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Biffbradford 9,454 Views

Joined: Sep 23, '10; Posts: 1,117 (48% Liked) ; Likes: 1,707

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  • Apr 1

    Quote from tablefor9
    3 words: Ready for step-down!
    More like ready for a trach.

  • Mar 14

    Some units are better than others in this regard.

    Always assume good intent.

    Keep smiling and don't let them see you sweat. If they are out to 'get you', then don't give them the satisfaction.

    Ask for help when needed so that you don't go down in flames. Patients crash, sometimes there's nothing you can do to prevent it, but the seasoned nurse will say I NEED HELP IN HERE!

    Be like a duck ... keep a cool head and calm exterior, even though under the surface you're paddling like crazy! The patients appreciate it, as well as the families, doctors, ..... and I think it helps you too.

    I might be thinking to myself - Gawd, just get me OUTTA HERE! On the drive home, I might roll up the windows so I can scream, curse, and swear at everyone I spoke with that day, pounding the wheel ... but not at work. Whatever you need to do ... take your time, do it right the first time, and move on. Your shift WILL END. (even those 12 hour marathons)

    Get your experiences and later you can move on to a unit that's a better fit.

    GOOD LUCK!

  • Feb 25

    Quote from bug2621
    I just found out that my preceptorship is in the cardiothoracic ICU and I'm excited but extremely nervous. What should I brush up on to not only be at my best but also impress my preceptor and show her that I want to learn. I guess I'm looking for what drips and meds to be aware of and what post op assessments/interventions I should brush up on as well. Also any helpful advise that you can offer would be great!!! Thanks!!
    15 years cardiac ICU speaking here:

    Don't try to impress, just be a sponge and absorb. Don't pretend to be a know it all, because you don't know squat and we know it!

    Be thorough in your work, don't take shortcuts, and if you're not sure ... ask someone.

    Cardiac patients, especially surgical, can turn bad in a wink of an eye, so stay on top of things. For example, if the pt is peeing a lot, or very little ... check a K+. Bleeding? Get an HCT. Not breathing right? ABGs. Got a gut feeling that something isn't right, even though they 'appear' okay? Go with your instincts.

    Need specifics? Start with the basics: EKG recognition. Review simple pressors like Dopamine, and Vasopressin. Inotropes like Dobutamine. Anti arrhythmics like Amiodarone and Lidocaine. Other common drips: Insulin, Lasix, Fentanyl.

    Push drugs: Morphine, Fentanyl, Digoxin, Protonix, Zofran.

    The CTICU/CVICU can chew you up and spit you out EASILY so just take it slow and don't get discouraged if you have a bad day. My first few weeks I wanted to quit every day. After a month I only wanted to quit once a week. After 5 years, nothing bothers you anymore and you're on top of the game. After that, it just gets tiring and you begin to want to quit again, but for different reasons.

    It's very rewarding however, and such an eye opener ... you have no idea.

    GOOD LUCK!

  • Jan 5

    Quote from HeyNurse09
    I'm sure every nurse has felt burnt out at some point in time but just remember why you chose this profession. Even though you feel your at your wits end remember you have made a positive difference in someone's life and probably don't realize it! Stay positive you can do this
    Speaking for myself, making a positive difference in someone's life had no bearing on the fact that I was miserable, sleep deprived, and would be constantly watching the clock. "Okay, only 11 hours 15 minutes to go." hoping and praying that I wouldn't crash my car when I fell asleep at the wheel driving home. If you've reached the breaking point, then nursing shouldn't be a jail sentence that must be endured just to make someone's stay at the Hilton more pleasant. Once a nurse, always a nurse? NOT! After working the past 10 out 15 Fourth of July Holidays, THIS one I enjoyed!

  • Nov 13 '17

    Quote from tablefor9
    3 words: Ready for step-down!
    More like ready for a trach.

  • Nov 13 '17

    Quote from tablefor9
    3 words: Ready for step-down!
    More like ready for a trach.

