cannew304

I had a kiddo yesterday with recently diagnosed NHL, in septic shock with fungal PNA who received Surfactant x2 after doing progressively worse on a HFOV. Ended up not having to go the ECMO route, and the kiddo is doing great on a conventional vent and there are even mutterings re: extubation in the near future-- it's the first time I've ever seen Surfactant used in a bigger kid, but looks like it might have been successful!

I went to the open house 3 years ago, and everything was nice except I only ended up being able to interview on one floor, even though I had expressed interest in 3 different areas. There were probably 35-40 people interviewing for peds, so I sat and waited for almost 2 hours, and it took them more than 2 weeks to offer positions (by which time I had accepted a position at another hospital). I was bummed that I didn't get a chance to interview in PICU or NICU. Just be careful!!

I started as a new grad on a general med/surg pediatric unit at a big teaching hospital (not a children's hospital, so we got the range of everyting from neuro to cardiology to heme/onc), and worked there for just over a year before moving to a PICU at a children's hospital. I know plenty of people start out as new grads in the PICU, but in my experience, it's a much smoother transition if you have a little nursing experience under your belt and are coming from a floor environment. Learning how to be a nurse is hard enough without having to worry about critical care and all the associated machines, drips, drugs and stress that comes along with it. Out of 11 new grads who started in the PICU when I started work there, only 6 finished orientation and still work there. For them, orientation was very stressful, overwhelming, and often frustrating. My orientation to the PICU - while stressful and frustrating at times - was very smooth and couldn't have been easier. Just a thought..

per Children's administrators, the hiring freeze does include nursing, but not "critical nursing positions." Examples given were ER & the ICUs. They're also trying to limit travelers and fill vacancies with staff, so sounds like they're still hiring!

What is your unit's standard for sedation when a patient is on a HFOV? I have always learned that it's important to keep patients very sedated & definitely not breathing over the vent, so as to prevent them from popping a pneumo, to help optimize the oxygenation from the vent, and to keep them comfortable because of the high pressures & rates. My patient today was a teenager who was continuously breathing over the vent, RR 20-30/minute, moving his hands and feet etc. I increased sedation per protocol throughout the day, but the docs weren't overly concerned, and kept just saying he "looked comfortable." All well and good until he sat bolt upright in bed and started coughing! What guidelines do you follow with oscillators?

I think in this kind of situation it isn't "how often do I HAVE to check on them, how long do I HAVE to stay with them".. it's more what do I need to do to keep this patient safe? A pt who is a fresh open-heart post-op just extubated isn't someone that I'd leave ASAP to go help others. This patient is your priority. Help others if you can, but don't sacrifice your patient for theirs. Many things can go wrong.. BP can drop, infection can set in, they may have respiratory distress etc., etc., etc. You need to be there in case something happens so you can act quickly. Yes, you may only need to take vitals q1h, you may only need to listen to BS q1h, but you may very well need to do it more often than that. ICU means you stay in the room or very close to it, and someone is always listening out for you and your kid.

I figured it was something like that.. I'm handling the off-site parking and not risking anything/taking up spots for patients. But wow, that patient lot is absolutely insane!!! I've never seen anything else like it! Thanks for the info!

thanks so much!!!! the hospital website seems to say $7/day max charge for parking at the hospital lot (for future reference!). just didn't know if staff were allowed in there or not, the hospital i'm at now HEAVILY frowns on staff parking in patient lots, even though they have an hourly rate. anyway, thanks a bunch!

hey! thanks for the reply!! i really appreciate it!! it's always funny the little things that you worry about when you're looking at jobs... so.. if you're an RN you can generally park in lots near the hospital for a few $$ a month, working the 12 hour shifts, regardless of seniority/length of time worked, you think? and nights and weekends @ the hospital for all, or just those who've paid the ~$52. do you know where the satellite lots are? or, when you metro to work, is the station within walking distance to children's or do you get a shuttle from there too? thanks so much! yay!

hey! i interviewed on the general peds & peds heme/onc units at inova fairfax last january for a new grad position.. ended up not moving to dc and thus not taking the job, but the interview wasn't bad at all! i met with the general nurse recruiter first, and then with the individual managers of the units. they asked the usual questions about why do i want to work with children, how would i handle sick/dying children, upset parents etc.. nothing tricky because i had no experience!! i brought some copies of my resume & cover letter, and then also letters of recommendation and a self evaluation, although they really only looked at the resume. definitely important to have multiple copies, because everybody wanted one!! just dress nicely, come with questions and good answers as to why you're interested in working with kiddos and why you're interested in inova, and you'll be good to go. everybody was really friendly.. my only problem was getting lost trying to find my way out!!! good luck!!

hey all! i'm a peds nurse moving to dc from central virginia, just wondering about the parking situation with children's hospital.. has anybody worked there? i hear there is a shuttle bus from an off-site lot. is it safe? where is the lot? can you park on site nights & weekends? thanks a bunch for any help! i'm excited about dc!

I agree!!! Which is why I'm now working on a peds unit. Nevertheless, it was a good experience.

Hi all, I'm a new graduate as of May, and I'm taking my boards on Monday. I've been reading through these forums for the last few weeks and feeling ok, since I've been studying material and answering questions (Lippincott, Princeton Review). Classmates of mine have started to take the exam, and the vast majority are passing, but they tell me that the questions were horrible and that they came out of the exam and cried for days. I am now officially freaking out, and with 3 days to go I'm not sure how I should be studying. When I do badly on a practice exam, I start to worry and can't focus.. leading to more missed questions (horrible cycle). If I'm averaging 72-80 on practice exams when I'm focusing, does that sound like things are going ok???? Help. Support. Prayers. Please. I can't wait for this to be over.

I'm a new grad, but I did my senior synthesis practicum on a bariatric surgery unit, and found it to be quite the experience. At this particular hospital, we handled pre-op patients (education re: the surgery, the post-op diet, possible complications, family support, placement etc.), fresh post-op patients (working on pain control, infection control, ambulating, gastric bypass diet), and then dealt with a lot of the patients who were suffering from complications. Patients had DVT's, PE's, muscle atrophy, respiratory problems, bleeding, malnutrition etc, and all were challenging because of their size. In general, this unit was similar to any surgical unit. You dealt with patients before and after surgery, and helped them work through the difficulties that inevitably arise. Family is very involved. I know you weren't talking about direct care, but nursing with any bari patient is going to involve a lot of education, reinforcement, and therapeutic listening, regardless of whether you're in a hospital or outpatient clinic.

I'm a student graduating in May, and I've been offered new grad positions on an acute care peds med/surg floor and a peds heme/onc floor. I'm really interested in heme/onc, but i'm not sure if it'd be better for me to start out on a more general unit and gain some experience before moving on to heme/onc. It's not a matter of confidence-the orientation program at this hospital is great and I'll be well-taught wherever I go-but I'm just wondering what other people have done. with peds, is it better to start out more general and then specialize? Or should I jump straight into heme/onc if I'm interested? thanks!!