Latest Comments by jbwozny

jbwozny 1,233 Views

Joined Mar 15, '05. Posts: 6 (0% Liked)

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    look about two thirds down the topics page on the flight and transport nursing forum and you will find a topic called "what steps do I need to take to become a flight nurse?" This should point you in the right direction.

    good luck

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    Granted I work in an ICU, not an ED, but does anyone else find it odd that a pt that had so little pressure that they neede to be left on 50 mcg/kg/min of Dopa (agree with the above posters about adding in other pressors instead of going that high on Dopamine) didn't get an a-line placed? Again, I know it is different paradigms in the the unit vs the ED, but one of the things that always happens whe we have some one code (or respond to one on the floors) is placement of a central line and an a-line. Likewise, any patient that gets placed on pressors gets both as well.

    Vampireslayer, this is not an attack on you. Just want to raise the point and see what folks from an ED environment think.

    oh yeah, good thinking on using the doppler with the manual cuff....strong work.

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    Vampireslayer,

    While I am not a "seasoned pro," I think I am just on the other side of the fence from where you are now. I graduated a little more than a year and a half ago and have been working in a "busy" (level 1, inner city, teaching hospital) ICU since then. I definitely remember being terrified coming into work and having that simultaneous dread/hope of getting a sick patient. You aren't alone in how you're feeling and your fear definitely doesn't mean you are in the wrong place (actually, the couple of new grads that I have known that didn't make it in critical care areas were folks who were either overconfident or didn't know enough to be scared). Some thoughts......

    1) When I first started I went to a lot of codes only to find the room PACKED with people (Or was too slow and ended up being the one left to watch all the patients in the section...lol). My solution was to run faster and to not be afraid to worm my way into the action. Being one of the first few in the room makes it easier to find a job. I also recommend being a runner if all of the primary jobs are being done (grabbing supplies, drugs, paging x-ray, etc.), just to be part of the action/team.

    2) Recording. I have said the exact same thing as you about recording. However, it is very important and is a great learning tool. When I was being precepted, my preceptor was of the opinion that recording is one of the best places for a new nurse to be during a code because it keeps you involved in the big picture, lets you learn the sequence of events, and keeps you a little removed from the action so you don't get too stressed. It is also something that is rarely done well and when you do a good job at it, you look good (vitals every couple mins, names of folks doing compressions, bagging, giving meds, starting lines, tubing, meds/doses, time procedures started, time finished, # of attempts, rhythyms, etc.).

    3) The most impressive person I have ever seen in a code is one of the nurses on my unit that has a lot of ED and ICU experience...surgeons were putting in a subclavian on his pt, dropped his lung and then panicked and completely disengaged as the pt went into PEA. This nurse totally ran the code (started an EJ in about a second, was pushing drugs and making sure everything got done). One of the things this nurse has said to me is that "Codes and traumas aren't rocket science." They are all about algorithims...do things in this order, if A then B, etc. Being calm, but still fast is the challenge and that comes with experience.

    4) You haven't had ACLS or TNCC yet?! Your preceptor needs to lighten up a bit then it sounds like to me. These are the classes that teach you about coding someone or taking care of a big trauma pt. If you haven't had them it is very hard to know what to do in these situations. You'll learn alot and have a much better idea of what is going on once you have taken these courses.

    5) Having your preceptor give you an assigned task is a great idea. Even if they don't, then just picking something that you are gonna try to do so you have some focus is good (first set of vitals, get the labs, etc). Also, don't be afraid to approach the techs or RT and saying ""hey, i've never done compressions/bagged a pt/confirmed tube placement/etc. would you mind walking me through it on the next code/trauma?" By asking these folks you will show that you are eager to learn, without stepping on toes (ie if the techs "always" do compressions they might feel like it is their domain and if you just try to step in and do them there could be some misunderstandings. also being willing to learn from folks lower on the pay scale than you is both classy and very educational).

    6) This doesn't seem to be a weak point for you at all, but I would echo someone else's post and say...learn, learn, learn. Book knowledge doesn't mean that you will necessarily be good in clutch situations, but the more knowledge you have to draw on the more comfortable/effective you will be. Study your ACLS drugs and algorithms, learn about rhythym strips, study a CCRN or CEN review manual, make note cards about lab values, drug doses, etc. Check out check out the software from www.madsci.com about codes and traumas...expensive, but pretty educational (you can even download free demos).

    Whoo...didn't mean to write that much, hope that at least some of it was useful to you. Just remember that you CAN learn to be good at this. Everyone was green once. Experience and repetition.

    Good luck.

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    First off I am not a flight nurse....merely another wannabe. Wat I have been told (from several flight nurses) is the kind of classic path is as follows....

