Latest Comments by Fox_RuN

Latest Comments by Fox_RuN

Fox_RuN 2,845 Views

Joined Aug 31, '10. Posts: 32 (50% Liked) Likes: 34

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  • 0

    Quote from meanmaryjean
    Camp nursing is not year-round employment, just so you know. And many camps (church camps in particular) rely on a weekly-changing parade of volunteers, not a full-time RN.
    I'm not seeking full-time employement, so camp nursing is perfect in that aspect...one of the reasons I graitated to it.

  • 0

    Quote from bethm214
    I am sure it is not want you want to hear, however, I STRONGLY recommend that you do at least one year of pediatric nursing in a major hospital center. Children are definitely not miniature adults and their needs are very different. How you cope with a child's medical and/or emotional situation is significantly different than anything you would have learned in school or on an adult unit. Children need to feel your confidence. Don't short-change yourself or the children. Get the training you need before attempting camp nursing.
    Thanks for your thoughtful response. You are right, definitely not what I want to hear I will have to get pediatric experience somewhere else...I refuse to work in another hospital again. My hospital was not bad as hospitals went, but the environment was toxic for me.

  • 0

    Has anyone had experience with the website greatcampjobs.com? Are they legit? The description of the camps in their system sound promising... I'm just always skeptical of things that seem too pretty on-line or things that seem too good to be true. Thanks

  • 4
    Drodri555, val421, CCKid2014, and 1 other like this.

    Quote from hbshearer, rn
    So, I just got my transfer request accepted to go to CVICU from med/surg -oncology, which is all I know. I am a fast learner and very dedicated....just wondering if the seasoned professionals have any recommendations to prepare myself for this transition! Taking ACLS next week and they will be sending me to the CCU classes along with additional CV classes. I didn't know if there was anything else I should brush up on, like meds, procedures, etc?? I just want to set myself up for success....thanks!!

    ACLS is a great place to start!

    +Do you know what types of patients you'll be receiving? In my CVICU, we see:
    -CABGs, pre and post-op
    -Valve replacements/repairs
    -Myomectomies
    -Congenital repairs in adults
    -Surgically/medically managed aortic aneurysms/dissections sometimes with lumbar drains/ICP monitoring
    -Pre/post-op and chronic device patients coming in with complications (Heartmate II/Heartware LVAD, Jarvik Heart, Impella, Tandem Heart, IABP, Centrimag, ECMO)
    -Cardiogenic shock requiring device management
    -CRRT/CVVHD patients
    -Heart and lung transplants
    -Miscellaneous thoracic and vascular surgeries (pneumonectomy, transhiatal esophagectomy, lung reductions, fenestration and stents, open femoral vein/artery exposure)

    +Things that almost all of your patients will have that you should be/or get comfortable managing/knowing when there are problems:
    -Chest tubes, both pleural and mediastinal
    -JP drains
    -Pulmonary artery catheters/Large bore jugular central lines and their care/management/calculations, such as cardiac outputs and cardiac indices (CO/CI), central venous pressures (CVP), pulmonary artery pressures (PAP).
    -Arterial lines
    -Foley catheters
    -Bowel management systems
    -Permanent/transvenous/epicardial pacemakers/ICDs and their management

    +Ventilators. Ask your respiratory therapists many questions; Most of them love it when nurses do.
    -Get comfortable with the most common ventilator settings and what it means for your patient
    -Learn what terms like 'PEEP,' 'Pressure Support,' 'Bi-level,' 'Volume Control' mean; don't be afraid to ask an RT to explain a more "exotic" ventilator setting to you, such as HFOV (high frequency oscillation ventilation)
    -Learn why you would use nitric oxide (a.k.a "nitric" as it's commonly referred to)
    -Arterial blood gases (ABGs) and venous blood gasses (VBGs)... learn the norms, learn what they mean...understand what an ionized calcium is (iCal) and why it's important
    -Learn your facility's policy for managing endotracheal tubes
    -Don't be afraid to suction those buggers out either...it'll make your patients cough, but that's the idea ..just make sure their hands are far away from them...having someone self-extubate will ruin your day, but it happens to even the most experienced and attentive of nurses, so don't sweat it too much if it happens...just make sure you get back-up ASAP
    -Tracheostomies

    Know dosages/pharmacology for ALL infusion medications below:
    +Vasopressors/inotropic agents:
    -Norepinephrine
    -Epinephrine
    -Phenylephrine
    -Vasopressin
    -Dopamine
    -Dobutamine
    -Milrinone (this one is special in that it is both an inotrope as well as an afterload reducer)

    +Afterload reducers/blood pressure reducers,
    -Nitroglycerin
    -Nipride
    -Esmolol
    -Fenoldopam

