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ICU, Intermediate Care, Progressive Care
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bewitched has 4 years experience and specializes in ICU, Intermediate Care, Progressive Care.

bewitched's Latest Activity

  1. bewitched

    Transition into Trauma Stepdown

    I have 4+ years of nursing experience on Intermediate Care (1.5 yrs), Multisystem/Transplant ICU (6 mo), Multisystem PCU (2 yrs), and Hospice nursing (6 mo). I have been an ANM at my current role for over a year now, effectively the full time charge nurse with some additional administrative duties. Hopefully I will not be too rusty on the hands-on clinical skills. I am now going to be transitioning to a bedside nurse role at Level 1 Trauma Center on the Trauma Stepdown floor, with an anticipated 3 months of orientation time. There will evidently be a lot of crossover with Trauma ICU, and many nurses eventually crosstrain and work both. I have picked up Asif Anwar's "Critical Care, Trauma, and Emergency Medicine" and I could see where that would be a useful pocket or desk guide, however it does not go into much detail at all. Anyone have any book suggestions to get a head start on learning? I have seen the TNCC mentioned, but I can't decide if this looks like something for a novice trauma nurse, or meant like the CCRN for an experienced nurse to get certified in their field of knowledge. Any tips for success with this transition? I am both a little scared and very excited which always tells me I am making the right move!
  2. bewitched

    100% online RN-to-BSN programs?

    I'd check out Western Governors University. 100% online with no clinical hours for BSN as far as I know. I have been enrolled 8 months now working on my RN to MSN. It runs about $3200 per six months IIRC, and in those six months you can take as many classes as you're able to complete. They schedule about 6 wks for each class which has been about right for some of the classes, but others like some basic nurses courses I completed in a week or less. Most finish the BSN within a year to a year and a half but I think some have gotten it in more like 6-9 months. I would totally recommend. I feel the quality is excellent and it is an accredited school,whuch was very important to me.
  3. bewitched

