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LovePurple 3,276 Views

Joined: Jan 18, '08; Posts: 108 (7% Liked) ; Likes: 8

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  • Nov 23 '13

    You definitely need to know hemodynamics. Do you have working knowledge of the normal and abnormal values of CVP, PAD, PAS, SVR, PCWP? What do they all mean? Do you know the most common ICU drugs and their side effects: Levo, Dopamine, Dobutamine, Milrinone, Nipride, Vaso, Cardizem, etc.? When would you choose Dobutamine over Dopamine? Why Nitro over Nipride? What's your experience with patients with DKA, HHNK, SAH, subdural hemorrhages, epidural hematomas, strokes, MIs, and everything in between? And I'm talking about when they are first coming into the hospital, not after a few days.
    I've worked in a level 1 trauma hospital in the Cardiothoracic Surgery ICU for almost two years and I JUST now feel comfortable in taking the test. There have been nurses who have been here longer who have failed the exam.
    So interpret it all as you wish but know that without prior working experience with all the above listed, it may be an uphill battle passing the exam. But good luck to us all!

  • Jul 8 '12

    The biggest difference between the two units is the level of monitoring. The CVICU has much more extensive monitoring. You have to familiarize yourself with PA, CVP, and arterial lines. You will also monitor patients on the balloon pump. I would begin to get a grasp of all the different lines you will come across and understand exactly how they work as well as what they measure. You will also need to know the various drips patients will have in the CVICU. If you want to get a heads start, look up vasoactive drips and understand exactly what they do. Questions that you need to ask yourself are: does this drug increase or decrease BP, what is the half life of this drug, when should I increase the rate of the drip so as to avoid dose stacking, does the drug affect veins, arteries, or both, is this drug used for ventricular or atrial arrythmias. There are a few more questions you will need to ask yourself. I am sure you get the picture. I can fill you in more if you are interested.

  • Nov 19 '09

    great post by jjjoy! And I agree that you don't want to be in a job where you have to take meds to get through the day. Unfortunately a lot of hospitals run on chaos and short staffing. Please remember some things are not worth your sanity, and living each day dreading the next is no way to live.

    Have you thought about applying for jobs outside of the hospital? Things like office nursing, school, insurance companies, community health, private care, etc? Click on the specialty tab, then nursing specialties to see a comprehensive list. It takes time, and is frustrating trying to find a job that will work for the long term. Give yourself a break, don't try to force things to work if it just won't.

    Also right now a lot of public health departments are looking for help to administer the h1n1 vaccine. Get in contact with them for some temp work, and that will help boost your spirits and resume.

    And if another career path is in your future, it is not considered a failure to not work as a nurse. It only adds onto your background as a knowledgeable person, with more to draw from. Your nursing experience would be helpful if you were to apply to nearly any hospital job - remember, they have marketing departments, HR (nurse recruiter), charitable giving department, etc.

  • Nov 18 '09

    Try to keep in mind that it would NOT be a failure or shameful if you ultimately left another nursing job. It would provide very useful evidence and experience. It would help direct you to an area where you can shine (instead of getting stuck in a job that makes you crazy but you don't want to quit). You could end up better able to evaluate future opportunities. You would refine old skills and learn new skills that could help you in future job pursuits. By being there, you might learn about some other great opportunity or make useful professional contacts. Or you might end up loving it and staying in acute care bedside nursing!
    I totally understand not wanting to make a "wrong" choice. Yes, it could negatively affect hiring decisions in the future. On the other hand, who wants to work for someone who won't be supportive of an anxiety-prone newbie? Remember that it's okay to be less than perfect. While supervisors and colleagues may be quick to point out problems, that doesn't mean that you're hopeless. The reality is that every nurse, every person in the world has their strengths and weaknesses. We've all met wonderful, long-experienced nurses who still do things that at times make us wonder how they've managed.

    Regardless of endless advice about careful evaluation and good decision making, the bottom line is if you don't know what job will work, how can you possibly know what the "right" choice is? You can't. And others will tell you what is best based upon their own experiences which may not be applicable to your situation.

    So you roll the dice, see how it goes, and move forward with whatever new insight you gained in that experience.

