francoml 11,344 Views
Joined Nov 7, '12 - from 'Dirty South'.
francoml is a ICU Nurse.
Posts: 147 (40% Liked)
Ultrasound.... Should be the gold standard. I don't know how it is in other hospitals but in my unit (large level one ICU) the majority of our nurses know how to use ultrasound to place difficult IVs. I am a pretty darn good at IVs and if I think a PIV is going to be hard I just grab the ultrasound.
That being said, I work in a very well funded and nurse friendly environment that fosters clinical expertise and training on advanced techniques. I have never worked in a rural hospital or a facility with poor funding or many restrictions on nurse scope of practice.
If your facility allows it learn how to use ultrasound. I truly believe that it will be the gold standard in the next 5-10 years.
Also remember that practice makes perfect and don't be afraid to try just because they are difficult.
Hey guys I have read many of your posts about bias, not fitting it, the mean girls don't like me, blah, blah, blah.
Let me give all you new male nurses some advice. Stop with this whole male vs female nursing BS. We are all professionals and should conduct our selves as such. I have been a nurse (male ha) for about 4 years now and I still don't understand why new male nurses are so sensitive about things...."Oh my patient doesn't want me to put a foley in because I'm male"...get over it. Just have one of your female colleagues put it in and return the favor some other time.
Maybe its because I work in a busy 33 bed ICU and at least 30%+ of us are male, but I just don't see the problem. We don't have problems in our unit because we are not males and females....just nurses. If your not comfortable working in close proximity with the opposite sex that is very telling about your personality.
Now Im not saying don't protect yourself. If you are putting in a foley, rectal tube, ect in a female just have one of the women hang out in the room for a bit till your done but dont pawn off your duties just because "you don't feel comfortable"
And for god sake stop assuming all women only talk about gossip, makeup, and bon bons (what ever those are lol). I for one know many women on my unit who hunt, work out, play video games, nerd out on medical stuff, and are adrenaline junkies.
LEARN TO BE SOCIAL AND EXPAND YOUR REALM OF THINKING!
STOP BEING SO SENSITIVE!
I recommend starting ICU as a new grad as long as you are willing to put in the time outside of work to learn everything you need to know. I started in the ICU as a new grad and it was an awesome and humbling experience.
First off, when you do your clinical in school learn everything you can and volunteer to do everything you can. Ask a million questions is all areas, not just ICU. I would also suggest networking as much as possible when are at your practicum sites. If you can impress these people during your ICU rotation they will remember you when you go back to apply for internships in the ICU.
Second, some schools let you pick elective classes in specialty areas. If this is possible for you choose ICU and again be super helpful, as a million questions, and let them teach you (even it is something that you already know).
Third, if you are willing to move, the chances of getting into an ICU are much better. Some ICUs hire mostly new grads while others hire almost none. I don't know about Cowley but there are a ton of level one ICUs that want new grads. If possible apply all over the place as many will give you large sign on bonuses and relocation assistance.
Hope that helps, keep shooting for the stars my friend.
Ohhh that is a very polarizing question on the differences between ED and ICU lol.
I will first start by saying that I have never worked in the ED except for when I am there as a rapid response and that is limited because they handle all their own codes and line placement. They are both awesome fields and it really depends on your way of thinking as well as what your future career goals are. If your are planning on going to CRNA school 95% of schools require Critical Care experience and ED does not count. Beyond CRNA there are a million different career opportunities that can arise out of ED and ICU alike.
I will give you a small window into a night in the ICU. I work in a 32 bed Medical ICU and it has been the biggest learning curve I have ever experienced. We take the sickest patients from a 500 mile radius and all of our direct admits skip the ED completely and come directly to us. An example of the toughest patients I take. Patient with end stage AIDS developed a massive infection (atypical pneumonia) which lead to septic shock and acute kidney failure. Patient was placed on CRRT, intubated on a high flow ventilator (250 breaths a minute), completely paralyzed with a vecuronium/fentanyl drips and placed on a BIZ monitor, due to failing cardiac output and hypotension the patient was started on Flowtrack hemodynamic monitoring with the following drips; epinephrine, norepinephrine, vasopressin, phenylephrine, and dobutamine. Beyond the pressors the patient was on multiple antiviral drips and antibiotic drips. I believe the most active drips I had with this patient was 13 between pressors, fluids, paralytics, sedatives, antibiotics, antivirals, electrolyte replacement, and blood products. The key to all of this, an ICU has complete autonomy when titrating all of these medications. There is no doctors orders stating, epinephrine at ..... or vecuronium at ..... or vasopressin at ..... The order states use these medications and titrate them based on your hemodynamic monitoring to maintain blood pressure.
In our unit our ICU suites can also function as surgical suits in the event that a patient is too unstable to transfer to the OR. I once had a patient that had a intestinal perforation and the surgical team came up and opened the patients belly at the bedside and then proceeded to take out the intestines and systematically inspect them for a bleed.
This is something you will never experience in the ED or in a small rural ICU. I will admit there are days when I have totally stable patients and I do little more than a bed bath, pass a med or two, and do a few assessments but this is rare (and much needed). You also have to realize that I am incredibly biased toward ICU lol. I am sure there are many people on here that will offer a look into the world of emergency medicine and will have amazing stories.
In the ICU you need to know A&P, pathophysiology, pharmacology, and hemodynamics inside and out. You also need to be very OCD about your patients because you should know damn near EVERYTHING about that patient.
Both will offer their fair share of adrenaline rushes and challenges but ED will focus on stabilizing a patient while ICU will be about actually keeping the patient alive and fixing their complex problems. If you truly love your job as an EMT I would suggest going into Emergency Medicine. If you want to truly push your limits of your medical and pharmacological knowledge go ICU.
That being said, I really hope some one can give you and in depth example of ED on here so you can make a better decision.
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