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Nurse162

Nurse162

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  1. I would really like some advice on how to handle this. I transitioned from inpatient to outpatient about 2 years ago. Two of the girls felt quite threatened for some reason, & at first I did feel a bit bullied. One of them wouldn't acknowledge me or look me in the eyes. In time we all grew & became good friends. We laugh & share problems & help each other now - we make a nice team. I am great friends with one of those women now; I'll call her Bretta. We tell each other everything & just connect very deeply. My coworker "Erin," however, has always seemed to be quite bothered by this. It started out pretty passive, like if Bretta & I walked to grab a coffee & came back, Erin would passive aggressively mention that we didn't ask her if she wanted one. I literally felt uncomfortable leaving the ward w/ Bre to get coffee or grab water or take a walk. I'm very friendly to Erin. We crack jokes & I'm always willing to help. She seems to be very fixated on my friendship w/ Bretta though. She now says things about how we can't be without each other when we aren't around. She told my boss we don't do work... although yesterday I received an award for going above & beyond during COVID... which probably perturbed her. She tells people we are mean to her. I have never once been rude to this girl, & if I had been, I would have apologized. Today we were given our annual competency & one part is on lateral violence. In front of my co-workers, she randomly said to my ANM, "if you ask me, we sure have A LOT of bullying & lateral violence around here." When asked what she meant, she said "um them" & pointed down to where Bretta & I usually sit. She said, "me vs. them." When a co-worker reacted & said "what are you talking about?" She said, "them leaving me out of everything is bullying." Later, Bretta was standing w/ a portable computer around the corner & I was sitting at the nurses' station next to Erin. Bre mentioned she re-scheduled something to Sept. I knew what she was talking about - an entrance exam as she is an LPN wanting her RN. I said I thought that was great if she didn't feel ready but she had to have a plan. She said "I don't like talking to you through a wall," & laughed. Erin then immediately grabbed her things angrily & said "I'LL JUST GO YOU CAN SIT HERE BRETTA" & started to walk away. I was a bit confused & kind of lightly said "Emily why would ya do that there are five open seats right next to us." She kind of brushed me off w/ her hand & said something I didn't hear. She then left the clinic. I have never gone to a supervisor w/ an interpersonal issue. I usually just work it out as I am an open communicator. But this has been going on for about a year & a half. I am a grown woman who has a friendship w/ another grown adult. We like to take our breaks together & we are laughing a lot because we get along great. I am also friends w/ my other co-workers - never ignore anyone or do anything weird/mean-girlish. I can usually anticipate peoples' moods & needs & am very empathetic. This however, makes me feel like I should draw a line. Sitting & talking to my ANM saying negative things about me after I leave work is inappropriate (he's kind of useless & just tries to say nothing). And not to be rude, but this girl literally does the bare minimum & no extra work. I have done major efficiency & workflow improvement projects. It's not a competition but she has no grounds to say I do no work. It doesn't make sense. I can brush it off, but when she starts referring to me stating I am a bully/lateral violence... That's unacceptable. It's my professional reputation & it's also really annoying. I get it, she feels left out. I don't know what else I can do for her. But I am not bullying this person. I see her getting more upset lately & I think I need to talk to my ANM about her odd fixation on my friendship w/ Bretta & resultant inappropriate behavior & offer a mediation or ask what he suggests I do. I don't think she knows that I am aware of all the things she's saying - she's hoping my image is tainted behind my back. Am I overreacting or is this an appropriate response?
  2. Nurse162

    Did I do the right thing in this code situation?

    Also, would CPR be considered a "recent trauma," causing the d-dimer to elevate that much?
  3. Nurse162

    Did I do the right thing in this code situation?

