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DesertSky, BSN, RN 2,634 Views

Joined Feb 21, '12 - from 'Missing the desert...'. DesertSky is a Critical Care RN. Posts: 87 (40% Liked) Likes: 81

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  • Mar 2

    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!

  • Feb 27

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

  • Feb 20

    Quote from Riburn3
    I'm an FNP (and also will have my AGACNP later this year) and really just went with the FNP because it was offered at the public university in my area, and offers more diversity in terms of job prospects. My background is adults and I currently work cardiology and internal medicine, so I'm not exactly using all of my degree, but I like knowing that if I wanted to go work in ER, an urgent care, or go work in a family primary practice, I would be able to. A pipe dream job later on in life is to work for the department of state overseas as one of their embassy providers, and you also need your FNP for that.

    Overall though I kind of doubt I will ever use the full scope of my FNP, but I do like know I have more options. Also, even though I never worked in peds and likely won't, it was by far my favorite rotation in school, and probably where I learned the most.

    In terms of jobs, I think most jobs for NP's are geared towards adults, at least in my area, so I don't think you'll have too much trouble.
    Thank your for your response! Your current job in internal med and cardiology would be the kind of position I would love to do.

    You do raise a good point about your FNP opening the door for urgent care, ER, and other opportunities. I am glad to hear you enjoyed your peds rotation because it's actually one of the reasons I was shying away from FNP as my professional experience has all been with adults.

  • Feb 17

    Quote from Rocknurse
    ‚ÄčWe have a critical care float pool in my hospital that we utilize a lot, and I really like the float nurses...they're awesome. I considered it but the one thing I really couldn't stand is that they seem to have to change units every four hours. I don't know about you but when I take over a patient I like to know exactly what's going on, do a full assessment, change dressings, bathe them and make sure everything is followed up. Usually I feel like I'm getting caught up after about 8 or 9 hours in a shift and if I had to do that 3 times a shift I'd lose my mind. There's just way too much going on, and way too much to get to grips with in 4 hours just to change assignments and units again. Nope...give me my two patients and let me fly for 12 hours. I know we get admissions and post ops but still....I would just hate having to give or receive report up to 5 times a day. No thanks. I think they're abused to some extent, and they never get the really interesting acute patients which I really enjoy taking care of.
    Thanks for sharing. I can totally see how float pool nurses don't routinely get the sickest and highest acuity patients. It is part of my concern about taking the position. I enjoy the challenge of a high acuity patient and would find myself frustrated and bored if the only patients I got were the "stable" ICU patients who routinely get downgraded or moved out to the floor the next day.

    I will clarify in the interview about how often I can expect to get new assignments over the course of a 12 hour shift. Thanks for the great advice!

  • Feb 16

    Quote from Sour Lemon
    I work per diem and float among a few units. I feel I am treated very fairly. I've also worked on units where unfamiliar nurses were given slightly heavier assignments ...not to dump on them, but to leave regular staff more available to help with the things only they knew how to do.
    It seems like agency nurses probably get the worst assignments, if anyone does. They may or may not ever return, and people tend to feel little sense of comradery with them. I've gotten to know many of the nurses on the units I float to regularly and feel like an integrated part of the team.
    I'm glad to hear you enjoy working as a float nurse! I assumed float RN's would hopefully be treated better than agency nurses as you can expect to see hospital float RN's routinely especially if the unit is routinely short staffed, but I appreciate you sharing your experience with assignments.

  • Feb 8

    Hi all,

    I have a question. I am a nurse with about 3 years of critical care experience. I have my BSN, CCRN, TNCC, PALS, ACLS, and BLS. During this time, I had one job where I was only employed for 6 weeks. I left quickly as I realized the unit was chronically understaffed and the ratios were unsafe. Due to the short time of employment, I do not list the position on my resume, however when I was recently filing out a job application I was sure to list the position in the employment history of the application. Is this an appropriate way to verify I did work there without highlighting it on my resume?

    Thank you in advance!

  • Feb 7

    Quote from Shineyfam
    And it it seems each state adds one little caveat that is impossible. For example, Kansas requires that your out of state fingerprints be sent to them directly from the Sheriff's office. Hello, the Sheriff's offices DON'T DO THAT! My fingerprints don't change if I send them to you! Uggh! So frustrating! And don't even get me started on states that require a PAPER written application. It IS 2017!
    As a nurse who had to go through the hassle of getting licensed in Kansas I feel for you. I was moving to Kansas from another state and had to navigate the process from miles away. The Kansas Board of Nursing continues to be a thorn in my side as they are my original state of licensure and they are one of the only states not to participate in the Nursys electronic license verification. I continue to cross my fingers they decide to join us in this century....

  • Dec 29 '16

    I have worked in critical care the majority of my career, so I have experienced a great deal of death. As others have mentioned, it is often not the deaths that are most traumatizing, but the suffering you witness leading up to the death of a patient or the reactions of loved ones when they find out their family member has passed.

