gracieD

Sounds like you need to initiate a policy revision or get the powers that be to consider writing a new policy with infection control. If another patient or staff has symptoms of said condition, absolultely write a variance! That being said, YOU are allowed to wear whatever PPE (gown, mask, hat) you think is appropriate for any given situation to protect yourself from being in contact with the patient, patient's bodily fluids, etc. You don't have to put the patient on isolation, but you can certainly 'isolate' them from yourself. If you get pushback on this, talk to someone at Occupational Health or even OSHA. You have a right to a safe work environment!

I have never heard of leaving it 'open' to visualize blood in case of balloon rupture. That seems like a fairly unreliable method to check for balloon integrity - I think you're more likely to figure that out when you can't wedge after significant repositioning and re-floating. Also, I believe the reason that you keep the toggle closed is to prevent unknown volumes of air from entering/exiting the balloon, which is a closed system. You won't need to worry about an air embolus unless your balloon is ruptured, which would open the system to the patient and potentially allow air to enter the bloodstream. Should the syringe come off and the toggle is open - air will not be sucked into the patient's circulation (assuming your balloon is intact), but it could alter the volume of air in the tubing/balloon which could potentially mess up your wedging down the road. Does that make sense?

I once un-spiked a bag of NS in a pressure bag without first releasing the pressure - I got instant, explosive rain that lasted about 20 seconds!!! Fortunately the patient was intubated/sedated. I got a lot of laughs when I left the room looking like I had just taken a fully-clothed shower.

Adult ICU RN here, just wondering if any hospitals out there have dedicated beds and/or staff for OB/GYN ICU patients. We see an rare pregnant patient just about as rarely as we have a post-section that went poorly.

Want to provide any more details? Is this for new-grads? A refresher course? I suspect this is the 'value' of your orientation. Other hospitals require a contract for X amount of time after orientation, and if you leave for any reason before your contract expires you have to repay them this value, as they they are losing their cost of training you.

The Piedmont Hospital this thread discusses is in the state of Georgia, not South Carolina.

If your patient is ventilated hopefully RT is going with you so you don't need to worry about oxygen. And if the patient is so unstable that you think you need to bring the defibrillator, then you seriously need to consider if your patient is stable enough to be wheeling around the hospital for tests.

If they are vented, hopefully RT is traveling with you. I'd bring someone else, too (charge nurse, tech, another RN) for moral support and managing the bed, pumps, etc. Take a phone with you so you can call someone if you need to - and know the numbers you might need to call - there's no cheat sheets of numbers pinned to the walls of the hallway. Disconnect whatever isn't vital - tube feedings, maintenance fluid, etc. Call the department you are traveling to before you pack up and head out so you don't end up waiting because they weren't ready for you or they had a Stat order come up. Always speak up if you think your patient is too unstable to transport - the risk of travel must be worth the benefit of having the test/procedure done. In situations that make me nervous, I play the game "What's the worst that could happen?" and then think through what the best options would be before they happen. Say the patient codes in the elevator or hallway - how do you call a code in this situation? Where is the nearest code cart? What is going to be your first action/drug for the most common arrhythmias - the start of the code is going to be all you!! Or say the IV pole gets too far away from the patient and your central line for whatever reason isn't stitched gets pulled (true story), and your patient is on pressors!! Does the patient have other access? How fast can you get an IV in? I'm sure you (or others) can come up with some other nightmare scenarios from road trips. I find comfort and confidence in being prepared for the worst. My advice is to think through the 'worst' when you have a clear mind and you should feel prepared for whatever should happen!!

Sorry about the duplicate post...I'm past the editing/delete time frame. :/

I have to disagree with csweetooth, 5E IS an ICU, but it is connected to IMCU (intermediate care unit) and is staffed by the same pool of nurses. They rotate who is assigned ICU vs. IMCU patients so everyone works both areas equally. Patients on 5E can be vented, have swans, CRRT, etc. They are definitely high-acuity, ICU patients. A bit of history on this unit, about 8 months ago 12 IMCU beds were converted to ICU beds, creating 5E ICU. The nurses who worked IMCU simply became ICU nurses! They received a lot of training and education on equipment/technology that isn't seen at the intermediate level. That being said, they have a lot of resources at their disposal which I think would be great for a new grad. In this very post I gave a pretty thorough review of the residency at Piedmont. I've been off orientation for about 6 months now and I feel very prepared and very supported by other staff (techs up to MDs) when I do need help or am unsure about anything. I can't say anything about other area hospitals because I have no experience there, but if you have any questions feel free to ask or PM me!

