ICU_nurse

Just finished reading it, absolutely loved it. I'd heard of it years ago and stuck it on my "to read list" but never got round to it. Recently spotted it on my friend's bookcase and decided to sneak off with her copy :-DStayed up 'til 4am reading this morning, read more at work on my break, and came home and finished it tonight. And I'm not really a reader. But it was impossible to put down. If I didn't have to work today, I would have stayed up til sunrise finishing it!Just wish it was longer :-D

Vents = 1:1 CRRT = 1:1 BiPap = 1:1 HDU = 1:2 I don't know how it is safe to have anything more than 1:1 ratios for critically ill patients. To those that work under conditions like that I take my hat off to you!

Good luck for your interview Beth! The questions I'm about to post may or may not be useful- I'm not familiar with how things are done in the US, but these are pretty stock-standard questions used in interviews here in Aus. There are a few categories that questions are drawn from. You can pretty much guarantee getting at least one question about conflict resolution, your attributes, a clinical scenario, and occupational health and safety. Conflict resolution You notice a coworker who smells strongly of alcohol at the begining of the shift, what would you do? You observe a colleague behaving inappropriately by yelling at a patient, what would you do? A colleague says inappropriate things about your clinical practice infront of patients, what would you do? Your attributes Tell us what skills or attributes you can bring to the unit? What would be some of your weaknesses? (always spin these into a positive!) Where do you see yourself in the next 5 years? What are your professional goals? Clinical scenario You are caring for 4 patients, and you receive a post op something/new admission (enter whatever patient for the specialty youre goig for). You do a set of obs and find they are abnormal (they'll normally tell you what they were). Outline what you would do from here You have 5 patients (they list what is wrong with each of them- eg; one has an AB due, one is calling out, one needs to go to the toilet, one is for comfort care and needs repositioning, one is deteriorating). Tell us how you would prioritise the care for these patients OH&S You identify a hazard in your workplace, what do you do? You have a bariatric patient admitted to your ward, but there is no bariatric equipment available. What would you do? How do you ensure your work environment is safe? Just a few off the top of my head, hope they help! parko

Smart casual is always the way to go with interviews. Nice top, plain coloured slacks and covered in shoes (heels or flats, whatever you're more comfy in). From there, if you like you can add a vest, blazer, cardigan, jacket, or whatever else you like on top. And a nice plain bag ("nice" as in not the ratty old every day one, not "nice" as in ridiculously expensive and one you'll never use! :)) You should look well groomed. That doesn't mean you need to spend a day beforehand getting primped and preened! Just make sure nails are clean, hair is washed (and tied back/pulled up if long), and you wear minimal makeup and jewellery. No work uniforms unless you have gone straight from work to your interview (and it's too short a time frame to change!). Putting in abit of effort with your interview preparation (that includes practicing possible questions, doing your research on the facility/unit AND your appearance) shows respect for the interview panel and the opportunity they have given you in regards to the interview! good luck!

In regards to the original question of would I call a MET/RR on a patient who is NFR/NFI? Yes. Just because a patient has been documented as not for resus/intuabtion/icu/inotropes/whatever esle, doesn't mean thay are not for continued medical management on the ward. I am an ICU nurse and am part of the MET team at my hospital. We often get calls from the wards for patients who have deteriorated, but are not for resus. Most common example for us is the COPDer who has come in with a nasty pneumonia (which is potentially a reversible cause), who has had previous ICU admissions and has had treatment limitations put in place (most common is not for invasive mechanical ventilation, BiPap only). They are, however, still for ALL available medical management, including AB's, fluids, bronchodilators, pain relief, medical imaging, invasive procedures etc etc... Unless they have been documented as "NFR/NFI, for comfort cares only" would i not call one. But a phone call to the RMO mightn't go astray to give them the heads-up, and also in the case of needing a review for pain relief/sedation. It's certainly a grey area, but at the end of the day it is your registration, and yours alone. You worked hard for it, so do what you have to do to protect it! parko

This is known as the "doctrine of double effect". A very interesting concept in law and ethics; doing something good that may in turn cause something bad, is ok to do if the bad outcome/side effect was not intended (the most common example in medico-legal circles is releiving pain in a terminally ill patient, whereby the side effects of the drug may "speed up" or bring about a patient's death). There are of course criterion to meet, for the doctrine to be applicable. And there are debates as to wether it really is an ethical concept. That's why it's so fascinating! Gets you thinking and challenging your thoughts and beliefs. This is a good article from the BBC regarding ethics, specifically the doctrine of double effect. Hope that helps :-) parko

