bluesky

When I was a female in a male dominated profession (electrical engineering), there was a complete pressure to prove myself. I had to meet or exceed the standards of my male counterparts. I never would have asked for special perks or privileges because I was a girl... that would have been defeating the whole point.

I completely agree with this. The first hospital I worked as a new grad (staff of course) treated all nurses like crap. Of course when you're in it, you don't think that way. You just think I hate so and so because she stabbed me in the back, and I hate so and so because she gets a lighter load than me and gets paid twice as much. You don't think, well the culture on this unit is very poor due to all-around worker dissatisfaction from poor working conditions and weak and manipulative managers love nothing more than to watch us take it out against each other. Disgusted with that experienced, I became agency. My overall experience with agency (I did it for 2 1/2 yrs) is that I just found that we were basically completely expendable. Everyplace put you through a testing phase... some will judge you fairly and some won't. I had one really bad experience as agency at a military facility but that's about it. I decided to switch to ER from ICU and carefully chose a hospital where the nurses were well treated. I am now working staff at this hospital and am super happy! About 1/2 the ER staff are agency nurses. Because we're all decent people, we just treat everyone the same. In fact, some of our agency nurses are some of the most experienced ED nurses and they are well respected and precept. I was very blessed to have 2 fabulous agency nurses as my preceptors here. I don't really care what the agency nurses are making, honestly. Many of them have to take agency jobs because of bad family circumstances which I don't envy.

Wow. Sorry but I couldn't disagree with you more. An agency nurse is still a nurse and a nurse's first priority is the wellbeing of his/her patient. OP, I applaud you for advocating for your patient. Shame on that facility for not having a clear cut set of orders. Shame on that turfy Hospice nurse for letting her ego and her pride get the best of her. If you were the only LPN in that joint it was NOT a safe place for you to be anyway. Getting DNR'd was probably a blessing in disguise.

Frankly that is what I was thinking too.

Well you know, I'm not talking about all nurses... just ICU at my current facility. First, they don't have to take stepdowns, so when I'm calling_ they only have one other sick patient. Secondly, they have 30 free minutes from the time I fax the SBAR (written report) before I am allowed to call or bring up the pt. When I was working SICU, the OR called telling me they'd be here in 5 minutes (the bed was already down there) and I had to get ready,accommodate, and maybe get a half orificed report from the CRNA who brought the pt on arrival. Just last week I sat on a DKA pt on an insulin gtt for 2 hrs before her highness was ready. Well, when I delivered the pt the RN tried to claim that one of her IV's was infiltrated, and then asked me a million questions that she would have known the answers to had she actually read the SBAR... such as about her urinary output, etc. She made a huge deal out of the IV although it wasn't red, swollen, cool but it probably was on it's way out. Well I was pretty peeved about her whining, so I left without my monitor. When I came back 15 minutes later to get my monitor, the IV was still in place, arm not elevated or warm compressed. Now the monitor showed her pressure to be like 70's/40's which I found pretty odd because she had been solid 160s in the ED (now I will say she was at great risk of getting septic because her foot was rotting off... and she was tachy but afebrile). But she was mentating well. Well these girls were all bent calling the intensivist, getting their boluses ready and giving me the evil eye. I then quietly noticed that the NIBP was loose and not properly placed. When I re-took the pressure with the proper fit much to the dismay and protest of chickypooRN, the pt's pressure suddenly perked right back up to the 160's without any bolus or pressor yet. All she could muster was "well she must have perked up". Mwaaahahahahahah! My charge nurse said I should have invited them over for an inservice on NIBP use but I didn't have the presence at the time!

When I was orienting in a very busy level 1 trauma SICU (that had open-heart, trauma, ventrics, IABP, CVVH, blah blah blah), my preceptor and I had, AT WORST, 2 unstable patients. All days are not the worst. There was time to read the ICU BOOK, do research and get to know my patients, to practice thermodilution CO's, to watch the progression of disease in one patient over days and even weeks, to sit in rounds for 30 minutes for each patient and learn, learn, learn. It was FABULOUS! : ) Morale on my unit pretty much sucked since a good 40% of the nurses didn't feel newbies belonged there. But if you were tough enough and motivated enough, you could learn enough (with a good didactic portion of course) and be a safe and strong nurse. Above all, one learned the disease process and critical thinking. After 4 years of working in ICU, I moved to ED about 5 months ago. I will say that I was a paramedic and ER unit secretary for 5 years before even going to nursing school so it's not like I didn't have any experience in it when I graduated. Well my point is, and this is just my opinion, that it is almost impossible to learn the disease process in the ED simply because you don't keep patients long enough. Yet you need to have an instinct about what's going on with your patients before they're even assessed by the doc and I feel that a large part of that instinct is based on knowledge of the disease process. And not just silly stuff you read in textbooks. I'm not saying you can't get those skills in the ED, but you have the competing challenge of learning to manage the traffic and get everything done super fast which doesn't happen so much in ICU. Now I know if someone had told me that a year ago, I would have disagreed but now I really see it.

