Sally_ICURN

As cactus wren and kimprn stated, pedi/neonatal ICU and adult ICU are two completely different beasts. As an adult ICU nurse I only float between the two adult ICU's and never float to PICU or NICU. It's completely seperate except for the cardiac surgery Residents who sometimes cover call for adult and pedi/nicu on off-hours depending what pg year they are and their experience. But many years ago on my cardiothoracic surgery ICU, the unit used to be combined pedi and adult to make an extremely specilized heart surgery unit. I've heard of talk of combining it again, but it will not materialize because peds is a huge seperate children's hospital now where it wasn't before the late 1980's, and it's only structurally connected to the adult hospital. Maybe in smaller hospitals, the nurses do cover both. p.s. John, Critical Care is AWESOME!

Oh yeah, I forgot Sequoia. They too have a pretty good acute psych unit. I did my psych clinicals there when I was a student. It was a great experience!

Most hospitals in the Bay Area have new grad programs that start periodically throughout the year. If I were you I'd check out: Stanford...seriously check out Stanford. Great pay, great benefits, good philosophical beliefs about nursing, not as snooty as you'd think. I know they have new grad programs every six months. Packard Children's if you want to work with kids. Valley Medical Center as sanakruz said (like the screenname name btw!) great place for spinal cord and burn (EXCELLENT nurse manager/staff in burn unit), also good environment for critical care - level one trauma center - affiliated with Stanford Medical school. If your going for med/sug, be careful here...not all floors are created equal. Don't let the "county" thing sway you too much - it's really a great place to work with decent pay (not outstanding) and excellent benefits! (I have a soft spot for Valley). El Camino Hospital. Good reputation for treating patients and employees well. My preference is a teaching hospital. AVOID Kaiser Santa Clara at all costs - having an asthmatic daughter, I've had very bad personal experiences with this place. Also avoid San Jose Medical Center - it's closing, and Regional Medical Center of San Jose (formally Alexian Brothers) at Jackson and McKee in East SJ - Both were taken over by HCA Healthcare, a for-profit company who sees only $$ and doesn't give a crap about the community - they're closing the only hospital in downtown SJ (SJ Med Center) because they don't think it's advantageous to spend 24 million to retrofit the hospital for earthquake safety! So sad. HCA Healthcare is the "reformed" HCA/Columbia that got popped by the feds recently for ripping off $$$$$ from medicare. Beware! Good Luck! ~Sally

If I or someone close to me were a patient in the hospital dependent upon the services of a nurse, I would want a nurse who is proficient in their field. It doesn't necessarily mean one has to be "super-smart," it means someone who is ethical, has my best interest in mind, is able to recognize subtle changes in my condition, and who realizes that they don't know it all but knows where to turn to find the answer. We all know the Nurse is the primary caregiver in patient care. We are the six senses for the doctors, some have a seventh sense. It is more often than not that a patient's course is based on our findings and observations--both objective and subjective. We must NEVER underestimate our important contribution. ~Sally

Oops! Being a 12 hour night shift nurse I beg to differ with that quote. I don't sleep at all during my shift but a lot of nurses do take naps...on their break...making sure their patients are covered. Some forego their shorter breaks and combine them into an hour long nap time. It's understood that if there's a code on the unit everyone returns to their assignment. I have no problem with naps on nights as long as it's safe for the unit. I only sleep 3-4 hours (5-6 on a good day) and most of the people I work with do the same because of daytime family obligations. ~Sally

you can do it, you really can!!! it took me seven years to complete my nursing education (including pre-reqs) and finally graduate. at the beginning, my two oldest kids were finishing up high school...they graduated in 1995 and 1996. during those last couple of years in high school my kids and i went through the application process and shopped around for universities. jump ahead 4 years...both my kids graduated from their persepective universities in 1999 and 2001. my graduation and my second oldest child's graduation were 2 weeks apart! i was an "a" student and recognized by my school as "student nurse of the year." that looked really nice on my resume!! while all this was going on i had a 4 year old (who's almost 14 now) and i was a single parent. we were broke, we applied for all the financial aid and scholarships we could and i exhausted a saving account that i had for years and years. i'm still a single parent and both my oldest are back in school, one in grad school in a doctorate program and one taking pre-reqs for nursing!! my youngest is an honor roll student in his jr. high! my oldest, who is 25 now, has thanked me for showing them when they were hard-headed teenagers in highschool that if you put your mind in it and work as hard as you can, than you can do just aabout anything you want. and i think that's true. i think i was a good example for them to model and even though my youngest was so young at the time, i think the success of his sisters and myself has rubbed off on him as well. if i can do it, you can too! but...it's not easy. ~sally p.s. my nearest family was almost 2000 miles away, but my ex lived nearby (thank gawd!). i'm tellin' ya, you can do it!

