sway

Yeah, that's pretty much what I was pointing out. EMT-P is a license and legally allows you to perform tasks. CCRN just means you can take a test (a pretty hard one, though).

Thanks for all the responses. It's good to know that there are places out there where I could receive training. I had a meeting with my unit director and nurse educator. After listening to her for about an hour, I still didn't have a clearer picuture of the situation, except that they're going to train me when they're good and ready. I do think staffing has a lot to do with it. I just don't think the education is very strong where I work, which is dissapointing. I've decided to give them until probably november, then I'll go to the ER if nothing changes. Maybe I'll learn something there...hehe.

My nurse educator took it and said that she thought it was way easier than CCRN. She has been a nurse for 15 years, and said that anyone who has been taking care of post op hearts for several years should be able to pass with minimal studying. She thought passing it with only a year or so of heart experience is doable with some studying. She said that there were a few odd things she wasn't sure of, but most of it was straight forward hemos, and stuff you do every day when taking hearts. Good luck to all....

Word up to everything CraigB-RN just said. I think the analogy of RNs switching specialties is an excellent one. Hey, just wondering, but FlyingSquirrel where did you learn to manage a-lines, swans and vents? I'll bet it was from an RN. I was never saying that after my bridge course I'll just jump out on the street and start savin' lives...or hanging around the station with my sweet gold patch trying to pick up EMS chicks. No, I'm just licenced to perform EMT-P skills in a pre-hospital setting. Just like the new grad RN that is legally qualified to perform tasks which the state board of nursing puts in that nice list that they come up with. Of course, if the new grad RN misrepersents their skills, and gets someone desperate to hire them, they open themselves, and their license to liability. Don't worry, I won't go out and do anything stupid with my EMT-P, but when I get CCRN, watch out...

It sounds to me like you're good to go. It sounds like you work in a supportive environment, and have a good amount of quality preceptor time, and then are paired with a partner when your preceptor time is done. As far as not knowing enough to 'sense' when things are going wrong, I wouldn't worry about that either. I've seen some pretty experienced nurses miss some big things, but the bottom line is that we all just do the best we can. The thing for you to do is to take nothing for granted. Double check everything...all meds, your drip concentrations and pump settings when you first come on, etc. When someone's BP drops 20mm but is still WNL, many nurses don't really pay much attention but the best ones are at least mentally thinking of why. Just try to be really observant and ask LOTS of questions. Have fun!!!!

Viva Indy! I spent the first 18 years of my life there! I agree, go to any hospital that will take you in the ICU. I think the next best thing would be to work in a step down unit, PCU, or a cardiac/tele floor. Many hospitals offer internships for RNs looking to switch specialties, and all the ones I've seen are fully paid per your normal wage. Be agressive and go meet with the director of the unit, get a tour. I would suggest maybe asking the director if getting ACLS would help your chances, but I wouldn't just take it on my own dime. It's too nice to get paid for it! ICU demand is quite high in most places right now, so I think with persistence, you'll get in. Good luck!

Wow, what a great idea, I wish I had thought of it. I think that next time I'm forced to take a triple that I feel is unsafe, I'm going to call the involved MDs and tell them that I think their patients are being staffed unsafely. I don't know about you all, but where I work doing this would probably create some big (and much needed) waves! Thanks!

Jeez, you guys sound busy! I'd say that about a third of my nights have me running for 12 hours straight, another third are steady but leave me with time for small breaks now and then, and another third give me a good 2-3 hours of nothing to do. Usually when I have down time I study for my CCRN, do hospital education stuff, or help other RNs...so I usually manage to stay busy regardless. I guess it all just depends on how sick the patients are. In two years of ICU nursing in 2 hospitals, I don't think I've ever not had time for dinner or time to pee. Maybe I've just been lucky! Actually though, I like the busier nights better...although maybe I'd feel different if it was like that EVERY night. At least it makes the time go by fast, right?

Thanks for the encouragement, it's good to hear that my frustruation is not without reason. I think my lack of training is because of several factors. Mostly, I think it's because those in charge think that you have to have many years of experience before you're "ready" to take hearts. In fact, just before I came they changed the rule that said you had to work there a year before pulling a swan or sheath! It's a very old-school mentality, and they're very distrustful towards new nurses. There's this 'old hens' club of people who have worked there for 30 years, and they think that they're the only ones that have skills. It's very frustrating. I think staffing is another issue, although I think they could work around that one if they really wanted to. They definetly don't like to give up a nurse to do a night of orientation. As far as my motivation goes, I've been VERY active in voicing my desires and doing my own learning. In fact, I border on being a pest. I'm constantly hounding them about when I'll be trained, and most days I call the charge before my shift and ask for a hard assignment, or a certain type of patient. I've decided that if they don't start me on this stuff by September, I'm going to the NICU or ER, since both would move me toward my eventual goal of working as a flight RN.

