commonsense

Sounds much more efficient than me. I typically just look at the patient and scratch my chin a couple times while saying hmmm. However, that's receiving, if assisting I run into my patients room and try to act busy so that I don't have to do anything.

It does get better, but a transition to the ICU does come with a pretty steep learning curve. I agree with Liddle Noodnik on speaking with your nurse manager, possibly more orientation is needed. I believe the individual you orient with does more for your learning than how long you orient. I've learned more from some people in two days than I have from others in months. Keep studying and try not to be too hard on yourself.

The fact that you would even compare pediatric nursing as a male and pedophilia makes me seriously question the validity of your post, If I am incorrect, then I have no words.

I'm fighting the urge to go off on a tangent, due to my extreme dislike of nursing report sheets. However, I realize this is a personal feeling and not up to date with the best practice. I'll start off with the fact that I have never tackled this issue, but as an experienced ICU staff RN I will provide my best advice. Your facility's system seems efficient, admission/history/MD's/head to toe, very well done. However, I disagree on the report covering the entire course of admission. Let me give you an example, You stated in your original post that your facility cares for post-op open heart patients, as does my current facility. Let's take into account a patient who is post-op day 2-3. I get three reports: First Report: Admitted for CABG x4 on 11/17, Dr. Jones, Hx of XXX, NKDA, A&O, SR/ST, 2LNC, Cardiac Diet, Accuchecks ACHS, Right Hand 18G with D51/2NS @ 30 mL/hr, Mediastinal CTx2, to 20 cm suction drainage on my shift 70 mL, Uses Urinal, Up ad lib, dressing on sternum, leg wounds open to air, clean, dry, and intact, Labs are stable, ready for transfer to step-down unit, just waiting on the CT surgeon to put in the orders. End of story. -Time of report: 1 minute 15 seconds, happiness of oncoming nurse (10/10)(Great Report) Second Report: Admitted for CABG x4 on 11/17 (Lima to LAD, Lima to Proximal RCA, Internal Mammary to Distal RCA, and saphneous vein to Circumflex), Dr. Jones (CT Surgeon), Dr. Cake (Anesthesiologist), Dr. Brown (ER physician), Dr. Hemme (Out of Hospital PCP), Hx of XXX, NKDA (However, reports itching at the site of his peripheral IV, I talked to his daughter about the itching, she feels like its an allergy to the metoprolol he's been taking for 27 years, I put the allergy in the chart), He was extubated on 11/18 @ 0600, Swan/Cordis was pulled at 0612, A-Line was pulled at 0617, pressure was held for 5 minutes on each site, no excess bleeding was present, He is A&O but sometimes he forgets exactly what day it is (it's Tuesday and he thinks its something like Tuesday/Wednesday, otherwise intact neuro-wise). He is on 2LNC but earlier today he felt like he was short of breath, I put him on 3LNC and he felt better, I left him on 3LNC for approximately 18 minutes and then took him back to 2LNC, he's doing alright now. He's on a Cardiac Diet but he keeps eating whole eggs, he latest research shows that only egg whites are ok for cardiac patient, but the cafeteria keeps bringing him the whole egg, I don't know what's wrong with them. His accuchecks are ACHS but the daughter is concerned that his CBG is running > 120, so I held the dinner meal, according to the latest research hyperglycemia a major drawback in the recovery of post open-heart patients so I've been trying to keep the glucose level between 116-118. He has a right hand 18G that is slightly sluggish, does not draw blood, but flushes ok, with D51/2NS @ 30 mL/hr, Mediastinal CTx2 with a JP that are working great at 20cm of suction, drainage on my shift 70 mL, Atrium was last changed on 11/17, Uses Urinal, urine is slightly clear, I'm not sure what the specific gravity is but I think it's low., Up ad lib, uses the walker, daughter wants him to ambulate q2hrs per the latest research, dressing on sternum, dressing has approximately 13 mL of serosanguinous drainage on the dressing, right leg wounds open to air, proximal wound on the right leg is approximately 3 cm, wound on the distal right leg is approximately 6 cm, both are clean, dry, and intact, Labs are stable, but WBC count is up to 12 and HGB is down to 9, no orders for transfusion yet, they say he is ready for transfer to step-down unit, but he's still pretty sick (Day-Shift Nurse's Opinion). -Time of report: 14 minute 35 seconds, happiness of oncoming nurse (4/10)(Too-Detailed Report) Third Report: Admitted for CABG a couple days ago, Dr. Jones I think, now sure if he has anybody else on the case, OMG, daughter is crazy, she wants us to ambulate him q2hrs, can you believe that, we don't even have any PCA's, I'm telling you this place is really going to shi*. He has an IV site with fluids going, and Ashley actually expected me to help her move her new admission into the bed, can you believe that woman, she must be crazy. I hate this place, I only have a few more years to go till retirement, I can't wait, my husband is going to take me to Cabo, this place is awful. Oh, so sorry, I'm gossiping, he uses the urinal, by the way his daughter is crazy, I think she has some serious mental issues, I'll won't be back in the morning, oh, by the way his blood pressure decreased a little today, they still had the anesthesia concentrations plugged in the IMED (4mcg/250mL Levophed) in for his drips but I just used our drips (16 mcg/250mL Levophed), it's at 7.5 mcg/min (30 mcg/min in reality), I haven't called the surgeon yet, but he's going through a rough time with his divorce, I'd try to handle it yourself. See you later. -Time of report: 57 minute 22 seconds, happiness of oncoming nurse (0/10)(Ridiculous) As you can see, the type of report you get depends upon the nurse that you're getting report from. Now, biases aside, here's what my facility does. -We use report sheets, I hate them, they are not updated on a regular basis. -Regardless of report sheets, the quality of your report depends completely upon the previous nurse. -In regards to the MD's cleaning up orders, I think it depends upon the orders. For example, I will discontinue an order for CO/CI/SVR/SVI/Core Temp q1 hour if the Swan/Cordis/Arterial Line was already pulled, however, I am more nervous discontinuing an actual scheduled medication, I believe this needs to be further clarified. -I have never implemented a new report system, but I wish you the best of luck.

