Dani_Mila

I know this is old but what did you guys choose?

I want to obtain a certification hopefully by the end of this year. I just left stepdown a month ago due to management and now work at a surgical unit. I worked at a cardiac stepdown for 3 years. Although I miss the higher acuity type of patients, I feel less stressed in my new unit. My unit is surgical focused but we get some medical as well with telemetry, but most patients are Med-Surg level of care. Anyways, I want to obtain my certification. Which one do you guys recommend? I would like to do my PCCN but now that I don't work in a stepdown unit, will that certification be a waste? I honestly don't know what my long-term unit will be, but I'm open to working back on a stepdown but it's a matter of when.

Exactly ? This is why I got so mad. She literally only has 5 experience nurses who can do the job, yet she chose the ones who works hard and barely calls out. How is that fair? The other two doesn't want to do it and by not making them do it seems like rewarding them. I told my ANM about it and she even agrees on making everyone get trained. I had a meeting with my manager and I told her that if I knew working hard and showing up to do work can lead to this kind of punishment I would have called out more often then. She was like ?. My manager is known for rewarding bad behaviors. This is why most of her charge nurses are leaving because she does not care.

Seeking Advice ? I work at a 23 beds cardiac/ stroke step down unit. We recently have a high turnover of nightshift staffing with 4 nurses leaving, 3 of them were charge nurses. There are 5 of us left who are experienced and can be trained for charge nurse role. There was a discussion of making the experienced nurses charge nurse trained. I was at first OK with it because I think it's just fair and we could help each other out when we work together, but I was still very adamant not to be in charge nurse role due to bad experience at my previous job. Well, I found out that 2 of the other experienced nurses won't be trained as charge due to them having FMLA and history of multiple call outs, so my manager thinks they are not reliable and won't be successful. I was very upset when I found out about this because in fairness none of us want to step up to do charge nurse role. The unit is stressful as it is. I feel like our manager literally rewarded them because of their bad behaviors. And, I. My defense, if they can be exempt then why can't I? On top of that, there was no formal notice of "Hey, we will train you to be charge nurses beam cause our unit is short!" Instead, I found out through Kronos that my manager scheduled me to be trained immediately without notice. I was panicking and stressed out for the entire 2 days off that I got. I emailed my manager about it and she claimed that she sent out an email to me and the other 2 nurses. My coworker checked and she didn't get any email and so did I. I was super stressed out that I felt like I need to leave the unit because I feel like I'm being forced to do something I'm not comfortable with and have been adamantly been refusing to do for 3 years. So, I decided to apply to a different unit (Surgical) on a whim. This surgical unit has 13 beds. They normally do general surgery like new colostomy, ex lap, fractures/ joint, etc. I had a meeting with my manager and there were some clarification involved which made me wished I spoke with her first. However, she still encouraged me to be a charge nurse even though I told her multiple times that I don't want the role. She claimed it will help my professional growth ? (more like you don't have anyone right now). She stated she was concerned because I'm not stepping up with leadership. She also found out that I applied to the surgical unit and she got a slightly upset about it to a point that she got a little sarcastic. Anyways, she told me to think it through. She said she will offer "adequate" training and even mentioned that I attend a workshop about charge nurse role provided by the hospital to help with my anxiety. Well, fast forward, I just did my interview with the surgical unit manager. My first impression of her was really good. I feel like she listened really well with my concerns. She knows I don't want to be a charge nurse, but like all managers do, she asked me if I want to be a charge nurse in the future. I said I like to try, but not anytime soon. Honestly, I should have been more transparent and told her a flat no. I get nervous during interview that sometimes I ramble or blank out. To be honest, I'm don't think I am a charge nurse material and I don't want that added responsibility and stress. Also, the position is for nightshift with dayshift rotation as needed. She emphasized "just in case" there's shortage during dayshift. She stated she doesn't forsee any rotation soon because they're adequately staffed during days. I told her I like my nights and would rather stay in nights. However, I heard most of the new job postings are like this where they prefer their new hires to be flexible for rotation and not strictly days or nightshift. From my understanding , it is not mandatory, but she wants flexibility. I have to actually clarify this with her since this might be an issue. The position is literally marked as "Morning shift, no rotation". She told me to really think about it. She said that I will hear from her soon. This unit is definitely going to be different from my unit. My unit is so chaotic, high stress level and really short staffed. My manager has been trying to hire people specifically for nights, but no one is applying and from what I heard she's planning on hiring more new grads. On the other hand, I heard there was no issue with surgical unit and my former coworker who is now a charge nurse in that unit had raved about how it's less stressful. She also said she has no issues with the manager and she encouraged me to take the job if offered. Honestly, I like my unit and the type of patients I get. It's busy, challenging and you learn a lot of things. However, management is the issue. A lot of people are leaving because of it. 40 staff have left in 3 years under her management, we counted. I like to stay, but I feel like I will eventually get forced again to be trained to be charge since she'll have new people coming. I feel like the expectation will also be high since she doesn't have a lot of experienced staff that's left. I'm concern that this refusal may end up biting me and will be the cause of termination. I really don't want to be her next target. I'm open to learn and work at a different unit, but I'm concerned that I might get bored or I might not like it. Also, that whole dayshift rotation thing may be an obstacle. What do you guys suggest? Sorry for the long post!

