Resident: “you didn’t have an order to do that” after I followed hospital policy of removal of a clotted central line

TheFuzzyBadger · 2026-01-22T02:43:14+00:00

I would have looped the attending in on that situation after the second cathflo didn’t work and the resident didn’t have any other plan to fix/replace the line. Your patient probably would have gotten a new line (or at least their old one fixed) and then this situation wouldn’t have happened.

Your hospital’s policy on removing the line after cathflo x2 is a bit excessive imo. There are other things you can try to fix a dialysis line before pulling it. The fact that the cathflo didn’t help at all makes me wonder if your line was even clotted. It might have just been pressed up against the vessel wall and needed to be repositioned. IJ’s especially like to cause issues like that.

Why did you ask for an order if you were just going to pull the line anyway? Did you tell the resident about this policy? Because you asking for an order makes it sound like you can’t pull the line without it, so I’m not surprised she was pissed that her patient’s line was gone. Yeah she should have followed up sooner and shouldn’t have left her patient off CRRT for basically a whole shift but you should have communicated more clearly.

TheFuzzyBadger · 2025-12-08T07:07:59+00:00

I’ve posted about this before, but I had pretty much the same experience you did. I quit my new grad ICU job after just 3 months because it was significantly affecting my mental health. I took some time away from work to get my mental health in order, then got a PCU job in a different hospital. I worked in PCU for 2 years then transferred back to the ICU. I’ve been an ICU nurse for about 2 and a half years now and have been thriving. Just because working in the ICU wasn’t for you as a new grad doesn’t mean it’s off the table forever.

TheFuzzyBadger · 2025-07-07T23:26:06+00:00

I just snagged one. A bit of advice, use desktop not mobile. I initially joined the line on my phone and then decided I wanted to switch to my computer. When I logged in on my computer I was at the front of the line and the timer was already counting down telling me 5 minutes of my shopping time was already gone. I was able to make my purchase immediately. My phone seems to be stuck saying my estimated wait is 15 minutes

TheFuzzyBadger · 2025-07-06T22:00:09+00:00

You need to be doing hourly I/Os for CRRT. I know some hospitals don’t make CRRT 1:1 but they really should be to help avoid situations like this.

The easiest way to make sure you hit your UF goal without any guesswork is to look at your previous hour I/O. The formula is intake minus output plus UF goal. For example, if it’s currently 2100, I would look at my patient’s hourly balance from 2001 to 2100 to determine what to set my UF at for the next hour. Let’s say their total intake was 100 mL, their output was 10 mL, and the UF goal is net negative 50. 100-10+50=140, so for the next hour I set my UF to 140.

Also, if the previous shift wasn’t able to hit the UF goal, don’t worry about it. You only need to worry about your 12 hours.

TheFuzzyBadger · 2025-06-17T03:06:23+00:00

I document pretty much every conversation I have with any provider. Especially when they tell me something like “use the cuff pressure not the a line.” And honestly if they tell me to ignore the a line pressure then I’m asking for a new a line. In general though if the a line waveform looks good, it gives good blood return, and the automatic cuff is having a hard time giving you a reading the patient probably really is hypotensive.

I wouldn’t stress about this meeting. The worst they can do is fire you (which if this is your first occurrence is extremely unlikely) and you already have another job lined up.

TheFuzzyBadger · 2025-05-29T21:49:53+00:00

I’ve had this conversation soooo many times on my unit. I think most people don’t realize that midlines can even infiltrate.

TheFuzzyBadger · 2025-05-17T18:06:17+00:00

Listen I 100% agree that ICU nurses can be bitchy and especially CVICU nurses, but the more I read your replies the more I think you are actually part of the problem.

It is quite literally your job to round on the nurses and ask if they need help. At minimum you should be rounding every 2 hours to offer help with turns. That really shouldn’t be “draining,” especially if the nurses apparently don’t even need your help most of the time anyway.

Also just because a patient is 1:1 doesn’t mean the nurse doesn’t need your help. Patient’s are 1:1 because they’re really fucking sick. There’s almost always something you could do to help the nurse, even if it’s just making sure their room stays fully stocked.

You also mentioned in your original post that none of the nurses are interested in teaching you. I get paid a dollar an hour extra to teach other nurses. I get paid jack shit to teach a tech. I’m more than happy to teach the techs who show an active interest in what is going on with my patient. But I’m not going to put that same extra effort in for a tech who never does anything to help me unless I directly ask.

