TemperStripe

Yes, I am. Feel free to PM me.

Great, I feel totally vindicated. :) I've set up some additional orientations at these places and feel totally solid that it's the right thing, not just for me but for my patients. Thank you everyone!

I'm with the RFP and I love it. Can't say enough good things about the managers, educator, and schedulers. It's a great fit for me because I hate unit politics and am very protective of my schedule. I float to 6 Centura hospitals and quite a few more with a backup agency when the work dries up (which, because I do ICU, pre-op, and PACU, is very rare.) Many people think I'm insane. :) Floating is not for everyone...it is very hard in a lot of ways I didn't expect but I do feel like the RFP will advocate for me if necessary, and that is a huge deal! PM me if you want more info.

I have been agency/float full time for almost a year now and have floated to probably 30 different units, but wanted to bounce something off everyone. I just finished paperwork for a large multi-hospital system and also completed a single 4 hour orientation at one of their hospitals. I am now eligible to float to ALL of their hospitals without any more orientation anywhere. Would you be comfortable with it? Here's my thing...I'm an ICU nurse, and never knowing what kind of assignment I might end up with, this just feels really unsafe to me. Yes, I am flexible and good at figuring things out on my own, but what if I walk into a critical patient situation and haven't had time to get Pyxis access, know where the code carts are, etc...? Even stable ICU patients are still ICU patients for a reason. I don't think I should be expected to come in early on my own time to learn all this, either, even though orientation pay is lower. My agency is very willing to sign me up with more orientations. I feel like I want a couple of hours at each new hospital just to knock out the basics. Or am I being overly cautious? Your thoughts are appreciated.

I started taking mine to work to use it during breaks and charting and 5 or 6 other nurses ended up buying their own lights. :) I use it mostly during the winter and also take a massive dose of supplemental Vitamin D. Does it help? I dunno...I did feel like I slept better but I struggled with a depressed mood most of the winter. Where I live, you could go weeks on night shift and never see the sun, at least during the winter. However, the depressed mood could have been caused by a lot of other contributing factors. I felt like it was a worthwhile purchase, all in all, and I'll definitely be pulling it out again this winter. It's better than nothing!

I have twice made the mistake of NOT calling in sick...thinking I'd be fine and it would pass. I was having sore throat/cold-like symptoms. MISTAKE. Both of those days ended up being some of the worst.days.ever. If in doubt, call in sick. Your physical health and your mental health can ALWAYS use it. It's usually painfully obvious who abuses sick time. If you know in your heart you're not one of those people, then who cares what people think. Take care of yourself first. If you're no good to yourself, you'll be no good to your patients. :)

I have heard it can already be done but who can afford it? Not sure. As economics allow, I definitely think it's the future of the ICU.

Side-Back-Side I posted a few weeks ago about a patient I couldn't turn at all so I just moved his arms and legs whenever possible. Miraculously he didn't have any skin breakdown when I checked him the one time that I could. I've never had a patient develop a pressure ulcer from the side-back-side method. I agree with a previous posted that there are some patients who need more frequent turning but I have found this to be the exception. That being said, even if I don't physically turn the patient, I try to "reposition" the bed at least 1x/hour (HOB up, chair position, etc.)

I had used melatonin and also found it to be useless. However, I was taking 3-9mg at a time before going to bed. I've been reading that this is way more than the pineal gland ever secretes, and sometimes taking a lower dose (1-2mg) in the sustained release version, and 5-6 hours before you go to sleep, is better at mimicking a natural release and can improve your sleep. Additionally, it's cheap! I may try that in addition to my light box.

Any night shifters use light therapy and/or sustained release melatonin? Just curious about your experiences with it, especially if you switch back and forth or live in a darkened climate.

This particular case was an incredibly unstable pelvic fracture so the wedge wouldn't have worked because the patient needed to be 100% flat, but I will definitely keep that in mind for the future. I agree with the above poster who mentioned feeling like a bad nurse...I felt the same way! Turning and skin breakdown is 100% nurse-owned and its' always been drilled into my head from day 1...so yes, leaving them flat goes against EVERYTHING I know. But yes, life is more important than skin...no life= no skin, right? Airway, breathing, circulation......skin.