Are you me? LOL I'm in the same position. We lost 4 nurses in 2 weeks and 3 of them are charge nurse. Now my manager is forcing the remaining experience nurses to be charge. We don't want to do it. I was told initially that it would be a rotation thing however I found out that she exempt 2 nurses from doing it. I was so mad. If they're exempt then why can't I? Like I don't understand that. I told my manager no many times due to bad experience from my old job and that is why I left the job because of it. My manager lost 40 staff members in a matter of 3 years. Think about that ? I never done charge nurse at my current job nor do I have any desire too. But from the looks of it, I may not have that option anymore if it means a termination threat is in place. I'm gonna meet with her in person this week.

Just found out that the PT was stabilized in my unit, then was sent to cardiac cath in the afternoon. He had cardiac cath and post cath that's when he coded. This happened at a different sister hospital. Also, I wasn't able to attend the meeting. My Internet was acting up and I did not have any connection to attend the meeting.

The dose was metoprolol 25 mg and when the medication was given his HR was in low 100s. Throughout his stay, pt did not have bradycardia. Also, I even asked the ICU PA if they will take him as we can't give pressors in my unit. I spoke to my charge nurse that night and I asked her too as to why can't they take him to ICU. Unfortunately, I don't make the call but the ICU PA. Although, I kept updating her on his low BP.

That is a red flag, I worked at a stepdown unit and our max is 5 pts. I would try to wait it out until you get another job. Management always lies just so that they can hire you, so it is not surprising.

