Stratiotes

I don't believe gender has any part in getting hired or how you're treated by employers. However, as much as stereotype deniers try to say otherwise, there are situations in which male and female nurses are treated differently. The truth is, while we as professionals may put stereotypes aside--many patients and even physicians have not. There are elderly women who can't fathom a man providing their nursing care. There are certain cultures where it is against their values for a man to see them naked, even in a professional role. It isn't uncommon for female patients to request a female nurse bathe them, place their foley, etc. Yet, I don't think I've once witnessed a patient, male or female, who didn't feel comfortable with a female nurse. And then there are times when patients who are confused or combative respond better to a masculine presence. This said, I've never once felt that being a male nurse is any more or less challenging. You simply work with your coworkers to accommodate the situations in which a certain gender would be more appropriate. I don't know how many times I've asked a female nurse to put in my female patient's foley while I offered to pass their meds or something in exchange.

I think that it depends on the context. If I were a patient, I wouldn't judge a nurse's worth by his or her bodyweight. That said, I would have trouble listening to any teaching they might have to offer on nutrition and/or weight control. This would be like a nurse teaching smoking cessation while he or she smells like cigarette smoke after each break. It has nothing to do with their ability to care for someone. That said, educating people on good health habits is part of our responsibility, so I think everyone should make a good effort to practice what they preach.

From what I've experienced, even those who have worked as nurses seem to lose touch once they get into admin. I'm not sure it really makes a difference.

I can't answer why normal staff nurses would want to wear a lab coat. They are hot and I would imagine easy to get soiled during patient care. I have never worn one while working as a bedside nurse. I do wear one when I am working as a clinical instructor so that I am identified as an educator (as the last poster said). I think white coats should be worn by advanced practice roles or educators. That said, I don't think it should be some status symbol, but just a means of identifying certain roles. I also don't think there should be some special rule or anything--just an understanding. I hate when people try to alter their appearance in some attempt to appear more important. It actually kind of disgusts me how much more respect I get from people when I'm wearing a lab coat as an instructor. Kind of sad that a simple piece of clothing can make people treat you differently.

I would say a lot of it depends on your personality. I think for the majority of people, it is a better idea to spend a year on a tele or stepdown floor. That said, I've precepted and worked with several new grads who have done great. I have also worked with nurses with a year + experience that didn't do well at all. There are always exceptions, but only you know you. Without any other hospital experience, I would hope your hospital offers a really good orientation.

I think whether or not people are successful in ICU (or any new setting) largely depends on personality. We mostly get nurses who transfer after a year on tele, but we've also hired on med/surg transfers, and even new grads. Some do well, some don't. I think if you are one who seeks out learning opportunity and experience, remains humble, asks lots of questions, and learn who you can go to for help, you will do fine. Having a good orientation with a knowledgeable preceptor is also important.

We have the same policy, but as a charge nurse, I generally would try to let the nurse with the CABG take over someone else's patient and have the other nurse take the admit. This depending on the acuity of the new admit. We get a lot of not-so-critical stuff so sometimes it is no big deal to get a new admit.

I'd say the ICU takes around 3-6 months (depending on the acuity level when you start which I've noticed can be vastly different at times) to even feel halfway comfortable. I didn't start feeling competent until year two! Now I have my CCRN and charge most of the time, but I still feel inadequate fairly often. That is part of being in the ICU. If you don't feel that way, you don't belong (with some exceptions). Having a good preceptor is vital. No orientee deserves having eyes rolled at them and such. I'd politely tell your director that you feel that you would benefit from a new preceptor. To avoid drama and conflict, talk to your preceptor first and let them know that you are going to ask for a different preceptor because you want to see if another teaching style fits you better (nice way of saying you suck). But sometimes it truly is just a clash in teaching/learning styles. Do not be afraid to ask for more orientation time. Some of the best ICU nurses I've worked with had a rough orientation and asked for an extension. Some of the worst I've worked with were seemingly having no issues with their orientation but once off showed that they were not ready. I'd much prefer honesty. It protects you, the patients, and your coworkers. Seek out good learning experiences. Preceptors should look for opportunities for you. Don't let them take the easy patients day after day. Take the scary ones so that when you get them off orientation you won't be a deer in the headlights.