    +Sedatives/analgesia:
    -Propofol
    -Dexmedetomidine
    -Midazolam
    -Fentanyl

    +Paralyzing agents (less commonly seen, but still seen):
    -Cisatricurium is the most popular one we see in our CVICU as an infusion... always make sure there is some sedative to go with this! Also, get comfortable with the term "train of four" in relation to intentional paralysis
    ---------------------

    +Telemetry, telemetry, telemetry! ACLS will take you a long way, however, become more intimately familiar with some more obscure things such as reading a 12-lead ECG, identifying ST-elevations/depressions, bundle branch blocks, electrical alternans, etc... it will pay off, can save your patient's life and will impress those around you

    +Common surgical complications, identification/management:
    -Clotted chest tubes
    -Conversely, too much chest tube output
    -Things other than blood/serous fluid coming out of chest tubes (stool, pus, chyle)
    -Cardiac tamponade (Look at your chest tubes, your ECG, your arterial/pulmonary artery waveforms/values as well as assessment findings)
    -Various pneumothoraxes

    +Get comfortable with blood product administration (PRBCs, FFP, PLTs, cryoprecipitate, albumin) and coagulation labs and monitoring

    +Be prepared to give pain meds, and lots of them...PCAs, fentanyl infusions and epidurals will be your friends

    +End-of-life/comfort care.. who runs your codes? Do you hit the "Code Blue" button or a "Staff Assist" button? We run our own codes, so we hit "Staff Assist." Utilize appropriate resources like bedside music, chaplains, social work, palliative care, etc... also be familiar with your state's organ donor policy

    + Know your hospital's restraint policy...and don't be afraid to use them if needed...some things are definitely worth the paperwork

    +A sense of humor! You will see some wacky shizz working in the ICU...laugh about it with your co-workers...it helps blow off some of the stress!

    WHEW! The above was a hitting on the more common things you'll experience. Some of the more advanced devices, if your hospital uses them (like CRRT, ECMO, Centrimags) will come with time as will taking sicker and sicker patients. Anyway, most important, find your resource people! Ask your charge! ALWAYS, ALWAYS ask if you have a feeling something isn't right or you're not sure of. The one thing the ICU builds is confidence; speaking as an extreme introvert, it took a while for me to be brave enough to question the doctors and/or go up the chain of command if necessary. There is a steep learning curve coming from the floor going to the ICU, especially a place like a CVICU. Ask questions, listen, ask to see/help in procedures you've never experienced before.

    If you have any questions in particular, feel free to grill me; I'd love to pass on my experience while it's fresh since I'm leaving the big city very soon for the boondocks and camp nursing

    icufaqs.org is a great on-line reference that I still peek at now and then too

  • 1
    Bossy Boss likes this.

    Quote from Dodongo
    Wait - so you're not an ICU nurse? But you were hired as a float RN for an ICU? How? Do you have an orientation? I hope you do. How else would you know how to manage the MI, arrests, drips, invasive monitoring, swans, IABPs, etc. This just sounds strange (read: a bad idea) to me. The float nurses at my hospital had to have at least a year or two of ICU experience.
    I second Dodongo without further information.... Are you floating to other ICUs, with your home base being in CCU? Yes, get a good orientation!!! You need to learn about vasopressor medications, medications that reduce afterload (i.e. nitroglycerin, nipride), IABP, pulmonary artery catheter management in conjunction with obtaining/calculating CVP/PAP/PAW and CO/CI especially by the Fick method, STEMI management, basic as well as advanced dysthythmias. Best advice, get your ACLS ASAP...you will need it working there

    Not to overwhelm, but you have a lot of work ahead of you if your only prior nursing experience was working med/surg. Definitely do-able, but prepare for a steep learning curve...if your CCU is anything like our CICU and CVICU, you'll be taking care of some of the sickest patients

  • 0

    I've been stuck with a (clean, thank goodness) needle before, after a patient got combative with me.

    Always keep a step ahead of your patient, get help holding down limbs if necessary, especially if you have to do IVs or butterfly blood draws where you can get stuck a bit easier if they decide to spaz out on you

    All depends on the area you're working in too...psych, ER and ICU I'd say have the highest risk...

    More common though are flushing those feeding tubes..it's like being shot...only with stomach/intestinal contents...always get a good grip, especially if you have a suspicion it may be clogged (and if it doesn't flush, check your tube clamps!) All of the above learned the hard way

  • 0

    Quote from CloudySue
    We're bringing my daughters' bunny rabbits this summer, but they do have an Animal Care program and an available hutch. I've seen dogs at camps. You just have to ask around!
    Which camps have you seen them at if you don't mind me asking? I will bring it up for any interview I have, but it's nice to know before hand what expectations are.

