Lisap91010

As someone who went into a busy surgical ICU as a new graduate it is possible for you to thrive. I for one don't feel burned out and am going strong in the ICU 7 years later. But it wasn't easy. Don't expect you'll know "everything". This seems like common sense but you will be amazed how much you may beat yourself up over not knowing every minute thing. I carried around a scrap of paper for months with a quote from my awesome educator "You don't know everything, & we don't expect you too. When you don't know something ask" That helped me a lot. I heard from multiple people that I wouldn't feel comfortable until 2 years had passed. For me it was more like a year, but be prepared that you will have a lot of uncomfortable moments at work for a long time. Identify your resources! Find those other nurses that have been the ICU gods since before you were a twinkle in your parents eye that love to teach and make them your mentors. Ask them questions, rationals, why, why, why, always ask why..... Always know why your don't something, and if not find out. And when your finally off orientation don't get into the habit of working next to other less experienced ICU RN's, seek out work buddies with the most experience and get help when you need it. Don't be a martyr. It may be more fun to hang out with the other RN's, but don't isolate yourself (I've seen this a lot with our new residents once off orientation, they are more comfortable working next to the other people they went through orientation with creating a void of experience when its needed). Be ready to study like your still in school. I'd recommend a small pocket sized notebook to jot down questions as the happen. You won't have the time to research all the answers while your at work and if your anything like me after 13 hours of mind overload if I didn't write it down I didn't remember it. Then later you can ask your preceptor, ask your educator, pick a physicians brain, and do your reasearch at home. My first 6-8 months I'd say I was studying outside of work at least 20+ hours a week. Get some ICU books for yourself I like Pass CCRN, pocket ICU guide, and ICU made incredibly easy to start. The AACN procedure manual is also helpful but I've always just used the ones at my workplaces. Also if you become a member of AACN you get their journal, and another publication with a lot of research articles to keep up your practice and opportunities for free CEU's. Oh and get as much extra education and certifications as they come, TNCC, ACLS, CVVHD, IABP, grand rounds, any opportunity to pound more info in your head. And as soon as you can take the CCRN, most places give you a nominal bump in pay, but more importantly it will give you an outline of everything you should know. Good luck, its a fun ride. I love my job and look forward to working, and I'm learning something new every week.

Well I'm not OB expert, but when it comes to blood products the team I work with has a definite less is more view. We typically don't transfuse unless Hct is less than 19, unstable, and actively bleeding. Otherwise the surgical team supports the patient medically to promote their own RBC production (IV iron infusions, procrit, fluids to maintain BP, and an adequate diet). In fact if the procedure is planned and the patient is anemic preop IV iron infusions are administered. The rational being each transfusing poses a lot of risk of complication (highest of any IV administered medication), each additional transfusion builds antibodies making additional transfusions riskier. Also if a patient is stable transfusing blood will make them feel better in the short term, however studies (sorry can't find citations right now) have shown that it does not increase positive outcomes.

ugh, I think one of my most hated policies. I know there has to be a sentinel event that triggered this event somewhere, but its really not conducive to timely patient care to find another RN to double check my insulin with each dose adjustment. And with insulin drips with Q 1 hour (sometimes Q 30 minute) adjustments that lock the computer charting system until another RN can verify/chart they indeed double checked the insulin dose. Its a Major PIA and frankly takes away from patient care. 24 + dose adjustments a day are more than excessively time consuming with the extra checks. Why with our license can I adjust propofol, versed, ativan, etc.... that can surely kill you a lot faster (and more often you would probably think) without having to use another RN to cosign. If 2 RN's are truly needed for safe patient care I would definitely have more time on my hands at work and all these new grads would have all kinds of work.

I too was required to make a portfolio when graduating, and I have found it to be helpful along the way. I have kept mine up to date and bring it with me to all new interviews and use it to store licenses, certifications, recognitions, ongoing education, volunteer work, etc... I have found it to be especially helpful for me to keep this information in one spot for a multitude of reasons. 1. I always have a copy of my previous resume (and multiple copies in the plastic sleeves when at interviews) just in case I lose the electronic copy and have to start over. I hating writing that thing the first time and it is much easier to tweak as the years go on. This also helps me fill out those in depth online applications. 2. It gives me one spot to store all those important documents 3. Doesn't hurt that when I interview with management I pull out my professional looking 3 ring portfolio with all my credentials, education, accolades.... and say I have my portfolio available for you with all of my information for you to review if you would like. Most have actually asked if they could just make copies of my licences and certifications located in the portfolio while in the interview. For me my portfolio has been indispensable. I however have spent a few years as a travel nurse then decided to marry a military man, so keeping my professional documents organized is essential for me since I am looking for new employment every 3ish years. However I think its a good practice for everyone.

Unfortunately I was the lucky one to be on the opposite end of that one. Admitted to a local ER after MVA I had shattered part of my pelvis but with not a scratch on me. Doc orders dilaudid IVP after my screaming when being rolled off the back board. ER RN decides not to give, I end up begging for pain meds as I'm rolled onto shattered side of pelvis for xrays with no pain relief. It wasn't until after the xrays came back that she gave me the dilaudid. As she was giving it she was apologizing saying she sees a lot of RN's that divert and since I had nary a scratch assumed I was just seeking. I was none to happy that scrubs = drug seeker for that RN.

lol I guess I'm in complete violation of hygiene rules. After reading through a lot of this I see I'm not supposed to wear my danskos anywhere but work . I really need to share this with my coworkers because a couple weeks ago at a baby shower for a coworker there were a wearing our danskos with jeans. Once those babies are broken in they are so comfy and easy to slip on, they are worn nearly everywhere!

