WoosahRN

I found people very welcoming. The biggest culture I noticed is people are less direct and more passive aggressive. Once I realized it I could figure out who was from WA and who was a transplant pretty quickly. Most people don't live in Seattle because it's so expensive. It's like people either commute or they live across the street. But we bought a home and my husband works far north so we live far north (our home would be more than double the price we paid if it was in Seattle). The city has really good public transportation though and the hospital has its own transportation department (meaning they help map out all the ways to get to the hospital) to enourage using public transportation (versus more cars on the road). The traffic here is the worst traffic I've ever lived in. I worked night shift and lived 35 miles away from work. It was an hour in, 45 min home and I live opposite of traffic. If I ever had to go there during the day it was 3-5 hours round trip. I grew up in Arizona and thought the weather traffic was bad. Now I miss AZ because here, a light drizzle causes traffic to crawl. It's insane. I always expect to see some big accident but nope. When I did clinicals there during the day I had to leave at 0530 to get there at 0800 because anything after 0530 and I found my commute was a solid two hours.

OP, your gut instinct was right. Just call 911. I will share my horror stories. I'm in PICU. 100% of the kids I've had come in that were "found down" asthmatics did not survive. Once that airway shuts its hard to get them back in the field. All of them had CPR in the field. One coded in the back of her parents car as they drove around looking for a fire station. Every single family said "I didn't think they could die from asthma." They were all very haunting situations. í ½í¸ž

I've been an RN for 10 years, all in Peds and the last 9 years in PICU. I love PICU. I'm good at it. I've worked really hard to gain the skills and knowledge I have. I've considered over the years maybe trying adults just to be more well rounded and to have different opportunities if I decide to ever leave ICU. Job opportunities are limited obviously when you only work PICU and I'm facing that limitation currently. 2 years ago I moved out of state. The children's hospital I work at now is almost 40 miles from home and an hour drive on night shift (an hour and a half each way for anything Day Shift related like education). I've lost skills with not being able to do a lot of the things I was trained at at my other hospital, mainly ecmo. Understandable as I'm still a newer staff member but it doesn't seem like something that will happen anytime soon. There is a large hospital 7 miles from me with a small general Peds floor but I have no desire to leave an ICU environment and want to grow in my skills and experience. I'm thinking about transitioning to Adult ICU and stay PRN at my current job just to keep the relationship open. Just the thought of a shorter commute is amazing. I have no expectation of doing ecmo or CRRT and know I'll be learning a whole new area of nursing. I'm hoping the general ICU/critical care skills will transfer. I dont see a lot of threads about making this kind of switch but there's got to be some people who might relate or have some information or anecdotes for me.

We look up compatibilities all the time. If our resources don't pull up information (not tested) we talk to pharmacy to get their input and check for additional resources. I've never thought of incompatibilities as killing a patient but I've lost lines before due to crystallization. IV fluids had an additive in it and I didn't check it with an electrolyte just not thinking. Lost a lumen on a triple lumen line. I'll never do that again.

I usually clock out between 0730 and 0745 just depending on how long report took or patient needs/changes (day shift comes on at 0700). If people are regularly needing to stay late (especially an hour after!) to chart, there's something wrong with time management skills. :/

Sigh. Or people could just offer their advice versus just coming here to respond with snark. Home care jobs. I worked in a small group home (just me, an LPN at the time and a CNA) where many of the residents (8 residents, 3 were wheelchair bound the rest were walker/talkers) went to a day program. Did days and nights there and there was a lot of downtime even with helping the tech with cares. I was able to work FT and finish my RN program. Also as an extra PRN job since I got my RN, I worked once a week on a home care case where I cared for a patient (I do peds) overnight in their home. Had a routine and once she was tucked in, meds and cares done, I did Q2 vent charting/assessment/cares. Paper charting. Turned in notes once a week at a drop box. The pay doesn't compare to hospital pay but for what it is, it's a great environment to still work/earn money but have some ability to finish programs.

10 years exp; night shift, ICU; Washington State; union. Pulled $90,000 this year with no OT.

I am in ICU but in our facility it is policy for the floors to call a "Code" for any new seizure or acute change in LOC. We also have a Rapid Response team and RISK nurse program but for the acute change, calling a code is appropriate.

