jedimasterr

I graduated from WS and while it's clear some things have changed for the better, some have clearly stayed the same. I've posted things before, so I won't say too much here. The things about WS that chafed me to no end while there seem to be pretty much the things that chafed friends who went elsewhere. Based on my experience and what friends told me about other schools, it seems that there are few instructors who value nursing as a profession, particularly, bedside nursing. One of the worst things about nursing school is that there really isn't any catalyst to make them more responsive to student needs. There is a shortage of nursing schools, nursing is a good career, and they have what you need rather than the other way around. And of course, they make that clear to you by their words and actions for the entire time and that is very difficult for adults to take. In the midst of nursing school, it is near impossible to not think that the heavy handedness is a moral outrage of the highest magnitude. Once you are done kissing all the rings and ego's of faculty and have received your degree, real life does resume and what nursing school did or didn't give you will quickly become irrelevant. At this point, I'm neither proud nor embarrassed that I went to WS. They were the school that was open when I wanted to start and I got my BSN. Once I started to work as a nurse, the annoyance faded pretty quick. Best wishes to anyone still engaged in the process (indoctrination?) of nursing school; it does get better.

When I took the test, I remember thinking that a lot of the nurses I worked with probably knew the answers to a lot of questions. The key is knowing how to answer the questions. The study guides are good, but I felt like my two day prep course was huge for boiling down what I needed to know. I didn't do as well either on practice tests, but managed to squeak by on game day. If you are getting close, I would say spend more time on practice questions than content. Just my

First suggestion is to not personalize the outcome. CCRN is a test of how well you studied and how good you are taking tests; it's not a measure of how good a nurse you are. Even without the added difficulty of obtusely worded questions, it's a hard test. I got through NCLEX two years ago in large part because I finally got good at answering questions and some of that carried over here. Content wise, I really tried to focus on what I was told would on the test. The two day review course really hit it on the head and was extremely invaluable with little tidbits of what to watch out for, especially with guidelines on hemodynamic values. I practiced with a fair amount of questions prior, but I really think the two day review was most helpful in honing in on what was important. If it was me, I don't know that I would try to reinvent the wheel and start over and re cram all the content. I would probably just focus on whatever sections I was weak on and try to retake it sooner rather than later while the questions I saw were still fresh in my head. For what it's worth, I did buy the 12 dollar CCRN question book from the AACN website and one or two questions from there were verbatim on the test. Lastly, have some confidence that you have now seen what it's like and that alone is going to make it different next time you go in. Good Luck.

Congrats! It's a great feeling to walk out of that test site with the passing paper in hand!

I admit that IV thing was a rant, but it does speak to a bigger issue of considering the next step and thinking about a continuum of care. Maybe just instill the idea to think, "What would I want on this pt if I had to stay with and manage him for the next 12 hours?"

I started in ICU right out of school and I am glad that I did. All the questions people above asked are important and for me, I had continuity of a single preceptor for the whole time and I went to a unit that was embracing of new grads. All I would add to what has been said here is that I think attitude is important too. I wanted to go to ICU because I was hungry to learn and wanted to work with that population. Conversely, I have since talked to and occasionally filled in as preceptor to some new grads who actually said they weren't really sure what they wanted and came to ICU because the pt to nurse ratio's were better then on the floor. Those nurses are getting by, but their work shows they aren't completely satisfied being there.

