Hopeful future Burn Nurse

marienm, RN, CCRN · Jul 6, 2016

You might be able to do the ABLS training, if it's offered near you. This was *not* a prerequisite for me being hired, and I don't think my trainer had me do it until I'd been working for a while. It covers the first 24-ish hours of burn resuscitation. RNs and EMTs and MDs from smaller hospitals come to ours to learn what they should do to stabilize a patient before they get them to a burn center. You also might be able to do ACLS after you're licensed...I think you have to be licensed to take it. (Obviously, I was! My hospital pays for and schedules trainings like this, so I had not done it before I was hired.)

You could look at the hiring requirements of the hospital where you want to work, if you have one in mind. Do they hire new grads in ICUs? (Mine did.) Do they prefer some acute care experience first? Is their burn ICU a separate unit from a step-down or rehab unit...would they let you start there if not in the ICU?

Can you work as an aide/tech/volunteer in the unit to get a feel for the place? I assume they'd be more apt to hire a familiar (and enthusiastic) person over another, unknown, new grad. And, if you find out that burns are actually *not* your thing, you'll still have some experience in an ICU environment on your resume.

Good luck with your last year of school!

msfb · Jul 6, 2016

I've been a burn nurse for 6 years and I love it

It's extremely rewarding. It's not for everyone. We had an nurse quit during orientation because she couldnt handle the hours long marathon dressings.

However, I strongly believe a burn center is not the place for new nurses. At my burn center you are so limited to burn care that when you go to other units it's easy to be overwhelmed. We rarely see drips other than insulin, heparin, dilaudid, and versed. And if they have head or other trauma they got to our trauma/neuro unit. You have to be basically healthy to burn yourself so we dont see a lot of sick patients, other than the occasional diabetic that burns their feet or if a big burn gets an infection.

I highly recommend starting on a PCU or Micu/Sicu. The experience you will gain on those types of floors will be invaluable. Ut will be a resource you can tap for the rest of your career.

Best of luck in your nursing school endeavors!

ha081917 · Jul 6, 2016

Thank you so much!! I will definitely look into that!!

marienm, RN, CCRN · Jul 7, 2016

I agree that if the burn center/ICU takes *only* burn patients, it will limit the exposure you get to other types of patients. I work at a teaching hospital that's also a trauma center. We have a small burn unit, but we'll take SICU pts as needed, and sometimes we're half full of MICU pts, etc...depends on the census of the hospital.

Maybe our burn pts are just unluckier than msfb's patients, but *not* all of our patients are healthy before they get burned. We've had numerous COPD/CHF pts who smoke with their oxygen on; we've had numerous alcoholics and/or opiate addicts who pass out with a lit cigarette or the stove on and get burned; we've had people with other physical disabilities who just couldn't rescue themselves when a fire/flame/scald event occurred; we have meth cooks who burn themselves and have a whole host of psychosocial and law-enforcement issues, etc. Our most common gtts are probably versed, ketamine, fentanyl, & insulin, but we run our share of pressors and some paralytics, too. (msfb, I'm intersted that you run heparin gtts frequently...we don't see these often for burn pts unless they have a DVT. What else do you use them for?). A small number of pts wind up needing CVVH.

If you think you're committed to the burn unit, try to shadow or get a preceptorship there in your last year of school! Then you'll get to see if it's what you want.

ha081917 · Jul 7, 2016

Thank you! I am working on doing that and getting it set up with my school. I wouldn't be able to start until next June thigh during my final term, but I am definitely trying to make that happen!

frozenmedic · Aug 22, 2016

If you're starting out as a new nurse and interested in the burn population, you should go for it. I think you'll find that a burn ICU can offer exposure to far more than "just" burns. Assuming you're working in a verified burn center, not just a unit that has burn in the name, you'll probably serve as a regional if not multi-state referral center.

I recently left an adult and pediatric burn center located in a level I trauma hospital, and I can guarantee that you don't "have to be basically healthy to burn yourself." We would see multi trauma patients with burns, tons of concurrent substance abuse and mental illness, plus, as another poster has noted a whole host of prior medical problems that will be exacerbated by their burn injury acutely, and during the potentially 6-12 month stay for our big burns.

The hyperdynamic nature of burn injury can induce MI or arrythmias in the patient with prior cardiac disease, renal failure in susceptible patients, then there is rhabdo from electrical injuries or unrecognized compartment syndrome from transferring facilities, massive PE due to immobility, and of course sepsis, sepsis, sepsis. We would also treat a fair number of patients with rare non-burn exfoliating skin diseases like necrotizing fasciitis, SJS/TENS, calciphylaxis, erythrodermic psoriasis, and plenty of others.

