JenSICU_CCRN

1.) what is your highest level of education? BSN plus 18 hours of graduate classes toward MSN 2.) What type of facility do you work in? (Hospital, homehealth, office, etc)? Community Trauma Hospital 3.) Is your current facility hiring? Does it offer hire-on bonuses? We are always hiring and they do not offer hire on bonuses 4.) Do you feel as though your place of employment is short staffed? My unit is not short staffed as we have a wonderful manager and medical director but the hospital is short staffed 5.) If #4 is "yes," Can you give one or two examples? The night shift nurses on some med-surg floors have 8-9 patients at a time and we practice primary care 6.) How many hours do you work a week? Do you feel valued? Overworked? 36 hours a week, yes I feel valued, and no I'm not overworked 7.) Is overtime expected of you? Nope 8.) Have you left a job bc of short staffing? No...I'm employed at the same hospital as when I was a student and have never worked any other facility 9.) How many years have you been working in the field? Almost 6...2 as a nurse extern and 3.5 as a RN 10.) If near retiring age, do you plan on retiring, or continuing to work? Do you feel as though retiring is an option-or do you feel as though you are "needed" be your facility too badly to leave? N/a ***thanks everyone*** Jennifer Smith RN, BSN, CCRN, Clinician II SICU

What I want to know also...is how did your hospital achieve magnet status if you are so understaffed? We have a magnet hospital in WV (Ruby Memorial) and people would cut of their arms to work there. Jenny

Well, this is a touchy subject. I am a SICU nurse, and in our hospital our patients tend to be the sickest of the sick. Our unit is known for having tons of nursing hours as we frequently have 1:1 patients. I do not think that our nurses should get paid more than the floor nurses (if this is what you mean). If I'm misunderstanding your post, then I apologize. The main reason for this is that we are all nurses....I chose my specialty and chose to not work on the med-surg floors. We are busy in different types of ways...Yes, the Critical Care nurse is more specialized, but I could not go to the floor and take 8 patients and not sink. I think this adds to the long time myth of ICU's nurses thinking they are better nurses than floor nurses and do not agree we should get paid more. I think this would further increase the rift between floor and unit nurses. Our hospital is wonderful to pay for inservices, trips for education, certification (initial and renewel), and other things. Just my 2 cents. Jenny

Congrats James....The called me in September and told me that I was accepted for this January, but I am going to decline at this time. Good luck to you and all you do. They also told me the letters were in the mail and I have yet to receive one-LOL. We will see soon then if they told you they mailed them out. Jenny

I don't think that anyone here has denied that it happens....nurses doing things without orders and so on and so forth. What we are saying is that it is illegal and giving extra medication is practicing medicine without a license. You did elude to the fact that nurses give extra because physicians don't order what is needed....well, maybe because what they have ordered is what they think is working when in fact it isn't because the nurse is taking matters into their own hands. If I feel that pain medication or sedation, etc...isn't working I call and get orders for a larger dose. As far as labs, PCXR's, ABG's, etc....yes, we do have standing orders for that in my facility for our patients in the Trauma/SICU so we can order those without calling. But, NOT MEDS....I would never dose a patient how I thought appropriate. Not my job, nor in my scope of practice to determine. I just don't feel it is right to make light of something so serious. YES, we generally know more than the docs about the patients....YES, we assess the effects of medication....YES, we are educated and smart enough to know whether meds are working or not....so, CALL THE DOC and get orders. Do you not think that giving extra insulin is a big deal? Do you not think that dropping a blood glucose too fast can cause problems neurologically among other things? We were not educated in nursing school for dosing of sliding scale....giving extra insulin is no laughing matter and could cause a lot of problems outside of 'just lowering the blood sugar'. Jenny

Heck no....thank God for our unit. I work in a very busy Trauma/SICU in a tri-state area as well. We have a PCA (unit secretary/CNA) 24 hours a day unless there are 3 or 5 patients. At 5 patients we have 3 nurses and no PCA and at 3...2 nurses and no PCA. If we can justify the need, then we are allowed to have the PCA anytime....like last week, we had 5 patients and worked with 4 RN's and 1 PCA...we had a 1:1 patient (CRRT, 9 drips, CCO PA Cath, 5 chest tubes, etc) so it was justified. Our nurse manager NEVER questions our justifications. We have wonderful support, and patient safety is the priority. I agree with the above poster about justifying why you need help. Oh, and by the way, I work nights and our staffing pattern is the same for both shifts, so don't let management stiff you if you work nights....ICU patients need the same at night as the day. Jenny

This is a common term in the south and nobody was stereotyping nurses from underdeveloped areas. Please don't make it out to be something it never was. Really, this isn't the main issue of the OP....the main issue is that giving more drugs than are ordered is not legal and is practicing medicine without a license. And then calling it a country dose is like making light of it, in my opinion of course. Yes, as critical care nurses we do have docs that under-order meds, but in referring to this post....is it because the nurses are giving more than ordered illegally and the docs think their ordered doses are enough? So, in the future this doesn't help ANY patient because the docs will order on past experience and also according to standards. There are consequences to these actions aren't there? So, are you all really helping patients in the long run? Jenny