Howdy all, I'd like to get a consensus from you all about how quickly in to your ICU nursing career you were trained to perform "advanced" ICU nursing tasks, like managing post heart patients, CRRT (CVVH or SLED), or IABP. I've been working in an ICU for the entire 2 years of my RN career, although at my current job for only one year. I am very eager to learn these skills, but am constantly getting the brush off from my boss when I ask about getting this training. I'm starting to feel genuinely ready to take this next step, but am becoming very frustruated with our unit director's apparent unwillingness to train me, and also to tell me why. I don't make any more mistakes at work than anyone else, and have been doing all I can to request hard assignments and otherwise demonstrate my skills. All my coworkers think I'm ready. Any advice?? Thanks....

Hmmm, If I understand your questions correctly, yes. If you compared two new RN graduates from the same program, and one was an EMT-P and one was not, I would expect a higher level of skill and knowledge from the one with EMT-P experience. I'm not sure this will make you more "qualified" for anything, but it certainly improves your knowledge. Just my opinion.

Squirrel, If you read my post more carefully, I think you'll notice that I never claimed that an RN fresh out of a 2 week medic course was "proficent". In fact, I think they would have a lot to learn. The point I was trying to make is that they're just as qualified, and perhaps more so, than a EMT-P new grad. Should I complete my EMT-P via a 2 week course, I will have the utmost humility and will readily bow down to any medic with experience. I won't, however, listen to anyone tell me that I'm not qualified to be a medic with only a 2 week course. I'm not saying I'll be an expert, but simply qualified. Obviously, NREMT sides with me.

Exactally, the patient takes the hit. It sounds like more of an MD problem where you work. If they want urine monitored closely, they need to order a foley. Almost every patient I work with has a foley, and if I felt like a patient needed one, I would certainly ask for an order pronto...or maybe just put one in sans order depending on the MD. The case of urinary retention is a good reminder for us about how even a scheduled surgery can cause complications. Interesting stuff.

In our ICU, measuring hourly urine is our standard of practice. If anyone were to complain that it wasn't convienent for them to perform this measurement, they wouldn't find much sympathy among the people I work with, myself included. We have foley bags with urometers, so all one has to do is look at the number, and dump the urine in the bag. It takes about 3 seconds. If someone has UOP Not checking hourly urine output on critical patients would be like not ever checking blood pressure or neuro status. You can't just ignore a whole system!

Where do you get the idea that ICU nursing is more prone to burnout than any other specialty? Most of the people I work with have worked ICU for between 10 and 20 years, and still love it. Besides, it's healthy to look for something new to do, to keep from getting bored in life...and you're a perfect example. Would you tell someone to not work in the places you've worked just because they might get burned out? If you want to be constantly challenged a work, learn a TON, and like science and technology, I think you'd love the ICU. I do.

Our RTs do the usual stuff, vent management, ABGs, suctioning. The thing that disspoints me is that they don't do oral care or change trach dressings on our rare trached patients. Frequently I see them sitting in their break room reading the paper and listening to music. I know that they work hard sometimes, and I really value their skills. I am certainly not skilled enough to run a vent. On the other hand, by their reaction you would think I'm trying to start WW III by changing the FiO2 on my vent!

Can you copy and paste your research results here? That's very interesting. Does anyone know of any other nursing research that shows a correlation between staffing and outcome? Some people at work are of the opinion that taking 3 patients is no big deal, and I'd like to prove otherwise.

It's really unfortunate that there are people out there whose lives are so miserable that they find it necessary to yell at others to make themselves feel better...although I think misery is one of the cornerstones of being an MD. Some of them just seem to deal with it better than others. I second what others have said, but would add a few things. First and probably most importantly, really watch your tone when you're interacting in this situation. Don't ever raise your voice or allow your anger or agitation to be apparent. Remain calm and plesant at all times. This can be really difficult, but is worth the effort since it keeps you from stooping to their level. It usually either helps to calm them down, or pisses them off even more, both of which I find enjoyable. Second (and someone already said this), write their little snide comments as verbal orders where appropriate. Especally when they say NOT to do something, it needs to be doccumented and there is no better place than the orders. Good idea to do it on a page with orders already on it! If an MD refuses to act in a certain situation and you believe that this is puting the pt at risk, it is imparitive that you call your medical director. The other day we had a MD admit a pt at 2am but refuse to come in and see the pt. who was in a bad way and needed an MD at the bedside. We got our med director (who is luckily very nice) out of bed, and I think that probably got the admitting MD in a bit of hot water...hehehe. Finally, if you're on the phone with someone who is yelling at you, just hang up. Call them back in 5 minutes and ask if they're ready to be professional. I like to remind them that I don't particuarly like waking people up at 4am, but am just trying to do my job. Remember that MDs often get called a lot at night, different floors and hospitals. I imagine it would suck badly, but still that's no excuse to be unreasonable. If am MD is yelling at you in person, I'd try and break in and tell them that their behavior is unacceptable and will not be tolerated...or just walk away. Of course, this is all assuming that you didn't mess up and deserve a good lashing! It's also important to support your more timid co-workers when they're on the recieving end of things. Good luck!

