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ccrnjen's Latest Activity

  1. ccrnjen

    Pay differential for ICU, CCRN, BSN

    That is awesome! This is the way I think the pay scale should look for RN's. Do you have any idea what departments are on each tier - particularly the 2nd and 3rd tiers? Just to know where I am coming from, the current hospital I work at has the same pay grades for all nurses, differentials for nights and evenings. No differential or increase in pay for ICU, BSN or certification. They do reimburse for the CCRN exam fee and give an annual bonus for each certification which varies depending on how good the year was. Typically between $250-500. For those doing math, that works out to about 0.12-0.24 per hour. Thank you everyone for your posts, keep them coming! The more ammo and info I can gather, the better!!!!
  2. ccrnjen

    Pay differential for ICU, CCRN, BSN

    Along the lines of a previous thread, I am interested in whether your institution has additional pay or differentials for critical care nurses, ICU nurses, BSN, certifications (particularly CCRN), etc. It has always bothered me that some places have the same pay scale for all nurses, regardless of level of training and education. I whole-heartedly agree that there are excellent nurses in all areas of the field and that each area is specialized in its own way. However, it is the ICU nurse that is called upon to take the patients that are too sick for the floor, to respond to codes, to respond to MRT calls, etc. It also seems that often ICU nurses are required to float to any other unit in the hospital while floor nurses are not able to reciprocate that and float to an ICU setting. I am in the process of gathering information on the compensation for ICU nurses to present to management and would appreciate any help you can give. Thanks in advance!
  3. ccrnjen

    Cardiology Conference Topic

    Depends on the audience you are presenting to.... I have always found interventional cardiology fascinating. The technology involved, the advancements made, current trends and devices... I still think it is amazing to see a blocked or narrowed artery re-opened. Or PFO closure that is now done in the cath lab in many places. What about something on ablation therapy for arrhythmias? However, these topics may be to "simple" for your audience.
  4. ccrnjen

    CVP readings

    Monitors do not always provide an accurate reading, particularly when there is respiratory artifact on the waveform. In order to get the most accurate reading, CVP should be read during the end-exhalation phase of breathing, when intrathoracic pressure is "zero". That is, there is not negative pressure for inhalation or positive pressure during exhalation (or vice versa on the ventilated patient). The CVP waveform consists of three waves (A, C, V). The 2 most accepted ways to obtain a CVP reading are to take the mean of the A wave, or find the z-point. Because determining which wave is the A wave can be difficult, especially for newer nurses, and because of abnormal rhythms (a-fib, AV dissociation) and physiologic abnormalities , I think using the z-point method is easiest. The z-point is found at the end of the QRS, just before the C wave (which represents tricuspid valve closure). It is a good indicator of right ventricular end diastolic pressure. To do this, make sure your transducer is at the phlebostatic axis and zeroed to atmospheric pressure. The head of the bed can be up to 30 degrees. Print a strip of your ECG and CVP waveforms, determine exhalation on the respiratory cycle, taking into account whether your patient is spontaneously breathing or on a vent (remember that exhalation is almost always longer than inhalation). Draw a line from the end of the QRS down to the CVP waveform and take the reading (be sure to check the scale!) - best to average a few. When this is done, you shouldn't have a negative number which is usually caused by negative intrathoracic pressure. All this said, many clinicians simply trend CVP measurement and treat it (or end treatment) when it has changed significantly. However, if there is significant respiratory artifact, you could be over- or under- treating your patient based on a "false" reading. Hope this helps and doesn't confuse things!
  5. ccrnjen

    B-cat exam?

    It stands for Basic Knowledge Assessment Tool and is developed for critical care areas. As the above poster said, it gives guidance to those who do the hiring or education so they have an idea about your strengths and weaknesses. It can help provide a more focused orientation or help determine the length of orientation needed. Critical Care Nurse (Aug 2006, vol 26, no 4) had an article about this "Follow-up Survey 10 years Later: Use of the BKATs for Critical Care Nursing and Effects on Staff Nurses" if you are interested.
  6. ccrnjen


    I would like to know what everyone does with post-op carotid endartectomy patients. Do they always go to an ICU? Only the ones with high blood pressure? How long are their hospital stays? What about carotid artery stenting (done in radiology)? Are these patients treated any differently (aside from routine post-arteriogram care) than the standard OR carotids? Thanks for the info!
  7. ccrnjen

    Ventric/EVD/Bolt site care?

    Thanks Roxann - anybody else?
  8. ccrnjen

    triple reflex

    I believe you are talking about triple flexion: Flexion at the hip, knee, and ankle, in response to stimulation of the sole of the foot. Typical of lesions of the pons. It is sometimes seen in brain death, but does not mean the patient has brain stem function. Can also be seen spinal cord injuries as it is a spinal reflex. Does this help?
  9. ccrnjen

    eating our young?

    After having spent a good amount of time as a preceptor for new nurses to ICU, the difference between a new grad and a more experienced nurse who is new to the ICU setting is huge. I feel that nursing school does very little to prepare you for what nursing is really about. As a result, new grads have a huge learning curve - just to become a nurse. Many of the daily tasks and skills have never been done by the new grad. Much of their time is spent learning the "tasky stuff". How can we expect them to even begin to critically think when they are focused on completing tasks, developing basic nursing skills and getting organized?? The nurse who has spent time on the floor not only has their organization and skills developed, but now has time to begin to critically think about what their patients are going through and the pathophysiology involved - only now it is a much less critical/stressful situation. When these nurses come to the ICU, they can pick up the new tasks quickly and spend a lot more time thinking about the "why's", developing the knowledge to become good ICU nurses. That being said, I truly feel that new grads have no place in the ICU. However, because of the current situation, we seem to be stuck with this. I do believe with the right orientation, preceptorship, mentoring and desire to learn, new grads can be successful in the ICU and it is our job to help them to succeed so we aren't saving their butts or cleaning up after their messes every day. On a side note of this discussion, I agree that it takes at least a year for a nurse to begin (notice I said begin) to feel comfortable in the ICU. It makes me absolutely ill to see these people with only 2 or 3 years experience, who think they now know it all, training the new grads or taking charge. Is it any wonder that many new grads do not get the training they need from their preceptors?? How can somebody with so little experience in such a demanding field be expected to adequately teach others or actually be the resource person for the entire unit?! Maybe this is just my experiences with ICU coming into play. When I started, nurses had to be on med/surg for a year before going to a telemetry or step down type unit, where they spent a year before applying to ICU. Typically nurses had to be in ICU for about 4-5 years before they were even considered to be a preceptor and another year before they were placed in charge. If only we had that luxury now.....
  10. ccrnjen

    Ventric/EVD/Bolt site care?

    Just wondering what everyone's policy is on site care and dressing changes for ventric/EVD/ICP's. The literature I've found so far pretty much says "per institution policy". I can't even find a recommendation on frequency of dressing changes. Any help/input is appreciated! Thanks!
  11. ccrnjen

    HELP! Arctic Sun and Cryoamputation issues

    Try doing a search on google - hypothermia cardiac arrest. you can also add protocol or policy to get more detailed info instead of just the research. There seem to be several that are available online. Hope this helps!