andi2634

Jessica- I went back to school to get my RN when I was 29- I already had a degree and chose the 2 year route- I had absolutely no problem getting a job after I graduated with a 2 year degree. I'm now working in a large teaching hospital that really stresses education and still I don't feel as though my degree held me back at all. I am thinking about going back to school for my BSN and eventually my masters, but there are many RN to MSN programs- some even online or part time. Several of the programs I've looked into I'll be able to work full time and go back to school. My younger brother is also stationed in Iraq now- near Fallujah- you are all in our thoughts and prayers- take care and stay safe- Good luck-

I would be sure to ask questions about staffing- does this unit have a large turnover- or do nurses stay. What is the orientation like- will you have one preceptor or be put with someone different all the time. At my first job I had over a dozen different nurses precepting me- while it was good to see how different people react to situations and see how things can be done differently- there really was no consistancy. I never knew who I would be with until I came in every day. At my present job I had 2 preceptors for the entire 10 weeks and it made a huge difference. How will your schedule be during orientation. Will you be following someone elses schedule- is there time alloted for reading and studying all the info you will be responsible for. Ask if you can come in and shadow a nursefor a day- try to talk to nurses who have worked in the unit for a long time and newer nurses. Find out how supportive the staff is to new grads- do they feel as if they have backup now that they are on there own. Is management available and accessable- does the nurse manager back up the nurses. Ask about support staff- PCA's, respiratory therapists- good respiratory therapists are so important! Scheduling is important- are you required to sign up for on call shifts- how are weekends and holidays scheduled, is there mandatory overtime, is it a unit that does self scheduling- Ask how the doctors treat nurses- at the first job I worked at we weren't treated very well a lot of the time- at my present job it's completely different- very good relationship with the docs- mutual respect- it makes a big difference. I just changed jobs about 6 months ago and these were all issues that came up- hope it helps- Good luck!

I worked adult cardiac surgery ICU for about 2 years and recently made the change to a level 3 NICU- and absolutely love it! It was a really difficult transition for me- I felt like a new grad all over again- you really do have to relearn a lot of what you know but now that I'm out of orientation and beginning to get a little more confidence I know I made the right decision. I love my job more with every shift. If you are feeling the pull towards NICU go for it! It was the best decision I've made. Good luck!

There are lots of threads on assessment if you do a search you'll find tons of great info- this is how I chart. We have a flow sheet that we can check of most of our assessment such as lung sounds, IV's, chest tubes, bowel sounds, cap refill, etc, and technically we could just write as a note assessment done as charted and write any exceptions, but for my first assessment of the shift I usually write a note like this: Complete assessment done as charted, see flowsheet. Pt. A & O x3, answers questions appropriately, MAE. Denies any c/o of pain or SOB. Lungs CTA bilat, O2 sats 98%. Monitor showing sinus rhythm. Abd soft, non distended, pt denies tenderness, +BS x4. NG to left nare placement checked with air bolus, to low wall sxn. #22 Hep lock to left hand, flushes well, good blood return. Foley draining clear yellow urine. All periph pulses palp. Monitor alarms on, call bell within reach. If there are IV fluids or drips the rates will be on the flowsheet. I always check the drips and rates against the orders at the beginning of my shift and redo the calculations to be sure that they are infusing at the rate that's ordered. We all make errors and if the nurse before calculated something wrong and you don't check it the patient could be getting the wrong dose of the med. I'll usually write NS and Dopamine infusing per order without difficulty, see flowsheet for rates. For IV med administration- check your hospital policy- there should be specific policies for flushing peripheral IV's and central lines, also for how long IV's can stay in, meds, and dressing changes. You will see nurses doing a lot of things their own way- they may not be wrong- but it may not be the exact way your instructor has shown you. There are IV therapy textbooks- they should be able to help you learn the steps for giving meds through IV's. If you see someone doing something different than you learned ask- you could learn a great tip technique.

I've been floating to our CCU lately and it's part of standard pre cardiac cath orders- I think with a bicarb gtt. to help protect the kidneys form taking a hit with the dye during the cath. Our pharmacy prints on the MAR to mix it with Coke to help prevent nausea- although patients still say it smells and tastes terrible.

We pull all chest tubes unless there has been a specific order for one of the SA's to pull them. When I was orienting on days I had a chance to pull many chest tubes but now I'm on nights and we pull the Swan but usually chest tubes aren't ordered to be pulled till after morning rounds. Usually they keep them in until the 2nd post op day. Since it's been a while since I've pulled them I would have someone with me- I occasionally float to our ICU and the nurses don't pull the CT's there- I think the volume of CT's that we have in the CTICU is what made them decide that nurses should D/C them.

Assessment skills are so important. When I was in school I precepted in labor and delivery. It was a great experience but I didn't really work with sick people. When I started working in a surgical ICU I knew I really needed to work on assessment. I made a point of listening to lung sounds on every patient in the unit so I could learn to differentiate between different sounds. Just by spending a few moments talking with a patient you can see so many things- are they confused, SOB with activity or speaking, have they had a CVA and slur their words or have a facial droop. The advice about checking pumps and drips is great- I don't know how many times I've gone to assess a new patient and there is only 10cc left of a drip they're dependent on, or something has been labeled wrong. You always want to check for the things you may need- you don't want to be stuck if something happens- do you have suction, if your patient is on a monitor are all the alarms on, even if nothing is running through the IV can you flush it if you need it quickly. Skills like foleys and IV sticks will come with time (I'm still terrible at starting IV's) but having strong assessment skills and maintaining the safety of the patient are a great place to start.