Does anyone have any suggestions for preventing skin breakdown on a patient that is too unstable to turn? I was moving his arms and legs and tilting the bed hourly at least. And of course, he pooped 3x...of all the patients that you don't want pooping...so he did get turned two times on my shift. When we turned him for his chest xray I was amazed that there wasn't any breakdown yet (after 2 days of laying totally flat) but I'm wondering if you guys have any other suggestions. Logistically, we were not able to get him on a specialized mattress either. Caroline

It's because the OSA makes them "high risk." However, many of them don't even have their own CPAPs. They're on room air all night long.

Obstructive sleep apnea.

We've had a rash of elective surgeries that have had to stay overnight in the ICU because the patients have OSA. The policy states they have to be in ICU even though they have q shift vitals! I'm talking about tonsillectomies and vasectomies. Anyone else experience this, and any suggestions on what to do about it? (Ha...yeah right.)

Good idea on fun stuff for the kids! Will try to squeeze in some candy and bubbles. :) I don't actually have any psych experience outside of my degree...well, I guess everyday is a new psych experience, but no official counseling or anything. I actually went straight into ICU but my psych background certainly comes into play everyday!

Any must-haves for my trip to Haiti tomorrow? (Yes, found out kind of last minute.) Thanks!

We get inappropriate admissions all the time. Lately it's been pretty bad. A lot of times, it seems the docs are more comfortable with the patient-nurse ratio on the unit, and even though the patient is and always has been perfectly stable, they are still hesitant to send people to the floor for this reason. Also, and I think this is extremely unfair to floor nurses, if ONE thing goes wrong on the floor, we will take all those patients for the rest of eternity. For example, one time, in a galaxy far far away, someone got a little over-sedated with ativan. Boom. Those patients now go to the ICU no matter what. Nevermind the fact that ICU nurses ALSO make mistakes and over-sedate people, or what-have-you. But there is no mercy and no respect for the abilities of the floor nurses, and no understanding of their job. It is very frustrating. There are many days when I wish I was in a more acute ICU, then I realize we have it really good at my place, so I try not to whine. (Although I do crave the sick ones...)

We get this all the time, especially in surgery. Read the book "The Final Exam" to get a better understanding of how doctors tick, and how they are taught, from Day 1 of medical school, that death is personal failure in all circumstances. It is very unfortunate but I also feel they are generally still doing what they believe is "right," it's just that we all have a different definition of "right." There's no easy way around it in a lot of cases. It does help to know how to ask for what you want in a way that you will get it...this takes time, I am still learning. Never stop advocating.

I have an iPhone but previously I had an iPod Touch which could support all of the apps I mentioned above. I loved my iPod touch... Don't know about a droid, you'd have to check their app store. Sorry for any confusion, guess I thought "ipod" was kind of a catch-all phrase for Apple products that can use apps. :)

I use my iPhone all the time at work. Here's what I have: Nursing Central: includes drug reference, lab reference, Tabers, and some random journal articles. I use the drug reference all the time, it's very hand to have at the bedside when I go in and realize I've forgotten to look up compatibility or something. The rest of the stuff I don't use as much anymore, which is why I didn't renew my subscription (but I get to keep everything I already have.) DrugInfusion: Use this all the time to figure out non-weight based IV rates. Math is not my strong point, so I use this to triple check myself. You can also do weight based calculations and they have a lot of drips already programmed in. This app is one of my favorites. Only $0.99. ABG: This is a free ABG calculator. I use it to double check myself after I look at a gas and come up with what I think it is. Can't really beat it for the cost. ECG Guide: Think it was like 4 bucks or something. I use this when I see weird blocks that we don't get very often and I need to re-familiarize myself with everything related to that rhythm. Epocrates: Don't use it a lot because I find it somewhat cumbersome. I have the free version and I have used it for unit conversions and sometimes drug compatibility. Calculator: The free one that comes with the iPhone...use it constantly. Love it. MedScape: I have it but I've actually never used it. Need to play around. This one was also free. I love my iPhone and it basically has my entire life on it, so it's never far from my reach even when I'm not making phone calls. I think there is great potential for medical apps but it appears that the development has kind of petered out as of late. Looking forward to a good CCRN app, for one. The possibilities are really limitless especially when it comes to these $0.99 apps.

