As The Hospital Pervs-- It's Overtime Time

[John Doe]

I haven't administered it yet! They use it in the OR with anesthesia, and are trying to get it back into the ICU for sedation etc. I wonder if the pharmers will give it up!

That's fine. Like I said, "I'll...", which is a contraction of 'I will'. It is the simple future tense and it does not imply whether I will do it immediately in the future or later in the future.

Keep track of your card, education is always like: I need your BLS card, so I hand over the ACLS card because I lost the BLS card back in December when I completed it. It's getting to be ridiculous.

I love when they say in real code time: "Get back on the chest."
Of course the nurse's are lucky because the Residents do the chest compression for us.

Yes, hands on the chest between the nipple line an 2 mouth on mouth resuscitation breaths.

People still do the breaths? I thought that was found to be a waste of breath (pun intended).

 

[sweepthefloor]

That's fine. Like I said, "I'll...", which is a contraction of 'I will'. It is the simple future tense and it does not imply whether I will do it immediately in the future or later in the future.

People still do the breaths? I thought that was found to be a waste of breath (pun intended).

In the simple future or the future future, be careful. You might need the rescue breath.

The breaths are optional for one person rescue in the field. The priority is on the chest.

Two person rescue deliver breaths with minimal interruption of circulation. The breaths are still important, but if you can't circulate blood to the lungs there can be no oxygen/ventilation anyway.

 

[John Doe]

In the simple future or the future future, be careful. You might need the rescue breath.

The breaths are optional for one person rescue in the field. The priority is on the chest.

Are we still talking about CPR?

Two person rescue deliver breaths with minimal interruption of circulation. The breaths are still important, but if you can't circulate blood to the lungs there can be no oxygen/ventilation anyway.

That makes sense. Wherever I heard that they must have been referring to the one-person rescue and/or they oversimplified it.

So this is what I should be pushing on?

 

[sweepthefloor]

Are we still talking about CPR?

That makes sense. Wherever I heard that they must have been referring to the one-person rescue and/or they oversimplified it.

So this is what I should be pushing on?

I think it's a great idea for everyone to complete CPR training. All children sport events should have an AED within close range. It's easy to use.

I do get confused with one-two person rescue because I am never in a one person rescue situation.

The goal is to simplify so that everyone will rescue without fear. If a person is down with no response and no pulse, yell for help and start chest compression.
Yes, it's a push on the heart with the hands between the nipple line. It's fast and hard.

 

[Balladeer08]

I think it's a great idea for everyone to complete CPR training. All children sport events should have an AED within close range. It's easy to use.

I do get confused with one-two person rescue because I am never in a one person rescue situation.

The goal is to simplify so that everyone will rescue without fear. If a person is down with no response and no pulse, yell for help and start chest compression.
Yes, it's a push on the heart with the hands between the nipple line. It's fast and hard.

And done to the rhythm of "Stayin' Alive" by the BeeGees.

I'm waiting to hear a patient came to and said "Disco sucks!" 8)

 

[sweepthefloor]

And done to the rhythm of "Stayin' Alive" by the BeeGees.

I'm waiting to hear a patient came to and said "Disco sucks!" 8)

or done to the rhythm of "another one bites the dust."

 

[sweepthefloor]

Supervisor: There’s a call out and you are short a nurse.
Me: So the night shift will be tripled?
Supervisor: Yes.
Me: Are you aware of the acuity here? Can you come up here and see what is going on?
Supervisor: I know my job.
Me: Can you call in a pool or float RN?
Supervisor: I know my job. I have the whole house to staff and it’s short everywhere.
Me: We need another nurse. We can not triple trauma.
Supervisor: You are making me angry.
Me: This has nothing to do with feelings. It’s a supply and demand issue, and the acuity demands safe staffing.
Supervisor: I am not talking to you right now.
Me: You don’t have to talk to me. You just have to know my statement is clear and valid.

 

[gotsnowgotslush]

No wonder, that there is such a high turnover. A bully, and a hardass.
(Does their attitude have something to do with a bonus, that will fill up a bank account ?)

 

[sweepthefloor]

No wonder, that there is such a high turnover. A bully, and a hardass.
(Does their attitude have something to do with a bonus, that will fill up a bank account ?)

It's disheartening because we put so much heart into the job. We make sure we do our job even under severe stress.

The house supervisor is not the manager of any specific unit. They don't get any extra money for managing the house, but they only care about the house. They will pull from ICU if there are ICU holding in ED or PACU. Even though PACU and ED RNs are critical care nurses and have the ability to hold patients so that we can stay in ICU and "create" beds for these admissions. They don't see it like that.

I am not sure they understand the acuity of the ICU, even though the last time I blew my mouth off to the super she responded: I worked in ICU for 16 years. You do what you have to do to survive. I am pulling a nurse to the ED, you're not getting her back.

It's not about survival, it's about optimal care and stress reduction because the patient is the priority. We will skip lunch, but even that 30mins is not enough to get it done on time. We survive like little children sticking close together when we know we are all about to get belt whipped for something we didn't do.

It's not the kind of whipping I like, but I don't have any power. I can't fight the system alone. I don't have the answers. I just go to work.

 

[sweepthefloor]

Surgeons demand that their patients never be 'tripled' and they mandate a strict 2:1 ratio, and sometimes they demand 1:1. This is the only case where I accept physician directed management of nursing practice.

