freedom22

I have been trying to apply without success in my hospital for a position in the ICU. I currently work in intermediate care, have excellent references, a great reputation and Im involved in many committees. However, when I interviewed for a position for our SICU I was denies the transfer because I admitted that I just stated NP school. Last Wednesday I interviewed for a position to our MICU- the interview went well, but when they asked if Im in school and I said yes the look in their faces was not good. Now I havent heard from them and I spoke to nurses on that floor who stated that I wont get the position because Im in school. What can I do about this? Should I drop out of school? Should I call the manager and try to argue my position- Im only in school one night a week and wont graduate for another 3.5 years. Please, ANY advice would be appreciated!!

infectious disease is on the case, of course. Im just writing this because its been so many weeks with this pt and I was hoping someone has seen some kind of unconventional treatment work. I really want her to get better.

My patient is bacteremic. This has been going on for weeks and every time we try a new medication she becomes resistant to it. Yesterday her C&S came back and she is now resistant to everything! She is resistant to all penicillins, cephalosporins, cyclines, levaquin, amikacin, meropenem and the list goes on. I really really care about her and feel so sad for her. She is young, A&Ox3 and the nicest woman I've ever taken care of. We think we know the origin of the infections but are unable to operate untill the infection is under control. So its a lose-lose situation, because the origin remains, and that results in infection, which prevents us from removing the origin..... She's had so many tests, multiple indium scans.... In a cases like this, what would be the next step to treast the infection????

Thanks for your responses again! I did chart "private CNA" but will make sure to chart "caregiver" if such a situation comes up again.

Thanks for all your replies. Im assuming that the aids are all privately hired since an agency was never mentioned. The aids were at the bedside 24 hrs even though the patient was on our intermediate care unit. Our social worker separately set up a home care agency RN to visit the patient every morning. In my charting I documented "Pt's private CNA at bedside "Renee" verbalizes understanding and demonstrates correct clean technique"..... Hope it's ok. Im a little nervous!

i did ask "what is the next step". the nm said "we will contact you early next week" which was this past monday/tuesday i assumed.

I had a patient who has been trached/pegged at home for 2 years. His 2 CNA's (awesome smart ladies) were taking care of him, doing all suctioning, trach care, tube feeds. I assume theyve been doing a good job because there have been no reported problems, such as infections, aspiration... When I discharged him, I gave the CNAs written instructions on trach care and tube feeds. I also demonstrated again, had them verbalize and demonstrate safe technique, including emergency interventions. Now my question is, isnt trach care and PEG care supposed to be done by a RN? Am I allowed to chart that I taught the CNA how to do it. (A home health RN visits the pt. every morning and is available on call) It seems like what I did was wrong, but then again, I have taught family members trach care before as well!

guess I'm concerned because the recruiter was so on top of things every time I emailed her or called before the interview. I think something is up! Also, the manager ignored my follow-up email after the interview.

PLEASE offer your advice! I have worked at my current hospital for 2 years now. I absolutely love it and am very involved in a number of committees, have done unit in-services.... I have received only positive feedback from my old manager (now we have a temp. manager) and all the time from patients and their families. Though I love my unit, it is highly time for me to advance to ICU as I always had planned. Recently, I contacted our recruiter and he set up in interview with the manager at the ICU where I really wanted to work. He said they have an opening and responded to every one of my phone calls and emails within the same day. I then met with the manager 1.5 weeks ago. For some reason, I simply did not perform well on the interview. However, I really still want to work there. After the interview, I sent an email to the manager again confirming my interest and how I enjoyed meeting her and her staff. Ever since, I have been trying to contact the recruiter since he is supposed to give me the word if I got the position or not. He has been entirely ignoring my voicemails and the email I sent. Its been 1.5 weeks now and Im so worried. I really dont know what to do next, who to contact... I really want this specific ICU and want to stay at this hospital. Any ideas on how I can proceed now?? Should I call the manager herself? Or wait more for the recruiter???? Thanks!!!!!

What an idiot!!

another issue we face is that our doctor's like to maintain control of their pt's as long as possible. When they go to ICU, the ICU team takes over by us and the primary doctor becomes a consult and cant even place orders. So to prevent this from happening they push the pt to our unit first.

Thanks for being honest. The problem was that ER reported great vital signs. That's s/t we do on our unit- i.e. take pt's with decent vitals and suspected sepsis. I usually get them to out unit, bolus them aggressively, start abx... and they almost always do well after the initial day. We usually run after the MDs untill they give us adequate fluid orders.... before the pressure drops, and the pt's tend to stablize. However, in the case I listed above as an example, over the last 6 months, ER keeps on giving us V/S that sound great. But when the pt comes upstairs, they crash. Maybe out ER nurses know that an ICU bed is difficult to obtain. When we get a call from the ER we try hard to open beds- see what pt can be moved to a med/surg floor... So ER knows we take pt's sooner. Or maybe they dont have time to take vitals all together? Anyhow, as soon as the pt got to our unit, the charge and I kept calling the MD saying he needs ICU. They doctors were less than helpful. At some point, the MD said, "the longer you keep me on the phone, the longer it'll take me to come up there." So we called his senior..... Apparently he was rounding on his pt's on the med/surg floor- a sure priority in this situation! After about 40min we got the ICU doctor from our SICU over to assess pt, but didnt want to help Tx him because he's only a consult. They refused the pt since it was a medical case. So we called MICU who opened a bed by transfering a pt to another step-down area. Finally, after about an hour the pt's MD showed up with his senior.

What does your protocol loook like?

