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I was looking back at my previous posts and came across this one! Its amazing I totally forgot about the night I wrote about. Probably blacked it out! Phew, got out of that position a year ago! I now work days in ICVR (like short stay for cath lab) and I still float to that unit at times. Things seem much better on that unit these days. They changed their staffing/acuity system and most of their night shift staff are experienced now. As strangely horrible as this sounds, I think one thing that has helped the unit is the poor census in CCU. Our 18 bed CCU has been averaging 4-6 patients a day, thus CCU has the ability to take their higher acuity patients. A lot of their staff has been given mandatory time off and people are taking a lot of PTO. Sucks for the CCU staff, but nice for the rest of us and our patients!

I passed. Woo hoo! I liked David Woodruff's program as well. I found his practice questions to be extremely helpful. I also read the AACN Essentials of Progressive Care Nursing by Chulay and Burns which seemed to include a lot more information than what we were tested on. For PCCN we don't need to know advanced hemodynamics and ventilator settings and that information was all included in the Chulay/Burns text. It was a pretty hard test but if you focus your study on cardiovascular, pulmonary and ethics/professionalism you should do great. Quick tip: know your ABGs and 12-lead relationship for MI (ex: anterior wall MI shows changes in leads V2 V4 and effects L-main/LAD). Good luck everyone!

I am also taking PCCN tomorrow Sept 15th. Also purchased the SAE and felt horrible after I took it! I spoke with two other nurses I work with who just passed and they both said that the SAE was not like the actual PCCN test. That in the SAE the questions were pretty vague and that the actual PCCN test is more direct and concrete. I hope this to be true. I am very nervous about the test tomorrow and sure as heck hope I pass! Good luck tomorrow

First off, sorry for the length and the spelling/grammar errors...its been a long night. I work nights on a busy 33-bed telemetry floor at an inner-city nonprofit hospital. I am a new grad and have been on this floor for 1 year and 4 months and I just finished training for charge. Our administrators have been making a big push to consider our floor a CICU step-down unit (but so far without the national certification). When I began working on this floor I had 4-5 patients during nights. There has since been a high turnover of staff, many RN's are moving to CCU/ICU and I find myself some nights being the most senior person on the floor. We are in a budget crunch and now are staffed 1:6 at nights with 2 CNAs and 2 monitor techs. We are accepting more complex pts, more confused/total cares and pts with gtts we've never worked with. Ok I apologize regarding the following text if it makes little-to-no sense...I would just like your opinion on the acuity of my pts this shift. how many do you take and whats your acuity? Do you think I am crazy for thinking this is too much? Tonight I started with 5 pts and then got an ICU transfer for a total of 6. Pt1- chf exasc, leg ulcer, chest pain (frequently on the call light for pain meds, random tasks...one of "the needy types" as horrible as that sounds. Pt2-my icu transfer, anemic h/h (7and 21), here with SOB/CP and CHF exas) on an insulin gtt (our protocol states chemsticks q 1 hr) and just finished her 1st of 3units RBCs when arrived on the floor. MD did not order lasix between units Paged MD, did not hear back. Pt initially, stable until 15 minutes into 2nd unit of blood, then her temp spiked, o2 sats down to 80s on 6Lo2, lungs increasingly coorifice. I stopped blood called MD, and demanded lasix, benadryl and that she be transfered back to unit Pt3- chf exasc on a dobutamine gtt going at 7.5mcg/kg/ (our unit protocol states we can't take dobu >5 mcgs but CCU/ICU full and pt "stable" so MD allowed pt on my unit) Pt4- heparin gtt and morphine PCA, s/p fem-pop and then an emergency thrombectomy...most likely going to lose her leg...dealing with low BP/urine output and tachycardia as well as pain thru HS... poss shock? should have been sent to CCU/ICU but only 1 bed left in each reserved for codes Pt 5 32 y/o with CP, frequent requests for dilaudid, trops (-), ct abd, lungs and angio (-) Pt 6 another young pt with CP, turns out was gastroparesis...my only pt that was low acuity except for the frequent requests for $ from her husband spending the night What types of gtts and what pts do you see? We used to take a limited # of gtts (amio,cardizem, dobutamine, dopamine, insulin, heparin and protonix) and now we are getting alcohol gtts, lasix gtts, isuprel, higher rates of dobutamine) and pts who require q 30 min vitals, bed alarms, turns q 2 hrs, and more and more confused people. To top this all off our staff is almost entirely new grads at nights who need a lot of assistance. Is this what its like on your floors or am I crazy for feeling overwhelmed? Thanks for the input.

I've been a nurse on an Interventional CV Recovery and Telemetry unit for over a year. I work night shift and its starting to take its toll on my body and mind. I have recently been looking for day shift positions and came across an opening for an RN in Diagnostic Imaging. Are there any RNs working in Diagnostic Imaging out there? If so, what are your thoughts...do you like your job? What are your roles and responsibilities? Thanks for the info!! :nuke:

Never get your buddies to help you trim the top of your 6 foot hedge by lifting a running lawn mower 6 feet into the air Never continue to inject insulin into the same abscessed spot on your thigh, and then debate about getting it checked out when you begin to see chunks of fat and a glimpse of bone on your thigh Never attempt to inject yourself with heroin via your central line (the one the IV nurse spent so much time trying to place because all of your veins were shot) and then end up pulling the line out in the heroin injection process Never let your wife use a key ring as a cock ring

