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  • Jan 14 '13

    Quote from StudentEtc.
    You know, I guess I'm just hoping that I can bank on the idea that I'm not wasting years of time and effort for someone to tell me that everything I'm doing this for is null if I don't pass a personality test. I have such a wonderful rapport with all of my colleagues, and I have for many MANY years. So, forgive me if I find it incredibly amusing that even though I've clarified my expectations, I can't get a more straightforward idea of what it is I could be doing * other than character development * to be more available for my future colleagues to utilize. Is there no one out there who can communicate explicitly about my inquiry?????
    Sorry if I'm only amusing you, rather than giving you the answer you had hoped for. Please take my answer as a response hoping to provide some input as to what you are expected to show when you're sitting in front of the interview panel for a slot in your ICU.

    You had written "I'd rather approach it as if I'm preparing for the job, and not so much preparing for the interview..." and "...technical skills - not necessarily character development ... skills that would encompass a solid knowledge base once I start, so that I am immediately able to contribute to the success of my team and my patients."

    Sorry if this comes across as somewhat blunt, but are likely putting the cart before the horse.

    As a new grad coming into the ICU, I have almost no expectations about the "technical skills" you bring to the table, other than:
    - be able to thoroughly assess your pt
    - be familiar with basic drugs, consider effects/side effects/contraindications

    Other than these 2 things, I think that new folks coming into the ICU are not expected to be fully up to speed on hemodynamic monitoring, vasoactive drip titration, assisting with bedside invasive line placement, running dialysis/CRRT, managing pts on balloon pumps/IABP.

    To be blunt - everything you had hoped for IS NULL if you don't pass a personality test (the job interview). We've had plenty of highly intelligent people either interview for our unit or get into the Fellowship only to crash & burn after the fact. Intelligence and motivation themselves are useless if you:
    - don't LISTEN during report
    - don't pay attention to what your preceptor is telling you
    - ignore monitor alarms
    - don't ask questions
    - don't listen/observe/examine your pt & watch for changes in their condition
    - focus solely on neato-keen technical skills & procedures, while ignoring the "big picture" of your pt dying in front of you
    - are sloppy and not OCD about critical details of your pt & their current therapies
    - are a "me me me!" type person, not a team player

    During your interview, you might have a clinical question or two thrown in your direction (stuff involving DKA, DIC, HIT, sepsis, ARDS, renal failure, cardiac arrhythmias, ...). You will not be expected to know everything. You may not even be expected to know the "correct" answer to the questions. What you will be expected to do is to be honest & say "I don't know, but here's how I'd find out" rather than trying to BS your way through things.

    As a person who has not worked in an ICU, you should have zero expectations about truly understanding the tasks/knowledge of an experienced ICU nurse. At this point, you might wish to skim the info available on icufaqs.org or in Paul Marino's "The ICU Book." Just try to be familiar with the stuff on an overall level, not a functional level.

    Every ICU is likely different, and my perspective is that of a person who fits into my organization's ICU. I'd be surprised, though, if any ICU expected a candidate (even a nurse with years of experience outside the ICU) to be up to speed on the ins & outs of ICU equipment/procedures/technical minutiae. At best, be familiar with the basics.

  • Jan 14 '13

    Recently I was traveling in Florida with my family to Disney World and a cement truck traveling in the opposite direction, on I 10, had a catastrophic blow out of a front steer tire. He started flipping and went through the median and hit us head on. The impact threw our car 88ft and we landed in a drainage ditch pointing the opposite direction we were traveling.

    To make a long story shorter, I had to be extricated with jaws of life, I went in to shock and while paramedics were medicating me for pain. I had an anaphylactic reaction to Fentanyl and lost my airway.I was airlifted to a trauma center and my kids were taken to ALABAMA to another trauma center because we overloaded the Panama City hospital with our wreck. I didn't know how my kids were doing for over 8 hours.

    The worst part was hearing the screams from my kids asking them not to let their mommy die. I am an RN in the MICU and I it was so hard knowing everything going on and having absolutely no control. I was the one that gave paramedics report when they arrived on scene and I told them when I was loosing my airway.

    Once I lost consciousness and they cut my clothes off and stuck things in every orifice I had, I became scared and realized I was no longer a nurse, I was a patient. I am used to doing this to my patients and I have never stopped to think how I make them feel. I rarely ever was told what was going on or that they were getting ready to do a procedure to me. I just wonder if any of you have experienced being a trauma patient and how did it make you feel.