    ANM considering return to bedside nursing

    I am fully aware that bedside nursing does require staff meetings, inservices, etc. However, I am currently meeting on a weekly basis with myself and the other ANMs and our manager, for several hours at a time, which kind of ruins a whole day off, and it is basically getting reminded/lectured of things we all already know, for the most part. Instead of being helpful or encouraging, it feels discouraging to me and only increases my feeling that what we do is never enough for our manager or upper management. I am considering other routes with my Masters' but I am still interested in leadership and management, but likely not with the hospital company I currently work for. I have another 6 months or more before I'll be into the leadership coursework with my masters so I have time to make that decision. I also feel like being both a charge nurse day to day yet still having the expectation of management-style work is a lot--I didn't feel this stressed as a charge nurse, and I don't think I'd feel this stressed as a Nurse Manager. It's being in the middle, I feel, that makes me not as effective at either part of the job as I would be if I was JUST charge nurse or JUST management. And I do think as the 2nd commenter said (shadowposted, sorry!) that for right now, I'm looking for something where I can leave work at work, focus on my school, have balance between work and home life for a while, then eventually when I have more clinical experience and have the degrees I need as well as the knowledge of leadership and management then I can move back up the chain.
  4. Just looking for some insight from anyone who's been here or similar. I am an Associate's-prepared RN with four years of experience in IMCU, ICU, hospice nursing, and PCU. I've worked my way up from CNA to new grad to floor nurse, then to preceptor, relief charge, and for the past year I've been an Assistant Nurse Manager. I am the youngest of the ANMs on my floor, and I feel that I am both intelligent and mature for my age. I take my profession seriously. I have gone back to school for my RN to MSN with a focus on Nurse Leadership and will be getting a BSN degree along the way. I am growing increasingly stressed at my current ANM position as leadership changes in my hospital as well as changes on my unit's patient population have become more and more challenging. The morale on my unit is dragging due to most days everyone having 5:1 because we are now doing a specific pilot program requiring a 3:1 pt ratio for one nurse. The staffing overall in the hospital has become an issue in the last few months, and we are often intentionally shorting ourselves because we are floating our nurses or techs to other units. Our patient experience people have stepped up in a big way and have gotten very strict about their scripting and other initiatives, which I am a proponent of in a general sense but don't believe in coming down hard on nurses if they don't do it perfectly, because I feel like you've got to trust your nursing staff and let them deliver quality care in a genuine way. That's more important to me than being a hard-ass about using key words, signing rounding logs on the hour every hour, etc. I don't feel that my own manager realizes ANMs need support too. It's as if she feels that our support and engagement is a given, and that it's the bedside staff we need to compliment (and write-up if necessary) and boost the morale of. I feel that my ANM role has all the expectations of a manager's role-the scheduling, employee rounding, leader rounding, employee annual evals, observations, etc--but with all the day to day struggles of a charge nurse--throughput, staffing, patient complaints, code blues, clinical audits for central lines, etc. I also get texts and emails from my boss on my days off regarding this question or that event or this/that patient who went home, etc, and every time my phone jingles on my day off I feel stressed because I know it's going to be her. I am getting frustrated because I am working my 3-4 12 hour shifts per week, then I have to come in on my days off for classes and our weekly meeting, plus I do the schedule on our unit so that is a time-consuming task on my days off as well. I enjoy the nurses I work with for the most part, but I am just not totally thrilled with my own job on a daily basis. Unlike bedside nursing, I can't not take a difficult patient back the next day; all the difficult patients are all mine to handle, which is OK sometimes, but I swear we get ALL of them that pass through our hospital doors. I also haven't called out sick in the entire past year because we have no relief charge on the unit to take my place, and I don't want to let the unit down. I am strongly tempted to look into returning to bedside nursing, partially because I miss having my own group of patients, I miss the hands-on activities of nursing. I miss my days off being my own, and I'd certainly have more time to complete my RN-MSN which it is sometimes hard to do with the demands of my current schedule. I'm also strongly considering leaving my company and going for the "other guys" hospital across town, who I've never worked for but the pay is said to be competitive if not a bit higher, and the work environment may be better. They also offer different specialties, including trauma, and I am getting a weary of my current hospital's culture. I am thinking about going back to bedside nursing for a couple of years while I finish my RN-MSN degree, then moving back up into management when my lifestyle can support a M-F/9-5 sort of schedule, and when my MSN degree qualifies me. Do you think there would be issues with having been in middle management only to return to bedside nursing? What would you do if you were me?
  5. bewitched

    Nurse Mgr position at Union Hospital?

    Hi there! I applied for a Nurse Manager position a few weeks ago at a unionized hospital in Florida (NNU) and I didn't know it was unionized until just today. I have had 2 phone calls with a recruiter who most recently said he was going to circle back with the hiring managers and be in touch with me soon if they're interested in an interview. I am currently an Assistant Nurse Manager across town in a non-union hospital. I am not against unions, I am familiar with NNU and my politics line up with theirs as well, for the most part. I just had no idea there were union hospitals in Florida and I don't know anything about how they work since I've never worked for one, nor how that would affect me as a Nurse Manager. My thought is, as long as I am keeping my nurses' wellbeing in mind and doing everything I can to foster a good working environment with safe staffing ratios etc to the best of my ability, I shouldn't have anything to worry about, right? Would I be expected by the nurses to join the union or vice versa would management expect me to be anti-union? Any thoughts on how, if at all, this would affect my day to day job if I were hired there?
  6. bewitched

