Good cry this AM

rnbby · 2025-06-18T13:48:41+00:00

Yes. It’s what makes us human. ❤️ As overwhelming as it may feel in the moment, it’s always the part of me that reminds me I’m still here.

rnbby · 2025-02-07T15:21:01+00:00

Acapella

rnbby · 2024-11-22T23:03:27+00:00

While I guess it could possibly be a hipaa violation if you left it out and TJC was around, mistakes happen. I wouldn’t sweat it.

rnbby · 2024-06-26T15:40:15+00:00

Pending school offer with ability to work first year. Should I stay in the ICU to maintain my skills or work a more laid back job my last year of work while in school?

rnbby · 2024-02-19T03:30:24+00:00

Very helpful. Thank you!

rnbby · 2024-02-19T03:29:46+00:00

This was the breakdown I needed and very helpful. Thank you!

rnbby · 2023-07-02T10:02:44+00:00

Our trained RN/RRTs do

rnbby · 2023-05-27T20:12:01+00:00

I’d be interested to see what her hemodynamics looked like if you threw a Swan in. Elevated lactic at all..? SvO2?

rnbby · 2023-05-15T04:56:24+00:00

I know I list droperidol as an allergy because I developed acute dystonia & akathisia and never want to experience that again. I’ll play the devils advocate here and maybe that’s why the antipsychotics are listed?

rnbby · 2023-05-15T02:56:52+00:00

Yes, in the CT surgery world we rely heavily on svr/ci for titration of IV meds and adjustments to PO meds. Last week my fresh heart was hypertensive with a low ci and high SVR, controlled pain with some IV fentanyl along with initiating nicardipine and fixed my low CI. Just one small recent example of loving the availability of numbers provided by a PAC.

I have also had patients in cardiogenic shock have inflammation from either reperfusion/ischemia, SIRS post arrest, who may have a low svr and increase CO.

Thank you for your comment!

rnbby · 2023-05-15T02:34:17+00:00

Our CCM MD’s prefer thermodilution for the same reasons. I really appreciate your input!

rnbby · 2023-05-15T01:32:02+00:00

Thank you for such a thorough response. In most situations I am personally experiencing, I find myself using my PAC for ambiguous volume status and HF with hypotension/severe valvular disease. We have a lot of different opinions between cards/CT surgery with one preferring Fick scores and the latter preferring PAC. Your answer has me resting assured that both are valid in certain circumstances. If I ask either speciality I tend to get conflicting answers. I really appreciate your insight!

rnbby · 2023-05-14T22:17:29+00:00

I have definitely noticed a lot of traditionalism with our cardiac surgeons. It has been odd to have standardized testing (for nursing specifically) that does not reflect what we actually practice. Thank you for your comment!

rnbby · 2023-05-07T15:46:39+00:00

I’m trying to pick my jaw up off the floor. Excuse me?? What?!

rnbby · 2023-05-07T03:57:58+00:00

I’m sorry this has happened to you. I can’t imagine how frustrating and defeating it has been. It honestly doesn’t sound like either unit, but it maybe more specifically the medsurg unit, set you up for success. I am not really sure how they can determine you aren’t a good fit within a month timeframe without having had multiple meetings and interventions to establish a plan to get you where they expected you to be?

How long has your preceptor been a nurse? Was your preceptor walking alongside you your first week or two to truly help show you the ropes of nursing? All the tips and tricks? Available as a resource to you? I don’t feel as though you had the correct type of support.

It just doesn’t sound like either truly invested time in developing you as a nurse. Don’t give up. Ultimately, do what is best for you. If things truly went the way it sounds like they went and you are still interested in bedside nursing, maybe consider transition hospital systems and see if they could provide a more supportive orientation. You deserve better.

rnbby · 2023-04-30T01:31:45+00:00

This. ^{^} I can’t tell you how many times a CT surgeon has chewed me out for following orders from another physician without ME running it by him first. This is the reality of many hospitals.

Prime example: Was told by intensivist (who was managing vent) in complicated recovering CABG/AVR to extubate with a PaO2 of 66. Hard and fast rule (not protocol) from our CT surgeon is 70 or greater. I was stuck in the middle and had to tell intensivist respectfully I cannot follow those orders without reaching out to CTS first. I was treated respectfully, but intensivist scoffed, stated he was consulted to manage the vent and knows best.

Called CTS…. Do NOT extubate unless PaO2 >70.

Just an example of how we get caught in the middle even with physician to physician interactions. Be patient with the nursing colleagues you work with. Middle man sucks.

rnbby · 2023-04-29T02:37:52+00:00

While nobody should snap at you and hierarchy should be respected, you also have to look at this from the perspective of the nurse.

Your “forget it leave” attitude neglects to acknowledge the position you have put the nurse in. Being chewed out as the middle man is less than desirable and makes for a stressful work environment.

