EMSnut45

Awwww, you all have me blushing!! Thank you so much!!!

Been there, done that. I LOVE the high acuity, technology, and independence of the ICU. It was the unrealistic family members, physicians that didn't want to discuss the real prognosis, and ultimately what we "do" to chronically ill and debilitated people at the end-of-life that drove me to my breaking point. I took a long look at what I liked, what I didn't like, and what my options were. I moved from the ICU into surface transport (ambulance). Here I am still caring for critically ill patients, but for no longer than 3-4 hours. I am not able to form the "bond" that ultimately led to my emotional distress. I am so glad that I made the move. I LOVE my job now and and think of anything I'd rather do!!!

Soooo very true, and exactly why I'm taking a breather from the ICU. Like others have mentioned, I have also found that families are more receptive if it is first presented as "it's time" rather than a laundry list of options given to an overwhelmed family. This usually comes after several previous family meetings where it is explained what heroic measures are currently being performed and the lack of response. If the groundwork is properly laid from the beginning (honesty, bedside manner, trust), then the final discussion, if necessary, is much easier for the loved ones. The nurses also play a role by re-enforcing the current condition of the patient through teaching. It really is a multi-disciplinary effort.

Approach the interview as you would any other. It was exactly the same as any in-person interview I've done, just through a computer screen. Dress as you would any other interview, have your résumé, list of questions, and note paper handy to reference. The first interview should be with a generic HR rep, so more customer service based questions. If you pass that, the next interview is with the medical director and they will run you through several scenarios. I felt very lost with many questions even just before I joined the ship. Not much in the way of a guarantee of a job (they supply the offer letter and obtain your signature upon joining the ship). Also keep in mind that this is WAY MORE than just a job. It will be a LIFESTYLE for a long period of time, and one that is far from what you are used to (living conditions, free time, food choices, luxury items, work hours, etc). You will be there first and foremost to WORK, not have free time. Also keep in mind that your scope of practice and job responsibilities as a paramedic will be NOTHING like here on land. There are no protocols for you to follow. You must get physician orders for everything you do. While you will respond to emergencies (few and far between for TRUE emergencies), the majority of your time will be doing sick call/clinic type work. I have also spoken with nurses who have worked the the company that utilizes paramedics. From what I hear, there is quite a bit of tension between the nurses and paramedics as the paramedics do not wish to function in the clinic environment and neither truly understand each others roles (plus the nurses feel like they are being "replaced" by the lower paid paramedics). I just urge you to think long and hard about this. It is a very big adjustment from "land side" living and American labor laws.

You are a pt advocate. It is perfectly acceptable for you to speak up in a professional manner. I have and will continue to do so for my pts. They are relying on us to do that! After reading your reply though, my bigger question would be why are they intubating a pt who does not appear to be in a moderate to severe amount of distress (granted that SpO2 is not great on a NRB and they will most likely decompensate shortly, all other respiratory signs don't point to immediate impending respiratory failure). From my experience, a little non-invasive support does wonders and can prevent the pt from needing intubation. Without knowing more particulars, as an ICU Nurse, Critical Care Transport Nurse, and Paramedic, the laryngescope and ETT would not be the first trick I'd pull out of my bag. I'm not sure how long you have been in the ICU, but experience will help you decide when and how to speak up. I love the doctors that I work with, but we are a TEAM caring for these pts. If one of us feels like there is a better/safer/more appropriate way, they need to speak up. I expect the same from my peers. When I function as a paramedic, my EMTs who function under me know they can and HAVE spoken up. Sometimes they see something I don't. Maybe I'm having a blonde moment. Or possibly it's an opportunity to do some teaching with them. Hang in there!

Sure!! Ask away!! as far as shifts, it was 24 hours on and 24 hours off. When I say 24 hours on, I mean I didn't get to sleep and worked for 24 hours straight.

