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CrufflerJJ RN

ICU
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CrufflerJJ has 5 years experience as a RN and specializes in ICU.

I am what I am...and will be

CrufflerJJ's Latest Activity

  1. CrufflerJJ

    Defibrillators that charged to 400 J

    On my fire department, we had an ancient MRL defibrillator with an aluminum case stashed in a closet ever since it had been taken out of service years prior. It would go up to 400 joules.
  2. CrufflerJJ

    Who's afraid of the ICU?

    I wouldn't say "be afraid" so much as "be paranoid." If you're part way through your shift and everything seems to be going too smoothly, consider whether you're missing something.
  3. CrufflerJJ

    VA Reputation vs Private Sector

    I've been a VA nurse since February, after having worked as a (2nd career) RN for 4 years in the private sector. The hiring process is long & drawn out. Plan on about 4-6 months from application to actually working at the VA (assuming that you're hired following application). The patients are amazing. Very appreciative. Yes, there are some who are a pain, but such is life. My coworkers are generally dedicated, with a few mega-slackers added in for spice. In my ICU, I have seen no shortcuts compared to the patient care offered at my prior hospital. Yes, the VA did have a horrible reputation for pt care years ago, and the patients will tell you about it. My current pts, on the other hand, will tell you how the quality of care has improved over the years.
  4. CrufflerJJ

    Er nurse vs icu nurse

    I LOVE your ADHD/OCD contrast. I've not done ER (but did volunteer in EMS x 19 years), and can see how the ER might be a triage/stabilize/move-'em-out environment, vs the ICU "What??? You don't know when your pt's last BM occurred" environment.
  5. CrufflerJJ

    Is this common practice?

    At least you get the pt with sedation in place. In my ICU, I often get pts with no sedation or pain meds ordered (other than a PCA ordered with no basal rate for an intubated pt). The CRNA dropping off the pt sometimes does a "dump & run" after pushing a bit of Neo & Propofol. A few minutes later, the pt starts to rouse, quite unhappy (along with a lousy pressure). To counter this, I try to get with the Intensivist ahead of time (after PACU calls report) to see if they prefer Propofol or Fent/Versed for sedation, and whether they prefer fluids or pressors for BP management. Pain management is important. Preferable IV pain meds, either continuous or PRN. Your thoughts of a sedated post-surgical pt lacking pain meds being barbaric is perfectly correct. It suggests laziness or a lack of intellectual rigor on the part of the surgeon. The surgeon's job isn't done when the pt leaves the OR. IMHO.
  6. CrufflerJJ

    New Grad, First Job (ICU)

    Get malpractice (professional liability) insurance through NSO or Marsh, among others. I've been insured through NSO at Professional Liability Insurance for nurses, nursing medical malpractice. since I was a nursing student. The link for Marsh is: Nursing Liability Insurance | Malpractice Insurance for Nurses I think they offer a 50% discount for first year nurses (new grads). Cost is roughly $100/year for the full price. CHEAP if you ever need it. Even if your employer promises that you're covered under their liability insurance, don't believe it. Get your own policy. More importantly, CONGRATS on starting a new job in the ICU! You'll see amazing things, wonderful things, and horrible things. Sometimes in the same patient.
  7. CrufflerJJ

    Did I just get thrown under the bus? Or I'm a bad nurse?

    PLease do not always give Lantus. Obviously, healthcare settings vary (LTC, med/surg, ICU,...). I work in the ICU. If you have a pt with poor PO intake with scheduled Lantus, it may not make sense to give a big whopping dose of Lantus if their gluc is 90-100-whatever. If you have a sedated pt on a vent, with tube feeding being held for whatever reason, and a pre-Lantus gluc of ~100-120, PLEASE consider holding the Lantus (especially if Lantus was ordered when the pt was receiving tube feedings). I can speak from personal (painful) experience that if you give a whopping dose of Lantus for pts like this, you may be quite surprised at the resulting Critical Low gluc 4-6 hours later. Always question whether to give a med or not. Please NEVER blindly give a med (especially insulins, electrolytes, & antihypertensives) "just because it's ordered." Take the time to question the order, the pt-specific circumstances, most recent labs, and just plain common sense. I'm not a robot - I'm a nurse with the requisite training, critical thinking skills, and willingness to question orders when appropriate.
  8. CrufflerJJ

    First night on my own. (Long vent)

    Congrats on surviving your first shift on your own! Expect to be stressed for at least the first few months, until you find your "groove." It's perfectly normal to be slow, somewhat disorganized, and chock full of questioning self-doubt as a new nurse. Do your best, PLEASE feel brave enough to ask questions of your coworkers/charge, and forgive yourself for the minor "oopsies" that are inevitable as you develop your skills as a nurse. It will get better!
  9. CrufflerJJ

    A mentor who made a difference for me

    Thank you for "paying it forward"!
  10. CrufflerJJ

    Critcal care review book recommendations?

