313RN

What kind of monitors are you using in your hyperbaric chamber? I'm a critical care nurse and work part time and on-call in a hospital based multiplace chamber hyperbaric program. I frequently dive with ICU patients who are obviously monitored. Lately my monitor (a ProPaq 106) has been acting up and giving me errors, etc. In monitor years it's about 115 years old. I've talked with BioMed /clinical engineering and been told not to break it further as parts are no longer available. I'm looking for a new monitor that is usable in the chamber. We monitor from the inside and don't penetrate the hull. My vent goes in as well. Anything we use has to have a solid battery life and be less than or equal to 25 volts. Shouldn't have NBP as those are run by electric brush motors. We're a large multiplace chamber and can go to 6ATA or 165 FSW, so it needs to be able to handle some pressure. The ICU's here use Spacelabs and I've checked with the manufacturer, none of their gear is hyperbaric compatible. So please let me know what you're doing in your center. Any suggestions or thoughts would be greatly appreciated.

Became an RN at 40, now 45. Round is the shape I'm in and I'm largely being held together by NSAIDs and neoprene. But my labs look like I'm a 20 year old marathoner. I should be good for another 30 years.

Neuro ICU ~2 years, SWAT & Rapid Response 3 years. Wound care and hyperbaric critical care 4 years with board certification in hyperbaric nursing.

"There isn't enough to call rapid response" I'm a Rapid Response nurse in an urban trauma hospital. From my perspective there's never a bad reason to call me. If you get a feeling, let me know and I'll come see your patient. If you're right hopefully we can intervene early and get a good outcome. If you're wrong (or maybe right but I don't see it yet) then at least the patient is on my radar and I can keep an eye on them. So call me. I won't be mad and we might all be glad you did. I'll take 100 false alarms to prevent one code. And if if someone tells you they think they're dying, tell me so that I can RUN.

I'm in an urban trauma hospital with 48 ICU beds out of about 200 total. Where I am senior staff (on the unit 1 year) takes turns as charge. Usually one day per week per nurse. Some units charge makes the assignment, some units RNs select their assignment after a brief report from the off-going charge. As far as assignments go, you get what you get. There's no effort for or expectation of a lighter load when you're charge. Rapid response never takes patients, SWAT (ICU transport/travel) gets pulled into staffing as necessary but generally has no assignment either.

Depending where you work the pace might not be as slow as you hope. I'm an ICU nurse who works in a clinic with a multiplace chamber. I dive all the critical emergent patients plus work in the attached wound care clinic. Techs do most of the diving with our out patients, but if staffing requires it I'll occasionally dive then as well. We have 2 scheduled dives per day and are sometimes close to capacity. There are two to three RNs in wound care depending on the day including me. We're fairly busy and can see upwards of 50 wound patients a day. Techs take dressings off and take vitals. RNs round with the physician and dress all wounds. We also chart on every wound we dress. Some patients have more than 10 wounds. Charting can take 2-3 hours a day after clinic hours end. Some days I'm the only nurse present. My personal best is seeing 28 patients myself in 3 hours. I think I saw around 36 patients that day total. Keep in mind that most of these patients suffer from one or usually more than one chronic illness that we have to continually address in our plans of care and efforts at patient education. We have to have a lot of patience with some folks who have to be told the same things over and over, like always take your anti hypertensives as prescribed. You'll be surprised how often this occurs. Additionally I'm on call 24/7 and have been for more than 2 years. I've had a total of maybe 15 days off in those 2 years. I take call because I'm the only RN in the trauma hospital where I work who wants to dive. I also get call pay which I feel is worth it. I've worked a full shift only to be called back a few hours later, dove critical patients all night, slept in the chamber for 2 hours and then started my shift again. It's happened a few times. if you dive in a multiplayer chamber and you take intubated patients it can get pretty stressful. Managing an ICU patient while you're effectively in a submarine as much as 165 feet below the ocean means that even if there's a whole support team outside there's not much they can do to help you in an emergency. In my facility we keep our vent and meds inside with us, so we're running the whole show. The MD on the outside might as well just be giving phone orders. Also, because I'm inside during the dive I'm at risk for the bends if we have to ascend in an emergency. We have plans in place to minimize the risk but it would be foolish of me to ignore the fact that the risk exists. Theres also the ever present risk of a fire in the chamber which could be catastrophic. It takes a certain amount of experience and self confidence (in my opinion) to be comfortable in those situations. I do it because I love my job and enjoy the challenges it provides. But I don't do it for the nice relaxing pace. If it sounds like something you want to do, then go for it.

