CrufflerJJ

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!

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."

I found the following on CNN: Nurses describe alleged assault by Kennedy son - CNN.com Such a gentleman. He needs to spend some "quiet time" locked up in a cell with his new friend Bubba.

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!

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.

Dealing with people in CP arrest can be difficult, paramedic training or not. Do the best you can. If in doubt, given a pt in arrest, DO SOMETHING. Darned if you do, darned if you don't. There will always be hyenas nipping at your heels, offering useless thoughts along the lines of "why didn't you do...". The "hyenas" weren't at the scene...you were. Make a decision based on your training/personal experiences...Then act. Realize that no matter how you act in this messy situation, you may incur personal emotional damage. Thoughts of woulda/shoulda/coulda. Be prepared to seek emotional/spiritual "first aid" for yourself after the event.

jamieslovingmom - I'm sorry that you had to experience this. It is never easy to see people suffer or die. Even for people with lots of EMS experience (19 years in my case), it can be rough. Two weeks ago, I had a similar event happen close to my house. A family (mom/dad/3/6/10 year old kids) were on their way to a local corn maze. Somebody went through a stop sign, and the family's car was krunched badly by a pickup truck going 50-60 MPH. I took the time to put on a pair of gloves & call 911, then ran to the scene (right across form my home). The 3 year old baby was in trauma arrest. I'm still amazed at how quickly I made the decision to "triage her out", and focus on the 6 year old baby. The 10 year old child had walked out of the car, and somebody else was taking care of her. The 6 year old was unconscious, and had a mouth full of blood & broken teeth, which I kept having to sweep out to maintain an airway. It's 2 weeks later, and I still have memories of the 3 year old, wrapped up in her coat & scarf, tucked in her car seat, blood running out of her mouth. Nasty stuff, mixed in with feelings of guilt (could I have...should I..?). It's not easy. Even knowing that blunt trauma arrest pts are typically not salvageable, it's still hard to make a deliberate decision to ignore a young child in trauma arrest to focus efforts on a less injured child. Sometimes, life just plain sucks. Please take care of yourself, and talk over your feelings with somebody you trust.

Oops! Sorry to the OP about the "very low" remark:sorry:. Waaaaay back in the Stone Age when I took the GRE (~2007), it was under the older scoring system, which went up to 1600. A score of 282 under the post-2011 system isn't bad at all, since the newer scoring system only goes up to a max of 340. Improving your GPA of 2.5 will be tough. I know - my undergrad GPA in chemical engineering was 2.59. It took me ~10 years of paramedic related and nursing prerequisite coursework (in which I maintained a 4.0) to raise my GPA above 3.0 . Even with the improved GPA, I needed additional letters of recommendation before getting accepted to my accelerated BSN program (which also required the GRE for admission). Have you considered touching base with the directors of the CRNA programs in which you are interested to ask them what else you might do to PROVE that you are capable of doing the work? Acing graduate level courses (plus any science classes you choose to take again) certainly can't hurt.

In Oct 2011, you had 7 years MICU experience (from a previou post). One year later, you have 9 years experience. Given your GPA, your very low GRE (282 - is that right?), and your past history of not passing the CCRN exam on the first try, it sounds like you've definitely got a lot of work ahead of you. Good luck!

Sorry, but we can't offer legal advice on this site. That being said, expunged/sealed records are often visible to your BON. Your best bet is likely to contact an attorney with a strong background in representing clients before the Board of Nursing in your state. For a list of nurse attorneys in your area, you might wish to check out http://www.taana.org . Best of luck!

My sensitive, kind, non-judgmental phrase for that approach is "dump and run.":sarcastic: I just love how you get a pt on a vent, only marginally sedated (with no orders entered for sedation upon arrival to the ICU). BP marginal when the pt shows up....then it tanks when the OR/anesthesia folks depart. This is generally followed by a pt coming almost awake, grabbing for the ET tube. Fun times!

Thank YOU for caring, and wanting to not only do your "job", but to support your pts and family members.

Ummm...yes, I can easily say no. That's if/when I respond to the message left on my cell phone or home answering machine. It's all about what YOU want.

Survey is done. FYI, for the folks "out there", the survey has LOADS of firearm-ownership-related questions. Not that I own any eeeevil firearms, mind you.....

Hopefully the Neo dose was 400 mcg/min, not mcg/kg/min. I am not sure about the answer to your question. Neo is a pure alpha agonist. Throwing dopamine into the mix would give you some beta stimulation at low doses (possibly boosting your pt's heart rate), and alpha only at high doses. Consulting Dr. Google gives a couple interesting hits: http://www.acnr.co.uk/pdfs/volume4issue5/v4i5management.pdf That link says: "Norepinephrine appears to be more predictable and efficient at augmenting CPP when compared with dopamine." Another link is: Comparison of Dopamine and Norepinephrine after Traumatic Brain Injury and Hypoxic-Hypotensive Insult | Abstract That abstract references a study in which norepinephrine and dopamine were compared for efficacy in boosting CPP following a hypoxic brain insult. A couple interesting statements from the abstract shown above: "After severe brain trauma, blood-brain barrier disruption and alteration of cerebral arteriolar vasoreactive properties may modify the cerebral response to catecholamines." ...and... "Both norepinephrine and dopamine failed to increase CPP, and ICP was significantly higher in TNE and TDA groups than in T group. Interestingly, norepinephrine was not able to alleviate the decrease in MAP. Neither norepinephrine or dopamine could induce an increase of MAP. LCBF decreased similarly in T, TNE and TDA groups. In conclusion, norepinephrine and dopamine are not able to restore values of CPP above 70 mm Hg in a model of severe brain trauma. Furthermore, their systemic vasopressor properties are altered." It's interesting to me that following brain injury, pressors may no longer work the way we expect them to. In the past, I've seen vasopressin used in head trauma pts suffering from hypotension refractory to catecholamines. Different receptors, and all that jazz. An interesting mention of vasopressin use in that situation is: Vasopressin in Acute Brain Injury: A Note of Caution Enjoy!

