diveRN

Just read this a 1/2 hour ago. Linky

Ditto on the above post. PACU is it's own critical care area. In 99% of cases, they have direct and immediate access to MDs if a pt frumps. No OR, PACU, ICU, or ED. Our RATT (Rapid Assessment and Treatment Team) responds only to floor requests.

Strongly consider your nursing degree because the paramedic scope is pretty narrow. If you get burned out, you won't have many options as a medic. With an RN degree and license, you can take an accelerated medic program, some agencies will often allow you to challenge the didactic portion, and then all you have to do is your clinical time. Here, medics have to do 400 precepted clinical hours. I had considered going this route to have something outside the hospital to do, but 400 unpaid hours would take me several years to recoup at a medic's pay. It didn't make any financial sense for me to proceed. I've recently dropped a few resumes for local CCTRN positions. Would get me out of the hospital now and again and pays pretty well comparatively.

Our better monitor techs / WCs will: - Answer call lights & direct appropriate staff. (CNA vs RT vs RN) - Screen calls/visitors - Verify orders and diets with me daily and enter them in the computer appropriately - Page MDs then let me know when they're on the phone - Thin charts regularly and make sure they're stuffed daily with blank order sets and prog note sheets. - Let's me know within a short time of ANY conduction changes or abnormal VS not caused by artifact or activity. (And knows how to tell the difference) - Enters work orders / requests for me related to hospital services like housekeeping following a DC or transfer, biomed, plant ops, etc, etc. - Keeps the coffee pot filled with good coffee.

I recently had a Cardiac Interventionist go off the hook at me when a pt stopped making urine for better than 3 hours in spite of a liter of saline over 12 hours to flush the kidneys out. The doc went off on me. He has a history of doing this, mostly with women though. "Why did you wake me up at this hour for that? Get me a nurse who knows what they're doing..." After I explained that I was concerned about ARF secondary to the contrast media, he continued to read me the riot act for waking him up. My final reply was, "with all due respect Dr. P________, if you didn't want to be woken up at all hours, perhaps podiatry would be a better specialty." I hung up without orders and called the house supervisor. Yes, there was a meeting the next morning in the Critical Care Director's office. Our director waved the P & P in front of him and pretty much told him the same thing... sans the podiatry comment. I didn't say a word the whole time. Arrogant MDs make good pt care tough.

Yeah. That. ^^^ almost exactly. Our class is 4 hours and we orient to the assessment and machines for a shift. The only difference where I'm at is that most of the HD RNs are pretty good at looking after the pt if they're compliant, relatively stable, and not too needy.

Who says you have to be home all the time?

One of our RN educators is 71 and she's still going strong. She's something of an icon/legend in local EMS and acute care circles. Was my plan to retire at 55. Doable, but I've got to bust me orifice a bit more than I have been lately. At my current pace, it'll be more like 65. I'm 39 now.

Many of our discharge and case managers are LVNs. In fact, it's pretty much the only position in our hospital that uses an LVN. We just don't have them around. Agree with prior post - arranges for health care needs post discharge such as home O2, medical equipment (liaison with suppliers/insurance), follow up care, STR, LTR, SNF, interfacility transfers and the like. Very administrative in nature, not much if any, bedside care. Requires solid communication and organizational skills.

Our pumps have electronic labels for the Guardrails drugs so it makes it easier to look at when you have 8 channels infusing something... We also label at the pt.

Procrit is usually refrigerated. I've found that pts don't complain AS much about the ouch factor if you let it warm up to room temp before administration. I usually take out the procrit about 30 minutes before I give it. There are only a few drugs off the top of my head I can think of where this helps... EPO and Octreotide.

The ones I know of are in the Central Valley, specifically from Madera (Valley Children's) north to Sutter Roseville and a few in between.

Yeah, where? I know of several. Just depends on where you want to be.

