TinyHineyRN

I get the flu shot annually for two reasons: 1. I work in the Peds ICU and not only come into contact with the flu a lot, but my patient population is particularly susceptible. 2. I can't afford to be out sick with the flu when all 12 of our beds are filled with little ones with flu and RSV on oscillators and JET vents and conventional vents.

The sheer fluid volumes alone will be a huge change! Yes, you can really give that whole liter bag AND 500ml of albumin AND a unit of PRBCs AND FFP!!!

The test they give you is really to guide you through your orientation and is helpful to determine where your strengths and weaknesses are. When I started at PCMH as a new grad, they told us straight out that most new grads will not pass the exam because it requires a certain amount of experience to be able to correctly identify certain interventions. If you don't pass, there will be a chance for you to retake it several months later. Good luck with your interview!! PCMH is a great place to work and a fabulous place for a new grad!

I'm pretty sure you can do a CCRN cert for NICU. Its interesting though how there is no distinction in the actual CCRN cert designation between adults, peds, and neonatal. For instance, I am a Certified Pediatric Nurse. The letters behind my name are CPN. If I were to take the CCRN exam for peds, there is no way to determine my cert from that of a certified nurse in a medical ICU. Its not like its CCRN-A or CCRN-P. Just strangely interesting...

Oh yeah I have totally cried, especially over the death of a patient who was very dear to me!

No nursing wasn't my first degree either, but my story is like a big, freaking circle!! I went to a university after high school and was pre-nursing. My sophomore year, I decided I didn't want to be a nurse, so I changed my major. My junior year, I decided that I did, indeed, want to be a nurse....whoops!! I was only about 2-3 semesters away from graduation, so I went ahead and finished. So I got my BS in Community Health Education and Promotion. During college, I actually made sure I had my nursing pre-reqs done so I didn't waste any time at all! RIGHT after I finished my BS, I went to a community college (MUCH cheaper!) and was admitted directly into the nursing program. 2 years later, I finished my ADN. I now work as an RN and I absolutely love it!! I don't regret (most days!) getting my first degree. A degree is a degree and while it doesn't help me much right now, no one can take that away from me! Good luck in your own nursing pursuits!

I had a friend a few years ago that couldn't find a job as an RN new grad. She also took a position doing flu shots and, while she didn't get a whole lot of varied experience, she can do one heck of an IM! Also, I think you may be a little misguided about the RN-BSN program. If I'm not mistaken, you aren't doing inpatient clinicals so the statement about school giving you critical care experience (I'm sure at this point you have been drilled enough to know you can't do CCRN without about 2 years experience!) isn't very accurate. Good luck with the job hunt! FYI, it also may not be the best idea to "beg" the nurse for home health assignments straight off the bat!!

SOMEONE is about to lose their callbell privileges!

I am never, EVER amazed at the things that come out of people's mouths in PALS!

I have an ADN and didn't need stats for nursing school but I did for my other BS. It hasn't changed my nursing practice but I have found it helpful when reading studies. On a different note, I had a health ed professor tell us that statistics are to be taken with caution as they never imply cause and effect. Statistics can be skewed any way the surveyor wants them to be taken!

The practice in our PICU is to flush the line (PICC, port, art line, whatever) with 10cc NS, waste 10cc blood, then collect the coag. The only time I have had a problem with this is the other day when I was drawing a coag from an arterial sheath which is quite a bit larger than an art line. I just did a bigger waste the 2nd time and then my value was right on!

Congrats on making the decision to go to PCICU! I transferred to PICU from the peds floor about 5 months ago and I definitely KNOW I made the right decision. My last day was a little scary. I remember thinking the same thing, "do I know what I am getting myself into?". It is so scary to think about leaving a place that is so familiar and comfortable with a family you have grown with and love. And I was literally moving down the hall, not hundreds of miles away like Jan! In the end, I have found a great match with PICU and I really love it! I hope you have a great experience and good luck with your new job! Oh yeah, and like Jan, we totally spent my last night on the peds floor eating! Oh I was pretty much useless that night!

I think another issue is that there isn't a rate in the order, or at least a time frame to infuse!

When you prime the IV line quickly, air will collect in the syringe ports. You have to flick the air out. Otherwise you will always have tiny amounts of air with a push no matter how conscientious you are of air in your syringe.

I had a teacher in nursing school that taught us this: Water is stupid and will follow sodium (salt, solute, whatever you choose) wherever it goes. Best rule on osmosis I have heard in a long time!

In my hospital, new Nurse Managers must have an MSN. The current NM's are grandfathered in, but must have at least an Associates Degree. My old NM was a diploma RN so she has been upset about the fact that she will have to get a new degree when she is within a few years of retirement!! As far as charge, I can't speak for anywhere else but degree means nothing for my unit.

Love it! Yesterday I took the most adorable 2 month old with old and new SDHs for a skeletal survey. While waiting for the radiologist to OK our films, I had the most major cuddle session! It was fabulous! He nuzzled his little head right into my shoulder and fell asleep. Our PICU census has been pretty low lately and our acuity hasn't been very high either so that was a fun way to spend an afternoon!

It can DEFINITELY be fun!! The other day, I got to cuddle the sweetest little 2 week old baby boy. Cuddle time is something I miss a lot from working on the peds floor so when there is a baby that is able to be cuddled, we ALL take advantage! Little guy and I took a walk around the unit since he had not been out of his room in a while!