Just forwarding on information as is current on the website. No need to be disrespectful. Glad my help was appreciated

Then I'd check on the requirements for your visa first then :-)

"just get someone else to do it". Not a great attitude to take into the nursing profession... It's sometimes not that easy to "just get someone else to do it for you". Your colleagues will be just as busy as you are. It's often hard enough to find someone to check the blood with you, let alone perform the task for you. Of course it doesn't make you a bad nurse, and you're not pushing your beliefs on anyone. But think about your colleagues who will have to pick up the slack. Do they deserve extra tasks? Sure sometimes its easy to work around (we work around our staff who are pregnant by not allocating them cytotoxic patients), but what happens when you're the only RN on a night shift and a bag of blood has to be hung? Not an unrealistic scenario. Totally agree. Everyone has been quite helpful, suggesting areas of nursing that may have no exposure to blood transfusions. The fact that people are mentioning colleagues and workloads etc is mainly due to the fact that it is something the OP needs to think about. If you won't perform a skill that is required, do you think that that is an appropriate area for you to work in? Very well put! Knowing what you can and can't work with and then planning your career around it is not an unrealistic exercise Of course they don't HAVE to work in an area where this may be a situation they are confronted with. Most would probably choose not to. Just as the original poster does not HAVE to work in an area of nursing where blood transfusions will be performed. I think that is the vibe of what people are trying to get across... I think that just about sums it all up! Common sense is all that is required. Parko

I find your question really interesting. I like how you already realise that certain areas of nursing are going to be "poor choices" as you put them. Good on you for taking it seriously and trying to plan early. What sticks with me though is if a transfusion did come up, you would simply trade a colleague for one of their jobs that shift. Coming from a current practicing nurse, honestly sometimes it's just not that easy, and that's something that you need to be aware of. The only reason I say this is not to be mean, simply to encourage you to look for a career path where this won't be an issue at all for you (as people have suggested, Aged Care, Community Nursing, Wound Care, Mental Health... its not as limiting as you may think). Because you never know, one day you may be faced with a situation where you are the only RN, and a patient requires a blood transfusion NOW. It's a night shift. You don't want to give it, but the patient needs it. What happens? Do you make the patient wait until the day shift? Try and get the after hours manager to come and give it? Just refuse flat out? Don't put that stress on yourself! There are areas of nursing where you will not be faced with such a dilemma. Good luck with your studies, and your future career path, wherever it takes you Parko

Hello lsid. Hope this can give you some direction! 1. Start the registration process (and start it early!). Give yourself a good 9-12 months (being generous) to get your registration sorted. As Mcadamia said, the national registration board is only new, and ever for our Australian registration there have been major headaches and delays. Be patient, and i know its obvious, but make sure you send everything that is asked for (saves you time and hassle) Visit AHPRA and open the pdf on the Internationally Qualified Nurses and Midwives page. It details what you need to be able to prove in order to gain Registration as a Nurse/Midwife in Australia. 2. Research your responsibilities regarding Visas and immigration requirements. Have a look at the website of the Department of Immigration and Citizenship 3. Figure out where you want to work. How much experience will you have before moving here? Considering you need to have completed your studies in the US to apply for registration here, I assume you'd plan on working your first year in the US while AHPRA take their sweet time to process your application. Gaining employment is hard with no experience, and new grad positions arent as freely available as you might think. Plus, you'd be competing with Australian new-graduates, and most applications for these positions start mid-year (open around June/July and close August/September). If you know which state (at least) you would be looking at working in, visit their health department website. You will find links to their employment pages. Have a scroll through them to get an idea of what's on offer. Remember that essential criteria are just that- essential, and if you can't meet them you won't get a look in. Giving yourself time to read through lots of RN positions will help prepare you for writing your application (you will see some common criteria repeated in each job ad) Links to some State Health departments: NSW QLD VIC WA SA NT TAS ACT Very true! You can literally find yourself in the middle of nowhere. Do your research No, you need to satisfy the Board's English Speaking requirements regardless of where you were born, educated or worked. You sit the IELTS test and need to achieve a score of 7 in each section. We have had articles in the media recently of "outraged" nurses who come from English-speaking countries who are required to take IELTS. I know, it sounds ridiculous. But they are covering themselves, everything needs to be proven these days! See the link posted above to the "Internationally Qualified Nurses" section of AHPRA for further info (open the pdf, it's criterion 2) hope that helps!