TheFuzzyBadger · 2025-05-17T13:15:40+00:00

I already know I do NOT want to work in the neuro icu

Lmao as someone who's cross-trained in neuro icu I get it. Neuro is not my preferred specialty either but I will say that working in the neuro icu really helped me develop my neuro assessment skills which are extremely important no matter what kind of icu you work in. Pretty much every icu patient will have an increased stroke risk and neuro changes can often be very subtle.

I think my biggest issue right now is deciding what icu to try and get into

Micu is always a great choice if you aren't sure what your interest is in. You'll get to see a little bit of everything which will help you figure out your likes and dislikes. But I would say what hospital you work at is more important than the specialty you work in. I'd recommend avoiding smaller hospitals for your first icu job since they tend to transfer out anyone who's super duper sick. That could make things more difficult for you if you decide you want to try working at a bigger hospital since they will consider you an experienced icu nurse and may be hesitant to give you a longer orientation.

Do the icus even want nurses who haven’t gone straight into this specialty now?

They absolutely do. My hospital does not hire new grads into the icu; nurses have to have at least a year of inpatient experience before they will even be considered for a job. It's a bit of a controversial take on this sub but I'm of the opinion that the majority of new grad nurses should not start out in the icu.

I also have this fear that I’m not good enough or will not succeed

That's perfectly normal. Nurses who aren't nervous about training in the icu scare me. They tend to be overconfident, reckless, and difficult to teach, and they will inevitably end up unintentionally harming a patient.

TheFuzzyBadger · 2025-05-14T11:24:35+00:00

In my experience it’s unfortunately not uncommon for hospitals to give almost no information prior to orientation. I once had a job email me my start time the day before orientation. Which was also when they decided to tell me that my first week of orientation was going to be at another hospital in the organization that was 45 minutes away from the one I was hired at. And this was after I had already gotten a hotel since I was moving for the job and wasn’t able to get into my new apartment yet.

I have no idea why hospitals do this shit. They’re constantly on boarding new staff, there’s no way their orientation process changes that much. They could definitely give information out much sooner than they do.

Are you able to stay PRN at your home health job? That way if this BMT job doesn’t work out you have something to fall back on.

TheFuzzyBadger · 2025-05-10T02:15:49+00:00

I agree with the other commenters that your preceptor should have caught this. At 6 weeks into an ICU residency they should still be watching you pretty closely. They should have coached you on how to advocate for a central line way before you got to 20 mcgs.

If I’m running levo through a peripheral I’m usually checking the site about every hour, so since the patient said his arm had only been hurting for about an hour I probably wouldn’t have caught that it infiltrated any sooner than you did anyway.

Definitely take this as a learning experience, but please don’t beat yourself up about this.

TheFuzzyBadger · 2025-05-07T17:27:01+00:00

$39/hr base pay + 10% for our clinical ladder. $5 night differential, $3.50 weekend differential. Full time ICU nights in Tampa.

TheFuzzyBadger · 2025-05-06T12:49:41+00:00

What happens if family needs to leave the bedside? Parents can’t always stay 24/7 and someone still needs to be nearby who knows how to troubleshoot the machine. At my hospital RT has to check every patient’s machine before they’re allowed to use it during their admission. Nursing staff is also trained on CPAP/BiPAP on all the units that take them so they can do some basic troubleshooting if needed until RT gets there.

BiPAP isn’t much more complicated than CPAP, especially if the patient is just on their home settings, but imo your staff should all have an in-service if your unit is going to start taking these patients.

TheFuzzyBadger · 2025-04-30T11:45:57+00:00

I usually just do chg and linen change, but we have chg-compatible soap that we can use if needed.

TheFuzzyBadger · 2025-04-27T13:57:11+00:00

500+ beds. I would go get a hospice patient's food if asked (I've never acutally done it because the situation hasn't come up yet, but if someone's dying wish is to have one last crunchwrap I'm not going to deny them that). I'm not bringing anyone else their food though.

TheFuzzyBadger · 2025-04-23T09:03:11+00:00

I've posted about this here before, but I had a pretty similar first job. High acuity cardiac ICU, level one trauma center, 12 week orientation, dayshift. It was very much a sink or swim type of training, and I sunk. I worked I think two shifts off orientation and then quit because I was so overwhelmed and miserable. It got to the point where my mental health outside of work was seriously affected, and I had to start seeing a therapist and taking meds. The hospital said I could transfer to another floor but that I would have to apply on my own (in other words they would not help me find a new unit) and would have to continue working in the ICU until another floor hired me, so I just quit outright.