Welcome to life as an adult student.

As someone stated before, you homework will not be done for you, and you will be happy that it wasn't later in your career. With that being said, I'd like to make a few points. NDX: Good R/T: Is the diarrhea truly related to antibiotic therapy, or could there be an underlying issue. AEB: Loose stool (good), what about some absolute objective information (Labs?) Goal: What is C-Diff (Infection), what do you do for infection? What does C-Diff cause (Diarrhea), what might that cause (Fluid/Electrolyte imbalances, skin breakdown, overwhelming infection, transmission to other patients, etc.)

I am curious of how this is playing out as well cayenne06. Patients will respond much differently to ideas depending upon how they are presented. For example, A. This is John, he's going to look for an IV on you so that we can get your pain under control. B. This is, what's your name again, John, from XXX University. He's a student there and he's learning how to be a nurse, he's going to look for an IV on you and if he isn't able to find anything I'll come in here and start something. You'll find that patients are much more receptive and less anxious to option B. With that being said, I'd be interested to know which semester you are currently in. If you happen to be in the maternity portion of your education, then this topic makes more since. When it comes to that area of nursing, males in nursing are few and far in between. Whether right or wrong, that's the reality of the situation. My advice: If you are in the maternity portion of your education, grit your teeth and get through it, all male RN's have done it before. If this is not the maternity portion, evaluate how your clinical instructor, preceptor, and yourself interact with patients, the issue probably lies within one of the three. Best of luck in your future endeavors.

I sure hope not. I'll start TCU's CRNA program in the spring and my CCRN will expire in sometime during the second year. I have an eery feeling that I'll have enough to focus on at that time without finding CE hours or retesting to maintain my certification.

Stats actually look ok man, my concern is why you only want to apply for schools in Northern CA or NYC. If it's a family or extenuating circumstances type of thing I get it, but if not you might want to give yourself a few more options.

I was recently accepted for the TCU CRNA program, you've chosen schools wisely. No biology courses needed, but organic chemistry is an important one. It didn't seem to matter that I took all my chemistry courses at a community college, but they should to be done prior to applying. A shadow experience, if not multiple shadow experiences, is an important aspect to your application. You will be questioned about this during the interview, it will also help clarify that this is the path you want to take in your career. CCRN prep courses are irrelevant when you have actually passed the CCRN exam, this is now required for all applicants at TCU. Best of luck.

Getting your BSN and having an appropriate GPA is not one way to get into a CRNA program, it is the only way. Best of luck in your future endeavors.

Go with your gut.

As delphine22 said above, it depends on whether you are the primary provider for the patients. In my opinion, if you're doing all the charting, passing the meds, etc. with a preceptor watching over you, then you are the primary provider. If the preceptor is doing the majority of the work, then it doesn't count as CCRN experience, but the time-requirement seems somewhat open to interpretation to me. I would ensure that the person you select as your voucher will verify that you indeed have the experience that claim to have.

ICU report is usually pretty basic because the nurses are generally type-A personality, no matter what you tell them they will double check anyways. I usually cover the background then go head to toe. -Admitted for: -MD: -HX: -All: -Neuro: -Cardiac: -Respiratory: -IV/IV Fluids/Drips: -GI: -GU: -Skin: -Labs: -Other Miscellaneous Data: -Pretty basic, but you know you've got a shaky ICU nurse when they give you a 25 minute report.

Loans. Lots and lots of loans.