Background story: Received a pt who came up to the unit (progressive care unit/ telemetry) an hour before start of shift. He came in with NSTEMI, was on hep gtt, Venturi mask (non compliant with home CPAP). No significant cardiac PMH, just BPH, HTN and something else (couldn't recall). Story: Pt came up in the ED just about an hour before I came. Pt was going in and out of A-fib with HR going up to 120s and 140s from report. I also observed it going up to 120s during change of shift. This has been addressed as pt had scheduled orders for BP meds. MD aware that he was going in and out of A-fib per day shift nurse. Pt was asymptomatic. He was on venturi mask with 50% FIO2 from the report it's because he did not want to use the CPAP and he is a mouth breather when he sleeps. He was non-compliant with his home CPAP. Pt came in for NSTEMI and was on hep gtt. Was made NPO for possible cardiac cath, no orders for NPO yet but I did tell the pt that just in case they send him the next day. Cardiologist was already consulted. During med pass, pt's HR was in low 100s, asymptomatic no CP. He received his night meds (metoprolol, flomax, lipitor, remeron), SBP in mid 100s that was his trends. There were 2 orders of metoprolol, an IVP and PO. I didn't give the IVP because per parameters. I asked him if he takes metoprolol or BP meds at home and he said yes he believe so, but does not recall dosage. He also takes his flomax as well at night. After he was medicated, he went back to sleep. He requested his CPAP on and off a few times because he felt uncomfortable with it. At midnight he was scheduled for metoprolol IVP, I rechecked his BP and it was in the mid 90s, HR normal and pt was in SR. I asked if he would like to go back on his CPAP and he said OK. I placed him on it and left. During rounds check at almost 2AM, I saw him sitting at bedside, diaphoretic and he felt uncomfortable. He was asking for a fan and I said we do not have it, but we do have ice packs which I can give him. He declined. I asked him if he wakes up in the middle of the night sweating like this before and he had said yes. He requested his CPAP off, venturi mask was placed back. I checked his BS and it was in the 190s. I checked his VS, pulse ox was good but he was hypotensive with SBP in the 70s. I asked him if he was having CP and he said no. I grabbed the manual and got one SBP in low 80s. Charge nurse came in to help out. I messaged the on-call doctor and got an order for EKG, trops, and 500ml bolus. I asked her if she would like to give him 1L instead. She said there is a concern that he is going into HF so she does not want to fluid overload him. EKG was read and she stated all normal. We started him another IV access for the bolus and drew more labs (on-call doctor ordered more labs for pt) . On-call doctor added the hospitalist and I believe she left the conversation. The hospitalist was asking a lot of questions instead of reading the previous conversation. Pt was still hypotensive despite IV fluids and symptomatic. Told the hospitalist that pt will be RRT, hospitalist had no objection. RRT was initiated, all that was done was listed on the board. Pt was still hypotensive his SBP dropped again to 70s, desaturated in the 80s on the Venturi mask, RT said to place him back on his CPAP. Gave verbal report to the ICU PA notified her of why the pt was here, what happened, and what was already done for him. She ordered more lab work including lactic acid and another 500ml bolus. Troponin came back and it was in the 2K (he came in with trops around 5K) **Our trop levels are not by decimals. ICU PA stated that his troponin levels was going down so that was good. She assessed the pt. I did point out that his d-dimer result came back and it was slightly elevated from the previous result. ICU PA wasn't too concerned about it. Pt reported to ICU PA that he is now complaining of slight CP he stated 2/10. He stated it was the same CP like he had before coming to the ER, still diaphoretic, but AAOx4. We checked what meds were given to him last time, according to the ICU PA she thinks it was the metoprolol that was given to him that caused his severe hypotension. ICU PA wanted to keep the pt in our unit instead of bringing him to ICU. She thinks once the medication wears off his BP will go back up and to let the fluids infuse. ICU PA did lower his metoprolol dose, discontinued metoprolol IVP and I believe she d/c Lisinopril as well. Once they left, he was still complaining of pain and I gave him PRN Tylenol. He had PRN nitro but I can't give him that due to his hypotension. The bolus was finished and SBP went up in the mid 80s with MAP > 65. I messaged the PA and updated her on pt's pain and low BP. I asked her if there is something else we can give him for his pain. Pt was still complaining of 2-3/10 CP. I reported that I only gave him Tylenol. She said to wait and see if that works because we can't give him morphine or nitro due to hypotension. She also did not want to give him any more fluids and she stated she is OK with his BP as long it as the MAP is > 65. I reassessed the pt's pain and he said it was a little bit better 1/10. He asked if I was done because he wanted to go to sleep. His SBP was still low in the mid 80s, no longer diaphoretic, and didn't complain of further CP. I stayed with the pt until 6AM for close monitoring. His repeat trop value came back and it was down to approx. 1K. All his labs came back normal with kidney levels slightly elevated, lactic acid was normal. No further complaint of CP. Then, it was shift change, I gave verbal report to oncoming nurse. I stayed for an hour to finish documenting. Before I had left, the oncoming nurse was doing another EKG per order on that pt probably by the cardiologist, and was conversing with him. I was off for a few days. After a few weeks, I had found out that pt was sent to cardiac cath that day (different hospital) and had died. I was notified that management would like my input and it will be a "learning opportunity". It is not mandatory, but now I feel inclined to join the meeting. Now, I feel so anxious and depressed. I keep playing the scenario over and over in my head thinking have I cause this pt's early demised? What could I have done differently?

