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Honestly, I’ve never found an acceptable solution short of advocating for a diverting colostomy and/or lots of prone positioning. FMS’s leak and can cause pressure/shearing. Same for “butt bags,” which can also sometimes make a bigger mess than not using one. Using chux to make “poop pants” keep the grafts/dressings too wet and can be a bigger mess too.

First off, congratulations! I too started out as a new grad in a burn ICU. Burn care is as much an art as it is a science, so most of what you are inquiring about will be learned on the job and will probably be somewhat specific to the unit you hired into. I’ve found out the hard way that, in general, no two burn units do things the same way; in fact, really, no two burn surgeons do things the same way, even within the same unit. That being said, one of the best textbook resources out there is Total Burn Care by Herndon. I have yet to visit a burn unit that doesn’t keep a copy hanging around. I also recommend the AACN Procedure Manual for Critical Care, as it covers most of the non-burn-specific procedures you’re likely to see. A great online resource is michiganburn.org. It was developed jointly by the University of Michigan Trauma Burn Center and the State of Michigan as a resource for providers in the event of a burn mass casualty incident. There are a number of Flash-based presentations that you can watch which will give you good insight into the basics of burn care. Best of luck to you! Mike in CO

Over my 4+ years as a burn nurse, the orders I've seen generally allow doses every 5 minutes. In your case, I'd start with 1 mg Dilaudid about 30 mins before starting the dressing change, then 50 mcg Fentanyl alternated with 0.5-1 mg of Versed every five minutes to desired effect and consider giving the last 1 mg of Dilaudid at the end of the dressing change. Also, consider if the patient has PRN orders for PO pain meds and give 5-10 mg of PO Oxycodone as premedication INSTEAD of the Dilaudid. This won't work for everyone, and certainly not for those 2-3 hour marathon dressing changes, but I've gotten overall good results. Remember, analgesics BEFORE sedation, except in those patients where their anxiety is obviously worse than their pain. As an aside, the Fentanyl orders seem a little light. The conscious sedation orders I "grew up" with were generally maximums of 500 mcg of Fentanyl and 5 mg of Versed PER HOUR. Don't be afraid to ask your doc for more meds if you're anticipating a longer dressing change. Regards, Mike in Colorado

I agree. Could have saved myself $80K in student loans for a master's degree that I'm not using. I also think that at a younger age, I would have had more energy and tolerance for the BS that I'm having trouble dealing with @ 31. Mike in Michigan

The vast majority of the time, I don't notice, especially since in my ICU, I'm rarely the only guy on between RNs, techs, RT, and clerks. That being said, there are days that I say to myself (and usually when venting to my wife) "why the **** did I go into a female-dominated profession?" Be aware that there will be women who will use you as a convenient target when they're looking to pick a fight, there are others who view you as a strong back/muscles and little else, and there are times when you'll feel that you're on the outside looking in. But for the most part, you'll make some great friends and IMHO having some good friends of the opposite gender is a very good thing. Mike in Michigan

I'd say you got a great deal. Me personally, I used to use the Littman Classic II SE, since I also spend time as a road medic and cardio scopes just hear too much when you're bumping down the road in the back of a 'bolance. But indoors, yeah, a cardio scope is awesome. Mike in Michigan

Time commitments are not uncommon. Mine was 15 or 18 months, I forget which. It's mostly due to the amount of money the unit has to pay to get you trained. I had to do a week of "central nursing orientation" plus a week of "critical care orientation," plus a couple other little merit badges required by the position. Added all up, it's several thousand dollars that comes out of the unit's budget, and if you don't stay long enough for the unit to make revenue on you, it puts the unit in a bad financial position. That's not to say that transfers aren't possible in extreme circumstances, and I know more than a few nurses who have left for a different facility in less than their commitment time. Also, if I'm being honest, looking at it as "opportunities passing by" while you're in your commitment period can be a distraction from the opportunities that you already have. Like others have said, getting a job offer this quick as a new grad is rare right now. A few students that I've precepted have said that they're being told that they may have to wait 12-18 months just to get a job offer, to say nothing of trying to get into their preferred unit. Plus, you never know what unit-based stuff you can get into that will look outstanding on a resume: committees, research, special care opportunities, etc. Mike in Michigan

I think the major sticking point is the fact that you're 5 going on 6 years away from the bedside. Most of the openings I have seen for ICUs at my facility want experience in the past 2 years minimum. I know that on my unit, there have been several evidence-based practice changes just since I started 2 years ago; I would think that hiring managers would be concerned about that, even with your CEs. I'm thinking that the manager was thinking that you should have gotten some specialty certs while you weren't working (ACLS, PALS, NRP/NALS, CCRN, ATCN, CEN, whatever). Unfortunately, yes, the nursing shortage has gone "underground" during the recession because many hospitals have had to implement hiring freezes due to shortfalls in income. Assuming that the economy recovers and retirement rates in the field continue to hold steady or increase as forecasted, jobs will open up again. It's always painful to hear, but you may have to take a less-than-ideal position for a year in order to get current experience or to wait for a more attractive opening. Mike in Michigan

