Steph41

I love that. I would love to implement that on my unit! ♥️♥️ thank you

The AACN has an online review course. That is all I used. I passed the exam first try. You also get a bunch of CEU’s when you complete the course. It was excellent. One piece of advice though. My experience did not do well for test questions b/c My CV surgeons do things a little different. So relying on the science and questions were more important than my experience taking open hearts. Know the science behind the medicine!! Sounds common sense but it’s amazing how often we default to the experience.

The AACN website has an online course that prepared me well. You also get 14 CEU’s once you complete the course. The course is fantastic though.

The AACN has a review course for the CSC that gives 14 CEUs when you have done the course even without taking the test. The CMC review gives 20 credits after the course without taking the test. However each of the online review courses cost money as well so not really sure if that is helpful. I personally find value in needing the CEU's b/c with all the continuing credits it keeps me up to date and able to make decisions clinically. Some of our practices become outdated and we don't even know it until the education comes up and then we can make changes based on best practices. Just a thought.

I studied very hard. I took several weeks to prepare. I found the Laura Gasparis Von Frolio videos helpful but do not rely on them as your soul study material. Some of the stuff she said aren't on the test actually were. I did not like most of the books but did find Barrons CCRN review book helpful they also have note cards that my co-workers shows me. Those were excellent. I found PASS CCRN too cumbersome as they used a lot of A&P review that was really not helpful. Too much info. In the end if you prepare each section with a good understanding of critical care pathways, you should do okay. Also with each question you take, understand why each answer is right but also why the other options are wrong or not as right. Good luck! Stephanie BSN, RN, CCRN-CMC-CSC

Since the spread of this Corona Virus and new protocols, lockdowns, school closures, etc, The ICU where I work has had a weird vibe. Then we got our first Covid-19 patient. All of the sudden, behavior has been concerning. People refusing to care for "that patient", nurses stating their cases and co-morbidities, nurses demanding masks when they are already in short supply, and the general vibe of the unit has been off and very concerning. Emotion and mental health for nurses is important but somehow we are missing this element in our unit. Add to that, many of our husbands have lost their jobs and home stress. I'd like to hear from some of you who may have experienced similar issues. Is there any units out there who have successfully maintained a positive work environment? In the midst of fear, how do you deal with co-workers who are spinning out? Do you all have a zen room or a place to debrief? Do baked goods or ice cream work? Any ideas how to bring a team together and debunk fear? Any ideas on how to cultivate that this is going to be a great day because we are all going to do what we do everyday and be here for one another? Thank You, Stephanie BSN, RN, CCRN-CMC-CSC

You can get Laura G videos @ allnurses.com. She also does one and two day reviews.

PT even if elevated is not the gold standard for Coumadin. INR is. PTT - used not just for hep but also lovenox. Beyond measuring effectiveness of meds, here is a few things to consider... 1. A huge percent of herbs and some foods effect the clotting cascade. IF you were a surgeon would you cut on someone without knowing their coags and PLT counts? also liver disease makes you coagulopathic. It will increase your PT,PTT,,INR with no help from meds. So the short answer is yes - they should be drawn on admission on any inpatient and as frequently indicated for pt.'s condition. Hope that helps.

Great reminders for us all

I appreciate all the feedback. I definitely see the benefit of getting certified. Our unit now has 5 CCRN's out of about 30 nurses. I hope others see see the value of being certified, not just for a raise or to have some extra credentials but to further their knowledge base and be a stronger nurse.

I'm from Wyoming and we do not have legalized ratios. Our policy, however, states that med/surg 5:1 maybe 6:1 on a bad day; PCU/Neuro is 4:1 but often is 5:1 b/c of staffing; ICU is 2:1 on a bad day we will be asked to take a team of three this is not the norm. I think I would look twice at staffing ratios and make sure that it is in your contract. We all agree this is unsafe but legally you have another issue. From a legal standpoint you may as well be saying, "I am okay with this. I got this. I am perfectly capable of taking on full medical care with full competency & responsibility of EIGHT pt.s at one time." You accept this - you will be held legally responsible to anything done, not done, missed etc. I can't imagine that I could wrap my brain fully around eight pt.s. At 5 pt.s my brain goes into task mode and critical thinking suffers. Not to mention ADL's with no help. YUCK!

I am about to finish my GRE requirement - I will be 41ish when all is said and done. On one hand those millennials are sharp and quick thats good. But life experience and critical thinking skills often are easier for older people going back to school. With out a doubt do it! Not only is it not too late, it will pay for itself.

I also used Barrons. It was my favorite. PASS CCRN was ridiculous. It went back to A&P days with amylase and pepsinogen etc. WAY too much info. The questions were overwhelming as well. I also used Laura G. Videos. I practically memorized them until I could explain the concept she was talking about on my own without the video. These were my main two resources. Good luck to you.

Start studying now. The more critical care knowledge you can apply to real life patients the better off you and your patients will be. It will also make you more comfortable taking care of critical patients. Most of the time if a person is uncomfortable in a situation - its because there is a knowledge deficit. Study now. By the time you meet requirements to sit for the exam, you'll be ready. Good luck!

Some have found the Critical Care Intravenous Infusion Drug Handbook to be helpful. I have not used it. I agree with Okami that your pharmacist is a good resource. Also with multiple pressors on the same pt. It is helpful to consult the intensivist. If a pt. has epinephrine, norepinephrine, vasopressin, and milrinone - the milrinone is not a pressor but often lower BP while increasing cardiac output. Epinephrine increases pressure and cardiac output but has undesired dysrhythmia effects. So knowing your pt.s cardiac output, CVP, PA pressures, and heart details (Valves,LVED, etc,) and goals is essential. Sometimes the cardiac surgeon or intensivist has a plan so I just ask, which one do you want me to titrate first. If it doesn't mesh with my thoughts I just ask them to educate me as to why and we discuss.