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!!