The worst part of it all is that as a licenced provider, you are the one legally responsible for providing a specific standard of care. If something ever came to litigation, you would be responsible for your actions (or lack thereof), even if we all know it would have been impossible for you to have been in 3 places at once. Does that make sense? The hospital may also bear some liability, but you will not be able to get out from under the liability by saying 'the assignment was unreasonable'...if you accept it you're responsible!! Basically, you're being set up to possibly fail so the hospital can save some money. Do you have a union? If not, remember that when bad things happen, the hospital has millions of dollars to spend on fancy legal teams to protect itself. Will they stand behind you?? Do all you coworkers see this situation as no big deal? I know there are many different nursing models, so if you have people (techs) doing all your baths, blood glucoses, turns, etc. I could maybe see taking 3 critical patients. Personally, I've never worked anywhere that assigned more than 2pts/nurse, unless they have transfer orders or are post stent. Protect your license and livelyhood...be careful!!!

Remember that just because an employer will put you in a situation, does not mean that it's right or appropriate. It's your license on the line. If you really want/need to take this job, make sure you force them to agree to a certain period of orientation. If they want you enough they'll accomodate your needs. And most importantly...GET IT IN WRITING!!! Don't let some desperate nurse manager fix her staffing problems by puting your livelyhood at risk!! Protect yourself!

Thrown to the wolves, as far as I can tell.

I work in Anchorage as an RN in an ICU. I have done considerable research in to CRNA jobs in the state. I've found out that there are are around 100 CRNAs practicing in the state, and that while this does not sound like very many, it's roughly 70% of the anesthesia providers. In my serach, I tried the Alaska Association of Nurse Anesthetists web site at http://www.alaskacrna.org/Home.html Unfortunately, this site appears to not have been updated for several years. The postings on the 'jobs' page are at least 2 years old! I tried emailing the officers of the association and got no responses, so I emailed the AANA for some current addresses, got them, and then did get some limited responses. I got the impression that nobody wanted to help me that much, but perhaps that was because I was a prospective SRNA. I know that from working here, Providence Hospital (the biggest hospital here) uses no CRNAs, that AK Regional uses a few, and Native uses a few also. I think there is 1 or 2 surgery centers in town that use CRNAs. Good luck, and please post any information that you find!

Our CABG patients ALWAYS come back with a Swan and multiple pressors running, often 5 or more. Some of my co-workers have told me that this isn't necessary, and that in some places they take the Swan out before the pt even leaves the OR, and all gtts are stoped, except maybe a little Dopamine or Neo. They say that these hearts do just as well. Has anybody actually worked in a place that practices this way?

I'm a pretty big and burly guy too, but contrary to some of you, I often introduce myself as a "male nurse" just to break the ice. Something like "hi, my name's Ryan and I'll be your male nurse today". People usually get a good laugh out of it, and I find it works especially well with people who seem nervous about having a guy as a nurse. Of course, it also helps if you're really, really, really good looking....to quote Mr. Stiller again. Seriously though, as a nurse you'll make very good money, have unprecedented job security, good benefits and only work 3 days per week (most jobs)! What could be better than that?! I say that anyone who makes fun of you is just jealous.

I think that's the biggest lesson to learn here. Just because someone will put you in a hospital doesn't mean you are qualified to be there. As a licensed practitioner, you are ultimately responsible for what you do. YOU will be the one who has to answer for any mistakes...not the travel company, recruiter or charge RN. Saying that you "didn't know" to do or not do something doesn't cut it! To all you new nurses out there who want to travel (or not), the first question you should be asking prospective employers is what kind of orientation/education they offer. The more the better. Just because you can make it through a shift somewhere doesn't make you a good or safe nurse. Some recruiters are like car salesmen...sometimes worse. They work on commission and are PUSHY! They'll tell you anything they think you want to hear just to get you to sign up. Take everything they say with a big grain of salt. Look out for you and your license above all else.