I so totally agree with you. Nothing, NOTHING gets to me more than when I get an assignment that includes, for example, a patient who's been on the unit for weeks, is lightly sedated, on a vent, has an open thorocotomy wound that gets bid dressing changes, but hasn't had any pain meds all day!!!!!! And they wonder why, despite giving the prn pressure drugs or maxing out a drip, the pt's pressure is still HIGH, or they're bucking the vent, or thier HR is high!! I will say though that if our patient's are sedated, they will usually have a fentanyl drip right alongside the sedation...but not always. Most times our patients cannot verbalize their pain and a really good assessment of nonverbal clues needs to been done, and done frequently. It bugs the crap out of me when a nurse charts "unable to assess" when it comes to pain. If a patient's face scrunches up or their body stiffens with the slightess stimulation, or their vitals are questionable, or they're restless, you better believe I'm giving something for pain and giving it as ordered prn around the clock. I strongly believe in this. Why would it be ordered otherwise? One would find that I do give prn narcs frequently when previous shifts have not...so does that put me under the magnifying glass? I certainly don't mean to minimize the fact that nurses do divert drugs for their own use. It's such a sad situation for both the nurse and the patient, they are suffering equally but in different ways and nurses such as the original poster in this thread are heros and true leaders in my eyes. Addicts, a lot of times if they are in recovery, have to be convinced that it's alright to allow us to treat their pain. How scary that must be for them! ~Sally p.s. I think random drug testing would be a terrible idea.

Horrible is an understatement! I too have been an RN for about 2 years and can barely manage 2 patients on ventilators with multisystem failures! And that's knowing I have help from another RN(s) if I need it. I mean geeze, these patients have multiple IV drips to be titrated and are usually hemodynamically unstable! How on earth is any one nurse to care for 8-9 of this type of patient?!?! I feel for you and the patients and I understand your feelings about families, but feel for them too. All this and you are taking classes as well!! Get out of there, but don't walk out (that could be construed as abondonment). I know nothing about nursing in Florida but there must be something else? Good luck to you. Take care of yourself and don't burn out before you've begun. Nursing needs you. ~Sally

If they've got the money for incentives or rewards why not just add it to wages for the way under compensated work nurses already do? I can't believe it's suggested that nurses need to do more. Give nurses decent wages, working conditions, and the respect they deserve. The quality patient care and productivity will follow. This just sounds dirty! I do the best I can in not wasting supplies, time, etc., but I think this type of thinking by us everyday staff nurses (especially the increase profits part) not only harms nurses, it will harm patient care as well because the focus turns from I'm doing everything I can to make Joe Blow in bed 15 comfortable to cha$ching, if I could just figure out a way to make Joe's stay a little more profitable. I'm also in complete agreement with those who oppose subjective reviews. No, I don't trust all of my co-workers. ~Sally

I'd like to know what the heck happens to these poeple when they end up in an ICU bed???? I had a completely oriented firefighter (yeah, a firefighter!) once in our ICU, he too was spitting all over the place and blowing snot out of his nose, not into a tissue, it was more like cover one nare and blow and wherever it went is where it went. There was no reasoning with him until I said, and get this, I'm going to call the doctor to come and talk with you about this if you don't stop it. He stopped. Jerk. We use leeches at our hospital. It's pretty nasty (pt is usually sedated) but very effective!!

I'm no GI nurse either, but maybe if they're checking for a rectal fistula or 'rrhoids? I know that OR positioning for surgical correction of a rectoanal fistula is in stirrups. Just a guess. The end. And have a nice day. ~Sally

abx