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Critical Care, Pediatric
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harryalexx has 4 years experience and specializes in Critical Care, Pediatric.

harryalexx's Latest Activity

  1. harryalexx

    Feeling down; Received first bad evaluation

    Good luck, dankat! It sounds like you have a good head on your shoulders.
  2. harryalexx

    Question about zeroing lines

    I think part of the orientation and reeducation of RNs in an ICU should include a basic physics overview. And why we do what we do. I don't like how a lot of people do things out of habit or "just because." Let's just take over the world, eh?
  3. harryalexx

    Dedicated med lines

    The only thing I'll add to what janfrn said (as my unit is quite similar): The med lines we use have a slide-clamp. We recently (2 years ago?) standardized its location to be between the tubing expiration label and the hub of the med line (or gtt line). That way, you can clamp the line to prevent air entry, scrub the hub of the line per protocol, top off with saline, and administer the med. I'm involved with the CLABSI/PI stuff on my unit, and our CNS recommends not using needless adapters (like you're describing) due to the risk of air entry as well as pathogen entry. I know they have fancy ones that claim no chance of air trapping and antimicrobial plastic pieces, but the most basic setup is also the easiest to manage and monitor. As janfrn mentioned, vasoactive infusions are not interrupted for medication administration. Peripheral access is more likely to be obtained than interrupting milrinone or other infusions for a medication. The only exception is that we run our electrolyte replacements "in front" of our drips if needed. I personally don't like this if it's avoidable, as a neonate with MIVF running at say 3mL/hr will have a change in BP if there are multiple gtts going. The change in rate causes swings in my experience. Hope that helps.
  4. harryalexx

    Question about zeroing lines

    What she said...hahaha! Janfrn, I wish I worked with you. I have a lot of coworkers who think that a patient who has moved, or changed bed position, or sat up, needs to have their pressure lines all re-zeroed. I slap my forehead and try to explain sometimes, but it's ingrained. Oy.
  5. harryalexx

    PICU Practicum

    How awesome for you! Congratulations! PICU is an amazing place to be for learning. I hope that the unit gets you involved and loving PICU. As for advice, I would say start off with what you think a good peds nurse would be. Review developmental practices and just focus on being comfortable with kids. A lot of the more technical stuff you'll get in any job (central lines, meds, drips, etc.). Like any preceptorship/practicum, of course act interested. Nurses will pick up on your level of interest. Be careful of what you say, as you'll be judged on what you say and how you act quickly since you don't already have longstanding relationships with the nurses. This is silly, but I was with a nursing student last month who spent most of the time on the cell phone or the computer working on assignments. Practicum can have slow times (duh!), but if you've got a personable preceptor, take advantage of it! Ask questions, be interested, volunteer to get your hands dirty. I hope you enjoy PICU nursing :)
  6. harryalexx

    Feeling down; Received first bad evaluation

    Like everyone else has mentioned, 8 weeks is such a short period of time in the grand scheme of things! The orientation the new hires on my unit get STARTS at 8 weeks, and goes from there. It's kind of an expectation that everyone comes with different experience and learning styles. I work peds cardiac ICU, and it is a very tough job. The learning curve is gigantic! Be easy on yourself, friend As for how to improve and get more efficient, try asking a preceptor/charge nurse/experienced RN their opinion. The managers get their information from these people and are forming an evaluation based on the collective response. Go to the source and figure out areas that you can work on. For what it's worth, 2 patients in a CICU is very tough. The acuity and pace of the patients is unlike anything else. I would recommend getting very familiar with the routine meds on the unit...major safety issue and tends to slow newer nurses down. Also take a bit before starting your shift to choose the most important things to do. Separate out the "do by the end of the shift" stuff from "Oh crap! I needed to do that 10 minutes ago!". Finally, of course you need to know defects. Cincinnati has a good interactive website for the defects and their repairs. Or maybe your hospital has an internet resource. You don't need to know every surgical intricacy at this point, but major nursing considerations as well as "trace the blood" type of stuff. Stick with it :) This is a super rewarding area to work. And in a year, you'll see how far you've come!
  7. harryalexx

    Moving to LA area... advice on hospitals?

    Hi ekr15, I also work at CHLA full-time, as well as a per diem (3x/month) in a PICU by where I live. It's true that CHLA doesn't pay top dollar, but you can comfortably live in LA with what you'll make FT. The PICU is an awesome unit, and as vivasmom said, very high acuity. CHLA also has a CTICU (my love)...congenital heart surgical ICU basically. Highest acuity in the hospital; I would argue in LA. Super fast-paced unit, all hearts. Message me if you'd like more info about other hospitals in the area or nursing in LA in general. Go PICU!
  8. harryalexx

    ANY CVICUs/ICUs hiring new grads?

    The hospital in which I work hires new grads into a 22-week long "RN Residency." It's amazing! It's a pediatric teaching hospital (Magnet status). Send me a PM if you're interested in more information.
  9. harryalexx

    How many patient's do you normally have?

    I work in a peds CTICU. My state regulates that pediatric nurses never get more than 4 patients. And in the ICU, you won't get more than 2 patients. A pair (2 pts.), though, tends to be more work on the nurse. The floor I work on is extremely high acuity, though, so it might not be comparing apples to apples. In a less-acute ICU, I know that adult RNs can get up to 3 patients. My suggestion: swallow your anger/resentment on the days when you feel like you have one too many patients. In the end, it will make you a better nurse. On my unit, I know that if you can take care of the worst/busiest/most inappropriate pair, you can take care of the SICKEST postop or otherwise critical patient. Look at it as a growing experience (as hard as that may be!). Hope that helps :)
  10. harryalexx

    RN ethical dilemma

    I am with this poster. Education is central to our profession. Persuasion and coercion are nasty weeds that find their way in. I've seen (and I think we all know) the difference. Scaring a person into treatment and/or diagnostics is unethical, but professionally and sensitively educating a patient about their condition and the consequences of seeing or not seeking treatment is just a part of the job.
  11. harryalexx

    Is med-surg really the best place to start as a new grad?

    Hi there! Congratulations on almost finishing! What a great accomplishment :) I am going to disagree with the previous posters, with some conditions. If you live in a large metropolitan area, I think that you would be more than fine to start within a specialty. If the institution is a teaching hospital and capable of nurturing you as a new nurse, then a specialty is definitely doable. The other piece of the puzzle is your own comfort level and confidence as a person in general. I started in a sub-subspecialty right out of school (a pediatric cardiothoracic ICU) and have been fine. The "basics" or "fundamentals" of nursing you will find in any new nursing job, assuming it is the right environment. I would contend that you could easily start on an ortho/med-surg floor and not get taught the basics, or even get trained to have bad habits or wrong fundamentals. It's all about the employer and nursing culture of the unit. My suggestion to you is not to limit yourself. Any direct patient care nursing job is going to give you a slew of fundamentals - you can't survive without them! If you know that you are a quick learner, flexible, and motivated then you'll do fine in a specialty. I wouldn't be able to work med-surg for more than 6 months because I need the stimulation, excitement, and constant learning that my specialty gives me. I hope you find something perfect, and best of luck!! -Alex

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