Rabid Badger

Not according to the Faculty of Nursing official grading scale

B+

Yes you need to be an RN for the ICU. Ive only seen LPNs in one ICU here and they worked well under scope and not as bedside nurses.

Ah ok.

Are you in Canada?

We are opening a huge new oncology centre with a year (I think, as it is under construction currently) at the Foothills Medical Centre. Keep your eyes peeled for positions there and specifically at Tom Baker Centre (the current oncology centre).

I did this exact move almost 6 years ago and was successful. I did not give notice in Winnipeg until I had landed something here. However I was successful for two reasons, there was a new hospital opening up at the time and I am specialized in critical care with experience. You didn't say if you have experience and in what area. Can you elaborate? It is much harder to find employment with AHS right now as an external applicant. My suggestion is to apply for the jobs posted online that you are qualified for and don't be picky about the FTE. Most people get in casual to start lately.

I've never heard of high dose insulin therapy for beta blockers. Its usually treated with glucagon and supportive therapy. High dose insulin therapy is usually reserved and well documented for calcium channel blocker overdose.

Sorry, but I think hourly rounding should be mandatory. I work on an extremely busy ward and I round every hour. It doesn't mean I have to do anything to check to make sure my patients are still breathing. Many a time the only way we have caught a patient from coding, in severe pain, IV's going interstitial, a confused patient climbing out of bed was by rounding. I can't imagine not seeing a patient for 3 hours and then finding they have been dead on the floor for the last two. At minimum, you should be thinking about your licence.

The one thing that I don't get from your posts are any personal responsibility. Somehow it's all the school's fault, its a conspiracy theory, they're out to get you. Occam's razor would suggest that there is a reason why they have put you on probation and learning contracts. The Dean doesn't get involved for fun. I have seen many a student nurse failed in their last term or in practicum, often because they were clearly lacking, but for some reason were passed through earlier clinicals. Better to fail them in school than to put them out on the wards and kill a patient. The fact that you do not offer up any semblance of responsiblity suggests to me that there might be some truth to the allegations.

I enjoy working codes, but dammit, why do they always happen at shift change?

Well this is unfortunate. Actually everything you listed for what you learned in ICU we do on my Medical ward! Except we don't do CRRT, but we recover HD. What else I do: Manage codes, on a virtually daily basis. Run 4+ IV continuous infusions on a single patient. Have a patient code, work on them for 2 hours, send them up to ICU only to discover your second (of 6) turns up a pressure of 70/30, spend the next 7 hours bolusing, giving 11ty billion cc's of albumin to, vitaling q5mins, hoping you don't lose a second in 1 shift. Manage central lines on all 6 of your patients. NGs/trachs/ostomies/chest tubes/vac drsgs/tpn/etc etc. Give every imaginable blood product. Airborne isolation. Assist in an on-ward endoscope QID drsg changes on a coccyx wound the size of a dinner plate, wherein intestine and spine are exposed. What to do when your patient collapses and bleeds out 3 litres in 2 minutes. What to do when your doc doesn't want to take the above bleed seriously. What to do when your patient goes into flash pulmonary edema. What to do when your patient starts hitting your staff and threatening your life. Take in 2 unstable admissions in at the same time while you are transfusing another and doing above mentioned drsg changes and trach mgmt on your others. Learn how to not kill yourself after the first 3 months. Manage non-intubated ICU patients where there is no bed for them in ICU. Recieve transfers from ICU, have your patient code 20 minutes later, then ship them back upstairs. Thanks for stopping by! This is only the tip of the iceberg. I'm sorry your med/surg experience was a whole lot of CNA work. But that's certainly a far cry from what I do on a daily basis. Medicine on this ward is a constant case of :uhoh3:

This is untrue. Since no vaccine is 100% effective, there is about 10-30% of vaccinated individuals who did not seroconvert. This is why herd immunity is so important. When you do not vaccinate, you risk not only exposing yourself and your loved ones to the illness, all others who have not been vaccinated, PLUS those 10-30% of vaccinated individuals who did not seroconvert, who depend on the 80% herd immunity to protect them. In addition, you are also potentiall exposing individuals who are either too young, too old, or too immunocompromised to be able to receive the vaccine or to safely seroconvert. This is why there is a public outcry. You are not only risking those who have made informed consent to refuse the vaccine, but plenty of others who are unaware or unable to protect themselves. Herd immunity for a number of diseases which had been virtually eradicated due to vaccines are now sitting at 60%. This makes the population ripe for an outbreak, and there has been recent evidence to prove this given outbreaks of measles, whooping cough and assorted other goodies that have been unheard of for the last many many years. Just because it is a rare contagious disease does not mean it won't be tomorrow, especially with the especially tenuous herd immunity rates according to US and Canadian Vaccinating monitoring agencies.