  • 0

    Also, are there any winter camps out there? I remember going a camp in winter with my 5th grade class, but that was a special session...

  • 1
    NCmcMan likes this.

    To Campnurse1....Maybe this really is EXACTLY what I need. I need a nursing job with autonomy that lets me be my quiet, introspective self. Just playing my guitar, reading, fishing. A job that keeps my nursing skills sharp, but lets me enjoy the woods I so desperately crave right now...

  • 0

    Which camps will let you bring pets? Dogs? I'm having a tough time doing some google searches on it

  • 0

    A background on me:

    -Moving from S.E. Michigan metro working at large, academic (adult) CVICU to tiny Ontonagon in Michigan's upper peninsula (Ontonagon is about 180 miles from Duluth, MN). Have a total of 3 years nursing experience out of school. I'm originally from northern Michigan and want to get away from the city. I miss being in the woods.

    - Have my Advanced Wilderness Life Support Certification and am a member of the American Holistic Nurses Association and am wanting to leave the hospital environment and preferably take care of some baseline healthy people in beautiful outdoor settings (I've decided hospital nursing isn't quite for me, although working at CVICU has shown me I can keep my cool when the world is literally crashing down around me and touch anything as long as I have gloves on oop:)

    -Embarassingly, I am much, much better at giving last aid than first aid, even though I'm comfortable handling multiple, complex extracorporeal devices such as centrimags, impella, CRRT, IABP, various LVADs, lumbar drains/ICP monitoring and titrating multiple drips.

    -I'm pretty good at wound care though, I do have to say.

    -I have no peds experience, only intermediate cardiac/telemetry experience before CVICU.

    - On my tombstone, I hope it will read "She worked herself to the bone...no, seriously." In other words, I'm not afraid of hard work. I get teased at work because my patients are always clean, generally stablized, expired gtts changed and back-ups ordered for the next shift and the lines/dressings/tubes/tube feeding supplies are organized, untangled, labelled and dated. If I'm sitting too long, I become suspicious and say, "Damn it, there must be something else I can organize or label!"

    -I unfortunately tend to be an introvert (I'm the weirdo who prefers organizing lines in her sedated/intubated patient's room rather than sitting idly on Pinterest chatting). I'm friendly, professional, and a forceful patient advocate when needed.. However I'm really just an awkward only child who likes to be involved in her work versus idly socializing. I'm not a big one for small talk and especially gossip. Another reason I want to leave the hospital.

    -Also, the ICU environment is physically and emotionally draining. I'm 25, physically fit, however only weigh 54kg. I'm tired of wrestling confused, 140kg men and my back coming out the losing end . I'd like to be in a place where the majority of physical demands come in the form of hiking, rather than lifting/wrestling. I think I'd like to retire from the WWF as "fun" as being "The Sedater" is.

    -----------------

    -Okay..... so as a hopeful camp nurse, I plan on reading "The Basics of Camp Nursing" and I have sections picked out to peruse in my Wilderness Medicine textbook by Paul Auerbach. What other resources should I look at? What general recommendations/tips do you have?

    -What camps do you all have to recommend in the Michigan, Wisonsin, Minnesota area? Are there other camps in other states you'd recommend that pay for license transfer and travel expenses as well as food/lodging? I'm not going to have another job other than maybe some flu clinics, so length of stay/time of year of camp isn't as important, however I'd prefer assignments 4 weeks or less. Which camps have a great support system/resources?

    -Also, not required, but STRONGLY desired; which camps will let you bring your dog, if any? I haven't adopted one yet, but would like to bring future dog with me (well-trained of course) if at all possible. Although partner could watch him/her while I'm gone temporarily, he's not really a dog person/trainer in the way I am.

    Thanks so much you all!

  • 1
    Ruby Vee likes this.

    Obviously you and the people who liked your post have never been stalked by a patient before have you? Until you've had strange calls on your cellphone and creepy friend requests on facebook, you should probably not be speaking about this with any authority.

    The examples you give... nurses deal out very painful and unpleasant treatments sometimes. Police deal with much unpleasantness, but to be blunt, they get to carry a gun to protect themselves.

    Teachers, secretaries, social workers don't poke people and insert things into peoples' orifices on a daily basis. Paramedics poke people, but sometimes they aren't even conscious and they don't care for those patients for as long as nurses do.

    I'm not in psychiatry either; intensive care, rather.

  • 1
    itk3838 likes this.

