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Cvepo

Cvepo

CCU, SICU, CVICU
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Cvepo has 3 years experience and specializes in CCU, SICU, CVICU.

Cvepo's Latest Activity

  1. Cvepo

    Portland Job Market

    Without prior experience, yes. If you have experience, it's pretty easy.
  2. Cvepo

    Esmolol and Norepi

    I'd like to get some ICU nurse opinions here. I have 3 years of ICU experience, but I'm confused about this event. I was supporting a newer nurse recently with a post-surgical Type B dissection repair from OR. The patient arrived with esmolol for rate control and norepinephrine for BP control due to a baseline poor renal perfusion. When I worked MICU a few years ago, we would rarely (but occasionally) use esmolol in sepsis for HR control, but if we encountered hypotension, we would use phenylephrine for its alpha response rather than norepinephrine. I know norepinephrine also can stimulate alpha receptors, but it does have a beta adrenergic response, which we are subsequently blocking with the esmolol infusion. Basically, I spoke up and asked the fellow (who by the way, we are currently having a MYRIAD of problems with on our unit) why not switch to a phenylephrine drip instead. He validated my knowledge and said that phenylephrine would also be a good choice, but that norepinephrine was still an appropriate drug as well. I asked for further clarification, because, hey, I'd like to learn, but his response was wishy-washy and he started citing studies than phenylephrine leads to increased mortality in sepsis patients. Great. But this isn't a sepsis patient. I could tell that he wasn't going to change the drip package, so despite my advocacy for the patient and my coworker, I dropped it. Long story short, everything turned out OK, but the patient remained on both esmolol and norepinephrine (and eventually CRRT) for roughly 24 hours until parameters were widened so that the drips could be turned off. I've taken the time to do some research, but can so far only find articles of esmolol usage in sepsis AFTER hemodynamic stabilization. Am I wrong or missing something that using a beta blocker (appropriate) but then counteracting the hypotension with a beta agonist, doesn't make sense when we have a readily available pressor like phenylephrine?
  3. Cvepo

    Do you look up the push rate for IVP meds?

    Only med you should ever slam in is Adenosine. That being said, with a very agitated or restless intubated patient, I've had to push the Midaz fairly fast.
  4. Cvepo

    Nitro tubing for Nitroglycerin and propofol

    We use the blue nitro tubing for Nipride and Nitroglycerine. I always thought it had to do with being protected from light. Never heard of using it for Prop. I just always learned to change Prop tubing once a shift.
  5. Cvepo

    Where are all the nursing jobs?

    You won't. I moved from Buffalo to Oregon with roughly 2.5 years experience and had no trouble getting a job in Portland, a notoriously tough and competitive market for new grads. Not much of an issue with experience.
  6. Cvepo

    Where are all the nursing jobs?

    Large metro jobs are never easy to come by. But with that experience, I'd be surprised if you have any trouble. Most places you hear with awful job markets are awful job markets for new grads because most hospitals would prefer experience.
  7. Cvepo

    Seniority

    Nursing is generational, and I actually find this to be a fascinating topic. It was discussed heavily at my old institution's preceptor course and charge nurse course because generational attitudes really do come into play in the nursing workforce because we have such a wide range of generations doing the same job. I would never ask someone why they don't retire so others can have jobs. However, I challenge some of the older generation to look into what the new generation of workers is entering into, and the disadvantages they face. I came out with a BSN from a state school with over 25k in debt, and that's low compared to most. Housing prices in moderately large metro areas are well out of reach for the younger generation. Pensions and retirements are almost non-existant to new nurses. The worst part is that many of the older generation workers, frankly, don't give a crap about any of this. They just simply don't care, because all they see is "I worked for this" ignoring the fact that they had some things easier. But I digress. I enjoy a thought provoking discussion on the matter, but I know it falls on deaf ears. All we can hope for is that the multi-generational nursing role can continue to grow and understand each other. It's not all about "me, me, me" on either end.
  8. Cvepo

    Seniority

    But we aren't talking about holidays, paid time off, etc. We are talking about career advancements, and I'm sorry, but just because you worked somewhere a while does not mean you're the best person for a job. It's not ageism; it's just fairness. My point still stands: just because you have been a company for a while does not mean you're the best fit for a job. And honestly, each shift needs a healthy mix of new and old on it. It isn't safe for an entire night shift staff of newbies compared to a veteran day shift.
  9. Cvepo

    Passed my CCRN Exam

    C'mon are people really putting their PALS and ACLS certifications (many of which are required for many nursing jobs) in their names nowadays? Congrats nonetheless.
  10. Cvepo

    Seniority

    ^^This. Seniority blows, and is often used by the older generation of entitled nurses who feel that they have "earned" everything that they can possibly get. I use the example when it comes to transferring to ICU, because I've known many excellent floor nurses get denied ICU positions because of seniority, even if the senior nurse taking the position is completely unable to handle an ICU position, but thought "only 2 patients" would be easier. I think it's a grave error to assume that just because someone has been with a company for a while that they are the best fit for a role.
  11. Cvepo

    Worried about future job search.

    Start reaching out to your hospital's nurse recruiter/HR team right away and get the ball rolling, as you may be able to start interviewing with managers and such for jobs sooner rather than later.
  12. Cvepo

    PEDS ER/ICU

    I will say that in Buffalo NY where I used to work there was a Peds Critical Care Float Pool that would do NICU/PICU/ED. But it's not possible to start in those types of positions. Your best bet would probably be to start in a PICU though and work your way from there. Depending on the facility, it may be possible to pick up shifts in the ED or get a Per Diem job.
  13. Cvepo

    RPN Employment Scenario

    I mean, no one can tell you what the scenarios will be. But from my interview experience, they will probably focus on teamworking, work conflicts, and maybe a few common, simple, clinical based questions, i.e. your patient is saying they can't catch their breath, what do you do? Not much you can do to prepare other than just being yourself, try to pull in buzzwords from the mission statement/organization, etc.
  14. Cvepo

    Not sure if it's the career for me! Help

    Some nursing students are way over the top about their "call" to nursing "I WAS BORN TO BE A NURSE BECAUSE MY MOM AND GRANDMA WERE NURSES Ok, I'm done being an ass. Serious now: If you have your heart set on OB, then everything else will probably bore you or be of no interest. I, for example, would have rather gouged my eyes out than sit through more disgusting maternity lectures and do OB rotations. You can't stand blood, I can't stand anything pregnancy related. It's just preference. Try to tough it out until you can at least get to the OB lectures and maybe things will change. The great thing about nursing is that you can have specialties. And sometimes, the things you hate end up being not so bad in the long run. And FWIW, my husband and I are both nurses and my husband kind of hates being a nurse a lot of the time. He is a fantastic and patient nurse, and patients adore him... but he isn't super passionate about it; he's just good at it. You don't have to convince yourself that nursing is your "calling" to be a good nurse.
  15. Cvepo

    CRNA GPA

    Yes they will care about your GPA. But PLEASE, do as roser13 said.
  16. Cvepo

    ACNP or DNP?

    ACNP is not a degree so much as a concentration. DNP is a Doctoral degree as opposed to an MSN, Masters of Science in Nursing. DNP ranks higher than an MSN, and many MSN programs are transitioning to DNP programs. You can graduate with a DNP and become an ACNP, if that makes sense. ACNP isn't really going to benefit you at all for OR nursing; I have never heard of an OR NP. ACNPs CAN work with post-operative patients in acute care, which may interest you. You may also want to look into an RNFA (First Assist). But in terms of degree, the NP portion is more of the concentration and not the actual degree. You're better off asking yourself MSN vs DNP.