tri-rn

Ask. Even if you don't get what you want you're showing initiative and a desire to stretch beyond your comfort zone.

Apply. The application process is so long, you could have your license before you get through it LOL. And yes, the VA does hire new grads...at least mine did :)

My facility works every other weekend...that means to get your weekend, or any other 2 days/nights off in a row on an 8 hours shift schedule, you work 6 shifts in a row. I'd like to see some studies that show that that's any safer than 12s...because I'll be the first to admit, I'm safer in my first 8 hours than I am in my last four. I'm also safer my first 3 nights at work than I am the last 3.

Have to agree with Netglow...the OP is new. She mis-spoke, or maybe isn't clear on the differences between types of ICU's having only experienced the one she's in. How about we help her out by explaining the difference instead of eating our young. Pleaseandthanks.

Wondering why the Doc found it necessary to call a code Stroke if the pt's NIH was negative?

I was scoring 80-90% on my practice tests (PASS CCRN! disk) and I passed on my first try. Remember though, cardiac and pulmonary make up much larger portions of the test than anything else. I didn't have much balloon pump or CRRT, but lots of Swan numbers. Good luck!

nope. Higher heartrate = more calories burned, although there are some caveats to this. Wear a heartrate monitor to work, then wear it to the gym. IF you're doing your workout at a proper intensity, your heartrate at the gym should be higher than it is at work (unless you're actually coding someone, doing compressions or whatnot. Or actually RUNNING...really RUNNING...up and down the halls). If we actually burned all those calories at work, we'd all be better off. *sigh* ETA: you are correct as far as working in different heart rate "zones" strengthening aerobic vs. anaerobic systems, etc.

I hate to be the bearer of bad news, but unless you're consistently getting your heart rate up to exercise levels at work - and then keeping them there for 20 mins or a half hour - all the walking, boosting, turning and lifting doesn't count for a whole lot as far as calories burned go. Then consider that the extra 200-300 cals you might burn in a shift gets put right back in one small frappucino, a couple of cookies or glasses of wine. It sucks.

This might sound counter-intuitive, but have you had a vacation lately? I've been on night shift for nearly a year as a nurse, but I did them regularly in the military too. It seems like I need a "sleep reset" every once in a while - a three night weekend every few weeks to kind of reset my clock. I know the consensus is "stick to the schedule on days off" but it doesn't work for me. Even though the quantity of sleep I get during the day is fine, the quality isn't. Every few days I need to get some "real" sleep at night, and every few weeks I need a few nights off in a row to catch up and get human. Then I'm ok for a few more weeks.

First and foremost, quit worrying about being a "great" nurse, just focus on being a competent and safe nurse, ok? Great comes later. In the ICU, it comes a LOT later. I don't know what kind of relationship you have with your preceptor but if it's possible, see if he/she would be comfortable kind of taking a back seat and only stepping in if they see you making a mistake. Maybe that would enable you to apply the things you do know in a safe manner. And you'd feel more comfortable thinking and acting for yourself knowing someone has your back. As for priorities, to this day (5 years of ICU and I went there as a new grad too) if I'm not sure what to do first I ask myself "what would cause the greatest harm if it waited?" Of course staying within facility policies for med pass times and such. If you have a lot of things on your plate but none of them are immediately pressing (think Airway-Breathing-Circulation) take a second to think of the most efficient way to get them all done. If you find out ICU isn't for you, don't think nursing isn't for you. Nursing has nooks and crannies for all sorts of people.

How about remembering that the N's DON'T go together? IE Norepi is Not Neo? ETA: I constantly confuse brand names with USP names. I still can't keep Ativan/lorazepam Versed/midazolam straight in my brain....luckily for me, our computers only work in USP names :) Another trick is I'll it read it back in the USP name to verify...if an MD says to "Give xmg versed IVP now" I'll say "2 mg midazolam IVP now, is that correct?" I guess this could be a problem in an urgent or emergent situation though, or anytime the doc is paying attention to 6 things at once and doesn't really "hear" you.

If anyone wanted to try to contract Apple, I would happily donate to the cause!

Go see your therapist NOW. PLEASE. For your own sake.

The high WBCs, esp with metabolic acidosis, and low pressure make me wonder if he was septic. If he was, levo would be the pressor of choice (along with fluids). But that's just a wild guess based on limited info.

Exactly!!!

Wondering about the rest of his picture. Was he making urine, did he look dry? did the 1L bolus help anything? The levo could make him irritable and hence the vtac - how were the rest of his 'lytes? Why couldn't they get him off the vent and why was he on it in the first place? Depending on when his blood was drawn in relation to the ectopy, the vtach could have contributed to the high troponin.

A rectal gel for folks in severe EtOH withdrawal? How's that working out?

When your agitated and intubated patient on whose behalf you have unsuccessfully pleaded with the pulmonary fellow for more sedation finally self-extubates despite your tightly tied restraints and constant presence in the room, and you tell that fellow "Well he's BEEN ready..."

Gitano, I don't quite understand what position you hold exactly but I do NOT envy you. Well, ok, except the palm trees and surf while you run. Here it's birds and...well, birds :)

Have to agree with Biff...dobutamine or milrinone may have helped short term, but if he needed that much help his long term outcome was questionable at best.

Do you ever try the brachial artery?

The small city I live in has a 24 hour doggy day care, so I'm sure a city as big as Chicago probably does too.

Chica, let me know which you pick and how you like it! I keep looking longingly at the new Orlando VA...I grew up in Florida and want to go back home so badly

Like crises, codes ALWAYS happen 45 minutes before shift change...usually on the day that you're short staffed and trying to call in help.

Milwaukee VA ICU some 8's, some 12s but the 12's are getting harder and harder to come by Rumor has it the floors still do 12s