CraigBSN02

What Missnurse said. No replacement for hospital experience. Start in the hospital, and forget about the EMT program. Unless you see your career path leading you to a first responder type position (Flight Nursing or Transport Nursing). However, with hiring being tight in my area, most all the hospitals here have reverted to a more traditional career path for nurses: requiring floor experience before critical care experience. I would try to get employed as Telemetry/IMCU/Progressive Care or ER so you can transition to trauma ICU later on. ER experience is helpful since TICU is a combo of both ICU and ER. However, go talk to the managers for the TICU and ask what they look for in applicant. that's the best path to take. -Craig RN, BSN and others.

Starting out in Tele gives you a leg up on the competition for the TICU positions. TICU is competitive and there are fewer of those jobs; They are going to take people who have floor experience first. It's also beneficial if you are working for the facility that has the TICU position as they will undoubtedly give preference to in-house candidates. Unless your geographic area has a dearth of applicants with experience, it is very hard to get into an ICU as a new grad unless they have a critical need and or you are an impeccable applicant with intangibles out the wazoo. You'll need at least one year floor experience at minimum before they even consider you for TICU. I have 10+ years experience in ER and ICU float and I still need my sh_t together when I apply to TICU . :-) Good luck! -Craig RN, BSN and others

Greets, I'm a 10 year CEN ER nurse who is "looking to try something new". I've done ER from 100,000 + academic centers to 6 bed rural hospitals. I love the really sick patients and I like the intensity that their care demands. I'm thinking about moving to a different critical care environment. The problem is I'm not sure which. I've already ruled out L&D, NICU, PICU and Tele/Stepdown. I'm not interested in Cardiac Cath Lab as it's more a lateral move. I'm looking to grad school in the future so I want to stay intellectually challenged and keep my options open for even CRNA school. i'm looking to change because I'm tired of the same old belly pain/drunks/lacerations. I really like when symptomatic overdoses come in (heroin, TCAs) and septic patients who need pressors. I get a little head rush when someone needs RSI, Levophed, central lines, and the like. I like the technical challenge of calculating drips and managing acute care. I've been thinking about Surgical ICU, Trauma ICU, Cardiovascular ICU or one of the other ICUs. What are some of the pros and cons of SICU, CVICU and TICU?? Would a confessed adrenalin junkie find happiness in any ICU setting? Would I be better served shooting for Flight Nursing? Your thoughts? -Craig RN BSN CEN and others.

Har har har. I love this thread. :rotfl: My least favorite are the ones with minor complaints and a condescending/demanding attitude. This is the nightmare scenario: Young couple late 20s, childless, possible married but in a relationship nontheless. Out on the town for dinner and drinks. The girl gets good and drunk, but since she's been a partyer since her high school days she can handle her liquor; the dude gets less drunk but also can handle his liquor. The girl wrenches an ankle/faceplants/falls and hurts her wrist, whatever the case may be. Essentially an ESI level 3. They come in and it's a jammin' night in the ED, they get directed to Fast Track but have to wait in the lobby until space develops. Within 20 minutes the girl is complaining about waiting and the dude gets uppity about her having to wait "in the condition she's in". "She's been waiting and there's been people going back that don't look sick". You continually reinforce the concept of triage and try to be nice and explain how their stay will go. You point out she's gotten ice and Motrin/wound care. They are not impressed. Dude gets on his cell phone. The girl continues to sneer at you when you walk by. More friends show up (also out to party and also a little tipsy). They begin asking. You respond but are brief in your response due to the pace and acuity of patients coming in. Dude shows back up, thrusts a cellphone in you face and says "her parents want to talk to you". You are barraged with the same questions the Dude asked you and has been asking you since they arrive. You end the phone call quickly and get back to work. 10 minutes later a guy you recognize as a rotating 1st year resident from some non-ER specialty shows up: a friend of the drunk couple. He starts asking you about the couple, what's the hold up, can't you just put them in fast track. You tell the resident if he values his life he'll get the flock outta your face and stop throwing his (miniscule) weight around..... on the inside. You tell him it ain't happening and his and their continued asking to speed things up are really bogging the process down, don't you remember what the ER rotaton was like for you?? Xray has been performed which gets them out of your hair for a brief respite. Xray is back; the couple make it to a room in Fast Track. They've been here just over 1 hour. You herd out the 4 friends who want to follow in. The couple start sniping at each other; the Dude starts in on you again, what's the hold up, her xrays are done. At this point you want to throw the dude out of the ER but you know the girl will get more obnoxious. You finally drop a bomb: stop asking me every 5 minutes, graba chair and WAIT like the rest of the patients have to do. The subspecialty resident/friend is still milling around cozying up to the attending. The attending finally goes in and sees the couple; they're giving him attitude over the wait and whatnot. He's seen the xrays and the diagnosis is minor; a splint will be needed and some wound care. The tech goes right in for wound care and the attending splits quickly. The girl is complaining to the tech, saying "nurse, can't you give me something more for the pain?". She's not being cooperative with the splint placement despite the repeated explanations that it has to be positioned properly for her injury to heal. She again asks for pain meds; you tell her she'll get a prescription for pain meds but she's been drinking so that precludes getting any narcs tonight. The Dude gets upset, asks you "why aren't you helping her pain". You ignore him and go and get their discharge instructions. You go back to discharge her, making it as brief as possible. No use of affected extremity, wound care, follow up, etc. The Dude asks to see the charge nurse, "so I can complain about the b*llsh*t care we got". You tell the Dude quit the cussin' and you'll get the charge RN. He drops another one. You ask again to drop the cussin'. He finally complies. You leisurely walk toward the charge nurse desk to inform her about an opportunity for service recovery. You instead loop the ER and come back to the room they were in; the patients are gone. They are now out in the lobby, complaining to the triage tech, xray techs, everyone except security. You wait for him to drop one more cussbomb, which he does in about 30 seconds. Ahh, sweet sweet relief. You page Security and let them know about the cussing guest in the lobby and let him handle it.... as you go back to your desk and enter a risk management report for verbally abusive guest. That's a nightmare patient scenario for me. Sadly it was a very common occurrence. -Craig RN BSN and others.

