NoviceToExpert

Dennison's CD for practice test questions is invaluable... and the book itself is an excellent reference... I keep mine in my locker... Yes, it's dense, but you should not expect to learn everything in it for the CCRN... use it to supplement your identified weaker areas... Ed Woodruff's review is good as well... as is the AACN review. Good luck!

Hey Xigirs, I sent you a private message. M

Hey Xigris... Are you able to maintain CCRN-CMC-CSC through your clinical hours as a CRNA? I see on the AACN website nurse anesthesia was counted... but I know a lot of CRNAs let their CCRN and subspecialties lapse because maybe they didn't know better... I had intended to keep mine as a CRNA but when I come up for renewal I'll have already qualified for my first three year round after anesthesia school... I'm planning ahead already for the renewal after... The hospital I plan to work after anesthesia school has CRNA Cardiovascular team...

Yupp... totally serious... Congrats again!

By the way, Intra-aortic... I just found out from AACN that there are only 129 (including you and me) nurses nationwide that hold both the CMC and CSC credentials simultaneously... something to be proud of for sure... Congrats!

I had read an anesthetist post some advice on the topic of being the goat...he said that one particular MDA suggested that he "think of everyone [who acts in an abusive fashion] as mildly retarded...!!!" This way it helps diffuse the assault and may even allow you to keep your mental teflon suit in tact...letting everything roll off your back... easier said than done, but I like the quote... and I've found that it actually does help... so KEEP GOING!!! One day at a time!!! Anesthesia school, like nursing school, is but a brief moment in the big scheme of your career... it will pass... :anbd: Of course, after I start my program I will probably be scrambling to get back to this post to listen to my own inexperienced advice if I have any similar experience... I hope it's your program and I don't encounter this... geeezzz... I heard about a couple of programs near me that were like this and didn't bother to apply... luckily I got into my first choice where all students I've spoken with who are in or who have recently completed the program have only good things to say...

ECCO can be very informative... However, the modules, if you do them carefully, take much longer than specified... My issue with ECCO (aside from typos here and there and the occassional miskeyed answer) is that it is completely non-printer friendly. If you want to print any of the information you have to print screen it rather than print page... in other words, you have to scroll down on the text and reprint the screen shown in order to capture all the text... it wastes a lot of paper and a lot of ink... I found that to get through the modules at my pace it was better to mute the sound and scroll the text and read myself rather than listen to the voiceover... In general I thought it was worthwhile, but feel I could have gotten a lot more out of it in a lot less time if it was formatted differently.

:ancong!: That's just awesome, Jake. It's a great feeling, isn't it?!!! ps... if you look on AACNs website for proper use of subspecialty initials... they want them hyphenated after the CCRN... as in CCRN-CMC-CSC... just so you're "in the know"... How great... Congratulations again! Good Good Good for you! Yipeeeeeeeeeee

The CMC and the CSC are cardiac subspecialty certifications... they stand for, respectively, cardiac medicine certification and cardiac surgery certification. They are separate examinations that have different criteria for eligibility. You can find information on AACN.org for all of this. There are presently under 500 CMCs in the United States and under 700 CSCs in the United States. I believe for those taking the subspecialty examinations in this area of expertise the pass rate is about 80%. You must be CCRN certified to take these exams and also meet the clinical practice criteria as well. Thanks for asking!

