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Hi. Every burn unit/center does things differently so I can only tell you what my unit does. We use primarily, narcotics for pain management (oxycodone q4h for base pain control, Dilaudid PRN for break-through pain and Fentanyl (and maybe Dilaudid) for dressing changes. We also frequently use Versed for patients with large dressing changes. Of course, there are other meds given depending on the patient, but those are out standard meds. As for burn cleaning and dressing: burns are cleaned with water and dial soap. Burns on the face receive bacitracin ointment. Ears receive sulfamylon cream if burns are partial or full thickness (otherwise bacitracin). On the body we mainly use SSD cream wrapped with Kerlix (rolled gauze) then a netting to keep the Kerlix in place. We use acticoat or aquacell on donor sites and then xeroform. We mix sulfamyon powder and amphotericin B in sterile water and wet down graft sites q4h (or PRN to keep moist). There are several other options depending on specific situations, but these are our basics dressings. Sounds like a lot and it is, but you'll sort it all out quickly. Just jump right in!!

I remember in nursing school they told us that nurses eat their young. I kind of laughed and said that yes, I'd heard that. Well, now I know what they meant; someone is trying to bite a little bit off each time I work now. All through nursing school clinicals and most of my orientation in the Burn ICU where I work, people were pretty patient with me, seeming to understand that I am a new grad. But then there is this one. Not even an 'old timer'. She's younger than I am, though has about 5 years of nursing experience. She seems to be a really good nurse, but is so openly rude and impatient to me- lots of eye rolling, snide remarks and not-quite-behind-the-back snarky comments. I think she is unreasonable to expect that I can flow like an experienced nurse and handle our sickest patients without getting behind or asking questions (she is usually charge when she works). Should I, after 3 months, not have anymore questions? It's true, I do ask the same questions over sometimes, but I'd rather ask repeatedly to double check and do the task correctly than not ask and cause damage. But it doesn't matter which I choose because she will tell me I am wrong, she will roll her eyes, she will speak rudely and sigh loudly - in front of coworkers and patients. I am not the type to run and tell; I would like, in fact, to "turn the other cheek"; but my barely-there confidence is waining and for the first time, I am truly wondering whether I can handle working in an ICU. Maybe it IS too much coming right out of school; especially out of an accelerated program. I hate to think of giving up, but I feel like a complete moron most of the time. Should I start looking for another unit?........ and yes, i know i sound hysterical.

I remember in nursing school they told us that nurses eat their young. I kind of laughed and said that yes, I'd heard that. Well, now I know what they meant; someone is trying to bite a little bit off each time I work now. All through nursing school clinicals and most of my orientation in the Burn ICU where I work, people were pretty patient with me, seeming to understand that I am a new grad. But then there is this one. Not even an 'old timer'. She's younger than I am, though has about 5 years of nursing experience. She seems to be a really good nurse, but is so openly rude and impatient to me- lots of eye rolling, snide remarks and not-quite-behind-the-back snarky comments. I think she is unreasonable to expect that I can flow like an experienced nurse and handle our sickest patients without getting behind or asking questions (she is usually charge when she works). Should I, after 3 months, not have anymore questions? It's true, I do ask the same questions over sometimes, but I'd rather ask repeatedly to double check and do the task correctly than not ask and cause damage. But it doesn't matter which I choose because she will tell me I am wrong, she will roll her eyes, she will speak rudely and sigh loudly - in front of coworkers and patients. I am not the type to run and tell; I would like, in fact, to "turn the other cheek"; but my barely-there confidence is waining and for the first time, I am truly wondering whether I can handle working in an ICU. Maybe it IS too much coming right out of school; especially out of an accelerated program. I hate to think of giving up, but I feel like a complete moron most of the time. Should I start looking for another unit?

Yup. I'm at Baptist, too and it's $4.00 for any work between 3pm and 7am and $1.25 for weekends.

To help patients deal with pain we give them lots of drugs, mostly narcotics. Generally, we see (10-20) oxycodone q4h, dilaudid for break through pain and fentanyl for dressing changes. On top of that, I talk to them, acknowledge their pain, help them with breathing techniques and go as quickly as possible; I say often, "I'm sorry to cause you more pain. I understand this is terrible, but this is going to make it easier for you later." I'm a new nurse who went right into a Burn ICU and I'm still coming to terms with having to cause patients pain; and we cause a lot of pain. Pain is unavoidable when recovering from a burn. I must scrub the dead skin off, I must move them to change the bed and change dressings or just for extra PT- all of this painful, not to mention the other stuff... constipation, multiple tubes/IVs that restrict movement, utter lack of privacy and independence. I dream of terrible things (one way I deal with things) and I talk to people. I have to deal with what I see and smell (horrible injuries, some of which were accidents, some done to themselves, some done by "loved ones"), I have to deal with my own fear of incompetence (being so new), I have to deal with the fact that some people won't make it. And, like you said, I have to deal with causing them pain. I just try to remember the fact that despite the pain, I am helping them and they'll be worse off if I don't do it.