    Also, one of the ortho surgeons that was in clinic got really excited over it all for some reason & talked to the Chief of Ortho on his way out & apparently mentioned that myself & two providers really took control & responded right away & did a great job or something, & the chief put in for an award to be presented to us - basically cash & recognition. I think someone important actually comes to my clinic & makes a thing out of it & takes a picture. I don't even know if that provider was watching, he wasn't even there in the beginning so I don't know why he went & said that. He was telling old stories though & was very amped up so idk if it was just all the excitement or what. It makes me feel weird though, especially since I'm feeling insecure about the situation. I barely did anything, & I literally just did what anyone would have done, & 3 of my co-workers were also really helpful throughout.
  4. Having some anxiety over how I handled a situation and would really appreciate some thoughtful feedback. Some background - I've been an RN for a little over 2 years, worked inpatient for 1.5 yrs & now work in a clinic. I have dealt competently and calmly w/ rapidly deteriorating post-surgical pt.'s on many different surgical lines (CT, vascular, ENT, etc.). Prior to being a nurse, I worked in a 4-bed stabilization room at a level 1 trauma center as an HCA, where I saw many traumatic resuscitations up close & did a variety of tasks during cases - EKGs, grabbed equipment, put syringes of blood into lab tubes, called stroke codes/trauma 1 or trauma 2/CT/house sup. about placement - but not giving meds or anything hands-on like the nurses & doctors. I've found that I am able to stay calm in stressful situations, however, I have not been the first one to enter a code situation nor have I actively participated in one. This entire situation lasted like 10 minutes but I've found myself stressing over it intensely since I left work. Any thoughts on the things I'm questioning/anxious about would be greatly appreciated. I'll take any advice for the future as well. Today a pt.'s family member popped out of a room & yelled out for help. (The pt. hadn't been seen yet so no injection was given nor anything done that typically causes a few of our pt.'s to faint). I ran in the room, the pt. was upright in a wheelchair (not slumped over) staring blankly (my immediate thought was TIA/stroke/who knows). I quickly moved two fingers across his eyes while asking him if he could follow my fingers (nothing), then asked if he could grab my hands (nothing) - all was said & done quickly. A nurse said press the code blue button (I said it's a smart code right now, call a smart code). A moment later his head went back & he took a slow/gaspy kind of breath & then a bit of a pause and 1 more - during this I felt for his carotid & there was no palpable pulse. I pushed the code button, told the PA that had been standing there to help me lift him to the floor immediately, got him to the ground, told the PA to start compressions & the other person in the room to be prepared to switch with him. I ran out and said I need a crash cart now! (Clinic staff was aware and it was on the way already). It's hard to remember but at some point the provider stopped compressions and said that the pt. was making a (barely audible) sound when he did each compression (he was in no way resisting or moving). I said keep going. Only about 60 compressions were done in total because when the crash cart got there someone turned on the defibrillator & I put the pads on the pt., handed someone the ambu bag who had asked for it, the monitor showed an organized rhythm, he was breathing so we put a mask on him w/ O2. He had soiled himself. Quickly took vitals - BP 189/109, HR 60s-70s, O2 sat 91% on however many liters the person had turned it up to, got a FS of 129. Things I'm feeling weird/just ruminating about: - I didn't realize that, in the outpatient clinics, the code blue button calls out a smart code. We apparently get all the necessary team members, just less than when a code blue is called on an inpatient ward... I came from a post-surgical inpatient ward (same hospital), where we had rapid, our co-workers, & the pt.'s surgical & medical on-call providers to help w/ deteriorating patients, & then we just called a code blue for code blues... I guess I feel stupid for telling my co-worker to pick up the phone & call a smart code because 1) the button would have created the same result - not feeling super bad about that because I didn't know & didn't want to call a code blue on what I believed at the time may not have been but 2) it ended up being a code anyway, quickly after I said that. - Me rapidly asking him to follow my fingers and squeeze my hand was sort of my way of seeing if he was at all responsive. He was holding his head upright but didn't move an inch. When I worked inpatient we did have some patients who basically went blank like that and didn't respond but also had a pulse... My mind was thinking stroke/TIA/something - not code blue. It wasn't until his head went back that I checked for a pulse and couldn't feel one. - I can't confidently remember the sequence of events after the crash cart got there - dangit... Did I hand that person the ambu-bag before I grabbed the pads? Also, I now realize I don't think they weren't doing compressions when I was taking the stickers off the pads so why did they stop, did they feel a pulse or were they waiting for me to put pads on? My mind was just focused on what I was doing. Pads on - monitor showed organized rhythm - afterwards I realized the defibrillator was on monitor mode NOT AED mode... we would have figured it out if the rhythm was