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  1. Steph41

    Best CCRN Test Prep Book for 2018

    You can get Laura G videos @ allnurses.com. She also does one and two day reviews.
  2. Steph41

    Indications for PT/PTT/INR

    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.
  3. Steph41


    Great reminders for us all
  4. Steph41

    CCRN as a requirement?

    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.
  5. Steph41

    1099 advice

    I was indeed referring to making a conscience choice. However, I've not heard of many successes with this. Just wondering if anyone has found the hassle worth the money or if it's all a big headache.
  6. Steph41

    Patient Ratio 1:8 and no tech!

    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!
  7. Steph41

    1099 advice

    Has anyone started a 1099 and been successful with it. I am considering starting one. I have a plan for the 401K, have insurance with my husband, and am wondering if it would be worth it. I've been warned of the tax issues and have heard nightmares. Just wondering if any of you out there have done it well.
  8. Steph41

    How old is too old?

    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.
  9. Steph41

    Best CCRN Test Prep Book for 2018

    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.
  10. Steph41

    New Grad interested in CCRN

    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!
  11. Steph41

    Critical care med drips

    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.
  12. Steph41

    CCRN as a requirement?

    The hospital will pay for the certification. They also provide materials to study. There is no pay incentive, bonus, or increase in wages.
  13. Steph41

    CCRN as a requirement?

    How do you feel about CCRN as a requirement to work in the ICU? Where I work it is not a requirement but it is encouraged. We want all our nurses to have their specialty but few are buying in. Suggestions to encourage the nurses to get their CCRN would be appreciated? Also, I'd appreciate any view points on why a nurse may not want their specialty as every 5% of nurses on a unit that hold their CCRN's decrease mortality by 6%. Thoughts please.
  14. Steph41

    "Safe Injection Houses"- What's This?

    I agree.
  15. Steph41

    My Body Is Not My Resume: Exploring Nurses and Body Shaming

    I work in an ICU. At least 1 in 4 pt.s are 350lbs or more. When they are immobile, intubated, sedated, etc. , we healthcare workers turn, bath, move each part of them. It seems to me (I'd like to see the data) that the employees who are overweight get injured on the job more. I am 19lbs overweight, 38 years old, and it ABOSLUTLY IS a wake up call. Physical fitness is more important than any pill we could ever take. After reading this article and attempting losing a few on my own, I'm hiring a personal trainer. We all have to take responsibility for ourselves and quit making excuses. Pray for me.