gromit1084

In seattle area, I would say the average hourly rate is somewhere between $35-45/hr depending on experience and specialty. Cost of living in seattle is also crazy high, probably comparable to SF.

Not a famous guy but I worked for a doctor recently on one of my travel assignments in very rural New Mexico and I SWEAR he was killing patients on purpose. All the permanent staff had seen him at one time or another, doing things that would purposely kill patients. They tried to report him but he was well connected and never got into trouble. I personally saw him refuse to treat someone with new onset facial droop and slur- never allowed me to get a CT for them so I can't definitively know it was a stroke but patient didn't make it.

Hey Pam64, I am so sorry to hear you are having such a hard time! That is awful!! You did not say what type of unit you work on but honestly, it might be irrelevant. It sounds like a toxic work environment. I was in a toxic work environment once and finding a new job was the best thing I did. Every day I would go into work dreading it, feeling a sword was hanging over my head the entire time. At the end of the day, I realized that if my work environment was that toxic, that my license was at stake. As a new grad, you need a supportive environment- one where you can feel free to ask questions, to reach out for help (and get it) and to make mistakes without feeling like its the end of the world (Because WE ALL MAKE MISTAKES!!) even nurses that have been doing this for 50 years make mistakes and if they say they dont, they are lying. As a new grad, you are just starting out and they can not expect you to be perfect. I know it is probably what you don't want to hear, but I would consider looking to see what other jobs you might be able to get. If you want to stick it out for a certain amount of time, it will be challenging but its doable. I would just keep your head down and do the absolute best that you can. Try to focus on keeping a good attitude, your spirits up, and on learning as much as you can off-shift. If they are really that mad that you are asking questions, try to tap into other resources such as pubmed. micromedex or uptodate. Perhaps there is another nurse there that is sympathetic to your situation who will be open to being your mentor? Sorry that is happening to you. You can always PM me if you need to chat!

I would also just not list it. But if you wanted to be honest, you could say that during your orientation you realized it would not be a good fit. and if they ask why, give them an answer that touches on the truth but not in a way that raises red flags. Something like, "I am very passionate about the quality of my work and the care that I give. During my time there, I came to realize they had different priorities and so it was a mutual agreement to end the relationship." that is an example but it touches on the truth without making yourself look bad. You have no reason to feel bad- you have prescription medication that you need to perform your duties. How can you give quality care if you arent allowed to take your medication? I would talk to a lawyer.

How exciting! The best thing I did for my CCRN was laura gasparis videos. She is amazing and simplifies what to focus on and how to remember stuff. Good luck!

Interesting insight from Pheebs! I am an ICU nurse so its interesting to hear about the difference. To answer your post, its a red flag that you were previously in the ICU and hated it. You might be in a different place in life and perhaps you will enjoy it more the second time around, but chances are that if you hated it then, you will probably hate it now. I would really think about why you hated the ICU and if things have changed for you regarding those reasons (perhaps it was too detailed, too stressful, too overwhelming in specific ways?) Good luck

When I was new I also wanted to find apps but there is surprisingly not that many useful ones. Edwards science has some interesting info on their app about CVPs and stuff and then there are some EKG ones but nothing fancy, I am afraid. Then again, I wasnt looking for anatomy/physiology, so I guess I am no use here. haha.

Hey Turtle_RN, congrats on the new position! I've been a travel ICU nurse for a few years and I've worked both shifts all in new locations each time. Day shift in the ICU can be very busy. I know nights can be busy too, but its a different kind of busy in days. Day shift deals a lot with different specialties, and patient activities (like early mobility, nutrition, procedures, etc). Again, its nothing you can't deal with because thousands of nurses do it every day. Its just a matter of adjusting and getting used to the new work :) By biggest piece of advice is to allow yourself a period of adjustment. It might be frustrating for a few weeks, maybe overwhelming, but eventually you'll get in the swing of things. Don't expect to feel comfortable or in your usual groove for the first little while. But if you can get through the initial couple of weeks, I am sure you will find your footing! its totally doable!! Good luck!! you can PM me if you want :)

