nekhismom

At my hospital, there is a ~1.00 to 1.50/hr premium. SUpposedly.

I've been in the cath lab for almost 2 years now, and before that my only experience was ob and NICU. Talk about a HUGE change and feeling so lost and out of place! I am a fast learner and I ask a ridiculous amount of quesstions, but it was a difficult place to learn. I still learn something new every single day. In my lab, RN's and all techs do EVERYTHING. Basically, regardless of your background (RN, resp. therapist, rad tech, or scrub tech, whateverr), we all learn to circulate, scrub as a first assistant, and monitor patients. We all administer conscious sedation and any other meds the MD orders. We take turns rotating through all of the positions. It was very difficult for me to learn to scrub at first, but now I love it. My lab is the busiest lab in the state, although we are not the largest lab. We do approximately 7 acute MI's PER WEEK, and several thousand angioplasties per year!! We do approximately 35-50 cases per day in cath, 2-5 in EP (pacers, ablations, etc), and 5-6 in peripheral. We do pacers, ICD's, loop implants and removals in the cath area as well as EP, but we don't do peripherals in the same labs. We take call 7 days every 8 weeks or so, depending on the schedule, and we rotate holiday call. There are very few nights that we don't get called in for an acute, and even fewer days that we don't stay late to finish a case. We are in lead most of the day, and it is HEAVY. Some days it feels like you are running a marathon with your lead on when you are circulating a PCI of any kind, not just an acute.....running around the lab getting meds, starting o2, starting IV drips, anticoagulating, reassuring the pt, fetching equipment for the md, making sure the scrub person doesn't need any other equipment, watching the pt's vital signs, anticipating needs, etc, all while trying to minimize exposure to x-ray. It is different with every patient, even though the set up generally remains the same. Scrubbing is fun, too. You still wear the lead, and you are responsibile for maintaining a sterile field at all times, setting up the scrub table and draping the patient in a sterile fashion, and helping the physician with the equipment. For example, when doing angioplasty, I prep balloons and stents and load them over the wire and advance them to the lesion. The MD positions the balloon or stent and then tells me to inflate the balloon or deploy the stent where he has placed it. So, basically, I put stents in patients, while the MD just says where to put it and what pressure to blow the balloon up to and for how long. It's a wonderful feeling. We do computerized monitoring, and that is like a little break for us. We don't wear lead behind the glass, and we get to sit down for a few minutes. But if the circulator needs help, the monitor person gets up and helps. It's the easiest part of the job physically, but very technical. When doing right heart caths, if your numbers are wrong, you could have a pt. sent for valve surgery when they really don't need it or have pts. who do need surgery not go because your data was inaccurate. You really have to know what you're doing and make sure that you get good data. I LOVE my job. I love the work that I do, and I LOVE the fact then when I go home every single day, I know that something I have done makes a difference in a patient's life. In exchange for this, I go home nearly every day bone tired, wore out and with a backache from the lead. But it's worth it to me. I can't imagine working anywhere else now that I've gone into the cath lab.

I walked out on my second travel assignment. I was considered a "registry" nurse with this agency, so I was expected to work at various facilities in a certain area. THe agency promised me hours, hours, hours, then only gave me TWO hours in two weeks! I had a lot of hassle about other things, too. The pay was ok, but not great, and worst of all, the housing was in a cheap, moldy motel. The agency kept trying to book me on units that I was not qualified for, had no training in, and repeatedly told them I could NOT work without orientation. I attribute it to the agency itself, not my recruiter specifically. My contract stated that if I failed to complete the assignment for any reason that I would owe them for housing costs, but it was worth it to get out of there. I wasted a lot of time, money and effort to prepare for that assignment, but it would have been much worse to sit around half way across the county and not work or make any money at all.

Does anyone know of any Cath Lab travel positions in the daytona area? I'd be very interested to hear of any news any of you might have. THanks. :wink2:

Good for you for trying! \I went from the NICU to the cath lab with no adult critical care experience, and it was hard at first, and still is sometimes. But if you are willing to work hard to understand the job and it's requirements, then you are likely to succeed. There is a certain degree of monotany in the lab, but then again, i feel like that exists in all jobs. Let us know how things turn out!

