Latest Comments by AngelRN27

AngelRN27 1,916 Views

Joined Aug 11, '12. Posts: 152 (30% Liked) Likes: 73

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  • 1
    Buyer beware likes this.

    Thanks for the advice, BuyerBeware. My choices are limited because (1) I need to stay local and (2) as per what I've been able to find on my own, there aren't really that many ACNP programs out there, at least not in my area. There are PLENTY of MSN programs (with varying tracks/"concentrations") but it's not too easy to come by a program for acute care. If it weren't for my specific end-goal, I'd go straight into an MSN program, but I don't think that any MSN programs will truly help me in attaining an ACNP as it now stands.

    Again, I welcome any suggestions for other schools/programs out there... or if anyone that has pursued the route of ACNP has any advice at all, it is most definitely welcome. Unfortunately, I don't personally know any ACNPs so I don't have any mentorship as of now. Everyone is really going after FNP in my area and within my networks.

    Thanks again!

  • 1
    brownbook likes this.

    The rationale behind starting distally and working proximally is that if you blow/damage a proximal vein (further up) then all veins communicating with that vein will run into that same clot/occlusion/injury. Therefore, whatever is being administered through that IV will not reach central circulation, OR could cause further harm if leaking into tissues (depends on what happened to that proximal vein).

  • 3

    This thread should be moved to LTC; LTACH is not the same as LTC/SNF/Rehab/Nursing Homes.

  • 0

    Good Afternoon All,

    I am finishing up my BSN in 2017 and plan on pursuing my ACNP (Acute Care Nurse Practitioner) soon after. I wanted to get some input on the programs that are available in the South Florida area. I live and work in Miami, FL. The two programs that seem the most "viable" are those offered at Barry University and University of Miami. I have been digging around researching program requirements and length of study. It seems to me that FNP programs are a dime-a-dozen, while ACNP programs are a little less common.

    Any current students or recent graduates of Barry or UM's ACNP programs? Thoughts? Tips? Regrets? Any other good programs nearby?

    Some background: I have been an RN for 4 years. Worked at a SNF for one year then moved on to a LTACH. I work MICU and telemetry, also work as house supervisor, occasionally also function as Infection Control or Clinical Educator (small LTACH--a handful of us wear many hats PRN). Plan on moving to a large teaching hospital and work critical care once my BSN is done (many don't consider LTACH ICUs to be true critical care, despite the patient population). PCCN certified.

    Any thoughts, suggestions, tips are welcome!


  • 0

    Thanks for all of your responses. I already prepared a new spreadsheet (by name) and printed it for use by charge nurses. I left for vacation after that and will be returning to work tonight, so I will see how it's worked.

    Thanks again!

  • 0

    Thank you for all the replies. I think I'm going to suggest we use a list of staff names instead the method we're using now. It's essentially a tiny printed Excel calendar and the names are printed in. Therefore, when it's time to cancel, you have to look for the scheduled staff members' names and go back and see who was canceled most recently, etc. I think it would be much easier BY NAME than by date.

    Thanks again for the input. It seems like a silly problem to have, but as some of you mentioned, the ROYAL FUSS that occurs when we call the "wrong" person to cancel is extremely frustrating.


  • 0

    We tried that originally, but then apparently the spreadsheet wouldn't save right across all users on our intranet... not really sure why.

  • 0

    Fellow managers/supervisors:

    I work at an LTACH facility and recently we've been in somewhat of a census drought, which of course has led to census-related cancellations often--especially of nursing assistants. Our facility is small, so charge nurses on the floor handle cancellations and staffing issues for the oncoming shift. Currently we keep track of cancellations on paper, which are later transcribed into our electronic scheduling software by our CNO. The trouble is keeping track of who is due for cancellation--that is, who has gone the longest without being cancelled due to the census. It's a tedious process, and sometimes we get it wrong...

    I was wondering how you all keep track of this type of thing? Is there a software out there perhaps? I know it's likely that most facilities handle this type of thing with nurse supervisors, which we don't have here, but perhaps they're in the audience!

    Thanks in advance for any advice or insight.

  • 0

    I straddle the fence on this one...

    My university taught us both IV & foley insertion, as well as the maintenance of both. They were introduced with "theory" (common practice/indications/cautions) and then were followed up by "skills labs" which we were required to accumulate a certain amount of hours in, in order to then attempt our "sign-off." This consisted of a full walk-through and demonstration on a dummy. Each student had two attempts to pass this demo perfectly in order to get their sign-off. Only students who had successfully completed this process could attempt/practice those skills in the clinical setting.

