Caroline Keith

Your intuition to be thorough is amazing, and KEEP IT UP. There are way too many times coming on shift that we get busy or distracted, and there's a ton of pressure to just go-go-go. Being that thorough is SAFE. I found myself in the same situation in PCU, sometimes, because I hated feeling like everything is just task-task-task and you don't get the chance to sit down and get the whole picture. That's fine with med/surg tbh and lower acuity PCU, but mid to high-acuity PCU is tough. That's why I DID transfer to ICU. I'm literally paid to take my time and research EVERYTHING, because it all matters. When I first started ICU I freaked out about giving things late or falling behind, but SAFETY comes first. Every thought I have in my shift is safety--first thing I do when I go into a room is ask, Do I have my ABCs (airway, breathing, circulation)? Do I have oxygen, an ambubag, suction, and a WORKING IV access? Are my gtts all running/properly programmed/compatible? Do I have an emergency chest tube kit/clamps in my room w/ a CT? Yeah, sorry my Senna is late, but I made sure the patient isn't gonna die. I also struggled a little initially in ICU because I was slower. Just give yourself grace, it's a tough specialty. Communicate clearly your learning style, your potential weaknesses, and especially your strengths, because they will help you overcome those weaknesses. You'll slowly find your groove and a system that works for you. Good luck!

5 PCU patients is just plain unsafe, dude. Depending on how heavy/sick, it should be at max 4 or even 3 (that's a stretch, probably only California could swing it). It's a safety issue, but it sounds like you did everything right. What was your load like? Is there a central monitor person, or do you have beepers or just auditory alarms around the unit? *** happens, don't take it personally--look at the system and what procedures/policies are in place that led to it happening. It could have been way worse. Did you find them, or did an aid? Or did an alarm go off? Were you busy with another very sick patient, so that you may not have been able to check on the trach patient for a bit? What if the patient didn't do well, and they didn't have a monitor/notification system/aid to tell you? The more they stretch your staffing the more dangerous it gets. What kind of unit do you want to transfer to? I ended up going ICU because I hated feeling stretched and like I couldn't give thorough care. At least in ICU you normally have one to two patients, and yes they're way sicker and have a lot of *** going on, but you HAVE the time to do right by them.

In my old burn unit, we didn't regularly replace PIVs or central lines unless indicated, but it still happened, as everything gets ooey-gooey and stuff happens. If the central line was in intact skin, we did our standard CHG patch + sterile central line dressing, changed q7 days or PRN by either bedside or IV RN. BUT if the line HAD to be placed in burn skinned, like with our very large burns, we would clean the site with CHG sponge/wand q12 or q24 (I don't remember, I don't work there anymore), try to keep a CHG patch on it, and sterile gauze on top, replaced frequently. We had very few CLABSIs, but I don't remember the exact data ?

Hey there burn nurses! I feel dumb asking this question, and it's just for my own knowledge. I started Burn ICU training but ended up going to Cardiac ICU, so I never experienced this issue. If you're doing a burn shower (hydrotherapy, however you like to call it) with a patient and they code into a shockable rhythm, can we defibrillate safely? Obviously we would dry off chest quickly to apply pads, but the table we have is metal. The floor is some sort of rubber, but water can some times puddle if you're not careful. I know we have to ground ourselves and not touch the patient, but is there something else we have to do? Or can we let it rip? I'm not even going to be near burn patients for years now but I can't stop thinking about it!! Thanks! Caroline