In Ohio-- patients just out of open heart are 1:1 for 1st 4 hours, if they have a balloon pump or are on CVVH are 1:1, once out of surgery stable patients and ICU overflow are usually 1:2, and if we're short staffed those with tele orders, very stable or DNR may be tripled

I started in an open heart unit directly after graduating from nursing school. My orientation was about 13 weeks and I started working nights as soon as my orientation ended. we also get a lot of ICU overflow patients and thoracotomies so I have had a very broad range of experiences. The only thing we don't take are traumas and neuro. I did have instructors that discouraged me from going into the critical care setting right away- but I made sure I found a unit receptive to new grads with a good orientation program. I had a really hard time at the beginning but have a great group of nurses that I work with that are very helpful and supportive. I think I would have had a hard time anywhere I worked right after graduation. It takes time to feel confident- I still have days when I feel scared- but I make sure I ask tons of questions- and if I'm unsure about anything I always check with someone else. I've been out of orientation for almost a year- and am now being put in charge alot of the time- we have several new grads that recently started and looking at them now I realize how much I've learned over the past year. Try to find a good unit with supportive staff and a good orientation and ask tons of questions. Good luck!

I thought the same thing about the patient/nurse ratio. I just graduated in May and am in a cardiac surgical ICU. We normally have 2 patients but we are 1:1 for balloon pumps or fresh open hearts. We may have to triple patients but they are usually those that have orders for telemetry but no bed yet. It's very rare to have a triple assignment and I can't imagine having more than 3 patients. Don't let people tell you not to go into critical care- anywhere you go as a new grad is going to be a difficult transition- but find a unit that really supports new grads and won't put you in a dangerous situation. You worked too hard for your license to risk losing it in an unsafe situation. Good luck.

I started on nights around the beginning of November, after working days for my first 3 months of orientation. I'm definitely more of a night person- but it was a hard transition after having to up during the day. There are some days that I have no trouble sleeping- and get 7 or 8 hours and days when I can't fall asleep till noon and I'm up again at 3 or 4pm. Turn off the phone, try not to eat a big meal right before you go to sleep- and the best advice someone gave me- know that you will be completley obsessed with sleep for the first few months- and that's OK- your body needs to adjust to a totally new cycle. My family and friends are so sick of me always talking about how much or how little sleep I got. But now that I'm getting used to it I don't know if I ever want to work days. I work in an ICU and while nights are still busy- it's not usually as hectic as days-there aren't a million people taking the chart, we usually don't have to travel to tests- and I feel like I'm learning to be more independent by working on nights we don't have as many resources at night- we have to wake someone up with a problem. I'm lucky- I have great nurses with tons of experience to help me- find people on your shift you can trust and who are patient and like to teach. Good luck! Andi

this is how I learned: To find the rate if you know the dose (amt. desired): Amt of drug(mg or units) / Amt of solution (cc's) x 1000 = A then Amt desired (dose) / A x wt (in kg's) x 60 (for min) ex: start 5mcg Dobutamine, pt wt is 70 kg 500 / 250 x 1000 = 2000 5 / 2000 x 70 x 60 = 10.5 cc to find the dose if you know the rate: Amt drug (mg, units) / Amt of solution (cc's) x 1000 x rate /wt /60 ex: rate is 10 cc, wt 70 kg. How many mcg of Dobutamine? 500/250 x 1000 x 10 / 70 / 60 = 4.7mcg/kg/min Hope this helps.

Definitely think about taking advantage of this opportunity. You will get a ton of hands on experience with patients and get good chances to learn while at work. If the staff knows you're a student they'll most likely explain a lot of what is going on and let you observe different procedures. You will get really good at skills such as bathing, ambulating, etc, - these are these are basic nursing skills that you will still be doing when you're a nurse. You can take assessment skills and other ideas you're learning in school and think about how you would apply them to patients you see while at work. It's also a great way to network- there were quite a few people I graduated with that stayed on as nurses where they worked as techs while in school. While ther are many positive things about working as a tech while in school- it can be a very hard job- I was lucky- there were a few nurses who graduated from my nursing program where I worked and they were helpful and made it a learning experience. It may not always be like this- if you know of anyone else who works there ask how the techs and aids are treated- and talk with the manager to find out exactly what your duties and responsibilities will be- Good luck!

I took the HESI twice- The first time at the end of our first year and then right before graduation. The first time I got an 84.73. If we weren't in the 85th percentile we had to do review questions every week. Our grades didn't get rounded up so I spent a lot of time on the computer doing questions. The 2nd one I took before graduation I got a 91. If we didn't get in the 85th percentile we had to show proof that we were signed up for a review course. They say that if you score at least an 85 you have a 99% chance of passing boards but I don't think the HESI was anything like boards. the HESI was more like the NCLEX review books.

One of our instructors is an attorney and she told us it was a really good idea to have malpractice insurance of our own in addition to the hospital's. Face it-- if the hospital gets sued who is going to be their first priority- also, she said that if we have our own insurance we're covered 24/7. Often hospital insurance will only cover us while we're working- I know that if I ever have to perform CPR in a restaurant or if I pass a car accident and help- I want to be sure I'm covered. I know there are good samaritan laws but I'll feel safer knowing that I have my own insurance. Some insurance companies will only charge new grads half the first year.