Sunshine716

I would recommend trying agency PACU work in your local area. I did that after feeling burned out in the ICU for the past 10 years and loved it. I would still be doing it if it weren't for the benefits that I needed. The health insurance requirements changed to requiring a three month full-time contract for benefits. I wanted to be a free-bird and make my own schedule like I had been for the past decade. It's great because you get to "try out" different facilities and that's how I found the one I work in now. It would give you flexibility with your kids and other job too. I made my own schedule and worked from 7am- 1 pm everyday. It was nice ?That's not the case everywhere and I occassionally did some 12's, but that was my normal routine for a long time. Many facilities don't want to pay for agency for the entire shift, but just for "rush time" to get lunches finished, etc. PM me if you want more info on my organization. They work all over the U.S., but you can do "local" travel too. I made my max distance 30 min. drive or less. A lot of it was day surgery, although still some hospital PACU as well and the change of pace was nice. The nice thing is that YOU get to say yes or no to working somewhere and make your own schedule. If you go somewhere and don't like it you don't have to go there again. Also, the pay difference is usually a bit higher for agency than full-time staff because of the flexibility and no benefits deal.

I'm actually a float pool nurse right now. However, if I'm put in a situation where I have no experience or don't have the knowledge necessary to care for a patient I let management know and they are responsible for either training me or changing my assignment. I feel like Psych is a highly specialized unit and shouldn't be interchangeable with Med-Surg etc. Once I got floated to Psych and had no experience there so I had NO IDEA about not having scissors, sharps, or a lanyard around my neck. Another nurse saw me with all of my gear and almost passed out.

It has always been my understanding that after 24 hours has passed you cannot add an addendum to the patient's chart or make any changes without any exceptions. Am I wrong in thinking this? If so, what she is asking you to do is not legal for a nurse to do, period.

I think this is a great place to come vent and express your frustrations with people who get it. So first, I want to validate so many of the feelings that you have that often nursing can be a horribly difficult job that is unappreciated and even at times a field where you can be verbally, physically, and emotionally abused. It's not ok for that to happen to you or anyone. However, I do want to say as a nurse and healthcare provider it's not ok to blanketly "hate" your patients. I understand burn out, but you've only been at it for a year so I would say to try to get out of there ASAP because patients pick up on that and if that is where you are coming from emotionally it is not healthy for you or for them. I've been a nurse for 14 years so I get it. It's hard and I can't even tell you all of the stories, but it's not fair to your patients that they FEEL that attitude towards them. You may not realize that they sense your hardness towards them. It's the worst time of their lives. We go home at the end of the day. They do not. Many of their lives are forever changed. Ours our not. Sure their insult may sting for a minute or wound our pride, but ultimately we are in a place of power and they are coming from a place of fear and powerlessness. Some of this has got to be resolved within you because 100% of the blame doesn't belong on the patients, or the staff, but we have to take responsibility for our attitude and mindset.

Yes, to clarify, I wasn't asking for medical advice, but nursing experiences possibly in larger hospitals with more capabilities. The doctors (in this small hospital) have a wait and see mentality, but I just wanted to hear from those that have possibly had experiences with other interventions for a saddle PE such as embolectomy and how common it is? I know care can vary greatly from hospital to hospital depending on the kind of resources and expertise available.

Hey nurse friends, I have a question. How do you usually see Saddle PE's managed? I know it varies depending on a ton of factors unique to the patient, but how common is an embolectomy, etc? Is that done by an interventional radiologist? Heparin gtt vs LMWH (Lovenox)? The patient is hemodynamically stable and there is only a small elevation in pulmonary pressure. Their EF is 65%. They had a large bowel resection less than a month ago so they are not a candidate for thrombolytics. Do these usually dissolve eventually with anticoagulants over time? I guess I'm just wondering what are higher level care options/interventions should the patient become unstable? Or is the best time to perform an embolectomy when the patient is stable or is it such high risk that it's only done when the patient's condition begins to deteriorate? Thanks for your help!