The economy affects us all, but hospitals in the DC market are still hiring. GWU Hospital, and several INOVA locations (Mt. Vernon, Healthplex, Fairfax). As far as travel nursing goes, fuhgeddabowdit! Contracts have all but disappeared nationwide. -Craig RN, BSN and others.

No no , and no! If ICU is really what you want to do, and you "really feel you belong", then there is no stopping you. Study hard, learn alot and you will succeed. This bogus "new grads can't handle the ICU" theory needs to go the way of nursing caps and all-white uniforms. It's backwards and counterproductive to advancing the profession of nursing care. -Craig J. RN, BSN, and others... :-)

More precisely, you can challenge (sit for the exam) for a paramedic certification as long as you have a BSN and a active RN licensure. -Craig RN, BSN, and others... :-)

Did you contact the attending MD and get orders for this guy's AMA? Did you have the patient sign the AMA form and provide him detailed discharge instructions about what could have and what he should do? Was the patient in command of his faculties? If you answered yes to all three of these things than take a deep breath and relax. You are in the clear. People can make their own decisions. His decision, unfortunately, contributed to him dying a little sooner than necessary. Tragic, but it's his own darn fault. Not yours, the hospitals, the MDs or anyone elses. Say a quick prayer for him and move on. Besides, people don't sue staff nurses. They sue facilities and anyone else with deep pockets cause they can pay. -Craig J. RN, BSN, and others... :-)

You stated that your goal was to become a flight nurse. If that's the case, the big messy ER is where you'll need to get some experience. However, that may not be the best place for you. Allow me to explain... Critical care/flight nursing is an advanced specialty requiring a large knowledge base and repeat exposure/practice. The specialties include critical care (preferably in a SICU or STICU) that *must* include being supremely comfortable with airway and cardiovascular management; and first responder/trauma experience. You need to keep the learning mode going for the next several years in order to get a strong foundation for this career. That being said, academic institutions are usually the best places to obtain that information. However, you need to pay very close attention to the new graduate orientation/preceptorship: does it include ICU time or is it a nuts and bolts this-is-how-the-ER-works orientation? The longer the better with orientation; 18 months is not uncommon and should be considered normal, The more variety of skills, the better nurse you will become. Emergency nursing is something where you need to have a working grasp of all the major disciplines of nursing: adult, pediatric, trauma, L&D, gerontological, cardiovascular, etc. Sometimes, those "backwoods podunk ERs" can give you the best experience of them all. Working there, you are out there on an island, so to speak, and you have no backup except a airlift to the big boys, but it's YOUR job to treat, stabilize, and transfer the train wreck that just got deposited into your waiting room/EMS bay. You have to be confident and know your stuff. If one of these smaller places can offer a comprehensive internship that you feel is a good fit for you, then take it! You can always get hired at the facility of choice in one year when you are magically anointed as "experienced" by the HR staff. Bottom line: take a critical care position that will provide the broadest exposure possible, and work your ass off learning every thing you can about critical care nursing. Attend CCRN meetings; join ENA/ACEN; get your EMS licensure and start volunteering on BLS/ALS rigs for ride time. Get certified in CEN, CCRN, CFRN, in addition to the standard ACLS/BLS/PALS. You will need to pay your dues in the form of years of experience before you can even think about applying for a flight nurse position. These coveted positions routinely get 10-20 times the number of applicants for the number of positions available. My friend has interviewed in three places; one position was available at each place and there were nearly 90+ applicants per position. Hope this helps, and I hope it doesn't scare you too much. Let me know what kind of internship UAB offers and I'll give you my teo-bit opinion. I can say that UAB has quite a good reputation for emergency nursing even all the way out here in the northeast. Take care, -Craig J. RN, BSN and others... :-)

