eCCU

No you shouldn’t quit. You have now learned something about massive PE. It sounds like the ER dropped the ball on that one and should definitely review this case for future improvement. On an experienced standpoint, anytime you feel that care has been delayed significantly in this case CT scan in a patient with high risk PE. I would advise to escalate it before they decide to wheel the patient in ICU. Call your pulmonary doc or cardiologist consulted to follow the patient and notify them your concerns. The reason why I say this is because they can ask the ED doc to do a quick FAST exam to determine the RV stress in PE which would determine a need for STAT systemic TPA or EKOS. This is a case you can use to drive change in your hospital to improve care. My ED any imaging ordered especially CT is usually completed prior to transferring patient in ICU. Do not quit☺️

I will not lie it's a steep learning curve and it doesn't matter how long a critical care nurse you were. That being said every decision must have an evidenced based rationale remember every action must be defensible in a court of law. No longer documenting you told so and so. Dealing with staff nurses is easy, appreciate their input by doing clinical rounds instead of intervening when something comes up. It also gives you an opportunity to meet the family and talk to them. You will have some nurses that will try to bully you, I see it happening mostly to NPs who haven't had a lot of experience previously as ICU nurses or work in the same ICU from staff RN to NP. Handle it gracefully and professionally, most workplaces now have bullying statements on their policies. Recognize your staff, be a role model, don't get into workplace gossip and politics. Know your go to people example...I love my ICU PCA! I rarely place a Central line without them. They literally know where my ultrasound sits, what size sterile gloves I wear, they drop all my required sterile stuff in my field before I even ask for anything. They are truly a blessing! Develop a relationship with the clinical pharmacist they are walking pharmacology books with current research. Several specialties to develop strong relationship and have their numbers... nephrologist I have been known to call them in the middle of the night to get the okay to start CRRT or emergency dialysis. Cardiologist...cause they do crazy stuff that works that's not in any textbook í ½í¸¹and I have yet to meet one that freaks out. Pulmonologist or intensivist when you have tried all the vent settings on your vent on that ARDS patient and you and the experienced RT are out of ideas in the middle of the night! Infectious disease if your facility doesn't have a sepsis team. Find out their pet peeves..Sanford guide is awesome Chaplain...if you are spiritual there are those cases that will have you wanting some spiritual guidance or continue to believe in humanity. Earn your FCCS by SCCM they have several classes around the country. Attend CE offered by the local medical school if your place of work is affiliated with one. Familiarize yourself with vent settings off the top of your head...I have heard the RTs complain there is nothing more annoying than intubating a patient emergently and the provider has no clue on basic settings. Imaging position of ETTubes, Central lines, chest tube can be the determinants of life or death. Ask to rotate with radiologist and anesthesia. I learned how bag appropriately with the anesthesiologist years later! And intubate gracefully with anesthesia, intubate with head of bed up with ED doc. Keep learning ask your intensivist for feedback consistently and ask for areas of improvement. The rest enjoy it it's actually funí ½í±Œ Hope that helps

Nurses and their titles kill me! í ½í¸‚í ½í¸‚í ½í¸‚. How about we focus on making our NPs ready when they graduate? I once knew a really smart friend who had 4 PhDs never once heard him introduce himself as a doctor. I introduce myself as a "Nurse Practitioner." No need to confuse the little old ladies in the ICUí ½í¸‹í ½í¸‹í ½í¸‹ use that time on important patient clinical issues.

AGACNP is the way to go working with 14yrs and up in TX. Plus you can stay in specialty clinics like cardiology clinic, nephrology, Ortho or even just internal medicine clinic. Best wishes the sky is the limit í ½í¸€

Go with Baylor Dallas or parkland

Did they not have a choice to walk away to the nearest attorneys office? This is insane and very abusive 😡

The OP is kidding right?

All are great schools including UT.I am not familiar with WCU. keep in mind Texas Nursing schools are very competitive so try to bring up the GPA. Good luck!

Sounds like this was their way of coping with the pain. I'd be more concerned with managing it than what coming out of their mouth. Besides every one has different tolerance levels.

