Latest Comments by francoml

Hello all,

It has been quite some time since I have been on this site. Anyways, I am currently in ACNP school at Texas Tech University. I am writing this to ask for y'alls help. I need to attend a professional meeting or conference before Oct. 21 and write a summary over the content covered.

The problem is, I am having a hard time finding something that would be acceptable. The meeting has to talk about nursing/APRN policy and how it can be incorporated into daily practice.

I live in West Texas and would be willing to travel up to a couple hundred miles in order to attend a quality conference.

So.....Do y'all know of anything in the West/Central Texas or Eastern/Central New Mexico area???

Thank you!

Its okay not to like cleaning *** and ****. God knows I don't. You just have to look at what makes you happy. I am an ICU/RRT nurse, sure I have to clean poop but I also get to run codes, manage CRRT, and titrate pressors and sedation.

It was mentioned before that men usually want ICU or ER. I think there is some truth to this. I was one of the people who got into nursing to save lives and manage critical patients. Sure I wipe butt and even though I dont like to, I do it in a way that gives my patients dignity and respect.

I understand that you are having a hard time at your current job, its hard when you feel like you are a glorified maid. Put in your dues and learn as much as you can so that you can land a job outside of patient care.

Personally I love high acuity patient care, I love the patho and pharmacology that goes with being an ICU nurse. I hate cleaning poop but I look at is just one more chance to further assess my patient.

I would give you a few words of advice. 1st, its okay to hate cleaning poop and vomit, just make sure your patients never know how awful it is for you. 2nd, if you decide to stay in nursing go back to school AND KEEP YOUR GRADES UP! 3rd, if you are strong in school and dont mind hard work and taking on a lot of debt become a CRNA/NP. It is the most autonomous field and you are not really practicing nursing anymore. CRNA/NP are medical providers ​not nurses and you will no longer clean up body fluids. Just know that if you chose this route you will have to be at the top of you field, study a lot, deal with ungodly amounts of stress/liability, and work 10xs harder in school then you did in nursing school.

I would like to say something on behalf of all the medsurg nurses out there. Being an ICU nurse and rapid response I too used to be on the side of we (ICU/RRT) should get paid more. I used to think that I was in one of the elite nursing fields and better than medsurg nurses.

Now that I have more experience, I see how wrong I was. Sure I can teach about advanced hemodynamics off a PA cath, I can manage critically ill patients on CRRT, I understand how to use different pressors/inotropes to maximize cardiac output, and I can use ultrasound to place difficult lines just to name a few. The thing is, all these things are done by using invasive monitoring. I see now that it is easy (with a lot of study) to see how your patient is doing when you have an art line, PA cath, and biz monitor. It is a true art to be able to treat a patient and recognize a de-compensating patient using only your eyes and non invasive monitoring while still being responsible for 5 other patients. This is a skill that many ICU nurses do not have as we are so dependent on our monitors. It wasn't until I worked rapid response that I was forced to learn how to use my eyes and ears more than my coveted invasive monitoring.

To be an excellent ICU nurse it takes experience, lots of study, and confidence in yourself. Thing is, medsurg takes these same skills. Many times the difference between a patient coding on the floor and getting better is nothing more than the nursing intuition that develops from treating patients without knowing every single aspect of their physical status.

So simply put, I now view medsurg as a specialty and have much more respect for them. It takes a very intuitive and vigilant person to recognize signs of distress before it become a full blown emergency. While I am not one of the people who thinks you need to work MS before going to the ICU, there are certain skill sets that MS nurses have that ICU nurses should learn to utilize. Much love to all the MS nurses out there! Don't let anyone talk down to you and have pride in your skills!

I thought the PassCCRN practice test where harder than the actual test. If you can consistantly pass those, even by the smallest margin, then just schedule your exam already! You will do fine! Look at it this way, if you pass HELL YA! if you fail then you gained a lot of insight and probably learned a lot of useful things along the way, pay for it again and test again soon. I don't know anyone who has failed more than once if they actually took it seriously and put in some good study time. You will do great just do it! ......and like the local vendors walking around on the beach in Mexico say, its only money Americano

So regretfully to say, I failed my CMC certification last week. I studied for 3 full days plus I have been an MICU nurse in a level one facility for 2 years and I float to CVICU regularly for extra shifts.

I got a 51 when the pass cutoff was 52 FML!!!!! Do y'all have any recommendations or study guides to get me over that hump? I am already scheduled to take it again in a few weeks. CANNOT FAIL AGAIN!

to be clear when I said bolusing propofol I was talking about when anesthesia orders induction meds for intubation. After intubation we can titrate the drips such as propofol ect. I do not bolus propofol at my own discretion.

I am a rapid response nurse as well as an MICU nurse in a level one hospital I am CCRN certified and have my BSN. I run CRRT, and can place ultrasound guided PICC lines and PIVs. I can run codes and order diagnostics and interventions without consulting a doctor. I do not get any more pay. In fact medsurg nurses get a $2 differential. Financially fair? maybe not. Will I get into a top CRNA school because of these skills coupled with high grades? Absolutely. If you plan on being a bedside nurse long term than it is a big deal. If you are going into advanced practice then your ICU time is really just an extension of the class room and one long clinical rotation where you learn critical reasoning, advanced pathophysiology, and improve your dexterity with procedures. I look at it like I am getting paid to go to school everytime I go to work. Just my 2 cents

Are you all allowed to bolus propofol and titrate drips? What about ketamine? I was under the impression that all ICU nurses could do this but apparently there are some facilities or states that it is not in our scope. Also do you all do conscious sedation as a staff nurse? Do you push induction meds for intubation or does the doctor? Just curious.