After leaving a 22 year Engineering career, I paid for about a year of nursing prereqs out of savings, and did an accelerated BSN program. In the accel program, I was able to get a "graduate scholarship" based on my GRE scores which paid for ~60% of the tuition. The rest was paid for out of my darling wife's salary, plus student loans, which are about 60% paid off (4 years after graduating).

CONGRATS on landing your "dream job" right out of nursing school! Starting as a new nurse is scary. You start to realize just how your efforts (and your mistakes) might impact your patients. It's obvious to me that you realize that even though you graduated at the top of your class, you've got a good bit to learn in the ED. Good For You! This is to be expected. Expect to be stressed. Expect occasional feelings of incompetence. Expect to make mistakes. You'll hopefully learn from all of these. Trust your preceptors. Ask them how you're doing, and on what areas you should focus to get even better. Enjoy your new job. Best wishes!

I am both certified and Certifiable!

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Wow! It certainly sounds like you've got your "stuff" together. I don't have any useful advice to offer re: Utah nursing programs. That being said, it's obvious to me from your short post that you definitely have a burning desire and are making a strong effort to achieve your goals. Working full time, with a young child, and still pulling down excellent grades....impressive, to say the least! You WILL get there. Best wishes to you and your family. Good luck!

Congrats! Enjoy/excel at your new job.

I work ICU, so, of course, I chose to vote ICU. The title of your post is "Which experience would a hiring manager find more appealing from a new grad?" If you were applying for an ICU slot, then externing in an ICU would be great experience that might give you a "leg up" on the competition for an ICU job. If, however, the large hospital (offering a Hem/Onc preceptorship) will be hiring lots more nurses when you graduate, you should probably take the 320 hours ICU time that you already possess, and move on to any sort of position in the larger hospital. In a tight job market, some hospitals will not consider "external" candidates for job openings. By doing your preceptorship in the larger hospital, you might be able to make contacts (even in other departments) that could help you land a job. If you could work as a part time extern in the larger hospital, that would be even better. That way, you've got experience as an employee in that hospital.

AGREED! The OP's feeling of "I still have so much to learn" is a GOOD THING. It suggests that the OP is not a over-confident type, and is looking to learn/improve. In my case, I had the feelings of "OK...what am I going to do?" right before I entered my first pt's room after completing the orientation program to my ICU. The answer was "do what you've been doing for months." It was still scary, but after ~6 months I "found my groove" (as you posted).

Every facility is probably different. My facility's Critical Care Fellowship program is 16 weeks of mixed class & precepted time in our ICU. Plan on being overwhelmed the first time you step into the ICU.....OK, for at least the first week or two. Lots of sick patients, hooked up to multiple powerful drips, attached to multiple machines all beeping/alarming. Then it gets even more "interesting" when your previously "stable" pt takes a turn for the worse. Fun times! Ask questions, listen & work to understand the answers you're given. If you don't truly understand the response, ASK again. Far worse than asking a second time is to blindly move forward, HOPING that you know what you're doing. If you're not sure, ask. Your pt deserves this level of caring/effort. Realize that the "ICU way" may be very different from the "med/surg way" of doing things. In general, I'd expect that the ICU RN may have greater autonomy to order basic tests (not out of the blue, but based on pt-specific conditions) than the med surg nurse, be capable of interpreting the results, and would be willing/able to aggressively advocate for your pt based on the results. In my ICU, the RN has a decent amount of autonomy, but also significant expectations to plan ahead (i.e., if you know the doc is planning to place a central line, it might be good to make sure there's recent PT/APTT/INR results available....if your pt had a K of 3.6 at the start of your shift and has dumped 3 liters of urine thanks to Bumex since then, it's probably a good thing to spot check a K level). Try to get a feel for how experienced nurses in your unit handle situations. Do they respond purely from physician orders, or do they try to "get ahead of the curve", and anticipate the needs/whims of the ICU docs? Once again, every ICU is likely different. Some will be more centrally directed than others. Please don't be afraid...too much. It's a balancing act between being a "scared newbie wimp" vs a "dangerous newbie know it all." The experienced (hopefully sometimes awe-inspiring) ICU nurses you will encounter all started out as ICU newbies. Hopefully they won't forget this when interacting with you and your fellow ICU newbies. Most of the folks I've seen fail to successfully transition to the ICU have failed for 2 main reasons: - "know it all", unwilling to accept repeated strong preceptor hints on a safer/better way to do their job, thus putting their pts at risk - "uncaring idiot" - a space cadet who is highly intelligent, yet doesn't feel the need to do the basic due diligence - refusing to look up the pt's history, lab values, or even listening to report from the previous nurse. They are oblivious to important pt trends during the shift (has O2 demand gone up, did Levo start at 0.02 mcg/kg/min, and are you now at 0.16 mcg/kg/min?) It's scary, leaving your "comfort zone" for a new environment. It's even scarier to feel your soul shrivel when you're stuck in a rut, doing the same thing...day after day after day after day. Life is too darn short to be unhappy. Congrats to you for being willing to try something different. Please keep your head up, your mind and heart open, and your hands busy as you start your new position. Ask questions, learn every day, and offer to HELP your coworkers on a daily basis. Helping your neighbors will go a long way at minimizing any stress caused by your inexperience. You can do it.

The ICU will offer you a tremendous learning opportunity. You might also want to take a look at index . TONS of handy information, nicely presented.