A roundtable for New Nurses, Student Nurses, Veteran Nurses, and everyone in between.
(A sister site to The All Nighter)
I would just like to take a moment to express my deep appreciation for my trusty dusty clamps. I never set foot onto the unit without a pair or two hanging from my scrub top, and I’ve never gone a whole shift without needing them. Whether they are kinking off IV tubing, twisting off a cap that is waaaay too tight, helping me find a leak in a chest tube, or simply holding closed a rip in my uniform, I love them so. I don’t think any nurse should ever be without them.
What’s one thing that you couldn’t do your job/clinicals without?
I had a patient this week, a woman with metastatic cancer recovering from major sepsis which admitted her to the intensive care unit.
I was told in report by the day nurse, “Please medicate this patient with pain medications around the clock per families request” because the “patient will not ask for it”.
I understand that some patients may be reluctant to take pain medication or be hesitant to admit their true level of discomfort. However, this patient did not verbalize any pain. She did not appear to be in any pain. The patient denied having any recent pain and was resting comfortably upon my assessment.
Then…the family arrived. They stormed to the nurses station and demanded to know when the last time the patient was medicated for pain (which was over twelve hours ago).
They were incredibly upset with me, believing that I was neglecting the patient and her “pain”. I felt a lot of pressure to administer pain medication to calm the situation. Although the patient had not verbalized pain a few minutes earlier, the daughter coaxed her by asking over and over again till the patient finally broke down and agreed. I didn’t want to administer the pain medication, as I knew it would add to the patient’s already increasing lethargy and confusion, but at this point I had to. Pain is whatever the patient says it is, after all.
I tried to educate the family on the fact that pain medication is given as needed. I explained that we will give the patient as much pain medication as needed until she is comfortable, but that our goal is to not give her more than she needs. What I really wanted to say was “I know you are having a hard time dealing with the sickness of your loved one, but controlling me and the timing of medications does not mean that you are controlling her hospital course or her health”.
So many times I have seen families become fixated on one thing - thinking that if they can control something in the hospital, they can control their loved one’s stay.
I can understand that desire - the hospital (and especially critical care) is a chaotic, unfamiliar and scary place. To acknowledge this, I do my best to educate families and patients on medications, protocols, equipment and even the sounds of the hospital. When families and patients are more included, they tend to feel more comfortable with you and gradually become less controlling.
How To Troubleshoot Air Leaks in Chest Tube Systems
An air leak is a sure-fire reason to keep a chest tube in place. Fortunately, many air leaks are not from the patient’s chest, but from a plumbing problem. Here’s how to locate the leak.
To quickly localize the problem, take a sizable clamp (no mosquito clamps, please) and place it on the chest tube between the patient’s chest and the plastic connector that leads to the collection system. Watch the water seal chamber of the system as you do this. If the leak stops, it is coming from the patient or leaking in from the chest wall.
If the leak persists, clamp the soft Creech tubing between the plastic connector and the collection system itself. If the leak stops now, the connector is loose.
If it is still leaking, then the collection system is bad or has been knocked over.
Here are the remedies for each problem area:
- Patient - Take the dressing down and look at the skin entry site. Does it gape, or is their obvious air hissing and entering the chest? If so, plug it with petrolatum gauze. If not, the air is actually coming out of your patient and you must wait it out.
- Connector - Secure it with Ty-Rap fasteners or tape (see picture). This is a common problem area.
- Collection system - The one-way valve system is not functioning, or the system has been knocked over. Click here for an example. Replace it immediately.
Note: If you are using a “dry seal” system (click here for more on this) you will not be able to tell if you have a leak until you fill the seal chamber with some water.
kittenzrule-deactivated20120110 said: Thanks for following me back! I was wondering what kind of nurse you are? Your advice and pointers are great, and so helpful to a student nurse :)
My pleasure, kittenzrule!
Thanks for reading, I hope this blog helps student nurses and new nurses out… I’ve been there, and I’m still making the transition from student to novice. I know as well as anyone that once in a while you just need a good laugh or a prod in the right direction!
I’m a fledgling critical care nurse in the Surgical ICU. It’s my first job out of nursing school (I just started in January) and so far I love it! I’m learning so much and every day is something new and challenging. What about you? Any ideas about specialties yet?
gingaaaaa said: Hi! just now i thought of using tumblr for nursing school purposes and i found you! =) so my question is, how important are summer externships? My school has been putting a great emphasis on it and sadly enough, none of the hospitals i have applied to has gotten back to me yet, thinking that summer is almost here! what do you suggest do I do? Would it GREATLY affect my ability to get a job after I graduate
Thanks for the question, gingaaaaa!
My suggestion to you would be to make the most out of this summer. Call up some hospitals ASAP, tell them you are a student nurse and when your anticipated graduation date is, and ask if there are any opportunities available for you. Paid or unpaid. See if you can volunteer somewhere or shadow a nurse, especially if you can find an opportunity in the clinical area you’re interested in. Or look for a position as a nurse’s aid that you could possibly continue into next semester. I did a summer externship, and the skills and concepts we were taught reinforced things I’d already learned in school… Externships are valuable because they expose you to the nursing environment, and steer you towards connections and contacts that may benefit you later. These are things you can certainly accomplish without the official title!
In terms of finding a job, it all depends on where you live. I live in New York City, and it was hard enough to get anyone to read far enough into my resume to find out I’d even done an externship. In the end, the thing that got my resume noticed was not my summer externship, but my GPA… and of all things, the format. When I interviewed with my current nurse manager, she complimented me on the way my resume was put together and barely even asked about my externship. Meh, c’est la vie. But job hunting and interviews are another entry entirely, gingaaaaa my friend.
Good luck to you!