I agree. It depends on the unit but in the ICU, the chances are they have a central line because they are sick enough that they need one. And usually in those cases, you access it when you need it, which can be multiple times in an hour. I can't think of an instance where I would hold a medication because I didnt want to increase to risk of infection from accessing the line. Typically, there is an effort to remove them as soon as possible. If they've had it around 10 days, that is usually when they try to figure out a different way. Some ICU's do not use piccs because research shows they clot more often in the ICU, but I've also worked in ICU's that use them more than IJ's. If the patient is that sick and there is no other way to access, the IJ will usually stay put for as long as we need it, unfortunately. The alternative is insufficient access or inappropriate access (as in the case of PIV and caustic medication), which if they are very sick could actually be more harmful than a high risk for central line infection. Admittedly I have also seen PICCs in people for months on end... like more than 3. Naturally, central lines are used more frequently than HD lines, because those are for one primary purpose while we use central lines for all kinds of things (drips, pushes, fluids, etc). Most nurses are very careful when accessing lines. To be honest, more than the accessing of the line, I personally think that the problem with high infection rates comes down to the dressing. In the ICU, people are sweaty, hairy, vomitting, and all kinds of things. And the placement location of some of these lines make it easy for the dressing to come off or not be entirely sealed properly to maintain a sterile site. In the instance of an IJ, the neck can be difficult to dress. The hair from the scalp line gets in the way, people's beards start to grow over time, sweat accumilates, if someone vomits it gets all over the dressing. In the instance of a PICC on the arm, I've seen a patient poop so much diarrhea that is went all the way up his back and all over his arm where the access sites sit on.

I think its totally doable! I had the same exactly career trajectory: started out in med/surg and moved over to ICU. It is very different... the experience from med/surg helped some but you will essentially still feel like a brand new nurse. But with determination, an open mind, and lots of learning, you can do it!!

I can see both sides of what is being said here but the truth is that 10 weeks is not a whole lot of time in the ICU. It really really isn't and I think everyone here could agree with that. You advocated for yourself by telling them you have not taken care of very ill patients and they reassured you it would be fine. At the same time, I also think its true that both patients are your responsibility, as frustrating as that is. The same thing happened to me and the management at that hospital just had it out for me. I ended up leaving and picking up travel nursing to other ICU's with a year's worth of ICU experience. People said it would be impossible but it isnt. I do really well in the ICU and that first job I had was a toxic environment. If they are not willing to work with you as a baby ICU nurse, thats a major red flag. There is no way they can expect you to function as an experienced ICU nurse, especially when they aren't giving you the assignments and the support to get there. 10 weeks is almost NO time to get proficient. So if they just don't want to give you the proper orientation, I would go to another hopsital/ ICU. I agree though with sugarmagnolia3: you need to be communicating and reaching out. This is not a job that one can do isolated. I used to feel like "oh my gosh, I need to show them I can do this!" and I mistook that for needing to be stoic, but this was a fatal mistake. You need to communicate, even when you feel like you don't need to. Tell your preceptors, the nurse's around you, the doctors, anyone involved. Don't be stoic! you can do this!! above all, they can not define what kind of nurse you are or whether or not you can be an ICU nurse!!

I had a similar transition to the ICU. Came with 2.5 years experience and felt like the dumbest, newest nurse. It was rough! But you have to give yourself at least a year. It does get better. There are so many emotions that one goes through during their "ICU growth", just remember that its normal, everyone has gone through that. Be patient and compassionate with yourself. And try your best to get through the preceptor part and the snarky co-workers. Once they get to know you and your work ethic, they'll (hopefully) come around. If they never do, then that unit is not a good fit but you will need at least a year to see how things settle. For me, I had a few preceptors that we worked well together and some that it was just constant tension and it felt terrible. On days like that, or when I had interactions like that, I would almost just do as they say just to get through it and try to learn as much as I could, even if I knew I would do things differently on my own. As long as the patient is safe and their care comes first, the rest is just an art form. As a new ICU nurse, it can be hard but you have to be really humble and receptive to other people's feedback and style of working. Mostly, just give yourself at least a year and lots of love and patience. It will come! thousands of other nurses have made it through, so you can too!!

I dont think it could hurt. I agree that its better than being unemployed. Don't give up and be relentless about getting to the ICU. Network constantly! In the meantime, I would recommend you really work to not get lazy. And by lazy, I mean dont get comfortable to the point that you forget all the knowledge you've learned, and you become content with the scope of practice as it relates to dialysis only. ICU is VERY detail oriented, it is important to know your pathophysiology, interventions, medication, etc etc. It is an area of nursing that you constantly have to be learning and deepening your understanding (because it never is deep enough for the ICU's patient population). Keep reading and studying and learning while you wait for your year to be up. You'll thank yourself later. A good book to read/study is "The ICU book" by Paul Marino Good luck!

Susie2310, I very much agree with all you said. I think one of the main things that really frustrated me as a nursing student and new grad was that I would actively ask everyone around me to help me develop this skill and nobody could directly answer me/guide me. Nursing schools do try to teach it but it obviously is insufficient. So I ended up just doing it like the rest of us do: winging it until I somehow learned it. I am curious... did you have the same experience? How did you learn critical thinking in the real world?

Yeah, I agree critical thinking isn't quite taught in schools. Mostly because real critical thinking in the real world is very highly context based and how can you teach that with multiple choice?