CrufflerJJ

Fading memories... I've been retired now for a bit over 2 years. Prior to that, I worked 10 years as a RN in a local VA Hospital MICU. Before that, I worked for 4 years in a high acuity mixed ICU in eastern KY (KDMC). LOTS of knowledge acquired during that time, by painful experiences. Sooooo.....now that I'm retired, I've noticed that I am gradually forgetting stuff that used to be super-important. This includes normal lab values for electrolytes & blood counts, names of typical ICU meds,... Last night, I was laying in bed, TRYING to fall asleep, when I suddenly found myself trying to remember the name of the biomarker that was frequently used for sepsis. NO LUCK. I had forgotten its name. As a former Type-A DRIVEN ICU nurse, I find this scary & sad. HOW DARE I forget something so "basic"! I just looked it up a few minutes ago.....procalcitonin, or "procal" for short. Stuff that USED TO BE "important" is now falling out of my poor decrepit retired brain. What I DO realize, though, is that emotion-based memories are embedded much more deeply in my brain. I STILL remember a former accountant at a >redacted...HIPAA< deciding to withdraw care on himself, knowing that it would result in his death. He's spent far too long in our KDMC ICU, on pressors to maintain his blood pressure. He got tired of the pain. After shutting off the drips, he passed quickly & peacefully. I STILL remember a guy at the VA who had been experiencing neuro symptoms. After being in our MICU for a while, the docs HOPED that it was something immune-related & treatable, but an excellent neurologist diagnosed him with ALS. He decided to withdraw care on himself. Room 286. His family members, all around his bed, FOCUSED on their PHONES rather than focusing on him. He passed on a weekend, when I was not working. I STILL remember a guy at the VA who used to work at a >redacted...HIPAA<. He's been in our MICU for >something< a few months before. He came back, in obvious distress. It turns out that he had terminal lung cancer of some sort. He told me words along the lines of "I don't mind dying, I just don't want it to hurt." Room 289. I'd settled him into the room/bed, dosed him with IV Dilaudid. His girlfriend was in bed with him. He bled/vomited into his airway, out his nose/mouth. At least it was peaceful.....except for me & his girlfriend. Strange how "important" stuff fades rapidly, yet emotion-based memories are still locked into my brain....years later. Maybe this is a sign of what truly MATTERS. Facts vs emotions....memories. I STILL remember....

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.

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.

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.

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.

Congrats on graduating, and even more congrats on securing a job as an ICU nurse as a new grad!!!!! Your feelings of knowing "so little", yet being "eager to learn everything" are perfectly correct. You're miles ahead of the folks who assume that they already know it all, and will wow/impress their fellow ICU nurses with their schoolwork-based knowledge. You might want to check out icufaqs.org, and I HIGHLY RECOMMEND their book available at Notes on ICU Nursing: FAQ Files from the MICU: Second Edition by Mark Hammerschmidt (Author) . Another good resource (deeper, more technical details) would be Paul Marino's "The ICU Book", available at: The ICU Book, 3rd Edition: Paul L. Marino, Kenneth M. Sutin: 9780781748025: Amazon.com: Books ...although I dread paying $65 or so for a used paperback.... Congrats, good luck, and all that jazz!

You can always learn to curse in a new language. This might serve to relieve stress & is less likely to cause problems at work, unless your coworkers happen to speak Russian or Japanese or...

Despite what your preceptor says, SWEAT IT. Each & Every time you access a "controlled substance" from the Pyxis, make double-darn sure that you account for the amount used, and the amount wasted. To do otherwise leaves you WIDE OPEN to diversion suspicions. Take care!

Nope. Not weakness, but being open & honest about your feelings. Best of luck to you!:)

I'd be careful in talking about stuff other than your immediate med/surg opportunity. If you mention CDE (??Certified Diabetes Educator??) as a goal, then the med/surg folks might feel that you're just "using them" to get your foot in the door so that you can achieve your ultimate goal. I'd recommend that you be somewhat vague in discussing long term goals. Good luck!

Every unit will have a different style of interviewing. You may very well not have any clinical questions at all. Then again.... Be able to tell about the sickest pt for whom you cared during your clinicals. Be able to discuss the disease process, what you found interesting. They may throw questions at you regarding DKA, DIC, renal failure, sepsis. Obviously, the type of questions would depend on the type of ICU. You might just take a quick look at icufaqs.org . Good Luck!!

Your idea of shadowing is an excellent one. Contact the ICU's manager, expressing your interest. Good luck!

Apologies in advance, but this is going to sound a bit harsh.... Congrats on having been able to be considered for a position. It sounds like you're being seriously considered, given that you've made it through phone screenings, a phone interview, and you have multiple people submitting references on your behalf. If you are NOT serious about taking a job 4 hours away from your current location, then please stop wasting people's time. It takes time/effort to interview candidates for positions. It takes time/effort to give honest, meaningful replies regarding reference checks. If you were not willing to make the effort/spend the $$$ to interview for the position, then why did you even apply for it in the first place? This decision should have been made loooooong ago. If you decide to go ahead and interview tomorrow, and you do manage to get the job, would you be able/willing to uproot yourself, move, and establish a new residence 4 hours away? If not, then please stop the interview process now.