I don't mean to beat a dead horse, but I can't get this posting out of my mind. I just re-read the original post, and I'm appalled that you all joke about this with physicians. It isn't funny to me that you give meds without an order....it is illegal and wrong. Just had to get that off of my chest and mind. Jenny

Some residents were saying pressors were contraindicated in neurogenic shock, but my literature states otherwise. Nurses argued back and forth with docs about pressors and finally when they let us start some neo we had acceptable bp. I am really interested to hear about some hands on with this. Pressors aren't contraindicated in neurogenic shock if they are euvolemic....however, giving a neurogenic shock pt. too much fluid is very risky and can cause cord edema to become worse. I'm glad that the nurses spoke up and did what was right. Good for you all. Jenny

We usually don't treat an acute SCI with bradycardia unless it is symptomatic (low BP). Usually these tragic accidents are young adults (probably with low HR's anyway) so is a HR in the 40's really as bradycardic as we think. As long as the pressure is OK then we watch it closely, but if I was taking a pt. for MRI and they had been doing this and holding their pressure, I would take a few amps of atropine just in case. In my experience, the bradycardia usually resolves within 1-2 weeks post injury. I hope this helps you some. Jenny

Oh, and as an afterthought after hitting submit....think about it like this. If you are giving extra insulin and extra ativan...the physicians think those doses are working and will be hesitant to write orders for more when you really need them. Blood glucose levels are nothing to mess around with, and if the physician thinks that sliding scale is effective then when the patient goes to the floor where they are less staffed and have less time to pay such close attention to specifics like the intensive nurses are....what happens? They won't heal, and it could lead to longer hospital stays. Please think of the larger scale when you are doing these things. It isn't always just about the right then and there in these cases. Jenny

While, I know that nurses give "extra" of a drug that is something that I would not do. #1 I'm not a physician (even though as RN's we know more about the pt. than they do usually) and #2 I worked too hard to get my license to lose it. If your medications aren't working, pick up the phone and get an order for it!!! I work in a trauma/SICU and I have never had a problem obtaining an order if it is needed. We can order PCXR's and EKG's and things like this without an order from the physician if needed, but not meds. I got accused of giving and writing a lasix order for a patient that the resident didn't remember giving me since she was asleep, and nothing came of it, because MY reputation is that I DON'T do that. Now, if it had been one of the nurses that had a reputation for doing those things, they would have been in big trouble. I don't know if this answers your question or not, but I'm appalled that a nurse would do this....is 1 mg of Ativan really worth risking your license for? Go get some soft wrists restraints until you can get more meds. Jenny

Sorry, I had my right and left confused-LOL....I do that commonly with everything right and left. I also had been up for almost 30 hours when I posted. Sorry again. Jen

Well, thanks. In my CCRN studies last year, I was fascinated with the Oxyhemoglobin dissociation curve and dug deep into it. My best friend was also so interested in it, she made an educational book on it for our unit since we get pts. from PACU, fast tracked, sepsis, messed up temperature regulation, hypovolemic (trauma), and with messed up ABG's. I would imagine the high FiO2 and bagging of the pt. will contribute to the great PACU gasses too though. Listening to the Laura Gasperis DVD's I always remembered her talking about the post op gas being the best ABG a pt. will have PO2 wise-LOL.....she is so funny and her antics make things stick in your mind forever. Jenny

Absolutely add your jobs that you wroked while in nursing school, because it shows that you can handle working with nursing school. As we all know, nursing school is very demanding and if you have good grades and worked as well, then that is a plus. Jenny

I 2nd what the above poster has said...that is why in the unit that I work that we have specialty drugs and items in our procedure carts, omnicell, stock rooms, etc. Plus we have nurse servers in each room at the bedside for frequently used items. Jenny

We have never had a problem with the bags breaking at our facility. Jenny

SICU nurse here, and we always get the CEA's even if for only 24 hours. They need intensive monitoring and ICU nurse eyes for at least 24 hours post-op. The med-surg floors are just too busy and with too large of a pt. load. A good watchful eye for hematoma, edema, reperfusion stroke, hypertension, etc. HTH, Jenny

They called me last week and told me I was accepted and to be looking for a letter in the mail, and I have yet to receive one. E-mail if you have any other questions. Jenny

we also reuse the bags too.....hope this helps. jenny

i would suggest that you retake some of your undergraduate classes, like the science ones. the two schools that i am in the application process won't offer an interview if you don't meet all the requirements, and one of them is a gpa (undergrad) greater than 3.0 if you retake some of your science classes, it might boost your undergrad gpa, but other than that i don't have any other suggestions....sorry & good luck. [color=#9acd32] [color=#9acd32]jenny

anytime, and if you have any other questions about the mu program, i would be more than happy to help you out. your gpa is good, and i'm happy to hear that you are getting the sciences under your belt...i would definitely take biology before physics....nursing schools would rather see that anyday than physics. take care and good luck. jenny

we only use it short term as well since there is in increased rate of infection while using propofol due to it being lipid based. also, we don't use high doses since it affects bp adversely sometimes....we are extremely careful with it in our unit. jenny

we never give d5 to a head trauma...our surgery team tried to do this, and if they won't change their order, i always call the neurosurgeon and tell them and they have my write an order that all ivf's have to be ok'd per neuro. our trauma surgeons don't manage the neuro part of a bad head trauma, they always consult neurosurgery. hope this helps. jenny