    frustrated with transition to icu

    I am an RN with 2 years of experience on a stepdown unit with a 3 to 1 ratio, lots of PNA, CHF, COPD, MI, stable trach-vents, GI bleeds, AFIB/RVR, DVT/PE's, etc. I consider myself experienced and very proficient with Heparin, Cardizem, Amio, and some other drips, BiPap and stable trach vents, and putting the pieces together to look at the multi system issues of a patient. At my workplace I was known for problem solving and advocating strongly for my patients, as well as catching evolving emergent situations. This autumn I took a position at a new hospital, relocated, and have been working in a fast paced ICU. I had 2 months with a preceptor and have been about two months on my own. I am frustrated. My preceptor and I did not get along that well, and I don't feel that there is a strong team atmosphere with my coworkers until there is an emergency -- very different from where I came from where you had a lot of backup from charge RN and those working around you and we always had each others backs. Additionally the learning curve is hitting me hard. I don't like, and don't feel confident with, a lot of the drips in the ICU setting, and I don't really like my patients to be ventilated. I live in fear of a doctor wanting to do a bedside procedure because I don't feel confident enough to know what they will need me to do and when and what medications to have on hand. I dont feel like I have all of the knowledge of the pathology I need for my patients -- we get a fair amount of oncology, for instance, which is totally new to me. I feel like I'm not able to put pieces together fast enough to intervene or notify doctors, and I feel like my entire core set of nursing skills are being negatively affected by me trying to concentrate on all the new processes/tasks that I'm trying to learn. I don't know if its the change to a new hospital and having to learn all of their procedures on top of jumping into an ICU, or the fact that I might just not be cut out for ICU, or is this really the same as when I was a new nurse and with time and experience everything will get better? I don't exactly want to ask to go to a less critical unit because I feel like the whole move would have been wasted. I took the job because it was a step into a more critical enviromwnt and I thought it would be a move up. Instead I find myself sorely homesick for the people and the hospital and the pt acuity that I left behind. If I try to get into a stepdown unit where I would be more comfortable with pt acuity, it will feel like giving up and going back to the same old same old but without the friends and coworkers I had at my old job. At the same time, I am very stressed out at my new job. I'll have some days that are OK -- pts pretty much sick but stable, I get everything accomplished and get out mostly on time - and those days aren't so bad. Then I have train wreck days that leave me getting out late feeling like I missed a thousand things and second guessing myself and crying the whole way home because I just hate it and don't want to go back. Just sitting here writing this I'm feeling frustrated that I have to go back there. When I think about asking to get to a leas critical environment, I feel guilt for failing in ICU,but I also feel a lot of relief. A lot of this is me venting and I'm sorry it's long winded. I just don't know what to do, except to take it day by day, but how long should I be miserable to see if it improves? Especially when I feel like a bad nurse and my confidence plunges with every bad day I have. I don't know what to do. Some days I feel like I should be yelling "I'm not a bad nurse" to the world, because that's what I feel like everyone sees when they look at me sometimes, and logically I know its ridiculous, but I have had my confidence broken down after being totally profocient and a resource person at my previous hospital, to here at my new place being looked at funny every time I ask a question...
  7. bewitched

    Nurses with worse spelling than mine are laughable.

    LadyFree28 is correct about the origin of "finna." I am in FL and I knew exactly what the word means-- it's a contraction of fixing to, which in itself is a very Midwest/Southern type of word to me. :) I don't think I say "finna" but definitely use "I'm fixing to go to the store." To me it's kind of like I'm getting READY to go, or I'm thinking about going in a little bit, or I'm trying to motivate myself to get up and get ready to go, whereas if I'm physically walking out the door I would say "I'm gonna go to the store, see you soon." I have more often than not been appalled by my coworkers' spelling/grammar (in)abilities. Particularly in a field where professional writing is preserved on patients' charts (both paper and electronic), where continuing education depends on not only literacy but a high capability of digesting and analyzing scholarly paper, and where the ability to read and comprehend technical writing in order to learn a concept or procedure can be quite vital, it really amazes me how illiterate some people are. On the other hand, I try not to judge, because these same people who are unable to spell are often also very good nurses in a clinical/bedside sense. We each have our strengths.
  8. bewitched

