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DesertSky, BSN, RN 2,360 Views

Joined Feb 21, '12 - from 'Missing the desert...'. DesertSky is a Critical Care RN. Posts: 76 (38% Liked) Likes: 69

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  • Nov 19

    Quote from Nurse_bre
    Hello all,

    I am currently going through the orientation process at a CVICU. I have one year experience on a med-surg tele floor. I am absolutely terrified when I'm on the unit. So many different equipment, lines, diagnoses and a whole new way of doing things.
    I was wondering if anyone had any tips on how to organize your day when you have what it seems like endless charting to do.

    On my unit, you can have up to 2 "stable" ICU patients. You do vitals, check IVs, check the monitor hourly, assess every 4 hours including a head-toe, measure CVP, I/O (unless foley then its hourly) and pacer settings. Stable LVAD is every 2 hours.

    If you have a patient with ECMO, IABP, CRRT, fresh cardiac surgery or a fresh LVAD... you only have 1 patient since everything you do is hourly or less documentation.

    They also want you to do a CHG bath daily, lotion the patient down, etc. (we do not employ aides on this unit)

    Then of course I have medications to give, labs to draw, other care in between.

    I feel like no matter how I try to consolidate, I always have something to chart and I'm always behind. (And this is me coming from a med-surg unit with 6 patients and having everything done by 10am)

    Any recommendations? Advice? Support?
    Take a deep breath and remember to be kind to yourself. You are still on orientation and are learning the flow of the unit on top of additional clinical skills specialized to ICU. Building your knowledge, confidence, and organization takes time.

    The best advice I have is to develop an organized approach to care. For example, after report assess both your patients before anything else. I always assess my more critical patient first.

    I always try to complete as much as I can as early as I can. Pass medications in the hour window before they are due. Stay on top of your charting! Of course this does not always happen in ICU when something emergent occurs, however if you can stay on top of your charting it will help. Realize that you will get faster as you gain experience and your comfort level will also increase.

    Always know who your resources are on the unit and do not be afraid to ask questions. You are a new ICU nurse and no one expects you to know all the answers. Write down concepts or topics that come up that you do not understand or do not know enough about and research them on your days off. Come to work with enthusiasm and a willingness to learn and you will do great!

  • Nov 18

    Quote from Nurse_bre
    Hello all,

    I am currently going through the orientation process at a CVICU. I have one year experience on a med-surg tele floor. I am absolutely terrified when I'm on the unit. So many different equipment, lines, diagnoses and a whole new way of doing things.
    I was wondering if anyone had any tips on how to organize your day when you have what it seems like endless charting to do.

    On my unit, you can have up to 2 "stable" ICU patients. You do vitals, check IVs, check the monitor hourly, assess every 4 hours including a head-toe, measure CVP, I/O (unless foley then its hourly) and pacer settings. Stable LVAD is every 2 hours.

    If you have a patient with ECMO, IABP, CRRT, fresh cardiac surgery or a fresh LVAD... you only have 1 patient since everything you do is hourly or less documentation.

    They also want you to do a CHG bath daily, lotion the patient down, etc. (we do not employ aides on this unit)

    Then of course I have medications to give, labs to draw, other care in between.

    I feel like no matter how I try to consolidate, I always have something to chart and I'm always behind. (And this is me coming from a med-surg unit with 6 patients and having everything done by 10am)

    Any recommendations? Advice? Support?
    Take a deep breath and remember to be kind to yourself. You are still on orientation and are learning the flow of the unit on top of additional clinical skills specialized to ICU. Building your knowledge, confidence, and organization takes time.

    The best advice I have is to develop an organized approach to care. For example, after report assess both your patients before anything else. I always assess my more critical patient first.

    I always try to complete as much as I can as early as I can. Pass medications in the hour window before they are due. Stay on top of your charting! Of course this does not always happen in ICU when something emergent occurs, however if you can stay on top of your charting it will help. Realize that you will get faster as you gain experience and your comfort level will also increase.

    Always know who your resources are on the unit and do not be afraid to ask questions. You are a new ICU nurse and no one expects you to know all the answers. Write down concepts or topics that come up that you do not understand or do not know enough about and research them on your days off. Come to work with enthusiasm and a willingness to learn and you will do great!

  • Oct 22

    I totally understand. I work dayshift in a busy ICU and I often leave work and collapse into bed at home. I used to work 3 12's in a row, but I have found I have more energy breaking up my work week into 2 12's and then another 12 later in the week.

    You must take care of yourself physically and emotionally. Leave work at work and find an outlet you enjoy for your days off. Take care of yourself by exercising and eating well.

  • Oct 21

    Quote from bauern5513
    I'm a new charge nurse in the ICU at our facility and have noticed a lot of friction between the CVOR nurses and the CVICU nurses especially when it comes to the information given in report when the patient is leaving the OR and coming to the ICU.

    The OR nurses claim they should not need to tell the ICU nurses which vessels were bypassed or what was done exactly, that its not important and it wont change the way we treat the patient anyways.