Thanks for the comments everyone! Great, great input! The line ended up being cleared with TPA and works fine now. I just don't have a lot of experience with PICCs and TPN together. My main concern was that over 24 hrs after the TPN was dc'd it still wasn't flushing (that was reported) I didn't know how long it could take before worrying about harboring bacteria since it was the highest dextrose concentration etc if it was clogged with TPN? My dilemma was also that the MD mentioned that we could just use the one port that flushed even if the TPA didn't work (pt going home on 4-6 weeks of IV abx). It just got me thinking and wondering if the next shift didn't get it to work, what then? I know it's an MD call, but wanted to hear some ideas/experiences y'all have had and I got a WEALTH of info for later!! Also, I ran into a PICC line nurse and asked him what he thought and he said that the TPA will typically dissolve TPN. He also said that if that didn't work he agreed they should pull it. The swelling resolved so maybe it was from a small superficial thrombi or something else? Thanks again everyone!

Faith, I'm so sorry to hear that you've been so disappointed as a nurse. A couple questions, how long have you been nursing and is this the only area you've worked in? I only say that because if I had stayed in the same area that I had started in I would have been really disappointed with my career as well. I've worked in many different areas over 14 years. I have done Med-Surg, ICU, PACU, Travel, Pediatrics, Home Health, Agency, Employee Health, International Nursing and I'm sure there's more I'm not thinking of. That to say, I've had areas that I've really liked and others that I've really disliked and sometimes it's just the type of nursing or the environment. For instance, I've loved PACU at some facilities and really disliked it at others. I think I added up over 50 hospitals and surgery centers that I've worked at as an agency nurse. It helped me to find the place I'm working at now that I absolutely love. I also really loved doing agency nursing for 8 years as well. There are jobs that you can work at as a nurse that aren't the typical inpatient hospital "floor" type of jobs if that is what you want to get away from. I even have a friend that works for a health insurance company that loves her job. There are all types of jobs you can do as a nurse that look very different from one another. I would say keep searching after all the work you have put into it. I ran into a woman the other day who was an RN who ended up thinking of a computer program that she sold to a company and works in informatics with computer systems now. There's a huge world of nursing out there- I hope you can find something that you like doing. I would suggest to write out the things that you like about nursing or why you wanted to pursue nursing in the first place. Also, write out the things that you don't like to see if it's nursing in general or maybe the type of nursing that you are in, or even the environment. Best of luck to you! Let us know how you are doing! Here's a list of some specialities to get you thinking (although I know there are many more specialities than this): 400 Bad Request

Hey fellow nurses, I know that TPA is used for PICC line occlusions when there is clot that is blocking the lumen, but what about if it was caused by TPN? I was thinking the PICC line should be pulled as to not risk infection (TPN was dc'd over 24 hrs ago)? Would they just leave it and use only the one functioning port for now with a PIV? The patient's arm and hand was slightly swollen as well and I suggested a doppler to check for any blood clots. Obviously it was reported, but wanted to get y'all's input :-) Thank you!

Thank you everyone! That was really helpful! I knew I wasn't going crazy, but started to doubt myself. Lol.

So, I'm working at this new facility and I've been a nurse for 12 years agency, ICU, PACU, etc. The new charge nurse I'm working with today looked at me like I was crazy when I asked her if we pull the regular insulin out of a shared vial in the pharmacy and return it (not bringing it into the patient's room, etc)- like I've done at many places. She said, "oh no, no one has 'shared' vials of insulin anymore for the past ten years". That's ancient. Everyone is given their own vial of insulin (this is for outpatient surgeries in preop- patients that will literally be at the facility for no more than 3 hrs). I know many places I had worked at we would only pull the 2 units in the pharmacy (or out of the pyxis), have it cosigned, and not waste an entire bottle for a couple units. Am I crazy? Everyone was backing her up and I felt like I was on another planet! How does your facility do it? Is it a big hospital, outpatient, etc? Where can I find new protocols for multi-dose vials? Thanks everyone!