Latest Comments by DesertSky

DesertSky, BSN, RN 2,448 Views

Joined Feb 21, '12 - from 'Missing the desert...'. DesertSky is a Critical Care RN. Posts: 77 (39% Liked) Likes: 74

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  • 5
    nitenite, TriciaJ, kiszi, and 2 others like this.

    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.

  • 2
    sevensonnets and Nurse_bre like this.

    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!

  • 0

    Quote from HouTx
    It's not very relevant to ICU practice. I'm assuming you are already ACLS certified because that is usually a basic requirement, so if you're looking for additional development you'd be much better off working toward your CCRN.
    As a trauma ICU nurse, I have worked at facilities that use both ER and ICU nurses during the initial triage and trauma resuscitation in ED. When critical drips are used, an ICU nurse is a great resource to the trauma team. It is also important to have TNCC as a trauma ICU nurse because of the assessment and clinical indications discussed during TNCC.

  • 0

    I have a question for those employed by the VA system. Have you observed there is upward mobility and advancement in the VA system for those looking to move from a staff RN position into administration? Or is it difficult and very political to move up in the ranks of the VA?

    Also, it is fairly easy to transfer within the VA system between departments and locations (such as different states)? Is there a waiting period to do so?

    Thanks in advance for your help!

  • 1
    sevensonnets likes this.

    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!

  • 1
    gb8852 likes this.

    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.

  • 3
    Sammie7, RNKPCE, and gb8852 like this.

    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 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.

  • 0

    Anyone else pursue a MBA to open other doors either in nursing administration or away from nursing altogether?

  • 0

    Quote from Rose_Queen
    Take a look at my article, Tips for New Operating Room Nurses. Basically, be prepared to have to do some studying outside of work hours, set realistic goals for yourself, and many other things that are touched on in that thread.

    Thanks Rose Queen. I was also wondering if you could share any advice about how to successfully find a job in the OR after coming from another specialty. Should I be looking for a periop program or will most transfers be given an adequate orientation when coming from another area like ICU?

  • 0

    Quote from 6ais277
    I am thinking of getting into OR nursing. I have almost 3 years exp in floor and ICU in a level 1 trauma center. I don't love being at the bedside but I love being in the hospital. I was thinking this could be a good way to go. Any thoughts of how this would looks to an OR nurse manager- i did 1.5 years on an adult floor and now i'm in the PICU. i dont want to do bedside anymore but i'm not sure that would be a good thing to say.

    I also interested in hearing the response to this question. I am a ICU nurse looking to transfer to the OR. I am feeling burned out from floor nursing and have always found the OR fascinating. I originally wanted to get into the OR as a new grad years ago, but was told to get floor experience so I didn't lose my skills. I wish I had ignored that advice as I now know the OR is a completely different and challenging specialty!

    Any advice about how to transition into the OR would be great!

  • 1
    DivaliciousMe85 likes this.

    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

  • 2
    ivyleaf and Fiona59 like this.

    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.

  • 1
    sallyrnrrt likes this.

    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.

  • 0

    I am at a crossroads in my career. I planned on pursuing an advanced degree in anesthesia or as a NP and I have worked hard towards gaining the education and experience needed to reach that goal. I have my BSN along with my CCRN, TNCC, ACLS, and PALS and have years of critical care experience. I was recently accepted to multiple NP schools, but now I'm not sure that is the path I want to take.

    Before becoming a nurse, I graduated with a degree in communications and economics. I really like working in business, but decided to pursue a career in nursing due to frequent relocations due to my husbands job. I miss the business world and cannot see myself continuing to work as a nurse for the next 20-30 years. There are too many aspects of nursing I do not enjoy and that I unfortunately do not see improving. Examples include long shifts, poor staffing ratios, emphasis from management on HCAHPS without sufficient resources to address problems, etc... I am also currently separated from my husband.

    I am considering returning to grad school to pursue my MBA in order to transition out of healthcare and open up more opportunities in business. I am 30 years old, so I feel I am still young enough to change career paths. I would be able to continue working full as a nurse while I attend grad school to pursue my MBA. I was hoping to get advice or hear the experiences of members who have done the same. Pros/cons/things to consider?

    Thank you in advance

  • 0

    Quote from Rnfolk
    I highly recommend the AACN review course available for purchase on their website. I know it prepared me to pass the CCRN exam!!

    Good luck!!
    Thanks Rnfolk! Are you referring to the online AACN review course that's offered when you sign up for the CCRN? Did you use any other resources like questions from Pass CCRN, etc...?