I have some things to add... since I was in your shoes... I lived through one heinous orientation... My second week I was told, "As long as I'm your preceptor...you're going to be my b*tch!!!" It went downhill from there...and the comments stayed the same... I could have actually sued her and the hospital for a clear cut hostile work environment. I finally, after a year and a half, left my unit and went to another ICU. I put up with it but cried many nights, hated going into work, wanted to quit all the time. I knew it wasn't me. In the last six months, 7 day-shift nurses have left the unit. I snagged another critical care job in our hospital on a unit where a day-shift slot only becomes available every three years...yet there's a "nursing shortage" down the hall on my old unit... administration hasn't ever questioned this... go figure... I was afraid I'd lose my job if I reported her... I found many errors on my orientation (like autotransfusions running directly without a filter...) We have an error reporting system that is anonymous... I was told if I reported anything "they" would find out who did and it would be the quickest way for me to lose my job. I was told perform MRSA swabbing "very lightly" so my preceptor wouldn't "have to wear plastic all day..." I was told "You can't multitask... but don't worry, you'll never be able to because men CAN'T multitask..." I took a scholarship from the hospital and wanted to fulfill my contract, although I could have had it null and voided because of the experience had I engaged an attorney...I probably could have retired on that. But I didn't want to take that route. I can't say I recommend sticking it out in a toxic environment. I can say you are not the only one having a terrible first nursing experience. I plugged away and dealt with it. In under two years I had my CCRN, and then my CSC and my CMC and I am now the only nurse in the hospital who is CCRN-CMC-CSC. I am going to get the last laugh because I just found out two days ago that I was accepted to anesthesia school at one of the country's top programs. "Ciaoskis" former preceptor!:chuckle "I'll be seeing you layta!" You are not alone in your experience. My issue was this... it is hard to get anywhere being in the position of putting anyone else down. I felt that if I tried to interview for another job I would have to say "why" in an interview... and then I would have to disclose my situation... and in doing so, I thought it would just make me look bad...leaving the interviewer to worry if it were me or if it were really the hospital (maybe I'd be seen as a complainer or problem)...so I figured I'd wait and then have my experience and a clear cut transfer/exit strategy after being off orientation. Then when I got off orientation everything changed. I still had problems with her... but they were minimized because I had my own patients and developed strong alliances with other supportive nurses who served as my resource. Then I started working my schedule opposite hers so I could minimize my contact with her. That made a huge difference. Because of the poor quality of my orientation and my strong desire to learn I did a lot of the orienation myself. Make a list of all your equipment and manufacturers of such... we use Edwards swans and arterial line sets, we use Datascope IABPs, we use NxStage CRRT, we use Atrium chest tube set-ups. Go to all the manufacturer's websites. Example: edwards.com, atriummed.org, datascope.com, nxstage.com...These companies all have inservice audiovisual training via the web... go to pacep.org, atriumuniversity.com... You will learn more from the manufacturers than any preceptor. A lot of nurses do things the way they were taught because that's how "we always did it." However, you will find a lot of manufacturer's recommendations are different. I do it the way the manufacturer recommends. Soon I had the sane nurses asking me about equipment. I was teaching them. I made a habit of everytime I opened a piece of equipment, whether an autotransfusion pack or an ETT hollister, of putting the manufacturer's pamphlet in my scrub pocket, keepin it in my bag with other resources and taking it to and from work with me. I'd read them thoroughly at home. You'll find no one on the unit has ever read them... and chances are you will learn something about the device that is unknown to other nurses on the unit. It all comes down to how good you want to be. You are in a terrible position. That resonates with me because I was in the same position. If you want this bad enough and are not going to another unit or hospital...you will need to take responsibility to educate yourself to make up for the inadequacies of your hospital's culture. You'll end up a better nurse in the end. Finally, in January, JCAHO is requiring that there be in place, at all accredited facilities, a disciplinary plan for toxic behavior among healthcare team members whether horizontal violence among or between nurses or anyone else up and down the medical food chain. You can find this on JCAHO's website. You may want to float this by the CEO of the hospital... maybe they don't know about it yet. They will not have a choice in compliance if they want to keep their JCAHO status. Enforcing it is another story... but at least you can make sure the hospital is ramping up to deal with it. Best of luck to you. You have my support whatever you decide. But if you stay...just know this orientation process is going to be, in the scheme of things, a very short time during a hopefully long and successful career...I chose to get the experience I needed and then moved on. You may move on earlier... but ABSOLUTELY DO NOT let a nasty nurse or toxic unit pollute your enthusiasm for the art and craft of nursing and/or critical care itself. Know it is not the norm, and when ready, seek out another unit... despite what they tell you... it is NOT the same everywhere!!!!