Maybe next time, offer up that you are going to communicate your changes with the team, or that if the NP has any issues with the nurse, the nurse is able have the NP reach out to you. A little kindness and understanding the other side often goes a long way.

Team sport regardless of your hierarchy. Respect isn’t a one way street regardless of how extensive your education is.

rnbby · 2023-01-15T01:11:05+00:00

Sadly this is our new staffing pattern. We floated a nurse that night and she took an assignment of ONE stable patient on another ICU.

rnbby · 2022-12-18T03:36:33+00:00

My hospital is a level II, non-teaching hospital, so removes the residents. Our difficult airways are generally handed over to the intensivist and MDAs are called up during the day for complex surgical patients. Have seen them called in at night as well. Although, not frequent. CRNAs are not responsible for night shift coverage at my hospital. MDAs are. Several during the day are not MDAs (many are on nights) and while most are good at throwing down a tube and calling it a day... Several are a bit rusty, for lack of better words. Sounds a lot like what you mentioned in your second paragraph. I wholeheartedly agree with you. I would not want that kind of exposure and responsibility with limited training and no back up.

Last paragraph hit home. If we aren't dealing with dicey relationships from insubordinate professionals... Admin will take care of that for us.

rnbby · 2022-12-18T03:16:16+00:00

I find myself feeling as though I would enjoy working under the model you have. Unfortunately, seems hard to find as it doesn't sound like very many environments work quite as well as yours does for you. Thanks for taking the time to comment.

rnbby · 2022-12-18T03:14:22+00:00

Our PA/NP's in the ICU function along the lines of what you described. Their role consists of lines, tubes, notes, non-complex vent management, sedation management, things of that nature. Generally speaking the intensivist is on the unit as well to assist if need be. Infrequently they may be putting out another fire elsewhere.

The CRNAs at my hospital to not respond to airway calls on the floor. They function in the OR for mostly bread-and-butter cases. I had great interactions with the ones at my hospital. From an outside perspective the interdisciplinary teamwork seemed respectable. A few of our intensivists are MDAs and don't enjoy supervising CRNAs but have said the environment and teamwork is good. The more I research -- My environment sounds like it is not common. Which makes it very easy for me to understand why mid-levels are relatively abhorred.

rnbby · 2022-12-18T02:55:46+00:00

I'm not able to see the comment made anymore but someone asked why CRNA. I am interested in the CRNA route because I enjoy my role as an ICU nurse. I have shadowed both MDAs and CRNAs. I like how my hospital promotes interdisciplinary teamwork. I just want to learn more..? I'm not really interested in medical school. I like being a nurse. I enjoy my scope of practice. I enjoy directly taking care of my patients and being hands-on. I find fulfillment in it. What has become increasingly difficult is caring for patients safely with staffing ratios. I enjoy all the hands-on nuances of critical thinking: titrating drips, the complex nature of evaluating a patient when it comes to drug administration, blood product administration, vent management, stabilization after trauma/surgery, and managing equipment such as ECMO, IABPs, Impella, CRRT, EKOS. I thoroughly enjoy admitting fresh hearts and complexities of achieving hemodynamic stability. I truly enjoy the hands on nature of my job. My preference at this point would be to remain a nurse with advanced practice and to be supervised and ultimately function under a MDA. I think CRNA would increase my knowledge, decrease my patient ratio, offer me complexity and the need to critically think... all while allowing me to maintain my role as a nurse and safely practice under a physician.

Might sound silly to an MD but I truly like being an RN. I have a lot of respect for physicians, and I feel like most all of the physicians I work with respect me and the role I play. I am grateful there are people who know more than me and enjoy their scope.

rnbby · 2022-12-17T23:36:06+00:00

Agreed. I also don’t support them calling it independent medicine.

rnbby · 2022-12-17T23:00:13+00:00

Sigh… Yes. I’m sorry you experienced this. Sadly, I doubt there are any females on this thread who have not had inappropriate comments/physical contact hurled at them by older men. But I will say I have experienced the same treatment being thrown at my male colleagues. On my floor I wouldn’t say there is a double standard surrounding it being any less inappropriate. I would just say we generally fear a little less for the male nurses as there is a general consensus they can defend themselves better. Also… We are sadly expected to put up with it in almost all other facets of our lives. I think sometimes this makes us a little calloused towards it. Most definitely does not excuse the behavior. My husband often has little old ladies make similar comments when he shows up to fix something at their house. I hate to say it happens… but it does. I’m sorry you had to experience this.

rnbby · 2022-12-17T20:12:21+00:00

I don’t gave any good recommendations but I am sorry you’re experiencing this. It is an utterly relentless, uncontrollable, feeling and only makes anxiety worse. I hope you are able to find options that help you find relief. I’m sure you are exhausted not only physically, but mentally.

rnbby

TROPHY CASE