I don't think interventional labs will be out, because there will still be plenty to repair. I think non-interventional is going to be out of a lot of cases, though. Our MD's are expecting the 64 slice scanner to "catch" a lot more disease than we currently see under angiography. We have ordered at least one 64 slice CT scanner for our lab, or so I'm told. I'm also told that the techs will be running the machine. In my lab, everyone is a tech, whether you're a nurse, resp. therapist, rad tech, cv tech, surgical tech, scrub tech, whatever. We all do the same job and have all the same training. So I'm looking forward to learning how to do some CT scanning!

We do interventions in my lab, and we have surgical backup available 24/7. We also have a diagnostic only lab in the house, but they have the same backup. If a pt is cathed in the diagnostic lab and needs an urgent or emergent intervention, then they are transferred to our lab. If an intervention is needed but it can wait, we schedule them for PCI in our lab. We get a LOT of our caseload done in the diagnostic lab that we would otherwise NEVER get done. We would pretty much be a 24/7 operation without the diagnostic lab. All that being said, I would not feel comfortable having a cath in a place that did not have surgical backup immediately available. I have seen too many things go bad even with the best of cardiologists-- dissected aorta's, plaques broken off and arteries blocking off during cath, etc. I would not feel safe, but that's just my humble opinion.

We only have Angioseal, PerClose and StarClose in our lab. We have Clo-sure P.a.d. in the lab, but I've never seen it used. We rarely use PerCLose d/t pt c/o severe pain with deployment. We mostly use Angioseal. Angioseal pts are on bedrest for 2 hrs post deployment, then can d/c if VSS, no other issues, etc. We do this regardless of anticoagulation status. StarClose states that their pts can ambulate almost immediately. Our MD's still insist on 2 hr bedrest.

I work in the cath lab, and I pull sheaths quite often. Worst one yet occured on a floor where I was to observe and check off a new nurse. Pt was hemodynamically stable but had a GIANT hematoma, had to be at least the size of my hand. Both of us were holding that groin with all we had, and all the unit nurses kept refusing to come into the room and help us. I thought the poor lady was getting a retroperitoneal bleed because she was screaming in pain, and the hematoma got so big so fast. We held for about 45 minutes on that groin. But in the end, her leg looked really good. The hematoma was gone, but there was a big ole bruise left. THe worst groin incidents I have ever seen come from pts who have blown their Angioseal. They all seem to be older pts who are not always very oriented to reality. And we've had several of those recently.

I've never seen the drip method! We pull back on all of our lines slowly with a 3ml syringe. We then obtain enough blood for the sample, and we give back the "waste" that we pulled off. All of our art lines have heparin in them anyway, and the blood draw is so fast that our policy says it is safe to re-administer the blood we drew off. We do have to open our lines, though, because we don't have a closed system for any IV or art lines.

I work in a level IV NICU. We're a regional referral center and we do have ECMO capability and do every surgery under the sun for wee ones.

We have parents that say who can and can not take care of their kid all the time. Usually it is because one nurse enforces the rules when others let the parents do whatever they want to do. Of course, there are notes at the desk saying "do not assign baby boy BB to nurse XX per parent request" all the time. SOme patients even have "parents request that only the following nurses be given baby girl GG." Everyone LOVES not to be on that list, because those parents can be so demanding.

We don't have DPAP either. We use nasal CPAP and are trialing vapotherms right now.

We have 24 hour visitation, except during change of shift reports. Parents can place 4 people age 18 or over on visitation list to visit when parents are not there, this includes grandparents. Children under the age of 16 are only allowed in if they are siblings (or sometimes the parents of the baby)and only after being screened by a nurse for illness. If parents are under 18, they can not bring in visitors or put anyone on their list under the age of 18 unless they are siblings. So they can not bring their teenage friends in to visit. Otherwise, parents may bring in anyone while they are present so long as the parents are over 18 and the visitors are over 16. Only 2 people at bedside allowed. It's confusing!! Parents are supposed to scrub in, but I've had moms walk back less than 30 seconds after the secretary opens the door to the unit, so there is no way possible!! Of course, they all say they washed up, but they don't always. Everyone who holds a baby must wear a gown. Gloves are not required.

