RN82

While floating to the ED last night, I learned from my Morphine-allergic, 10/10 "all over" pain, q1 visit-per-month patient that you can INDEED draw "Dilantin levels" from veins in your feet...and legs...and neck - several times a week. I also learned that the "nurse" at the clinic who does this must not know what she's doing, cause just look at this nasty cellulitis in his arm! Daggone. Glad I don't need those levels! I ALSO learned that "Pepsi" can blow your pupils to a 6 and make you jittery with a flight of ideas. So THAT'S what I've missed in all of these years of drinking Sprite. And to top it off, I learned that you can't be pregnant, because you had sex when you were high, and the Heroin kills the sperm. Right? Someone tell me why we do this...

As the daughter and niece of ER nurses with 30+ years of experience, I heard both sides of the coin when I chose ICU as my specialty. It is my understanding that in the ED, your attention must be on a focused assessment of the patient, rather than a full, head-to-toe assessment. This being the case, a rapid assessment of ALL physiologic systems is necessary for your focused assessment to be accurate. I understand if you didn't check your GIB's pupils, but please know if they are following commands, confused, etc. Please know how much O2 they are on, and WHY. Secondly, if a patient has a wound, and you put a dressing on it, please complete the proper wound documentation. We will actually need to remove your dressing, clean, measure, and re-dress the wound properly otherwise. (In fact, this may happen, even if you DO document it. But please at least report what you see). TURN YOUR PATIENTS. At least CHECK them to see if there are wounds or concerns on their posterior aspect. And please, please, please clean them up when they are incontinent. Not every patient becomes incontinent in the elevator ride up. And if they do, you can stay for 5 minutes and help me clean him up. As far as hemodynamic monitoring, I have never received an ER admit with a Swan, and rarely do I see one with a CVP. When I have seen a CVP come up, I get report that says "CVP was 3..." Unfortunately, a CVP is not a one-time-read, and is impacted greatly by a number of factors, all of which are important for us to know through the initial phases of ICU care. Ie: How much IVF did the pt get down there? What was the trend of CVP or MAP w/ IVF? Is our hypotension a fluid volume concern? A sepsis concern? Please know the names and mechanisms of action of the drugs administered in the ED. In receiving an intubated pt, I was told, "He got At...at...atropine for sedation." I would hope not. Alot of what I see goes back to basic nursing skills. Focused assessment with a thorough understanding of what you are assessing, projected needs upon arrival to the unit, and clean, comfortable patients.

Are you a student? Or a nurse? Either way, if you have not worked in Critical Care before, my best suggestion to you is to start by making a list of all of your skills and experience. (Not what classes you took, but what skills you possess out of the realm of standard nursing assessment and practice.) Ie: CRRT, Balloon pump, Hemodynamic monitoring, ICP drain placement and management, assistance with central line insertion, etc. You want to highlight your CRITICAL CARE skills...not your nursing skills. And no, not all ICUs are the same. Some are very generalized, taking medical, surgical, and cardiac patients, and some are very specialized (ie: CVICU, multi-trauma ICU etc). Make that list, then decide how best to format it to your resume. You want them to know that you are competant to learn the skills you do not yet posess, and able to be independent in performing the ones that you do. Hope that helps.

Look into OPOs (Organ Procurement Organizations) in your state. They all branch off of UNOS (United Network of Organ Sharing). The job title you're looking for might be called "Organ Recovery Coordinator" or something similar. In essence, when brain death is declared, and the OPO is called, a social worker will come and obtain consent from the family for organ recovery. Once consent is obtained, as the coordinator, you go to the hospital, and work as a liasion between the patient, hospital staff, and transplant teams - often clinically managing the patient up to and through the recovery in the OR. Hope this helps!