I struggled with this for several months after moving to ICU nursing. While I have encountered the rare individual who simply does not seem to learn from experience, most people do. At first, everything in the ICU is so overwhelming, task based nursing is pretty much the only way one can cope! But once the tasks themselves are easier to handle, you can start flying on autopilot and focusing more on the big picture. Furthermore, as you experience more and more situations, you will begin to develop a greater awareness of your patients. Let me give you an example. Not too far into ICU nursing, I had a post surgical patient who was breathing pretty fast. He was hurting, so it didn't concern me initially. I asked if he felt short of breath or if he was just hurting. He assured me he was just hurting. The pain medicine ordered was not relieving his pain, so I finally called for new orders. I mentioned to the physician the patient's respirations had been around 30 for a while, but like me, he chalked it up to pain. After giving the new meds, the patient reported his pain was better. Now I was starting to get concerned because he was still breathing really fast. I asked again if he felt okay. He assured me he felt much better. His other vitals were great, heart rate and rhythm perfect--absolutely no signs/symptoms aside from tachypnea. My gut was telling me something was wrong, but my lack of experience was leaving me without answers. I decided to draw my AM labs just after midnight and this guy had a potassium around 7.0. I immediately called and got orders to fix him, but in the few seconds it took me to draw up insulin, this patient went into vfib and coded. Of course, then it hit me that the patient had been acidotic and he'd been breathing fast to compensate, but having never seen such a case without any accompanying symptoms, that hadn't even crossed my mind. Another night later on, I walked into a fellow new ICU nurse's room to help her turn her patient. The patient had been fine, but I noticed she was breathing really fast. The nurse said she'd denied pain and everything else was fine. Given the experience above, bells and whistles were going off in my head. I knew this patient was acidotic and we were able to get a blood gas and determine the cause long before it became a serious problem. An experienced ICU nurse might say "Well, duh!" But, for the noob, you have to have some bad situations before you learn to recognize when patients are heading in that direction. You'll get there!

Sorry to bump an old thread, but I thought I'd throw my $0.02 in. I've done both med-surg and ICU. Everywhere I've worked has a "Critical care" differential. In my opinion, this is absolutely fair. I never claim to work harder than a med-surg nurse, but critical care requires more education and skills. ICU nurses where I work have to maintain PALS and ACLS. We must train annually on balloon pumps, impellas, and other technologies. We must know several protocols like hypothermia, DKA, etc. I can't believe anyone wouldn't support at least a buck or two more an hour for specialized nursing roles.

Actually, most registry positions around NWA are around $35 an hour. There are also a couple of PRN agencies that pay this. But, these jobs do not come with benefits.

I thought I'd made a big mistake by going into critical care my first few months. The fact that you feel the way you do is actually a great thing. It shows that you care about your level of knowledge and want to learn. Soak it up. I posted this one another thread... something I do is take notes of things I find confusing or want to better understand and study it later.

Keep a notepad with you at work. Anytime you question something or feel that you don't fully understand a concept, write it down and study it later. Unfortunately, in my case, I run into these questions at the worst times. For example, when I was new in the ICU, we had a patient whose temporary pacemaker wasn't working correctly. It so happened that I was the most experienced nurse working that night and I was clueless as to how to change the settings. The doctor on the phone angrily walked us through it, but I vowed to learn everything I could about pacemakers after that night. Read the stuff over at index -- very helpful!

Many new grads have been accepted into our ICU, though it is a smallish hospital. However, we do take open hearts and stuff--so it isn't an "easy" ICU. I started after a year of med surg right along with some new grads, and I can tell you that I didn't feel that my med-surg experience gave me any advantage over them except perhaps a little edge in my time management skills and familiarity with charting. I'd say that the most important thing is making sure that you get a good orientation or residency and learn who are the best resources on your unit to seek help from.

Has anyone encountered this? According to my director and verified by HR, it is hospital policy to not write letters of reference due to liability. It is nice to find this out after 18 months of employment.

I had one nursing school instructor who I felt discriminated a little against men. But, in practice, I've never felt that way.

There is no excuse for any specialty to look down on another. We are all on the same team. That said, for anyone who hasn't worked in ICU, I want to highlight a few things I've noticed. When I worked med/surg, unless I had patients several nights in a row, I never felt like I really knew everything that was going on with them. I could grab my report sheet and tell you my current observations, admitting diagnosis, vitals, where their IV's are, lab values, etc--but I would never know all that off the top of my head or be able to tell you that their urine output had been falling over the past 3 hours, for example. When you're passing a million meds, restarting bad IVs, often covering for lack of PCA staffing, admitting, discharging, unless perhaps you're super nurse who's been doing it for 30 years, I don't think it is realistic to expect you to know your patients very well. From an ICU nurses perspective, it is really hard to treat a patient without knowing some things. When responding to rapid responses or codes, I don't know how often I hear "I don't know" to every question asked of the nurse caring for the patient. The patient is lethargic and diaphoretic... has anyone checked a blood sugar? "No, not yet." Blood pressure is dropping--how has the urine output been? "I don't know". They've had a heart rhythm change, what do their labs look like? "No idea." These are just examples I've come across again and again. Some nurses look at us like, "I don't know, just fix them or take them to ICU!" But we all know it isn't that simple most of the time. Do I look down on the nurse or think them less intelligent? Heck no. I remember feeling like a deer in the headlights whenever a patient went south. That isn't a fault of the nurse but a fault of the system for such a high patient to nurse ratio. On the flip side, I think med/surg nurses often think ICU nurses are just sitting around chilling with two patients. But those two patients truly do require almost constant attention. At my facility, we don't have PCA's in the ICU-and no secretary at night. So, we put orders in, clean the poop, get patients up, give the baths, draw labs, dress the wounds, and all this on top of managing drips, writing down vitals every 15 minutes, charting, etc. All this to say--I think we should all have respect for what we each do. We all do the jobs we're trained to do. If anyone could manage 6 patients and know and care for each of them as well as an ICU nurse with their 2 patients, there would be no need for ICUs in the first place.