The yuck factor I guess has never really struck me. I follow all the standard precautions while at work, gown, glove, wash religiously. I even sanitize my equipment and shoes at the beginning and end of every shift. In the rare occurrence I get bodily fluids on me I change my clothes at work. And all my work clothes (underclothes included) are separately washed and sanitized, no repeat scrub wearing. That being said, I go grocery shopping , pick up dinner and out with my coworkers with no qualms about either my professionalism or potential germs I may be spreading around. I'm a professional at my job, I portray a professional nurse in my work and social life, because that is what I am. If I need bread, milk, or whatever I am going to stop at the grocery on my way home and pick it up in those "YUCK factor" scrubs. I'm not rubbing my scrubs all over the merchandise, Ive washed my hands and people you should really be washing your fruit and veggies ;-) As for going out to a bar, or for food after work. There is no stopping this RN after a particularly horrid shift when the entire ICU staff heads out for margaritas and Mexican food. Oh and I mean Docs, Rns, RTs.... the ""old" middle aged and 20 somethings. So my basic opinion is get over yourself, if it grosses you out or you think it unprofessional that is your issue. Until I have hospital scrubs provided when I hit the door my attire leaving work will be those scrubs I've been wearing the last 12+ hours. I probably have contact with as much poop/pee as any parent in the establishment I'm in, and I'm confident I'm not spreading too many super bugs around.

I've worked in many different ICU's staff, traveling, etc... And thus far I am at the best in terms of support for turning. We have permanent lifts mounted on the ceilings in each room with slings under our patients so we can boost and turn patients independently with out additional staff in most situations. Still need another person or people to change linen, and to get a good look at patients posterior but so much better than the HillRom auto turn function

I worked the night 7p-7a and 11p-7a shift for 9+ years (and a few years of day shifts when I could swing it). I've seen the gambit worked at placed with a no sleeping policy and caught once you were escorted out the door, at places it wasn't allowed but everyone looked the other way, and I've been lucky enough to work at a facility where sleeping on your break was encouraged and a room with bed/locked door with an alarm were provided. I can say 99% of the time when I worked nights I was well rested and could go my entire shift without a yawn, but on the occasion that life happened I was useless unless I got a quick set of zzzz's in. I don't understand the controversy over napping. There have been multiple studies demonstrating the benefits of shift workers napping during their breaks to increase productivity. And I know of at least one study that specifically involved night shift nurses, that demonstrated that taking a quick cat nap left the nurses refreshed, more productive, and less likely to have errors when compared to nurses who stayed awake the entire shift. Not to mention years of evolution have hard wired our bodies to sleep at night, constantly fighting our own bodies doesn't always work. If a system is in place that allows night shift workers to nap in a safe way so patients don't suffer I say go for it. That being said working in the facilities where napping was a no no I would never nap, resorting to excessive caffeine, snapping rubber bands on my wrists, ice behind my neck..... anything just to keep my eyes open. I can honestly say on those rare occasions that the 2 am slump happened it would have been better and safer for my patients if I had been allowed to get a 20 min nap to refresh myself. (BTW those were the occasions that I would honestly nap in my car for 30 min before driving home). Oh and it does burn me when I see someone nodding off at the desk, watching monitors, or when they are supposed to be watching a patient. If its that bad get someone to cover a break for you, or go home. p.s. its not just the "older" nurses that need a nap, I'm in my 20's, we all need sleep.

I have recently moved across the country and started working at a new ICU. I am not new to the ICU setting, in fact I'd describe myself as competent. I have all the appropriate certifications, CCRN, IABP, ACLS, etc... and have various experiences working in large level 1 trauma centers across the country. I've been working as a traveler on/off for the past 3 years so I have a fairly thick skin and know how to hit the ground running. However, I seem to have forgotten how long it takes for other people to become comfortable with my skill level when working as staff again. I know it will just take time, but man is it frustrating to get patients on the verge of step-down every night that sleep all night and are stable. Yeah, its nice once in a while for a change of pace, but I can only review so much pathophysiology and read so much People before I go cross eyed. Probably doesn't help I'm a day shift gal, and the only shift available right now is nights. And to top it off, I finally get a patient that is a little unstable and needs some pressors and blood products in the midst of shift change and all of the sudden I have 5 other RN's in the room taking over, not listening to me or what is going on acting as if I truly F'd up the whole thing.......LOL guess I just need a couple more months here before people know I have a good work ethic, and know my stuff. But in the mean time.... SOOOOO FRUSTRATED!

As for those working with no visiting hours during shift change and rounding, what are your thoughts on bedside reporting. I've seen at least for the last 3 years at all the facilities I've been working (I do some travel nursing) that report is at the bedside with family included. Of course we don't say anything inflamatory while family is in the room, but I have found it helps with the continuity of care. Family gets to know you when you say hello/are introduced during report, and they generally after you answer their questions right off the bat, leave you alone for the most part.

Well I'm definatly in the minority here, but I'm for open visiting hours and rooming in. Of course you need to set limits from the beginning (2 visitors only at a time, let them know they will be asked to leave for patient care etc..., up front if they do stay overnight they will be getting little sleep) but I've done all kinds of visiting policies and the open visiting hours seem to make for happier patients and families. Yeah they ask a ton of questions, and can be time consuming, but come on.... there loved on is in the ICU! If my family member was in ICU I'd be there 80-90% of the time. Yeah, there are those families that are annoying and detrimental, but deal with them. Times are a changing, patient/family satisfaction is the bottom line when healthcare is becoming more competitive. And like it or not we are providing a service. Put yourselves in their shoes, if your SO was critically ill would you want to go home at 2030? I know I wouldn't.