Congrats on your acceptance. I have a CS background, was actually my field of study in college and my second career. I don't miss the computer bidness at all. It is THE most dog-eat-dog profession I know of. By comparison, nursing is pretty kick back, if not boring at times. Nursing is my third career, so I'll leave it just to when I was in pools and hot tubs. Way back. I miss: being outside at work. When it was hot, I'd jump into a client's pool to cool off. Having a good tan. I don't miss: Working in the sun from daybreak to sunset 6 days a week from May 1 to Labor day. I miss: Making obscene money in spring and summer for relatively easy work. I don't miss: Draining a significant chunk of my savings account every winter because the phone never rang. Doing collections. I miss: Having winters off and being able to kick it 4 or 5 days a week. I don't miss: Having to lay people off every year. I miss: Being my own boss. I don't miss: Being my own boss.

Even if it's one antibiotic, I always set up a NS rider to which the abx is piggybacked. Even if the pt is fluid compromised, an extra 10 or 20 cc of fluid isn't going to hurt them. We run PIVs at 10cc tko and 20 on central lines per policy). I would rather have them get +/- 20cc of NS than lose one port in a central line or have an IV clot off on a pt who is a difficult stick. Since most of our ICU pts are on IV protonix and some sort of abx, so we often have at least two med infusions to do in 24 hours. Running a TKO for a 1/2 hour to an hour buys time until you can get back to it and lock it. We keep 100cc NS bags just for this.

My old manager tells me that our pharmacy orders them specifically for drugs purchased from Wyeth, so readily getting one may be problematic. Pharmacy guys didn't go into much detail, said I had to go see my manager to get one.

Ok, here's how I do it. I work 19-07 in a level 1 ICU Tuesday night through Monday morning ... 6 days on. Our pay weeks go from Friday to Thursday so I get three shifts in one week and three in the next. After that, I take 8 days off. I'll often pick up extra shifts during my 8 "off" days. I'm in an off week right now. To prepare for my 'on' weeks, I'll stay up pretty late Monday nights (0200 or so) and sleep until about 0730 on Tuesday. Then I nap from 1300 to 1700 and get up to go to work. Weds and the rest of my work week, I'm in bed by 0830 and sleep to 1600-ish. Sometimes later, sometimes earlier. I wake my 3YO son when I get some, spend a little time with he and my wife and then off to bed. He's in preschool Tuesday though Friday 09 to 1500 so when he gets home, I'm about ready to get up. He and my wife will spend most of the day Sat and Sun running errands, visiting grandparents/cousins, playing out front, etc.. anything to keep him out of the house when I'm sleeping. Been doing this for over a year and so far it's working for me. My wife works from home, so it's easier on us. As for sleep schedules, I take 5mg Melatonin, 50mg benedryl and a B complex vitamin each of my work mornings before bed. I also have blackouts on all the windows and French doors in my bedroom. It's pitch black in my room even on the brightest of days. The only real issue I have is that if I've been consuming a lot of Diet Pepsi in the previous shift, I'll often have to get up to pee around noon, but I can minimize it by cutting out the drinks at work after 0300. Our bedroom is also in the very back of the house and I can close it off with pocket doors... so neighborhood noise isn't a problem for me. As for flipping back to a regular schedule, on Monday morning when I start my 8 days off, I'll come home and sleep to 1100 or so. Then I'll get up and do some light house work or pay bills, etc, nothing too heavy. I'll then go to bed that night around 2300 and sleep to 08 or so the next morning, which pretty much gets me back to a regular night sleeping pattern. I do take 5mg melatonin, the B complex, and 25mg of Benedryl on Monday nights when I get off. Even with three hours sleep, my body is just used to being up at night after 6 days of a noc schedule. Tuesday night is pretty easy, sometimes I'll take the melatonin if I'm restless, otherwise it's just the B vite... which I take every day, working or not. Not gonna kid you, some days I'm pretty wiped out but not so much that I can't function. I just get some extra sleep at night or spend one of my afternoon days off sitting on the couch with a book and napping. Hope this helps.

When I was more active in dive instructing, I thought this was going to be the way for me to go as well. I went so far as to become a DMT, it's only 40 hours if you're an EMT, but never actually used it in practice because there isn't a chamber near me. Driving 2.5 hours to volunteer didn't thrill me either and relocating wasn't an option, so I've since let my cert lapse. If you're not an EMT, plan on getting that done too, that's +/- 160 hours. I found that hyperbaric jobs are few and far between, but they are out there. If you don't live in an area with a large diving population, don't count on finding anything too quickly. If you can volunteer somewhere and get your foot in the door, even better. You're an instructor... you know the industry... if you can relocate someplace where the diving population is more dense, you probably stand a better chance at finding the work you seek. SoCal, southern Florida, the Caribbean ... when I was actively looking, that's where I found the jobs to be. DAN offers DMT and HCO training and is probably the most recognized in the diving world. Get to know some people there, you could probably get your foot in the door. My .02.