    -approx 5 years of nursing experience split between ICU and ED. ICU for the critical thinking and exposure to those super sick patients. ED for volume, speed, trauma, getting good at assessments, triage, and physical skills. For the ED, I've heard Level 1 experience is best (for obvious reasons). For ICU, I have heard various opinions about which one is best and a pretty sound rationale for all of them. I would guess that whatever kind of unit it is, you would want it to have the highest possible acuity and exposure to different patients. I have also been told that getting some peds exp is very helpful.

    -certifications. CCRN and CEN certs are very helpful in getting a job and you learn a ton while studying for them.

    -courses. Obviously you have to have ACLS and PALS. Some programs require NRP. Most will put you through an ATLS(advanced trauma life support) audit or TNATC (transport nurse advanced trauma course) once you start working. Other courses that I have been told are helpful are TNCC (Trauma nursing core course) and ENPC (Emergency Nursing Pediatric Course....which you prob already have from working in the ED anyway), PHTLS (Pre-hospital trauma life support...especially if you do any prehospital stuff...more on that in a sec), CCEMT-P (Critical care emergency medical transport program). I have also been told that it is very worthwhile to become an instructor in ACLS and one of the other standard courses (TNCC, PALS, etc.).

    -prehospital. I have been given advice both ways about getting prehospital experience ("yeah work on the street for the autonomy and to understand the prehospital setting and use advanced airway skills" and "No, you are a nurse so focus on nursing, you will learn the prehospital stuff once you start"), but you already have prehospital experience so the point is moot and I am sure that that experience will be an adantage to you.

    Also, check out www.flightweb.com for a lot more info about this ....just search therough the Getting Started forum.

    Hope this was helpful.

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    I am a nurse who is just about a year and a half out of school and have been thinking about working in South Africa, in a couple of years, and would like ot ask a couple of questions to some folks (either natives or transplants) who live/work there.

    First a bit about my experience.... I have been working in the MICU of a level 1 Trauma Center (also the city/county hospital) since graduation and will probably be going to our ED in another 8 months or so. I will probably stay there for a year and a haf- two years...giving me 2 years icu and 1.5 years ED exp. I have experience living outside of the US (2 years in West Africa as a Peace Corps volunteer).

    Questions....

    1) How does the scope of practice for nurses in SA compare to the US in the critical care/trauma settings? I have been told that the scope of practice for South African nurses is greatly expanded compared to the US role. Is this really the case? Do nurses do minor procedures (such as central lines)? How does the amount of autonomy compare? This is really my biggest question.

    2) What is the pay like? Comparable to the US? Better? Worse? IS it enough to live on in some degree of comfort?

    3) What is the ratio of male nurses in SA? Would I be an absolute anomally being a male nurse?

    4) I have found an agency (PHP) that specializes in bringing nurses into SA. Does anyone have any exp with them? Would I be better off trying to use such an agency or trying to work directly with hospitals?

    5) Is SA experiencing the same type of shortage as the US? How difficult is it finding positions in the ER or ICU?

    6) kind of a tangent, but does SA use paramedics similar in training to the US? I will be working part time as a Paramedic and would like to be able to continue this after moving.

    7) How difficult is it to emigrate to SA?

    thanks for the info,

    jay

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    I am a nurse who is just about a year and a half out of school and have been thinking about working in New Zealand, in a couple of years, and would like to ask a couple of questions to some folks (either natives or transplants) who live/work there.

    First a bit about my experience.... I have been working in the MICU of a level 1 Trauma Center (also the city/county hospital) since graduation and will probably be going to our ED in another 8 months or so. I will probably stay there for a year and a half- two years...giving me 2 years icu and 1.5 years ED exp. By the time I go I will have my CCRN (hopefully my CEN as well). I have traveled in NZ before and have experience living outside of the US (2 years in West Africa as a Peace Corps volunteer).

    Questions....

    1) How does the scope of practice for nurses in NZ compare to the US in the critical care/trauma settings? Do nurses start IVs (have heard they don't in Australia)? Do they do more precedures than in the US? Titrate gtts? How does the amount of autonomy compare? This is really my biggest question.

    2) What is the pay like? Comparable to the US? Better? Worse?

    3) What is the ratio of male nurses in NZ?

    4) I have found an agency, Tonix, that specializes in bringing nurses into NZ. Does anyone have any exp with them? Would I be better off trying to use such an agency or trying to work directly with hospitals?

    5) Is NZ experiencing the same type of shortage as the US? How difficult is it finding positions in the ER or ICU?

    7) kind of a tangent, but does NZ use paramedics similar in training to the US? I will be working part time as a Paramedic and would like to be able to continue doing prehospital work in NZ.

    Thanks for the information,

    jay



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