Australia has recently changed from state nursing boards, to a single National Regsitration Board. There are 5 Criterion that you must meet to gain Australian Registration. AHPRA (our board) has a page dedicated to internationally trained nurses, you can access it here it will explain what you need to do to fulfil each criteria. If you have further questions, specifically about your qualifications and experience, I'd refer them to AHPRA, they will give you the correct information. You can contact them via an online request form, scroll down to the bottom of the page and click on "contact us" in the bottom right hand corner. As for satisfying immigration requirements and obtaining relevant visas, I'd suggest you visit the website of the Department of Immigration and Citizenship For accurate info, going to the organisations that will ultimately deal with your application is the safest bet. hope that helped!

Hello there. I'm an RN working in ICU for the last 4 years. Hope I can answer afew of your questions 1. How similar is ICU nursing between the two countries? That I can't answer because I've never worked in the US! However I have heard they are quite different time-management wise, due to the number of patients you have, the different technicians and assistants you have access to etc etc. To give you something to compare to, I work in a 14 bed ICU in a regional hospital. Ratios are 1:1 for ICU patients (all ventilators/NIPPV/CRRT) and 1:2 for HDU. I am responsible for all the care provided to my patient over the course of my shift. I look after the drugs (all infusions, meds etc), the equipment (monitor, ventilator, dialysis, balloon pump, etc), patient needs (turns, washes, mouth and eye care) and social and family issues (talk to the family, answer questions, attend family conferences, be a "go-to" person, organise referrals for family such as social work, pastoral care etc). I will have the ICU team and the patients admitting team come to do rounds (admitting team rarely stay for long!), the physio will come to do some chest physio, reposition and help with splinting/passive ROM exercises etc). The Nutritionist will come and check our feed rates are correct and let me know of any changes. And thats about it, everything else is up to me! I feel I have a lot of autonomy (this has obviously increased with the more experience I've gained). As our registrars and residents rotate through the unit pretty frequently (RMO's 10 wks, Reg's depending on what training theyre doing be it ICU/ED/Anaesthetics or a combination will be around for 3-6 months at a time) you find that in some cases you have more experience and or knowlege regarding ventilation than the medical staff (I know I've spent many a night shift giving the Registrars a crash course in BiLevel!), and they are quite happy for us to tweak settings as necessary (eg- ABG looks good, might turn my Fi02 down abit, next gas looks good too, might turn the PEEP down by 2...). However, I know of other (bigger) hospitals where they dont like it as much, and youre expected to discuss any changes you want to make before you do it. The autonomy in our unit came from our previous medical director (so ive been told); he really valued the nursing staff and their skills, and wanted them to feel empowered and able to feel responsibility and ownership for their patients (although ive also heard its beacuse the registrars were tired of getting woken up only to be asked "can I turn the Fi02 down, the PA02 is 120....." hehehe 2. Do australian nurses complete additional training for vent management is it in uni, or is it learnt on the job? Learnt on the job. No training in ventilation as an undergrad. You learn as you go, and are supported (well, I know I was). When newbies start in our unit they're taught as they go, advancing frm NIPPV, to maybe a slow trachy wean on PSV, to a post-op on SIMV, to a sick pneumonia on BiLevel etc etc. Our unit runs afew different ventilation workshops (Introduction, Advanced 1 & 2) which people are tapped into, normally each one runs at least once a year (it all depends on money, time, resources, etc etc). Each one has worksheets which you fill out, and are marked and returned. My unit is lucky to have some very knowledgeable senior nurses who are just amazing with ventilation. Needless to say, their brains regularly get picked on night duty! Advanced ventilation education is part of your post-grad studies. My Grad Cert had a respiratory topic, and ventilation was covered in that. Other organisations may provide short courses (like a one-day seminar) on ventilation. We currently have one that is run by Fisher & Paykel through one of the big hospitals in Sydney, which I've been told is really good. 3. How is physician / nurse interaction in the ICU ? (in my hospital it is very much a partnership, very respectful and unlike a lot of other floors in the hospital) Where I work, we have a great working environment, all our members are part of a team. Consultants will ask your opinion, discuss your concerns, and generally