I disagree with csweetooth about 5E. It IS an ICU, but the unit is connected to an intermediate unit that is staffed by the same group of nurses. So yes, you will get regular med/surg ICU experience, but you will also be staffing IMCU (intermediate care unit). They rotate assignments so that everyone gets their fair share of ICU vs. intermediate patients. Patients on 5E can be vented, have swans, be on CRRT, etc. A bit of history about the unit (which is probably why csweetooth thought it was an intermediate unit) - maybe 8 months ago 12 beds of IMCU were converted to 5E ICU, and the nurses who worked in IMCU simply became ICU nurses. They have done a lot of training and education for these nurses, as now they see a lot of equipment/technology that isn't used at the intermediate level of care. They have lots of resources available, which probably would be great for a new grad. I myself just went through the residency as a new graduate about a year ago and I would highly recommend it (see my previous post in this very thread!). There are a few other residency-graduates on 5E who are very friendly and great nurses...I'm sure you will have great co-workers if you chose Piedmont!

What about an "NCAT"? Law schools and medical schools have come together and developed their own test that covers concepts they find minimally necessary to succeed in their profession, why can't nurses? All of the concepts highlighted by other posts--critical thinking, math, broad concepts from A&P and microbiology, and writing ability--could easily be wrapped up into one exam.

You could list this experience as 'in-home caregiver' or 'companion caregiver.' There's no need to list the location or the fact that you are caring for a family member. If it comes up in an interview, be honest, but if you were caring for someone else, I wouldn't see you listing their name and address on a resume! :)

I can only speak to conditions/pay at Piedmont, and the Critical Care Program at that - they only hire new graduates into their residency program which is described in detail on their website. Side note, they also hire nurses with experience who work on other floors who want to transfer into one of the ICUs, so it is not all new graduates in the program. The Critical Care Program is five months long and involves rotation through five ICUs so you are able to gain experience in both Med/Surg ICUs and Cardiac ICUs. The preceptors are great, nearly all of them have been through the residency themselves (the program has been around for a long time!). Most nurses and I'd say ALL of the charge nurses are awesome and very supportive and available, in addition to your preceptor. You start just taking one patient and work up to taking two as you progress through the program. About half way through your five months of orientation you'll find out what unit you are going to be placed on - everyone starts on the night shift. The starting pay is $23.22, plus differentials (evening - $3.50, night - $4.50, weekend $2.94), which I think is probably near the top for Atlanta-area hospitals. There are mini classes taught by MDs about common conditions seen in the ICU - ARDS, shock, sepsis, etc. They are great for getting up to speed on the rationale behind all of the protocols that are followed for treatment of these conditions. They also allow you to get to know the MDs a little better. I'd also like to mention that Piedmont utilizes an 'intensivist' approach in the ICU - they have an adequate, dedicated staff of critical care physicians and mid-levels that are available and on-site 24-7. Since I've never worked at another ICU I'm not sure if this is a common practice, but it makes getting someone to see your patient or getting orders pretty easy. The program also requires completion of ECCO ( ECCO ), which is a comprehensive body-system-based review of anatomy and pathophysiology of common ICU issues. It was developed by the AACN, is computer based, and is worth a whopping 90-some hours of CE credits - and no it didn't take me 90 hours to complete but it did take about 2 months - it is definitely an endeavor. Overall, I am very happy with Piedmont and the Residency program - it isn't easy and the expectations are very high, but there are a lot of resources to take advantage of if you have the motivation and the time to put into it.

While this may not speak to a protocol, you may consider more psychosocial/spiritual reasons that are 'delaying' her passing. I have heard many stories of patients waiting for certain family members to be ready, to be present, or even to leave the bedside. Just a few weeks ago I had a patient who was placed on comfort care, extubated, started on a morphine drip, and simply held on. Her family was at her bedside for over 24 hours straight. I suggested that perhaps she didn't want her family to be present when she passed on, so they decided to wait in the waiting room. It wasn't thirty minutes after they left the room that she passed, and they were so relieved. This could be something that you could explore that you don't even need a protocol for!

Joey - I guess I have used and heard these terms used interchangeably - what is the difference?

Most programs have a graduated pay-back schedule, for example if you leave half way through the program, you have to pay back half of whatever they value the program at. It should be pretty clear in the contract you signed what your obligations are, even if you haven't started. If the contract isn't clear, that's a question you'd probably have to ask your manager/supervisor, but I would wait until you actually have a firm second job offer that you are going to accept before you take that route.