Kitty, I wish we had a letter similar to the one you posted available to our parents. I have NEVER heard of our dr's discussing long term outcomes with parents except in exceptional cases----you know, baby is 6 mos old and has never reached a single developmental milestone, has hydrocephalus, liver failure, signs of CP, etc. We NEED something like that!!

nope, we don't cobed at all. ever.

I work with 2 male NICU RN's and they are both great. One is full time, other is PRN. The f/t nurse jokes about the NICU being his "kingdom", but we all love him. We also have a male NNP, who is also very good. I say it doesn't matter what your gender, a good nurse is a good nurse, period. If you want to be a NICU nurse, go for it!

Used it before, and I liked it a lot better than the junk we use now (PIPP/comfort scale)

I do use it quite a bit, but still prefer good ole fashioned handwashing! Cathy, have you tried Aveeno brand intense relief hand cream? It is supposed to last for 24 hours, but it does last through at least 2-3 handwashings. You can feel it hanging around and it is wonderful. No artificial scents, either. Got mine for about 6 bucks at Target.

and where would one find the ice cream cone??

And I was just thinking about how to edit it. THere are several personal attacks on the previous 2 pages. These need to be edited, or I will edit them. Aside from those personal attacks, however, the thread is informative and doesn't violate the TOS, so it will remain open.

Yikes! I actually read the Similac HMF box at work the other night, and it does say 1 pack to 25 ml=24cal!! I asked some of the other nurses about this, and they were all surprised, too. So, I was wrong, I've been adding extra calories to milk for some time now! I'm planning on doing a short training on the fortifier asap!

Our RT's don't do chest PT and we rarely give neb tx here (don't know why), but I guess they would do that. They handle EVERYTHING with the vents, fit kids for cpap and maintain those machines, basically they maintain all resp. equipment. They can draw blood gases from our babies, both art samples and capilary samples. They also do blood sugars and iStat's. They do NOT like it if we try to re-tape. When I first started here and I was re-taping, I got laid out!! That is ONLY a resp. function in my NICU. RN'S NEVER EVER EVER re-tape! Some of our RT's also go on transports. We usually have one RT per suite, unless someone is on transport. Last NICU, we were still trying to figure out what the RT's were there for. THey physically rolled a vent into the room and put some tubes on it, then walked away. Didn't test it or anything, just left it. THey didn't assist with anything. During codes, they were usually standing off in the corner somewhere watching, not helping. THey only went to deliveries if it was multiples and nurses were short. Nurses drew all samples, art or cap. THey did do CPT when and if they felt like it, and nebs were the same. Usually didn't happen. One of my kids had nebs ordered q1 and I was LUCKY to see an RT ONCE per 12 hour shift. Basically, the RT sat in their little room and put the cap tubes in the machines when a nurse brought it to them.

Is fluff like sheepskin??? IF SO, then yes, I use it like that too, and I love it~

One place where I worked, using a midwife was very discouraged. If you had used a CNM throughout your entire pregnancy, then had a complication and needed to deliver at the hospital, or just decided when it was time to deliver to show up at the hospital, then you were dubbed a drop-in, and labeled as having no PNC, even when they had records in hand. The CNM's in the area were NOT recognized as competant caregivers. I had one nurse tell me that there was no useful information in the midwives' prenatal records, and that the pts. would have been better not to have brought them. There were also a great deal of lay midwives in the area, and there patients were treated the same way...as drop-in's with NO PNC. The pts. who did come to us in an emergency were a train wreck. You never know when an unexpected complication could arise. Personally, I feel better about having a CNM who delivers in a hospital that has a LEVEL III NICU. As a NICU nurse by trade, I'd be way too terrified to deliver anywhere that did NOT have a NICU.