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ObtundedRN

ObtundedRN BSN, RN

Critical Care
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ObtundedRN has 6 years experience as a BSN, RN and specializes in Critical Care.

ObtundedRN's Latest Activity

  1. ObtundedRN

    New grad hired onto MICU, I need advice!!

    ICU nursing is very physical as well. So be prepared to go home feeling like you've been physically beaten. Buy critical care nursing books and read them. There is so much to learn in the realm of critical care. Rapid Interpretation of EKGs by Dale Dubin is great for learning EKGs. Hopefully you're in an area with a strong AACN local chapter. If so, join! At the least join the national membership and read the monthly magazines, but the monthly local meetings can be really great too. AACN also has their Essentials of Critical Care nursing, its a decent resource. Kathy White's Fast Facts for Critical Care (or something like that) is a decent reference to keep with you on the unit. There will always be things you don't know. Always ask! Its when you don't ask that you'll **** people off. And always keep your charge nurse aware of things. If your patient is turning bad, having procedures, is super busy, etc.
  2. ObtundedRN

    Carolinas Medical Center Nurse Residency

    I think all of the jouney interviews were done last week. Sorry if you didn't have an interview . The interviews are done by the individual nursing units. You could be asked to interview with a few of the ICUs or just one or none. The hiring managers and interview teams for that unit decide who to call in. Which also means, you could interview with several units and have job offers from more than one unit. In which case you then get to pick which unit you want to accept an offer from.
  3. ObtundedRN

    ICU vs ER

    As a new grad, I went straight into ICU. I've never had any doubts that its what I wanted. I worked in EMS for 3 years prior to being a nurse. Working EMS, I already know exactly what comes through the ED. The appealing side of the ED is that you don't have to neccessarily be with the same aggrevating patient for your entire shift. But it also doesn't mean you won't deal with several jerks throughout your shift. My EMS experience told me that I know how many of the people come through for absolute BS, which that sort of thing leaves me banging my head against a wall. For me personally, I probably would've burnt out very easily in the ED. Another appealing thing about the ED is that there are many things you don't have to worry about. You might get your patient's food, but you're not worring with meal carts and trays, at least not as much. You're not worried about if they've been bathed unless they need a clean up. You're not as worried about turning them and doing mouth care every 2 hours, etc. And your documentation is a little more streamlined and focused. I work in a medical ICU at a level 1 trauma teaching hospital. I see all sorts of really complex patients, and of course we always get overflow from other ICUs. So I still get plenty of trauma patients etc. And in all honesty, I only find trauma patients to be fun out in the field or in the ED. I hate trauma patients once they've made it upstairs, but that's beside the point. I always have two ICU teams available to me, always sitting on the unit unless they're off the unit to see someone in the ED or a patient crumping on the floor. We have a huge amount of trust between our docs and nurses, which gives us a lot of autonomy, and they listen to our suggestions and take our concerns seriously. I feel like there is a lot more to learn in the ICU. I like to just have my 2 patients (or sometimes 1:1). Downside to that is that sometimes I hate having to be responsible for EVERY human need of those 2 patients... lol. Sometimes it sucks to have a patient who can't turn themselves or anything, and so they're sitting in poop, thristy because they're NPO, and need to be turned, but they have to wait a few minutes because you're trying to keep your other patient alive. Anyways, I think I went on a tangent. I have a really good friend who is an ED nurse. We get together and talk shop often. We share stories and discuss what we like and dislike about our specialty and how it compares to the other. She loves the ED, and I love the ICU. I will say though, she has said that working in the ED has made her feel like she has lost some skills, and often get disconnected from hospital policies and procedures since they don't really apply in the ED. Its really all a matter of personal style.
  4. ObtundedRN

    Without Orders

    Haha, thank you. I always say the doctor has "prescribed" this XYZ treatment, and it is up to me to ensure it is appropriate to carry out.
  5. ObtundedRN

    Charge nurse doing staffing, supervisor overriding orders?

    I could be wrong here, but specifying only males vs females allowed to care for a patient could be considered as discrimination. I would think they would do their best to get you a male, but I'm not sure they can actually require it be a male to care for the patient. Anyone else have thoughts on this?
  6. ObtundedRN

    Rectal Cath. Foley bag disposal?

    Red biohazard trash at my hospital.
  7. ObtundedRN

    write-up for insubordination because I turned my back to cry...

