stressgal

And here I thought I was the only one who had a rough week, lol. Our facility, including critical care has open visitation, anyone and everyone can visit at anytime. We had been told by management that we would "always be backed" if we needed to ask visitors to step out for patient care. That only works until a visitor doesn't want to leave. All demands from "customers" seem to always be granted. Let's face it, people are less respectful and more agressive. Seriously thinking of a career change too.

Love my Tarascon Pharmecopeia pocket giude. Small, fits in my pocket and has all the info I need. I also have the Critical Care pocket guide. I must say these are my FAVES, and I do tend to buy lots of reference guides :)

Yes and absolutely

A few thoughts from an ICU staff nurse, charge nurse, preceptor, and clinical instructor for 4th quarter ADN students in the ICU: As a liscensed RN I am responsible for the patients assigned to me during my shift. As a liscensed RN precepting students I am responsible for patients and the student assigned to me As a liscensed RN precepting new grad RN's I am jointly responsible for the patients and trainee assigned to me As a liscensed RN teaching students in a clinical setting I am responsible for their actions, assessments, charting, medication administration and any care provided. Maybe it is different in your state. As a clinical instructor I will only pass medications with two of my students per clinical. I am responsible if there is a med error. Once again I teach in an ICU setting. My students do nothing invasive without me at their side. With that said, it sounds as if you are developing effective critical thinking skills. The more assessments you complete the more thorough you will become. It will in time become instinctive to assess the patient completlely every time you enter the room. Chalk it up as a learning experience and move on. Good luck in your future studies. Keep up the good work.

I would save my money. Hospitals will pay for the certification once you are hired. In my area it would not make you more "marketable". We actually don't allow our new grad critical care nurses to take ACLS until the have been on the floor for about 6 months. Once they have a few hours on the floor they have a better understanding and retain more information. In this job market we hire new grads based on previous employment within our facility, job performance in that position, or through their final semester preceptorship.

Each department at our hospital wears a different color scrub. The uniforms are provided by the hospital, pretty much. We get an allowance annualy and if we want to spend more than that they payroll deduct. I like knowing who is in my patient's room, be it phlebo, radiology, tech or whatever. I think it also assists with security. I may see someone in scriubs but can easily identify if they are an employee or not. Our dress code is pretty strict when we are not in scrubs, say attending a staff meeting or ed day. No open toe shoes, no capri's, sleeves on shirts, no jeans and so on. I chose to work there, pay is good and location is important to me, so I comply.

I work Intensive Care and here is how our shift change occurs. The off going charge nurse gives a brief report to all nurses coming on shift on all patient's in the unit. These include dx, drips, rhythms, O2, chem sticks, treatments etc, takes about 15 minutes for our 13 bed unit. On coming charge nurse hands out assignments and walking rounds are completed between off going and on coming nurse. There was a lot of resistance from staff about walking rounds initially but I love it. We have a lot of new grads on our night shift and I think it is a good time for all nurses to visualize, ask questions and transfer information. Of course we use common sense and may report sensitive information to each other away from those who don't need to hear, I think the example was given earlier about a patient not being aware yet of a diagnosis. When I have floated to the med surg units they just do walking rounds without the initial group report. They have up to 8 patients per nurse and it works for their situation.

I agree with the above poster. New grads are very task oriented. Nursing often does not allow for a set "routine", some days you are simply stamping out fires as they occur. With that said I attempt to take report from the off going nurse, doing so with walking rounds helps me lay eyes on the patient, address any urgent needs. Then I glance at my labs, grab meds and head in to assess the patients. Usually after that it's about time to check my new orders, and then reassess my patients. Some days go better than others. Some days I have radiology, physicians, pharmacy and whoever else coming at me in all directions. It really does take time to find your groove. But as the above poster stated, try to find ways to streamline your tasks. It's a 24 hour day and everything will get done eventualy.

Our facility invested in the "Vocera" system. Basically it is a cell phone that we wear around our necks on a lanyard. It is a hands free device that works on voice activation. It will announce the caller and ask if you can take the call, you simply answer yes or no to connect. If you want the calls to be private you must wear a earphone. When we got the a couple of years ago we were hesitant. Recently the system was down for a couple of hours and boy did I miss it! It is so beneficial to call for needed assistance when a patient starts circling the drain. We do not transfer "family" calls through the system, I think that would probably send me over the edge.

Congrats!!!!!!!

My understanding is they have the same purpose/action. Calcium Gluconate is perferred as it is less irritating. Still nasty, worst infiltration I have ever seen.

