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umcRN has 4 years experience as a BSN, RN.

umcRN's Latest Activity

  1. umcRN

    Parents required at bedside?

    I work in a peds CICU but also float to the picu and nicu (and used to work there). No where in my hospital are parents required to stay, even on the floors where nurses have much less visibility of their patients. At my hospital kids can stay in the ICU for weeks to months and there's no way parents can afford to stay 24/7, they have to work and take care of other children, we even encourage the parents of our post ops to go home and get some real sleep the nights after the kiddos have their surgeries. There are VERY few children who could try to get out of bed and if they are they're either headed out to the floor or in a caged/covered crib. If they're really a risk to themselves (pulling lines/tubes etc) then they buy themselves restraints and/or in severe cases a one to one sitter.
  2. Hoping someone can point me in the right direction here. I have an active license in DC and I work in DC. I am currently trying to get a PRN position in Virginia (I also live in Virginia). When I go to the website to apply and fill in all the info it says my license is pending me passing the nclex/submitting my transcript from college. I've been working as a nurse for five years now. Am I working on the wrong application/website? Or do I actually need to resubmit this stuff? *side note, in the application there is an area for me to enter current license info which I did*
  3. umcRN

    Puplic transportation Washington D.C.

    The shuttles are typically for hospital staff and you might not find out info about them on general transportation websites, more likely you might find info about them on hospital websites. Where I work for instance there is no onsite staff parking (unless of course you work some non essential office job...don't get me started) so I park at an offsite lot and take a shuttle from that lot that is for employees only to the hospital.
  4. umcRN

    Puplic transportation Washington D.C.

    There is no metro in or near georgetown, there are shuttles that run from the metro to the hospital. There is a metro right next to george washington hospital, there is no metro near washington hospital center or childrens but there are shuttles from the metro to the hospital. Most hospitals in/around dc do not have onsite parking but do have shuttles from the parking lots or metro. Those are the only ones I know specifics of, I am not sure about howard, walter reed or sibley. I don't live in the city so I can't help much with good places to check out but commuting in from northern virginia or parts of maryland are not too difficult
  5. umcRN

    do you mask/bag during DNI

    Our unit uses the term "limited code" which has advantages and disadvantages. Often times I think it makes things confusing for the parents (this is peds). They are basically given a list of things we "could" do and they choose what they do and do not want. This can range from giving code meds but no compression's (point?), clearing/suctioning the airway/bagging but no intubation, starting vasoactive drips and giving fluid but no epi boluses or compressions to being a complete AND (allow natural death term is used rather than DNR). I've seen it all. I've seen one "limited code" that said we could do everything for the patient EXCEPT place a chest tube...??? what doctor wrote that order I have no idea. In any case to answer your question if I had a patient who was a DNI but NOT an AND/DNR then yes I would suction/bag them and increase noninvasive respiratory support if indicated.
  6. umcRN

    What do you tell parents when...

    Agree that sometimes there is nothing to say. You can validate their feelings and stress that the medical team is doing everything in their power to take care of their child. Does your hospital allow family presence during resuscitation? This is something we have adopted in my unit and we always try to have a trained family presence facilitator available when a child is decompensating. These people are usually RN's or social workers who know what is going on and what info to relay to the parents. When possible we try to get the parents to the child's bedside if they can do so without interfering with care. Sometimes just being able to touch a hand or a foot while the medical team is working brings comfort to the parents.
  7. umcRN

    Low blood pressure great neurological status?

    Kiddo did ultimately get a cath that showed no obvious issues. Yes he may have been sitting up coloring but looking at him funny could throw him off the deep end, he was tough but exceptionally fragile at the same time.
  8. umcRN

    Low blood pressure great neurological status?

    Sadly this little one ultimately passed away about three months after I started this thread. Multiple organ failure. Toughest kid I've ever met or had the pleasure of taking care of. I learned a lot from this patient, both in nursing, medicine and how to enjoy life even if it appears you have no reason to. This little one will forever be in my heart.
  9. umcRN

    Boston Travel Gigs..Are they out there?

    I have two friends that just resigned a contract in Boston for a total of 6 months. I'm not sure what company they are with, they are working at Brigham's cardiac icu
  10. umcRN

    A Med-surg/onc/tele floor to add Pediatrics!

    yes bubbles! use them all the time with my cardiac kiddos. Every time I go to target and see bubbles on sale I grab a bunch
  11. umcRN

    What kind of Medic alert do you use?

    road ID has some great ones! http://www.roadid.com/Common/Default.aspx including some that can be worn on the ankle
  12. umcRN

    Any PICU RNs from CHOP or Boston Children's here?