If you have to ask this question, then you do not need to work during nursing school. :-) Those of us that needed to pay rent, eat, put gas in the car, etc. etc.... we worked because there wasn't a choice. If you're a "traditional student" coming right out of high school (and have college paid for) and the credit card/auto companies haven't sunk their twin fangs of debt into you yet, keep it that way. Make school your life, enjoy it, there is nothing like the first time around. Plus that makes you look good when applying to grad school. Your grades will be better (hopefully) and you can devote time to volunteering and whatnot. -Craig J. RN, BSN, and others... :-)

If you wanted to be a policeman, how much sense would it be to be a firefighter for a year? If you're a person who is certain that one specific specialty is what you want and have make it your career path thus far (eg: you want to be in ER, so you became a unit secretary, then a tech, then an EMT, etc), why would you waste your time to "serve time" on a M/S unit? While I agree you should have an appreciation for how other units operate, nursing needs to move past this punitive mentality of 'pay your dues' in order to work in a specialty. It depends on the person's experience and aptitude, frankly. I am all for having new grads rotate thru ICU, M/S, OR, L&D, etc., but the mandatory M/S service should go the way of the cap. -Craig J. RN, BSN, and others.

For shears, there is only one correct answer... http://www.bigshears.com (picture attached for proof) Suckers are big, too. Weigh about a pound (~400gm) They can cut thru anything. Denim, leather, boots, bad attitudes, you name it. -Craig, RN, BSN, and others

I agree with your decision. The fact that this lady had risk factors out the wazoo is a side point. However, this doesn't sound like new onset cardiac pain. The salient points are: reproduceable RIGHT side chest pain x 1 year and dyspnea on its own that sounds fairly stable. Call it what you like: costochondritis, etc. As far as Junior and Senior go... I initially thought Senior was gonna pass out, since it's logical sequelae of events. However, the depth of his symptoms caused me to second guess. -Craig RN, BSN, and others. PS - Yes they let Senior go home. My facility isn't the most aggressive in drumming up business, as they already have enough of their own. Plus, I doubt Senior would have stuck around for a full 23-hour syncope workup.