    On the other hand, the ICU nurses want to know everything down to the smallest minute details.

    What is the normal expectation for the report from the CVOR?
    Anesthesia and the CVOR RN's bring the patient to our CVICU recovery bay and we do bedside report. The only thing I care about is that the CVOR nurse call me when they are closing so I can call RT and pull my meds.

    Sometimes anesthesia doesn't even know the details of the operation regarding grafts, vessels bypassed, etc. And it really does not matter in your post-op care. How would your care differ if a patient had a CABG X2 or a CABG X3?

    I usually read the operative report from the CV surgeon once it's up in our EMR. I'm more concerned with hemodynamics, complications during surgery, labs, and things of that nature.

    Are these new nurses to the CVICU? Perhaps they are looking for all this information because they want to be prepared and do not realize the expectation during normal post op CVOR report. If that's the case, some education regarding expectations would probably be useful.

    Good luck and let us know how it goes!

  • Oct 15

    When the charge nurse looks at you when you walk in and says "I'm sorry..."

  • Oct 12

    Quote from gb8852
    Hello fellow Nurses, I am a nurse here in Southeast Georgia. As I'm sure most of you know, this area was hit pretty hard by Hurricane Matthew. As a result, emergency response teams were activated. "A" team is responsible for remaining at the hospital during the storm while "B" team is allowed to evacuate and relieve "A" team as soon as medical personnel can re-enter the area.

    Long story short, I am on "A" team and we have now been at the hospital for more than 36 hours. We have had to clock in and out for our 12 hour shifts and management is claiming we will only be compensated "call pay" ($2/hr) for the time we are forced to sleep here at the hospital.

    I am just wondering...is this standard pay/practice for when hospitals have to activate emergency response teams?

    To me, it just seems like $2 is insulting considering we are away from our families, the sleeping arrangements are less than ideal, the cafeteria food keeps you in the bathroom every 2 hours and the hospital's census is the highest it's been in months. Not only that, we also have the added emotional stress of not being able to check on our homes to assess damage caused by Matthew.

    We are very lucky that we even have food and that the generators are still keeping the lights on, but $2/hr is just ridiculous.
    At my hospital, nurses are split into 2 teams as well. The initial "A" team arrives at the hospital prior to the hurricane and is expected to stay at the hospital until the storm passes and members from the second "B" team can safely make it into the hospital and relieve them.

    Team A is paid double time for each 12 hour shift worked and regular pay for the 12 hours they are "off duty" but still required to be at the hospital. Team B gets no special incentive/pay, but are not required to spend the night or stay at the hospital.

    Your hospital sounds like they are being very cheap and inconsiderate about compensation regarding activation of its personnel. I hope you and your family made it safely through the storm.

  • Oct 10

    I'm glad you and your family are safe. I'm sorry to hear about the property damage some of your coworkers suffered.

    I agree that hospitals need to understand that when we as nurses are called upon in a crisis, we often must put the needs of our organization and our patients ahead of our own family's needs and securing our own property. A coworker of mine worked the three days prior to being activated on team A during Hurricane Matthew and essentially had no opportunity to board up her home prior to the storm hitting. I was lucky enough to be on team B and had the chance to stay safe with my family.

    Perhaps you and your coworkers can address this with administration? It won't change the present situation, but perhaps could improve the situation for those in the future.

  • Oct 9

    Quote from gb8852
    Hello fellow Nurses, I am a nurse here in Southeast Georgia. As I'm sure most of you know, this area was hit pretty hard by Hurricane Matthew. As a result, emergency response teams were activated. "A" team is responsible for remaining at the hospital during the storm while "B" team is allowed to evacuate and relieve "A" team as soon as medical personnel can re-enter the area.

    Long story short, I am on "A" team and we have now been at the hospital for more than 36 hours. We have had to clock in and out for our 12 hour shifts and management is claiming we will only be compensated "call pay" ($2/hr) for the time we are forced to sleep here at the hospital.

    I am just wondering...is this standard pay/practice for when hospitals have to activate emergency response teams?

    To me, it just seems like $2 is insulting considering we are away from our families, the sleeping arrangements are less than ideal, the cafeteria food keeps you in the bathroom every 2 hours and the hospital's census is the highest it's been in months. Not only that, we also have the added emotional stress of not being able to check on our homes to assess damage caused by Matthew.

    We are very lucky that we even have food and that the generators are still keeping the lights on, but $2/hr is just ridiculous.
    At my hospital, nurses are split into 2 teams as well. The initial "A" team arrives at the hospital prior to the hurricane and is expected to stay at the hospital until the storm passes and members from the second "B" team can safely make it into the hospital and relieve them.

    Team A is paid double time for each 12 hour shift worked and regular pay for the 12 hours they are "off duty" but still required to be at the hospital. Team B gets no special incentive/pay, but are not required to spend the night or stay at the hospital.

    Your hospital sounds like they are being very cheap and inconsiderate about compensation regarding activation of its personnel. I hope you and your family made it safely through the storm.