See if your medical director will approve a wound vac. VNA will manage.

Had one two days ago. 18yo male with a 2 week old driver's license who wrapped his car around a tree with his unbelted mother in the passenger seat. Mom was a traumatic code on scene following her ejection, went to another facility with multiple traumas including a complete cord transection at C6, according to a friend of mine who works in that facility's ED. Grim prognosis. Junior comes to us with a broken nose and probable concussion. Had to CT him from the head on down to rule out the usual stuff, but he was agitated and combative on scene, all the way to the hospital, and in the trauma bay and wouldn't sit still at all so we could get pictures. Our ER docs and neuro guys don't much like haldol or Ativan with potential head cases, so out comes the RSI box. All films were negative. He was extubated the next morning, moved out that afternoon, and discharged the next day. Oh yeah, tox screen showed him positive for meth, cannibis, and ETOH. We've done it a few times for heavy meth users who are withdrawing.

Actually, about 90% of the time, I take an hour for lunch (two combined 15 minute "rest periods" and 30 minute lunch) and use the restroom whenever I need to. Of course if I have a pt going south or am getting an admit, I plan accordingly. My post turns the topic away from the original post, so I'm not going to press it, but I'm still curious about why all the added time. Am I busy? Most nights, yeah, but other nights there is time where I'm struggling to find things to keep busy with. I'd say that one, sometimes two shift in six, the unit will be very quiet so much that I'll get to crack a book for at least an hour. We sit right outside our pt's room so we can watch monitors and do other things.

Our insulin gtts currently come 100units/100ml. Our policy when setting up a new line is to flush 20% of the bag through the new tubing to saturate the line with the insulin. Priming with anything but insulin doesn't achieve anything but to deprive the pt of needed meds. When you've got a DKA or HHNS with BS of 1000 or more, you want to get as much insulin to the pt as quickly as possible and not waste any by having it bind to the tubing as it goes in.

If the patient is sick enough for an Aline, then I follow that after zeroing, square wave testing, and correlation against the NiBP. If they aren't sick enough for one and BP has been stable, then I seek orders to DC it. We see most emergent A lines in the groin, and non-emergent ones inserted brachially. Groin lines are especially susceptible to infection.

I asked my old manager where she got these when they were giving them out in our facility. She got them from the pharmacy, but added that she hasn't requested them in a LONG time because pharmacy quit filling her requests. I'll ask our one of our pharmacy guys if they're still available and from whom.

I agree with every post here. If you work more than your designated shift allotment, you should be paid OT for it. If we get slammed during a shift, we'll stay over as long as necessary, but it's the exception, not the norm. If managers don't want to pay OT, there's a problem. My question is though, why are so many people working past the clock? We have 59 ICU beds split in three units with a 2:1 ratio and 1 aid per unit, sometimes less. RNs do ALL primary care including baths, turns, empty foleys, chart VS, etc. The aids SOMETIMES help with turning, but they are there mostly to stock linens and be an extra set of hands when pts go awry. Our hospital practices 24 hour care. If we don't get something done on our shift, the oncoming RN can do it and VERY few b*tch about it. Unless a pt is filthy stinky dirty, we'll skip a bath if we're that FAR behind. If we don't get to a PICC drsg change, oh well... the oncoming will get to it. Our actuities are as high as anywhere given that we're a level 1 trauma facility serving an overall population of about 1 million. We do all manual paper charting save for the 4 hour rhythm strips which the monitor techs do. Even on a really busy night, we're rarely there past 0730. If we run a code or get an admit, we'll sometimes stay as late as 0800, but that's not often. For those who are routinely working past the clock, what does your shift consist of that puts you so far behind? I'm not slamming anyone, I'm just really genuinely curious about this because where I'm at, it just doesn't happen as a matter of routine.