 

[Balladeer08]

Supervisor: There’s a call out and you are short a nurse.
Me: So the night shift will be tripled?
Supervisor: Yes.
Me: Are you aware of the acuity here? Can you come up here and see what is going on?
Supervisor: I know my job.
Me: Can you call in a pool or float RN?
Supervisor: I know my job. I have the whole house to staff and it’s short everywhere.
Me: We need another nurse. We can not triple trauma.
Supervisor: You are making me angry.
Me: This has nothing to do with feelings. It’s a supply and demand issue, and the acuity demands safe staffing.
Supervisor: I am not talking to you right now.
Me: You don’t have to talk to me. You just have to know my statement is clear and valid.

I think I love you.

I know I respect and admire you.

 

[sweepthefloor]

I think I love you.

I know I respect and admire you.

Love me Love me.
My co-workers appreciate my mouth, surely the administration thinks I am a trouble maker.

 

[LoudFastHarley]

Love me Love me.
My co-workers appreciate my mouth, surely the administration thinks I am a trouble maker.

I appreciate your mind and your mouth. Trouble makers are sexy

 

[sweepthefloor]

I appreciate your mind and your mouth. Trouble makers are sexy

The mouth is the easy part the mind is the stress. I don't like making trouble.

 

[Balladeer08]

Love me Love me.
My co-workers appreciate my mouth, surely the administration thinks I am a trouble maker.

You just used the words "administration" and "thinks" in the same sentence.

That was sarcasm, right? 8)

 

[sweepthefloor]

You just used the words "administration" and "thinks" in the same sentence.

That was sarcasm, right? 8)

It was unintentional! I do feel bad for them, I guess it's stressful to make sure the whole place is staffed. I just think it's a bad idea to short the ICU.

 

[sweepthefloor]

I can lead, but I couldn't manage. I learned about this during "leadership & management in nursing" course work. I can't manage a budget. Let's be serious, we wouldn't even have enough money for 2 inch silk tape!

The only thing I have to work on, is forgetting about the need for constant validation. I slave for the nurses when I don't have a patient assignment.

I don't mind slaving.

 

[Balladeer08]

I can lead, but I couldn't manage. I learned about this during "leadership & management in nursing" course work. I can't manage a budget. Let's be serious, we wouldn't even have enough money for 2 inch silk tape!

The only thing I have to work on, is forgetting about the need for constant validation. I slave for the nurses when I don't have a patient assignment.

I don't mind slaving.

And every guy reading this thread just got wood. 8)

 

[sweepthefloor]

And every guy reading this thread just got wood. 8)

I have been the boner killer lately. It's just been so fucked up.

 

[Balladeer08]

I have been the boner killer lately. It's just been so fucked up.

I hate hearing things are going badly for you. You seem such a resilient and resourceful person. For things to be that bad, they must TRULY be fucked up! FUBAR squared.

Hopefully things will return to an even keel soon.

We need you here. I go into sweep withdrawal when you are not posting.

 

[sweepthefloor]

I guess there is no sense in fighting the system. It's just "take a beating" and don't fucking cry about it. Maybe that is why I am a nurse.

 

[sweepthefloor]

I hate hearing things are going badly for you. You seem such a resilient and resourceful person. For things to be that bad, they must TRULY be fucked up! FUBAR squared.

Hopefully things will return to an even keel soon.

We need you here. I go into sweep withdrawal when you are not posting.

I am resilient and my coworkers love me. The problem is that I am hot-headed sometimes. I imagine that is why they love me.

 

[Balladeer08]

I am resilient and my coworkers love me. The problem is that I am hot-headed sometimes. I imagine that is why they love me.

I can think of a number of reasons why they love you.

Non carborundum illgitimi. Don't let the bastards grind you down. 8)

And please, keep posting. I was beginning to suffer from Sweep Apnea.

 

[sweepthefloor]

I can think of a number of reasons why they love you.

Non carborundum illgitimi. Don't let the bastards grind you down. 8)

And please, keep posting. I was beginning to suffer from Sweep Apnea.

Sweep Apnea, that is really cute. I guess I am just tired. It's July. All of our Second Year Residents are now Third Year Residents. It's a transition.

It's not just that. The body pays a price for stress.

 

[sweepthefloor]

I will just go to the library now to print the articles, but I don't even have a clear research question yet. So far I have: "Does the CIWAar protocol decrease the escalation to DTs in the acutely ill patient?"

This is not a well defined question.

"How does Valium loading compare to the CIWAar protocol for the treatment of DTs during the first 72 hours of admission in known alcoholics with histories of DTs."
(not enough evidence.)

"How to treat Alcohol Withdrawal Syndrome (AWS) to prevent DTs on admission to the hospital, when the known peak of withdrawal is usually 48 hours after the blood alcohol level drops to zero."

"Should all patients with a history of DT requiring heavy sedation and mechanical ventilation be admitted to the ICU before signs of DT occur?"
(not cost effective, but may prevent a longer length of stay. not enough evidence)

Make it easier: "Are general medical floor nurses capable (secondary to work load) able to properly assess, medicate and utilize the CIWAar protocol?" "What are the issues?" "Fear of over-sedation?"

I need help. It's a serious and valid topic but it's too broad and general because not all those with AWS escalate to DTs. I can't find the answers. What are the predictors? It's the same scenario every time: Admit to floor, under-medicated and 2 days later admitted to the ICU, it's too late to back track and catch up with the Benzo load, so the patient gets the breathing tube and sleeps it off for a week on the machine and high dose sedation: and that has terrible side effects. Now they have a pneumonia too!

I guess I have to keep working.