are just interested to hear what you as the nurse caring for the patient, have observed throughout your shift. Having said that, it depends on the doctors you work with, their attitudes and experience, and the culture of the unit itself. That I think is different unit-to-unit. If you're referring to something like the concept of "Dr's treat nurses as handmaidens" (a very outdated professional relationship), then no, our working environment is not like that. We are professionals and are recognised as such. 4. What is the pay like, is there any extra differentials for ICU nursing? Pay rates are different in each state. They are negotiated by the state nursing union in consultation with the state goverment/office of industrial relations. Awards are negotiated every 3-4 years, at the end of which the terms, rates, benefits and conditions are up for re-negotiation. So it depends on which state you're thinking of working in (Visit QLD Nurses Union for more info) In my current state, pay is via an incremental scale based on years of service, from Year1 to Year8+ thereafter (so your pay goes up for every year of fulltime service for 8 years, at which point your pay then no longer increases. Pay will only increase for an 8th year RN if the award is re-negotiated ie: we get a pay rise) To get an idea of some numbers, I'm an RN5 (5th year of service) workin in the NSW public sector, and my pay rate is $31.75/hr. There are no bonuses or extra allowences for working in ICU, you are paid as to your year level (1-8). An RN1 in a dialysis unit gets paid the same as an RN1 in ED, as does an RN1 in theatres. You can, however, get access to the continuing education allowance, whereby you receive an allowance for having completed further formal education, for example a Graduate Certificate or Masters. For example, I completed my ICU Grad Cert, and get an extra 84c per hour, which is about $64 a fortnight (FT). This is different for every state, as awards are negotiated differently, so again check for the state you're interested in. 5. Do you need any extra certifications or qualification to be an ICU nurse in oz or is your bachelors and experience enough? You can work in ICU if you are an RN, regardless of how you became registered (University or Hospital trained). However, your experience can count for alot. For example, you would be very hard pressed to find a unit willing to employ you if you have little to no recent acute care experience (eg- med/surg). Your current ICU experiece should be perfectly acceptable. Your potential employer(s) may want to know abit of detail about it though (which is the case for any job you apply for anyways!); how long? patient acuity? unit demographic? unit size?... etc It depends on the unit that you work in as to how "essential" further formal education is. I started my post-grad studies when I was in my 2nd year of ICU (which alot of people said it was too early, but I had the support of my CNE's, NUM and senior staff who said go for it). I knew ICU was for me, I decided thats what my career was going to bed based upon, and went for it. Its not something that is pushed upon you, there are nurses in my unit who have been there for 10+ yrs who dont have formal post-grad qualifiactions. And there's nothing wrong with that! However, some units may have a more structured career development pathway that post-grad study forms a part of, and it will be expected that you will at least gain a grad cert within a certain time-frame of having worked there. Of course, it also depends on your own career goals; do you need a Masters or a Ph.D to get where you want to go? Senior positions (such as NUM, CNE, CNS etc) will require you to have some form of post grad qualification. I know for my CNS pathway I needed my Grad Cert. Some CNE positions require education qualifications. NUMs may be required to gain management qualifications. Hope that helps a little!

I (personally) love Landau just because the cut looks smart and fits well (we wear navy scrubs, thank goodness cos I really hate patterned ones!). I have one top in the Urbane range which i don't like because it's too short and is cut weird (says its cut to give you shape, which is nice but it should be longer!) plus i think they are cut small (which isnt a problem but i like a little room in mine) But, each to their own, try as many on as you can, you'll know what feels right for you! parko

Nothing wrong in my opinion about buying uniforms (or clothes in general!) from an op-shop. They get washed before they get put on the shelf, you'll wash them when you get them home, so they're just as clean as someone washing their own when they get home from work every day! Oh, and they don't need to be sterile, just clean. If they needed to be sterile then it would be hospital issued all the way, and they would only stay sterile in a sterile environment (ie- theatres)! Either that, or I agree with trying them on in-store somewhere, and if they're cheaper online (often are if you buy in bulk) then order via the net Happy shopping! Parko