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eCCU, APRN, NP 6,314 Views

Joined: Aug 31, '10; Posts: 222 (36% Liked) ; Likes: 174

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  • Feb 7

    I will not lie it's a steep learning curve and it doesn't matter how long a critical care nurse you were. That being said every decision must have an evidenced based rationale remember every action must be defensible in a court of law. No longer documenting you told so and so.
    Dealing with staff nurses is easy, appreciate their input by doing clinical rounds instead of intervening when something comes up. It also gives you an opportunity to meet the family and talk to them. You will have some nurses that will try to bully you, I see it happening mostly to NPs who haven't had a lot of experience previously as ICU nurses or work in the same ICU from staff RN to NP. Handle it gracefully and professionally, most workplaces now have bullying statements on their policies. Recognize your staff, be a role model, don't get into workplace gossip and politics.
    Know your go to people example...I love my ICU PCA! I rarely place a Central line without them. They literally know where my ultrasound sits, what size sterile gloves I wear, they drop all my required sterile stuff in my field before I even ask for anything. They are truly a blessing!
    Develop a relationship with the clinical pharmacist they are walking pharmacology books with current research.
    Several specialties to develop strong relationship and have their numbers... nephrologist I have been known to call them in the middle of the night to get the okay to start CRRT or emergency dialysis.
    Cardiologist...cause they do crazy stuff that works that's not in any textbook and I have yet to meet one that freaks out.
    Pulmonologist or intensivist when you have tried all the vent settings on your vent on that ARDS patient and you and the experienced RT are out of ideas in the middle of the night!
    Infectious disease if your facility doesn't have a sepsis team. Find out their pet peeves..Sanford guide is awesome
    Chaplain...if you are spiritual there are those cases that will have you wanting some spiritual guidance or continue to believe in humanity.
    Earn your FCCS by SCCM they have several classes around the country. Attend CE offered by the local medical school if your place of work is affiliated with one.
    Familiarize yourself with vent settings off the top of your head...I have heard the RTs complain there is nothing more annoying than intubating a patient emergently and the provider has no clue on basic settings.
    Imaging position of ETTubes, Central lines, chest tube can be the determinants of life or death. Ask to rotate with radiologist and anesthesia. I learned how bag appropriately with the anesthesiologist years later! And intubate gracefully with anesthesia, intubate with head of bed up with ED doc.
    Keep learning ask your intensivist for feedback consistently and ask for areas of improvement.
    The rest enjoy it it's actually fun
    Hope that helps

  • Jan 29

    Certainly views of big money differ from person to person. Unfortunately most nurses duo think they are rolling in cash. Lol i remember as soon as we graduated most of my colleagues bought luxury cars worth $50000 or more. Well years later they are still paying plus the kids came plus the house....then its no longer big money. Just live according to your means you will be fine...;-)

  • Jan 8

    Nurses and their titles kill me! . How about we focus on making our NPs ready when they graduate? I once knew a really smart friend who had 4 PhDs never once heard him introduce himself as a doctor. I introduce myself as a "Nurse Practitioner." No need to confuse the little old ladies in the ICU use that time on important patient clinical issues.

  • Nov 8 '17

    Quote from Sassy5d
    How does that work with emtala?

    You could say you're jumbo smith, don 01/01/1929. We can't refuse you treatment just cuz you like to lie.

    What do the palm readers do? You get no treatment unless you're honest?

    I also like the twin situation.. Lots of twins come to my ER

    Hahaha... you are funny...smh
    Palm readers save us money and time! They automatically pull the patient chart saving me and docs a whole lot! Most patients with no insurance come in using someone elses name and address and when we pulled the chart the treatment and history would be completely different sending mds on a wild goose chase and wasting valuable resources, time and money.
    We a level 1 trauma and huge system time is precious to us and the many waiting and this is way better especially for trauma pts since their emergency contact is part of the chart...beats the police department coming in to fingerprint pts days later to find next of kin...:-) and yes if it's your first visit we initiate the process for future visits....

  • Sep 29 '17

    I will not lie it's a steep learning curve and it doesn't matter how long a critical care nurse you were. That being said every decision must have an evidenced based rationale remember every action must be defensible in a court of law. No longer documenting you told so and so.
    Dealing with staff nurses is easy, appreciate their input by doing clinical rounds instead of intervening when something comes up. It also gives you an opportunity to meet the family and talk to them. You will have some nurses that will try to bully you, I see it happening mostly to NPs who haven't had a lot of experience previously as ICU nurses or work in the same ICU from staff RN to NP. Handle it gracefully and professionally, most workplaces now have bullying statements on their policies. Recognize your staff, be a role model, don't get into workplace gossip and politics.
    Know your go to people example...I love my ICU PCA! I rarely place a Central line without them. They literally know where my ultrasound sits, what size sterile gloves I wear, they drop all my required sterile stuff in my field before I even ask for anything. They are truly a blessing!
    Develop a relationship with the clinical pharmacist they are walking pharmacology books with current research.
    Several specialties to develop strong relationship and have their numbers... nephrologist I have been known to call them in the middle of the night to get the okay to start CRRT or emergency dialysis.
    Cardiologist...cause they do crazy stuff that works that's not in any textbook and I have yet to meet one that freaks out.
    Pulmonologist or intensivist when you have tried all the vent settings on your vent on that ARDS patient and you and the experienced RT are out of ideas in the middle of the night!
    Infectious disease if your facility doesn't have a sepsis team. Find out their pet peeves..Sanford guide is awesome
    Chaplain...if you are spiritual there are those cases that will have you wanting some spiritual guidance or continue to believe in humanity.
    Earn your FCCS by SCCM they have several classes around the country. Attend CE offered by the local medical school if your place of work is affiliated with one.
    Familiarize yourself with vent settings off the top of your head...I have heard the RTs complain there is nothing more annoying than intubating a patient emergently and the provider has no clue on basic settings.
    Imaging position of ETTubes, Central lines, chest tube can be the determinants of life or death. Ask to rotate with radiologist and anesthesia. I learned how bag appropriately with the anesthesiologist years later! And intubate gracefully with anesthesia, intubate with head of bed up with ED doc.
    Keep learning ask your intensivist for feedback consistently and ask for areas of improvement.
    The rest enjoy it it's actually fun
    Hope that helps