I was actually diagnosed myself with ADHD about a year ago and it is the most life-changing revelation I have ever experienced! I know it is a controversial subject and it is so hard to put what goes on in my head into words, but being treated has helped me so much personally and professionally. Looking back, I have always had problems r/t ADHD but my brother had a very severe case as well as possible other mental inflictions. I remember telling my mom that I thought I had a problem and she told me, "You don't have ADD, your brother does." Well, yes, he does, but he is a waaaayyyy different person than I am! I did very well in school despite the fact that I never cracked open a book. Even in nursing school I never studied, I never looked at my power points, I doodled in class. Nursing/health/medicine comes very easily and very naturally to me (don't hate me....I don't want to sound like I'm bragging b/c I'm not trying to!). I even went to a university and earned a BS prior to nursing school. How I graduated twice....I have no clue! How I passed the NCLEX....who knows. But I have been pretty successful so far. The reason I finally sought out a professional diagnosis was b/c it was starting to affect my work. For example, I would have a pt ask for a drink and I would remember about 3 hours later! Not such a big deal when it came to things like drinks or blankets, but I didn't want to progress to the point that I would forget meds...not such a good thing! I have been on Adderall for about a year and it has made all the difference. I am a much more productive person when I take it. I feel like it makes me a better nurse to my patients. There is such a negative label on ADHD and I, for one, am not ashamed to admit that I take meds for it. Its not because I'm lazy or seeking meds. As far as the note is concerned.....time to get over it!

Its a rare day that I have a triple lumen CVL that I'm not using all the ports of!

I'm with you. As a floor nurse, I understand that the "fluffy" stuff isn't what the ED is all about. I'll do the clean up stuff, no problem. And most of the ED nurses I have received pts from are fabulous. What drives me nuts about a few of the nurses I have received pts from is, for example, when I would get a sickle cell kid or an oncology kid in the ED and the peds satellite pharmacy sent the antibiotics to the ED....please start the antibiotic!!!!! Starting abx on a febrile hem/onc kid IMMEDIATELY is a huuuuuuuge deal! This isn't a big problem because our hem/onc kids usually don't come through the ED. They are usually direct admits. I once had a little one with a neonatal fever come in and, in report, the RN told me they already did blood and urine cultures. All we would have to do is the LP. Awesome! Thats a fantastic help! When I got the patient settled, I happened to have a few free moments to read through the notes. I read from the nurses note that the CNA attempted to cath the baby for a urine culture but was unable to get urine, so a bag urine was sent to the lab! For those who don't work with pediatric patients, we have urine bags that we can use for clean catch specimens that attach to the perineum and sit in the diaper, waiting to collect urine. Obviously, this can't be used for a culture as it has a very high risk of contamination with stool. The most frequent cause of neonatal fever is UTI (specifically e. coli UTI), so we have to have a GOOD urine culture! I would have loved if the nurse had told me the culture was a bag urine, not a cath, instead of telling me the culture was already done!! You are at a unique advantage that you have been a floor nurse and pretty much know what proper "etiquette" is in terms of transferring patients! And just remember that some nurses are just going to be ticked off that they are getting an admission and will take it out in anyone they can!

I'm not sure what best practice is but, in my own practice, if the only access they have is a central line, you have to kinda make do with what you have! Often times, our practitioners/attendings will put in triple lumen lines. If I have TPN/lipids running through one port and then things running through the other ports that shouldn't be interrupted (ie pressors), then I really don't have much of a choice but to interrupt my TPN for a medline. Preferably, I would put a trifuse on my TPN/lipids line so I can infuse a med through the same port without breaking the line. If its a med that isn't compatible with TPN/lipids, I would pause them, flush the line, infuse the med, flush again, and restart.

The practitioners I work with are all PNP-ACs, but I work in a Peds ICU so its a little bit different. When I worked on the peds floor, there were two practitioners, one was a PNP and one was an FNP. Both were on equal footing and performed the same jobs. The FNP was actually a staff nurse on the peds floor for about 15 years so she was very well known, trusted, and respected by everyone. Both are phenomenal. A friend of mine works in a pediatrician's office and one of the practitioners there is an FNP. Her background as a staff nurse was all newborn nursery. She is horrible. From my own interactions with her, I have found that she makes terrible decisions related to care of her patients and often times performs unnecessary, invasive procedures with no benefit to her patients. This has nothing to do with her background or the fact that she is an FNP versus a PNP though and is just the way she chooses to practice. There are several practitioners in our area that are FNPs that work with kids because, in NC, there are only 2 schools that offer PNP programs and that is Duke and Chapel Hill. Lots of people just find it easier to go to ECU and become an FNP. As far as choosing one program over another, thats truly personal. I have thought about becoming a practitioner myself, but I know that FNP is not for me. I know 100% that peds is for me and I don't want to work with grown ups. For that reason, I don't want to spend time in an FNP program learning about grown up stuff if I want to be a tiny human NP!!

I hope I'm not supposed to like fluffing pillows either....because I don't! I made the transition from peds floor to peds ICU because I wanted to take a more critical patient load. I love the pathophysiology of health and medicine and I am definitely getting that where I am! One of my least favorite things about working on the floor was "playing waitress" and while it isn't totally taken away, I certainly don't spend NEARLY as much time fetching comfort items now. Of course, I'm going to do what I can to keep my kiddos comfy but there is no hard and fast rule that says that, just because you are a nurse, you are supposed to love giving baths and changing diapers and massaging your patient's feet.

But you had PEDS experience. I never said anything about needing peds inpatient experience!