I just passed it today by the skin of my teeth. Four more wrong questions and I would not have passed. I have exactly two years experience as a nurse, all of it in a MICU. This is for what it's worth. I bought Woodruff's package back in April of 07, and passively listened to the CD's while going to work or when I went to the gym. Pros: This is an excellent critical care course and was an awesome resource for me after leaving orientation. The lectures are a decent length and are great for listening to while driving or while at the gym. It helped me create a knowledge base that allowed me to tightly focus in a two day prep class later on. Cons: by itself, I don't think this would have been enough to get me through coupled with my lack of experience. Despite being a great base of knowledge, I'm not sure this succinctly covered what is on the test. In some cases it was more info than needed while at times being less then needed. For an experienced nurse, there are probably better resources. In june, I bought the CCRN study book, 5th edition by Ahrens, Prentice and Kleinpell. I mostly bought it for the questions, though I did read some of the content. Pros: Good format that allows you to study more in depth or focus on what will be on the test. The authors seem to have a good feel for what will be on the test and put at blurb before each block of content that tells you whether what you are about to read is testable or not. Several questions were verbatim to the test. Cons: Not many that I see other than it is a little pricey. I plan to read more from here to broaden my knowledge base. In October, I took a two day prep class that was paid for by our hospital. From what I heard from others, many of these two day prep deals are very on the money at least with respect to very tightly focusing in on what is likely to be on the test. This was probably the most helpful, but without experience or without some other knowledge base builder like the Woodruff course, it probably would not have done much for me. These classes seem designed for someone who has decent knowledge and needs direction on what is most important. I wish I had taken the test right after this class as I felt pretty confident then. Lastly, I bought the 13 buck practice question book directly from AACN. This was very helpful for just sitting down and getting in the groove of answering questions. Like the Ahrens book, some questions here were verbatim. In hindsight, I think that if I did the Woodruff course as recommended, took a two day prep shortly thereafter and used the AACN question book, that probably would have done it. Despite all the prep, I felt that I was flat out guessing on maybe 30% of the test. What was most difficult about the test was that they frequently ask you to diagnose something by the MOST obscure finding rather than something common. Even though the two day prep didn't cover everything, it really helped me zero in on the general areas that were important and this was invaluable. With just my experience at two years, I could not have passed this test. Hope that helps someone.

I didn't read every post here, but one thing that makes me grind my teeth about the ER is when they start and IV and attach the primary tubing line directly to the catheter hub and then plaster it down with five pounds of tape because it is in the AC. Dozens of times they have done this with blood tubing which MUST be changed out then the bad is dry, or they hang saline wide open without a pump and then let the bag run dry which leaves us unable to prime a the line when we hang a new bag. It just seems kind of ignorant and lazy to not take the extra one second to attach a J-loop before covering with a tegaderm. GRRRRRRR

I bought the second edition of Marino's book for five bucks several times from used book stores. If you are just starting out, I think the second edition is more than adequate.

I had Dewolff for community quite awhile ago. In that class, the quizzes were very heavily based on the powerpoints from class but she was one of the few teachers who actually presented information in class that jived with what the book taught. She's a big fan of the NCLEX style of testing with distractors and what not and very much a stickler for format with papers. Overall I thought her tests were fair if you knew the material moderately well. My advice, read the power points close, skim the chapter in the book and maybe make a couple of notes from the book where power points and the text overlap. Hope that helps.

I posted on some other West Sub threads awhile back. Two years out now from graduation and my attitude has not changed much. Compared to other places, West Sub has, I feel, a very reasonable pre req list. Well, that is of course except for the computer class requirement, that is just plain stupid. As for the organic chem or nutrition classes other schools require, they aren't going to make you a better nurse. On out unir, I have precepted one West Sub grad and several students. All have been pretty sharp students and are clearly getting something from the school. As someone else said, it is what you make of it. If you study hard and seek out the teachers who have solid work experience, you will get a decent education. If you show up and do the least required, you will struggle with boards and possibly struggle once you start to work. When I was there, I felt that there was no one thing that West Sub did that said EXCELLENCE. This bothered me from an accountability perspective, but it hasn't hampered my career as a nurse in the slightest. It's a mid tier school and if you can accept that perspective and stay focused on getting in and getting out, then I think it's a great place to be. If you really want a more strenuous academic environment to ensure you are getting you're monies worth, there are better places to go. Feel free to email if you have any direct questions.

