sicushells

What does the second "t" stand for? (Chest Tube T...ube?)

1) You have to go to LVN school to be an LVN. 2) Money is always going to be tight, don't use that as an excuse not to get your BSN. It's incredibly difficult to get a job as a new grad with your BSN, not impossible, but difficult. Things might turn around in the two years you'll need to finish school, but they might not. There are so many scholarships and loans out there, especially if money is that tight (and when you're 22 you don't have to claim your parents income, which makes things much easier). 3) It might help you to take a CNA class of some sort to get some clinical experience if you have a few semesters to go before you finish your first sem. of clinicals. That's something you'll have to evaluate considering your specific circumstances. That said, I think most hospitals require either CNA certification or significant CNA experience, I don't think that's something they ever hire for if you don't have cert or exp.

First of all- Great Job! It sounds like you gave a really solid interview. That's awesome! Second of all- no, not necessarily. It's unlikely they'll spend money to give you a drug screen if they're not really really interested in you. However, you only have the job when someone from the company says, "We're offering you a job as a staff nurse at XYZ LTAC for $zyx differential. Typically it will be the HR recruiter that contacts you and makes the final offer, not the floor manager. Often it takes a few days to a few weeks before they'll officially offer you the job, so don't stress if you don't hear anything right away. Good luck!

1) It's possible that they'll be interested in you. Whether you hear from them or not depends on several factors (how much they need someone, how strong your resume is, how relevant your experience is, etc.) Make sure that your resume is good. Have career-oriented friends/former supervisors look at it. Write a cover letter tailored to each job you apply for- make sure you highlight why you want that specific job and what you have to offer. 2) Don't follow up. Recruiters are busy and don't want you to "remind" them you exist. If you call and follow up unsolicited it makes you look unprofessional. After the interview, it's okay to set a time frame and follow up after that. askamanager.org is my favorite website for career advice. She's not in health care, but her general resume/cover letter/etiquette advice is incredibly helpful. Good luck! I hope you end up somewhere great!

Ruby: Thank you, sincerely. I posted on here because I was frustrated and trying to figure out if I was being an ICU know-it-all diva or if I had legitimate safety complaints. So far, I think my answer is: a little of both. I was concerned because the patient was very sick, the vitals were all over the place and we were frequently titratting gtts. In my past experience, all these things automatically = q15 MAPs (sometimes other VS if indicated), and potassium was never ever given more than 20 mEq/hour. Again- new place has no policies I can find, and I spent quite a bit of time later looking. I've done a very little bit of research online after originally posting on here, and have found several sources that say 40 mEq/h is alright "with physician orders" but I don't know our physicians well enough to know if they'd actually know/care about things like medication administration rates (cue story about my past job experiences here). Also at past jobs, I always kept my alarm volumes high enough to hear them if I stepped slightly outside of the room, and kept my alarm limits fairly close. At my new job, we're not supposed to change the alarm limits if we can help it (I haven't figured out why yet), and the alarm volumes are kept at 10% to promote patient rest. That said, I am aware that "The Way We Did Things" is not the only way to do things. My knee jerk reaction of course is to go back to my past experiences when I'm working- if I didn't I would be a slobbering idiot. When someone is telling me to do things that seem unsafe, I typically get concerned (and so do you- if you had a new job and your preceptor told you it was unit policy to jump of a bridge, would you do it?). But then I have to rethink what is actually un/safe vs. just standard operating procedure in my past life? So thank you for giving me honest feedback. I absolutely promise not to come here and whine that they're "eating me" or giving me crappy assignments (I expect it and know that I have to prove I'm not a slobbering idiot) or a crappy schedule (ha- joke's on them! I don't really care what I work and love overtime- bwhahaha).

I looked up the protocols and policies and there really isn't anything specific. "Typical" care of post-op patients is VS q15min x's 8, q30min x's 4 and then q1h. That said, I've always worked places where we would do VS more frequently if they were on gtts we were titrating, or unstable.

Sorry, I could have been more clear. I continued to chart q15 minutes. My rationale was that q1hour vitals (esp. BP) aren't really appropriate in a patient on a lot of support.

I'm pretty sure that was sarcasm, my dear. That said, if the hospital doesn't make money, we don't get enough money to eat.