Go for it! You have your whole career. That's the beauty of nursing (and the various personalities that go into it...we can all find a niche). Don't get stuck in one area especially if your heart is in another (and especially if what you're doing now is exactly what you didn't want to do in school). If you don't love it, you can move on, but at least you'll have bedside experience and clinical skills.

You've gotten some great advice here. I've been in PICU for 9 years and I'll tell you my weakest area are the 3mos to 15 mos (give or take). Fluffy and chubby are the toughest even with tools. I'm also really bad at ACs (got figure) and love feet on those little ones. Yet ironically feet can be the toughest due to wiggling. A good hold is honestly the most important part. Get a couple people (never underestimate those little ones) and get that limb clamped down. I would say that if you don't feel or see anything or don't feel confident, ask someone else or get help. Even with experience and having regular peds poking opportunities, if I can't find anything, I find someone that does (though I understand this depends on your environment and being able to get help).

I've also never had someone say "just a nurse" to me.

(I'll preface this with I have not read the entire thread.) So I have no problem telling people I'm a nurse. I'm super proud of my job. What I tend to keep close to my chest is that I'm a PICU nurse. I'm also very proud of that job but saying you're a PICU nurse gets one of two reactions. 1) "Awwwww! Babies!" with that lovey doe eyed look. And then they proceed to say they would love to hold babies all day. You get the gist. Or 2) "Oh wow, I could NEVER do that. Your job must be soooo sad." Both are annoying and lead to superficial clarification. I can't convey my 9 years of experiences in a quick encounter. So I usually say "I'm a nurse" and leave it at that unless they ask more questions. Since most people know what I do, this is mainly with strangers or new meetings and they are just asking to be polite. I will say I've never gotten a negative response to telling people I'm a nurse (with the exception of an jerk of an ER doc when I was a patient...I discussed a few things with him regarding his comments and he actually came back and apologized). Usually people are like "Wow, that's cool." And regardless, I think my job is cool and that's about all that matters. *My clarifications: "Actually we see patients from a few days old up to 18 technically, though we see patients into their early 20's as well. We rarely get time to hold babies and most of our patients are critically ill with lines and tubes." Or, "Yes there are some sad moments but there are some pretty amazing moments. I get to see patients who I didn't think would survive a few hours end up making a full recovery."

Not sure about the details in the original post but picu nurse here and heard from many coworkers about an experience where a teenager in our cvicu went into an arrhythmia needing CPR and was fighting them and trying to push them off of her. Very disturbing. Until that situation I hadn't realized it was possible for the patient to be alert during compressions but I guess it makes sense if they're started immediately and done well. I'm sure it hurts like hell.

I have only ever worked in pediatrics. I've been a nurse for 9 years. But keep an open mind in school. You can't always predict where your niche will be. (We only got 2 days in peds out of my entire program....but 8 weeks in psych. Go figure. 😉)

Met my husband after becoming a nurse and working night shift. We met on match.com. Dated long distance for some time before getting married. My odd schedule made the long distance work because I could schedule a week on/week off and could see him more.

You are a NEW nurse, you are not a BAD nurse. You need to learn and appreciate the difference and give yourself a break. All the things you described involve experience, not knowledge. You have the knowledge. You passed nursing school and the NCLEX. Get to know your coworkers and slow down while you are doing things. And remember this experience so you can be a great teacher and a patient coworker when you have a new colleague.

I just can't imagine a scenario where a child is coding and staff stands around and does nothing. I have faith in my profession and fellow nurses that even if inexperienced or panicked, they would at least jump in and try to get an IV or try to find stuff. I believe there are some bad facilities out there and some bad employees but 100% of the staff involved? ("The first thing I asked the nurses to do was prepare an IV. But they hadn't gathered the tourniquet and IV needle in advance, nor did they know where the supplies were kept. I had to leave the child to gather everything myself.") And in what world does the doctor know where all the supplies are and not the nurses? Or refuse to treat (unless he ordered some obscene dose and they were uncomfortable).

Normal ratio for the general peds floor is 4:1. Can be 3:1 if patient is a heavy teaching patient (new diabetic, new trach). My last hospital they were going to 5:1 but have techs who do all I/Os and vitals. I have worked in two pediatric hospitals full time over the last 9 years as well as two other peds hospitals with PRN jobs and this is typical at all of them and in two different states. Two states are on West coast, North and South locations. ICU is 2:1 or 1:1.

