0.9%NormalSarah

1. Stethoscope, I recommend Littman classic or lightweight, affordable and reliable. 2. Good computer 3. Good shoes 4. Scissors, 4 color pen, highlighter of choice, fine tip sharpie, regular sharpie. This is what is on me every shift as an ICU nurse along with my stethoscope. 5. Good attitude and study habits. Everything else is secondary and are things you’ll find a way to deal with as you go along.

There is a shortage of nurses who are willing to put up with the very hard under appreciated and underpaid workload. There may well be enough people with nursing licenses, but they don’t want to stay in acute care. On another note, most hospital managers I know won’t hire someone without acute care beside experience part-time because that person would essentially be a new grad. Some places have programs they call “transition to acute care RN” because it’s a rigorous educational program for those who have been working in long-term care, home care, and clinics etc. Nothing at all wrong with that experience, you’d just most likely need to commit to a full-time job for now for them to make the investment in training. Best of luck to you!

LOL no. How on earth is someone supposed to unleash you on unsuspecting patients without verifying that you know how to perform a skill safely?

This just reminded me of the time I had a long night and said “butt hole” in report because the word orifice fled my vocabulary. ? Admins I sincerely hope that is okay and intend no profanity, but fully understand if it’s not kosher.

The doctor refused diluadid, so you did what you could do. I’d disagree with the doctor, personally because we’re talking narcs here, give some of one, give another one, whatever works, not every med works for every person and I’ve seen that. However, I definitely don’t blame the posters bringing up drug seeking. It is a real problem and something we’ve seen a lot of in the ICU. It’s tough. The patient is sick enough to be there and is likely uncomfortable or in pain, but they still may simultaneously have a drug problem. It’s a complex issue, and yes nurses have to deal with it face to face the most as these patients come to the hospital and they and their families often become aggressive when attempting to medicate to their needs.

Heck yes, 4Runner life!

I’d like to confess that I am one of these people. Sometimes the shift is just absolutely too crazy to get everything done, and by the time I look up it’s time for report. I might ask the next shift to please change the IV tubing, start a new IV, give a med, or even give a bath. It’s a 24 hour job. I would maybe write it down so I remember what to ask them to do. If the list is long every time, maybe make a comment on how that person always passes a lot of items to you.

I don’t think you’re too slow if you’re getting things done on time. I’ll say that maybe you could spend slightly less time initially reviewing the entire chart so you can get assessments and meds done on the early side, but that’s nitpicky. As for your other coworkers, my money is on the chance they aren’t as thorough as you. You sound like an ICU nurse ?.

I personally think it’s reasonable to leave a job when you don’t feel like you fit in. It’s a shame but if the culture of a unit runs out good nurses, maybe they will change the culture. But also maybe you could try sticking it out a little longer for the experience? Is there another ICU in the area you could work in?

Also just want to toss in here that some drips like levophed can be run weight-based or not. My current hospital runs it as mcg/min, but my old place ran it as mcg/kg/min, so there can be a difference. And while I was used to the latter way until I changed jobs, it still works out because we do titrate to effect. Also pointing out some drips are run by ideal weight, like ketamine, which should not change.

I’ve done both and currently rotate working both. Yes days has a lot more going on, we get the bulk of the orders on days, often docs during rounds will decide on the need for new imaging, plan of care will change, ancillary staff are always coming by, family, meals....it’s overwhelming. But nights are a different type of busy. There are less people around to help when things go south, you may only have a resident or two to call for a change in condition, and you may be more judicious in your calls to attendings or specialties, making your assessment and troubleshooting skills with your standing orders very important. They are different, but both are crazy in their own ways. I’ll say I’ve had some super chill nights where nothing happened at all and I caught up on hospital training modules or even read content for school, but when stuff hits the fan it’s chaos just like it would be on days.

I like to put pressors, inotropes, high concentration critical meds together on a lumen, then sedations on another, and fluids or low risk meds that can be flushed safely on another. (Obviously whichever ones are compatible.) Basically I always have a lumen on a central line or PICC or a peripheral that I could flush or draw from without pushing a med through that would cause a problem. Most heparin bags we run are pretty low in concentration, like 50 units per mL. If I couldn’t withdraw the drug before flushing, that’s a med I’d feel comfortable flushing a mL or two of perfectly safely. Think about it, even when setting the rates most orders instruct you to round to the nearest 50. Now for something like a vasopressor or insulin, I’d always withdraw the drug from the line before flushing it if I absolutely had to do so. And as @NICU Guy said above, the y site with 2 different meds running won’t change any rates of infusion, that is determined by the pump. I loved his explanation!

I always pull back on my PICC lumen before administering a med to make sure the end of the lumen isn’t forming a fibrin sheath as someone else pointed out. Sometimes I don’t get blood return right away until I flush it, then I get blood return. It doesn’t mean the PICC can’t be used, but it does mean a further assessment is required. Typically we cath flo those that don’t get blood return, and a CXR would confirm continued appropriate placement. However I’m not sure what you would do in the LTC or OP setting for that, in the ICU I can easily troubleshoot the issue.