I am a new grad RN and have been in my current position for the past year. I have been offered a different position by my nurse manager and eagerly have accepted. According to hospital rules, my NM will need to create an open position that I will need to apply to using the organization's website. This means I will need to update my resume. Having not looked at my resume for the past year I was curious about what most 1-year-in-the-field RN's are including on their resumes. Have you been eliminating non-medical related work history and still listing college clinical experiences? Or have you been keeping the same resume and just adding your current position to it? What I put on my resume likely will not have much of an effect on my situation, but I am still curious what the "standard" is.:) Thanks all!! Em

I've been working as an RN for the past 6 months in cardiology. My base pay is 27.99/hr plus 5.25/hr night differential and an additional $1/hr for weekends. This is in Oregon. I just realized I really need to start picking up extra shifts. Not only do we get time and a half but we get incentive pay thats $18/hr extra. That's $65/hr before taxes for picking up an extra night shift which as a new grad I find insane.

I was told by a cardiothoracic surgeon on our unit that intraoperatively when the heart is disturbed, the body releases glucose stores. He described it as a sudden surge of glucose. Which makes sense, your body thinks its under attack and it needs the energy (via glucose) to flee to safety. Any stressor can raise blood sugar, and in this instance the stressor is having your chest ripped open...pleasant huh? Thats why patients undergoing open heart procedures like CABGs are placed on insulin drips to prevent hyperglycemia for a variety of reasons.

I think the main issue with dilution would be that you are limited to using a large muscle for IM administration. I believe 2-5 mL is the max for IM injection in the ventrogluteal (which i've read is the current preferred site) according to most institutions, so it would all depend on how much you are diluting by. Personally, I would be prone to using Z-track and pressure; or even distraction as I do not believe its caustic effects are such as when it administered IV. But it'd be interesting to see the literature about it.

7/11/2007, took a couple months off and traveled; now 6 months into working in cardiology

Another thing the patient had been on 2.5 mg lisinopril bid and 200mg amiodarone qid. His cardiologist upped the lisinopril to 5 mg despite having a SBP in the 90s. I am wondering if the prescribing MD wanted to lower the BP so that the heart would pump more efficiently. I have heard about certain circumstances in which MDs want the BP low enough to cause dizziness in order to make the workload easier on the heart. It would have been nice if she were to include that in her progress notes or med orders!

Thanks to all who answered my post! A little more information, because now more questions arise! I am so perplexed by this patient's situation. Sorry for the novel here.... The pt is very young and had an AVR when he was a teen d/t aortic stenosis. Now that valve is failing so he's in CHF but has an EF of 78-88%. With CHF I thought EF was lower? But I suppose with an inefficient valve the cardiac muscle would be working harder and cardiomyopathy could ensue? Could that lead to the increased EF? So last night I could not for the life of me get his blood pressure up. Baseline BP was 120s/60s not on any meds. Last night his BP was 96/56 so I held his lisinopril but ended up giving him his PO amiodarone. A couple hours later his BP dropped to 86/54, the pt was nonsymptomatic. I attributed this decrease as being from the amio and the fact that the pt had been sleeping. About an hour later the pt woke with 10/10 chest pain. BP was 84/52; I medicated w/ morphine, cutting the dose in half d/t his BP. CP resolved. But BP was still 84/52. I spoke with my charge and contacted the on-call cardiologist who ordered a 250mL NS bolus followed by routine NS @ 100 mL/hr. I was very fearful of fluid overload d/t CHF but the pt's lungs remained clear, he had a good urine output, he denied SOB/CP, and had no edema. But the bolus and fluids did absolutely nothing to increase his BP. In fact, at one point after the bolus, his SBP dropped to 82 but then returned to 84. So I called the on-call MD again who decided to DC the fluids and just have me hold his AM amio; the latter I was planning on doing anyway. For the rest of the shift he had no CP and his BP remained 84/52. I neglected to mention that the patient had been in sinus rhythm in the low 70s for the entire shift. I have read that with aortic stenosis a person may suffer from low BP and that there is an increased pressure gradient regarding the aortic valve. Could this be why the fluids didn't effect his BP? Could his high EF be playing a role in all of this? I feel like I did something wrong but I don't know quite what. Thanks everyone!

I am a new grad nurse 6 months into my position on a busy cardiac floor. I was always under the impression that an ejection franction (EF) of >55% was good. I was giving report to a fellow nurse and her student, I commented in report that the patient's EF was 78-88% and said "so thats not too bad." The nurse was like "actually thats horrible." But didn't give any rationale. I should have asked her but I was quite embarassed by the manner in which she called it out. Is it possible to have an EF that is too high? Whats the cause? Or was I right...is an EF of 78-88% ok? I've tried looking it up but all I've found is information about low EF's. Thanks! Em

Thank you so much for your advice. I know I made a mistake and a pretty big one at that. I definitely have learned from it and know, that being a new grad, I unfortunately will probably make more. It is a huge learning process. In future situations, I need to think more critically and take more time making decisions but most of all, consult with my coworkers. Patient safety relies on it. So far I haven't heard anything from my nurse manager about the situation but I still have fears. Regarding the post from CPNEgrad07, it is disheartening that physicians (especially at night) are so difficult to get ahold of but I believe it is our duty as nurses to be knowledgable and capable of making "medical decisions" such as holding a beta-blocker if our patient's condition warrants it. We must maintain the safety of our patients and many times, we know more about our patient that a physician might. I completely agree with you that the system is quite chaotic, and I understand where you are coming from with your comment about avoiding the hospital, but the majority of patients leave in a better condition than they came in with.