Latest Comments by Fox_RuN

Fox_RuN, BSN 3,272 Views

Joined Aug 31, '10 - from 'The Great Lakes'. Fox_RuN is a Registered Nurse. She has '7' year(s) of experience and specializes in 'CVICU, Cardiac/Telemetry, SICU'. Posts: 35 (46% Liked) Likes: 35

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    I'm currently getting ready for my first travel assignment through the University of Colorado. I'm already looking towards next steps though. Does anyone have experience with the Alaska Native in-house travel program? Not a lot of info on the website. I'm from Michigan so the prospect of winter travel nursing in Alaska doesn't bother me, especially if it means extra benefits/pay.

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    We are nurses. What's a weekend and holiday, much less a "day"? Because I, and many of us, don't get them. P.S. coming from a union hospital here.

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    Hey all,

    I'm a current, experienced CVICU RN from the University of Michigan am looking to relocate to Portland and OHSU's CVICU.

    I'm planning a trip back out there in March and have been trying to get a hold of the nurse manager via e-mail to set-up a shadow time just to make sure the unit would be a good fit before I start getting serious about moving. I e-mailed this past weekend and haven't heard back yet (is she difficult to get a hold of via e-mail? on vacation/leave? etc...?)

    I saw there were job postings up now, but I'm hoping there will be listings May-August.

    I have 7 years experience with everything from basic LVADs to ECMO, BSN grad from University of Michigan, SICU/CICU float experience, Ebola/BSL4 training, won a fellowship position and am currently publishing an article with AACN. I'm pretty sure I would be a fairly "turn key" nurse on that unit, but I just want to see the unit and hear candidly from nurses who work there about the unit. Also makes me nervous I haven't heard back.

    Thank you!

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    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.

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    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.

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    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

  • 5
    kmichellex, Drodri555, val421, and 2 others 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

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    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

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    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.

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    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...

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    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...

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

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    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.


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