    General workplace/personal life separation

    I think I am fortunate that the friendships at my worklace do not seem like a facade to me. There are some people who are casual acquaintances with everybody but keep a professional distance, and that works for them. There are a few people who are drama queens and over sharers--maybe three or so of these people, off the top of my head. Then there are a few groups of friends. For myself, I have about five or six people I am happy to talk to about both work and non-work issues because I consider them trusted friends. Do we spend time together outside of work? Not really, though we've met up for work parties and things. But do I consider them friends, absolutely. There are no rivalries/backstabbing from what I can see, either. Guess I'm just fortunate that everybody is able to get along with each other at whatever level they're each comfortable to share/involve in personal life and details. :) ^^^ just saw this from up-thread. I work on a highly critical stepdown unit and THIS is exactly how my workplace is. We see enough s#!% that we don't need it in the workplace. We're a family or at least a close-knit team busting our butts to deal with difficult situations and a stressful but rewarding environment.
  9. bewitched

    afraid of being stuck by a needle

    I used to hate needles, and I still get a fair bit of anxiety from them, but getting my blood drawn for my first hospital job 3-4 years ago was not bad, and neither was last week's for my new job. They go in the AC. The worst part was once when they needed quite a few tubes, maybe three or four tubes, and I swear I felt like the vein was going dry on them, it was uncomfortable to say the least. On the other hand, my new hospital has nurses do all lab draws, something I've never had to do before, and that makes me nervous! I don't know the first thing about phlebotomy. I suppose it's simply like starting an IV only with a needle and tubes instead of an IV catheter...
  10. bewitched

    Did you know? "Code Brown" means tornado. . .LMAO!

    The explanation I've heard against DNR armbands at both of my hospitals has been that it's a HIPAA violation, as in, they might not want the whole world knowing they don't want to be resuscitated. Code Blue, Code Red, and Code Pink are standardized between both of my hospitals. I believe Code Black is a bomb threat at both, Code Grey is a combative pt/visitor at both, and Code Brown is a hurricane/tornado warning at both. As far as armbands go, my first hospital uses yellow for fall risk, pink for arm precautions, and a white one (sep. from nameband) with red writing for objections to blood products. My new hospital, which I've just oriented at, has a lot I'm not used to--obstructive sleep apnea arm bands, blood bank arm bands that are handwritten when they're typed and crossed, and some others... I'm just picturing a ton of armbands up and down a patient's arms! LOL
  11. It's been about two years since I posted on AllNurses--now I'm back with some real nursing experience under my belt I hope to be a helpful contributor as opposed to the nursing student asking questions all the time! (SMH at some of my old posts, haha.) I've just been hired on at a hospital that is Det Norske Veritas (DNV) accredited as opposed to the Joint Commission. I was never aware there were any other accrediting bodies, so I'm very curious to hear from anybody who has worked for a DNV-accredited organization as opposed to JC. I think we are all familiar with how a JC visit goes--all of a sudden the managers are rushing around to make sure the most trivial of things are up to snuff, and you've got to know the most obscure policies "just in case" you're asked--and the charade of perfect 100% adherence to regulations is kept up for as long as inspection and reinspection takes, then when it's all over everyone breathes a collective sigh of relief and resumes their usual method of doing things. It's not the big things that I take issue with--patient safety goals and all that are great, I have no problem with regulations and policies that are common sense and patient-based. It's all the little nitpicky things that drive me up a wall. From the explanations given in orientation at my new hospital (well, really, my new primary hospital, I'm still working at my previous JC hospital, too), it sounds like DNV is less concerned about the details of how things are done and leaves things more to the individual facility to dictate, so long as the end results are the same and everything is done safely and with good practice. Does that actually reflect the nature of DNV as an accrediting organization? My new place says that with the DNV accreditation they were able to take ~1500 policies and streamline them into ~600, making things much easier and less conflicting information, etc.
  12. bewitched

    New Grad in Intermediate Care?

