SNIXRN 6,903 Views
Joined: Jul 10, '08;
Posts: 272 (28% Liked)
; Likes: 217
3 year(s) of experience
I hear you loud and clear, FossilRN. When everyone else is too busy putting out fires to help you with your own fires it can be maddening. Today I had two critically ill patients and I was just about literally darting back and forth between the two of them like a maniac just trying to keep my head above water (read: keep my patients' stable/alive). My charting was pitiful and the rooms both looked like hurricanes had hit. But the patients were alive when I gave report. I am now sitting here at home (3 hours later) obsessing over everything I did -- what I forgot to do and what I should have done better. Not always a warm, fuzzy, rewarding job. I could have REALLY used some help...
We don't give it in our BMT patients unless they're a child or the temp is very high. Letting them have a fever is one of the only defenses their body has naturally against bacteremia. The bacteria don't tolerate the higher body temp as well and die more easily. Also, we don't want to mask the fever. Left untreated, the fever can be a good indicator of if the antibiotics are working, especially in someone who otherwise feels decently and isn't obviously septic.
Now any idiot understands that a pt w a BP of 60/30 is getting less blood to the brain than someone with a pressure of 130/80, but sometimes it is interesting to see the actual numbers.
I, too, work in Neurosurgery and I would have called for an order for this at 3am. The difference is I work in a teaching facility and we have a resident in-house 24/7 who would just write the order.
I disagree that the surgeon would not be able to operate in the morning if he got woken up for 2 minutes to give a verbal/telephone order for an antacid. He'd still operate in the morning if he got called into an emergent case or had to come in at 3am to see a patient in the ER, wouldn't he?
I have started asking pts that I admit, "What do you take when you have heartburn? What do you take if you can't sleep? What do you take if you have a sore throat? What do you take if you're constipated/have diarrhea?" "Is there ANYTHING that you can think of that you take OTC for any reason?" I put every single one of these things on their home med list as a prn and hope that the doc checks off to continue it while in the hospital, so when they decide to get obsessed about their bowels at 2330 I can just give the meds.
Every day is different, but in general I arrive to the OR between 6-6:30, even though my time isn't 'counted' until 7 to make sure I'm ready for the day. The group I'm with does keep track of hours, but it really doesn't make any difference because I'm paid a salary. If there's something with the procedure or patient that I need to brush up on it gives me time. Otherwise I get ready and chat with the other CRNAs. It's about the only time we see each other because the rest of the day we're each in our own rooms. About the first thing I'll do is go meet with my first patient. Often they are nervous and it helps relax them if they meet me and I develop some rapport with them. Around 7:30 the first case goes to the room, and I either induce general anesthesia, place a regional block, or start sedation. Most of the time I am pretty quiet and just concentrate on what's happening with the patient and the case. sometimes the surgeon likes to chat if things are going as expected. Once the case is finished it's emerge the patient as quickly as possible while maintaining safety. Get to recovery room, give report. Then go see the next patient, assess them and get consent, back to the OR to clean up, and set up for the next case. From the time one patient leaves the OR, and the next comes in is about 15 minutes so you really need to move quickly. I draw up a label my drugs for the next case during the middle of the first case otherwise you are behind. Do that throughout the day, usually get 20 minutes for lunch. We don't do the coffee break thing, but some places will have someone get you out of a 10 minute break morning and afternoon.
I'm telling about this part of the career, because I've work with student's who seemed surprised that:1. there is no set time that you can leave, depends on the OR schedule, it's not shift work, 2. you have to move quickly while remaining completly accurate in what you are doing, 3. it's hard work with few breaks during the day, you will leave tired. 4. you are fairly isolated while you work, I'm the only CRNA in the room and we are independent so I don't see a MDA unless I call one in. 5. your work schedule will effect your entire family, maybe I'll be done to go to the soccor game, or maybe I won't. Cell phones are life savers! 6. you need to be good at getting along with people, because surgeons, patients, etc can be difficult and you need to get done what is needed while hopefully keeping things on an even keel.
I find it very rewarding because every anesthetic is different, and it's a challenge to keep up with the new developments in the field. Like many CRNAs I enjoy the technical skills of intubation, and regional blocks, etc. You need to not require a lot of reassurance and be comfortable thinking for yourself.
Have you been to icufaqs.org? It is definitely an excellent resource for new ICU nurses, it lists a lot of the common drugs, explains labs, A lines, PA lines, etc. It's definitely a good starting point
And congratulations on your job! You should be very proud to obtain a position in what is probably the hardest part of the country to obtain a job, and it's hard everywhere.
The one that got a few of the nurses when we were applying for the critical care fellowship was "your patient is post op 2 hours. His blood pressure is 75/40. What would you do first?" Almost everyone said "call the doctor". They were looking for a more "critical care" answer such as "how are you getting the pressure, via a manual cuff, dynamap, or arterial line?" Also, they wanted to know if the patient was stable, what their heart rate was doing...stuff like that. They want to make sure that you see the BIG PICTURE of your patient, and not just the fact that their pressure is low.
Do you know what area you're interviewing with? I had a general interview with HR; then they walked me over to the hospital and I had pretty standard interviews with nurse managers--response to conflict, communication style, that kind of thing--and a few behavioral and prioritization questions with imaginary scenarios.
Lots of my colleagues commute by bus/ferry/bike/walking, from a few different areas. Capitol Hill is one.
RNinWhite - I am taking your advice! I am actually starting the process to volunteer at the Mayo Clinic. I currently work at Mercy Care Plan and I have heard nothing but good things about Mayo. I don't know which campus I'm going choose (Phoenix or Scottsdale) but I would love to work for Mayo after my graduation. I heard that they are really selective, so if volunteering could help me land a job, I'm all for it!
I work at Children's as a new grad and am still in orientation.
What unit is your interview for? The staffing ratio is different for each unit. PICU and SCCA are 2:1 usually. Surgical is 3:1 on days and 4:1 on nights. Same with Medical I believe. Pay for a nurse with less than 1 year experience is $27.49. Night differential is about $4.25 and weekends diff is $4. Evening is around $2-ish. Most positions require that you work 2 weekends a month.
Good luck! Let me know if you have any other questions. I absolutely LOVE this hospital and it really is a dream job for me.
Exerienced? About a week
Competent? About a year
Expert? 10 years or more
I can think of about 2 dozen in HR and nurse recruiting that I would like to see on the bricks.
I still personally think that babies look an awful lot like old men.
CXR to verify that you've got it coiled up in the back of the throat.
I had one placed in me before surgery once. Like having a 3 ft long #2 pencil shoved up your nose. Eeeeew.
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