airborneinf82

While you have a year of ICU experience, that still makes you pretty new in the grand scheme of things. Last thing you want to do is be the new person who seems like a "know it all" or isn't willing to listen or learn. (Not saying this is you). This is the hardest thing coming with experience to a new unit. Just take it all in and be a sponge. A lot of things are going to be quite different than where you came from. MANY more will be the same. Nursing is nursing after all. At the end of the day, be open and receptive to new ways of doing things. If someone is showing you something you already know, let them show you or explain to you. Show people you know what you are doing through your action and your collaboration with others when they need help. Don't worry or let it bother you if you a hearing something or having something explained to you as if you "don't know what you're doing." This isn't the case as no one really will know you yet or what you are capable of.

My biggest pointer for CCRN is just to do a bunch of questions and make sure to read and UNDERSTAND the rationale. Anything you don't full understand, go look it up; read in a book, Google, or even better find a YouTube video to explain it. There's so much to critical care that you can't possibly know it all but over time and with practice you can learn to look at the questions the way they want you too and can often times reason through much of what you don't "know." Good luck!

Congrats! Soon that "aha" moment will change to an "oh s***" moment and you'll question what you are thinking! haha But we've all been there and stick with it and be a sponge! I've loved being in the ICU!

I agree you should definitely shadow in each if you can and talk to the nurses about what they like and more importantly what they don't like. I personally have worked a majority of my experience in Trauma/Surgical ICUs but for the past few years I have worked both Trauma and CVICU as our hospital has both those ICUs under the same management and the ability to work both units at times. Having worked trauma I have worked with many neuro patients and I do like many aspects of neuro, but personally there are many things I don't like with it. Working in the CVICU I have really rounded out my nursing understanding. Obviously the cardiac picture dictates a lot of what goes on with the body. I really have enjoyed learning and understanding more about hemodynamics and the heart. And you are right that the CVICU is very device heavy. We do everything your CTICU would do minus transplants. We have a very robust ECMO program as well which has been a very unique learning experience. Personally I have loved learning all the various devices and taking care of those complex patients. CVICU sees some very sick and very complex patients and you can find yourself with a myriad of various drips going. If technology/devices and really micromanaging drips to optimize hemodynamics is what you are looking for, then the CTICU would be perfect for you. Someone people just really love neuro and wouldn't trade it for the world. It definitely is a different world so it really depends what you want to get out of your experience.

She does also have her courses online. CCRN Review

My first ICU job would triple. I couldn't take it and felt it was horribly unsafe. I left and will NEVER work in a job that triples ICU patients.

Might start with some research with the Infusion Nurse Society... Welcome to INS1 - Infusion Nurses Society I personally prefer a flush line with a manifold otherwise "daisy chained" IV's run the risk of changing overall flow rates (temporarily) and inconsistent immediate results with titration of one or more drips.

Just manually push it back in. But as always, check your hospitals policy for numbers on when to hold, how much to re-infuse, etc. Also, when you have the time, if you have a shared governance or whatever, look up and then pass along the latest research on tube feedings. Current studies show less than 500ml is no issue and even not checking residuals in intubated patients. There are obviously exceptions to these rules, but it is what current research shows. Also, post pyloric and J-tubes you wouldn't check residual... Ultimately though, it doesn't change your practice until a policy is changed, hence, check your policy. A lot of times hospitals will also have access to resources that cover nursing tasks and outline the steps to do things (aka Lippincotts [sp?], etc). Sometimes the policy will just say do "this" and you have to refer to the proper procedure there. Just FYI. Great things to address with your preceptor or other experienced RN there.

As long as, while reading, it is properly positioned, it doesn't matter where it is in relation to the patient. Some places place them on poles, on the side of the bed, in the bed, on the patient. Doesn't make a difference.

Probably better off reading through the chart then getting report from the ED anyways a lot of the time. I'm not sure who is worse, them or the OR. I agree though. I like a verbal report. It doesn't need to be long at all, but it ALWAYS involves a little back and forth. I think this is best for patient safety. But what do I know.

Not to mention the latest research suggests that gastric volumes of less than 500ml's is nothing of concern. Another study even suggested that checking residuals is an antiquated practice, at least in ventilated patients. Either way, pausing tube feedings is an old practice that is perpetuated by a lack of critical thinking, and as seen on here, a lambasting culture that those who don't get along are "killing" people.

Yup, killing patients. Wow....

Oh dear God please tell me you aren't serious?!?! The 120cc's in there already wouldn't be a problem, but that 124.8 that is now in there is what pushed it over the edge and now the patient has died from complications of aspiration pneumonia......

Pausing tube feedings is one of the stupidest things that nurses do religiously... nothing like saving a patient from potentially aspirating on 4.8cc's of additional TF.

Welcome to the field. Former 11B with the 82nd Airborne here. Now Trauma ICU RN for 4+ years. Honestly, as a new RN, much of what you review won't really "click" until practical application is present. You will learn a TON in orientation and should, if long enough, have you at an acceptable spot to be able to start taking some easier patients yourself. You will have plenty to review as things come up during orientation and honestly you won't do yourself much good "cramming" before you start. Take the time and enjoy the calm now, because you will have plenty to do and know soon enough!