vfib/vtach or asystole or whatever but it appeared organized. I should have realized that it hadn't said "analyzing rhythm" though, but there was a lot going on. - We used a hover-jack to get him on a stretcher and he was brought down. He wasn't speaking but did look at me at one point and looked a little scared, and I said everything was ok. Sounds like the he didn't say anything the whole way down but right when they got to the ED he then said something along the lines of... "I feel like ***." I looked him up later when I went in his chart to write my cardiac arrest note. Chief diagnosis at that point was syncopal episode. There is this thing in nursing where if you call a code blue and people feel that it "wasn't a real one" - you suck. No one acted that way at all, but it's like, his head went back and he took those weird breaths and I really couldn't feel a pulse. It's not like he woke up and rolled over or became alert at all when we brought him down to the floor either. I mean I did the right thing right? I was thinking, I should have tried to shake him a bit when he didn't move but then I thought... pretty sure if he didn't need CPR he would have reacted to being lifted out of his chair, brought to the floor, and given compressions... Looking at the chart - from the labs that were back, trop was negative, electrolytes normal, d-dimer 5000 (pretty sure imaging report was negative for PE). Idk. - Everything happened so fast I now realize I hadn't really said out loud, with the code team there, that I saw his head go back and stuff. I feel so stupid for not saying that. In the rush of things I was just focused on helping. I know that other people were talking though and the PA was there the whole time so I hope he said something? From the notes the team wrote, it doesn't look like he did. But it does say the daughter was in there and yelled when the pt. stopped responding, etc. So it's not like he was found down and we didn't know for how long. And then when I charted I just said "Pt.'s daughter yelled for help. Writer ran to room. Pt. in wheelchair unresponsive w/ no pulse. Pt. brought to floor w/ assistance & compressions started - bla bla bla." Do I need to go back and create an addition to my note to change it? Or should I leave it because that will look weird/bad & I documented the point, which is that he went pulseless and we initiated CPR. Idk why I didn't write the first part. I was trying to be concise and feel dumb and anxious now but am not sure if my feelings are warranted. - I think I also feel weird because it happened so fast and I'm going through my checklist like. Did I make sure compressions were good? Did we have anyone get epi. ready? But it was over as soon as it started. And I know I'm not a provider and that all of those things would have been done if the code continued because someone would have taken over and we would have been doing the appropriate tasks. Thank you so much for reading that very long post & for giving feedback. Hopefully I am, for the most part, overthinking. I really do care about doing reflecting on first-time situations though and want to make sure I do the best I can.
  5. Please take the time to read, I am open to any ideas/suggestions and would SO appreciate any help. I am taking over a sub-category of the sub-category that my co-worker teaches as part of a class titled "Nursing Care of the Telemetry Patient." The initial and main part of the class covers: STEMI, cadiac workup, interventional cardiology, cadioversion, what tele is teling you/rhythm strips, and emergenices. My co-worker speaks about post-operative management of the cardiac patient, something I am extremely familiar with as we receive post-op CABs/AVRs from the SICU frequently on my ward. The part she would like ME to re-do and teach is titled, "Assessment and Nursing Care of Telemetry Patients: Neuro, GI, GU (renal), and Ortho." My co-worker told me this section was added on for her to teach and she wasn't really sure what to do with it. My understanding is that I must relate telemetry to these body systems. I'm having trouble because the connections she made were not very strong and the set-up is random and not related to telemetry as requested. I would love some feedback and ideas. For example, for the renal patient I could talk about common electrolyte imbalances in renal failure patients like hyperkalemia, what you would see on your tele monitor (peaked T waves, flat or absent P waves, broad QRS, brady/irregular rhythms, vib if severe), and how you would correct the issue (calcium, bi-carb, insulin/d50, keyexelate). I'm having trouble with the other sections: neuro, GI, and ortho (and could still use some other ideas for renal patients). For ortho I could talk about co-management of surgical patients who have heart histories and are at risk for dysrhythmias. For example, I once had a standard TKA pt. w/ a heart history on tele that developed asymptomatic sustained SVT. I suppose we could see s/s of infection (tachycardia), fat emboli? I don't know. Neuro... she talked about stroke patients... yes we may monitor them on tele after a stroke but unless I'm missing something you don't look at your tele monitor and think, "wow that patient might be stroking out right now." GI... maybe talk about a bleed and hypovolemic shock and what you might see? We have patients in the OR for pro-longed amounts of time that may be placed on tele but even our big GI surgeries don't have orders for it most of the time. I just don't have many concrete ideas and don't want to make random connections that won't serve the nurses taking this class. Any help is appreciated. Thank you so so so much to anyone that reads this and offers up suggestions.