tothc2

I was at a church Christmas party a year ago and a woman there in her 60s became diaphoretic, sob, and was having indigestion. (Im still in school at this point) My mind immediately went to MI so I got some aspirin and had her chew it and her husband was going to drive her to the ER because she refused EMS. As she was walking out to the car she developed AMS and collapsed to the floor. I checked her carotid pulse and there was nothing. I had someone hold c-spine because she had hit her head and I started compressions and told her husband to call an ambulance. They arrived (what felt like an eternity of doing CPR) and defibrillated her back into a perusing rhythm and took her to the hospital. She ended up being ok but what a night!

Awwww snap. Waiting for a backlash. Haha. I think this would be an interesting study to carry out. Comparing the outcomes of codes on med surg floors at hospitals where all nurses take ACLS with hospitals where med surg nurses take BLS only. I wonder if there would be a significant result?Like I said before, if the hospital has a good intermediate care set up and a good rapid response team, then ACLS for med surg nurses is probably over kill. IMO. Just my 2 cents. FWIW.

You say "naturally" like this is the norm. But it is not... All ICU nurses should have ACLS, the majority of step down RNs should, but I have never heard of med surg RNs having or being required to have ACLS. This is very strange and very much not the norm. At my hospital between the MICU, SICU, STICU, TICU, NICU, MSICU, CCU, CVICU, etc and all of their respective step downs, how there would be enough classes, money or time left for med surg nurses to get ACLS certification is beyond me. And if I were a med surg nurses not planning on going into critical care I wouldn't waste my time or money. And yes hospitals have a ton of money, but I'm saying when have they ever invested it into their nursing staff (to send all of them to sims, acls and code observations). Which from your post I see we agree on.

Your med surg RNs take ACLS? And all nurses go to codes and simulations? You have to have meant something else here. Unless you are at an extremely small hospital. Even then, where's the money coming from for all of this? And maybe he can anticipate a code on a med surg floor if they go from one extreme to the next over a period of time. But in the ICU? There would have to be a rapid response nurse just hanging out in each of the ICUs in the hospital because there are MANY if not all patients on the verge of a code. Your hospital has a lot of resources and money.

As a rapid response nurse you're probably arriving to a code after the more chaotic period has passed and everyone has decided what they're going to take care of during the code. Like dodongo said, usually it's just the first couple minutes when everyone is caught off guard that are helter skelter. Even for ICU nurses that do it all the time. It's unexpected, your adrenaline is going and you want to make damn sure that everyone hears you and gets what you need.

So in other countries they either have about twice as many RNs as we do in the states or they have half as many ICU beds available. How the hospitals can eat the costs of that many employees or that few patients is beyond me. And epi at 1L/hr?? We use one concentration at my hospital 16mg/250ml with a "preferred" dosage range of 0.1-0.15 mcg/kg/min. You can go pretty high above these parameters, and I have, but I am also generally getting another pressor to hang along with it... And how did you program the pump or know how to titrate if you didn't know the conc? That is a bit scary.

Hundreds and hundreds of critical care RNs manage it everyday they go to work - myself included. You're busy every second of your shift. We have computers on the wall in all of our patients rooms so I usually do my charting in one of my patients rooms. The monitors show you what's happening in your other patients room so if you gotta go do something you go do it. We have clinicians and 2 charges covering so if you need help then you ask (or call the RIC nurse).

I completely agree. I work in a mixed MICU/CCU (just like you according to your profile) and shock, pressors, IABPs, vents are totally common and are not considered criteria for 1:1. (Swans make things easier btw, i love them) Stable vents, stable pressors etc aren't even necessarily criteria for ICU, just step down. This is ICU nursing at a large academic hospital. My hospital has over 1600 beds. People from states away are transferred there. If other hospitals cant fix them - they come to us. If we can't fix them - they go to heaven.

Hi SandraDeeRN, I am just wondering if you ended up taking the job at AGH's trauma ICU. I am in my last semester of nursing school at Pitt and I have been in the ER at Presby working with the Trauma team - and LOVING it. I love trauma. However, I want to care for patient's *after* they leave the ED, up in an intensive care setting. If you are there, do you like it? Is there any way I could come and shadow there some time? Thanks so much!