    Sounds like a place you don't want to work at anyways.
  8. ObtundedRN

    So what exactly is a bed alarm?

    Turning q2 isn't evidence based. Maybe it's not good enough. Or maybe it really only needs to be done q4. And taking it as far to say criminal as a blanket statement could be a little drastic. If you willingly neglect the patient and it develops, sure. But in critical care, some people are just too unstable to turn. I've seen it cause someone to code. And if they have some advanced hemodynamic monitoring on them, you can actually see how it affects them. Or someone in a roto-prone bed and on the oscillator often develops PUs in some odd places. This is just an unfortunate consequence of saving their life.
  9. ObtundedRN

    ACLS Certification

    An employer will pay you to take the class, versus you paying to spend your time taking it. Also, some employers like mine will make you retake their class anyways. Also, most likely as a student you may not be able to identify the EKG rhythm u less you had a really good instructor/EKG tech class/ or have previous experience. As for it lookin good on a resume, I guess that depends strictly on the hiring manager. If I was interviewing two candidates, I'm going to rely on how well the interviewed not if they have ACLS. But other might feel differently.
  10. ObtundedRN

    Lpn- central/picc lines

    Can I add to the above: NC Lpns can only do as stated above as long as the facility has a policy allowing them to do it, and the facility provides eduction on how to do it, and maintains competency training/validation.
  11. Using. Strong penlight works well for them. You shine in into the skin and the vein will be darker. With all the fluid, the light passes through easily. You can shine it from the underside of the hand. Or just directly down into the skin where you're looking. Be a mentioned above, becareful of the heat from some penlights. LEDs are cool, but a halogen bulb is going to get very hot.
  12. ObtundedRN

    Pain assessment: do you believe your pt when...

    If only this was true. This sounds like dayshift propaganda to me... Lol
  13. ObtundedRN

    Critical Hgb value changed

    At my hospital we usually don't transfuse unless it's
  14. ObtundedRN

    What is the difference between Step Down Unit and ICU?

    Step-down does vary depending on the hospital. In my hospital, our ICUs are all the unstable with titrated vasopressors and sedation. They are 1:2 Our Progressive care is more stable but critical. Policy states they can have titrated pressors and sedation like the ICU, but they really only do pressors at set rates by the MD, but can still do titrated sedation. Most of the patients have already been trached and are often still vent dependant. They are on all the same bedside cardiac monitors as the ICU, but A-lines, Swan lines, and pretty much any other invaisive hemodynamic monitoring go to the ICU. CVPs and ICP monitoring can be done in the Progressive unit. Patients requireing q2 or more frequent neuro checks, accuchecks, vitals, etc are by policy required to be in a minimum of at least Progressive care. Ratio is also 1:2 like the ICU. Our progressive unit has sicker patients then most other ICUs in our region. Our prog unit is actually pretty difficult and is considered part of our ICU division. ICU nurses hate floating to Prog because they know they are going to have to work way harder then they ever do in the ICU. Then we have our Step-down units. They have tele, and are used to getting people who come out of the ICU. They aren't sick enough to need ICU or Prog, but not well enough for a normal cardiac tele or med/surg. They are often medically stable, but have more frequent meds or time consuming dressing changes, full care or almost full care, etc. I think ratios are 1:4. Cardiac tele is mostly walkie talkie patients who are in need of just cardiac tele monitoring. Ratios are 1:5. Med/surg is probably pretty generic to other hospitals. The most stable of all hospitalized patients. Unmonitored. Ratios are 1:6. All of these descriptions vary greatly by hospital. Even other hospitals within our own hospital system are entirely different.
  15. ObtundedRN

    Venipuncture

    I have to say, when starting out and even today I find IV starts to be easier then venipuncture... A lot of it comes with lots of practice, a lot of failure, and a few successes to find what works. Sometimes I've found that too tight of a tourniquet will blow the vein. I barely tie the tourniquet on the old frail veins, it seems to work for me. Watching other nurses who are good at it helps a lot. Just rewatching their technique can be as good as trying yourself.
  16. ObtundedRN

    Heparin SubQ administration?

    Perhaps the OP just didn't give it the way the instructor prefers it be given? Slow or fast, you can't exactly say it was "wrong." Just not how that instructor believes it should be given. I don't know if my personal technique is considered fast or slow, maybe in between, but i've had patients actually tell me it doesn't hurt so much when I do it.