    This experience has taught me to ALWAYS, whether they are conscious or not, tell my patient what I'm doing. They may not understand but when you are having a rectal probe used on you and they just flop you over and use it..WARN ME that its coming! I never knew how much Lovenox burns when going in, I never realized how hard it is to "cough and deep breathe" with broken ribs, or how it feels to ambulate with a broken foot and busted knees. Also, DVT's HURT like heck! Yeah, I got one.

    Needless to say I have learned so much from being a patient and if I can help one nurse realize that patients are scared and just to have a friendly voice or a hand to hold, MAKES a HUGE difference. Once I have recovered and get back on the unit my patient care will be quite different and I think my patients will be better for it.

  • Jan 14 '13

    Quote from DEE S.
    MSTICU (Med/Surg/Trauma ICU)

    I am a new graduate, this is my first job interview for nursing and I am very excited about this opportunity. Please give me some interviewing tips. Especially questions I should have and be prepared to answer. Strengths and Weaknesses, 5-10 year plan I am prepared for. That's just about it though.
    I occasionally participate in panel interviews of candidates for our ICU.


    You will need to be able to explain WHY you want critical care - what draws you to it. If asked your future plans, it is generally not wise to say that you want 1-2 years of CC experience as a prereq for applying to a CRNA program. That would be an instant "fail."

    Experience as a PCT/extern (especially if it's in a CC unit) is very helpful. ACLS certification isn't a requirement, nor is it really much of a "plus" for a candidate. If hired, you'd be going through a bunch of added classes in any case.

    Be able to express excitement, a willingness to learn, and the fact that you do not know it all. Teamwork is a biggie. You would need to be able to fit in with your coworkers, and be willing to offer help and ask for it when needed.

    Be able to tell about the sickest patient for whom you cared during nursing clinicals. What did you see/experience/learn?

    If you could shadow for a shift in the ICU (and were well received), that would also help your candidacy.

    During your interview, you might have a clinical question or two thrown in your direction (stuff involving DKA, DIC, HIT, sepsis, ARDS, renal failure, cardiac arrhythmias, ...). You will not be expected to know everything. You may not even be expected to know the "correct" answer to the questions. What you will be expected to do is to be honest & say "I don't know, but here's how I'd find out" rather than trying to BS your way through things.

    Good Luck!

  • Jan 14 '13

    Behavioral interview is very common in nursing and basically they ask you to give various stories of how you dealt with a particular type of situation. For example: Tell me about a time when you dealt with a difficult patient or difficult patient scenario and how did you resolve it? Tell me about a time when you had to adapt to a difficult/challenging situation or environment and what you did? Or tell me about a time when you were part of a team, what made that team good, and how you contributed etc. Those are just some examples of behavioral questions I've been asked.

  • Jan 14 '13

    Also, some ICU's give you scenarios when you interview so maybe think of how you would respond to that (example: you find a patient in resp distress - what would you do, a Dr. prescribes sedative for already zonked out pt - what would you do etc). A question like why the ICU is a good fit/why that floor/why that hospital is always a good one to prepare for. I also highly recommend making a career portfolio if you are doing an in- person interview - it helps you to stand out, and depending on how lengthy and nicely put together it is, shows them how much you want the position (i.e. put extra time and effort into preparing). It also shows them what makes you stand apart from other new grads, especially if you have extra experience beyond nursing school and/or some good accolades. When they ask you if you have any questions, I think its always good to ask something about 1. How does this program/residency go basically 2. What do you look for in your new graduate residents (when they say something, I would try to as subtly as possible get a word in about how you match what they are looking for). If it is a behavioral interview, try to frame your stories using the Situation, Action (you took), Result, and What your learned technique. Smile and try to find a way to let your passion show - not in a crazy way, but let them know this is the job of your dreams and you have the dedication and enthusiasm that makes you worthy! I had a panel interview for the ICU and it was very intimidating but I was successful, so I could maybe give you a few tips on those too, if you'd like.

  • Jan 13 '13

    Just my , but a patient who is 6 hours post-PCI (percutaneous coronary intervention - 'PTCA' is not used very much anymore) should be pretty darn stable, especially compared to the other patients in this scenario. The patient should be on hourly groin/vital sign checks and could very well be off bedrest at this point, too.

    I would see patient #4 first, then 3, 2, and 1. Here is my rationale:

    #4 is going to wind up coding if we don't address his breathing and IV situation right away. And I'm a cardiac RN through and through - get that guy back on the monitor STAT!

    #3 needs a glucose check to make sure she's not tanking. She just came from ICU today, so it sounds like her sugars aren't very stable yet.

