pH7.40

"As a student it is sometimes hard to read your preceptor.... does she want me to jump in? Does she want me to wait to be asked? Does she want me to follow her every step or does she want me to back off????? All questions that we wrestle with in our heads. The absolute best day I EVER had was when I had a seasoned ICU nurse meet me eye to eye at the desk. She said "I'm glad you are here today. This is how I work. This is what I expect from you. I am here to teach you anything that you want to learn, but I will not beg you to follow me and get involved. I would love to have you right beside me all day long, but if you just want to sit at the desk, I'm not going to come and get you. I would love to show you how to do procedures, but if you don't want to try, I'm not going to beg you". She scared the crap out of me, but I knew exactly how it was going to be up front and I learned a ton! It was a great day! " This is a great example of drawing very clear lines for expectations while allowing for the student to step back if they feel overstimulated or overwhelmed.

First off set very clear rules or expectations for them so they know what not to do and dont hurt anyone, including themselves. Secondly, critical care is really intense. There is so much to learn! Try to focus more on keeping them safe and cultivating a love of critical thinking and pathophysiology rather than splitting hairs over every detail. It takes years to learn and master the details. Give them simple hands on tasks, like priming IV tubing. Break it down into simple steps. Also the students who seem like slackers just simply might already know that they do not want to be critical care nurses... and thats ok. Its not your fault, critical care just isnt for them. In my nursing school during clinicals I was dying to get to the hospital every day, even went the day before to pick out my patient and look up everything in advance while other nursing students absolutely hated it and couldnt wait to leave. Its an intense environment and some people can take it only in very small doses. One fellow student of mine I remember passed out during a rather bloody insertion of an ng or foley ( i wasn't there). She fell hit her head and got a black eye. It was just too much for her. Just accept people for where they are in the process and try not to scare them...because lets face..us ICU nurses can be intimidating. hope that gives you some words of encouragement. And its awesome that you are willing to share your knowledge by precepting.

Does anyone know the average cost per day per patient for staying in the icu? I heard its around $10,000. I'm trying to gather facts. Thanks, Your fellow icu nurse!

I work night shift and the hospital where I work is cutting break relief so that we don't have break relief till our census at medium acuity is 15. Yet day shift has break relief with 1 patient. Does anyone know if there is a study which states when the majority of codes/rrts happen? When in your experience do most codes/rrts happen? Thanks everyone.. Stay strong in this trying economic time.

Our nations tap water is regularly screened for the acceptable limits of toxins and bacteria. Tap water should be acceptable. The bottom line for you as a bedside nurse is to check your facilities policy and procedures and follow what your facility has decided. I would like you to ask the advocates of "sterile water" why is the water that is unacceptable for patients to drink, ie tap water, considered acceptable for the hospital staff nurses doctors and visitors to drink at water fountains and cafeteria. We need those flora and fauna to populate our gut!

Hey Everyone! I'm originally from louisville but now work as a BSN RN in the bay area. Am a little home sick and considering moving home. I'm just trying to figure out how much I would be making in Louisville as compared to here. Can anyone tell me the hourly rate for an RN? Any info about shift diff for a BSN RN in critical care with two years experience would be greatly appreciated. Thanks!

I'm in the same boat and was wondering what this would be like. Thanks for asking. If I find out anything else will let you know.

Really is that anatomically possible? omg............dilaudid please.

never drink gasoline.. no matter how much you want vodka.

actually thought of wearing one myself. I don't think the family realizes how they exhaust the pt. as well as themselves. And no I can't brush her hair now because I need to hang some fluids and a pressor to keep her alive!

the maggots kept the wound "clean". I have friends who have done leech therapy as nurses. that sounds so nasty. you are brave.

One step at a time. First just get into an associates program and see if you even like nursing.

I wonder if the ER forum on allnurses has a thread titled "things you'd like the ICU to know"

TWICE! seriously? lol

We have the same concern with our ED regarding sepsis. We are trying to get the ED docs to insert central lines to better manage fluids in our septic patients, but they have really resisted. This thread is amazing. I thought it was just our hospital that had these issues! We really seem to have found something here.

Yeah thats true, you are right. I do like the discussion. I was so stressed about bed baths when I started. Now just roll up my sleeves and get it done. It sounds very stressful to have the instructor like the one described. We have a woman on our unit who really goes at it with the bed bath. She gets out the water basin and cleans every nook and crevice of her patients. While some nurses just use the warmed wipes and the shampoo shower caps. My point is that everyone does it a little different. As long as you do it.

exactly.

There is a difference between an AED and when a nurse who is ACLS trained defibrillates. An AED reads the rhythm and decides for its mechanical self if a shock is appropriate and then either shocks or standby. An ACLS nurse reads the EKG and determines if a shock is appropriate. The difference is that the nurse is a living, thinking being with critical thinking skills and the AED is just a machine reading a strip without other clinical assessments and observations.

is this question really supposed to be in the critical care forum?

For septic patients, get that antibiotic in immediately and make sure you report that to us when you give us the patient. If you put in a central line please be sure to put the biodisc on correctly, blue side up, and a proper dressing after the doctor inserts it or else I am just going to half to change it again when they come to us and this really irritates the patient. Thanks.

I couldn't agree with you more. At least with a vent you know you can control airway and ventilation, ie know your patient is breathing. I would much rather care for a patient on a vent than BIPAP where they could go into respiratory failure and have to emergently intubate. My second Med/Surg rotation I always volunteered to care for the chronic patients on ventilators and after getting over the initial fear realized that they are some of the more stable patients. Don't be scared, just ask for help and remember the RT is your friend.

Also, just to let everyone know There is no nursing shortage in the bay area. Getting a position here is highly competitive. Do not expect a job to just be handed to you. The word is out on nursing here. Everyone knows about it and everyone wants to come here. My advice is to work as a traveler at a bay area hospital first and then see if you can handle living here. After this I would then approach the hospital for whom you work as a traveler about getting a position as a staff nurse.

getting back to the original post concerns A BSN does not really pay more. At my position I don't think it pays more at all. But some hospitals wont hire newly graduated ADN. They want the new grads to be BSNs, so the advantage in having one is not directly financial as it is that having a BSN will get you the job over someone with an ADN. Like I said some places/units wont even hire ADN unless they have lots of experience. :redpinkhe If you are thinking that the mortgage meltdown will give you a good deal on a home, I wouldn't count on it. Out here a "deal" is getting a one bedroom condo for 400K. You could live way, way out in the suburbs and buy a home for less. Some people at my hospital do this and work all their shifts at once. 6 days in row and then commute back home with a week off. Northern California is a great place to work. We have a strong union and strong nursing centers like UCSF and Stanford. I love it here, but it is a trade off. You won't have the big house that you could probably afford somewhere else.

I am a critical care nurse with 10 months experience in critical care. I am joining the navy nurse corp as a reservist. My brother is active duty navy, currently deployed to iraq. So, being from a navy family, there was never a question of joining another branch. I don't have a problem with getting deployed as that is the nature of this position. Just want to do my part. I have been using the allnurse forum to gather information and answer questions as I complete the very thorough navy application process. For instance, in my letters of recommendation, to whom do my supervisors address the letter? Thanks for a great forum.

https://www.netc.navy.mil/nstc/otcn/Schoolhouses/DCO/index.htm To answer my own question, DCO for a RESERVE BSN nurse already working is 12 days or two weeks. I also spoke to the medical recruiter again and she definitely said for Navy RESERVE nurses DCO is two weeks long. For ACTIVE navy nurses it is FOUR or FIVE weeks. The link above should help out. Hopefully this information helps other people as well. Have a good weekend everyone!