RNMeg

At my facility we cannot push propofol under any circumstances - a nurse actually recently got fired for doing it. We can push anything else under the sun, though, it seems like - etomidate, fentanyl, versed, paralytics. I've not seen ketamine used much outside OR here. We can run propofol drips, too, on the Alaris using guard rails and we can titrate based on RASS score per the orders.

I'm surprised to read all these responses saying critical care nurses are not compensated extra where they work. Many specialty areas in my hospital are starting to get a $2-3/hour differential, including ED/OR/PACU/critical care. We do have a HUGE problem with RN retention, though, which is probably the reason for the "raise". Most hospitals in my town seem to offer this. For what it's worth, we're a nonunion state for nurses.

I took the FCCS course after working in my combined NeuroICU/MICU/SICU for a little over 2 years. I felt it was valuable, especially as a new-ish ICU nurse, but I don't have any certifications or other courses I've taken that covered the same material. Also, the providers (ACNPs and MDs) who put on the course also work in my ICU, so I knew them personally and had a good rapport with them, which made it more enjoyable. I did find the skills stations/megacode type situations to be a bit over my head as a bedside RN, though.

We had a crazy occurrence in my ICU. We have windows between our patient rooms so that, if we are in patient #1's room, we can see the patient and monitor in room #2. All nurses are familiar, I assume, with the practice of opening a window after someone passes so their spirit can escape the room? And sometimes we open them early to "encourage" patients whose bodies are done but their spirits hold on? Well, we had one such patient.. but we neglected to open his window. He passed late one night, and at the moment of his passing, the glass between his room and the next shattered. We never forget to open windows anymore.

I am currently in year 2 of a 4-year contract with my employer. They paid for my BSN in full, and if I should leave before my contract is up, I just have to repay a prorated balance. Otherwise, I am treated exactly as any other employee. I was given my choice of department to work in and I was permitted to change jobs within the facility (I start my new position in ICU next week!). This was a good career decision for me, but only because I was agreeable to the terms of the contract. I would recommend going in with open eyes :)

It sounds to me like you did everything you were supposed to do. PCTs as "runners" during codes are the best, because you know where everything is on the unit and can get it quickly because, as you said, every second counts. Most codes are chaos at first, and then our training kicks in and things move more smoothly. If the patient was able to be resucitated and had stable vitals when they took him to ICU, he may well make it. I've seen patients with pulmonary emboli do just fine, although it does depend on where it is in the lung. It's okay to feel upset or sad when you code a patient, especially if it's someone you connected with. It sounds like you had your "moment" after the code and then were able to continue your shift and meet the needs of the rest of your patients. That is the mark of a true professional. Well done! :redbeathe

I was in a similar situation. The patient had a No Code order, but was clearly septic (tachy, hypotensive, diaphoretic, source of infection, lactic and white count through the roof, etc). She was declining steadily on my shift, and I was torn. Do I call the doctor and initiate severe sepsis protocol (which would likely end with her intubated), or do I allow her to continue declining? I went with my gut, called the doctor, got some orders that would stave off some of the worse symptoms without doing SSP, and as I hung up with the doctor she died. I was glad I at least called and got orders, even though in the end it was futile. That was an awkward call to the doc 10 minutes later, though.

That policy is scary, and frankly, the nursing home is opening themselves up to a lot of liability if a full code patient arrests and compressions/intubation/code drugs are not initiated per their wishes. As another poster asked, are family members and patients made aware of this policy? The policy basically says that all patients admitted, regardless of their wishes, become DNRs upon admission. I have not heard of any healthcare facility having a policy like this and can't fathom the facility's reason for having that policy. You seem to think it's a money issue, but it seems to me they would make more money from living, resuscitated patients than from dead ones.

I work, in general, to pay my bills. On a day-to-day basis, though, what motivates me to get out of bed and go to work is a desire to not leave my coworkers working short (or in a bind to find a replacement charge nurse, because there aren't many of us on nights).