"I was like . He's in here because he was bleeding you idiots" Best quote ever. I love it. This is exactly what I would say, since I am a very much a loud mouth assertive nurse. If you were my student I would LMAO then give you a big shiny gold star. Excellent work.

Thanks for proving my points so eloquently throughout this thread! Simply genius!

This is untrue. The fever is a symptom of the immune reaction to infection, not the cause of the immune reaction. You can treat the fever with meds without affecting the immune response. By giving tylenol, you reduce pt discomfort, reduce dangerously high temps, and therefore can reduce tachycardia, resps and a whole host of other cascading factors. Reducing temp in no way decreases our ability to respond to the infection. If you truly beleive in informed consent, then it is imperative that you know what you are talking about when providing the options. We are not doing any service to the patient by injecting our own biases into situations that are not appropriate. For example, offering cold cloths to a patient versus tylenol stating it will work as well is illfounded. I'm sorry, but if I have a multisystem ill patient who suddenly spikes a temp i'm not going to first lay them out in cold cloths, bed bathe them etc only to discover, OMG its not getting better!!! A more educated response would be to assess the fever along with other signs and symptoms of infection, have the urine and blood cultures drawn, then give tylenol, administer antibiotic treatment and monitor them like a hawk because they are now rolling down the slipperly slope of sepsis/septic shock/death. The tylenol does nothing to change this other than to make the patient more comfortable.

Wow. Are you kidding? You seriously cannot compare 6 high acuity medicine patients to LTC patients. There is a reason you have half a ward to yourself. Same reason rehab patients have such a low ratio. Because there is considerably less to do! And yes we do chemically restrain, and physically. Next time you have a 30 yo year old 250 lb male who is HIV pos, Hep C pos spitting blood in your face and kicking 3 staff and 4 security guards, threatening to kill you, while you have another patient bleeding out 3 litres in 5 minutes in the next bed, ask me again if its ethical to restrain. Seriously, come work on an acute ward for a while before you start spouting such remarks. *eyeroll*

LOL, I'm the loudmouth gutsy one on the ward. I have noooo problem calling out the medical team and managment etc. I consider it a necessity for advocating for your patients.

I'm union, I think it makes a big difference. That being said, I have exactly those hell shifts too. Our ward is difficult to staff and we get many sick calls. Management seems to work in complete opposition to the staff, in pushing more and more complex patients onto a tighter staff ratio. I personally don't put up with it. A few things I do to cope: 1) incident reports, tons of them 2) reports to the union 3) written (recorded) complaints to management 4) ensuring your unit manager and charge nurse are aware of your unreasonable assignment and that you require help. Ensure that you are making it loud and clear that you feel that the situation is unsafe. 5) we still work by the old system, transcribing our orders by paper, often ourself, on top of the busy assignment. MAKE A HABIT OF CHECKING YOUR ORDERS EVERY TIME YOU WALK BY THEM, even if they are not flagged. I walk past the charts/med room every few minutes, and I am anal retentive about checking my charts to ensure nothing is missed. My patients are far too sick for an order to go missed for four hours. 6) Chart chart chart 7) resign if nothing else works. Nothing speaks louder than your staff leaving in droves. Remember, you can't expect others to advocate for you. You must advocate for yourself and advocate on behalf of your patients. It is your responsibility. If that order is missed and something happens to the patient, you are responsible, unless you take documented steps outlining your concerns and measures. And if you think you don't have time for documenting this stuff, realize that it MUST BE DONE. Nothing else will save your a$$.