I went in to nursing for the glamor. No, honestly it was for job security. I spent 15 years in sales and was tired of the stress and the constant stress of having my performance measured to two decimal points. Having a quota is stressful. The pointlessness of all the meetings, planning, forecasting, and manufactured urgency is soul crushing. I have no stress at all now, and I work SWAT/rapid response at a large urban trauma hospital. I may have come for the security, but I stay because I have the best job in the world (after fighter pilot and cowboy). I tell people that nursing is only life and death, but business is serious. It sounds a little hyperbolic, but for me there's a lot of truth too.

Do you see babies? Mom/dad have to be in on it... Parent calls your orientee and says something is bothering the baby. He starts his assessment, you come in behind with a loaded diaper. Ask 1: does this look like blood? 2: does this smell like blood? (Take a whiff yourself) 3: does it taste like blood? (dip a finger in and take a taste) Wait for his reaction. The diaper should be "filled" with baby food to look appropriately dark and not have an easily identifiable fruity smell I had this done to me once. I laughed like heck once the shock wore off.

We're cutting unit clerks (secretaries) left and right. They now cover multiple units each day, as many as 60 beds each. On nights there might only be 2 in the building (we're an urban trauma hospital). It has caused many problems and put a greater burden on he nursing staff, but now that they're gone we don't expect to get them back. I don't know where he growth is being projected, but it's not in my area.

When I was teaching I told my students that at my hospital we didn't eat the young. We ate the weak. There's a fair amount of truth to that.

2nd career here too. I spent 15 years in business before I left looking for more job security. I found it and now I love critical care. I like the challenge of figuring out what's going on with a patient and having the autonomy to order tests and act on those findings. I'm in SWAT/Rapid response and I'm covered by protocol orders to do so. I'm also an adrenaline junkie, although I wasn't aware of it until I started working in the ICU. I like giving dangerous drugs to critically ill people (-as needed and with MD oversite). I get to do or assist with cool procedures. I like being the guy other nurses call when they need help. The job isn't a calling for me either. I love that I leave it at the door at the end of the day. For me the money is fine. 6 figures is doable with OT and a contingent job. You just have to be willing to work. All in all I highly recommend it.

That's not silly at all. We don't know the particulars of the arrest, but gastric contents sometimes to end up being aspirated. It's possible that it was the cause of the arrest or that the pt vomited during an intubation attempt (either in the hospital or unsuccessfully in the field). I've suctioned some really nasty stuff out of OET's, including stomach contents. But I do wonder how an NG tube managed to slide past the cuff on the tube. Once an OET is in place it usually it's hard to get the NG into the lungs. That seems a little unusual and I would have expected to see/hear a cuff leak or a decrease in tidal volumes if the cuff was displaced enough. Is there more to this story?

My dream is to work in a hospital that only admits Supermodels and Olympic athletes. Can someone please tell me where I can apply. Any floor. Any shift.

Hats off to the peds nurses out there. I work in a neuro ICU in a trauma center and in another highly specialized unit and all the things that go with don't bother me in the least. But not long ago I had to treat a sick kid who was about a month short of his third birthday. After I assessed him and sent him back to his unit I had to go in my office, turn off the lights and blubber for a bit. No thanks. I'm not tough enough to be a peds nurse.

Slash and dash

It depends on what's going on. I have 4 jobs, 1 f/t, 1 contingent, 1 as Adjunct faculty and another job in education. Short week: 40 hrs Medium week: 52 hours Long week: 64 hours Longest week: 82 hours, I think. I'm also on call with the f/t job 24/7 and have been for the last 7 months. I don't see that changing anytime soon. I'm also not counting time outside spent grading, etc.

I don't know if they beep any more than any other pumps I've used (Alaris and Baxter). I think there was more beeping early in the adoption of the pumps. Overall I think they perform well. We use multiple drug libraries (critical care, acute care, L&D, catch lab, onc, etc) and they're easy to navigate. We can program regular doses, loading doses and stepped doses as needed. There is a lot of upside to the pumps and really my only complaint is the size and weight of the triple pumps.

We use the Hospira Plum A pumps. They're ok for simple stuff and are easy to use, but they only come in either a single pump (with 2 channels) or in a triple pump (with 6 channels). The triples are huge and have to have a dedicated IV pole with a "Lily pad" to support them. Still not a big deal, but we can't travel with them because we can't take them off the poles and the poles won't fit into the elevators with the bed and two to three staff members. I like the Alaris a lot too. Easy to use and I love how you can just slap another channel onto the side as needed. They are a lot less bulky than the Hospira. I suspect however that they cost a bit more.

Pay for a Staff Nurse who is contingent is about the same as a f/t RN. The difference is no benefits. Shift premium is about 7% for afternoons and about 10% for midnights. I've never heard of "system flex" and $48 an hour sounds like a fantasy. You might get that on OT w/ a bonus if the manager is really desperate for staff and uses it to get you to come in or stay a few extra hours. But if there was a $48 an hour RN job there'd be lines around the block trying to get in. The "float pool" is called DSG. That also carries no benefits but I'm told the pay is higher. DSG is typically f/t or p/t only as far as I know (but I could be wrong).