    Personally, I tried several bedside nursing jobs and didn't last long. Besides the usual dreadful struggles of feeling totally useless, overwhelming responsibility, managing chaos, etc. Even while my competence and confidence grew (when I started feeling like I really had something to offer patients besides a bumbling idiot), I was observing the experienced nurses and thinking 'THAT is what I'm striving for? To be running all shift, never getting a chance to really give holistic care to patients, constantly having to put off important tasks because an even more important things need to be taken care of. Sure, I could build my competencies & become more confident in my practice, but I'd still be looking for a way out of the chaos. And many non-bedside jobs rightly require a good deal of clinical experience. But if working a bedside-related job wasn't for me, then much of the job security & flexibility with decent stable pay etc that is so appealing about nursing flies out the window. Yes, there are other options. Through my experiences, I decided that instead of using my nursing degree directly, I could make good use of my background in other ways.

    I applied to jobs that sounded like something I would really be able to be comfortable coming in for day after day, year after year, focusing on health-related job openings (eg local hospital, medical supply company). I ended up in health information and have taken to it like a duck to water.

  • Apr 28 '09

    I am almost relieved to have found this thread because I feel the same way. Why do we subject ourselves to this abuse? I get that this is a "female" profession so that automatically means its abusive but that doesnt make it right. I am a new grad and feel like I dont recognize myself anymore. I am tired ALL the time. I don't have a social life. I don't sleep. I dont see my husband. I am alone on almost all my days off and when Im at work Im running like crazy. Doctors snapping at you, NAs snapping at you, higher ups wanting more from you when youve given everything you can give. I have been working for about 9 months now and I am honestly beginning to wonder if I am cut out for nursing. The first 4 months were ok. And I keep trying to tell myself its just the first year, but over the last few months Ive become depressed. The sleeping issues, the lonliness, the stress levels....all of it is worse. Everyone tells you they are there to help you-keep asking questions....but when you do they tell you need to figure it out on your own-find ways to cope. It is such a abusive profession-and I dont know that Im THAT tough.

    The sad thing is those who have been in nursing for a long time know its abusive. and when you tell them that its wearing you down and you feel depressed...they say well everyone on this floor is depressed-were all taking one drug or another for it....

    Thats not ok and Id like to know why senior nurses say that-how they justify what happens to nurses on a daily basis. And I dont want to rely on some pill to feel happy. I dont want to give up happiness for this.

  • Mar 30 '09

    Quote from LovePurple
    so I only have a couple weeks left on orientation.. things are decent, but I'm getting so stressed with the responsibility of people's lives in my hand that I'm starting to have panic attacks before work! Tonight I even had to call off because I just couldn't get myself calmed down, and the idea of going to work like that made it even worse! Not to mention the nights are killing me ... and my body is not adjusting to this. I feel like I'm MUCH more comfortable at a desk! Not messing with the unexpected at work! What is a less stressful job... that I can do day shift on?

    Any suggestions about other options for nurses??

    Bedside nursing is not for everyone. I, for one, cannot see myself doing bedside nursing forever, and yet I think I'm fairly good at it because I communicate well with people.

    I was originally hired to work nights along with another classmate. I have a very supportive manager and she took both of us off orientation at different times per our "readiness." Fortunately, my boss allowed me to stay on orientation almost as long as the other new grad because I didn't feel ready. Also, one of my biggest concern was whether I could switch my sleep cycle back-and-forth to work nights. By the end of my orientation, my unit had an opening for day shift and my boss allowed me to switch into day shift. I'm sure this was after my preceptors agreed that I could handle the day shift load. This was a big anxiety reducer for me.

    My classmate ended up quitting <1 yr off orientation because she could not handle nights and, I think, the acuity of our population was a bit overwhelming for her because she was always anxious about going to work too. She didn't want to do bedside nursing either, but with less than 1 yr of experience she had a hard time getting a job in a clinic or doctor's office. After months of unemployment, she accepted a job in a rehab unit as a bedside nurse on days, but I think it is a better fit for her because these patients are stable, therefore less anxiety for her.