I don't think it takes a rocket scientist to figure this one out. Benner's "Novice to Expert" theory and research is widely accepted and incorporated into schools of nursing and licencing bodies. Novice nurses are not equipped for the independent and quick problem solving required for ICU work. Stage 1: NoviceBeginners have had no experience of the situations in which they are expected to perform. Novices are taught rules to help them perform. The rules are context-free and independent of specific cases; hence the rules tend to be applied universally. The rule-governed behavior typical of the novice is extremely limited and inflexible. As such, novices have no "life experience" in the application of rules. "Just tell me what I need to do and I'll do it." Stage 2: Advanced BeginnerAdvanced beginners are those who can demonstrate marginally acceptable performance, those who have coped with enough real situations to note, or to have pointed out to them by a mentor, the recurring meaningful situational components. These components require prior experience in actual situations for recognition. Principles to guide actions begin to be formulated. The principles are based on experience. Graduate nurses are widely accepted to work on at the Novice stage of development. Reaching the competent level was found to require approximately 2 years of experience. Personally, I've finally reached the competent stage, and I know this by introspection and reflection. A grad nurse who is unable to realize their limitations is clearly at the novice stage and requires closer supervision. If you've ever worked with students or been one yourself you know full well that when you first start out you need plenty of guidance, help with prioritizing, and have greater difficulty recognizing changes that require intervention. It also doesn't take a million studies to know that overconfidence kills patients. Cross research in any field and the evidence solidly points to greater experience = better outcomes. If the nursing research lacks publications on such matter, let me know, and I will be more than happy to conduct the first study. I honestly have a little difficulty understanding how we are even questioning the veracity of this. I honestly think the US idea that grad nurses can head into ICU with 14 weeks of training is based on widespread ICU staffing shortages. If you require experience and 8 months of additional unpaid training, it is more difficult to staff such areas, understandably. Our ICUs are short staffed as well, but despite that, our health authority has sought to aggressively recruit using incentives for experienced nurses, while maintaining a standard of care and minimum expertice requirements. I've gone online and researched ICU positions in the US, and I've seen that I can hop right into an ICU position, without further training. That my dear, should frighten us all. I guarantee you don't want your family members cared for by a novice overconfident nurse. Don't get me wrong, I love working with students, I love teaching, I'm precepting a senior student nurse currently. So I'm more than fully aware of their capabilities.

I went to school with the idea that I only wanted to work in L&D, mat/child. What I discovered during school is that I LOVED medicine more. I'm working adult medicine now and I love it to death. I've never been more challenged. I am looking to progress to ICU in the next year or so, however. You should go in with a goal, definitely, but keep your options open, as you may discover you like something else, or employment opportunities vary. I'd have to say when I started nursing school a quick survey of the students showed that about 50% wanted L&D (and similar) and close to 50% wanted ER. LOL, by the time we were done, our goals had changed drastically. It's fair to say we didn't all end up in L&D and ER.

I stopped giving meds gravity after I clogged an NG and nearly lost a SBFT. The problem was when you pop the plunger off and dump the meds into the syringe to give gravity, sometimes it chunks and blocks either the syringe or NG. So I mix each with water, draw them up and administer push individually, with a flush in between. May not be how its supposed to be done by textbook, but I was trained to be evidence based, and my personal experience points to gravity method not being NG and frustration safe. At least if I draw them up into the syringe, I know the meds can pass through a smaller bore than the tube itself, thereby bypassing clogging the tube.

Don't be sorry. I don't think it reflects on Americans as much as it does on the new grads who think they are infaliable. I feel sorry for the patients who will be put at risk. An overconfident student or grad nurse is a serious safety risk who doesnt belong on any ward, especially an ICU. If I had a student/grad nurse such as these, they'd be mopped up in a hurry on our ward. Overconfidence kills patients and poorly prepares the student/grad for real world nursing, and sets them up for losing their jobs and licences in a hurry. I'm proud of the fact that we require a minimum of 1 year acute nursing experience plus 8 MONTHS of ICU training and practicum prior to being qualified to work there. It seems our province has its head on straight when it comes to patient safety. More education and more experience do make better ICU candidates than new grad nurses with an extra 14 week training course. Period. And the patients are safer for it.

I love the fast pace, the unpredictability of the ward, nothing is the same from day to day. I love learning everyday, I love bringng comfort and reassurance to someone who is dying or ill. I love being the one to advocate on their behalf, to ensure they receive the best possible care. I love teaching new students, and helping them learn to be the best nurses they can be.

All our oral meds are prepackaged in the PYXIS individually and labelled. Some nurses take them out of the packages before they head to the rooms, but I open them at the bedside, in front of the patient, as I expain (every time) what the med is for while I sign it off in my MAR.