I am not in the current group, but graduated the accelerated program this past February. The accelerated program does not have semesters or abide the traditional school schedule at all- no spring, summer or fall breaks and no federal holidays (though they did make sure we had some days for Thanksgiving and Christmas). You will be in 2-4 classes at any given time, but only one class that requires clinicals at a time (so maybe Pharmacology, Gerontology and Adult Medicine I at the same time, but only Adult I would have a clinical). Classes are generally during the week, though you may have an odd weekend day class. Med-Surg clinicals are done at Baptist, except for OB, which is at Forsyth. You may also have clinicals at Oak Summit nursing home. Community nursing clinicals are done at a variety of locations in the community and parts of Psych nursing clinicals are done in the community (AA, NA, mental health meetings). The classes that have clinicals are Intro III, Adult I, Pediatrics, Maternity, Psych., Community and Adult II.

Yes, we do that, too; but I do think it's a fairly new protocol... perhaps a study even. Makes sense, though, because burn patients are missing their first line of defense against bacteria (skin), not to mention having somewhat (or extremely) compromised immunity due to severe trauma. I'm glad to do it if it helps, but it is rather tedious and HOT!

We got a few days for Thanksgiving, and a whole week for Christmas, which was a new thing. We did not observe any school breaks, like spring break or fall break; and you will not necessarily have federal holidays off. This program will consume your life. There are only a handful of instructors that teach in the accelerated program; some fantastic and some really dreadful. And yes, if you get the contract, you can either fullfill it or pay it back within 30 days. If I had known what to REALLY expect I might not have left with such a bad taste in my mouth.

I completed the accelerated program just a couple months ago, so it's doable. I don't regret it because I'm finished and did well, BUT I if I had known before I started what I know now, I would definitely NOT have done that program. Regarding the schedule, you are expected not to work and it really was very difficult for those who tried to keep a job. At first you have classes 3-5 days a week (occasionally on weekends) and once you begin clinicals, classes are 2-3 days a week and clinicals are 2-3 days a week (everyone will have at least one weekend clinical rotation- a rotation is weeks long). Classes begin 7-8am and clinical begins at 6:00am. The farthest my classmates lived was 2 hours away. Everyone with families had difficulty juggling family time and school time. Some who traveled a distance to school actually rented an apartment because clinicals are 6a to 6p; and after clinical you'll have to spend several hours doing care plan(s), not to mention other work. Starting this year, they did not offer a contract to every student in the program; I don't know any details about that.

Hi! I'm a brand new RN and will begin working on a Burn ICU in Winston-Salem in a couple weeks. I just finished an accelerated BSN program which was paid for by a local hospital who, in return, requires 3 years of employment/indentured servitude (haha) with them.

depends on how close you want to be to the beach. :) here is a list of nc's teaching hospitals: university of north carolina hospitals carolinas medical center duke university medical center durham va medical center pitt county memorial hospital wake forest university baptist medical center from: http://healthguideusa.org/teaching_hospitals_north_carolina.htm

Yes, you are wanted. Nurses are badly needed. I just completed an accelerated BSN program in Winston-Salem. Whether there will be discrimination I cannot say, but most of my classmates were "grown", though there were a few coming straight from the their first degree. Anyway, there should be plenty of people your age, with and without families, mortages, etc. *I realize you didn't ask, but I would offer that if I knew in the beginning what I know now, I would NOT have gone the accelerated route, at least, not in Winston-Salem. I recommend talking to a few people who have completed the program in which you are interested. Pursue nursing, nonetheless and best wishes to you.

Did he die from his burn injuries or congestive heart failure from the fluid overload?

That's what I've heard. Shriner's seems to be the "mothership" of burn units. I've never been, but am incredibly impressed by what I learned about them while in school.

No difference that I know of - I'm a new grad starting in a Burn ICU and, aside from shift/weekend differentials, my pay and benefits are the same as other new grads at my hospital.