Are nurses allowed to do art sticks for ABGs where you are?

Personally, I think previous experience is not necessary for ICU but I think it's absolutely necessary for ER.

I give a lot of leeway to med-surg nurses as they do have 5+ pts and I know it can be hectic. BUT, as a long time ICU RN, I have no patience for the ICU nurses at my facility. They don't take stepdowns so when I'm about to take my pt up, they only have one other pt. THEN, they get 30 minutes from the time I faxed an SBAR and the orders AND an EMSTAT. Which has everything that's been done in the ER double documented. WELL... I just luuuuuuuv it when I wait the whole 1/2 hour then get blown off with even dumber excuses...."she's helping with a sick patient" well duh, you're the ICU, all your patients are sick! And I take the patient up and then they ask me questions about stuff that was straight up on the SBAR and the EMSTAT_ so of course they didn't read them....which is the whole excuse for the 30 minutes in the first place! GRRRRRRRRRRRRRRRR.

I just switched to ER nursing about 3 mos ago. When I take patients to the ICU I don't take any crap from the occasional jerk... as I was myself an ICU nurse for 4 yrs and know exactly how to outgame them. It's pretty fun, actually.

Sorry, hun, I wasn't in any way referring to your comments. I was directly speaking to the post that I will now quote verbatim; "As someone with no intention of working as a bedside RN , I feel that it is plain silly to be learning about bed-making and hanging IV's and learning how to designate to a care partner etc. Not because it is beneath me, but because it is taking time away from learning skills I WILL be needing and using as an NP. The point is, the time could be used to have classes on what I WILL be doing instead of doing this back door way of becoming a mid level provider" All my comments were directed to this post, not any of yours... ; )

I'm sorry but the problem here is that you are essentially a new grad who's been accepted to graduate school. Your opinions are not based on your own primary experience since you do not have bedside experience and therefore cannot directly speak to the relevance of bedside experience. Now, does this mean that you haven't performed exhaustive research on the subject, no. Perhaps you are aware of a reproducible double-blind study which has shown that NPs with no bedside experience are just as competent as those without. Please feel free to cite those, or perhaps to cite the many counselors and professors who have influenced your decision. Perhaps you could suggest that even they should contribute to this thread. So the complete mis-characterization of a bedside RN as merely someone who hangs IV's and delegates tasks to techs is the beginning of the proof to me that you have not truly done your homework. Clearly during the nurse training component of your education you didn't learn much about what bedside nurses really do. QED

You must not need to learn advanced assessment, critical thinking or time management skills ... or see complexe and rare cases through either... because those are all skills a bedside nurse hones over the years.

You know I am also orienting to the ED. My previous experience is 4 yrs ICU. I have been orienting for about 3 weeks (only 2 shifts a week, though). For me the whole taking care of more patients than I'm used to.. and fast... is my biggest challenge. My preceptor and my ED educator both have stated that learning about the populations I don't know (peds, psych, ortho) is the main goal. My preceptor is an agency nurse and she ROCKS! Whenever I get a little antsy about my performance, she simply tells me in this setting if anyone has an issue with you, they will let you know! Unlike the ICU where RNs are on a mission to tear their newbies apart, I am feeling great love where I am. That said, the critical thinking and assessment skills I learned in critical care are very helpful. But have similar skills from your floor experience. For now, I am just enjoying having a preceptor who actually cares about my learning. When I was an ICU agency nurse at a new hospital, I got at most an hour or two to learn a whole new unit before I started to work. It sucked!

We haven't been able to get our 6 y/o out of our bed yet. Overall I'm glad we did it ... but I will say it didn't help our private intimate time... if ya know what I mean!