  • Oct 25 '17

    Speaking from first hand experience, I can't say that going straight from school to ICU is a necessarily a good idea. Irregardless of how brainy you are, or 'worldly', the first few months for you will most likely be like a deer in the headlights. I'm not knocking the idea, but just suggesting that you stay open to the possibility of some med-surg first where you will still learn a TON without all the stress of having patients trying to die on you right out of school. FWIW

  • Oct 5 '17

    I'm in the exact same boat as you, except substitute in the month May. Just today, I see that a local hospital, less than 5 miles from me, has opened up 5 ICU positions and I have found them advertised AROUND THE NATION. So, I apply and send them my resume:

    https://docs.google.com/document/d/1.../edit?hl=en_US

    ... and in less than 1 hour, I get:

    We have identified an initial group of candidates that we are pursuing; at this time you are not being actively considered for this role. Should the situation change, we most certainly will contact you.

    That's complete BS.

    I'm trying to find the email or phone #s of the unit manager since HR obviously is clueless.

    Hang in there, we will WIN THIS FIGHT!

  • Sep 9 '17

    I would say that 8 weeks orientation is on the short side, but to be frank, you never stop learning in CTICU/CVICU and it takes several years to get really comfortable. Fresh post-ops are heavy on fluid replacement as they third shift everything, as well as bleeding management (giving lots of PRBCs, FFP, Platelets, managing clotting chest tubes), while at the same time, dealing with confused/restless/intubated patients, multiple inotropes/pressors/insulin drip, rhythm changes/pacemakers, family ... and hopefully you're one-to-one and not managing another patient at the same time!

    Good comaradere with solid team members is key to survival.

    It's very challenging so say the least.

  • Sep 5 '17

    READ YOUR ORDERS

    Every surgeon will be specific as to what will need to do.

    You cannot do chest compressions, the chest is open so it would have to be direct cardiac massage. Only saw that a few times and always by the surgeon.

    As far as defib, our surgeons always left a metal retractor in place to hold the sternum open, so there's no way you could use external paddles. We had internal paddles in the bottom drawer of our code carts right along with a chest opening tray that had all kinds of nasty goodness inside.

    LVAD/RVAD - READ YOUR ORDERS. In most cases - no compressions. Depending on the type, if the VAD fails, there is usually a hand pump or something as a backup.

    Good question!

  • Sep 2 '17

    I don't remember any of the details (thankfully), but I DO remember getting to my car, driving off the property, rolling up all the windows and SCREAMING $&(@(*#!! BLOODY MURDER and slamming the steering wheel.

  • Aug 11 '17

    Don't beat your self up over it. If you're unable to get an SpO2 or ABG's, or even a real blood pressure, then you're really fighting a loosing battle, it was their time to go. Pat yourself on the back for doing the best you could on that day, and move on.

    Hopefully, they didn't have you pick up another patient right away once you cleaned up that disaster!

  • Jul 30 '17

    I left, took 2 years off because I got burned out, went back for another year and a half and got burned out again. The 'medical' part is still interesting, but am totally sick of the politics which is getting worse and worse and tired of the highlight of my day getting a patient to finally take a crap after surgery. Look what I accomplished today! Whooo Hoooo! Yeah, the money is pretty good, but I also don't want to fall asleep driving home anymore.

  • Jun 13 '17

    There are times though, when patients ARE on their lights too much. Their families tend to their every whim in day to day life, and now it's YOUR turn.

    "Oh, straighten the wrinkle out of the lower corner of the pillow. Nooo ... the other side!"

    "Okay, wait, don't go away .... give me a minute to see if that's okay."

    NO!

    Here's your Percocet, it's time for you go for a walk in the hall. When you get back, brush your teeth and sit in the chair for a FULL HOUR to do your coughing and deep breathing.

    I know, that's not the case every time, but there are times when you need to lay down the law. It's your job to help them get better, and if it's a kick in the a** they need ... then that's what you give them.

    When they've done their part, then I'll give them a back rub. Not before.

  • May 11 '17

    Quote from That Guy
    I stop being a nurse the second I leave the hospital. My job is not who I am, or even a part of me. Who I am is reflected in my job though.
    +1 agreed



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