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Joined: Sep 17, '09;
Posts: 37 (46% Liked)
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Hmmm. Something about 120+ degree temperatures and indirect fire doesn't seem too sugar coated.
Well those of you who didn't hear from UMDNJ's program...count it as a blessing...the program truly sucks and be thankful for getting into Columbia's program..it's more money than UMDNJ's but as the saying goes you get what you pay for..you pay very little and that's exactly what you get in terms of education...very little. I truly regret turning other programs down for this program where the education is sub-standard at best and I'd be surprised if this school keeps its accreditation. Run for the hills!!!!!!!!!!!!!
I personally just don't care to spend two years in the ICU or even less really.
Could also be he only has 1 1/2 years as in ICU nurse. The applicants he was competing against may have had more than that on average. While most programs say 1 year is the minimum required, I'm sure most applicants to CRNA programs have 2 years or more. Tell your husband to stay strong and keep going for it!
Here is a general outline that may help you prepare:
1. Complete nursing school (if you haven't already).
2. Find work in a good ICU. Spend at least three years there learning and working with critically ill patients.
3. Take ACLS, PALS, NRP, and TNCC (or another trauma course).
4. For a bonus, work two years in an ER on top of your ICU experience. The combination of this experience will be very helpful.
5. Get certified. Take your CCRN exam (or CEN, or hell, take both if you have ICU/ER experience).
6. If you have the time and want an edge on pre-hospital knowledge, take PHTLS and an EMT Basic course. If you are really a hard charger, you can go all the way to your paramedic certification, but it isn't necessary to become a flight nurse.
7. Most important of all, be patient. There is no substitute for experience. Do not try to rush it. Being a flight nurse requires quite a bit or learning and critical care time. When you put on that flight suit, all you will have to care for the patient in your aircraft is the medic by your side, the supplies in your bags, and the knowledge in your head. That is why the years of experience matter so much. Take the time to build your base knowledge and hone your skills.
8. Once you have all your ICU (and/or ER time) plus certifications, start applying to flight programs. Do not get disappointed if you don't get hired right away. There may not be any openings when you start looking. Just like iten #7, be patient. You may have to consider applying for flight positions a good distance from your home to get your foot in the door. When you do finally get an interview, get ready. You will most likely sit in a panel interview where your critical care knowledge will be assessed. The company is looking for good flight nursing candidates. They will have a pretty good idea after that interview if you know your stuff or not. When you get through the interviews and are given a job offer, that's when the training will begin. After that, congratulations! You have made it! You are now a flight nurse!
This is just an outline of what you can do. However you go about it, good luck down the road!
If what you really want is to be a flight nurse, why not focus on becoming a flight nurse? I don't see how CRNA school fits into that scenario ...
I took around an $8.00 per hour pay cut from my previous ICU job to become a flight nurse. Not so great. Since my wife is also a nurse, I can handle the pay cut. The upside for me is only having to work 8 24-hr shifts per month. I also like the autonomy and experiences of being a flight nurse. If you are looking into this career path, understand that most markets will pay less than hospital jobs. For the all-to-real hazard of plummeting from the sky to an untimely death, the pay is kind of lousy. All I can say is you come to this job because you want to do it, not because it will make you rich. What more can I say?
Consider the educational preparation. As a CRNA, your expertise will be the administration of anesthesia and management of the peri-operative and immediate post-operative patient. This does not necessarily translate to the knowledge needed for managing patients during flight. Now, on the other hand, doing flight nursing first could help you prepare for a CRNA career down the road. The autonomy of flight nursing combined with the advanced skill set and critical decision making skills would be a big plus for anyone looking to apply to a CRNA program.
I guess my take away point is - get some really high end critical care experience. Mix this CC experience up and really challenge yourself. Keep you foot in the ambulance and your nose to the grindstone for a few more years. I am not trying to discourage you, just hoping to give you a snapshot of the realities (some harsher than others) that the under-prepared will face. I want you to avoid that. Sure, flying is cool and all that - but, it is just a way to get an often really sick patient from point A to B. It is a job and has inherent risks and challenges (this year has been less deadly, but 28 of my colleagues died last year) - so, be sure.
Hello there. I am one of those nurses who has been on the front lines with a forward surgical element. Yes, it can be scary. Yes, there is always the chance you could get hurt. And yes, PTSD is always a concern for anyone who goes to war. The way I dealt with such issues was always remembering it was never about me. It was about being there for those troops who faced the enemy day to day. There will always be fear in our lives to deal with. It is not unusual to feel uneasy about signing the dotted line for the military. There have even been days where I seriously wondered why the hell I joined up. The decision to make that final leap into the Army is one that only you can make. All of us on the forum will give you advice or support based on our experiences and perspectives, but we cannot tell you what is right for you. Take a deep breath and think about what it is you really want to do. When you can face your fears and still do what needs to be done, then you have found your own personal courage. The Army Nurse Corps life is not always easy, but what we do is always important to someone, somewhere. I wish you the best, no matter what choice you make. Take care.