    When I worked trauma ICU, I often joked going to work made me scared to leave my house as most of our patients were young, healthy, and just going about their daily lives when they were a victim of an accident, violence, or some tragedy.

    When I worked in medical ICU, it used to make me sick to see families who said "do everything possible to keep them alive" when their loved one was never going to recover. I suffered some serious moral distress when I witnessed patients subjected to painful procedures that were not going to reverse their impending death from chronic illness and disease.

    Now in cardiovascular ICU, I do still see death, but not nearly as much as in other areas of critical care. It's rewarding because most of my patients recover and do well after open heart surgery, valve replacement, etc.

    I will add that most nurses who have experienced any amount of death usually have a coping mechanism whether it be a morbid sense of humor, love of extreme sports, or some other outlet in order to blow off steam.

  • Dec 26 '16

    I have worked in critical care the majority of my career, so I have experienced a great deal of death. As others have mentioned, it is often not the deaths that are most traumatizing, but the suffering you witness leading up to the death of a patient or the reactions of loved ones when they find out their family member has passed.

    When I worked trauma ICU, I often joked going to work made me scared to leave my house as most of our patients were young, healthy, and just going about their daily lives when they were a victim of an accident, violence, or some tragedy.

    When I worked in medical ICU, it used to make me sick to see families who said "do everything possible to keep them alive" when their loved one was never going to recover. I suffered some serious moral distress when I witnessed patients subjected to painful procedures that were not going to reverse their impending death from chronic illness and disease.

    Now in cardiovascular ICU, I do still see death, but not nearly as much as in other areas of critical care. It's rewarding because most of my patients recover and do well after open heart surgery, valve replacement, etc.

    I will add that most nurses who have experienced any amount of death usually have a coping mechanism whether it be a morbid sense of humor, love of extreme sports, or some other outlet in order to blow off steam.

  • Dec 24 '16

    I have worked in critical care the majority of my career, so I have experienced a great deal of death. As others have mentioned, it is often not the deaths that are most traumatizing, but the suffering you witness leading up to the death of a patient or the reactions of loved ones when they find out their family member has passed.

    When I worked trauma ICU, I often joked going to work made me scared to leave my house as most of our patients were young, healthy, and just going about their daily lives when they were a victim of an accident, violence, or some tragedy.

    When I worked in medical ICU, it used to make me sick to see families who said "do everything possible to keep them alive" when their loved one was never going to recover. I suffered some serious moral distress when I witnessed patients subjected to painful procedures that were not going to reverse their impending death from chronic illness and disease.

    Now in cardiovascular ICU, I do still see death, but not nearly as much as in other areas of critical care. It's rewarding because most of my patients recover and do well after open heart surgery, valve replacement, etc.

    I will add that most nurses who have experienced any amount of death usually have a coping mechanism whether it be a morbid sense of humor, love of extreme sports, or some other outlet in order to blow off steam.

  • Dec 24 '16

    I have worked in critical care the majority of my career, so I have experienced a great deal of death. As others have mentioned, it is often not the deaths that are most traumatizing, but the suffering you witness leading up to the death of a patient or the reactions of loved ones when they find out their family member has passed.

    When I worked trauma ICU, I often joked going to work made me scared to leave my house as most of our patients were young, healthy, and just going about their daily lives when they were a victim of an accident, violence, or some tragedy.

    When I worked in medical ICU, it used to make me sick to see families who said "do everything possible to keep them alive" when their loved one was never going to recover. I suffered some serious moral distress when I witnessed patients subjected to painful procedures that were not going to reverse their impending death from chronic illness and disease.

    Now in cardiovascular ICU, I do still see death, but not nearly as much as in other areas of critical care. It's rewarding because most of my patients recover and do well after open heart surgery, valve replacement, etc.

    I will add that most nurses who have experienced any amount of death usually have a coping mechanism whether it be a morbid sense of humor, love of extreme sports, or some other outlet in order to blow off steam.

  • Dec 23 '16

    I have worked in critical care the majority of my career, so I have experienced a great deal of death. As others have mentioned, it is often not the deaths that are most traumatizing, but the suffering you witness leading up to the death of a patient or the reactions of loved ones when they find out their family member has passed.

    When I worked trauma ICU, I often joked going to work made me scared to leave my house as most of our patients were young, healthy, and just going about their daily lives when they were a victim of an accident, violence, or some tragedy.

    When I worked in medical ICU, it used to make me sick to see families who said "do everything possible to keep them alive" when their loved one was never going to recover. I suffered some serious moral distress when I witnessed patients subjected to painful procedures that were not going to reverse their impending death from chronic illness and disease.

    Now in cardiovascular ICU, I do still see death, but not nearly as much as in other areas of critical care. It's rewarding because most of my patients recover and do well after open heart surgery, valve replacement, etc.

    I will add that most nurses who have experienced any amount of death usually have a coping mechanism whether it be a morbid sense of humor, love of extreme sports, or some other outlet in order to blow off steam.

  • Nov 19 '16

    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 '16

    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 '16

    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.


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