Yup— been there, done that. You'll learn real quick that US employment standards are pretty posh! I worked 100-120 hours per week on less money than I made landside. Living quarters were tiny although not as terrible as the staff lower on the totem pole. You can get off in port as long as you aren't scheduled to work, attend training, or participate in a drill. As essential personnel, alcohol is forbidden and you are always on-call. It it may sound like I hated it, and that is far from the truth. I very much enjoyed it and am glad I did it. Just don't go into it thinking that it will be anything like when you are a paying passenger. You are there to work and are not granted access to the luxury amenities that the passengers are. A ship nurse does 99% primary care for crew members. The rest of your time is spent catering to the passengers minor (and rarely not so minor) injuries and illnesses. You also maintain and submit a ton of data for the Coast Guard and CDC. And the list goes on... That being said, I was better respected for simply being a nurse (by the crew, not the doctors) than I ever have been and most likely ever will. I met some amazing people from around the world that I never would have met otherwise. The limited amount of time that I managed to get off the ship while in port, I was able to take in some beautiful sights. I learned to live simply (very limited storage space and living quarters were about as big as the foot print of a king bed), to rely on my assessment skills (very limited diagnostic tools), and to appreciate the modern medicine that we easily have access to here in the US (nothing quite like debarking a STEMI in Hondoras to a BLS crew without any medical equipment and the closest hospital is a 2 hour drive). It was a long 4 months that I'm glad I did, but would not sign up to do again. I recommend that you do your homework. I sense that you think it will be a "dream job." It's hard work with little compensation and pampered relaxation doesn't exist. Feel free to PM me if you want more info.

Hind sight is always 20/20. It's not easy to turn off the criticism, but it sounds like you did everything you could to get him to take care of himself. Please know that you were a loving friend to him. I can't imagine the pain that you are feeling right now. I am also in EMS and a critical care nurse. I have coded the loved ones of close friends as well. It isn't an easy position to be in. From what you said, you did absolutely everything you could have with the supplies that you had available to you. Are you affiliated with the fire department or EMS service as an EMT? If so, they should have a counselor available to you (CISM). If you are not affiliated, there is a great resource, Safe Call Now (safecallnow.org), which is an organization that provides support to first responders. As as a nurse, you also have benefits through work. EAP is a wonderful benefit that many people forget that they have or are afraid to use. It provides (usually) 6 free therapy sessions per year. PLEASE take advantage of one of the above resources. This is the type of call that will follow you for a long long time. You need to take care of yourself and your baby! ((Big hugs)) from one who can relate. EMSnut

PLEASE don't call EMS providers "ambulance drivers!" I can run a full ACLS/PALS/NRP cardiac arrest and initiate hypothermia. I can RSI and intubate. I can perform a chricothyrotomy. I can rescue patients from any number of traumatic events and initiate stabilization. I can activate a stroke team at the receiving facility based on my assessment. I can interpret an EKG, identify changes (one of many of which is a STEMI), begin the ACS standard of care and activate the cath lab. I can deliver babies and initiate resuscitation if need be. Would you like for me to continue? For the 10 years prior to being a paramedic, I was an EMT. Yes, ONE of my responsibilities was to POSSIBLY drive the ambulance. But I did a heck of a lot more than that. My education STARTED with a course that took 200+ hours to complete and was required to take numerous hours of con-ed per year to maintain my LICENSE. I rely on my EMTs to provide care alongside me or to provide their own BLS care to those patients who don't require ALS care. EMTs are not just ambulance drivers. Oh, and by the way, I am also an RN. My paramedic training took just as many years to complete as my RN and included far more clinical time. And no, I did not take a bridge class. I sat through every second of both degree programs. Before anyone calls us "ambulance drivers," I challenge you to work just one shift in the back of an ambulance. I'm pretty sure you'd have a different opinion.

Precedex is not intended to be the sole drug for sedation when used for longer term (not immediately prior to extubation). By using precedex in addition to another sedative, the amount of that sedative can typically be reduced significantly (sometimes by 50-75%) to the point where the pt can be interactive with their surroundings. This info came from several inservices from a drug rep for precedex as well as personal experience. I've found it to be very effective if combined with fentanyl or versed pushes or low dose fentanyl or propofol drips. Also very useful to "chill out" the non-intubated ETOH withdraw pts. The only complaint I have about it is the bradycardia that it can cause.

"Sit down and critically think..." Ha! I wish! It's more like running like a chicken with its head cut off while doing ten things at once, keeping track of orders, vitals, drips, tests, charting, family, all while wishing you could cut yourself in two to be in both pts rooms at the same time (in the case of ICU, or 4-5+ pts in ER). Sitting down rarely happens in critical care or ER nursing.