    #2 received her PPM for CHB, so we need to check on her for three reasons: she has a fresh surgical incision following a procedure where a major chest vein was punctured, she probably received moderate sedation during the PPM insertion so her LOC should be assessed, and she received the PPM for a life-threatening dysrhythmia, so she's probably pacer-dependent. Let's make sure she isn't unconscious or bleeding out and that her pacer is still firing (which would be 'unconscious' for a different reason ). Also let's give her a quick reminder to keep her left (or right) arm immobile to prevent the lead(s) from being dislodged from her heart muscle.

    #1 (see above). This guy should be relatively stable since it has been six hours post-procedure.

  • Jan 13 '13

    hello all - i'm a new bsn graduate in the process of applying to a critical care internship, as my senior practicum with within an icu and i fell in love with it.

    part of the online application for the critical care internship involves responding to a scenario and listing out how i would prioritize care for four patients. like most hypothetical prioritization questions, not nearly enough information is provided on each patient for me to feel confident about my selection. prioirtizing is one of my biggest weaknesses right now and one of the things i'm hoping the internship will help me gain a better handle on.

    if you happen to have some free time, i would greatly appreciate the input from some experienced rns. i don't want anyone to answer the problem for me, but i'd just like to know if you think i am on the right path.

    here is the scenario:
    ------------------------------------------------------------------------------------------

    you are working your first week of night shifts on progressive care unit. you have received a report on four patients, and are prioritizing and organizing your plan of care for the night.
    your patients include:

    1. 52-year-old male who is six hours post ptca (percutaneous transluminal coronary angioplasty) with two stents placed in his lad (left anterior descending artery)
    2. 83-year-old female who just received a permanent pacemaker for third-degree heart block
    3. 34-year-old female type 1 diabetic recovering from dka (diabetic ketoacidosis). she is still on an iv insulin drop, and was transferred out of the icu earlier in the day
    4. 78-year-old male in for chf (congestive heart failure) exacerbation

    suddenly, you hear a three-star alarm on the central monitor. you quickly see it is your chf patient and the rhythm appears to be asystole. upon entry into his room, you find everything a mess. patient is trying to get out of bed, his oxygen is off, his iv is out and he is bleeding all over his gown and bed sheets. you see that all of his telemetry leads are off, his oximeter is off and he is pulling at his foley catheter while yelling he needs to go to the bathroom. between every two or three words, patient pauses for a labored breath and you can hear him audibly wheezing from across the room. his frail little wife is crying while attempting to quiet him down and keep him in bed.

    in detail, explain your priorities and describe your interventions for this group of patients.
    ------------------------------------------------------------------------------------------

    i'm leaning towards prioritizing care as 4, 1, 2, 3. here is the rationales for this ordering:

    patient number 4, the 78-year-old male in for a chf exacerbation, is my top priority for this group of patients because he is currently experiencing airway and breathing complications. patient number 1, the 52-year-old male who is six hours post ptca with two stents placed in his lad, is my second priority because of the risk for impaired cardiac and cerebral tissue perfusion should he experience a stroke. patient number 3, the 34-year-old female type i diabetic recovering from dka, is my third priority because she will continue to require frequent cbg checks and insulin drop rate adjustments until her blood glucose has been returned to between 70 and 130 mg/dl. patient number 2, the 83-year-old female who just received a permanent pacemaker for third-degree heart block, is last on my list of priorities at this moment. though she is at risk for decreased cardiac output should the pacemaker malfunction as well as at risk for infection with the risk factor of an invasive procedure, the patient's primary concern at this time is likely acute pain at the surgical site.

    i can come up with the individual care plans no problem but i keep second guessing my prioritization order. should the diabetic have higher priority over the ptca post-op? thank you in advance for any input or words of wisdom you might be able to provide!
    [color=#888888]

  • Jan 13 '13

    On a PCU you will see a wide variety of things. Chances are your patients will all be on telemetry, so know your cardiac rhythms and know your cardiac drugs. Know some drips, too. On my PCU, we can administer dopamine (up to 5mcg/kg/min), nitro (titrate for chest pain only, though, not BP), Lasix, Heparin, Amiodorone, Integrillin, octreotide, dobutamine (usually if they transferred from ICU and are being weaned) and cardizem.

    Admitting diagnoses/comorbidities that I see a lot on my unit: acute respiratory failure, ARDS, COPD exacerbation (we often get a lot of those patients requiring BiPAP support), status asthmaticus, pneumonia, obstructive sleep apnea, seizure disorders, ischemic stroke/TIA, renal failure (both acute, chronic and acute on chronic, ESRD), electrolyte imbalances (patients get admitted a lot for hyperkalemia/hypokalemia or hyponatremia), acute coronary syndromes, cardiac tamponade, heart failure, cardiomyopathies, hypertensive crisis, pulmonary edema, DVT, PE, DKA, HHNKS, GI bleeds, acute pancreatitis, substance abuse, sepsis/SIRS.