Undergraduate alumni, great reputation for Acute care, in-state and awesome professors great mentors, one can tell they are happy to be part of the program 😀

72hrs but most will allow extra shift esp in critical care

Galleria is a nice location but known for heavy traffic and the prices are similar to Rice Village area or upper kirby with significant reduced drive time and same amenities.... FYI...Former galleria area resident

Just turn on your cellphone on record go close to him and say " oh doctor would you please repeat the whole conversation about nurses being monkeys? I just want to make sure I get an accurate description for human resources " That should fix him 😂😂

The problem with us Nurses we accept and start positions without getting a job description, hours, pay and out of norm expectations in writing. Always ask for this before you start otherwise your job description becomes a he said she said discussion!

Here is my therapeutic touch " oh sure no worries I will be more than happy to request psychiatry and chaplain consult services, am sure they will be able to guide us on any psychological treatments needed" 😂 😂 😂 nobody bugs me after that!

1:1 only if they are on crrt, IABP and multiple pressors, otherwise we try to pair with a less acuity pt

I had sworn never date anyone from work! After seeing so much drama between people when they break up at work lol. Not to mention those residents that slept with any girl that thought was cute. One fellow slept with over 6 nurses on my floor! Imagine the drama when he married someone his parents preferred 😂😂😂 it was hell scheduling assignments no one wanted to see the other 😂 I was the "mean scary charge nurse" that didn't flirt with the residents....or that's what one of the residents told me when he became the attending! I would rather have that title than some titles they gave nurses during their little parties!!! Met my hubby in comicon....yes I am one of those nerds😜 and love it!

TOF 1/4...2 is ideal 1 too much, 4 up the paralytic. We paralyze all pts on controlled mandatory ventilation, hypothermia therapy, extreme ards the list is long.

ECMOs are 2 RNs to 1 pt. 1 RN just for ECMO. Otherwise they have to get us a circulatory support to run the ECMO. I don't see how you can have 2 pts. ECMO pts in my experience are " a hot mess 🔥! "

The professor was very nice! I know a few professors that would have sent the students home with zero credit and an email to the dean!!

TX metropolitan areas $27+, 401k 5-6% 100% contribution, medical benefits. State and VA pension plans +contribution plans

Was the patient in septic shock? If so then SCCM recommends norepinephrine as the first line of therapy after fluid resuscitation had failed aka 1.5-3 liters. Neosynephrine decreases SV and is only recommend as salvage therapy that is after 2 or more pressors have failed, pt had a high CO or norepinephrine has been evidenced to be a source of arrhythmia. ... there's is a whole long EBP on surviving sepsis.....so since you know the MOA here is the order....first line norepinephrine, epinephrine can be used as an alternative to norepinephrine. Vasopressin can be used in combination with norepinephrine but not alone, dopamine is reserved for only bradycardia patients and is not recommended for so called "renal protection" dobutamine can be used to increase CO after attaining MAP and still in a hypoperfusion state. ... hope this helps.....

......and that's probably why that person is running the program despite lack of experience. ...that does not mean they are not intelligent, as you said this person is a novice in this role or maybe teaching is not their forte, maybe their mentor in orientation was pathetic; we all know the results to that! Have you sat with them in person to express your frustrations to learn their perspective? ......after all let us be honest...the criterion is pretty competitive to get into such schools even though it is online, just go to JH and look at their DNP candidates it public info.....do you expect a new resident to be on the same level as the attending? Nope I hope not....nursing has always had a tendency to pick on each other instead of improving each other. This behavior has led to lack of respect from other disciplines....I am yet to see my 2 attendings going off on each other infront of their peers "....you went to UPenn I went to Harvard...blah...blah...blah who went where and who cares...." all I see is collegiate respect and yearning for more knowledge from each other all day long. They may not like each other but they have mutual respect for each other. On the other hand, all I see is nurses biting each other off......chew....chew....we shall continue.....unless we change it.....the end.....

Agree the top nursing programs offer online NP programs these include. ....Johns Hopkins, Columbia, Vanderbilt, UCLA and many more. .... so.... can we stop this unattractive behavior and try to improve the nursing situation? Thank you. ..