Dakeirus

Once a upon a time, I put the mattress of a stretcher on the floor for one of our cray cray patients who kept trying to get out of bed. He rolled around that mattress all night and the 1:1 kept him from crawling out of the room. He didn't fall and we didn't have to constantly go to the room trying to wrestle him and keep him on the bed.

Sure, I am all for that. But there's a difference between someone calling me from the OR saying "Just an FYI, the patient who's about to come out is HIV+" and "You absolutely need to wear gloves. This patient has HIV." Ermagard, let's wear hazmat suits!! The sad part is they say it out loud in front of the patients like they're, as you put it, some sort of leper. I've had a nurse question me on why I was touching an HIV+ patient without gloves when I was merely talking to her and only touched her shoulder once. Seriously? And when she wanted to shake my hand and thank me for taking care of her before sending her off from the PACU, was I supposed to say, "Hold on, let me wear some gloves first. OK, now you can shake my hand." Honestly, I'm more worried about bringing home Cdiff whenever I work in the MICU.

Having worked at multiple hospitals, I can tell you that this notion of putting on gloves just because someone is HIV+ is still pretty rampant. I've heard it from nurses, nursing assistants, CRNAs, and yes--even doctors. It's pretty freaking moronic and ignorant. We know a whole more about HIV now than we ever did in the 80s. Nothing ticks me off more than someone telling me to put on gloves as they signal me that the patient is "high five". We place patients all the time on the monitors without putting on gloves and then all of a sudden, I have to for this patient? Really? I just stare at them and ask them why. And if they tell me it's because the patient is HIV+, I ask them "Can you please remind again how HIV is transmitted?"

I've been lucky in the ICU since we are generally exposed to everything. I can tell you though that I've lost my mind (or more like burnout) a few times working in the unit.

As someone who has multiple per diem jobs (but still work a full-time), I can tell you there are some benefits to it. -Pay rate is generally higher than a regular staff. If you're relatively healthy, the pay will offset calling in sick a few times per year. -There are facilities that will allow you to contribute to a 401k/403b as a per diem. I work in one of them. If not, so what (unless your facility offers matching)? Set up an IRA/Roth-IRA account. My fulltime job gives 1 year credit for vestment in our pension even to per diems as long as you work 1000 hours/year. Find out what benefits you'll retain from HR. -You can set your own schedule. At one hospital, I only work during the week. In another per diem, I only work on the weekends. You can use this to your advantage if you have kids or need a whole chunk of days off together. If you're scared of getting cancelled or floated all the time, put yourself on the days that you know are the busiest or the days when nobody wants to work. -If you know want to go on vacation for like a week, work 4 days/wk the month before to make up for the lost income, etc.

Don't feel bad. We've had new grad in our ICU do orientation for 9 months. As alarming as that sounds, it really isn't a bad thing. But my manager had the budget to spend and the nurse has been working in our unit for 5 years. I, myself, had to be on orientation for almost 4 months coming from the floor. As a new grad, you not only need to learn the basic nursing care/skills typically learned on the floor--you also need to learn critical care and how to manage your patients. That can be very overwhelming. Take the PCU position. Learn everything you can in 1-2 years and apply again.

There are some hospital PACUs that are also closed on holidays/weekends. Finding it is the problem. There are PACUs that will hire new grads or floor nurses but it will be hard unless you know how to sell yourself or know someone. PACUs generally like hiring ICU or ER nurses because the transition is a lot easier. Depending on the facility, most of the time, the patients recover okay with no issues. But then there are patients who will obstruct, go into a laryngospasm or just really crash on you. And you need to know what to do. That is when critical care experience is really valuable in the PACU.

Hard to say without a full background. Some chunk of the HR is probably caused by the levophed. Can they be switched to a phenylephrine drip?

My two loves: ICU - If they're sedated and vented, you just come to the room and do your thing. PACU- Most of the time they're too drowsy to talk to you. And if they're chatty--ask them if they have pain so you can put them to sleep with some dilaudid.

Why do people keep thinking that the ICU is be-all and end-all of nursing? It's so dumb. Different specialties require different set of skills and learning curves. If I were to suddenly transfer from the ICU to L&D, I would be freaking lost and would require months of orientation. If you were to float me to the floor out of nowhere, I'd freak out. Nurses (who have been there for decades) in my ICU get stressed out the moment we're short and they have to take 3 patients. I can't imagine just suddenly floating to the floor and taking 8 patients when I haven't worked there in years. I wish people would wake up and see this.

What the hell? Why do you think I went to an expensive college to get my BSN? I deserve better than to clean up somebody else's poop. It's too nasty.

Wanting to not work at the bedside is fine and all. But, before you went to nursing school, did you even look into how you're going to get a research position right after graduating? Or did you just think you were going to get a nursing research job right off the bat, if that was your ultimate goal? I don't know about other states, but a quick search in NY's major hospitals alone will tell you that you need years of clinical experience before you'd even qualify. That is, of course, unless you have connections. :no:

It was always my DREAAAMMMMM to work in the ICU and be the coolest and most knowledgeable nurse in the world unlike those floor nurses, who only know how to give meds. How awesome is it to have only 2 patients, clean **** 50-75% of the time, turn patients who are more than twice your size Q2H, and clean more ****?? And the best part is... you get to do it all by yourself because your PCA only works 3 days/wk and is not on your weekend!! :) Oh, and your coworkers cant always help either because their patient is actively trying to die on them. What an absolutely cool and glamorous job!!!

I have a question to nurses who take call in states where it's illegal to work more than 16 hours in a 24 hr period. If you work a 12 hour shift and you're on call right after that shift ends--then it turns out that you do get called in 1 hour later--would you need to be relieved if you end up needing to work more than 4 hours after?

Just a little background--I've worked Med/Surg for over a year and I am currently in an ortho unit and work per diem at an outpatient EENT department at another hospital. I was talking to one of my seniors who encouraged me to work in the ICU for a few years before "settling" down. She said that the ICU experience will take me far and that I don't want to be stuck in a specialty for the rest of my career considering today's economy. She told me that things might change in the future and that at least once you have the experience--if you end up looking for another job you can say that you have a solid ICU experience. It does make sense to me. But the thing is, I've come to realize I don't really like the floor/inpatient setting and I have no interest in critical care at all. I love ortho. But who knows? I might end up getting bored of it in the future? I don't know. I really like what I do also in my other job at an outpatient setting and have come to like ambulatory care. Is working a specialty for years that bad if you like it or should I really consider sucking it up and work ICU for a couple of years despite my lack of interest?