Puppies, It seems that in practice, rather than in theory, a lot of EICU's are run very differently. On paper, this idea does seem to make a tremendous amount of sense in some situations. If you work in a hospital with no resident coverage where you have to call an attending for everything, it's obvious how much sense this makes. If you work in a teaching hospital though where there are residents and medical students aplenty, it doesn't make as much sense. Many of us still feel the role of the EICU is purposely undefined. In some rare cases so far, they have been there to give us an order we needed and they have been an invaluable resource for the resident team when confronted with something complex. From a nursing perspective, it's very mixed. When you are admitting a complex patient that needs a lot of things set up like a-lines, or CVP or pressors, getting a phone call from the EICU to give them a height and weight on your patient can make your blood go from zero to boil in about 3 seconds. Likewise, getting a call asking what you are doing about someone's hypotension while you are already standing there talking to a doctor is equally galling. In our set up, I think the nurses in EICU are tasked with watching a large group of patients and because of this, they rely on their computers to flag critical values and alert them to a situation that may be getting out of control. Functionally, our program goes something like this, Nurses and Critical Care intensivists monitor our patient vitals, progress notes etc from an off site location. They also have the ability to look into the room with the camera's mounted on the wall and they can also speak to the patient directly. If we, as nurses, are stuck in a crashing patient situation without a resident or attending around, we can hit a panic button on the wall and instantly have a camera zoom in with an open mike that we can communicate with the EICU staff through. Most often, I hear from an EICU nurse when they want a height and weight for a new admit, when I have disconnected a patient for transfer or transport to a test and when the MAR does not reflect common medications like proton pump inhibitors. One time, an EICU Doc did actually call with a worthwhile suggestion to cut a med dose for a renal insufficient patient, but it had already been addressed and his side simply had not reflected that yet. Other than that, my discussions with EICU have not been very fruitful. By my own admission, I take a lot of pride in what I do and having a stranger call me for something makes me feel like I am being critiqued or "sweated" by an outsider. However, as the nurse who does the physical work of titration, transport, butt wiping and family soothing-I don't see the EICU nurse as an equal partner in what I do. I'm far from thinking I know everything, but from the nurses around me, I have decades of experience to draw from as well as an already established trust and I really don't want to go reaching outside that circle of trust unless I absolutely have to. It's not so much a matter of not trusting EICU nurses, rather it's more a matter of they are "over there" sitting on their butts while we are "over here" doing the heavy work of nursing. That's perhaps not a fair assessment of them, but it's honestly how I feel. Again, in some situations I can accept that EICU is an awesome tool. For a teaching hospital, not so much. that's my anyway.

After a couple of months now, I have to say I am not real fond of the EICU. On the one time I did call for consultation with a Doc, I was given an un asked for critique of nursing care, an order for a CBC that I could have gotten without him and a suggestion that I should call the cardiologist. After that the EICU doc washed his hands of the matter. Luckily it was not a life threatening situation. Prior to going live, we were given a view of EICU that doesn't really match the actual practice. I don't think the staff is incompetent or inexperienced, but I do sort of feel like they are basically fixated on things that will electronically flag like nothing being prescribed for stress ulcer prophalaxis or when a pt disappears from a monitor due to transfer or transport to a procedure. As a group, I think our floor is very prideful and as a result not very friendly to being called in the middle of solving a crisis that an EIUC nurse has become aware of after the fact because something started to flash on their screen. So far, not much synergy exists between our floor and EICU and I'm not sure that's really going to change. As a floor nurse who really tries to stay ahead of the curve, I don't see myself collaborating with an off floor nurse to direct my patient care when I have people I work with who may have even cared for my patient in days prior. I hate to see that kinda money going to waste, but I haven't seen any value added from it yet. I hope that changes.

I try to be direct with them and politely ask them to set the phone aside for just a minute while I finish my assessment. Aside from listening to lung sounds, there isn't much I need to do assessment wise that requires them to stop talking. It seems a bit rude of them to not stop talking for just a minute, but that's the way some people are. Given that I work in the ICU, seeing a patient continue to carry on a conversation while I am assessing them is a crucial assessment piece by itself in that if they can carry on that well, they likely don't need to be in the ICU For people that just won't stop talking, I think bringing in a thermometer works best! Then you have at least a few seconds to tell them to stop talking while you complete the assessment.

Hey Shy, I couldn't tell from your post if you are a new grad or a nurse heading to ICU with some experience from another floor. If you are the new grad, my first piece of advice would be to relax and just try to accept that you are not going to become a crack ICU nurse overnight. Just over a year and a half ago, my preceptor told me it takes a good two years to get comfortable while another nurse I respect told me it's probably closer to five. I still get frustrated at times when I am presented with a situation that seems common yet has never crossed my path until now. It happens to me all the time. Luck of the draw dictates the patients you get and my experience is that you may see tons of common drugs, procedures etc and still go for a long long time before you get to take care of that yourself. In any event, it takes a long time and patience is key. As for learning how to manage things, something I had to start to do for myself was to literally stop throughout the day and mentally tell myself, "You won't have time to do that later". Once I learned the absolute basics of what needed to happen on my shift, I was able to start to think ahead to what needed to be done. Even with that though, I still got caught short a bazillion times by thinking I would get back to some task later. Repetitively telling myself "You don't have time" seemed to help me prioritize better. For whatever that's worth!