    I've been out of nursing school for only 2 years, and this was a career change for me. It was EXTREMELY scary and challenging for me when I went off orientation. I was nauseated and lost sleep before going to work, but I think for many new RNs that's the routine. So take a deep breathe and reflect on each day to see what caused problems for your shift/anxiety. After doing that for a few shifts, I found that TIME MANAGEMENT was my biggest issue b/c I struggled to get my tasks and charting done AND clock out by 7:15pm. I was constantly clocking out late (usually 8:45pm or after 9pm). How did I fix this? I asked other RNs how they managed their time, tried their routine, and saw what components worked/didn't work for me and incorporated it into my own routine. Now? I leave at most 15-30 minutes late instead of the after 9pm as before. So... reflect after your shifts to see what was good and what was bad to help you reduce your anxiety.

    Do I still get nervous of the unknown? Not as much. Why? I'm on a telemetry unit and after a while, you get the hang of the population. At times, I get cases that I'm nervous about because I had not treated such a diagnosis before. But that's what charge nurses are for. I just let the CN know after getting report that I may need help with that case because of XYZ and they say, "OK." Instead of getting anxious though, I approach these cases as a new learning experience to break the monotony.

    Don't be afraid to ask for help. Other more experienced RNs and CNs are there to help you during your shift. They may not have the time to do things for you (and you shouldn't expect them to!), but they are there as your resources.

    With the economy today, it is unsure as to what will provide you with job security. If bedside nursing is not for you, look into other avenues/niches of your interest. Are you good with computers? If yes, perhaps look into computer charting development teams. Or if you're good with starting IVs, join the IV team at a hospital. Or become a PICC nurse, home health RN, educator, diabetes teaching, clinician, nutritionist, research, insurance companies, school nurse, etc. Or you can pursue a MSN and go into teaching others to become an RN.

    IF you can tolerate working as a bedside nurse for a couple of years, I think the experiences will make you a better teacher/researcher/developer, should you pursue these avenues... My !

    Good luck!

  • Mar 20 '09

    i feel for your situation and I am happy you took steps in getting out your unfortunate circumstance. It seems that you had 2 big issues going on. First, perhaps hospital nursing may not be for you. face it, majority of the nursing jobs require a bedside or procedural area experience. even in the areas of research nursing may require experience. secondly, the night schedule is not for everyone. I work nights and love it and I am still in the first year of nursing. i work in the psyche floor (talk about unpredicablity). I was a tad overwhelmed @ first but I was really focused and determined to succeed. In my second month working, I was fast tracked out of orientation and was made charge nurse much to my surprise. Talk about overwhelmed and intimidated. Fear was the dominant feeling as I wanted to run a "tight ship" in my shift and made sure everyone on staff did their jobs properly. I was blessed with wonderful coworkers who "had my back" and were equally determined to see me succeed. So my first taste of being in charge of so many people in my watch went so smoothly . In fact I was teased for being such a "general" for being very professional and speaking with such authority.
    Over time, I felt more at ease with my role as an RN. There is still that nagging feeling @ the back of my head, and fear at times. But i used those feelings of anxiety to be a careful and mindful nurse.
    But as much as I enjoyed working NOC shift, my family did not. they missed me and it was tough on them. I began to look for other departments within the hospital that can use my newly acquired psyche nursing skills. I did not have far to look. I applied in the ER/ED for a position in one of the sattelite urgent care clinics. Beginning next week, I will be working days, holidays off and learning new nursing skills in the emergency/trauma area. though my clinic will not see any emergent cases, being trained as an ER nurse, I was told if I wanted to that I can pick up some hours @ the ER whenever I am free and what the schedule allows.
    So my point is that don't give up on yourself with nursing. Here are other areas of nursing you may consider, case management, infection control, quality assurance, peer review, admitting and discharge planning, nurse educator, insurance nursing, even a school nurse, public health nurse...the list goes on. You have many options. One door may close but many others open.

  • Jan 21 '09

    It sounds like driving that far for 4 or 5 months until you move might be the thing to do. I work with several people who drive at least 2 hours, stay in town to work their shifts and then go home--and they have no intention of moving. My hospital subsidizes their hotel rooms while they are in town and one person keeps an apartment in town.