Respiratory were on top with him, they were giving him medications, breathing treatments, suctioning him, but the mucus is inside the chest, he just could not cough it up. He has been given medications to thin it but he just have a poor cough reflex. I spoked with the respiratory that night and she was like "it's expected his lungs sounds horrible for the past few days, getting him to cough is a piece of work, he will cough and then he sounds horrible again after an hour, no matter what we did."

Just had a baby 3 days ago, did you guys use paid parental leave and short term disability concurrently?? My hospital policy offers up to 12 weeks paid parental leave. I've been approved for 6 weeks, I'm still pending for the other 6 weeks bonding time. I also have short term disability insurance in which they opened a request for me. I was told to just email them of my baby's birth certificate and then the case manager will do the rest. I don't know if this can go concurrently or it might affect my pay. I know paid parental leave I think pays for my usual pay rate and short term disability I can get up to 70% of pay after taxes. Any input is highly encouraged. Thank you!

I've been a nurse for almost 5 years and this was my first Code Blue on my patients. Quick hx on my pt who coded, he is a dialysis pt, anuric. He came in for GI bleed. MD r/o that it's possibly from his hemorrhoids since his hgb is at 10 and has been consistently up there. He is also being treated for PNA, receiving ABT (Flagyl) and PRN duonebs. He has a moist non-productive cough with poor cough effort, his lungs had been sounding coorifice, rhochorous, and wheezy for the past few days. MD is aware of this, he had his dialysis 2 days ago, removed an extra 500cc of fluids, he is also on Certizine BID. His O2 SATs has been sustaining in upper 90s with 4LNC. He also has a HX of A.fib, has a rhythm of A.Fib RVR, his HR goes up to low 100 to 140s, but at times it goes down to the 90s. He is getting treated for this as well with metoprolol. His BP had been running soft in low 90s and his BP med had been held couple of times. I was able to give his metoprolol on my shift because his SBP was on 100 in the low teens, BP med had parameters. Anyway, this pt was stable within his baseline for the most part of shift. Scenario: I was stabilizing my pt's roommate as he desats to low 70s with minimal movement (not new), he recovers very slowly, sometimes you have to place him on a non-rebreather just for his lungs to catch up. Both of my pts are getting treated for PNA. After getting the roommate stabilized, I immediately checked on my pt because he was coughing, sounded very rhochorous and coorifice, audible without a stethoscope. I assessed my pt and he has this moist loose non productive cough that just won't clear despite his attempts. I encouraged him to cough, elevated the HOB further to help him, checked his telemonitor his O2 sat was still in the 90s. Kept encouraging him to cough and he stated "I'm trying". Immediately his eyes started rolling, his O2 sat went down to low 80s, I increased his oxygen but his O2 sat kept going down. I came out of the room and screamed I need a non-rebreather, one of the nurse went inside while I grabbed a non- rebreather. I immediately came back to his room and his O2 sats came down further to low 70s. One of my coworker initiated an RRT. I tried to place a non-rebreather on him, but his O2 went to low 50s. Pt became cyanotic, unresponsive, then no pulse was palpable. Code Blue was initiated. This happened within minutes. He went on PEA. Chest compressions was started by my coworkers. I was so overwhelmed, I couldn't do a compression as I am 37 weeks pregnant. Thank goodness my coworkers and charge nurse immediately came in to help out. It was very chaotic and overwhelming. ICU PA and ICU nurses (they responded to RRTs and code blues) came in and took over the code. He asked me a bunch of questions regarding my pt as to why he was here and what he is getting treated for, and how he became unresponsive. I was so overwhelmed I feel like I gave him the bare minimum. All I could do was stand back and watch and answer any pertinent questions they ask. The code lasted for 12 minutes and pt was able come back, but he was on Afib RVR and HR was in the 180s. He was sent straight to ICU and was intubated. The whole situation was kinda hard to process. It happened so fast, his oxygen level went downhill immediately, he went from responsive to unresponsive and it went from an RRT to a Code Blue. After he was sent to ICU, the MD spoke with the family and his code status changed from full code to DNR, may intubate. I was thinking maybe he had aspirated from his mucus plug? It was so traumatizing, I feel like I could have done more in my opinion. What are your thoughts?