Okay I am sure y'all get this a lot but could a current CRNA tell me how strong my resume is please?

I have really worked hard over the last year to boost my resume.

Credentials/Experience
BSN
CCRN
2 years level one regional medical center MICU
1 year Rapid Response Team
PICC certified

Grades
Sci GPA - 3.3
Last 95 hours - 3.783
Las 45 hours - 3.96
Last 11 hours of science (Chem II, O Chem, and Genetics) - 4.0
Have not taken GRE yet

MISC
Contributed to research in synthetic marijuana. That research was cited by Texas Senator as a major driving force in him proposing a senate bill to outlaw all analogous of synthetic marijuana.

Community service with free clinics and Ronald McDonald house

Taking CMC certification this week.

I have to stop using IV drugs!!!!! HAHAHA jk. I have really good veins so I usually let the new nurses and nursing students practice their IV skills on me. A little pain for the advancement of my fellow nurses is worth it right??? Well I never had any issues until last week when I let a student practice and she blew the hell out of my vein and now a week later any time I touch my vein it sends a weird electric feeling down the course of my vein. No redness or phlebitis just a strange tingling feeling.... Nerve damage maybe lol? Anyways maybe my days of being a pin cushion are over. I think I will be spreading my conceptual knowledge more than offering my juicy veins (well scars now hahah)

It kinda depends what kind of facility you practice in. I was a MICU nurse in a level one facility for about a year before taking the test. I took a week off work and studied HARD for 4-5 days and passed. It kind of depends on how much you try to get out of your day to day practice at work. If I wasn't busy I was reading about something medical and I would always ask the docs to explain what we were doing in detail. The catch is, we always have at least a few patients on hemodynamic monitoring, advanced vent settings, or swans. I was lucky to cover the vast majority of what is on the test in just my day to day nursing. If you don't have the opportunity to see super sick patients everyday then I would recommend the gasparis videos and a TON of practice questions. For me I didn't use them but other say it is really good. I just printed out the test plan and tried to read as much as a could about each topic. No specific book I used just google, uptodate, medscape, ect. For the cardiac stuff I just made a table with all the hemodynamic/Swan stuff, right vs left heart conditions, and a 12 lead table with all the corresponding coronary vessels that would effect each lead. Biggest piece of advice, try not to stress, study hard but don't burn yourself out. OH AND PAY FOR THE TEST so you are forced to study because you only have 3 months to test after signing up. That really helped with my procrastination.

Ya so I use ultrasound for all the difficult sticks... I still stick at least once without it to keep my skills up (unless they are +4 edema or something). Also I have 2 inch needles in all the gauges an I use them anytime the vein is >1cm deep because it cuts down on infiltration especially for deep upper arm veins.

Plus I can drop a 2 inch 14 gauge in a PICC site faster than doing a central line if we are in a pinch with a massive GI bleed. Obviously in a massive hemorrhage you want solid large bore central access (cordis) but you can use a level one rapid transfuser with a 14 gauge in a PICC site or EJ until the medical team can come up and drop the central line. When someone is vomiting liters of blood at a time 5-10 minutes can be the difference between keeping your patient alive and coding. Additionally in the last few GI MASSIVE GI bleeds I have had the docs would rather me drop bilateral 14 gauges so they can focus on placing a minnesota or blakemore tube. God I love where I work... Like I truly thank God for the opportunities that he has placed in my life. I love our medical, team they trust our core team of "go-to" nurses without question.

When all shizzz hits the fan we just react, Docs do procedures while we drop large access, initiate mass transfusion protocol, start pressors, ect. They let us mix all our drugs on the floor and start them without specifically giving us orders. Example.. A few weeks ago we had a GI bleed and while they were placing a blakemore me and my charge started transfusing blood, Levo, vaso, and epi. When they were done intubating and securing the blakemore they looked up and said start pressors and transfuse.. Me and my charge looked at them and laughed, "all ready done doc." They smiled gave us that "look" and bought us lunch that night.

Google sherlock ultrasound and you will see it.

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.

Luckily I work in a facility that has a very strong support team plus we have procedure carts that carry just about every type of access one would need at a given moment. One technique that I have pick up along the way that has allowed me to drastically cut down on the time of my PICC lines is positioning the patients head correctly when feeding the catheter. Most of the PICC nurses at my facility use a special transducer that is placed over the patients chest that detects the guidewire inside the catheter. I have found that you can bypass this step an save significant amounts of time simply bringing the patients chin to the shoulder on the side you are accessing. This closes off the EJ/IJ and prevents the catheter from traveling up the neck an almost always directs the catheter into the correct position. Another tip I have learned is to also twist the catheter in a clockwise motion (right side access) or counter clockwise motion (left side access). This further directs the catheter into the right position. I was lucky enough to have another nurse available to drop all my tools using sterile technique while I was setting up my sterile field. Additionally, once you find your entry point on the vein, place your ultrasound probe parallel to the vein. This gives you a longitudinal view of the vein and you can see the needle enter the vein and your guidewire travel down the needle and up the vein. This technique assures that you are in the correct spot and eliminates the chance of puncturing through the opposite wall of the vein. Further more I have a really good relationship with all of our docs and they will let me place PICCs in lieu of traditional central lines when ever possible. Every time a place a PICC I try to get a little better and a little faster while still providing a safe level of care. #LoveMyJob!!!