders, and I've seen some even put in medication orders. I can't bring myself to do it, mainly because I'm worried it will land me trouble both at work and with the BON. The other nurses say I'm too cautious.

pH 6.5; bicarb 2.5. The patient was discharged home 3 day later.

I work in a medical-surgical ICU so lots of CVCs. I was taught that, when pulling labs, you have to stop all drips or fluids running. Doesn't matter if it's pressors or sedation running, you always stop them. The rationale was not doing so would/could cause a dilute sample. Doing this has always caused me a bit of stress, especially with some of the more unstable patients that drop their BPs quickly. I usually set everything up in advance and work as quickly as possible all the while hoping that the line isn't positional or something. I was just reading on another thread (from 2013 which is why I created a new thread) that you should never stop pressors, just pull from another lumen. So now I'm seeking some clarification. Stopping drips/fluids during lab draws is common practice on my unit, everyone does it and every new grad is taught to do it. Is this wrong? Or is it a matter of hospital policy? I'm also going to add that I am a relatively new nurse (just 3 months shy of 2 years) and am still learning new things.

It's funny OP because I am also in GA and did not feel weeded out during my prerequisites. Yeah, it was difficult, but A&P is a difficult class, as is Microbiology. They both require a lot of effort and dedication to pass. Instead of making excuses about not getting the grade you wanted, put more work in and actually get the grade you want.

Yeah, I wasn't adding the 10mL of cipro into the calculation. Thanks.