The only problem that I had with my preceptor was that if she saw I was busy and there was something to be done (which is pretty much always), she would just go ahead and do whatever to "help" me. This was only an issue when it was not communicated back to me what had already been done. This resulted in multiple calls to pharmacy, physicians, duplicate orders entered, etc. It took away good learning opportunities and added frustrations with other members of the patient care team because they weren't sure who they were supposed to communicate with. When I realized this was happening, I just told my preceptor that I would prefer that she not help me unless I was seriously drowning and asked for help, and if she did something to let me know! Once we cleared that hurdle we worked really well together. Yes, sometimes I struggle but that is when I really learn the most about time management and communication. When I get caught up it feels so good to know that I am indeed capable of doing it all by myself!! Other things that I expect from preceptors include - mutual respect - a knowledge of and adherence to policies and procedures --please don't teach me how to do something just for me to find out later that it is a shortcut or workaround - I don't want to start with bad habits - specific feedback that is both positive and negative. It's not very helpful to me to tell me that I had a "good day" - think of something specific that I did or remembered so I know you are actually paying attention :) - think out loud. The experience that a preceptor has likely allows them to assess a situation and jump straight to an action, however I need to either talk through it or hear your own thorough rationale. Personally, I'm far more likely to remember what to do if I understand the rationale for doing it. Things that I wouldn't necessarily expect but would be nice - keeping an eye/ear out for other patients who have something interesting going on and letting me know so I can be exposed to new or uncommon conditions, treatments, etc - including me in the social aspect of the unit. Part of growing into the role of an RN includes understanding the culture of the unit. I'm not saying that you have to dish all the gossip, but introducing me to other nurses, physicians, etc. makes me feel like less of an outsider. Overall, I think a good preceptor will let you struggle, if only a little bit. I can't possibly prove that I am competent to make independent, safe decisions based on my own critical thinking if I am simply doing what you tell me.

I signed a contract for 2 years for my new grad program. In my interview I asked what percentage of 'contract' nurses stayed on their assigned unit beyond the required timeframe. I also asked what were the reasons that they left - good answers will be relocating, going back to school, etc. Their response should give you an idea of the turnover rate of new grads at the facility and can also tell you about the work environment of the unit.

I personally think the idea sounds a little ridiculous! Actually, a lot ridiculous, considering the cost. I see that this is associated with a nursing program - I looked at the clinical competency list that they provide and it seems like these are basic things that should be learned as a student during clinicals. The certifications and training they provide are beneficial - EKG, IV, and especially ACLS, but seriously not worth $4500!!! I don't know what new grad would have that kind of $$$ laying around unless they had a job, in which case I don't think they would need this program. I personally don't think that employers would consider this work experience since you are paying for it, but it may be worthwhile to talk with someone from HR at area hospitals to see if they are familiar with the program. It may be that they frequently take nurses who have completed this program, or they may have never heard of it. I'm a little weary of this but you never know. Keep us posted if you talk to some HR people...I'm curious what their take is on a program like this!!

I just started at Piedmont in their Critical Care Residency this week. I am starting with two other new grads. I am from out-of-state, as is another new grad, so it seems that they don't reserve their programs for only graduates of specific schools. My advice is to check area hospitals' job postings EVERY DAY or set up a search client to send you an email when jobs containing "New Grad," "Residency," etc. are posted. Due to the high numbers applicants they only keep these jobs open for a few days, at best, so you have to apply quickly!

I live in Atlanta and I just graduated in July. Fortunately, I was just hired into a New Grad Program last week!! I have had only 4 interviews after applying to practically everything I could find. In every case but the last, they hired someone with experience, which was always discouraging. As far as major Atlanta hospitals go (Emory, Piedmont, Northside, Tenent, St. Joseph), the firm response that I've received is that they only hire new graduates into their new graduate programs, the only exceptions being scholarship students or students who did externships there. Even then, these new graduates can fill up the program spots, leaving fewer spots for less-connected new grads. Overall, I would say that the market for Atlanta new grads looking to get into a hospital is very competitive.

I applied for licensure by examination the first week of August and it was taking forever just to get my ATT!! After four weeks of waiting and no ATT, I called and wrote emails to the Secretary of State, Brian Kemp - the Board of Nursing is under his administration. Interestingly, I received my ATT 2 days later. :) My total time from application to licensure was about six weeks. Here are the sites that I used to contact him/his people: Georgia Secretary of State campaign office - Kemp for Secretary of State - Connect : Contact Brian

I was scheduled to interview on September 9th for the CV Residency but they called me the morning of to cancel the interview because all of the positions had been filled - kind of shocking that an HR department would do something like that but hey, what could I do? I guess this means that they have made their decisions, hopefully they'll let you know either way! The woman I spoke with told me that they would be opening ALL of the residency programs within the next month or so, just for everyone's information!

I got really excited when I got a letter from GSU in the mail today...but it was only a Statement of Intent to Register. It doesn't mention anything about the school of nursing at all, I'm pretty sure it's just because I had to apply to the school first because I'm transferring. Obviously I got in to the school, just not the nursing program (yet). The wait continues....