I started a full time BSN program at age 38 and was through NCLEX and was working as a new grad in an ICU by the time I was 40. Straight up, there was absolutely nothing pleasant about nursing school. Academically, it was not the most challenging thing I have ever done, but as an adult, being talked to and treated like a teenager did not sit well with me at all. Once I graduated and started in the ICU though, I did not regret choosing to go. Since the majority of the nurses in my ICU match the national average age of low 40's, I think my age was actually a bit of a benefit. I can't speak for all hospitals, but based on my experience in school and as a new grad, I tend to think that most veteran nurses are going to extend a bit more lateral respect to a new grad who is closer to their own age then they are to a new grad who is half their age. Likewise, when it comes to taking care of patients, I think that many of them feel more comfortable dealing with someone who they assume (rightly or wrongly) better understands their fears and concerns. Coming to nursing as a second career, I brought a wealth of people skills and life experience with me that you just can't learn in school and I think most managers are going to appreciate that. All jobs have their downsides and nursing is no different. Thus far, I have been able to work around what I really dislike about it and it is very comforting to know that if something changes that really drags the unit down, I can leave and try a new hospital or even a new area of nursing. That alone is a flexibility I never had before. I say give it shot, I don't think you will regret it. That's my anyway. Good luck.

I'm not sure how many people still read this particular thread, but I would like to put a feeler out to see if anyone currently working in California would be willing to chat a bit via PM. In short, I am a ICU RN with one a half years of experience and a BSN. Next year, in July to be specific, I am looking to make a move to California and will likely start out on a travel contract unless I find a hospital and area that I really like in advance. The general info I have seen on some of the threads here has been helpful, but if anyone was willing to take a whack at some questions via PM I would greatly appreciate it. Since I am not yet sold on any particular area in California, replies from any area in the state would be great. Thanks to all who have already taken the time to put out good information on this thread!

Nursing is a second career for me after I was basically pushed out of a good paying gig working on a commodity exchange floor because of automation. At the time, many of us felt that our hard earned expertise at what we did would eventually win out. It did not. Undoubtedly, I am extra cynical (perhaps a touch bitter) because of what I went through in my last gig and that may be unwarranted here. That said, though I have only been a nurse for a short time now, I look around at some of the changes I see approaching the nursing world and it feels more than a little like the environment I was in five years prior to the explosion of electronic trading that wiped out the trading floor. Despite my fears of being relegated to glorified clerk forced to bow to a faceless voice on the wall, I can see the potential benefits of this system. Even though I work in a teaching hospital with very good attending and resident coverage, there are still times when you get stuck with a crashing situation that could be easily taken care of by an order for something basic. And of course, if I worked in a smaller hospital without the coverage I enjoy now, I have little doubt I would really appreciate the backup. Without a doubt, there is upside. From the managers in our system, what I hear is that it is not going to be one to one coverage and that the Eicu nurse off site is not going to be watching us 24-7. On the other hand, what I hear from agency nurses who have worked in our system hospitals with Eicu is that the off site nurse made their lives miserable by hounding them to fax over progress notes, turn the IV pump toward the camera and just in general chase down their requests. If this is true, I can't see how this is going to help patients or help with retention and job satisfaction. In just a couple of months, I am going to see this firsthand whether I like it or not. Coming from a business background, it's hard for me to not see this as something that dilutes the control a bedside nurse has over their practice. Nobody likes having someone "sweat" them and that is going to be very hard to get used to. If it truly does become a resource though that we can tap into rather than be directed by, it might not be a bad deal at all. That's my

