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harryalexx 2,180 Views

Joined: Apr 26, '10; Posts: 18 (39% Liked) ; Likes: 15
Pediatric Cardiothoracic ICU RN; from US
Specialty: 4 year(s) of experience in Critical Care, Pediatric

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  • May 28 '13

    Yes. The hearts. That's something else entirely. The best advice I can give you for that is that while you're on orientation (and after) get a picture drawn of every heart you care for, because odds are, you will rarely find two that are alike. I still print out the cath pictures of kiddos whose combination of defects I just can't put together in my head, seeing the picture and being able to trace the blood flow really helps.

  • May 28 '13

    Please take advantage of PHARMACIST discussion regarding medication and infusion compatibilities. They are a tremendous resource often overlooked and should be go-to person to help devise a policy regarding Lipid infusions.

  • Nov 27 '12

    Quote from RNFiona
    Folks who enter nursing for no other reason than financial security usually make lousy nurses.
    Then again, I've met more than a few substandard nurses who claim that they were 'called' to the nursing profession by some intangible higher power. Although money was not their primary (or even secondary) motivation for becoming nurses, their love of humankind and proclamations of a calling still do not render them safe to practice.

    Some sloppy nurses are solely in it for the money. Some sloppy nurses were 'called.' Also, excellent nurses are cut from both types of cloth. It takes all types to make the world go 'round.

  • Nov 27 '12

    Am I the only one who becomes at least mildly irritated whenever a random individual finds out that someone is a nurse and proceeds to say, "You're rolling in the big bucks!"

    To keep things honest, I'll recall a few observations about the people who generally do (and don't) broadcast their feelings about nursing pay. In my personal experience, no doctor has ever told me to my face that I'm earning 'big money.' No engineers, attorneys, pharmacists, speech language pathologists, or other highly educated professionals have hooted and hollered about the supposedly 'good money' that nurses make once they discover that I am one. On the other hand, bank tellers, call center workers, clerks, and others who work at entry-level types of jobs have loudly made their feelings known about the incomes that nurses earn.

    I was employed at two different fast food chains while in high school, and during my late teens, I worked a string of dead end jobs in the retail sector. From ages 20 to 23, I maintained employment at a paper products plant in high cost-of-living southern California as a factory worker and earned an income of about $40,000 yearly with some overtime. Of course I thought that nurses earned handsome salaries during my years in the entry-level workforce. After all, the average RN income of $70,000 annually far exceeded my yearly pay back in those days. Keep in mind that I paid virtually no taxes as a fast food worker because my income was so low. Also, I paid relatively little in the way of taxes as a retail store clerk.

    Many of the certified nursing assistants (CNAs) with whom I've worked over the years have fallen into the trap of believing that the nurses are awash with cash. However, the ones that pursue higher education and become nurses themselves eventually come to the realization that the money is not all that it is cracked up to be. For example, Carla* is a single mother to three children under the age of 10 and earns $11 hourly as a CNA at a nursing home. Due to her lower income and family size, she qualifies for Section 8 housing, a monthly food stamp allotment, WIC vouchers, Medicaid, and childcare assistance. Moreover, Carla receives a tax refund of $4,000 every year due to the earned income tax credit (EITC), a federal program that provides lower income workers with added revenue through tax refunds. Much of Carla's CNA income is disposable.

    Carla returned to school part-time, earned her RN license, and now earns $25 hourly at a home health company in a Midwestern state with a moderate cost of living. She nets approximately $3,000 per month after taxes and family health insurance are deducted as she no longer qualifies for Medicaid. She pays the full rent of $900 monthly for a small, modest 3-bedroom cottage because she no longer qualifies for Section 8. She pays $500 monthly to feed a family of four because she no longer qualifies for food stamps or WIC vouchers. She spends $175 weekly ($700 monthly) on after school childcare for three school-age children because she no longer qualifies for childcare assistance. Carla's other expenses include $200 monthly to keep the gas tank of her used car full, $300 a month for the electric/natural gas bill, a $50 monthly cell phone bill, and $50 per month for car insurance. Her bills add up to $2,700 per month, which leaves her with a whopping $300 left for savings, recreational pursuits and discretionary purposes. By the way, she did not see the nice tax refund of $4,000 this year since she no longer qualifies for EITC. During Carla's days as a CNA most of her income was disposable, but now that she's an RN she lives a paycheck to paycheck existence. I'm sure she wouldn't be too pleased with some schmuck proclaiming that she's earning 'big money.'