    @jan, goodness that sounds like a mess! Our peds transport nurses don't typically hang out in the unit, I don't know what they do when not on transport. NICU transport stays in the unit and helps out if needed or will take a patient to MRI/Fluro etc As far as docs go each unit has their own dedicated attendings however there are a few cardiac attendings who will occasionally cover picu shifts. picu/cicu has an attending on the unit 24/7...for the cicu this was recently implemented in the last year or so because of dangerously high acuity for a few months. I believe they hired 3 new attendings during this time to get us to this point. We have peds ICU fellows and nicu fellows. The peds ones rotate between picu and cicu for a few months at a time, nicu ones stay in the nicu except for 2 months (in three years) that they do in the cicu to learn about cardiac babies. The only doc issues we have is that the picu team goes to all acute care codes so if a cardiac kiddo codes on the floor the picu team goes but like I said our docs are all pretty on the ball with the cardiac differences and you can bet if a cardiac kid is coding on the floor our charge nurse already knows about it and is sending our docs over. As far as nursing goes we all work in one specific unit unless we are floated which is rare, and in my hospital icu only floats to icu, acute care only to acute care. We also have an icu "float pool" to help fill the holes, these nurses are trained in all three units. All our units have unit secretaries, sometimes two, staffed 24/7, all the units are "locked" units meaning that visitors have to be buzzed in and our secretaries are usually pretty good about enforcing our 2 visitors at the bedside rule. All our icu rooms are private (including nicu) so that eliminates the isolation problem. We also do not decrease the level of care on a 2:1 assignment (or 3:1 in the nicu) so we still do hourly vitals, I&O, q4 hr assessments etc but our techs can also prime and hang feeds among the other things i mentioned which helps too. For breaks/lunch everyone is assigned a back up and it is written on the morning assignment sheet. Usually we only have to cover one other person but occasionally we end up in a 3-way but since we know ahead of time we can usually get a plan in place well before lunch. Respiratory therapists will only cover one unit for their shift (and we typically have anywhere from 2-4 RTs in each unit depending on census) but they are all trained in all the ICU's and will rotate between them. The role of the resource nurse in the cicu is continually being developed but they serve as a point person specifically for our newer nurses, to make sure they're on track, caught up, don't have questions about anything etc. we have found that this resource nurse is helping to get newer people working with the sicker kids sooner but not feel like they are completely on their own with them. Hope you guys are able to make some changes, that does sound like it's getting unsafe!
  13. umcRN

    A Med-surg/onc/tele floor to add Pediatrics!

    Treatment rooms are nice if you are able to use them because it keeps the kids room "safe". Where I did my pedi clinical they had a procedure room and would use it for everything from IM injections to spinal taps. I know the floors at my hospital utilize them as well. I work in an ICU so all procedures are done in the rooms but I think for an acute care floor environment that's a nice thing to have
  14. umcRN

    Any PICU RNs from CHOP or Boston Children's here?

    I'm not at boston or chop but am at another large childrens hospital so if you're looking for comparable stats I can give mine. My hospital has a PICU/CICU/NICU. There is a peds transport team and a nicu transport team. For cardiac nicu will get the babies, peds will get the older kiddos. Size of units: NICU - 56 beds, PICU - 40ish beds (can't remember exact), CICU - 26 beds. NICU/PICU always have 2 charge nurses WITHOUT assignments, CICU typically has one charge RN and a "resource" RN if staffing allows, both without assignments. All units have patient care techs and patient service techs. "PCT"s can assist RNs with cares such as trach care, baths, bed changes, turns, dressing changes and can also string lines (fluids, non narcotic meds, tpn), they can also feed kiddos who have no aspiration risks and entertain kids that need it. "PSAs" help with stocking carts and supplies, picking up blood, meds, assist with transporting kiddos etc but can not do any patient care. Staffing in all units is typically 2:1 or 1:1, NICU occasionally gets 3:1. Our staffing abilities fluctuate with with acuity/census of course but picu/cicu never have 3:1 and are usually​ 1:1 if able. We did have a situation a few months back during a very high acuity/census time when a charge rn in the cicu was forced to take a patient. Well a patient on the opposite side of the unit coded and she couldn't be there. The attending was LIVID because our charge RN's typically co-run the codes with the docs keeping order and pretty much anticipating what the docs are going to do and making sure everything is ready so when the charge nurse was unable to be at the code the attending made a huge stink about it. That hasn't happened since.
  15. umcRN


    Again depends on the school. I would guess that at least 3-5 people leave each year from my hospitals PICU/PCICU to go to CRNA schools. Big schools to such as Georgetown, Columbia, Duke, BU etc. My children's hospital also employs CRNA's and often try to get those nurses that used to work in the unit to come back on as CRNA's Also my pediatric cardiac icu regularly sees patients in their 30-50's and the PICU often sees teens to 20 year olds. Granted the adult patients seen in the cicu would likely never be seen in an adult hospital
  16. umcRN


    From what I have heard most programs will not accept NICU experience but will accept PICU or peds CICU experience. NICU is so so different from the rest of the hospital population that I don't think the experiences gained in the nicu would be helpful for what you need to learn as a CRNA