    I've been working as a PCT (basically CNA) for the past seven months at a local hospital and the chances seem promising that I may be offered a position on nights on the Intermediate Care Unit after graduation in December, since I am precepting there and the unit director sounded interested. Now I'm not going to count my chicks before they hatch, but I would be thrilled to work on this unit due to a great team of co-workers whom I already know, familiarity with the unit and patient acuity, and the extensive orientation process--I want to feel prepared when I hit the floor on my own and I think this unit can give me that. Our intermediate care unit is basically a step-down from ICU and a step up from the basic med surg unit. We get pts transitioning to the floor because their status is improving, and we get pts coming in from the rest of the hospital because their status is declining. Nurse to patient ratio is 1 nurse to 4 pts. We do take vents on occasion, trachs frequently, and drips fairly often. Does this sound like a good place to get my feet wet in nursing care? Truthfully critical care nursing is my second choice after maternity/L&D nursing which I can't get into without at least a year of med-surg experience. But I am not the kind of person to do something half-@$$ed, if I took on this Intermediate position I would do everything I could to be the best intermediate care nurse I could be. What can I do to improve my critical care nursing knowledge prior to taking this position if it is offered? Are there any books you could suggest? I saw one of the intermediate care nurses studying from a textbook for her CCRN test, but the book had mostly Q&As, not a review of critical care nursing content... I appreciate any and all input! I am not so overly confident as to think I can do anything and know everything right from the start, however, I don't want to bite off more than I can chew and end up endangering my patients with a lack of knowledge. I want to set myself up to succeed, and to give the best care that I can to my patients.
  13. bewitched

    Medical Terminology

    I understand everyone's answers so far and I agree with them. However I voted "eh" in the poll because although I took both Latin in high school and a Medical Terminology course, I don't feel that either of them helped in learning medical terminology. This could be because I have always had a basic and innate understanding of words from context and from being an avid reader. But I have not encountered very many words that were totally unfamiliar to me during my nursing education, and those that I have were either immediately explained in my textbook, or I was able to ask someone, etc. So since my med term class was a boring pain in the butt that really did not teach me anything (truly, I don't think I learned a single new thing in it) that I still got a 100% A in because it was so easy, I have to say I would not retake it again if I could go back in time (it isn't required by my program). Most of the folks in my classes hven't taken medical terminology and they're doing just fine.
  14. bewitched

    What and How Much Can You Tell to Patient's Family?

    The hospital where I work uses a pin number system. The number is given upon admission. Only family members/friends/whoever that has the number may be given any information about the patient.
  15. bewitched

    Hospital Nursing: Vision vs. Reality

    I don't know what to tell you because I am a nursing student, I spent the summer working as an Intern (basically just a tech job) and I felt this way almost every shift I worked. I am terrified that I will experience the same thing when I graduate in December. Working my butt off all day just trying to do the bare basics that my job entails, then feeling terrible when I realize something I forgot to do for someone or the anxious patient I just couldn't get in there to spend time with like I promised to.
  16. bewitched

    Staring Nursing Program

    I'm in an ADN program. :) Be confident, realize that no one is out to get you. Except that you probably will have one instructor sometime in your nursing education who is out to get you, or at the very least doesn't like you, or is hard on you; it seems like everyone ends up with one of those types... Anyways, I know in my program our first semester focused on the nursing home setting, which is where we did our clinicals. Second semester we moved to the hospital (med-surg, orthopedics, surgical floors) and began taking on two patients at a time. In the upcoming semester we get more med-surg, but we also get peds and OB/GYN which I am totally excited for. Nursing school is hard. My second semester was the hardest so far. But if you make it to the halfway point, it all looks brighter from there--the worst part's over. Nursing school doesn't teach you to be a nurse, by the way. All nursing school does, and all it is meant to do, is teach you the bare bones of what you need to practice safely, and to teach you how to THINK. :) It's all about nursing process, critical thinking, prioritizing care, rationales, etc! So there are your words of wisdom from someone who's been there, done that, and about to go back into the crazy world of nursing school in less than a week. Good luck!

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