JustKeepSmiling

Those applying, how recent was your ICU experience and for how long? I emailed them asking what the stipulations were and they just said it would be considered with other factors.

Yep reviving an old post because I know I cannot be the only nurse to now discover the PMHNP and FMHNP difference. now if I could make sense of why PC has been added to some FNP programs, it seems a bit redundant PCFNP. or maybe I’m just particularly inquisitive as I just started FNP/AGACNP and find it a mouthful to explain to non-healthcare folk!

Hey there yayFNP2018, did you go to Herzing?

I landed a job in the ER at a rural-ish hospital very close to home, best pay of my nursing career, like the facility/staff/job itself. But I'm in ICU to EM transition HELL. I googled & reached out to some online posters in various forums who posted/commented about this but am hoping for more specific feedback now that I've narrowed down my questions. The transition is a nightmare. Hx: tele, m/s charge, ambulatory clinic nursing and some ambulatory procedural ICU - cardiac/neuro/medical unit in a mega academic center, transplants, SWAN/CRRT anything that moves, early progressive ambulation with vents just waltzing down the hall with their IV pumps full of gtts, IABP, VADs, Impellas, helping residents learn and build teamwork skills, anticipate needs and ability to prep for just about any bedside procedure including RSI drugs except no bedside ex-laps Current problems in some order; 1. Slow with tasking IV/labs/cath/EKG while simultaneously going through the questions for the chief complaint. I can dart in a 18g, draw my labs, 12lead, in & out cath and get monitoring on in less than 15minutes but I just don't "know" all the things for each different variety chief complaint to ask and when I have enough data for EM needs. *for this I would be eternally grateful if anyone has chief complaint quick reference guides or example order sets* 2. Wrapping up charting. So the software is horrible and archaeic and just bad. I'm adjusting, I type 70-80wpm, just remembering where and what ******* F key does what. Learned the enter key on the numeric pad is evil and not equal to the other enter key in terms of functionality and mistakenly deleting entire sections of my charting. I really hate charting at the bedside. I'd rather chart at the desk. Thoughts? 3. Speaking of charting- if I did a damn neuro exam but charted under neuro reassess and not the abbreviated mini NIH tab (which is way less info but the SAME as in other too) I got a nastygram for it. Bc surveyors might miss it under that other title. SPARE ME PENCIL PUSHER. Of note: we don't have techs. We do it all from start to finish. Team nursing. But I'm being oriented with 4 rooms solo to fully grasp the entire enchilada. So great minds that be, give me your best advice, spare me the encouragement "you'll get it keep trying" nonsense. fellow nurses... assume you like working with me and my potential is there, just need me to do what better/differently? I want straight up advice only. I really want to hear what matters most to you from your coworkers and what you could give a **** less if they did or didn't do. Please and many thanks to any contributions.

I have always utilized SBAR. From working in a community non-teaching hospital full of seasoned doctors to a huge teaching hospital full of residents. Never once got ripped by a provider or coworker. I once even called a very seasoned doc and said I need to move this patient to ICU asap and he responded with I'm writing the orders and I'll meet you there. Pt was decompensating quickly on bipap and was minutes away from needing to be intubated. Which she then was and was successfully extubated a few days later. I've always tended to build relationships with the providers in a sense that they know I mean business, I don't BS when I call you with a concern and I won't shut up until I feel my patient is safe and problem addressed. Be it a new consult, medication, transfer to higher level of care, etc. ESPECIALLY working in an ICU with residents now, I recommend orders all the time. "So I've seen X given a lot in this situation and it worked well" I tell them experiences I have had in the past and they appreciate the insight. Be concerned of older docs and their "cook book" of medicine. Each doc has a way about doing things and it doesn't work that way all the time. By being an advocate for your patient, using SBAR, and presenting a suggestion in a gentle way can break them of their usual recipe and get your patient better treatment. For example, lortab doesn't treat neuropathic pain. I truly enjoy having good interdisciplinary relationships and when the patient gets good results or relief from my suggestion, I enjoy seeing the provider happy too and know that we work well as a TEAM. Lord now I'm on my soapbox here but the residents are TERRIFIED of ordering benzos and getting ripped by certain attendings. If that was your mom intubated on crappy precedex with a resident trying to place an IJ and scared so she can't hold her head still because she's delerious from poor day/night regulation, nonstop alarms, frequent vitals etc. wouldn't you want her to be calm enough to reduce the risk of a pneumo?? I try to put things in perspective for them. This is not just a procedure you are doing. This is a human being and there are real risks here especially with an uncooperative patient. I suggest a bit of ativan and you tell me no because it causes delerium and drops BP? First of all she's already scared out of her mind and delerious. Secondly 0.5 ativan in the hundreds of times I've pushed it in various levels of care has NEVER dropped a pressure to a concerning point. So if I can't convince you to start propofol and/or fentanyl to get her off this crappy precedex then at least please order a short acting benzo so the patient can relax and you can more safely place this IJ. Then said patient starts biting down on the ETT and I can't go up on the precedex anymore at this point. So now your AGITATED and delerious patient is trying to bite through the ETT. So now not only do they need an IJ but I'm calling anesthesia for back up reintubation in case she manages to bite through the tube because no one can get a bite block in. The resident did not know that is was possible to bite through an ETT. Needless to say, this resident did not get to do the IJ. I HATE precedex. Off the soapbox. [emoji58]

Going to look into that! We have statlocks for PICCs, but they aren't compatible with other lines. It wasn't a permacath. It was an IJ trialysis. Now if we could find something to keep the cordis/swan from flopping around and aggravating patients we would be on a roll!