Hope I don't drift too far off topic here. I am very satisfied with choosing nursing as a second career, but this issue of compensation is one the relatively few things I find very frustrating about the field. After working in environments where initiative and quantifiable contributions were directly rewarded, the compensation and promotion scale of the nursing world seems very inefficient and limiting. On the one hand, I get what management is up against-less and less money coming in due to insurance and medicare strong arming leaves them in a position of needing to not give out any more money than is absolutely necessary. Moreover, once a nurse hits an hourly rate that begins to exceed agency rates, what do you do? I don't like that reality, but I accept it's part of the problem. On the flip side of that though, there is no quantification and reward for the kind of nursing initiative that cuts length of stay and saves thousands and thousands of dollars. Catching a critical value before it becomes a code because the rhythm strip looked funny, sending off urine to the lab and catching a UTI no one is treating. ETC. Everyone here knows that good care can do volumes to ease suffering and cut costs, but at best it seems to me like that good care simply makes the monthly loss less severe and as such, nurses don't get a cut of what they directly save the hospital. In my hospital, I am fortunate to work in an environment where the attending's respect the nurses and drill that same attitude into residents. Without a doubt, I feel appreciated for what I do and as a newer nurse I have no complaints about how much I make.........yet. In the bigger picture though, I wish the nursing contribution was quantified a little better. I really don't want to have to move around to make better money, but it seems to me that this is inevitable until nursing is quantified as more than a room charge. Just my take anyway.

I am an ICU nurse with 1 and 1/4 years of experience who went right into the ICU after school. So far, my experience has been very positive and I attribute a lot of this to the open arms my unit has toward new grads who have a good attitude. I feel that I am a very conscientious nurse and that I do a good job, but I can also readily admit that support from my fellow workers is a big part of that. After surviving my first year as a new grad, I have made taking the CCRN exam one of my major goals to get done by the end of this year. From that groundwork, I have some questions for the more veteran nurses here. For those that passed the test, regardless of time on the job, was your accomplishment acknowledged positively by your co-workers or was it seen as being showy? Related to that, did you feel that people expected you to be a "guru" who should be chock full of answers to everything and then roll their eyes at you if you didn't know something? Lastly, do you feel that studying for the exam improved your overall knowledge base to the point of making a permanent improvement in your practice? And for anyone who would like to weigh in on this part with experience or wisdom, please do. Right now, I feel I do a good job at work for the reasons listed above, but at the same time I am keenly aware that there is an enormous amount that I don't know yet because I don't have experience. I don't take it for granted I will pass CCRN on the first try, but assuming I do, I am worried about how other co-workers with much more experience then me will look at me. At age forty, I feel like real experience is almost always better than book smarts and at my level of time as a nurse there isn't much I can do about my lack of experience. I do think studying for CCRN will help solidify some of the things I have seen so far but I know it's no substitute for experience. Any thoughts on any of the above from the wise I have seen here would be most welcome :bowingpur

Like most folks here have said, our ratio is one nurse to two ICU patients. Open hearts are one to one for a certain length of time. On the step down telly unit, the ratio is one nurse to four patients but they do have some help on that floor from the techs for vitals and accuchecks which are Q4H as opposed to our Q1H vitals. When the hospital is full and we can't transfer patients, we are expected to follow the protocols of the unit the patient should be on, and this can be a drag when you have four step down patients and no assistance like you do on the telly floor. Luckily, our unit is very team oriented and you are not left to hang when it comes to cleaning patients. That said, it is still a lot more work than would be expected otherwise. Overall, I think our unit is safe. However, there are times you get stuck and can't get more help. So far I have seen nothing that indicates to me the unit manager or the hospital are OK with just "stuffing" the ICU nurses. For the most part though, we are expected to float to any unit except the ER and as you would expect just about no one likes that. Someday, we will have eICU and due to my experiences in another field prior to nursing, I have nothing but suspicion toward how eICU will be used. I can certainly see them using it someday to be that perceived "extra" help that allows patient ratios to climb. I have nothing to back this claim up right now so that is admittedly speculation on my part.