Everyone else has said it--that is the typical med-surg experience. When I started my first job, I was told I'd never take more than 5 patients. As soon as I was off orientation, 6 was the norm. At my current hospital, I think the med/surg nurses typically take 7. I couldn't do it! That is why I made the switch to ICU. It isn't that it is less stressful, but I'd rather my stress be due to my patient's condition rather than simply being overwhelmed with the sheer number of patients.

I left med surg after exactly one year. I started in an SICU about the same time as 3 brand new grads. Except for having a slight edge in knowledge of routinely given medications and time management, I don't really feel that my year of med surg gave me any appreciable advantage over my newly graduated colleagues. I moved to a different facility, so even the IV pumps and other routine equipment was all new to me. If you work with a good team, ask plenty of questions, and never do anything you aren't sure about without asking someone for help, you'll be fine. If you're like me, everything will just freak you out the first time or two and then you'll be ready for the next.

Haha... Very good point about the needy "q4 hour vitals" patient. Even if they aren't particularly needy, it never fails that they'll need to get up to the bedside commode or on the bedpan while you are in the middle of some crisis with the critical patient.

I'm fairly new to SICU myself. We have a binder with our drip protocols on the unit--always important to check this. I find that the most important thing for my learning style is to know the physiological response to each drip. Does it work by constricting the vessels or stimulating more cardiac output? I say this because when I was new, I simply wanted to get the patients blood pressure up to a point where I was comfortable and didn't care how it got there. But, now I realize that it is more important to treat the reason that the blood pressure is low to begin with. If volume is low, a pressor may not be necessary and if too low, even harmful. There should be enough volume to "press". As far as titrating, I've just followed my facility protocol and go by patient's response. It seems that in my short time in ICU, I've only had two types of patients--the ones who respond to small increments in titration, or the ones that want to crash no matter how fast I up the pressors. icufaqs.com has tons of good info!

I work primarily SICU, but float to MICU on occasion. We have a relatively small hospital with only an SICU and MICU. So our SICU gets pretty much everything from immediate post op CABGs to craniotomies. We also get our fair share of medical ICU on weekends or when MICU is full. I think it depends largely on your personality and tastes. I'll try to compare the two a little. I imagine this varies largely from hospital to hospital depending on what types of surgeries are done and whether you have specialty units for your CABGs, neuro cases, etc. Also keep in mind that my experience is solely on night shift. SICU- Post op protocols and routines are usually busy--drawing labs, up in AM, pulling lines, pain management, stressed families (especially with patients who have newly diagnosed problems). - post op CABGs are busy--q15 min vitals, redrawing labs, frequent assessments, labile hemodynamics often requiring intervention, insulin drips requiring q1hr and sometimes more frequent CBG checks, EKGs, nighttime calls to surgeons (ours are usually hateful), vent weaning, pain management, up in AM, pulling art lines, SWANs, etc which are time consuming. - "most" patients recover within a few days and are transferred out to a floor or long term acute care as neccessary, so you rarely deal with the same surgical patients for more than a few days. - Still get a lot of medical patients if MICU can't take them (which happens often). At least 1/4 to 1/2 of our "SICU" patients are actually medical. MICU - Medical cases like DKA, ETOH withdrawal, COPD exacerbation, MIs, strokes, etc. are common. - Patients seem to stay longer due to multiple comorbidities, and fair share of frequent flyer DKA and ETOH W/D patients. - patients tend to be on vents longer than SICU and they see more trachs. - Our MICU takes our induced hypothermia protocol patients which are few and far between, but very busy and tend to be last ditch efforts. - Families not as acutely stressed as SICU since medical issues more chronic in nature, however sometimes they can be just as difficult given that they are around for a longer period of time. Both units have different types of stress, but I find that I usually have more downtime in MICU at night than SICU. I also am more likely to get out on time in MICU due to fewer AM routines than post op patients. Some people like having slow times where as others like to stay on the move.

Our unit staffs 2:1. 3:1 is only if there is a necessary admit and no nurse to call in to take it. I would never work where 3:1 is the norm.

I am fine with patients. It is the other nurses and doctors that I feel treated the worst by. Doctors who expect you to vacate their favorite seat when there are 3 other empty identical ones adjacent to it. Nurses who act like their world is ending because you left something for them to do. It isn't even enough to get everything done up to shift change--if anything comes up DURING or even after shift change as long as you're still on the floor, they expect that to be done too else they scowl and pout. lol I wish everyone would just chill and act like adults. Unless I know someone to be habitually lazy who likes to pass the buck, it doesn't bother me to have a task or two passed on to me. That is what 24 hour care is about. Get over it. *rant over* lol

Here is a good thread full of report sheets to download. https://allnurses.com/cardiac-nursing/share-your-brain-266401.html