You know I can't be of much assistance to you because I've never worked in LTC.... : ( I just wanted to post to support you in your decision to go back to work with kids... I know how hard it is. I think it is super conscientious of you to study before starting. You know you can always ask to be oriented again for a while when you start again just to cover yourself. I once left my area of specialty for about 6 months. When I went back to it, I made the only med error of my career. If I had to do it over, I would have asked to orient for a little longer... or perhaps not returned to agency immediately. Anyway best of luck to you either way!

Please feel free to list any healthcare organizations that have closed related to union activity. Please also present your evidence of such a causal relationship. Thanks!

nothing personal but i am not here to either 1) be quoted in your lawsuit or 2) do your nursing school or critical care fellowship homework sorry!

I mean you know his kidneys were gone, his platelets depleted, hypotensive and motled. This man was in an advanced stage of an aggressive septic process. It sounds like he was in MODS or at least starting to be. You did everything you could. Here is an excellent e-medecine article on sepsis... http://www.emedicine.com/MED/topic2101.htm I mean OK let's say he had landed plum in the middle of a high acuity teaching hospital with CVVH and specialists galore within immediate reach. Even then he was looking at about a 50% chance at best. But then again you could have been a nurse somewhere in a rural clinic in Nicaragua and he could have been a 6 month old baby and you might not even have basic equipment to work with. That baby would have died in your arms septic. Life is full of what ifs that are completely beyond our control. I truly wish I could develop a full-proof therapeutically sound method of making sense of it all. There are only 2 things I can say. 1) Becoming numb and jaded is not healthy and won't work. 2) you can either run away from the pain of these experiences or use it as a reminder of both your greatness (your all-out effort, your empathy for this man and his family, your rigor with yourself and your team) AND your limitations as a human being. Hugs :heartbeat

WoW!!! : ) I just want to thank everyone from the bottom of my heart... for helping me get the gumption to GO FOR IT! Today I had my interview in HR for an ED near where I live. I am keeping all appendages crossed! Hopefully I will be one of you soon... Thanks again for all the inspiration and support :redpinkhe:redbeathe:heartbeat :heartbeat:redbeathe:redpinkhe:redpinkhe

To the OP. It is completely OK to feel like you do. I would completely trust my instinct if I were you. Your instinct is not telling you " I am a weak nurse who is overwhelmed". Your instinct is telling you "I don't like it here". "I want to try something else". That is absolutely fine. You can always try something else and then return to the ICU if you want to. Some people spend 6 months in the ICU and think they know it all. These people annoy me. This post isn't about them... it's about you and what you want to spend the next couple of years of your life doing. What struck me about your post was that you are very specific about what is bothering you. You are not overwhelmed by the tasks or mad at a petty diva nurse. You have identified certain intrinsic aspects of ICU life that just don't mesh with your personality. Have you ever floated to other areas and found yourself invigorated or like that is where you belong? All that said, only your own true self and time will tell whether you are experiencing temporary angst or indeed in need of a permanent exit strategy. I think you may want to figure out exactly where you want to go before discussing it with your manager because the manager won't be 100% thrilled that a nurse she invested in wants to leave her unit. If he/she is a good manager, he/she will help you find placement in another unit and leave the door open for return. If he/she is not a good manager, they will guilt trip and rationalize you into staying. I don't have the full picture of what you are dealing with. All I can do is encourage you to follow your heart and believe in yourself. : )

I just want to thank all of you for taking the time to answer my post! I feel so relieved...

Hi All. Before going to nursing school I worked ER as a secretary and EMT for about 5 years. I absolutely loved it but when I graduated the ER of my dreams didn't have any openings (hard to believe I know but it is the only level 1 trauma center in this part of the state). So anywhoooo..... I somehow ended up in ICU for 3 1/2 years. I have to say I absolutely hate it. The main reason I hate it is the snooty pack mentality diva type A nurses I work with. And bed baths. And seeing the same patient over and over and over and over. I've gained 50 lbs and have major anxiety before I go to work. I am really thinking hard about transfering to ER. I have floated to the ER on several occasions and really liked the energizing pace and meeting new patients all the time. So I guess I'm looking for ex-ICU nurses who've made the switch to tell how they like it. The most important issue for me is the nursing culture. I really want to get away from the ICU divas. Thanks! : )

What's "resp swing"? Thanks!