You are very welcome, ICURNBSN!! I posted that four years ago and have made multiple revisions as my pt population changes. I have since worked in an "all in one" ICU and now work as a critical care transport nurse. I still use the same "brain!" I'm glad someone else finds it to be useful as well!!!

I always wear a suit. Studies show the interviewer makes their decision within the first 30 seconds of meeting you. Appearance is a major influence. Elude confidence (but not overly so). Remember your manners. Treat the receptionist well. Spit out the gum. Carry your own pen and a pad of paper to jot down notes. Bring a copy or two of your résumé printed on linen paper with references attached (the computer application generated resumes often are difficult to read and linen paper makes a nice statement). Afterwards send a thank you card-- not an email-- an old fashioned snail mail card (I usually write the note prior to the interview and fill in the hiring managers name and drop it at the post office on my way home so they receive it the following day). I have quite a few interviews under my belt from high school through now. I can count on one hand the number of interviews that did not result in a job offer.

It sounds like you are having a rough time right now. If you look around here on Allnurses and over in the Breakroom, you will find that many of us on this site have depression, anxiety, bipolar, and the list goes on. Having the diagnosis in and of itself will not hinder your ability to be a successful nurse, but you certainly cannot be successful unless you take care of yourself first, and this will take some work from several key players-- you, your husband, and your physician. It is a strong first step to creep out from the darkness and ask for help. I urge you to speak with your physician again about how you are feeling. Another great option is your employers EAP. It is a free benefit that usually offers several free therapy sessions and is totally confidential. If I could give a hug through the computer screen, I would! Hang in there and know that you are not alone!!

A co-worker called out because their "fish was sick." Seriously! Apparently it was some high dollar exotic fish that they had to take to a vet (didn't know vets cared for fish-- learn something new everyday) and give it frequent meds. They later brought the vet bill in to prove it, but they sure got razzed about it!!

They say an interviewer knows within the first 30 seconds of meeting you whether they like you or not. Walking into a room, they see you before speaking with you, so your appearance makes a strong statement in that brief time. I've worn a black suit for every nursing position I've interviewed for and gotten a job offer for each one. I often get comments about how refreshing it is to see an applicant dress in a suit. With my track record in this tight job market, I give a lot of credit to my trusty suit.

There are no questions regarding mental health when applying for or renewing a nursing license in Maryland. I've been a nurse for 4 years and a CNA for 3 years prior to that, and the MD BON does not have any information regarding my mental or physical health. Best of luck in nursing school!

UPDATE!! I recently returned from my first contract... boy does it feel good to be home!! Here's what I learned: -Even though you, as a nurse, are an officer-- which should give you additional privileges, it is entirely ship specific. The captain/staff captain can make or break your experience. If they respect and value the medical team, then you will be treated well. If they view the medical team as "just numbers," then you will be treated like crap by all of the shipboard management. -The majority of the job is ridiculous amounts of paperwork and crew primary care. Passengers generally stay out of the medical center unless they have legit complaints (I said "generally"!!!). -The comforts of knowing you have a fully capable lab, blood products, CT scan, fully stocked pharmacy, etc-- throw it out the window! Creativity and trust in your assessment skills will get you far. Trust your "nurse instincts." -Keep your mind open! Your fellow nurses and doctors will be from all around the world. You can learn a ton from them! -Be nice to the galley staff! They'll bring you all kinds of yummy desserts (all fat-free, of course!). -Find a friend and get off the ship whenever you can! It's easy to not even see the outdoors for days at a time due to the way you live on a ship and the lack of outdoor crew areas. When in port, use the fact that you work on the ship to your advantage! You can get very reduced and even free excursions, taxis, and admittance fees to various attractions. -Take lots of pictures and write down a little blurb about it before you forget! You'll see so many places and do so much that after 4 months, you'll forget all about it! -Go with a goal. My goal was to save as much money as I could so I could pay off some student loans. I had to remind myself of that all the time! There was so much cool stuff I could have bought! -Suitcases are HEAVY and expensive to bring with you. Pack the minimum. You can buy toiletries once you're on the ship. They take up a ton of room and weigh a lot. The prices in the crew mart are very reasonable. -Internet and phone calls are expensive. Prepare to go low-tech. -Most of all, have fun!! It's a once in a lifetime opportunity that I'm so glad I did!!