Emphases my own. *Pause for deep breath here* Yes, we all feel that way sometimes. Different things trigger this kind of response- the homeless braindead ICU patient who's sucking away the hospital's (and therefore my ability to get OT/raises/etc) money. The homosexual drug abuser who has AIDS and q1h fingersticks. The smoker/drinker oral cancer patient who tries to punch you when you won't give him a ciggie. The morbidly obese patient who cries when no one will move her (100 lb) leg 1 inch to the left because she's too lazy to do it herself. Yup, it happens to all of us. Just because you have difference prejudices than I do doesn't make one of us wrong and the other right. It's just something for each of us to try to set aside while we care for those who have come into the hospital to get care. I do want to point out that you said, "I find myself not feeling sorry for them." I very much doubt that anyone, ever, wants you to feel pity for them. They knew they might end up sick from their choices, just like you know you might end up with your 50 lb foot cut off because you ate too many twinkies and ended up with diabetes or whatever (insert whatever unhealthy choice you make into my example- we all do something "wrong" or risky- s*** happens). None of us are perfect. I accept that I make mistakes, and so does my 500 lb 90 year old homeless AIDS-having drinker/patient. We're there to try to help them make better choices and ease their suffering. Not to be their friend. Not to forgive them their trespasses.

I started a new job recently, and I come with several years of experience in CVICU nursing. I feel pretty confident in my ability to safely and effectively care for the sickest of the sick. That said, the way my new job does things makes me incredibly uncomfortable. I had a fresh-op patient who was on supratherapeutic vasoactive meds, on an IABP and his index was 1.8-2. The nurse who was "precepting" me told me that I should do q15minute vitals x's 8, q30 x's 4 and then q1h. I declined. Politely. ish. She also tried to hang 30 mmol of Kphos while the patient was getting 40 of KCL. She has several years of CV experience in other hospitals so I was surprised to see such a difference in what we thought was appropriate. I tried to find hospital policies to back me up or prove me wrong, but I couldn't find anything. I have some intention of talking to my manager if I this seems like normal behavior, or possibly trying to find a new job, or just getting boatloads of malpractice insurance. However, I don't want to cause a ruckus if this level of care is...acceptable elsewhere. So, is this considered appropriate and safe elsewhere? Am I being a know-it-all since I've had a few jobs before, and "the way we did it there is the only way to do things"?

Ehh... employers LEGALLY can say anything truthful they want about why/how you left a job. SOME companies have decided they will only confirm dates employed. There's a huge difference. It's also not a good idea to say you left because of a difficult pregnancy if you really left because you were fired for "poor job performance" or whatever it is the manager told you. It is probably a good idea to email/call your manager (or whoever told you you were fired) and discuss exactly what it is they will tell future interviewers. You also could ask what specifically you need to work on in order to succeed in your next job. www.askamanager.org is an amazing blog full of advice for what to do when interviewing after being fired. Even if you chose not to go back to nursing, it's a good idea to have a game plan for how you will address this in future interviews. Good luck in whatever you choose to do!

I probably could have clarified- I'm not looking at changing to floor nursing. I am curious as to whether the transition would be easier because of ICU experience. I am switching jobs soon to a hospital that keeps their patients in one room throughout the hospital stay, so the floor is mixed ICU and tele. We'll see if I can adjust to taking tele patients, but I'm hoping they keep me mostly on the ICU side of things.

Just out of curiosity, did the ICU nurses get floated to step down often, or was it an occasional situation? I've been floated a few times, and holy cow- I respect float pool nurses! I hate being out of my comfort zone. It takes so much longer to get things done, simply because it's not second nature yet. That doesn't mean I couldn't work in the NICU or neuro ICU- but I definately am a weaker nurse when I'm unsure of things.

It's not such a big deal to accept a job, and then change your mind. As long as you give the clinic notice, they should be understanding and it shouldn't affect your ability to get hired there in the future. And that's only if you like the residency program, and get an offer there. You should interview and see what you think.

There are many threads about the merits of going the Nursing School -> Med Surg -> ICU route vs. Nursing School -> ICU route. However, I've never seen on here or met anyone who has gone from the ICU to floor. I'm wondering if it could be done and if ICU anal-retentiveness would make floor nursing easier or not. Any opinions/thoughts/experiences?

I wish there was a "Shut Up" button- like an "Easy" button, y'know? And when the 75 year old physician tells me my chronically critically ill patient can't possibly be adrenally insufficient I could hit the button and finish working, and then teach him about critical care. *Sigh* a girl can dream I guess.