This is not the first time I received a pt with such a scenario fromt the ED. Doctor asks us to take pt ASAP, since pt is possibly septic and he's had to personally hang fluids in ED because the nurse there seems to be "too busy". I work step-down, all pts on cardiac monitor, we do alines, drips.., but to a point- I have 4 pt's. Doctor assures us pt does not require ICU care. I call for report at 1700. Pt had been in ER since 1300 but only received 1 L out of 2L fluids ordered. Oh, only one IV access, so fluids where stopped while zosyn infused. I get last set of vitals (that the nurse "just" took) HR 98, SBP 110, 100%spo2 on RA... The nurse than asks me if I can come get the pt. Um, I assume care once the pt gets to my floor. Since when do floor nurses have the leisure to come get their pt's.?? She than asks me if the pt should come on cardiac monitor. I explain that we're a monitored floor, so probably yes, but it is her judgement call- I havent assessed the pt yet! 20min later, I look up, escort dropped off pt on a stretcher, no RN or MD or monitor. Pt looks pale, obviously very sick. Get my charge, get him into bed, hook him up to all fancy monitors. My first set of vitals: HR 130, BP 72/49, Spo2 98% on RA. 2 L bolus, insert another access BP does not increase. Pt is obviously septic, febrile, c/o of SOB, dyspnea. Poor clinical picture. Now running fluids wide open in both 18 G IV's. Finally, MD agrees to come see pt. I insert foley, set up Aline and CVP monitoring, MD inserts Aline and Central line. Pt is dyspneic, desatting to 80's by now on 6L NC. Albumin seems to help a little. For some reason, (maybe ICU nurses can explain here) glucose is 40. 3 hrs later, after 5-6L (not sure, just kept on hanging bags), Albumin, foley, central line, aline, 100% NRB, 50% dextrose for glucose level, ABG, full set of labs sent, Neo drip set up to ready to start, and much more, now mildly confused pt is rushed over to ICU. (I had 3 other pt's that I simply ignored this whole time) HERE'S MY QUESTION: This is not the first time that in report from ER I got a perfect set of vitals that totally doesnt correlate with the vitals I get on pt arrival. Did this pt's BP drop from 110 to 70 and HR increased from 98 to 130's in 30 minutes??? Yes, septic shock happens fast, but when I see this happening to ER pt's often, should I start thinking that nurse in out ER are doing s/t wrong? What else can explain this. Second, do our ER nurses only see crashing pt's as sick? ER Nurses need to be educated that in suspected septic pt's, fluids must be started STAT, even if BP is ok. In early stage of septic shock BP often looks fine do to endotoxin effect on the CO. When the BP drops thats when its usually too late. The above pt, in his late 30's didnt make it. Went into MODS... I truly regret not calling for report earlier (shouldnt have done so much teaching with my discharge pt earlier....)

Yes, nursing is more holistic based, but "Happens to include the body"??? Maybe that can be said for bedside nursing, but for a NP who has to dx and prescribe as well, thats so sad to hear you say this.

actually I dont mind nursing research- its really important. One theory class is also improtant so you have a solid foundation. But Im talking about my other 3 classes, decision making, nursing trends, and social policy. Each class has like 5-10 major papers and so much work, which I would welcome if it helped with practicing as a NP and caring for patients or understanding social issues. I can replace each with an advanced clinical class and be a much better practitioner. Atleast replace it with something like advanced therapeutic communication... These 3 classes should to be electives!

What school are you at and what NP program is it? If you dont mind me asking.

Thanks, but I think 2 theory based classes would be enough, and then they could build in leadership prinicpals in the remaining classess. 5-6 such classess is whats driving me crazy!

Lisa, Thanks for your response. All in all, do you feel NP school covered enough in depth clinical knowledge needed to diagnose, treat and prescribe? What kind of NP did you get?

I think that the nurse should have assessed the pt not just the monitor. If its a mucus plug issue- suctioned pt, given nebulizer Tx to break up the much plug (no order needed for saline nebs and works great), raised HOB, increased oxygen flow temporarily atleast, and helped calm the pt. Also trach teaching for the pt and caregiver would be indicated. I would never work at a place that makes me call a RT to do any of the above. How shameful to nurses! The fact that she stood there for a minute tell me nothing- ie she may have just been thinking through in her head what to do, who to call...

I was thinking about CRNA school more seriously recently, but I cant bring myself to give up that pt relationship. I want to have relationships with pt's- follow them over the course of their illness. My dream is to work for a cardiology or CT practice and also round on pt's in the hospital. If I were to go to medschool I would certainly become a cardiologist. This is why I never worked ER.

First, let me tell you about myself. I love nursing, the interactions with patients and even sometimes dealing and solving difficult family situations. But, more than anything, I love and am passionate about the study of human physiology, diseases..... I love to understand a disease, why it is treated a certain way, how meds work... So I was sooo looking forward to starting NP school. Now, once in the program as a Part time student, I realize that I will be spending the next entire year learning about nursing theory, statistics... and nothing related to clinical medicine. I am a clinical person and am dreading this year. I looked at many other schools and thier curriculums all include these annoying classess (annoying for me). Then I looked at medschool curriculum and it starts immediately with really interesting clinical classes such as advanced A&P, patho.... All my coworkers are pushing me to go to medschool since they say Im very passionate about the clinical aspect of medicine. Now Im sooo lost. Anyone else felt that NP school included to little clinical classes? Any advice?

My real question is where will I learn the most- in terms of critical care knowledge, cardiac knowledge, and skills. I do have surgical skills, but dont mind learning a whole new set of skills if necessary.

Im a RN with 1 year surgical step-down experience.