Ever seen when a character passes out? All the "color" drains out of him so that he's see-thru?? I ask for a reason. Keep reading. My pt is a young adult, transferred to us for a distal comminuted humerus fracture with radial nerve palsy. We'll call him Junior. Me and the Ortho and the pt's father (we'll call him Senior) are in the room. Me and the Ortho are taking down the Junior's (shoddily applied) posterior long arm splint to better assess the palsy and swelling. PS - ever want to easily assess radial nerve palsy in a patient who's splinted? Ask him to make a thumbs up sign. The extension of the thumb indicates the radial nerve is doing its job. (back to story) Junior, who I think has been less than forthcoming regarding his youthful indiscretions regarding pharmaceuticals, has quite the tolerance to hydromorphone. So, he's yelping, panting and generally letting it be known that what we are doing, HURTS. We finally get the splint off, prop up the arm, and complete the assessment, at which time Senior says... "I'm feeling a little dizzy." I tell Senior, "Sit down in that chair right now. Do not get up." Senior takes a seat in a chair, with his back leaning against the wall. He's perpendicular to us. I notice that in the next 15 seconds, Senior looks awfully gray and has quite the faraway look in his eyes. With Junior's arm secure (for the time being) I go assess Senior. Junior opines, "What the fiddle is wrong, Dad?" Senior's head slumps forward, and he's guppy-breathing. Senior looks dead. Looks stone warm dead. Like immediately post-code dead. If he were a Monthy Python character, I'd call him a Norwegian Blue parrot, what beautiful plumage! He's pining for the fjords!! "What the FIDDLE is wrong with my Dad?" Sidebar: I have witnessed plenty of people suddenly expire in front of me. I have witnessed a visitor to a patient in Urgent Freakin' Care pick that particular moment to allow his previously undiagnosed thoracic aneurysm to rupture. I have watched a man promptly launch himself into ventricular fibrillation upon being told, 'you are having a heart attack' by the attending MD. I have also witnessed plenty of people pass out in front of me. I could not tell what this guy was doing at this particular time. I take 7.5 seconds to stick my head out the room and holler (in my *best* big adult man voice): "I NEED SOME HELP IN ROOM SIX NOW! NOW! NOW! I preface this with the name of the first person I can recognize & who's name I remember. I prop Senior's head up to open the airway (and stop the guppy-breathing to a more quiet agonal/bradypneic pattern) & I check a carotid pulse; I'm not sure if I feel it. I look at his crotch: no visible or olfactory presence of urine. I continually ask Senior if he's ok. I am answered with glassy eyes and more agonal-esque breathing. The calvary arrives. Junior is asking, in no uncertain terms, just what the fiddle is wrong with Senior, repeatedly. Within 15 seconds after the calvary arrives, Senior goes from ash grey to red face (like a newborn taking a poop, still with the walleye look, however). Senior postures a little (flexion abduction in the upper extremities, for those keeping track at home) and has a brief 2 seconds of myoclonic jerking, at which point his color returns to normal. The calvary murmurs: "Is he seizing?" "Is he coding?" "WHAT THE FIDDLE IS WRONG WITH MY DAD?!" Senior gets lifted out of the chair to the (newly available) stretcher by myself and a few other nurses. I grab around the chest and they grab legs and we plop him down. I now look at Senior's face. Senior look like he did when I first met him in the waiting room. Normal color, eyes clear, looking maybe a little more sheepish than before. We wheel Senior to an available room to give him the business... ...at which point we're informed by the ED medical director, "don't register him, just give him food and something to drink" and promptly walks away. (I mean, I was in full on this-dude-is-coding mode) Senior is awake, obviously not post-ictal, and sweating like a MLB player in front of a congressional hearing. "I guess I must've passed out.", says Senior. Normal pulse, respirations and color. Affect normal. Eyes clear and bright. "Yeah, you had us going there for a bit." Radial pulse 67 and strong, regular. "It's really hot in here.", says Senior. "Well, you passed out, that's a fairly normal response. Drink some juice and get up SLOWLY when you feel better." I go back to room six and inform Junior that Senior is alive, well, and consuming the best apple juice (with 10% real juice from a variety of sources!) our facility can provide. Moral of the story: -Airway, Breathing, Circulation: always open the airway. A jaw thrust is easy to do to a sitting person facing you. -Incontinence is the fifth vital sign: a fairly reliable indicator of significant LOC or something worse. -You're not so tough: If you even THINK family members will not be able to handle what you are about to do to little Junior, ask them to leave and promise to bring them back when you are finished. Senior was a little wound up from Junior's mechanism of injury, a perceived attitude from the front security officer, and lack of sleep and *I* should have trusted my gut. I have scraped more big, tough 'it's okay I'm a firefighter/marine/contract killer' guys off the floor when daddy's little girl is getting her first stitches. Post script: Senior was driven home ~50 miles by a friend, and Junior went to the OR for a surgical correction (I'll find out which one tonight). Nobody else passed out or otherwise created a stir for the remainder of the evening. I was reminded that sometimes, people will pass out and try to make it look like they're coding. It's up to me to determine whether that's true and sometimes that'll take 30 seconds, maybe less. Don't get my knickers in a twist and remember the important stuff. Airway, Breathing, Circulation. -Craig RN, BSN, and others. :-)

Yes, they have internships and externships. Usually coincides with school graduations, but ideally they'll start a new grad training class whenever they're enough people. I think it's pretty heavily skewed towards newbies, though I don't know what the numbers are. I think about 18 months: 6 months minimum for classes and orientation and a contract year for the remainder with financial penalties if you quit early. Classes cover the gamut: ER, OR, ICU, the floors, and even newborns. However it's all from a unit perspective (ie: how does this affect you in the ER). Level 1, sees 100,000+ visits per year, about 2500 of those real trauma. Keep plugging away, be proactive, smart and driven and you'll get whatever position you want. It's still a buyers market out there for nurses. -Craig RN, BSN, and others.:hrnsmlys: