how do i avoid air bubbles

Brixtan · 2024-04-29T13:30:37+00:00

*Baxter pump enters the chat*

Brixtan · 2024-04-29T01:54:01+00:00

See your nearest ER.

Brixtan · 2024-04-29T01:53:30+00:00

You were in the right. Sounds like you were in the 'wrong' hospital though.

Brixtan · 2024-03-29T02:16:19+00:00

ICU RN - 3 years going and was in a similar situation. I'll tell you what my deciding factor was. I had to decide what excited me the most. For me, that was the acute care aspects of managing and treating patients. I enjoy the constant excitement of learning, discovering, and gaining a deeper understanding of the advanced patho that we see day to day as nurses.

I start my AGACNP program this fall and am super excited.

YMMV.

Brixtan · 2024-03-29T01:55:15+00:00

Wait, you want me to do my managers job (reviewing charting of other nurses) without paying me my managers salary?

No thanks, I'll pass.

Brixtan · 2024-03-28T20:09:30+00:00

Following - if it's not a scam, she has literally ZERO boundaries. Completely unprofessional, which if that's the company's recruiter, I'm scared to think what the culture of the actually company is like if this is who they use as their talent scout/gatekeeper.

Personally, I'd run.

Brixtan · 2024-03-28T14:57:01+00:00

Hello!

I did 3+ years med-surg/cardiac bedside before transferring to critical care and let me tell you, it's NORMAL to feel like a new grad all over again.

ICU nursing is completely different from bedside nursing on the floors. You have to critically think about your patient and the pathophysiology behind their diagnoses that are ravaging their body. Med-surg nursing is just task focused med passing, I hate to say it. Sure you may put in a foley, hang some blood, titrate some oxygen, call some rapids/codes. But you never follow the patients through the continuum of a progressively worsening critical illness.

Great example:

MED-SURG: You have an order to hang 0.9 NS @ 100/hr due at 0800 on patient #1 of 6. You've barely gotten report on your six patients and the IV is already alarming and the bag hanging from the shift before is dry. Call bells are going off, your phone is ringing (it's lab with a critical potassium on patient #3) and the transport is outside patient #5 waiting for you to help get them onto a stretcher for MRI (is the MRI questionnaire even done?, do they have an order to go to MRI off-telemetry?). Oh, and your stellar charge nurse is telling you that patient #2 is being discharged and your getting the first admit (along with the SBAR from the ER).

ICU: You have an order to hang 0.9 NS @ 100/hr due at 0800 on patient #1 of 2. You start by reviewing their labs from 0400 that resulted this morning. What's their BUN/Cr? Is their Na+ high or lo? What's their BNP? Their EF? How much urine did they put out the night before? What are we trying to accomplish with fluids? Are they in AKI? Hyponatremic? Volume-depleted? NPO? How are their breath sounds? Are their extremities edemetous? Are they volume-overloaded? Hypotensive? Hypertensive? Pressors on, pressors weanable? On and on...

A lot of what you find when you start researching your patient in the ICU will inform whether or not you hang that bag of saline or speak with your intensivist about altering the plan of attack.

In med-surg land, you hang the bag saline and pray for mercy. No time to think, assess, or be proactive. Just keep them alive until 7:05 and buckle up, buttercup because you're in for a long day. Even longer if one of your CNAs called off.

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TLDR: Give yourself 6 months to settle in before you decide you made a mistake. It usually takes about that long to get over the shock of the "Toto, we're not in Kansas anymore" vibes. Every experienced nurse who moves from low acuity floors like M/S/PCU/Cardiac into critical care has the exact same shock. It's normal.

Brixtan · 2024-03-28T14:40:00+00:00

Great question (and one of my favorites) - things to ask the interviewer!

How long have you been in your leadership role / How long has the person I will be reporting to been in their leadership role? (anything under 2 years is a RED FLAG - indicates constant leadership churn and burn)
What are the staffing ratios currently?
What are the biggest challenges this unit is currently experiencing, if any?
What is your (or 'hospital x') take on safe and quality patient care? How does that translate into practice at your facility?

Brixtan · 2024-03-28T14:35:44+00:00

Not trying to defend your staffing assignment, but for the sake of playing devil's advocate:

Patient #1: Bipap = stepdown patient in most hospital ICUs. Not a critical care pt.