I took the advice of others and "practiced" a few days before-hand to make sure that lighting, clothing, etc. looked ok. The actual interview went well, it was much like the generic interview you would have with an HR recruiter. At the end, I was asked to interview with the Medical Director the following week. The Medical Director ran through a few scenarios, some of which were pretty intense! The combination of my EMS and ICU experience really worked well, although I leaned heavily on my EMS experience. Immediately afterwards, I was offered a position that starts in a few months and was told which ship I would be assigned to. There is a huge amount of paperwork that needs to be completed as well as a VERY detailed physical exam that I must have completed by my PCP (I believe I will get reimbursed for this once I board the ship). I have accepted the position, but I'm looking for the answers to a few questions that I'm still fuzzy about. I know the company does not deduct taxes from their employee's paychecks, so I need to figure out how I end up filing my taxes at the end of the year. I'm also unclear on what passenger areas are off limits to "officers" (since a nurse is an officer) during their time off. I don't want to end up being confined to my cabin-- some outside time would be nice! The itinerary for the ship that I was assigned to is fantastic! It will take me to places I have dreamed of seeing (even if only from through a window), but would never be able to visit otherwise. Thanks, all, for your words of wisdom! Mattfro-- I'd like to pick your brain about some of the questions that I have, but you don't have enough posts for me to PM you.

Welcome to all nurses.com!! You have summed up all of my (and many others here) complaints about our current healthcare delivery model into five short, but powerful paragraphs! I can't wait to see what else you'll contribute to our online community! If this article is any indication, you'll fit right in with us!!!

NedRN, you certainly don't have to worry about me weighing 300 pounds! I understand what you state about attractiveness, but I wonder how they could get away with such a subjective assessment when they state they are an EOE?

Yup, it's a video interview! I guess they are opting for video since their headquarters is halfway across the country from me.

I have just gotten the opportunity to interview via Skype for a cruise ship nurse position. I have never used Skype before, let alone have an interview that was not in person. I plan on doing a few practice trials with my family to make sure I know how to work Skype, and choose the right background and clothing. Does anyone have any other suggestions regarding this new way of interviewing? I'm also interested in hearing from others who have worked as a cruise nurse. It seems very hard to find any first hand info from those who have experience. Thanks!!

HIT= Heparin Induced Thrombocytopenia If HIT is suspected, a blood sample can be sent to lab to confirm or rule it out. OP-- A pending HIT test should be passed on in report. If not, you should have seen the order as you reviewed the chart with the off going nurse, or during your 12 hour chart check (something I always do at the very beginning of my shift). As a critical care nurse, you need to know your patients lab values too. This is something else I check at the very beginning of my shift, right after report. If I have two patients, I can do this in less than 15 minutes. If I have an inevitable emergency at change of shift, this is something I make a priority to do once everything settles down again. I consider it a part of how I keep a patient safe (what if the physician missed the K+ of 2.5 and by you looking, you can alert them?). Also, a + HIT should be a critical value that the lab should call and verbally report to the nurse as well. Does your hospital do that? It's hard to be new in the ICU! Hang in there!!

My greeting changes depending on if my patient is conscious or sedated/vented. Conscious patients-- "Good morning/evening, Mr./Miss/Mrs. [last name]. My name is [first name], and I'll be your nurse until 7a/p." I then address the visitors in the room and state any goals for the day. Sedated/vented patients-- "Good morning/evening [first name-- preferably the name they go by with friends/family], my name is [first name]. I'll be taking care of you today/tonight. You have a tube in your mouth to help you breathe, so you cannot talk and medicine to keep you sleepy. Your hands are tied down to keep you from pulling out these very important tubes/lines. You are very sick with _____, but we are taking good care of you to help you get better. I talked with [spokesperson] and they will be coming to visit later today /OR/ [spokesperson] was in earlier to visit and went home to ____." I think it is very important to keep sedated patients as oriented and aware of their surroundings as possible. How am I to know if they are worried that their dog is at home alone and hearing that their neighbor just went home to let them outside is a big relief (True story! Very agitated sedated patient calmed right down after saying that!)? I also hold their hand as I introduce myself to them. Introduductions to these patients (in my opinion) are a very big part of gaining their trust and the trust of the visitors in the room. It's also a good time to assess their response to stimulus. I know I won't respond to Ms. [last name] or my legal first name-- that stuff is reserved for when I'm bad!!