I'm a big fan of Gold Bond lotions. They are thick, not watery. Once they dry, your hands don't even feel oily. Good stuff!

It means that you made the first cut. There may still be multiple candidates for the available job(s). The folks interviewing you at the peer interview willl likely be your potential coworkers. Good luck!

Your feelings of being 'constantly reminded of what happened all day long" sounds an awful lot like post-traumatic stress flashbacks. I'm not a psych person, nor did I stay at Holiday Inn Express last night. Before going into nursing, I did, however, run volunteer EMS for 19 years and saw lots of "stuff." Critical Incident Stress Debriefings were invaluable not so much in terms of helping me "get over it", as allowing me to gain insight into why I felt the way I did. I wish you luck!

Does your employer have any sort of Employee Assistance Plan (EAP)? If so, you might want to get with them and talk over your thoughts about your dad's death, and how you're concerned that it is starting to affect your ability to provide patient care. Transferring to a different department may provide a short term fix, but the underlying trauma (your dad's death) will still remain.

Having worked as a chemical engineer for 22 years (& volunteer paramedic for about 19 of those years, in my "copious free time") before going into nursing, I'd encourage you to follow your heart. Life is too short to settle for a job that merely pays the bills. Of course, I say this as a person who had the luxury of a supportive loving spouse with a good income, a prior college degree, and a relatively short (accelerated BSN) path to a RN degree. Your mileage may vary...void where prohibited... Your concern about employers of ME or astrophysicists being "picky" is interesting. It took me a year following graduation as a ChemE to get my first job. If you think that nursing employers aren't picky, well, I'd ask you to reconsider that position. Especially when recruiting/training newbies, employers can be very fickle, and quick to dump a potential or current employee. As a new grad without experience, expect it to take months to land your first nursing job. PLEASE do not think that a nursing career will give you job stability. There's no such thing. Yes, on a short term basis, you might enjoy a job. Should a hospital decide to cut back, you're expendable. Accept it, plan for it, and move on. If the "fast-food-like" approach to pt care doesn't appeal to you, then many aspects of nursing might also be less than satisfying. In a perfect world, you'd have the time/equipment/support staff to adequately meet your pt's needs. In current nursing reality (at least, "reality" as I've seen or experienced it), your job is to meet the basic needs and move on. This is especially the case on medical/surgical floors, where a single nurse must not only meet the needs of 4-6 (or more) pts, but also the needs/whims of their family members. You are right about nursing being a job (for the most part) where you can "leave work at work." This is one thing that I thoroughly enjoy about nursing. Back during my engineering manager (facility management/production engineering/...) days, I was essentially on-call 7 days a week. Even when I left work at the end of the day, I was still "at work", subject to being called at any hour of the day/night, or having to travel to a customer's site anywhere in the US or Canada. Fun, fun, fun! Of course, I worked for a supplier of "stuff" to automotive assembly plants, so this was much higher stres than if I just worked for a manufacturer of peanut butter or whatnot. As a nurse "worker bee", the pay isn't as nice as that of an engineer, but there's a better work/life balance. Only you can decide what's right for you. Good luck!

If allnurses MUST change its logo, I'd go with #202. The box around the "all" part suggests the all-inclusive nature of AN. That being said, I wouldn't change the logo at all.

As to whether you can get hired before NCLEX, that's up to the hospital. Some places will hire you, though. Congrats on getting an interview. Research the hospital beforehand, so you know some basic info. Smile, be enthusiastic about starting your nursing career with them in ortho. If asked a question for which you don't know the answer, please don't try to BS your way through it. Have an answer lined up on how you'd find out the answer (ask your charge RN or whatnot). Ask if you can shadow on the unit either before or after your interview. Good luck!

I'm sorry, but that's not the behavior of a gentleman.

Congrats on getting ready to start your accel BSN! I'm not working in OB or L&D, but would recommend the following: - Make sure your OB professor knows your enthusiasm for the subject, and why you want to work OB - Over the next 15 months, "work" your contacts made through the perinatal provider network. Make sure they know you're doing nursing school now, are strongly interested in OB/L&D, and see if they can connect you with any nurse managers in that work area. - Once you're in your OB class, see if you can shadow with some of the local hospitals. Either you should contact the department managers to try & set this up, or see if your professor (or perinatal provider contacts) could make this happen. Shadowing is like an extended 2-way interview. It would get your face in front of the manager, and your potential coworkers. Good Luck!

The Pass CCRN book can be overwhelming. I mainly used the CDROM of sample questions that came with the book. Se if a coworker or your unit educator has the Laura Gasparis CCRN CDs or DVDs. Those would be very helpful.

Google is your friend. Search for "narrow pulse pressure" or "wide pulse pressure."

It sounds like she's having a significant allergic reaction to a med. Research anaphylaxis. Besides blotchy skin and facial edema, what are some other significant potential problems encountered by that type of pt? OK, so you can't choose the highest priority diagnosis, per your instructor. Why does she experience facial swelling? Is it due to too much sodium in her diet? Answer: no. Look into why the swelling occurs. On a systemic level, if the mechanism that causes localized (facial) edema occurs body-wide, what might happen. Hint: fluid being where it's not supposed to be can cause the swelling. If the fluid is not where it's supposed to be, what other highly important issue might happen, due to a lack of fluid? Risk for....(fill in the blank)