umcRN 18,721 Views
Joined Nov 28, '10.
Posts: 872 (33% Liked)
I was working in the peds cardiac ICU one day taking care of this kiddo 1 day post op who really wasn't doing to hot. He was acidotic, hypotensive, having respiratory distress, just in general looked bad. We all though he'd be reintubated before lunch. Well it turns out he was not draining from his chest tubes well because the fluid was so thick so the docs on rounds tell me to aggressively milk his chest tubes, which I did roughly every 20 minutes, getting a good amount out.
After a while of this one of the attendings turns up to check on him, she is definitely one of those "I am holier than thou" types and asks me if she can take a turn milking his tubes which I gladly let her so I could get caught up on other stuff. Well when she realized how much was coming out she proceeded to milk the tubes for an hour and a half straight! Now, really if that is what she wanted, continuous tube milking, I could have done it, but he was obviously improving and the other nurses and I knew that she would keep at it just to be able to tell everyone how she "fixed" him.
The best part of all this, as she is going on to her colleagues about how amazing her handiwork has been, the kiddos parents turn up, they talk for a few minutes but then, not actually knowing who she is (she was a new attending for them), ask her if she was the charge nurse that day! The look on her face was priceless! And most of us nurses had to walk away for a minute to not crack up at that comment and watch her stutter in shock to tell them who she was.
Don't know of any good pocket books but check out survivalcards.com they sell small cards packed with info, mainly about meds but have some abg info, intubation info and vent info as well as general vitals for nicu, they also sell a nrp card and peds/pals cards. I have mine attached to my badge for quick reference
I hope you're getting a REALLY good orientation (like 4-6 months). I was a new grad in NICU with 6 mos orientation and then tx to CICU with 4 mos orientation and even with my experience (and previous floating to that unit) I really needed that orientation. As a new grad I think ICU is totally do-able if you're well supported and educated but float pool seems like a whole other ball game.
And never, EVER hesitate to ask questions in the ICU, no matter how dumb it may seem. It could be the difference between life and death. 3 years in ICU and I still ask questions on a daily basis.
I am a 24 year old ICU nurse of almost three years. I was recently hospitalized for a brain tumor & crainiotomy to remove it. It was an enlightening experience for me to be the patient, especially for major surgery and an ICU stay. For the most part though nurses didn't treat me any differently, they still explained, comforted and were present for me. The only people who seemed to take my being a nurse for their advantage were the anesthesiologists. They explained things to me in "our" terms prior to surgery but since I seemed relatively calm they didn't give me any sedation prior to going to the OR, in fact I was being strapped down to the table before being given anything either! And no reassuring words or soothing voices from anyone as I was put under, just a mask placed over my face which I can remember fighting a little because I started feeling claustrophobic and unable to breathe, and I remember the anesthesiologist holding it on my face not even looking at me but communicating over me with someone at the foot of my bed. Ugh. That would have to be my only bad experience of my time there. The nurses and other doctors were wonderful and though I only had a 2 day stay after surgery I made sure to go back with a thank you card and goodies for all the nurses.
I have actually been blogging recently about my experiences, mainly to keep friends and family in the loop. I have a new found interest in spreading awareness about brain tumors, especially because I work in a peds cardiac ICU and have had no experience with anyone with a brain tumor until now.
Horribly frustrating! Similar thing had happened with my 26 year old BMT patient, one day the patient said he didn't want to do this anymore, next thing you know moms getting papers signed to be his POA and making him "incompetent" to make decisions
I also had a similarly frustrating situation happen to myself, not as severe obviously and not at a children's hospital, but I was awaiting a call from a doctors office to make an appointment after a biopsy confirmed I may need radiation/chemo and when the woman couldn't get a hold of me (sorry I showered) she immediately called my dad. She only told him she was calling from "such and such CANCER center" but couldn't tell him why else she was calling, only that I needed to call back and make an appointment. Ok I though the "in case of emergency" contact was for a medical EMERGENCY, not making a doctors appointment. In any case I didn't need treatment at the time but I think my dad lost ten years off his life. HIPPA violation anyone?
Really? With all due respect, I find it hard to believe that a transport team RN can tube a patient more proficiently than a CRNA/MDA. Intubating is a skill, just like starting an IV. The more you do, the better you become at it. If you are not intubating multiple people on a daily basis (And I find it really hard to believe that transport RN's are) then you simply cannot be as proficient as an anesthesia provider at managing an airway. This includes tubing newborns emergently as well as 430 pound pts. presenting for laparoscopic gastric sleeves; all of which are not uncommon during an average day for an anesthetist.
You need to consider your feelings towards each age group. You can become a clinical instructor in any of the units though I would say more likely so from Adult icu or picu.
Having worked in both NICU and Peds CICU I can think of a few things to consider.
How are you with families? Family members are going to be a much bigger presence in peds & nicu, there is a lot of teaching them and a lot of learning from them. They are another member of the childs care team and we must work together to have the best outcome for the child.
Are you good with kids? Silly question maybe but this is an important part of working in a PICU, you have to be able to identify with all age groups, neonates, toddlers to teenagers and if its a cardiac unit then even adults with congenital heart issues. You have to be a little silly, willing to do an assessment on the floor and sometimes chart with a toddler on your lap (yes, even in the ICU). More so you need to understand developmental levels and how to approach painful/difficult tasks with each age group.
What's your patience like? Even in a level 3c NICU you will spend days trying to encourage an old preemie to eat, it's time consuming, frustrating and actually takes quite a bit of skill.
And then there's your own personal beliefs and ethical issues to consider. Every ICU has ethical issues. In the adult world it's the 92 year old with breast cancer and mets to every organ in the body but family refuses a DNR, in peds its the child abused right to the brink of brain death by moms boyfriend, mom won't press charges or leave said boyfriend and wants everything done for said child who, if he survives, will never walk/talk/see/hear again. In the NICU its saving the smaller and smaller babies. The "23" weekers who by the time they've been resuscitated really appear more like 22 or even less and now parents want everything done to keep essentially what was trying to be a miscarriage, alive.
Now picture yourself someday doing chest compressions, because in an ICU it will happen, what is the age of the person you are working on and does it seem like something you can handle? For me I could never do compressions on that 92 year old and feel ok about it. Sometimes I still don't feel ok about it with the kiddos, but when we have a good outcome, and many of them are, I feel satisfied that I've helped that child potentially have a meaningful life.
Don't go after something because of what you think you might want to do someday because that can always change once you've spent time being a nurse. Think about the present and what appeals to you right now. Also what is available to you. It's much easier to move around in nursing after getting that initial experience and you may find what you thought you wanted to be completely different in a few years.
llg is also right in saying that there are few ICU focused clinicals to teach. I do have a friend of mine though who works in the peds cardiac icu and she teaches a clinical elsewhere in our children's hospital, but she's in school to be a peds NP therefore has done her own work and additional clinicals outside of the ICU setting
Had a ten year old who was from another country, had been very sick for weeks, now doing better but her poor hair was matted to the core. Her mother had been working on it for days and finally resorted to cutting some of the mats out. She actually had very long hair so you couldnt tell where the cut parts were but she was sobbing and sobbing. Well I had brain surgery a few months prior and they had shaved a few inches off the front of my head, it's a fairly interesting look to say the least so I started showing her my hair, telling her about my surgery and how my hair was growing back but looked really silly for a few weeks. She shooed me away and said "but that is the style in america!" Haha oh I wish, but she made me laugh
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