CCGMatt

In my facility, we (ICU Nurses) set up and maintain the CVVHD ourselves. Like other posters, we also pass competency on from nurse to nurse, so there are a few of us who are very good at troubleshooting, and some who just don't take CVV patients at all. We staff 1:1, but the administration tried to fight this from time to time - they say "there is no standard that CVVHD or IABP need to be 1:1." Unsafe, I know. Our Nephrologists refuse to use citrate and calcium. I don't have an opportunity to ask them why, either, as I work night shift, and they're never in. So, our run time is usually anywhere from 3 hours to 12 hours before we have to replace the venous side of the tubing. We do use heparin often, and flolan occasionally, but it's still not enough. We were also told that we're the last hospital in the country using the Baxter BM-11A's and our administration, in their infinite wisdom, sold the 1/2 of the machine that governs UF / outflow, so we have to rig up a crazy system with strange tubing combinations and IV pumps. Our SICU has new machines they have been using for 8 months or so - we were supposed to get them for the MICU back in Jan, but you know how that goes......

It's true, nurses really do eat their young. Flame away...

Dealing with a dying patient can be both a trying and life-affirming situation. It sounds to me like you did all that you could - the fact that the family was appreciative of your care should tell you that. I've found that a number of Attending physicians, especially intensivists, see D/C'ing pt's to a hospice program as a "failure" on their part to be able to save the patient's life, and will not ever discuss or deal with it. I and other nurses I work with have been yelled at for discussing it with families. But as long as you're an advocate for the patient, the family, and their wishes, you're doing your job.

In terms of restaurants for organic food - not a lot. Not my cup of tea, though, so I don't know a lot about that. I do know there are a couple of organic food markets though I don't know anything about their quality. Toledo is a VERY big "D" town. Republicans like me find it hard to deal with at times!

I agree with the previous statements about Toledo's weather. I've lived here in Toledo for the last 8 years, and as we say in Ohio, "If you don't like the weather, wait 15 minutes and it will change." Tuesday we had 3 inches of snow on the ground and it was 28 degrees. It's warm, wet, and 50 today. I work at MCO as an RN (MUO, if you like - got my BSN here as an undergrad), and I can tell you it is a good hospital. I don't know a lot about the GEMINI program other than what people have told me. From what I hear it is a difficult and challenging program, but what nursing program isn't? There will be a lot of excellent clinical opportunities here in town with three Level I trauma centers and a lot of regional hospitals nearby. As for stuff to do in Toledo, it's what you make of it. It's true that there is a lot more to do in the summer - we have some awesome metroparks, and a lot of activities / festivals in the summer. There is stuff to do throught the year, however... A world-class art museum, COSI, Zoo, etc, etc. We have the highest number of restaurants per person in the entire country, so there will never be a shortage of places to eat, either. Hope this helps!

My advice would be similar to nurses above - get out of Med/Surg. I have been an RN for 16 months, working nights in Neuro/Medical ICU, and I couldn't be happier! 1:2 or 1:1 ratios are great. This was my first job out of Nursing School. I seriously disagree with any nurse that says you need to get 1-2 years experience in med/surg before trying any specialty. Also, remember that nursing is a 24/7 job. There WILL be days that you don't get everything done, and it's OK. Don't let the nurse you report off to make you feel bad because they are bitter and unhappy. The tasks WILL get done. (Just don't make it a habit of it!)

Another option to consider might be to pursue a "float" position at a hospital, where you're oriented to all floors, and given a different assignment each shift. You can get a broad exposure this way, but depending on thie hospital, it can be stressful, as you don't really have a "home" and may have to change assignments every 4 hours or so.