Assuming you work at this type of high acuity place you'll get exposure to tons of drips (pain, sedation, pressors, insulin, paralytics, continuous antibiotics), bedside procedures (trachs, bronchs, PEGs, bedside endoscopy), plenty of CRRT, and potentially unique vent modes or ECMO for patients with inhalation injury if your unit does that sort of thing. Your assessment skills will be tested as you simultaneously care for patients across the age spectrum, attempt to manage pain in the paralyzed patient, or try to walk the line keeping your non-vented patient breathing but not suffering as you give huge doses of meds for wound care.

As other people have mentioned it's crucial that you try to get into that unit for a shadowing experience, clinical rotation, or preferably capstone. You need to make sure that you really enjoy working in a super heated room (burn patients get hypothermic easily) while dressed in a plastic wrapper, and that the sight and smell of huge wounds doesn't bother you. We have had both students and regular employees lose consciousness during wound care. Our unit would happily hire new grads, but they were required to spend time on the unit (preferably during a capstone) to make sure they could deal with the realities of burn ICU care.

There are plenty of people who have spent their entire career in burns-maybe you'll be one of them. One of the underappreciated benefits is your coworkers: people generally don't come to burns just because there was a position open. People come because they're specifically interested in the field, and want to do what they're doing. These are they types of people you want to work with.

ha081917 · Aug 22, 2016

If you're starting out as a new nurse and interested in the burn population, you should go for it. I think you'll find that a burn ICU can offer exposure to far more than "just" burns. Assuming you're working in a verified burn center, not just a unit that has burn in the name, you'll probably serve as a regional if not multi-state referral center.
I recently left an adult and pediatric burn center located in a level I trauma hospital, and I can guarantee that you don't "have to be basically healthy to burn yourself." We would see multi trauma patients with burns, tons of concurrent substance abuse and mental illness, plus, as another poster has noted a whole host of prior medical problems that will be exacerbated by their burn injury acutely, and during the potentially 6-12 month stay for our big burns.
The hyperdynamic nature of burn injury can induce MI or arrythmias in the patient with prior cardiac disease, renal failure in susceptible patients, then there is rhabdo from electrical injuries or unrecognized compartment syndrome from transferring facilities, massive PE due to immobility, and of course sepsis, sepsis, sepsis. We would also treat a fair number of patients with rare non-burn exfoliating skin diseases like necrotizing fasciitis, SJS/TENS, calciphylaxis, erythrodermic psoriasis, and plenty of others.
Assuming you work at this type of high acuity place you'll get exposure to tons of drips (pain, sedation, pressors, insulin, paralytics, continuous antibiotics), bedside procedures (trachs, bronchs, PEGs, bedside endoscopy), plenty of CRRT, and potentially unique vent modes or ECMO for patients with inhalation injury if your unit does that sort of thing. Your assessment skills will be tested as you simultaneously care for patients across the age spectrum, attempt to manage pain in the paralyzed patient, or try to walk the line keeping your non-vented patient breathing but not suffering as you give huge doses of meds for wound care.
As other people have mentioned it's crucial that you try to get into that unit for a shadowing experience, clinical rotation, or preferably capstone. You need to make sure that you really enjoy working in a super heated room (burn patients get hypothermic easily) while dressed in a plastic wrapper, and that the sight and smell of huge wounds doesn't bother you. We have had both students and regular employees lose consciousness during wound care. Our unit would happily hire new grads, but they were required to spend time on the unit (preferably during a capstone) to make sure they could deal with the realities of burn ICU care.
There are plenty of people who have spent their entire career in burns-maybe you'll be one of them. One of the underappreciated benefits is your coworkers: people generally don't come to burns just because there was a position open. People come because they're specifically interested in the field, and want to do what they're doing. These are they types of people you want to work with.

Thank you so much!!!! I am hoping to get into a burn center that has a trauma related things too! I have been researching and everything but I don't graduates for another year so I have time to keep doing more research. Do you mind if I ask what part of the country you work in?

frozenmedic · Aug 26, 2016

I worked in a burn unit in the southeast. It's a great place to be.

Daisy_117 · Sep 7, 2016

I agree with a lot of what marienm notes here. As a burn nurse the pts that I have taken care of are not always healthy and there can be a number of psychosocial pieces that factor in to the situation. We run a full ICU for Burn patients and on a rare occasion can get overflow from SICU. Being only one of two full fledged Burn units in a 5 state area makes for a very interesting patient population. The other thing to remember about burn is that you are dealing with patient populations that span the cradle to the grave. Everyone is susceptible to be burned. It can be one of the most rewarding places to be as a nurse, but it can also be one of the most emotionally trying.

As a burn nurse you can expect to deal with the unexpected at all times and the psychosocial aspect can make this even more trying. I would definitely wait until you are hired somewhere to get your ACLS or PALS certification, they will likely be a requirement at some point on Burn, but as a new grad it can be difficult to fully understand the circumstances and situations around when to push what and truly how you initially will respond in situations. As you get out and are exposed you pick up the critical thinking that is important to making these rash decisions in high stress situations and you learn how you will react under pressure.

Good luck as you finish school! Nursing is a very rewarding and challenging career path.