    Review chest tubes and how to properly manage one.

    I love working on PCU. I did my preceptorship on a similar unit that also had a vascular ICU built-in. I ended up getting hired on a PCU after graduation. You definitely learn a lot on this type of floor. Good luck and feel free to PM me with any questions you may have!

  • Jan 13 '13

    good brain sheets.....to keep you organized
    brain sheets.......here are a few.

    mtpmedsurg.doc 1 patient float.doc‎
    5 pt. shift.doc‎
    finalgraduateshiftreport.doc‎
    horshiftsheet.doc‎
    report sheet.doc‎
    day sheet 2 doc.doc

    critical thinking flow sheet for nursing students

    student clinical report sheet for one patient

    i made some and some other an members (daytonite) have made these for others.....adapt them way you want. i hope they help

  • Nov 17 '12

    Quote from Yee213

    Thank you so much for your reply. I did some research about public and private system, from what I understand is in general the public hospitals are higher acuity, and I enjoy working in the teaching hospitals, so I think I would prefer public hospitals. Which hospital is the cardiac hospital in Brisbane? I would like to do some research on that hospital can you also give me the names of some excellent hospitals so I can do some research on them too? Sorry I have too many questions :P Thank you!
    Public system is great, more resources and better nurseatient ratios. Research "Queensland Health" it's the name of the major public system in Queensland. The Royal Brisbane hospital is the largest public hospital in Queensland, followed by the Princess Alexandra. These are both what you would call "level 1" trauma and teaching hospitals. I've heard very good things about the cardiac wards and CCU at the PA. Don't know anyone that works in cardiac at the Royal but its a good hospital also. The hospital in Brisbane known for cardiac is called the "Prince Charles" hospital. It's apart of Queensland Health also. Right next door to Prince Charles is its private cousin "Holy Spirit" which has multiple cardiac wards and a CCU.

    Even though it is private, "Greenslopes" hospital has an excellent CCU from what I hear but avoid the regular wards.

    St Andrews is a known cardiac hospital as well though it is also private.

    Avoid outer suburb hospitals such as Redcliffe and Caboolture. Avoid Logan. And when it comes to living unless you get a job at the PA stick to the northside of the river.

    Did any of this post help or make sense? Sorry I'm half asleep at this time! Haha

  • Nov 17 '12

    Hi,

    I just received my eligibility letter from AHPRA yesterday. From what I understand is my license is finalized and all they need from me is physically present in AHPRA with my passport and visa, and I should be receiving my license few days after. I'm a nurse in US with 1 year exp. The whole process for applying the registration is fairly smooth for me. I Fedex my application on June 9, they send me ane -mail on June 19 saying they received my application, time frame for my application is 4-6 weeks and they also requested some additional document. I Fedex my documents to them and they received it on July 4. I received an e-mail from my professional officer on July 25 saying they've mailed me my eligibility letter.

  • Nov 17 '12

    I passed NCLEX in August & applied to many jobs online with no results. With an ADN & no healthcare experience, I really had to stand out from all the others. In September, I finally started calling places & asking to speak directly to the RN manager, then following up with my resume via email. As a very shy & introverted person, it was really hard to do so but I'm glad I did it. I got 2 interviews out of it & was offered a job from one of the companies. My employer never even received my online application; I ended up filling out a paper one at my interview. I will admit, it is not the area I hoped to worked but I am grateful for the opportunity and intend to give it my all and reevaluate my situation in a year. Keep volunteering, stay in touch with classmates, network with everybody. Good luck!

    Also, I found this article was really interesting. A bit depressing/scary for a new grad but a good reality check. Had I read this before I started nursing school, I may have changed my educational plan or at least had a better idea of what to expect when out of school.

    Why Nursing School Grads Have Trouble Finding Jobs

  • Nov 17 '12

    That's a great point about what Malela says, status stuff like BMW'S don't seem too important here I live in Waikiki and it is more expensive, I pay about $1300 for a rather small one bedroom that includes security, parking, water and basic cable. Electric runs about 90 a month (yes it's high). Food costs are of course high. But some of the high costs are offset by other advantages such as not needing winter clothes. And the beach is free. I moved here seven years ago and I was well aware of the COL but it was a LIFESTYLE change that took a bit longer to get used to..coming from the mainland where I had a three bedroom house, and now I live in a small place in a high rise..but really all I need is a computer and a place for a surfboard, so if the lifestyle suits you, there's payoffs to the higher COL. I'm a single mom and I do case management, I don't have loads of money laying around but it supports me pretty good. But I don't have any debt, no mortgage, no credit card payments, and nothing fancy.



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