Just celebrated my 2nd year in a major regional burn center. The ONLY time I've ever seen docs do a dressing is in the OR, after having done a debridement/graft. Otherwise, it's all nurses and techs, with the docs popping in to see the wounds after they've been undressed and scrubbed. Mike in Michigan

We've done some post-arrest hypothermia at my facility, but I believe only certain units can perform it (Med ICU, Surg ICU, and Cardio ICU, IIRC), requiring transfers from any other units. Mike in Michigan

I have classmates who went straight to Mott out of school (BSN, not ADN, but shouldn't make a difference), including the PICU. L&D and the general floors, shouldn't be an issue. Holden NICU and the PCTU (Peds Cardio ICU), probably should have some experience elsewhere first. Mike in Michigan

1. We graduated 47, and there were 6 guys (including me). About 12%. 2. 50/50? Probably not. Although, interesting to note, many medical schools are reporting 50/50 male/female entrance ratios and some even a majority of female students. However, I attribute this to aggressive equality programs on the part of women (to which I give kudos, btw), which I don't believe will ever be equaled by men despite the ongoing efforts to recruit more men into nursing. 3. My pipe dream is that as more women go into medicine, more men will go into nursing. But like I said in #2, probably won't happen, at least not in my lifetime. I do agree with tuttle, as more men go into nursing, I would hope that respect for the profession (and for men in the profession) will follow. Mike in Michigan

ABLS (Advanced Burn Life Support, sponsored by the American Burn Association, required training for all in my unit) states that any burns over 20% TBSA are to go into DRY DRESSINGS. Heat loss is not "just a fact of life" with burn patients, hypothermia can kill a burn patient just as surely as sepsis. If you just want to temporarily cover the burns for transport to the unit, sterile towels moistened (NOT WET) with NS are OK. Xeroform would be OK, silvadene would probably be better, except for the fact that, like Sondheim said, the dressings are coming off when the pt gets to the burn unit anyway. I guess my main question would be, is your burn unit in-house or do the patients have to be air/ground transported to the burn center? If it's in house, the moistened sterile towels (covered in warm blankets) will work. If it's an external transfer, silvadene covered with kerlex, then burn net. Next time, I would also recommend starting LR instead of NS, per the Parkland Burn Resuscitation Formula (2-4 cc fluid x weight in kg x % TBSA, give 1st half in 8 hours, give 2nd half over 16 hours). I sincerely appreciate your asking the question here as a way to improve your practice. I have seen more than a few mishandled major burns in my almost 2 years in a major burn center. Mike in Michigan

About $200 is probably the cheapest you're going to get, unless you can find classes sponsored by your employer. Mike in Michigan

Megan- If this helps, be aware that all NP/CNS/CRNAs will be transitioning to a DNP (Doctorate of Nursing Practice) within the next 5 years or less. Having looked into this, UM-Flint is one of only a few programs in the state with a Family NP DNP program, and the ONLY one with an online option available to BSNs (there are others who require that you already have an MSN). UM Flint's program is structured so that you do all didactic portions on-line, schedule clinicals local to your location, and only have to go to campus 1-2 times per year. The upside is that it makes it easier to maintain employment, the downside is that it takes 4 years. Good luck! Mike in Michigan

Check out the Longtail T from Duluth Trading Co. I haven't tried them myself yet, but I hear good things about the coverage in your specific trouble region. www.duluthtrading.com Mike in Michigan

I suppose I'm a bit of a hypocrite when it comes to the term. I refer to myself as a "murse" on occasion, but mostly only around other "murses" or people who remember the episode of Scrubs when J.D. used the term to describe Elliot's boyfriend. However, I have run into a few occasions where it's been used in a derogatory manner, mostly by hypermasculine guys who've gotten a bit over-beveraged and feel the need to compensate for having a lap pinky by belittling anyone who doesn't fit their definition of a "man." In those instances, I HATE the term. Mike in Michigan

I had no issues with any of my friends, although all of them knew my intent to go into some medical field and all of them knew me as I went through my EMS training. I hate to bring up the age thing, but I suspect that all your friends are of an age that grew up thinking that nursing was only a girl's job. The one thing that will probably change about your friends, and I've found it to be for the better, is that you'll make lots of new friends and most of them will be attractive, intelligent, and compassionate females across the age spectrum. Just sayin'. Mike in Michigan