Charge is an extra $1.00 per hour. Senior staff is expected to share the duty. After about a year you're considered senior staff. Charge takes an assignment just like everyone else, usually two patients. I'm on a neuro ICU with 10 beds. Great Lakes region.

I work in a hospital-based wound care clinic. We measure and picture wounds every week. We use Pt labels on post-it notes stuck to paper rulers and only frame the wound. Eveything goes directly from the tablet computers camera into our EMR, so names are not an issue with HIPPA, etc. We have patients sign a photo consent at their consult visit and establish from day one that photos are a standard part of treatment. So far no one has objected to a wound photo. IIRC, I think the standard of care says pics every month at minimum (pt's still having the right to refuse of course).

Big dude-As a graduate of the SDO program as well I'd like to disagree with some of what you said. First, I disagree with your assessment of the faculty. The academic faculty is largely made up of instructors who either have a doctorate or are pursuing it. In fact I can only think of two members of the faculty who are not pursuing their doctorates. Clinical faculty in any program is unlikely to hold a terminal degree. As far as NCLEX pass rates I can tell you some classes are stronger than others and the program has been changed to increase their pass rate. That being said, my classes pass rate was over 95 percent. There is some organizational weakness but it seems to be improving. From what I've read on AN, disorganization seems to be a hallmark of many ABSN programs. Lastly, if the program is not to your liking you have the option of withdrawing at any time. If you're currently in the January cohort you still have most of the year ahead of you and can apply for fall admission to one of the other schools you mentioned. If you're in the May cohort you should be starting your preceptorship shortly. I hope you're more professional when you're at work than what I'm seeing here. Lastly, I'd bet that most of your class will pass NCLEX handily. I've found that most of the students who complete the program do. Best of luck to you.

We call them Unna boots, too. We wrap from just above the toes to just below the knees. We also put a fan fold more or less centered on the tiba with each layer to provide a little relief when it dries. We never wrap toes. Santyl, silver impregnated materials, dermagrafts and apligrafts with iodoform or iodosorb when appropriate all go under the boot in my clinic. We use the calomine lotion impregnated boot with Kerlix and coban. We may place an ABD pad between the boot and the kerlix if there's a lot of drainage. Coban gets wrapped in a spiral like the kerlix with decreasing compression as we go up. We also use Coban 2 and Profore Unna's boots for patient who won't tolerate the gelocast or who need more compression (extreme lymphedma, etc). I know some clinics that use Dynaflex instead of Profore but they're very similar as far as I can tell. Before getting a boot we make sure there's no CHF and the ABI has to be >0.6

I seem to have, yes. When I went into school I was interested in Hyperbarics. Going through the program I enjoyed L&D a lot and considered Midwifery for a while. Coming out of school I was just looking for any job I could find and wound up in Neuro ICU. I hated that for about six months and then got pretty comfortable and started liking the job. I really like taking the sickest patients. Turns out I like adrenaline (I did not know that about myself). Then a job opened up in Hyperbarics. They needed an ICU nurse to go into the chamber (it's a multiplace) with vented patients. We're the only 24/7 chamber in the state and I'm the only critical care nurse in the hospital that works here so technically when I'm on call (also 24/7) I'm covering the state. Taking someone on a vent, sedated and critical gets really exciting when you're using primitive equipment (no IV pumps for drips, no defibrilator, extra-basic monitor) in what's effectivley a submarine that's 60 or so feet underwater. Because there's not a lot of these patients I also work ICU contingent in a large urban trauma center to keep my critical care skills current. I also thought I'd like to teach, so I teach clinicals a few times a year. I really enjoy the challenge of working in those environments. So it turns out I'm doing something I was really interested in from the start.

You could create a wick in the area that's tunneled with something like iodosorb or a thin slice of hydrofera blue or an acticoat flex 7. Pack the rest of the wound with the Aquacel Ag and cover with fluffs and a heavy drainage pack if you have it. Otherwise try and double or triple an ABD pad and then tape it with hypafix or paper tape. You could leave the drain in place and the change the Aquacel when it turns into mush while just changing the outer pads. I think you need the Aquacel for its cytotoxic properties so I'd suggest you keep it if possible. If you've got Acticoat flex it will drop some sliver too but is non-absorbent. There is an Acticoat absorbent but it's quite a bit more expensive than Aquacel. A wound vac may be appropriate, but you'd have to be able to get the sponge into the area that tunnels. As a very, very last resort which I don't really recommend you can put a OET suciton catheter into the wound wrapped with an acitcoat flex or gauze and on low continuous suction. Dress the wound as normal and cover with tegaderm. Cut a small hole in the tegaderm, lay the cannual over it and cover with another tegaderm. If you have a good seal it will suck up most of the drainage. We call it a "weep no more". Good luck.