SCBlueICU

I've never seen it personally, but I have a thought. I wonder if the patient's body was trying to keep the neuro perfusion pressure up, so when you dilated blood vessels with sedatives, the body increased HR to increase CO in order to keep the pressure where it wanted it to be in order to perfuse the brain adequately. That's just off the cuff, not sure that is what happened. Interesting!

I would make sure you make yourself available in any code/emergency situation. If you are not busy at the time, head to codes around the hospital too(as long as that's alright with your Charge anyway). Just being around those situations a bunch will make you more comfortable when it's happening to your patient in the future. Also get ready for lots of lovely liquidy tube feeding poop. Nothing gets everywhere like that stuff does.

Lack of understanding of critical care medicine and what it can and can't do are huge across the USA. Big problem.

I agree with in my. If you have a place that speaks with you about an issue for the first time and then pulls in the CNO to investigate you, you should get out of there ASAP. Nobody knows everything and a "most transfusion issues happen in the first 15 minutes, so stay with your patient next time" should be good enough for a first time missing. As far as the insulin thing goes, if I have a diabetic patient that appears to know their diabetes well and they tell me not to do something, I don't do it and I would say 95% of the time they have been right on. Diabetes is different for everyone and while blanket protocol orders that the docs click may work for many people, they don't work all the time. That's why nurses are people with reasoning ability and not machines. Yeah, don't fractionate the dose next time, just hold it, but sounds like they are being a little harsh. It would be more concerning if you gave them more insulin because you thought they needed it. You had your patient safety in mind which is the important thing. I see more problems caused by mindlessly following a protocol without applying it to the situation. I see the issues as needs for improvement on your part, but please don't let this convince you that you are a horrible nurse. Find a new job that will teach.

Either one I think. I did Telemetry for a year to start and it was perfect experience. Rhythm interpretation and understanding of cardiac issues helps a lot in the MICU. I'd imagine the specific cardiac focus would help more with CCU as well. I know at the hospital I did Tele for the CCU recruited several of our Tele nurses. I would be open to the possibility of working nights for a year or so when you first transition to critical care. Good luck!

We've had a lot more push to improve "productivity" lately. It does create unsafe situations and it is frustrating to see the things our unit does to save money and then talk to people who work on the business side and hear they sit around doing nothing a lot of the day. I understand it is a business, but there have to be limits. As far as our charge taking patients, it does happen, but not very often. Which is good since our charge also responds to code blues throughout the hospital...

If I was you I would definitely explore my options Go-Getter. I just wouldn't feel right condoning that kind of on the edge care by staying. Sounds like you deserve a better unit to work on. We are 3 to 1 rarely, and they are usually a stable bunch. 2:1 is the standard with 1:1 when necessary due to acuity.

Like many other posters here, we have a lot of protocol driven orders. Fever protocol, electrolyte, EKG's, etc. However we have an intensivist around 24/7 and they are usually easily accessible just to run something by quick, or to come over if things are looking pretty rough. With the way our protocols are set up I wouldn't order an ABG, chest xray, KUB, without running it by our docs first. They are the ones with the authority to order and sometimes they think things I would want are unnecessary, so I would end up costing the patient if I had ordered it. Do what you feel is the right thing to do. Also, I think our docs would be weirded out if I called any of them sir. Some of them don't like us calling them Dr. ...

I think it happens to everyone sooner or later. The way people can bend sometimes is unreal. Obviously we do everything we can to stop people from doing it, but sometimes there isn't a lot you could have done about it. I've never seen one of our doctor's lose it when a patient self extubates. I have a friend that is a doctor that doesn't understand why the nurses get so freaked out about it. In short, the fact that you're analyzing it after in your head means you're going to try something different next time, which is all you can ask for.

I worked on a Telemetry floor for a little over a year before moving to the ICU. That was a perfect amount of time for me and learning heart rhythms really well helped me out a lot. I think that once you feel comfortable with time management, responsibility, etc., on the floor, you will be fine in the ICU if you are interested. Takes some studying once you get there though! I work in the MICU.

@midnitej Hang in there! It is a lot starting out in the ICU as there are so many things to wrap your head around. I agree with the suggestions to read through the doctor's notes and h&p in free time pre/post work. It was so helpful to me when I first started out to do that so that I really got an idea of what the big issues were for the patient. I agree that Critical Thinking skills take time to develop. It is a hard skill to build, especially when there are so many tasks around to distract your time. I would suggest bringing up things you don't fully understand to other nurses. Nobody knows everything! I ask questions of my brethren all the time. You can learn so much from it! Also when you have the time, get in on bad situations so that you get a picture in your head of it and can hear everyone trying to reason it out. Something that helped me time-wise when I started and was running around trying to get everything done like a chicken with my head cut off(inevitably getting behind), was my preceptor telling me to check both patients quickly to make sure there was no emergency, set your alarms in those rooms and trust them to alert you if something is wrong, and then give yourself an hour in each room to get the big stuff done. That helped so much because it stopped my mind from wandering all over the place thinking of things I needed to get done. I was able to focus on one patient at a time. Now for a book suggestion! http://www.amazon.com/Notes-ICU-Nursing-Second-Edition/dp/0741417057/ref=sr_1_1?ie=UTF8&qid=1409579856&sr=8-1&keywords=MICU This book called Notes on ICU Nursing is written in a very conversational tone and was huge for me when I first started out. They explain so many things in a very understandable way which was a good way for me to get a base to work from. They tell you some stories from their experience as well which really help drive the message home. This was invaluable to me. Keep pressing! Every day you get more comfortable in the ICU. @Henrica80 You can definitely be fine in the CCU! The program you are going into sounds great. I would recommend using that classroom time well to get a good understanding of the processes you will be seeing. If you are able I would start studying big processes in your free time in those weeks too, again that book above was great for me. Remember, they hired you and they wouldn't have if they didn't think you could do it! I say take the opportunity!

Oh yeah! I definitely learned all there is to know about L and D in the 3 shifts I worked there during nursing school. Throw me in the fire and I'm sure the babies will pop out fine. :/. Saying "No" was a skill I had to develop. So hard when you think of everybody running around taking more patients than they should. Then I realized most of the time they are just fine without me...