They will come suture it in when we ask. I just don't like that sometimes they think the sutures are optional and want to promote a policy for it.

I don't recall the specifics of the story but remember a patient who came in with stroke like symptoms. Was actively having a massive stroke but also had urosepsis and didn't know it. She died of sepsis. Family felt it was not coincidental and the death from sepsis spared her from living with the severe deficits she had from the stroke. One way to look at things.

I get like that. More with new grads than experienced nurses. When I tell you about the rapid response patient I got then intubated, dropped every tube and line known to earth and started gtts then went for a stat CT. Then the other patient had an acute mental status change, got combative and had to be restrained due to nearly destroying the IV pump. I ate a few pieces of candy to replenish glucose, thank heaven for coffee and still have a full bladder. Then the sweet, wide eyed and bushy tailed new grad asks me which one is the night bath. I start twitching. Patient hygiene is very high on my nursing care but keeping them alive and stable trumps

I get it if it was dropped in emergently but still there are ways to secure it without taking time to tie a neat bow. I don't think we have a policy on this, going to bring it up to the powers that be. For a sick ICU patient to lose a good line just because it wasn't properly secured is not cool and then the risks of infection, hemostasis, needing a new line...

Do you encounter a lot of lines not being sutured? Central, dialysis, alines? I did a dressing change yesterday on a trialysis that had not one suture and no securement device. No apparent reason either. I was pretty mad! Curious what others encounter and do you have policies? I work at a large teaching hospital. So naturally tons of residents, variable skills and techniques. I help guide them and offer advice, they are always appreciative of the help. I just cannot believe this trialysis was left unsecured. Even if suturing was not an option because of a bleed risk, etc - could have at least used a sterile IV catheter securement device.

Get whatever color you like! I love purple, so I went with that.

Purple Master Cardiology. Comfortable on neck. Incredible acoustics.

Thanks! Think I'll try a pair.

When I tried the on the stretch was more fitted. I liked the stretch better.

They don't shrink at all. Or at least never have for me. The Butter Soft brand has a lot of cotton, so I'm expecting that to shrink a bit. Depends on your laundry habits too. I use cold water wash and quick cycle dryer.

We're the same size and their XS petite pants are actually too tight for me. The 4252 XSP size fits well, I just bought them the other day. I have a hard time with tops because of cup size. XS snug on breasts and under arm area, S baggy. The S mock wrap top fits but I'm so sick of the style. That's why I'm trying the 71166 I mentioned in my thread. The UA Butter Soft XSP and XS fit wonderfully, I'm concerned about durability. I may order one pair and see how it goes. I loathe Wonder Wink's material. The only other brands I have considered switching to are Mavaen (spelling?) and Med Couture.

Any problems with threads coming undone?

I've had a hard time parting with Grey's Anatomy because of their fabric. Hardly wrinkles, breathes well and has held up to 1000's of washes. I can't stand brands with thick fabric.

I'm short and so need petite pants and scrub tops that don't look like a mini dress. I've worn Grey's Anatomy for a few years. I'm tired of the style and want more pockets on my pants. Grey's also is running differently now. Now their small pants are huge and their xsmall feel too tight - no win. So I bought a pair of a different grey's style than I had before, the 4252 pant and 71166 top in xsmall. Not sure if I'll like it till I wear it to work. SO... Aside from that, I fell in love with the feel and fit of the UA Butter Soft. Their petite cargo pants have 2 back, 2 front and 2 cargo pockets which is perfect. And they have scrub top that is fitted and not too long. EVERYTHING I WANTED! Then I noticed loose threads and seams coming undone... Anyone that wears this brand can you comment on the durability?

Do you use electronic charting to acknowledge orders and document meds? If so, did you document that you gave it and forgot to give it - or - did you just acknowledge the order and forget to give it and chart it? That changes things depending on exactly what you charted. Acknowledging an order does assume you are taking accountability but these things do happen. Or if you acknowledge a stool collect order but it doesn't happen on your shift - then it just doesn't happen. I've seen this scenario several times in various ways. Mostly coaching is done, sometimes performance improvement plan if its a recurrent issue. Was the surgery postponed? Did postponing the surgery cause harm to the patient? Was the patient harmed by not receiving the ordered med? I wouldn't be too concerned with an angry surgeon, I'd more concerned with how this affected the patient and how you plan to prevent forgetting something in the future.

Not necessarily a "hack" but something I thought to do.. Put a stopcock on the IV to draw blood so not to have to undo the leur lock and reconnect. For example if you're getting continuous CVP through distal, put the stopcock on the port so you can get Scvo2 and blood draws without having to disconnect. I've transduced CVPs through the stopcock without change in waveform and the CVP value was consistent with and without the stopcock, haven't found EBP on this so please let me know if you do. I also prefer using bi/trifuses instead of y-siting if compatible gtts. Those can be really handy if you have limited access.

Definitely going to check that out next time in that scenario.

How about this... Ignore his bags. Put in return bin. Pull your own meds just like you're going about your business. This is in accordance with "what you allow, you encourage."

This in theory sounds helpful. This in practice sounds like it has too much potential to cause a med error. I'm too neurotic for this, I want to pull my own meds. No narcotic should ever be hanging around in a bag or cup. Narcotics should only be pulled when needed then immediately administered or returned. I question how this charge nurse has time to do this, and why. I suggest you keep your guard up. And politely decline the help, give a reason if you prefer. When I look at the MAR to pull meds I'm thinking about the patient's dx and hx, making correlations. Say you want to keep that going.