  • Oct 9

    Quote from gb8852
    Hello fellow Nurses, I am a nurse here in Southeast Georgia. As I'm sure most of you know, this area was hit pretty hard by Hurricane Matthew. As a result, emergency response teams were activated. "A" team is responsible for remaining at the hospital during the storm while "B" team is allowed to evacuate and relieve "A" team as soon as medical personnel can re-enter the area.

    Long story short, I am on "A" team and we have now been at the hospital for more than 36 hours. We have had to clock in and out for our 12 hour shifts and management is claiming we will only be compensated "call pay" ($2/hr) for the time we are forced to sleep here at the hospital.

    I am just wondering...is this standard pay/practice for when hospitals have to activate emergency response teams?

    To me, it just seems like $2 is insulting considering we are away from our families, the sleeping arrangements are less than ideal, the cafeteria food keeps you in the bathroom every 2 hours and the hospital's census is the highest it's been in months. Not only that, we also have the added emotional stress of not being able to check on our homes to assess damage caused by Matthew.

    We are very lucky that we even have food and that the generators are still keeping the lights on, but $2/hr is just ridiculous.
    At my hospital, nurses are split into 2 teams as well. The initial "A" team arrives at the hospital prior to the hurricane and is expected to stay at the hospital until the storm passes and members from the second "B" team can safely make it into the hospital and relieve them.

    Team A is paid double time for each 12 hour shift worked and regular pay for the 12 hours they are "off duty" but still required to be at the hospital. Team B gets no special incentive/pay, but are not required to spend the night or stay at the hospital.

    Your hospital sounds like they are being very cheap and inconsiderate about compensation regarding activation of its personnel. I hope you and your family made it safely through the storm.

  • Oct 9

    Quote from DivaliciousMe85
    I am in the complete opposite boat. I am 30 years old and have had my MBA for 4 years now. I can tell you that it has done absolutely nothing for me. I am now changing careers into nursing. Hoping maybe it will come in handy when I climb the nursing ladder. I don't know if your situation of getting your MBA will be the same as mine, but for me it was pretty much a waste of money. I don't mean to sound like a downer lol I really wish you all the luck and I hope that if you do pursue your MBA it turns out to be a positive experience for you.
    DivaliciousMe85- Thanks for sharing your experience. May I ask why you feel your MBA was a waste of money? Did it not open doors for you that you assumed it would?

    I hope you enjoy your career change into nursing, but I would greatly encourage you to shadow a nurse if possible. I feel many people are not fully aware of the realities of being a nurse prior to actually becoming one. Nursing does offer a lot of opportunities, but it also has its pitfalls.

  • Oct 9

    Quote from DivaliciousMe85
    I am in the complete opposite boat. I am 30 years old and have had my MBA for 4 years now. I can tell you that it has done absolutely nothing for me. I am now changing careers into nursing. Hoping maybe it will come in handy when I climb the nursing ladder. I don't know if your situation of getting your MBA will be the same as mine, but for me it was pretty much a waste of money. I don't mean to sound like a downer lol I really wish you all the luck and I hope that if you do pursue your MBA it turns out to be a positive experience for you.
    DivaliciousMe85- Thanks for sharing your experience. May I ask why you feel your MBA was a waste of money? Did it not open doors for you that you assumed it would?

    I hope you enjoy your career change into nursing, but I would greatly encourage you to shadow a nurse if possible. I feel many people are not fully aware of the realities of being a nurse prior to actually becoming one. Nursing does offer a lot of opportunities, but it also has its pitfalls.

  • Oct 9

    Quote from DivaliciousMe85
    You are correct. It did not open any doors for me. I went on interview after interview for jobs that used to require an MBA, but I never got those jobs because I was "over qualified" or even the opposite, "had no experience." An MBA today is not what it was 10 years ago. Job interviews I went on that had MBA in its requirements were nothing more than sales positions. I even worked for a marketing firm while I finished my MBA and it did nothing for me. I know someone who received his MBA close to 10 years ago (he is about 2 years older than I) and found a great job right out of school working in finance. I, however, struggled. I continue to apply to marketing agencies, corporations, etc, but nothing bites.

    As for the nursing aspect. My husband's best friend and his fiancee are both nurses. So I have heard every story you can imagine. It seems I'm actually surrounded by nurses almost every day - through friends/family. Not one of them has had a bad thing to say about their job. I plan to go into psychiatric nursing, which is very close to my heart.
    Thanks for sharing your experience. I hope you enjoy your career change to nursing! Best wishes

  • Sep 24

    When the charge nurse looks at you when you walk in and says "I'm sorry..."

  • Sep 15

    I was recently accepted for the November 2016 cohort. I will be attending PT and plan on working FT as long as I can. I know I may have to go PT at work once clinicals start. One thing I really like about the program is the online format and that Simmons helps students with clinical placements, however I'm a little nervous about the cost of the program...

  • Sep 13

    When the charge nurse looks at you when you walk in and says "I'm sorry..."


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