I had an awful dream the night before my first shift on my own. I dreamt that my assignment consisted of 10 dogs..and a baby. It was nuts. I spent the whole night trying to figure out how to pass meds for all those dogs, and how to keep them in their beds. Also, I take care of adults..babies scare me

My very favorite..insulin drips for DKA. Checking blood sugar every hour on the hour makes the night go by so fast! Plus they're usually younger and walky-talky, which is getting kind of rare on my unit

Yes, especially if I'm getting report from a nurse who tends to give..anecdotal report ("He's just the nicest guy, can't say he's not, his wife was in earlier and they told me all about their grandkids and she gave me this recipe for blueberry cobbler and...") Just give me the assessment rundown and the plan for tonight, kthx.

Bloody teeth gets me. On film or in person. I could have never, ever been a dental hygeinist.

My final project as a senior nursing student didn't go very well. It was a public health class, and we were a group of 10 with massive senioritis..we just wanted to graduate already. We turned in a project that, frankly, we were not proud of, but we felt it met the minimum requirements and felt pretty decent about it. Our instructor disagreed. She spent two hours dissecting our project, berating us for every little thing. We were feeling pretty low by the end, when she announced our final grade..a B. To this day, I can't figure out the purpose of yelling at us for that long, only to give us a B. I guess it made her feel better.

Some people may also be referring to tuition reimbursement/payment contracts. I have one with my hospital. They paid for my BSN, and I have to work for them for at least 4 years. If I break the contract, I have to pay back the balance.

Can you transition to Gyn oncology? You would still be working with a population you're familiar with in a reproductive context, but it would incorporate your interest in oncology. From there, you might be able to transition to more general oncology after you familiarize yourself with cancer treatments/drugs.

Your questions about the admissions process and prerequisites really depend on the specific school you want to apply for, and would best be answered by the school. There are 3 or 4 colleges of nursing in my city, and every one has different admissions criteria. There really isn't any such thing as "specializing in trauma" in nursing school. You take general classes in each aspect/"specialty" in nursing (pediatrics, labor/delivery, public health, med/surg, etc), graduate, and pass the NCLEX. Then you get a job in a specialty. Hope this helps Good luck on your journey!

I actually wouldn't be that concerned about a COPDer satting in the high 80's..they need a lower O2/higher CO2 to keep their respiratory drive alive. That said, I'm sure they drew ABGs and did other assessments during the rapid response, so obviously something was going on. If the patient is alert and oriented, and understands the consequences, he has the right to express his end-of-life wishes and refuse any medical treatment he wants. I would have allowed him to pass peacefully as per the wishes he expressed.

In my experience, Ambien and IV pepcid are bad for elderly patients. Like another poster said, instant dementia and a HUGE fall risk. My unit manager banned IV pepcid on our unit because of this effect.

I'm 7 weeks pregnant with my first, and I wouldn't have known except that I took a test on a whim. We were trying, so I had a bunch of pregnancy tests around. It was less than a week after my last "period"..which I think was just spotting because it was short and really light flow. I'm having no early-pregnancy symptoms whatsoever. I almost can't believe it, but the tests keep coming up positive! :redbeathe

On my unit, the CNLs basically equate to charge nurses. They occasionally take patients and work the floor, but they usually work in a charge nurse role. They're not really paper-pushers, though..they do rounds, start IVs, handle staffing, coordinate admissions and discharges (bed control), act as clinical support for those of us doing direct care, that sort of thing.

I never used to get massages. Now that I'm working 3-4 12's in a row, it's almost a weekly requirement. I go to the kiosk in the mall, where they do a 20-minute massage for $20..it erases all that back strain from being on my feet, boosting patients, and leaning/reaching around telemetry equipment

As a student, I wish I had paid more attention to the unit routines. I think I would have been more confident if I knew what I was supposed to be doing at any given time. Also, I was kind of scared of "difficult" patients as a student (vents, especially). I wish I could tell myself to get over it, because it's not that big of a deal for me now.

I'm a new grad, not in a residency program, but I am under contract with the hospital that employs me. I am required to work for 4 years to pay the hospital back for paying my tuition. My husband and I have recently started trying for a baby, and I understand (according to co-workers who have been through it) that their system is not sophisticated enough to "pause" my payback schedule during maternity leave, so I won't have to tack extra time onto the end of my contract. Your mileage may vary, though, since every contract and hospital is different. :heartbeat

mentalhealthRN, do I ever wish we had a system like that! It would solve SO many problems. My hospital is broke as it is, though, so I can't see it happening any time in the near future.