GPA 3.93, GPA 4.0, GPA 3.88 No GREs, waived because of GPA 1.5 years CTICU Now MICU/SICU/Trauma unit CCRN-CMC-CSC

:ancong!:

:ancong!:

:dncgbby: :ancong!:

Hey ghillbert... I wrote a little more of what I thought of the CMC and CSC certification exams on the CSC/CMC thread... if you can't find it let me know or if you have other questions after finding that thread let me know... pm me... I follow your posts and you will obviously have no problem passing either... I can tell you what study materials I used... you should definitely go take them! There are less than 500 CMCs in the country and less than 600 CSCs. I believe the pass rate for CCRNs taking these exams is somewhere around 80%.

I agree with all posts on here... but remember, it all depends on pt Dx... if you are talking about certain myopathies and diastolic dysfunction the picture changes, if you are talking about CABG pts, you have to worry about grafts with high pressures... what if you titrate to your MAP and your systolic goes out of range based on that pt's particular hemodynamics?... Sometimes it's a problem keeping both parameters above the prescribed low end if one rise too high, especially as your circulating volume changes in relation to your preload and/or SVR treatment... then, in addition, there is the issue of watching trends in parameters... widening or decreasing pulse pressures (maybe if you are only watching your MAP you won't notice these if the MAP remains fairly stable)... pulsus paradoxus, tamponade, etc. etc... You have to keep an eye on all three parameters SBP, DBP and MAP and consider those in relation to the pt's condition to guide your assessment, titration and plan. Watching these trends all will help you catch difficulties early. I commonly have orders that specify for titration to both SBP and MAP as mentioned above in another post... I sometimes have order sets on stent pt's to watch SBP and MAP and when I call the physician because the MAP is under 60 for a certain time interval I get asked what the pressure is and am told "don't bother me with the MAP if the SBP is over 100," (go figure....this physician didn't even know the order set he signed... he's an invasive cardiologist, so what does he care about the kidneys?...not like he gave his pt contrast or anything and the kidney perfusion is important...argh!)...then there is titrating to the AUG on an IABP...I wouldn't go by one parameter across the board of the pt conditions we handle on our unit... it is all case specific...and I try to keep in mind that generalizing may get me and my pt into trouble...

Congratulations!!!!! :ancong!: I started in CVICU right out of school... I am now, in less than two years, the only CCRN-CMC-CSC in my hospital. It can be done...if you are up for the challenge... which you seem to be. Good for you!!! If you have any questions along the way, please don't hesitate to contact me... I'll help you in any way I can...

Take the night job on CVICU, get your orientation and then move down to days on that unit, or another, or at another facility after you have your experience if you need days...I have seen nurses who wanted days remain on nights because they prefer them... there is an advantage to new grads starting nights... days are busier... they just are... not that nights can't be incredibly busy... but days have rounds, consults, tests, imaging studies, procedures, meals, visitors, allied health consults, etc. etc. etc... I started on days... I stayed on days... but there is no time to really go through a chart, thoroughly analyze history, progress notes, surgical reports, etc... as a new nurse developing critical thinking and assessment skills, you are at an advantage if you can take half an hour and have the luxury of going through this information and putting it all together... you will learn a great deal by assimilating the information in the chart with the real time hemodynamics of the pt you are assigned to...nights will give you more time to look things up, answer questions thoroughly, and focus on the patient rather than all the goings on of the day shift... just me opinion, I expect others will disagree... but that's the way it is on our unit... we are a combination of CTICU and CCU...

I've only seen proning in a very rare circumstance... From what I've read proning can be efficacious... the problem is that patients are proned, often, too late to appreciate the benefit... in other words, the literature that suggests that proning does not correlate with improved outcomes acknowledges that most of the time it is brought on board as a last result... so it should be done earlier to maximize benefit... however, the risks are to be considered... one of our nurses reports the case of a younger woman blinded because of increased pressure on the optic nerves over time... maybe could have been prevented if pt. was not left proned too long... I don't know the details, but remember the warning... and the risk of pulling or displacing lines is significant... so make sure there are PLENTY of hands on deck to safely prone with attention to line security...