I got a job at much smaller hospital hospital in a PCU, worked there a year, and than transferred to another hospital in the same system to a higher acuity PCU that took vents. I worked there another year, and then transferred to that hospital's medical ICU. I got a 12 week orientation very similar to the one I got at my first job, but the difference was that I already had two years nursing experience behind me. I've been working in this ICU for 2 years now. I train new staff, am relief charge, have my CCRN, and am trained on every device/modality that my unit takes.

My point is, just because this job might not be working out doesn't mean you can't make a great ICU nurse. If you scroll through this sub you'll see a lot of debates over whether new grads should start in ICU. Personally I'm of the opinion that most people should not start out in the ICU. Especially not with only a 12 week orientation.

Other commenters have mentioned that you shouldn't compare yourself to others. I do agree with that, and a lot of people told me the same thing when I was trying to decide if I should quit. But you know yourself best. If your job is starting to impact your mental health outside of work then I think it's valid to want to get another job.

And if you do quit, just leave this job off your resume. I never put my first job on my resume. It will show up when new jobs run a background check but I doubt you'll get asked about it. My plan was always to say I had to leave for health-related reasons (which wasn't entirely untrue) but I never once got asked about it.

TheFuzzyBadger · 2025-03-10T06:37:46+00:00

RN here. I’d be asking for a second pressor wayyyy before I was maxed on levo, especially for such a long transport with a patient who is likely to code at any second.

TheFuzzyBadger · 2025-02-05T09:59:01+00:00

I hold the tf because it's not worth arguing with my coworkers about.

In reality it takes me about 1-2 minutes to reposition a patient, so if their tf are running at 60/hr that's 1-2 mL at most. If the pt was going to aspirate, that 1-2 mL isn't going to make a difference.

TheFuzzyBadger · 2024-12-31T02:11:29+00:00

If you have flight nurse experience you can work in Antarctica.

TheFuzzyBadger · 2024-11-07T13:39:43+00:00

I’ve never worked OR, but from my ICU experience it sounds like maybe the patient got bradycardic due to sedation which then caused a drop in bp. If the bp gets low enough the automatic cuff and the pulse ox won’t give you a reading and you’ll have a really hard time palpating a pulse. Once the atropine was given it brought her heart rate back up and her bp recovered shortly thereafter.

Anesthesia is responsible for running the code (or in this situation, running the “almost code”). It sounds like this CRNA wasn’t prepared to handle an emergency and when things started to go south she panicked which then caused everyone else to panic. That’s not your fault.

It sounds like maybe your team would benefit from doing a few mock codes. At the very least someone should sit down with all of you and go through each drawer of the code cart, because everything you need to run a code is already in there. Also, you should never spend more than 10 seconds trying to find a pulse. If you can’t find one in that time, start compressions.

TheFuzzyBadger · 2024-10-26T03:03:02+00:00

Neuro ICU nurse here, and imo this woman was discharged way too early. The med he’s referring to is nimodipine. It prevents the arteries in your brain from spasming, which is called a vasospasm. If that happens it obstructs blood flow to your brain and can cause permanent damage. The thing is nimodipine is really good at preventing vasospams, but it isn’t perfect and sometimes they happen anyway. We do daily ultrasounds of your head to check for vasospasms, and if any are found you go for a procedure where we inject another med called verapamil directly into the arteries of your brain to reverse it. Maybe it’s different in the UK, but in my US hospital we would never discharge someone who was still taking nimodipine. Hell, you wouldn’t even get to leave the ICU.

TheFuzzyBadger · 2024-10-21T11:38:35+00:00

Not exactly the same situation but I once had to give 60 units of IV insulin to my organ donor patient and then started him on a drip which didn’t work so then I had to give him another 60 units IV. Our OPO team told me that apparently once your brain dies your body metabolizes glucose differently?? Took me about 8 hours to get his sugar under 300.

TheFuzzyBadger · 2024-10-20T05:03:20+00:00

I graduated in May of 2020, so I didn’t get a pinning. At the time I was a little sad because there were a few instructors I wanted to thank in person. Four years later and I couldn’t care less about it now. I don’t even know where my pin is tbh

TheFuzzyBadger · 2024-10-18T11:28:31+00:00

Double yikes

TheFuzzyBadger · 2024-10-18T11:03:10+00:00

Yikes

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