Current commute is 37 miles, 1 hour, for 3-12 hour night shifts. For night shift it goes smoothly. I would say the worst part is carpooling here and there. I like the time in the car myself to listen to music, podcasts, get ready for work or unwind after a shift, make stops if I want, etc. I never had to commute before at my other job in a different state and never wanted to commute. 7 miles, 15 minutes. But moved out of state and now have the much longer commute. When I used to rotate, the day shift traffic is insane. I had one morning when I was on orientation where my commute took 2.5 hours. Thankfully no one was waiting for me. The reason? It was lightly raining. Sigh. It's been a year with this commute and it's doable but I do look for other closer jobs, but it would require a pretty significant change in specialities. My husband (not healthcare) commutes 75 miles one way. His time is about 1 hr 20 min each way, 5 days a week. We work in opposite directions so it's not an option to move closer to either job and we both are pretty limited on where we can work in our current jobs. Mine is the job that would have to change. His is location dependent. He never complains though believe it or not.

I do calculations every single shift. I'm in PICU and all our dosing is based off of weights of the pediatric patients. Many times our dosing is ordered as x/kg and we'll calculate it on the spot if we are doing procedures (intubations, lines, sedation). Codes? We have code sheets but everything is double checked independently as well (especially if we can anticipate the need). Drips are hand calculated by two nurses. You don't rely on the pump, you have to be able to do the calculations. That goes for starting and titrating a drip. Dosing insulin. Same deal. Need to know all the equations and plug in their info (correction doses, carb dosing). When hired I have to pass a math test BEFORE I can pass any meds and do an annual math test as well. Definitely need to be comfortable with math. Can't believe it would even be uttered in nursing school that nurses don't need to do math. 😕

Well, I am two classes from finishing my MSN. I did an RN to MSN online program. I had two large breaks (a year) because I just abhor my program and keep losing the motivation (it's embarrassing that it's taken me 5 years). Also had a wedding and a big cross country move and new job all in there so some of the breaks were to accommodate that. So, almost done. But I'm not sure on the NP part. I just am not sure what I want to do with it. Still enjoying bedside and not quite ready to do a FT NP program, not work (we need my income) and rack up another several thousand dollars in debt. Check back with me in 5 years.

There's a lot of things wrong here. I'm not sure who to escalate it to. One would be to your employer. They should handle it and address that nurse's employer. I'm not sure how to advise you on how to escalate to contacting her hospital. Technically this could be many violations. This patient is not hers anymore so her being involved in medical care should be at least a HIPAA violation. And it's completely out of bounds to be making medical changes or even to be touching the patients line when she is not the paid caregiver. Not to mention the unprofessional attitude of trashing you and your company. I understand we can get attached and territorial with patients we take care of for a long time. This nurse was primary nurse for a year. That's hard to break but doesn't excuse being unprofessional. The parents you need to understand are going to be nervous. This is the first time being home with their child in their live and after a very tumultuous year I'm sure. So being able to deal with these parents is a tricky step but made worse because you are being undermined by someone they trust. Overall it's a disservice to the child. Keep us updated.

Most of what you learn will be on the job skills. And kids don't read the text books so your expertise will be gained through experience. Be honest about your skills and find out who are the best teachers or those with the most experience. In my two year RN program, we had 8 WEEKS of psych clinicals and two days of Peds. I got a peds job as a new grad and a year later went to PICU. So school clinicals are definitely not an indicator of real life jobs. Good luck!

I've never found flavoring to work. But we only had the Cherry kind and it just smelled mediciney to me anyway. I doubted it covered any taste. Plus added volume in the end. -If they are infants use the binky to your advantage and sneak it in while they are sucking on binky. -Bribery within reason (not a toy for every single oral med). -Counting and distraction. -Squirt in sides of mouth, harder to spit (or at least not a direct way...though sputtering is very effective if they figure that out). -Involve the parents. If the kid just doesn't like me I have parents give the med (while I am watching).

If I get a terrible or scattered report I usually just sit back, get it over with and look stuff up. I make sure I know the important details of each system but usually it's less painful just to try and get in there and gather info. I'm in PICU and we exaggerate about the type of nurses who need to know every detail..."Were they full term?" Asked on a 17 year old previously healthy child.