I graduated from University of Michigan's Second Career program, and I found that most (not all) nurses don't really have an issue with second career/accelerated program nurses. For starters, since (at least for the second career programs) we already have a degree in something else, we're viewed as having more life experience. Also, accelerated programs grads tend to be viewed as committed and hard-working, since we're cramming all the clinicals of a traditional program into 25% of the time (and at UM, the second career program actually has a few more clinical hours than the traditional program due to scheduling). One thing to note, UM, MSU, OU's programs are all accelerated/second career BSN and it's generally accepted that BSN grads have more theory knowledge vs. clinical knowledge compared to ADN grads, so the ADN's tend to perform better the first year or two, but after that point the BSN's and ADN's are virtually identical. Mike in Michigan

Yes, there are hiring freezes at several hospitals in SE lower MI, but also keep in mind that we are currently in the "slow" season, when pt. censuses are down, so staffing has to follow to remain within budget. Providence Novi still has openings and the St. Jospeh Mercy system (SJ-Ann Arbor, SJ-Livingston, SJ-Saline, and St. Mary Mercy Livonia) is conducting phone interviews the end of this month for all interested nurses. What many people complain about, especially after graduation, is that they can't find work... in the exact hospital or unit they DESPERATELY want for their first job. You will almost certainly need to keep your mind open about where you work, both location and unit. Take a deep breath, you are (or are going to be) an RN, there will be a job for you somewhere. Mike in Michigan

[quote=RNREMT-P;3357969 The best thing that seems to be coming from this process is the potential for uniformity nationwide in the provision of emergency medical care. A person in Wyoming deserves the same care as someone in Florida, and even more importantly, when that person from Florida is on vacation in Wyoming and needs to call 911, they do expect and should receive the same care they would be given back home. While state-to-state uniformity of care would be great, right now I'd settle for uniformity of care within the same state. Where I am in SE Michigan, we have a "regional" treatment protocol that spans 4-5 counties, but there are some counties that have opted out of some provisions and others that have added some provisions (usually centered on research protocols in their county), to say nothing of the counties that have multiple EMS providers through the various township and city fire departments who put their own "spin" on county protocols. Mike in Michigan

If you can wait until spring or summer, try that. There's ALWAYS a slowdown in patient flow between Thanksgiving and New Years, which makes things doubly hard in the current economic climate. FWIW, look specifically at hospitals connected to universities. They tend to be larger and have a more stable patient base. Mike in Michigan

In 2006, I had heard by Christmas. Strange that it's taking so long, but when I graduated, they had cut the position that was the Second Career program liason and I also heard that they were establishing a waitlist, in addition to supposedly starting rolling admissions. I wish you the best of luck, and if you don't get in this time, try again next year. Took me two tries. Mike in Michigan

I know you're looking for guys who are applying... I graduated from the program in 2007, one of 5 guys in a class of about 45. I loved every second, although there are parts of the third semester, when you're doing Community Health Nursing and Mental Health Nursing that drag a bit. If you still have time and haven't already, try to get a part-time job in something health care-ish. Phlebotomist, EMT, patient care tech... something that requires you to actually touch patients when you interact with them. It makes your clinicals and your assessment class that much easier. Feel free to PM me if you have any specific questions you want answered. Mike in Michigan

The 'typical' burn dressing is silvadene (aka SSD), wrapped in Kerlex, then covered in burn net (elastic/cotton netting). Depending on any infections present, they may add Nystatin powder, or use sulfamylon in place of the SSD. Faces are usually done in bacitracin and ears are usually done in sulfamylon. Grafts typically get wrapped in xeroform impregnated with bacitracin. Donor sites get Aqua-cel, Acticoat, or dry Xeroform. Surgical debridement usually is done in the case of full thickness burns (known to the public as 3rd degree), where there is a thick eschar of dead tissue that needs to be removed for healing. Sometimes, deeper partial thickness burns will develop eschar that will also need surgical debridement. Typically only areas requiring surgical debridement will require grafting (i.e.-any full thickness areas). Circumferential burns will also need escharotomies to prevent compartment syndrome and loss of function distal to the burn. Yes, scrubbing is typically done during every dressing change, which is usually once a day, sometimes twice a day, rarely three times a day. If you don't scrub, the topical medications build up a pseudoeschar that prevents the healing process from continuing. It also helps to remove dead tissue that may contiue to develop as the burn wound evolves, and helps to combat infection, which is the biggest challenge facing any major burn. For what it's worth, this may not be standard practice where you are; this is what we do on my unit, which is ABA accredited and part of a level one trauma center. Please feel free to PM me with any other burn care questions. Mike in Michigan