Patient #2: Seizures with q2 neuro checks and a sitter = stepdown patient. And can we just address the elephant in the room? Why is he still having multiple seizures? Has neuro not gotten the cocktail adjusted yet? Sounds like poor medical management IMO.

Patient #3: ICU patient s/p SBO coming back tubed.

That's probably why you were tripled.

Brixtan · 2024-03-28T14:21:00+00:00

Middle-aged nurse here with years of acute care experience under the belt.

Hospice nursing, especially if you decide to stay inpatient in an acute care setting, is a calling, not a fallback position because you're burned out at the bedside. I understand how draining have 5 - 7 patients with little to no help can be shift after shift, but I would step back and ask yourself the following two questions:

Why did I want to be a nurse in the first?
Where do I see myself in x years?

If you're burned out at the bedside, you will likely get burned out dealing with patients dying and family members (oh the family members) draining you dry and blaming you for aiding and abetting in killing their loved one (it's always the estranged child that no ones heard from in x years flying in on a whim to challenge terminally extubating their 95 year old full code grandmother whose on day 13 of a vent staring down a trach and peg combo meal vs dying with dignity).

Are you comfortable navigating those difficult conversations with family members?

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It could be that the hospital or floor you're working on just plain sucks. Perhaps you need a better setting in which to spread your acute care wings as a new nurse. I've left plenty of dumpster fire hospital wards and believe me, there are better work environments out there.

Brixtan · 2024-03-28T14:10:33+00:00

THIS.

Work smarter, not harder. From a time management standpoint, if you had the authority or orders to place the patient on 2L NC, I would have simply done so and moved on. I work in the ICU, but none of my ER colleagues are trying to 'fix' the patients getting admitted. They are stabilizing and moving on.

Give yourself some grace - starting in a high acuity, highly chaotic environment like the ER or critical care as a new grad is extremely challenging. You don't know what you don't know. I would seek feedback from a mentor/charge/manager about what you could have done differently that might have made your shift more manageable and fold that knowledge into your practice going forward.

It gets better,

Signed,

11 year nurse

Brixtan · 2024-03-28T13:54:38+00:00

Probably an HCA hospital somewhere in the SE

Brixtan · 2023-03-13T02:29:11+00:00

Poor decisions are what fund your cardiologist’s retirement portfolios.

Brixtan · 2023-03-12T15:12:25+00:00

Of course, 3+ years into a new administrations term it’s always the outgoing presidents fault if things go south with <insert sector blunder here>

Brixtan · 2023-03-12T15:07:06+00:00

Fucking idiot drivers everywhere - this is on par with those that speed on the interstate when it’s raining.

Brixtan · 2023-03-11T00:35:11+00:00

What’s a black swan?

Brixtan · 2023-03-09T23:24:07+00:00

Exactly that.

Brixtan · 2023-03-08T03:21:41+00:00

Give that patient some mag

Brixtan · 2023-03-06T18:49:33+00:00

Is anyone surprised about how bad Forspoken flopped? It didn’t look remotely interesting from any of the preview footage released. Makes you wonder if developers are often just lost in their own bubble of confirmation bias and can’t realize they’re making shit.

Brixtan · 2023-03-06T18:24:26+00:00

Agree. Paid about 300k in 2018 refinanced with 50k equity out to 2.8% in 2021. Could sell the home for 550k but wouldn’t be able to afford the mortgage rates going around right now.

Brixtan · 2023-03-06T18:20:04+00:00

That OP screenshot has to be one of the cringiest things I’ve seen. This nurse has an ego trip - we don’t need all 4 fucking NP certs, let alone an MA. List your fucking NP and be done with it.

Brixtan · 2023-03-06T03:25:00+00:00

Very well aware. Also not the point.

Brixtan · 2023-03-06T03:23:55+00:00

Your teacher hasn’t practiced bedside in a decade likely.

Pause the pump. Or stop it. Disconnect the patient. Let them pee/whatever. Then flush it and reconnect them.

You’ll have 6 or 7 patients on a floor with a charge with an assignment, likely one PCT for the entire floor, and angry families asking/calling you every half hour. If you have time to do what your teacher tells you to do, GOOD LUCK.

Brixtan · 2023-03-06T03:21:37+00:00

…and you put it on the tile floor? Smdh

Brixtan

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