    I started out of nursing school on a cardiac telemetry step-down in a big teaching hospital. I worked there for a year and a half before transferring to their CVICU. There we get frequent transfers in massive cardiogenic shock and cardiac assist devices from outside hospitals via survival flight.

    You are one step away! Sounds like you'll be in good shape.

    The other thing I forgot to add is that you will want to make sure you work with peds at some point. Our ER has two separate ERs, with one just for peds. Not sure if yours is like that or if you will get all of them in which case it'll be easier for you and you'll have to spend less time getting your peds experience.

    I had looked extensively into flight nursing at one point, but ultimately decided that it probably wasn't for me. Never completely closed it off as they are all awesome, insanely intelligent rockstars, but just some of the cases they have to transport...I am not a squeamish person but would have difficulty transporting an infant with their face blown off by gunshots...

  • 7
    maloneys, lwnet, lcmtcrn1, and 4 others like this.

    I loved reading the other posts (neuro, pediatric, general nursing). I thought that we in the ICUs/CCUs could come up with a good list too.... I'll start it off with what I can think of off the top of my head... (I'm in CVICU for nights so mine might have that flavor to it...)


    -Your heart transplant comes back bleeding, with an open chest and 4 chest tubes and your first thought is, "it's just a flesh wound!"

    -Your ECG leads come off, giving the illusion of asystole. When your co-workers get to the room, you wink and say, "gotcha!"

    -You have a sixth sense of when your post-op patient is going to wake up and reach for the ETT

    -At least 50 times a night you say, "you're in the hospital- you just had heart surgery"

    -Say it with me, "it's like breathing through a straw!"

    -Before you even get to your room for report, you pick up some macrobore tubing, a liter of lactated ringers, normal saline and blood tubing on the way

    -You alphabetize your drips

    -You have figured out a way to arrange a Swan-Ganz catheter to look downright pretty

    -You have seriously considered giving yourself an IV coffee bolus before

    -Your first introduction to a patient was your hand in their groin holding pressure and you asking, "Sooo... how're you doing today?"

    -For cheap entertainment, you bring your co-workers down to gawp at the completely apneic ECMO patient up in the chair

    -You and your co-workers have considered recording an album, entitling it "Ventilators, VADs and Moans - Sirenic Sounds of the ICU"

    Keep it going!

  • 3

    I have nothing but respect for floor nurses- I've never had more than 4 patients at a time, ever. One of my best friends is med-surg/tele nurse in a semi-rural hospital (or as she jokes, "we are the garbage dump for the rest of the hospital"); she'll be in charge with 6 patients.

    I started out as a cardiac telemetry nurse with high acuity patients in a huge university hospital and have been working in their CVICU where we get the sickest of the sick since then. Full disclosure; I have never worked as a nurse anywhere without tele monitors except the clinic I volunteer in (when those people complain loudly, outwardly I'm all sympathetic like, "It must be rough to have a sprained ankle!"...in me head I'm like, "Y'all can walk and talk, autoregulate your hemodynamics and BREATHE on your own, you're doing juuuuust fine so take a number!") To be fair though, it's all a matter of perspective; I hope they never have to come to my unit and can continue to complain happily and healthily. Just do it away from me

    How do you guys manage without tele?!

    ANYWAY, I have been on the receiving end on the ICU snobbery as a new nurse from the neighboring CICU nurses who would literally sigh when I brought someone over (it wasn't just me either..), EVEN though with time, I had managed to make my transfer reports very thorough for them.....and they would STILL ask irrelevant questions (I say this now with hindsight too...they didn't need some of the info they asked for in order to provide post-arrest care). But, I think that was fairly isolated to that particular ICU and a core group of individuals.

    We also had dual unit nurses who spent half their time on my unit and half in CICU. I used to get miffed when they would hardly ever seem to listen to my report. Now, having worked in a cardiac-focused ICU, I can understand why they did that. My patients were all fairly stable with AICDs/pacemakers; they were fine, no pressors, no swans, no assist devices...they are FINE....go home and sleep little tele nurse....even the sickie chronics on that floor were usually never quite ICU caliber. We all used to get excited when we had a patient on dopamine at 1 ...

    And nowadays when I receive people, I do my very best to be thorough, but gentle, especially as many of the nurses on the floor are newer, and I've been there, not that long ago myself. I've always wanted a chance to grill the survival flight nurses but they don't give a report until at bedside and usually don't stay longer than 10 minutes unless someone is REALLY crashing as they roll them in.

    I think many times, depending on the ICU, if they have intensivists and team with NPs/PAs, at least at my facility, they are grilling us about the details we learned from report, and many times they are not very gentle about it themselves. I think a lot of the snobbery is really displacement originating from the docs and advanced practitioners. It's not right, but there you have it.


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