Cvepo

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

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?

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.

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.

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.

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.

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.

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.

^^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.

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.

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.

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.

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

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.

Yep, definitely Littman. I have a Cardiology III, but I didn't get that until after I finished nursing and started working critical care.

I've worked in 2 different hospitals with unions. First was a CWA union -- which mostly represents (obviously) communications workers. They sucked because they don't have strong representation in the hospitals. When I moved to Oregon, I joined the ONA which is a strictly nursing focused union, and I see much more support for the union from staff. Our staffing is great, pay is great, we get COL adjustments, etc. So far, no complaints but I have not needed to reach out to them at all. I know the union isn't afraid of administration and were a few hours from striking a couple years ago I guess until administration gave in. Large medical centers NEED nurses, and that collective threat of striking is detrimental to money-hungry administrators that know daily operations and patient care would fall apart if nurses started to strike. Unions for nursing DO work when they are properly formed. Wages are often much, much higher for staff than in non-unionized places. Also, nurses are usually happier and feel safer knowing they have representation. If you ever get pulled in to a manager's office for a mistake, you are always given a union rep. Also, FWIW, bad employees can and still do get fired in union facilities. It is a misconception that they don't, and I find it to be a fear tactic and anti-union rhetoric.

Sounds like you need a new preceptor for starters; she sounds awful. Is your hospital unionized? I find it shocking that they can fire you for just 3 orientation shifts. See if you can try a new preceptor? Not sure if that'll help on such short notice, but it's worth a shot. Good luck! I'm sure others will have better advice! =/

You'd be better off asking the Virginia Nursing topic. Go to the link that says "U.S." in the top row and find Virginia. That being said, you should consider looking into residency/internship programs for new graduates. Many Trauma 1 centers (especially in popular cities) are very difficult to get into as a new grad.

Do you ever read those stories from nurses that completely play up and skew what nursing actually is for the sake of an article? I see them now and again and I distinctly remember them all over the place during that stupid "doctor's stethoscope" debacle. You know, the articles that go something like: "I am a NURSE. I've HELD A DYING WOMAN'S HAND while simultaneously SWADDLING A NEWBORN. All while I've been HOLDING MY PEE FOR 22 HOURS." And then there's like a stock photo of a newborn with like 12 IV pumps. But seriously, does anyone know those articles? The ones your nurse friends post on Facebook that make you shake your head because they were clearly written by someone who was upset that someone said something insulting about nursing that they feel the need to validate their career by exaggerating the profession? Yeah, they drive me crazy, and I feel weird that I can't relate to them. I roll my eyes everytime I see them, and yet I feel guilty if I don't "Like" the post. Am I ashamed to be a nurse? Not at all. Nurses do amazing work and we help people everyday. But I really get annoyed at how these posts over-exaggerate our profession. Does anyone else have any thoughts on this, or am I just a jerk for feeling this way?

If that's the only thing that grosses you out, I'm confident you're faring better than many nurses already working. Do what Luckyyou said, and just avoid units where you work with those types of things. No need to change career paths...

*sigh* I once again feel like many of these posters have such a bizarre image of what ICU nursing actually entails. TBH, true adrenaline junkies would probably be happier in the ED. The rush of that incoming code, STEMI, stroke, etc is a lot less exciting once they get to the unit. Don't get me wrong, it's fun to titrate the drips, manage the IABP, vent, etc but many people find ICU boring and I can see why (I don't find it boring at all, but I understand why some do). The "sickest of the sick" is somewhat laughable because the only difference in care sometimes between a Medical ICU pneumonia patient and and a Med/Surg pneumonia patient is the presence of a vent. That's it. They aren't unstable or crashing. They just are intubated with maybe a Fentanyl gtt and accompanying Levo gtt for sedation-related hypotension. There really is no secret to getting in. Specific hospitals will list their requirements for what they want. Meet those requirements (exceed if you can) and just prepare for an interview. My last interview into critical care (the job I currently hold) had 0 clinical-related questions, but instead were more focused on my ability to think on my feet, advocate for my patient, collaborate with others, etc. AKA questions any new grad could answer.

Housing is nuts here! Very few houses for sale, and those that are are selling for like 4x what they were assessed for. My husband and I are both hospital nurses here, and the housing is borderline unobtainable for us (at least within the city). Living further out helps, but the traffic is crazy. Get your BSN if you can! Good luck!

For most classes like that, I'm pretty sure you can enroll as a non-matriculated student. When I retook Stats at CC, I did it as a non-matriculated student with no issues.

A few weeks off orientation, I had a sickle cell patient who had a well documented pain medication plan with a pain management specialist that said, and I quote: 8mg IV Dilaudid (yes, 8) q8h ATC (0800, 1600, 0000), with 4mg IV q4h prn for breakthrough. Mind you, this patient was not admitted on my shift, so he had already received a few doses of the 8 mg. This order was entered by a physician, and verified by a pharmacist before it could be given. Of course I give him his scheduled 8mg IV for his severe sickle cell crisis -- and he's talking, appropriate, and saying he's in 10/10 pain. Well guess what? We were Narcanning him an hour later when he became unresponsive. I felt awful because I knew 8mg DID NOT seem right. Having complicated surgical patients and sickle cellers often, it was not uncommon on my unit to have 2mg, 3mg, and an occasional 4mg IVP of Dilaudid, but even new I knew it didn't seem right. My preceptor was charge that day, and even she wasn't sure, but agreed that if multiple physicians said it was OK (and this pain care plan the patient had was well documented by a consult note from the pain management provider), I wrongly assumed it was ok. I knew if I called his primary medicine team, they would have just referred me to what pain management had recommended and ordered. I didn't get in any trouble, at all. But I felt awful. This pain management doc has a reputation locally, and I know that now. Patient wasn't too happy, because his doses all got cut in half. Every now and then I'll see his name on the ED tracking board and it makes me shudder because I can still remember that day! Now I am much more weary with heavy doses of pain medications. I learned and you will too!

I hear Albany Medical College is more medical-based. I think they even take Gross Anatomy? Not sure though.