Good Job!

No raise for us this year but the Hospital did cover the rise in insurance premiums. I do participate in the career ladder program and will see a couple dollars/hour increase from that. We too are running a tight unit/hospital with staffing and are taking low census on occasion. I think it has come around every couple of months or so. I'm not complaining my turn happened this past Thursday. Thanksgiving, my holiday to work and I was told to stay home. I refuse to get too involved in what management gets monetarily. I have worked management and they can have it. I cannot think of a business that I have ever worked where management and hourly employees would see equal benefits. Just my experience.

I studied for about 2 1/2 months with the Laura G videos and Pass CCRN questions. I spent a little bit more time as I work in a 13 bed community hospital ICU. We have about two baloon pump patients and a handful of PA lines annually. I passed the first time, but boy was it the hardest test I have ever taken. I am preparing to study for the CMC certification over the winter months. Good luck!

Stay strong and put in the time. I too faced challenges as a new grad in the ICU. That was over 4 years ago, now I have earned the respect of my peers. Believe me, it isn't easily given. A couple of the "seasoned" tough nurses have retired, a couple others now ask me for advice. Pretty cool! Lead by example. If you ever need an attagirl, pm me.

I attended Chamberlain College of Nursing. It was a bit pricey but I completed in less than 12 months, had no clinicals and it was completed ALL on line. There are many options available. My suggestion is to do your research on each school and decide what works best for you.

Congrats!!!!!!

Great advice from all the above posters. I will add though that holding meds without clear parameters from a physician is "practicing medicine" or "prescribing" without a license to do so. While I may not administer the medication initially based on my judgment I always clarify with the physician and have written orders with parameters.

13 bed ICU, 1 nurse per 2-3 patients. Sometimes we have a tech or two, sometimes we don't and provide primary care. Our techs are trained to provide and assist with a lot of tasks and often these tasks are missed during primary care. IMO consistancy one way or the other would be better.

Yep. Never have I known of an individual being fired over one offense.

Our facility provides visits for newborns to the moms residing in ICU, when it happens. Usually a couple of times a year. I cannot understand how the "newer" ICU's are considered dirty. We are not a ward but private rooms. Reverse airflow in each room, if needed. We care for fewer patient's, therefore having less contact and risk of cross contamination. Assignments are delegated based on such issues as well. Our moms are discharged from our ICU unit to postpartum.

I am not sure I understand the problem. You have a job, working in Neuro. Your facility is paying for critical care training. You will have experience that, after obtaining the required hours, qualifies you to take the CCRN exam. And the problem is you don't work in the same unit as your "friends"? The unit you work in doesn't have the title or status you perceive/desire? My advice is to set goals for yourself, do not follow someone elses. See those goals through. Learn from the past, but don't dwell in it. I am a firm believer that you are where you're supposed to be, when you're supposed to be there. Good luck!

We are required to double check insulin, PCA pumps, and any heparin product. This includes TPN/PVN which contains heparin/insulin. Yes we were crabby at first (still are at times). We use a computerized MAR and must scan our bar code, found on our name badge, along with a second nurses initials and bar code. Time consuming.....yes! In all of my checks I have never come across an error. Pressors do not require double check at this time, however if I am utilizing a concentrated dose that is not programmed into our "smart pumps" I have a second RN check my entry/rate. Actually the only error I have ever experienced was when a POCT reported a lunchtime fingerstick glucose aroud 350, which I covered and then saw the lab result cross over the computer as 120. Turns out she had swapped the glucose check number for the foley output. The patient was provided with a really good lunch and no bad outcome but I did have and reported a med error. Needless to say I now wait until I see confirmation on our computer system prior to administering coverage. Live and learn.

In my facility we take patient's when we are in charge. Some people are better at assisting while in charge than others. These are the nurses who are normally team players. I think you will come across a lot of different "styles" of nursing. Find the people you want to emulate and stick close, develop relationships. If your unit self schedules attempt to schedule yourself with the team players. I also believe you should voice concerns through the chain of command. Finally remember that you can really only control your own practice. Do as you know is right and go home each day confident that you cared for your patients to the best of your ability. Good luck, and don't get too discouraged.

They should be thankful and proud! Do not let anyone keep you from your goals! I have had co-workers/seasoned nurses who say passing a test doesn't make you a better nurse. BULL! The continued quest for knowledge and empowerment definately makes fo a better nurse. Welcome to the world of critical care and good luck!