    Check out index for a great website, with lots & lots of info. My favorite critical care book is "The ICU Book", by Paul Marino.
  11. CrufflerJJ

    Risk Management, what does it mean to you?

    I don't know anything about the official risk management process, or even know how it's implemented in my organization. As an ICU nurse with a whole three years experience under my belt (wheeeee!), I attempt to remain aware of how I've made mistakes, and try to be willing to share those errors with the folks around me. No, I've not admitted to all my errors. Boo on me. Admission of errors requires a comfort level that in admitting fault, you won't be strung up by your reproductive organs (OUCH), poked with sharp sticks, reported to your State Board of Nursing, then fired. It's taken a while to reach this comfort level. As a preceptor, I always try to tell my favorite "Stupid CrufflerJJ" story to those I try to instruct. This story is somewhat painful, since it makes me repeatedly realize how I could have killed a patient had it not been for the attentiveness of others. That being said, I feel obligated to share my faults with others since I was not crucified by my department's management as the result of a single error. It's a careful balancing act, between being quick to find fault & severely punish the "guilty", and being lackadaisical (oh well....mistakes will happen....move on & hope that nobody else notices). Errors WILL occur. To think otherwise is pure foolishness. Nobody is perfect. I recently started doing a 1 hour presentation to the nurses going through the Critical Care Fellowship (ICU) training program at my hospital. My purpose in doing this was to try and let these folks know just how quickly an error can occur, and the life-altering impacts that these errors may have on our pts and the caregiver involved. I also want them to know that they WILL screw up. Guaranteed. Mistakes happen. How we choose to deal with them reflects on us as individual caregivers, and also reflects on our employers.
  12. CrufflerJJ

    critical care NP question

    Melissa - Yes, it's quite possible to go straight into grad school after you graduate (depending on the school & grad program). You'll probably get a variety of viewpoints from your post as to what's the best approach to achieve ACNP. My perspective is that it would be good for you (and for your patients) to get a year or two of direct bedside experience in an ICU before going for ACNP. I felt this same way when I went to EMT-Basic school twenty-mumble years ago. While it was possible to go straight from EMT-B school to EMT-Paramedic school, I felt that it would result in what I call a "shake & bake" paramedic. You'd end up with the spiffy neato-keen NREMT-P certification, but would have almost ZERO real world experience upon which to base your scene safety/pt care decisions. How would it be possible for a "shake & bake" whatever-level-of-practitioner to step back & see the big picture if you're still at the skill level of having to focus on each & every little teensy tiny baby step of the process? I ran as a basic EMT for 2 years before going through paramedic school, and always felt that this time was well spent. Having worked for a year or two as an ICU RN would also give you the "street creds" with the nurses coming to you with patient concerns. Rather than basing your actions/replies on "well, the textbook approach is such & such", you'd be able to respond with confidence, basing your decision not only on "book smarts", but what you've seen & done as an ICU RN before going on to ACNP. The ICU can definitely be a fast paced, demanding, stressful environment. Is it fair to your critically ill patients for you to be learning the basics of critical care nursing WHILE trying to stabilize/heal them? I don't think so. That being said, I think I've seen posts on allnurses taking the opposite approach, saying that there's no need to work as a RN before going on to a NP role. Sorry, but that approach is not for me. You might want to shadow a few shifts in a busy ICU before deciding if ICU-RN or ICU-ACNP is a good goal for you. Good Luck!
  13. CrufflerJJ

    ICU panel interview - Help!!

    Expect questions like "Why do you want to work in our ICU?", "What do you know about our hospital/network?", or "Tell me about the sickest pt for whom you've cared."
  14. CrufflerJJ

    The Disrespect Of Nurses

    I found the following on CNN: Nurses describe alleged assault by Kennedy son - CNN.com ... It was the second day of Kennedy's criminal trial on misdemeanor charges of harassment and child endangerment resulting from what happened in January at Northern Westchester Hospital in Mount Kisco, about 40 miles north of New York City. One of the nurses, Cari Luciano, said that as Kennedy tried to get past the nurses and into the stairwell, his infant's head was being jostled, unsupported, in his arms. She testified that she instinctively reached out to steady it when Kennedy kicked her squarely in the pelvis. Nurse Marian Williams said she saw Kennedy kick Luciano with "such force" that it knocked her off her feet. The third nurse, Anna Lane, testified Kennedy twisted her arm off the stairwell door as he tried to leave. ... Such a gentleman. He needs to spend some "quiet time" locked up in a cell with his new friend Bubba.
  15. CrufflerJJ

    Online stats. Anyone take it this way?

    Despite my prior degree in engineering, I was LOUSY at math, and feared stats. That being said, once i decided to DO IT, I was able to complete an online nursing prerequisite course in stats with a minimum of pain. The instructor was very available by email, or "in person". If in doubt, go for it!
  16. CrufflerJJ

    First day of clinical!

    Clinicals ARE stressful. Enjoy/remember your first day of clinicals. Remember how stressed out/excited/terrified you were when you've got a nursing student following you in a few years.
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