squirlkeeperCCRN

thanks everyone! I have passed the test once (and think I am capable...come he** or high water). I too agree that Laura Gasparis is the way to go...good luck to you (and me).

Call me crazy, but I have decided to retest rather than get ceu's to re-up my ccrn certification. I did ceu's the first time I renewed, but feel like studying and retesting will give me the knowledge that I want. I'm nervous about hemos however as we rarely use swans anymore. Not using that information daily has lead to me losing everything I once knew...normal values, calculations etc. A big part of the test did require use of this information to get the right answer. My question is, do other hospitals still use swans alot? How can I prepare for this portion of the test? Back when I originally tested every other patient in our unit had a swan...now, maybe one every 4 months or so. Any advice?

Optimus, LOL! It does make it really interesting when the family calling the shots has no idea what they are talking about...very frustrating to take care of these patients.

I stopped doing resource when our facility implemented the RRT that families could summon. I think it is poor use of resources. I laugh when these patients are then transferred to the unit because they needed lasix and bipap...soon enough the same families are demanding to know why their family member can't eat or shower...you can't please everyone and I think administration sees this as a good pr move. I think staff calling an RRT is legit and a good idea...families, not so much.

I was hired for part time and have worked part time for about 8 years now. I think previous experience might make the difference though (sounds like you have that) so think it's worth a try. We actually have many part timers that work in my unit.

Our unit has developed a protocol for patients with sepsis. If they meet certain criteria the protocol is instituted. We rarely use Swans anymore, but use the sepsis protocol often. It is based on CVP, blood pressure and is complete with lots of boluses, antibiotics, and pressors. From the nursing stand point it is very hard to keep up with, very time consuming, but shows to reduce mortality greatly. It is standard procedure that if a patient is being admitted to the ICU with the diagnosis of sepsis that a line is placed and the protocol started in the ER.

Chica, Going from Oncology focus being on comfort most of the time, to ICU life saving no matter what mentality is very anxiety producing. I know because I took the same route that you did (Oncology for 12 years, ICU for almost 8). I remember the feeling when I started doing resource and went to all of the codes and traumas. Very scarey at first but it is as easy as ABC...seriously make this your mantra and follow it and you will do well. Also remember you will not save everyone, it is not possible. More experience will make you more confident. Hope this helps.

I just found this site a few days ago, and was thinking of posting this very topic after caring for a patient with the family from he**. We have open visiting in our unit and when we put a 12 bed addition onto it, built in beds for families to spend the night. Most families given the facts of stimulation on their loved one's health in certain situations is enough to promote proper behavior on their part. There are those families (you all know the ones I am talking about) that see this as an opportunity to get attention. They literally "take over" the waiting room, hang out at the desk (multiple family members asking for an update), all walk around being dramatic on their cell phones, sleeping on the floor next to the patient (there is only one bed in the room), and consume 50% of my time. God forbid you spend anytime taking care of your other patient, they will hunt you down for some piddly request (more than once I've had family members enter my other patients room looking for me). The ultimate annoyance is when multiple family members call on the phone or come to the desk during report for their hourly update....not appropriate! I do and always have been an advocate for families to be involved in the process of healing, I truely think it is important, BUT shouldn't there be some limits? What can be done? The family I recently dealt with's mother was elderly, in poor health, and in constant attendance, not taking her meds, didn't want to hear any bad news...fired one nurse who was honest with her because she didn't want to hear what she said. She became aggresive toward anyone giving her any bad news...problem is there was no good news. Would we have been serving her correctly to lie? We called family to come and get her and she flat out refused and became irrate with the nurses for going against her wishes...she nearly passed out twice from hyperventilation, but would not leave or go to the ER. Meanwhile she was threatening the whole time to sue the hospital over various issues (none of which had any validity). How do you juggle taking care of critical patients and ongoing issues like this? It's really beginning to wear on me. What can you do if that is your hospital's policy? I like the ativan salt lick idea, but like the old saying goes...you can lead a horse.... Seriously, thanks for all of the ideas and laughs, I guess it's nice knowing I'm not alone in my feelings.

RUNurse, good point, reguarding Hespan. Our sugeons like Hespan, our Pulmonologists like albumin with lasix chaser. No consent needed for either.

I get the best of both worlds and we have a 30 bed mixed unit...little bit of everything. Have no fear neuro patients will give you everything.

I work in a general ICU (not neuro specific) but get plenty of heads and do enjoy taking care of them. I think the inconsistency in neuro patients is stimulating. Just when you think you know what they are doing...you do another exam and things have changed...that keeps you busy. It is a real challenge to maintain ICP's in tight parameters with so many interplaying factors. I like being involved in the organ donations process and all that goes with that. It is very traumatic and sad at times but the good outcomes help me to accept the bad.

I agree that going from one's comfort zone to a new, overwhelming, very busy ICU can be very un-nerving. I think new critical care nurses need to allow themselves a year before they get critical of themselves or question the move they made. Take evey opportunity to learn when ever you can and eventually everything will start to click. Good luck to all of you, (and to me who will be retesting and needs to re-remember everything I once knew for my CCRN).

for many years when I started nursing we didn't wear gloves if it wasn't obviously bloody...that was universal precautions. In this day and age we wear gloves to just give back rubs, pull a pt. up in bed or anything...I would say with your 3 pairs of gloves you should be fine (unless you stuck your finger in your eyes, nose or mouth at some point).

you are so right!!!! then the real report begins after you have answered whether or not you will be back in the morning. I like the head to toe method as well (due to the fact that we no longer have flowsheets or anything written for that matter).

funny this is I don't think it's that far out...just around the corner! I think "heely's" for nurses with built in room deoderizers and mini-spray stations would come in handy after the day crew passes out suppositories at 6pm (just before they go off duty)!