Speak to your unit S-1 if you have an questions. He/she should be able to access your permanent records through HRC to check what awards you have. However, in your case, if you have not deployed, were recently commissioned, and have completed OBLC, and have not received any commendatory medals then you should have the following:
1. Army Service Ribbon
2. National Defense Service Medal
If you have completed three years of service in the reserves, then you are eligible for the Army Reserve Component Achievement Medal (basically a good conduct medal for reservists). As the other forum members have stated, if you don't have proof of the award, you can't wear it. I would recommend creating your own military records at home. Make copies of any awards you receive down the road. Scanning them into an electronic format is also useful (you can email the awards to a promotion board in the future). Take ownership of your military career. While your unit staff can be helpful, in the end, you are the only one who can ensure that you have all your paperwork that is necessary. That's just the Army. It's a big green machine and stuff will get lost if you don't stay on top of it. Now as for the rest of your uniform needs, you can google Army Service Uniform and find the official Army website that will explain how to set up your uniform. Also, as JeckRN has pointed out, look up AR 670-1. This is the official regulation that states exactly how and where items should be on your uniform. Good luck with that uniform inspection down the road!
Getting Hawaii or Germany out the door as a new officer is difficult, but not impossible. I would suggest a large medical center like San Antonio (BAMC), Ft. Lewis, WA (MAMC), or Walter Reed Army Medical Center to get your basic nursing experience. Those places have a large patient population that will help you learn. I think the Army is trying to keep new nurses from deploying during the first year post-graduation, so you may be in luck. I know that was a goal of the Army Nurse Corps, but all things are subject to the needs of the Army. Good luck and thank you for joining up!
Wow, I have never heard of a "Nurse Marshal". You'll have to keep me updated on that. It would be an interesting job for sure.
They have something like 30 slots (nationwide!!!) for all of 2010. Good luck!
You might be missing the bigger picture here. Consider the variables that affect your BP:
1. Preload (volume present in the ventricles prior to systole - think of it as the
amount of volume available for the heart to push out)
2. Afterload (resistance the left ventricle has to overcome to pump blood to the body)
3. Contractility (the strength of ventricular contraction - stronger squeeze = better cardiac output)
Look at these three areas for an answer. Since your patient had a screw placed in the femur, I am assuming a femur fracture was present. How much bleeding was there before surgery? What was the EBL intraop? How much fluid resuscitation was given post-op? You may be dealing with a pre-load issue here. Elderly patients who are hypovolemic will sometimes develop A-fib due to the decreased volume (less ability to deliver oxygen to the body, including the heart). If she has chronic A-fib, than this is probably less of an issue. The presence of beta blockers can further complicate your situation by reducing myocardial contractility, reducing her cardiac output. Cardiac output is calculated by multiplying the stroke volume (amount of blood ejected from the left ventricle with each beat) x the heart rate. If your patient has decreased preload and therefore a lower stroke volume, the heart attempts to compensate by increasing the heart rate. This will increase the cardiac output. This situation may explain why your patient's BP improved as the HR went up. Not knowing anything else about your patient and judging by the history presented, I would venture to say she needed more volume. This would increase preload for the heart and also optimize Starling's law with her left ventricle. Some fluid boluses would have probably helped out and improved the BP. One thing you did not include in this scenario was her urine output. That would also be another indicator of how well your patient was resuscitated post-op. Of course, all these numbers mean nothing compared to how your patient tolerates the low BP. Was she A&O x 3 or was she disoriented? Did she have clear lung sounds or were there crackles in the bases? Did your patient have warm skin or was she cold and clammy? Those assessments will let you know if that BP is an emergency or being tolerated. It's the classic "treat the patient, not the monitor" situation.
As for the situation with calcium channel blockers, remember that there are three separate sub-classes of these drugs (benzothiazepenes, phenylalkylamines, and dihydropyridines). Cardizem belongs to the benzothiazepines, which causes vasodilation and also has cardiac depressent effects similar to beta-blockers. I would say that your desire to hold the metoprolol in the face of hypotension and the patient being on a Cardizem drip was a good one. Further reduction or myocardial contractility in the presence of possible hypovolemia and an existing EF of 40% would not be optimal for this patient. I hope this helps you get closer to the answers you are looking for. Cheers!
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