Dec' 08 grad here. We rarely see 3:1 assignments, even when our acuity is low (which does happen...our hospital has no step-down unit so they tend to hang out in ICU longer.) Hope you're able to find a unit that cares enough about your license to be VERY careful with this practice.

Just heard from a coworker who returned from a conference that there are a bunch of new, really cool, much less invasive way to measure cardiac output and such, and that we are going to be swanning people less and less in the very near future. Anyone have any experience with any of these? Are you actually seeing fewer swans?

The answers to these questions tend to be very unit-specific. As a new grad, you should ONLY work on a unit with great, supportive team members. I would say that is the number 1 thing to look for when you interview. There is no quicker way to sink when you're new in ICU then working with nurses who are not 100% on your side and looking out for you. No if's, and's, or but's about it. As for the rest, sometimes there are aides and sometimes not. 99% of time on my unit, there is no aide, we do it ourselves, but we do have an awesome team that will help you whenever they can. In the last year, I can only think of 1 or 2 instances where I needed immediate help and had to manage on my own, and that was only because there were multiple other patients crashing all at the same time. Even still, we made it work. No one can teach you have to prioritize; you have to learn it yourself, and it really depends on the patient's situation. ICU nurses tend to be picky about things looking neat and clean, but when you're patient's losing their airway or their blood pressure, it doesn't matter that their pajamas are from yesterday and the bed linens haven't been changed. Be prepared to make a plan, then change it immediately. But make the plan anyway, because occasionally things go the way you expect! :) (And it's very exciting when that happens...a cause for celebration, really!) Also in terms of prioritizing, learn to think of yourself, too. YOU are a priority. Your charting is a priority, for example, so that you can go home on time. Fit it into your day. MAKE time for the things YOU need to do to get your job done and done well. And as for time management, you have to learn that one for yourself, too. I think a lot of the pressure on new grads is self-imposed. (At least it was for me.) Remember: this is a 24 hour job and it IS okay to pass things on to the next shift, even if they whine. You simply cannot do it all in 12 hours, end of story. Of course, people will sniff you out quickly if you are being lazy. :) Technical skills like IV starts, suctioning, etc, will be slow at first, but soon you will be amazed at how quickly you can accomplish these things. It just takes time and patience with yourself. Good luck!

I graduated in December, '08. Switching days and nights in the same week is extremely difficult, even without all the pressure of just being a nurse, let alone being new! It's no surprise that you are exhausted all the time! When can you talk to your manager about doing one shift or the other? That kind of horrible schedule is one reason why nurses are leaving the bedside, if you ask me. Don't be a martyr any longer...tell you manager you need a change! Now that you have one year under your belt, you ought to have at least a LITTLE bit of seniority, right? As far as outings with friends, I set up a google calendar with my work schedule, and gave my friends access to it. Most of them work a regular 40 hour week (M-F, 8-5) and I'm the only one that really needs to be "scheduled around." It's a bit of a pain for them, but they do understand that this is just one of the downsides of my job. I think it's really important to hang out with both nursing AND non-nursing friends; gives me some balance in my life. Also, many of our outings are planned 1-2 months in advance so I can request the time off if necessary. All this being said, even after a year, I still feel like I'm "adjusting" my life, and constantly having to be flexible and make sacrifices for my job. I think once you get on a set day or night schedule, it will be much easier for you to enjoy your time off, rather than having to spend it all sleeping and recovering! Good luck.