Don't forget that when your patient's pain was well managed on the dosage prescribed it was preoperative management, as least that is how your post reads. You don't mention what type of surgery your patient had. Depending on the surgery, the preoperative dose might not manage her pain nearly enough, so don't worry about the higher dose needed. In the future, since you are concerned about making a mistake regarding possibly confused medications, use your safety nets such as scanning barcodes on drugs and bracelets and running through the usual checks... the five rights... etc... right patient, right medication, right dosage, right time, right route...but don't forget the other "r"s that include the right technique (such as differences in types of injections, duration of IV pushes, etc.), the right documentation, and the right to refuse (on the patient's part). Your anxiety is normal just starting out... and will be there whenever you get to peak dosages, and also you will have difficulty giving dosages over normal parameters prescribed by physicians... have a nurse double check with you whenever you are unsure... hold up the syringe to your computer screen or original order...check the spelling...refer to dosage recommendations in drug guides and question anything outside of those dosages... and also, just as importantly, do not hold back pain meds because of your discomfort if they are accurately prescribed and indicated... give them within the ordered time frames and parameters... and stay ahead of the pain... or it may be hard to catch up... Your discomfort is something all of us went through...you will get more comfortable the more you encounter these things...don't talk while you are giving narcotics... either at the drug dispense cabinet or cart or at the bedside... do not get distracted... complete the task by really going through your rights... and keep focused... you'll be okay. Don't forget to reassess pain 20 minutes or so after the med administration and document such. Keep on pain assessments every four hours at least regardless of the med schedule and document such as well. Make sure your reassessment isn't just "How's your pain"... remember to evaluate physiologic response... potential reactions... decreased respirations, differences in BP or HR...Document waste immediately, because otherwise you may forget... and really have a nurse watch the waste instead of saying "I trust you"... you want your reputation to never be questioned... and don't witness wastes unless you have really seen them... The more nervous you are in the beginning, the better you will be later... it is an indication of your safety concern... be grateful for it... Pass on in report changes in pain control and new dosages and responses... keep everyone up to date... Also watch for cumulative effects of medications, especially in the elderly or those that have decreased metabolic functions... have Narcan available if giving narcotics... You'll be okay... stay scared... it's serious business... and you'll do fine!

Hey everyone... I just passed both the CMC and the CSC. They are very different. I thought the CSC to be more difficult than the CMC... but both very fair. Bojar is very helpful and also the AACN reviews are great. I particularly enjoyed the CMC DVD review... the CSC was on CD ROM and a little more difficult to use because of how it needed to be viewed... the NTI speakers on the CMC review are superb... Both are easier than the CCRN in that they test a focused area of information so you aren't spread too thin learning specifics of multi-systems... on the other hand they are a lot more difficult because they are so much more specific... the case studies require more inference and astute pick-up on minor details that aren't broadcast to the test taker... There is a difficulty in knowing things you don't see every day... like Protamine reactions and heparin rebound... I'd say you really need to have a solid understanding of things, for the CSC, that are otherwise unfamiliar... the whole surgical process with implications... things that aren't happening on your unit... things that are happening before the pt. gets to you that impact the care or potential complications after they arrive... you need to understand the time-line of complications because you have an idea of how far out from surgery the patient is... and have to work your differentials according to that... it's implicit in the question... But overall, very fair... like the CCRN, you cannot pass it if you aren't prepared through book study as well as bedside nursing... Everyone should take them who qualifies, in my opinion...As of last AACN posting, there are only 477 CMCs in the country and 642 CSCs. I don't know how many hold both certs. I took them both on the same day. I thought the overlap of information was enough to do this without spreading myself too thin on study requirements... I felt I could have studied a lot more... but I did study a lot... Like the CCRN there are many questions that seem basic... and many that are very complex... It's a mix... But overall, the CSC, in my opinion, is a more expert test.

i'm so happy about it...!!! thanks for the big to do... all these happy cheerleading icons!!! so fun..... as far as reward... the hospital i work at pays $ 0.25 per hour more for certifications... if you have three, like i do, it doesn't matter... you only get the differential once...it's absurd! but i do get a $1,200 budget for continuing ed per year... i used it for home study reviews on dvd and now that i have passed i can substantiate having "completed" the home coursework... so... i'll get reimbursed up to that figure for reviews and books i purchased to reach the goal... but not for the cost of the exam... i did it for me and my patients... not my hospital... thanks again! it was a great day for me!

I did a little research on this... I think ghillbert beat me to the punch... but the pump will default to the best trigger source...

....And that's why you need a nurse to save your life... good work!