    I appreciate that this is how my school handled most (if not all) hands-on skills. It made the majority of us more confident as we knew that we were taught the process from A to Z. We were also truly lucky in that our clinical professors usually worked on the units that we visited as clinical sites (at some point in their career-- or they worked on a neighboring unit, and had seen many of the nurses around) so we were often provided with awesome hands-on opportunities.

    That being said-- as many posters have mentioned, a skill such as IV insertion is something that requires a good amount of practice to get any good at, and that's something that will occur on-the-job. I don't necessarily think it's something that needs to be practiced in nursing school, although, again, I really appreciate that I was given the opportunity to.

    PS. I had no idea prior to this post that it was so common not‚Äč to explore these skills in school.

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    I realize that the CCRN is more comprehensive, but just as an aside, I passed the PCCN with 83% only using the resources provided by the AACN. No DVD's, no expensive reviews. Their resources are pretty good, so if you have a good amount of experience and a good foundation, don't spend too much money. My PCCN score was exactly the same as my SAE (self assessment provided by the AACN online) score, despite the SAE only having 50 (or 60?) questions.

    Good luck!

  • 1
    sapphire18 likes this.

    Quote from Nalon1 RN/EMT-P
    If you have issues with the tap water, your facility needs to fix that. The gut is not sterile, no need to use sterile water IMO.
    I could maybe see it in a neutropenic patient, maybe.
    ^^^ This. The gut is not sterile, so I'm not sure how effective using sterile water for NG/OG tubes would be. Did those of you who use this method at your hospitals have some sort of evidence-based back up for this practice? It's uncommon for hospitals to install policies without some sort of foundation outside of either research, practice norms, or some sort of association recommendation (such as the CDC, for example).

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    How new is this SOFA scoring? I currently work a PCU/ICU and haven't heard of this yet. We currently use the SIRS method. I am also PCCN certified (granted by the AACN) who uses the latest evidence-based practice and they still publish SIRS information.
    Just curious about how the SOFA scoring works, what it entails.

  • 1
    Maevish likes this.

    Hello BendyEm,

    I assume by "site" the NG, you are referring to insertion? (that's not really a term we use in the US) Personally, I have been working ICU/Step-down for 3 years and have never even heard of an MD inserting an NGT, that's like having an MD get a peripheral line for you! LOL. Anyhow, here RN's insert the NG with a medical order, verify on the spot via the classic method (air bolus and auscultation of the stomach) and then order CXR by protocol to positively verify placement. Tube feeding/med administration can begin after CXR confirms placement, if need be. My hospital does not require any in-house education for insertion of NG tubes. Usually, the newbies will ask for support anyway, but we do not need any sort of approval by our educator to insert as our nursing license covers this. Good luck!

  • 0

    I don't know that your practicum site/area plays a huge role in the direction of your career, IMO. I was lucky enough to get my first choice as my practicum site, which was PICU at our local, nationally renowned children's hospital. I loved it & learned tons, but it really had no bearing on where I worked thereafter.

    While I applied for jobs as a new grad, not ONE prospective employer ever asked me about my practicum site, though it was listed on my Resume at that time. I even applied at the same children's hospital that hosted me for practicum (where I was well-liked and had plenty of contacts) but I consistently got the "unfortunately, we aren't currently hiring new grads" spiel.

    My first job ended up being at a LTC/SNF which was rewarding, but not quite what I was looking for. I moved on to LTAC (see the LTACH threads-- this is comparable to ICU/Tele/ICU Step-down in larger hospitals-- except with ridiculous ratios!) and have been there for 2 years now...

    My point in all this is that, although you may have a clear picture of where you *eventually* want to be, there are plenty of paths that lead to the same destination. Not only that, but as sure as you may be now, many times nurses change their minds after being exposed to a certain area of nursing that perhaps they didn't even know existed...

    As a new grad, you really can't be picky. Just do great wherever you go and things will pop up for you! Also, take your time to gain valuable experience once you do get to critical care. In my experience, bedside expertise really makes a huge difference for our ARNPs and CRNAs... there is a world of difference between them, and those that sort of went straight into advanced practice.

    Good luck and have fun!

  • 0

    Our facility has a q4hr oral care policy (also shared between RN/RT when possible) but our policy for rotation of the ETT is qshift and PRN as someone mentioned above. We also use the Hollister holder as another poster mentioned. My facility hasn't had any ETT related breakdown for over a year, per administration, so I guess this policy/technology works. Generally, the tube "belongs" to the RT's, but depending on the pt load, the shift, what's going on-- RN's can rotate the ETT if need-be. Our RT's are big on teaching, so the majority of our RN's feel very comfortable with tubes. You should never go all-in if you don't feel safe or are unsure at all of the best practice. I prefer to have someone in the room with me (another RN or grab any RT) when moving the ETT, just in case...