  • Sep 22 '17

    I will not lie it's a steep learning curve and it doesn't matter how long a critical care nurse you were. That being said every decision must have an evidenced based rationale remember every action must be defensible in a court of law. No longer documenting you told so and so.
    Dealing with staff nurses is easy, appreciate their input by doing clinical rounds instead of intervening when something comes up. It also gives you an opportunity to meet the family and talk to them. You will have some nurses that will try to bully you, I see it happening mostly to NPs who haven't had a lot of experience previously as ICU nurses or work in the same ICU from staff RN to NP. Handle it gracefully and professionally, most workplaces now have bullying statements on their policies. Recognize your staff, be a role model, don't get into workplace gossip and politics.
    Know your go to people example...I love my ICU PCA! I rarely place a Central line without them. They literally know where my ultrasound sits, what size sterile gloves I wear, they drop all my required sterile stuff in my field before I even ask for anything. They are truly a blessing!
    Develop a relationship with the clinical pharmacist they are walking pharmacology books with current research.
    Several specialties to develop strong relationship and have their numbers... nephrologist I have been known to call them in the middle of the night to get the okay to start CRRT or emergency dialysis.
    Cardiologist...cause they do crazy stuff that works that's not in any textbook and I have yet to meet one that freaks out.
    Pulmonologist or intensivist when you have tried all the vent settings on your vent on that ARDS patient and you and the experienced RT are out of ideas in the middle of the night!
    Infectious disease if your facility doesn't have a sepsis team. Find out their pet peeves..Sanford guide is awesome
    Chaplain...if you are spiritual there are those cases that will have you wanting some spiritual guidance or continue to believe in humanity.
    Earn your FCCS by SCCM they have several classes around the country. Attend CE offered by the local medical school if your place of work is affiliated with one.
    Familiarize yourself with vent settings off the top of your head...I have heard the RTs complain there is nothing more annoying than intubating a patient emergently and the provider has no clue on basic settings.
    Imaging position of ETTubes, Central lines, chest tube can be the determinants of life or death. Ask to rotate with radiologist and anesthesia. I learned how bag appropriately with the anesthesiologist years later! And intubate gracefully with anesthesia, intubate with head of bed up with ED doc.
    Keep learning ask your intensivist for feedback consistently and ask for areas of improvement.
    The rest enjoy it it's actually fun
    Hope that helps

  • Sep 20 '17

    I will not lie it's a steep learning curve and it doesn't matter how long a critical care nurse you were. That being said every decision must have an evidenced based rationale remember every action must be defensible in a court of law. No longer documenting you told so and so.
    Dealing with staff nurses is easy, appreciate their input by doing clinical rounds instead of intervening when something comes up. It also gives you an opportunity to meet the family and talk to them. You will have some nurses that will try to bully you, I see it happening mostly to NPs who haven't had a lot of experience previously as ICU nurses or work in the same ICU from staff RN to NP. Handle it gracefully and professionally, most workplaces now have bullying statements on their policies. Recognize your staff, be a role model, don't get into workplace gossip and politics.
    Know your go to people example...I love my ICU PCA! I rarely place a Central line without them. They literally know where my ultrasound sits, what size sterile gloves I wear, they drop all my required sterile stuff in my field before I even ask for anything. They are truly a blessing!
    Develop a relationship with the clinical pharmacist they are walking pharmacology books with current research.
    Several specialties to develop strong relationship and have their numbers... nephrologist I have been known to call them in the middle of the night to get the okay to start CRRT or emergency dialysis.
    Cardiologist...cause they do crazy stuff that works that's not in any textbook and I have yet to meet one that freaks out.
    Pulmonologist or intensivist when you have tried all the vent settings on your vent on that ARDS patient and you and the experienced RT are out of ideas in the middle of the night!
    Infectious disease if your facility doesn't have a sepsis team. Find out their pet peeves..Sanford guide is awesome
    Chaplain...if you are spiritual there are those cases that will have you wanting some spiritual guidance or continue to believe in humanity.
    Earn your FCCS by SCCM they have several classes around the country. Attend CE offered by the local medical school if your place of work is affiliated with one.
    Familiarize yourself with vent settings off the top of your head...I have heard the RTs complain there is nothing more annoying than intubating a patient emergently and the provider has no clue on basic settings.
    Imaging position of ETTubes, Central lines, chest tube can be the determinants of life or death. Ask to rotate with radiologist and anesthesia. I learned how bag appropriately with the anesthesiologist years later! And intubate gracefully with anesthesia, intubate with head of bed up with ED doc.
    Keep learning ask your intensivist for feedback consistently and ask for areas of improvement.
    The rest enjoy it it's actually fun
    Hope that helps



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