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francoml 12,724 Views

Joined: Nov 7, '12; Posts: 148 (41% Liked) ; Likes: 239
ICU Nurse; from US
Specialty: Critical Care at Level 1 trauma center

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  • Dec 26 '17

    I just placed my first ultrasound guided PICC yesterday!!! It was a freaking awesome experience. I still have to get 2 more successful insertions before I can place them by myself but I am on my way!

  • Dec 22 '17

    Hey everyone. Haven't posted here since I was I baby graduate nurse. Fast forward 4.5 years into my career, I have been a MICU nurse at a level 1 trauma center (4 years), dedicated rapid response nurse with ability to independently order emergent medications and diagnostics (1.5 years), PICC nurse (3 years), and most recently 4 months as a CVICU nurse recovering openhearts, impellas, and balloon pumps. I will graduate as an AG-ACNP in three more semesters. Long story short I love critical care and my goal is to specialize in pulmonology/critical care as an ACNP. I love doing procedures (only PICC lines at this point) and I want to intubate, do chest tubes, bronc, paracentesis, etc. I'm currently in New Mexico (independent practice) but would relocate to find an optimal job.

    So my question.... How many of you are doing invasive procedures? For those that do, what procedures are you doing? How often? Independently or supervised? Can you bill yourself? Big trauma center or rural hospitals? Basically anything you tell me to give me the best chance at landing an intensivist position!

    Thanks!!!

  • Jul 12 '17

    Quote from VANurse2010
    Your autonomy is perceived autonomy, and a lot of floor nurses exercise the same also.

    I have to respectfully disagree with this statement. I have way more autonomy as a ICU nurse then floor nurses do. I have standing order sets that allow me to give multiple drugs without first contacting the physician if my patient is quickly deteriorating. I can order just about any diagnostic test (labs, cultures, CT, EKG, ABGs, ect.) with out contacting physicians. I can also give ativan for seizures, reversal agents, and fluid boluses. Further more I can give atropine and start vasopressors if a patient drastically declines and a physician is not available. If a patient is hemorrhaging I can initiate mass transfusion protocol before consulting the doctors. Granted these are all standing order sets and only used in emergencies but they are at my discretion none the less. As far as access goes I can place large bore (16g and 14g) ultrasound guided arm and EJ lines if fluid resuscitation is needed. Although great floor nurses have great clinical judgement I highly doubt floor nurses can do all of these things. Much love to floor nurses for what they do but the scope of practice is drastically different.

  • Jun 29 '17

    I have been an ICU nurse for about a year now. I have learned a million and one things and still have a lot left to learn. I just wanted to offer a little help to new grads trying to get into the critical care scene and newly hired nurses in the ICU.

    First....


    If you want to be an ICU nurse go for it. It is one of the biggest learning curves you can take on but if that is your passion don't let anyone shoot your dreams down.

    Second....

    Apply to a large teaching university hospital. Usually those hospitals will have an internship program that lasts 4-6 months which includes one on one patient care, constant supervision by a preceptor, and critical care classes to teach you critical care medicine.

    Third....

    Study on your own time. Pharmacology, pathophysiology, A&P, ect. This will all be things that help you tie the whole picture together.

    Fourth....

    When in clinical (students) or once hired as a new ICU nurse, participate in everything you can if your patients are stable. If they are intubating a patient, ask if you can record or push meds. When coding a patient be the first one to hop on the chest and due compressions, bag the patient if needed, record everything that is going on ect. Watch the nurses place lines with ultrasound and ask them to teach you. Basically, as long as your patients are taken care of and stable, go around and ask if you can watch and learn or help out with procedures.

    Finally....

    You have to love what you do. You will see more death then any other form of acute care nursing. Some of the things you will see will tear your heart out. You have to go into this career path knowing that there is a very high turn over rate in this field because of how stressful it can be. That being said, there is nothing more rewarding that seeing the 19 year old girl who should have died, walk out of the hospital with a full recovery. It is the "little miracles" that keep you coming back for more even though the day to day can be gut wrenching.

    I hope this helps, ICU nurses are a breed of their own. It has been the only job that I have ever had that I truly wake up in the morning and am excited to go to work. You will either love or hate working on a unit and you will most definitely develop a dark sense of humor. I wish all of you students and new grads the best of luck in your nursing careers and always remember, there is a lot of people out there that are "dream killers." Don't listen to the negative people out there. You can accomplish anything you want as long as you put everything you have into it.

  • Jun 7 '17

    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.



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