Hey @LibraNurse27 I am 100% the same way. I have had some patients go bad for reasons that had nothing to do with my care, but when it happens while they’re on your assignment you just beat yourself up forever. In that way I’d say nursing has truly damaged my mental health, too. I’m a perfectionist and highly self-conscious and sensitive, so when things go awry I am my own worst enemy. I don’t know what to do about it aside from just do my best and try to decompress after each shift. Not really offering advice, just sending a hug your way, we sound very similar.

Best thing to do in a nursing program is fly under the radar and do not in any way call negative attention to yourself. Saying something once is understandable, but continuing to email and discuss with other faculty makes you seem like a busy body. It’s just not a good look. I’m not saying it’s fair, but your goal is to prepare to be a nurse and make it through the program. These little issues are just distractions and if you continue to focus on them, you will build a poor reputation for yourself.

I’m a California critical care nurse. I had covid, then I also got vaccinated. I highly trust and believe in vaccine science, and I wish people would get vaccinated. However, state policy mandating vaccination for healthcare workers puts a bad taste in my mouth just because of government interference, I’m personally very libertarian and I think it’s government over-stepping. But I will say, employers requiring vaccination except in rare cases is something I support. It’s a free market, if they require it and you don’t want to do it, I’m sorry but it’s time to look for another job. You are free to have a choice, your employer is free to let you go if you don’t comply with their policies. And it’s not discrimination, they require it of all employees. By the way, I’m religious and lean slightly conservative, there’s nothing in my teaching telling me to avoid vaccination. If anything, my religion calls upon me to be an example to my community and protect others, and be considerate of the needs of others before myself. I happily protect my patients, family members, and community members by being vaccinated and following local health recommendations. That’s just my two cents. I’m tired of seeing all these outspoken religious and conservative types who are vocal online make a mockery of our faith and political leaning. Some of us care deeply about how we affect our communities and I am here to say I’m proud to accept the recommendations to be vaccinated from the leaders in my scientific community. It’s just not all about me.

I would waste about 3 - 5 mL out of the IV first, then grab a syringe and fill it with the amount needed. Or, if you have a particularly juicy IV, I’d waste and then connect a vacutainer directly to the clave adaptor/IV port and then connect the tubes to the vacutainer and let them fill themselves. Then flush your IV and you’re done.

Well my point is that if you worked that long, you weren’t being successful in your job as a manager. I think others have said the same thing.

“Successfully”

If you don’t have a lot of good veins, you can always stop the IV running for about 2 minutes and get an undiluted sample. I do this all the time, and sometimes I have a great PIV that works well and have something running through it. I just stop it running, wait 2 minutes or so, flush it, draw a waste, and then sample through the line, then reconnect my fluids or whatever was running. Or you could simply stop the fluid for 2 minutes and draw on that arm or hand, then restart after your draw. Caveat: I would NEVER do this if what was running was unsafe to stop or flush into the IV, such as sedation, pressors, etc.

Ask for a longer orientation. 8 weeks is far too little for the ICU (and arguably any floor for a new grad). It’s normal to be overwhelmed, just do your best to take care of your mental state so you have the stamina to get through the days and retain the info you’re learning. It’s hard, but if you stay focused you can do it. And for sure get at least a few more weeks, preferably at least double that 8 weeks.

I use saline flushes to reconstitute when I know I will use the whole syringe, such as with protonix and IVP antibiotics. With dilution, I would typically just use a new syringe and draw up from a vial because it’s typically small volumes I’m diluting and the flush syringe is too big for me to be accurate. As a side note, I also wrap my empty vials around my syringes in the case of intubation, conscious sedation, etc, any time I won’t use it all or right away, or if I’m handing the syringe to another nurse for use.

Had a patient that just had abdominal surgery, was doing fine with pain, but began having a huge amount of abdominal pain a couple days after surgery. Like he wasn’t requiring much in the way of opioids for pain control, then suddenly started needing full PRN doses on schedule. I worked nights at the time and the surgeons rounded early in the morning. I expressed my concern about this increased pain that didn’t seem to match up with the situation, incision was looking great, no drainage, and no other s/s of sepsis, although I was concerned the extreme pain was trouble brewing for an infection. The senior surgical resident looks right at me and goes, “well he just had major surgery...” I couldn’t help myself, I said, “oh wow I did not know that, that must be the cause!” Like really dude? I know! I’m concerned something bad is happening in there!

Ain’t nobody got time for that.

The code nurse was rude and shouldn’t have behaved that way. It is best to cultivate an environment where nurses feel safe calling rapids and codes. If not, inevitably there will be times when no one calls a rapid because they fear being “that nurse that called a stupid rapid for no reason” and will wait to call until the patient has severely deteriorated. I think you did a good job. The only thing I would say is that if you have patients on opioids, there should be PRN Narcan and I would have retrieved and used it if this patient was somnolent and bradypneic, you can save a person from intubation. Sounds like you did great, though, you got a physician and others to the bedside for evaluation. You took care of your patient. As a side note, I’d check into the policy for belongings for patients like this. In my ICU we go through everything to make sure they don’t have any contraband or substances they can take under the radar. I know it’s tough with visitors bringing things in though.