Just out of curiosity, but how do you hook up multiple gtts if you don't use a manifold? And don't you always label your lines? (unless it's just IVF or something) I tried to find a picture of the ones we use, and couldn't -but- they have one-way valves on every port, so there's not a safety risk of, say, Levo, backing up the line instead of going to the patient. It's not really a "production" when you're used to using them, but isn't that true of everything? lol

I hope your preceptor is available for you to talk with about these "procedural" sort of things. I'm not sure what your hospital policy is, so I'll hold off on telling you exactly what to do, but you absolutely should talk with your preceptor about it. A better use of your time at home would probably be learning how the gtts your patients had today worked. What receptors does Levophed work on? Exactly how does it get the blood pressure up? After going up or down on the rate- when will you see a change in the blood pressure? How is Epinephrine different? Why was your patient on Dextran (and not, say, NS)? If your patient's CVP is 2 and (assuming "normal" adult parameters) HR is 120, why is the blood pressure low? A trained money can write down vitals every 15 minutes, give meds, and hook up IVs. It's not what we do with our hands that makes us good nurses, it's what we do with our brains that saves lives.

Nursing is hard, hard work. You're typically caring for sick people, and sick people tend not to be nice. They often have family members who are seriously stressed out, and thus, are not very nice. However, some people are really sweet and appreciative and I can tell you that there are several patients who are still frequently in my thoughts, heart and prayers, even though I haven't seen them in years. But nursing is physically, emotionally and mentally challenging- I honestly think it is THE hardest job in the world. The pay is good, but not amazing (not nearly in keeping with how exhausting it is). As a career, it's fairly stable, especially if you stay bedside and don't divert narcotics. There are a ton of things you can do in nursing. I, for example, don't always "love" taking care of people, but I do love teaching them how to care for themselves. I love making stressed and overwhelmed patients and families feel empowered and educated. I love when I have a patient who is absolutely miserable, but I can crack a stupid joke or hold their hand, and get a smile out of them. I hate the politics that sometimes get in the way of good patient care. I hate that I never leave absolutely everything done and the work I do will never, ever be finished (though that does lead back to the "job security" thing). Something that's hard about seeing nursing from the outside in, is that the public and media often portray nurses as divinely inspired or something. You've probably heard that nursing is a "calling" and there's so much mythology that makes nurses out to be some sort of angel of mercy, who tirelessly and selflessly helps sick patients with nothing in it for herself. The reality is that nursing is just a job. Typically I go home after twelve hours and (try) NOT to think about work. Often at work, especially when it's bad, I think about nothing but the paycheck I'm going to get. So if you're not feeling "called" to nursing, or you don't think you can care for people day after day with no break and a full bladder- none of us can. I guess what I'm getting at is, if you're scared off by some nurses venting online about nursing, don't be. So, rambling over. -You said your mom suggested nursing and you made a "mature" decision to major in nursing in college. What drew you to nursing when your mom suggested it? -What is it you think you'll get out of a nursing career? -Shadow an actual nurse in an actual hospital if you can (instead of listening to us b**** online). If you don't know any nurses, see about volunteering in a hospital over the summer, or working as a CNA. Those are all smaller steps that will solidify what nursing has to offer and what the stressors are. -That said, I didn't really know what nurses did until I was almost done with school, so even if you do all of that, you're still going to have to take a leap of faith- but that's true of any career. What ever you do, best of luck to you!

I heard the audio clip on my way to work last night and it's been bothering me since, too. It's not the he said it all- it's that he said it to the public. He also said something to the effect of, "I won't allow her to have any sort of neuro affects. She's going to be just fine." Umm...dude... you aren't a Time Lord. You can't go back and un-shoot her brain.

First of all, I agree with squantmunkie- she's going to be anesthetized and won't be conscious to feel embarrassed. Second of all, you really should be talking to the hospital/surgeon/OR coordinator about this. You can always ask them. Regardless of what we say on here, the hospital may or may not be able to accommodate you.

I just wanted to point out that this isn't the case. Salaried employees work extra quite a bit. Our nursing manager works extra all the time when we need someone extra for staffing, because then the hospital doesn't have to pay someone else overtime.

Actually not the most humble statement one could make.

Code is just slang for an emergency situation, usually involving chest compressions. http://circ.ahajournals.org/content/vol112/24_suppl/ from the American Heart Association has a lot of information about emergency/rescue events. It is a lot of reading, but it's absolutely worthwhile.

*sigh* I hate when managers/hr act like this. Good luck with your first job! once you have some experience on your resume, it gets easier to figure out where the good jobs are imho. Basic EKG interpretation is not incredibly difficult, but it does take some time for it to click in your brain. Once you start studying, let me know if there's anything you're not getting and I'd be happy to try to explain it. I'm sure you'll do find though:)