    The people who are convinced that nurses earn plenty of money are like shrubs on the outside looking in because they do not know how much sweat and tears we shed for our educations. They remain blissfully unaware of the daily struggles of getting through our workdays. All they see are the dollar signs. I'm here to declare that I worked hard to get to where I am today and I deserve to be paid a decent wage for all of the services that I render. Instead of begrudging us, join us.

    Further information to help readers decide (added by staff)

  • Nov 27 '12

    I know at least a dozen people who have done missions with ICHF. One of my friends is in Ukraine on one right now (her first) and another has just gotten back from the Dominican Republic (his second). Two others will be going to Libya in a week or so. Yet another is a clinical educator with the program. It's a very intense and hectic experience with great learning opportunities. I would love to go almost anywhere with them but don't think I can make it work for me for a number of reasons. But where there's life there's hope...

  • Nov 6 '12

    Thank you everyone!!

    First let me clarify the time of orientation:

    We do 6 weeks on a the step down unit and then 14 weeks in the ICU. So it still is quite some time. I now will be doing 16 weeks instead of 14.

    my strengths have been great charting and keeping up with my "tasks". It is just that when the unexpected happens, I get thrown off a little bit.

    I am taking all of your advice and thank you for the encouraging words. I have made a list of topics to study by studying the previous patients' diagnoses. So if I had an ASD that day, I will read about the surgery and diagnosis the next day. I figure that's the only real way to tackle so many of these cardiac diagnoses. I think the problem I had (after coming down from my initial shock) was that my preceptor would tell me I was doing a great job every day and then have such an evaluation; Basically my boss did not think I was independent enough to be on night shift and I have been working on that!

    I have asked my preceptor to step back and not jump unless she sees something grossly wrong and allow me to talk to the doctors myself. I realize to work in such a unit I have to really use my critical thinking skills so it was hard to not compare myself to my friends on med/surg floors who are already off orientation. I am happy to announce that as long as I keep on track, I start nights this upcoming Sunday. I will keep everyone updated.

  • Nov 1 '12

    Too funny, harryalex! I think we work in the same unit... I've asked many people what they're doing when they zero their lines and they can't tell me. When I ask them how turning their patient from the left side to the right side has changed the atmospheric pressure in the room and get a blank look. And when I point out that the only entity that can change the pressure in the room is Mother Nature (via the weather), well... it's priceless. Don't get me started about EVDs. That's a horse of a totally other colour!

  • Nov 1 '12

    ok. Spoke with a nurse with over 30 years of experience, working 6-7 nights a week nearly the entire time.

    She said yes she has seen it, and it can def happen. Somewhere along the line they ended up absorbing some. She said at least for the first 12-24 hrs or so you can see that increase, and it sounds like from your scenario it is def within that time frame.

    will ask a doc if I ever see one (night shift)!

  • Nov 1 '12

    When you're zeroing your lines, what you're really doing is calibrating the transducer to the atmospheric pressure in the room. The transducer is the electronic interface between the pressure wave produced by the patient's heart which is transmitted through the fluid-filled rigid column of the tubing and the monitor; it translates that pressure wave into numbers. Calibrating it to the atmospheric pressure in the room removes that factor from the equation. So it really doesn't matter where the level of the transducer is at that point. BUT... for the reading that you're obtaining from the transducer to be meaningful and accurate the transducer must be level with the phlebostatic axis, at the 4ICS. If the transducer is too high the pressure wave traveling through the fluid in the line will have to go "uphill" against gravity and therefore the number you get will be falsely low and vice versa. Does that make sense?