I found out that the reason why they did not take this patient was because they were short staffed in the ICU and since he was "sort of stabilized" that they did not want to keep him yet ??

My little background: I work in a progressive care unit/telemetry. I've been working at my hospital for about 5 months. I have been a nurse for about 5 years mostly working in subacute rehab then have recently transitioned to acute care at hospital setting. I work night shift. Well, it was last night was just a horrid shift for me. I came in and took my reports. One of my patient was transfered to our floor 15 minutes before change of shift due to hypoxia and hypothermia. Pt was cachetic, smoker, former drug abuser, COVID + with PNA, had a multiple abscess in his lungs that's being treated with 2 ABT. Pt was on 4L then needed to be on 12L therefore he was sent up to our unit. The day shift nurse received a report and passed it on to me. She stated I don't know about this pt and she barely gave me anything regarding his PMH, previous assessments, and etc., therefore I treated this pt as an admission instead. Well things were going OK at the start of shift, we were treating his elevated lactic acid, he has a warming blanket over him, his O2 sat was fairing fine on 12L high flow NC. Then suddenly, his O2 sat decreased in low 80s and he was asking for more O2. I put him on a non-rebreather (NRB) at 15L, Called the RT to evaluate this pt, we placed him on a heated high flow NC since he was not improving with the NRB. Well, that did not work so I RRT this pt, MD and ICU PA was at bedside ordered a bunch of test and an CXR. ICU PA ordered an Ativan IV for him. His CXR revealed R side PNA and COPD. He finally slept for a while and was on the heated HFNC and on top of that the NRB mask. He was satting in the upper 90s. I asked the ICU PA if he should go to ICU because he is on max O2 and anything further than that would be intubation, we tried to place the pt on BiPaP but he felt like he was "suffocating". She said not at this time since he is tolerating the current intervention and has been satting fairly well. Pt's family came to the hospital because the ICU PA told them that he should be comfort care however family decided to change their mind when they got to the hospital and wants to keep him full code, the pt also stated that "he did not want to die". I was so busy with this pt that my med pass was late, I had 3 other pt's to take care of, thank God I had 2 of them previous shift so I knew about them. I barely sat down to document. One of my other new pt, 91 yo female, was complaining of chest discomfort and her BP/HR elevated. EKG read Sinus Tachy and MD ordered troponin to trend, while my other one was picking on his wounds and just bleeding everywhere, he is alert and had to educated to refrain from picking his scabs. It was so busy that I have not yet documented and it was almost the end of shift. I passed my morning meds early so I could have time to sit down and catch up. I checked on my critical pt with hypoxia and there he was removing his NRB and heated HFNC. I spoke with him about keeping it on and he started getting agitated, pushing my hands away, he did not want anything. His O2 sat decreased to 70s. Mind you, this was almost at 7AM. I notified the night charge nurse who was giving report to the day shift charge nurse that my pt had to be RRT again. The day shift nurse came, but I have not yet given report as I was in the pt's room. Well this pt was RRT, I was praying to God that it's the same people to come so that I don't have to explain his tedious situation. My charge nurse was awesome, she came in to help me on both RRT. She gave report to the ICU nurse that came, I was just fairly exhausted mentally and physically. Mind you I am 8 months pregnant as well. Pt was not having it, he was agitated, pushing us away when we attempted to put his mask on, he did not want the BiPaP at all. The day shift MD finally said he needs to go to ICU to be intubated. I was like thank God. Honestly, this pt should have been transferred to the ICU after the first RRT. It's not my call to transfer the pt, but the ICU PA. I even voiced my concern to my charge nurse that if he gets worse he will need to go to ICU. They did not want to intubate him yet because he was tolerating OK. Overall, it was a mess for me, I stayed on the unit for almost 2 hours past my shift, finishing up. I didn't really get to sit down at all until 0740. I cried going home because I felt like I barely did anything, I am mentally and physically exhausted, felt guilty for not focusing on my other patients since one patient took majority of my time. My time management sucked. My nurse manager was on the floor and saw me still charting and it was 0830. She asked me if that pt that had been RRT twice was mine and I said yes hence I'm still on the unit. I just felt inadequate like maybe I should have done more. Ugh, it was a rough shift.