Like most folks here have said, our ratio is one nurse to two ICU patients. Open hearts are one to one for a certain length of time. On the step down telly unit, the ratio is one nurse to four patients but they do have some help on that floor from the techs for vitals and accuchecks which are Q4H as opposed to our Q1H vitals. When the hospital is full and we can't transfer patients, we are expected to follow the protocols of the unit the patient should be on, and this can be a drag when you have four step down patients and no assistance like you do on the telly floor. Luckily, our unit is very team oriented and you are not left to hang when it comes to cleaning patients. That said, it is still a lot more work than would be expected otherwise. Overall, I think our unit is safe. However, there are times you get stuck and can't get more help. So far I have seen nothing that indicates to me the unit manager or the hospital are OK with just "stuffing" the ICU nurses. For the most part though, we are expected to float to any unit except the ER and as you would expect just about no one likes that. Someday, we will have eICU and due to my experiences in another field prior to nursing, I have nothing but suspicion toward how eICU will be used. I can certainly see them using it someday to be that perceived "extra" help that allows patient ratios to climb. I have nothing to back this claim up right now so that is admittedly speculation on my part.

After nursing school, I went straight to the ICU in the hospital my school is attached to and after just completing my first year I have given this question considerable thought. I think people keep asking this question because there are so many variables that can make or break the situation. I don't feel savvy enough to make broad generalizations about nursing, but I can share my experience. Overall, I remain satisfied with my decision to go right to the ICU after graduation. Outwardly, there were many things that contributed to my feeling this way; my preceptor loves to teach, my ICU welcomes new grads, the larger organization my hospital is part of has a significant amount of courses available to nurses who want to take them (mandatory but with pay for new nurses) and while I was in school I had several opportunities to spend time in both the ICU and ER, including 180 hours with a preceptor in the ICU during my last semester of school. Without a doubt, I feel that an investment has been made in my development. Inwardly and at the risk of sounding arrogant, I feel that I had some things going for me that were equally important. Nursing for me is a second career and prior to coming here, I spent many years working in an environment that demanded prioritization and communication skills. Additionally, having some career success before coming to nursing gave me a base level of confidence in myself to ask questions without worrying someone will think I'm stupid while also giving me a history of difficult times I survived to look back on and take stock in when I struggled as a new grad. Lastly, for better or worse (sometimes I feel both) I told myself, "Self, I want to be in the ICU period". From what I have seen on my unit of new grads who did not have a similar feeling or for whom ICU was a second choice, I think the flow of the unit wore them down until they left. As a newbie with limited experience, I see choosing any one unit as a somewhat limiting decision. There are times I wish I had the basic skills efficiency of friends I graduated with who went to ER or Med Surg. By the same token though, they don't yet have some of the skills or confidence that I do with titrating drips or dealing with vents or dealing with unstable patients (and their families) in general. I respect the view of some seasoned nurses that everyone should do med surg first; I think I can see where that would be helpful. On the other hand though, my experience is that it worked out for me and quite a few people I know. The only recommendation I could make to someone, based on my experience, is that it seems almost impossible to survive in the ICU unless you really want to be there. Good luck and I hope the long winded answer was useful to somebody.

Hey all, I am a recent grad and have just finished up my orientation in an ICU here in the Chicago area. Down the road I hope to move out West somewhere, and Oregon is high on the list of possibilities. If anyone is interested in taking a whack at this, I would love to hear from people out there (especially ICU) about how they feel about the hospitals they work for, IE is the collaboration high or top down from doctors?, What is the weather like? and anything else people might care to ad. In the long run, I plan to go back to school for a master's degree, so I would especially like to know what kinds of opportunities exist across the state for advance practice nurses up to and including NP. Thank you in advance Mike

On the surface, I agree with what most people here have said about how you need to know content (IE patho meds etc) and need to know test taking strategies to pass. On a deeper level though, I am a bit more cynical after having taken the NCLEX and passed the first time through. Everyone's experience is diffferent. Based on what the test was like for me, I would tell just about anyone to not spend much time reviewing content and instead to focus on the strategies listed in the front of NCLEX test prep books, and to specifically focus on know what taks can be delgated to whom, and to focus on how to prioritize patient care. In most cases, I felt that prioritization was easy enough to figure out using ABC's or Maslow. Again, everyone is different, and for me I really did nothing more than try to pound through 75 questions of Saunders per sitting, and I did this about three times a week for two months before taking the test. As a last piece of advice, keep in mind that close to 85% of all test takers pass the first time. Those are pretty good odds. Good luck Jedi