Hmmmm... class bonding... Well, you will have a partner in lab. You will know that person the best I think. Or, you will know their body like the back of your hand! Haha. I've had my hands down the pants of half of my classmates... And I've had my hands on most of the girl's chests... Haha. It sounds very strange... but you are practicing everything on each other. I am a guy and I think it is much more weird for the guys. Especially during cardiopulmonary exams. Everything you do HAS to be on skin. The girls maybe felt a little awkward palpating the men's femoral pulses. But the class is definitely bonding and getting to know each other really quickly. You will know your clinical groups really well straight away also. Like I've said before, everyone in this group is older and there isn't any sort of competition or cliques. Everyone is there to learn and to help each other learn. The clinical hours aren't from 6:45 to 9:30. Next semester we have class and clinicals on the same day. So half the day is class and half is clinicals. You will have psych, peds, ob, medsurg, etc. All in the same semester. Now, I am not sure if the clinical instructors will be keeping us there for that long or not... I'll let you know when I'm there. I am not overwhelmed. I do feel centered. For now. I am in front of my work load at the moment. We had a quiz in nutrition today. We have our first test in pharm, our neuro homework due, a PICO question with 2 primary data sources, plus a ton of reading in every class - all for next week. But I feel capable of doing it all. There will be weeks where we're going to have 3-4 tests and homework and reading and we'll all probably feel like just starting to walk and not stop until we hit the coast... haha. But we're having fun at the moment so I'm going to enjoy it while I can. I also think I had a really strong foundation for this program from my undergraduate degree. There are some people with english degrees or something similar and this is all very new to them. So, maybe you'll come from where I did and it won't be so bad?

Yeah. I think she wasn't dead set on being a nurse in the first place and she was just overwhelmed. There was another woman who dropped out in the group that graduated in December. I definitely don't think it's a zero attrition rate... There are now 26 in our class. 3 guys and 23 girls. But in the class that graduated in december there were ~7 guys out of 24. You are assigned readings and videos to watch and homework to complete. Then you come in and have a fast paced lecture that covers the major ideas and this (along with the lab) is your chance to address any questions you have. Then you go to lab and practice. Then you have a test. Haha. I don't think you can really teach yourself something horribly. The videos allow you to see everything performed step by step. And the videos correlate to the books so you can always go back and read over something if you didn't understand it in the videos, or vice versa. I don't think you have anything to worry about. It's just A LOT of time and work. Like today I was in the hospital from 6:45 to 3:30 and then in class from 4-7. It's just long. Next semester we'll have days where we are there at 6:45 and aren't done until 9:30 - nights, saturdays... Just know that you will have a LOOOOONG year. Haha. But it's A TON of fun so far! So be excited!

OH! And I got a 100% on the first competency exam! Almost everyone did though. This just goes to show that they make sure that you know what to do. They honestly want you to go to clinicals and know what the heck you're doing. So now we are starting neuro assessments and drug administration next!

Well, if that's how you picked it then you are lucky! It really is a great program. By the way, I forgot to mention one thing. The way Pitt presents their nursing classes (at least in the first semester) is that you do your learning before coming in to class. You have to do the assigned readings and homeworks before you come in to class. They have you watch these videos by Taylor (have to purchase) and videos by Bates (can be purchased but also free online through pitt) to demonstrate assessments and skills, then you come in to the lab and you basically have to know what to do. They'll go through it with you again, but it's more just to answer questions. This makes fitting the program into a year more doable! HAha. But that is why I said you have to keep up on everything because they won't wait for you if you fall behind. We've already had 1 person drop from the program and it's only the first week...

There is an orientation day where they will tell you all that stuff. There are 3 background checks you need to do. You can find the info online if you go to the undergrad students tab of pitt nursing. The uniforms are purchased from American Discount Uniforms. They definitely want the class to succeed. During your lab times there are a ton of professors that come in to help and they are all giving you advice and little tricks and hints to make everything easier and more understandable. They are joking around with you and they make you feel really comfortable and they also increase your interest level! My undergraduate experience was unsatisfactory so I guess for me, maybe, I have a falsely elevated view of the program. But everyone in the program is really liking it so far... so I don't think it's just me. The only problem I've had with the program thus far is the organization of courseweb online - hence my original post. But once you get there the first week the professors will help to make everything you need to do much more clear. And as for hiring of the Pitt ABSN grads, a few other students and I were asking one of the professors about this and it sounded pretty good. She was saying that all the students that were seeking jobs were hired at some place or another. Most of them were in ICUs. Neuro, surgical, general. I want either ICU or ER so that was really encouraging!

And we also have a class with the CRNA students. It's called Research for Evidence Based Practice. Which is basically reading research studies and determining how to apply them to clinical practice. And writing PICO questions...