I just started working in a telemetry/step-down ICU unit. It has been 2 weeks post orientation I'm not a new nurse but it is my first time working at a hospital setting. I had a pt who was admitted due to COPD exacerbation (non-smoker, family members are) and PNA. She was scheduled to be discharged but was just awaiting a bed in a rehab facility. I've had this patient for about 2 days so I was quite familiar with her baseline. It was my third shift and after getting an update, her family ask for her to be changed. CNAs were busy taking their VS therefore I proceeded to change the patient. I laid the patient down and proceeded to change her, she asked for something to drink and her daughter immediately was about to let her drink fluids on a supine position. I immediately stopped her and gave education regarding aspiration precautions. After changing her, I sit her up, her O2 was at 3L NC starting in 92-93%. Pt baseline is confused, non-compliant at times, combative, and a very heavy mouth breather with non-compliace to using a BiPap at night. She sounded coorifice and diminished, but that has been her baseline for the past few days. She is very obese as well. Family left and after an hour, RT came to give her breathing treatments. She told me that pt sounded more coorifice than usual and more rhoncorous, audible without stethoscope, she started satting in 85% on 3L. I asked her to cough and take deep breaths but pt is very poor with coughing. We repositioned her and she placed a simple mask over her NC since she is heavily breathing through her mouth. She has asked me if she received any diuretics and I told her she does in the morning. I looked around the room and pt's family had at least 6 bottles of soda and 4 were empty, this was not there on the previous days I've worked. RT recommended that I get a BiPap PRN order and possibly a chest x-ray just in case. I spoke with the doctor and the x-ray results was "bilateral pleural effusions" which are considered new. Told the doctor about it and he ordered to stop the IV fluids and give her a IV Lasix 40 mg, pt started putting out a lot of urine that night. Pt kept removing her NC/mask and combative most of the shift, I had to put mittens on her in which she still somehow finds ways to remove it. Because of this, I kept getting paged because her O2 sat would be in the low 80s because of that. RT decided to place her on a BiPap setting 14/6 65%. Luckily, she was able to keep it on her. She was tachypneic at times in the 30s but it would go down to her baseline in the 22-25. I gave an update to the MD and told him she still sounded coorifice and rhochorous, but is putting out a lot of urine more than 1000cc so far, the doctor said to just continue to monitor her. I was with this patient most of the night just trying to keep her mask on. She was hypertensive in 190s, I have her BP meds and she went down to 140s which is her baseline. It was almost the end of shift, gave an update to the oncoming nurse who had her previously. I stayed for an hour just trying to finish up my new admission who came to the floor at 5:30AM. It was about 8:30 AM and Day RT came out of the room and told the oncoming nurse that patient might go to ICU because she was tachypneic, diaphoretic and is on high air pressure (BiPap). Oncoming nurse didn't want to call RRT yet and called the hospitalist instead to see the patient. Luckily, she came in immediately and I gave the doctor a brief update on what happened throughout the night and what interventions were placed. The doctor decided to keep the patient on BiPap and stated that she would start to heavily diurese her with diuretics. She was not concerned about sending her to ICU yet since pt was alert and awake and the BiPap is maintaining her O2 SATs at 93%. I showed the doctor the drink bottles that family were giving her during the days despite her being on IV fluids. I told the oncoming nurse that maybe nephrology can be consulted because her BUN and creatinine are elevated. Oncoming nurse called ICU to evaluate the patient just in case. I left the hospital so late thinking maybe I should have done more? Maybe I should have called RRT? What do you think I should have done differently? It was a busy and horrible night just dealing with pt downgrades, admission and an irate patient. I'm just lost for words and overwhelmed just trying to keep things together.