alaskaman

Indeed I was thinking that his hostility compounded by a basic dishonesty is his and his alone. I let go of the ICU component with the manager due to this yesterday in a meeting. I will be in the step down float pool now which is OK with me. Throughput is the focus in their ICU's to an extreme. I asked him if he felt they had enough staff and he said yes. No one really takes their breaks there and the care is great for the super critical patients who most likely would not survive however as he himself rolled a 350# pt without assistance I could not help to think that the glory days of adequate ICU staffing are gone. Imho due to the focus on punitive charting *which no one reads* which takes time away from the clinical judgements so necessary to promote healing I will see what I find on the step down units. His intrusiveness was hard to fathom.

so last day in ICU orientation the preceptor was odd. He was constantly micro managing, and even to the point of changing drip rates and not communicating it to me. I have a check in the team manager this morning (surprised). There appears to be so much emphasis on moving patients quickly that they have not paid attention to actual care. In one case he turned off the precedex drip and turned off the levophed. The pt became more uncomfortable so his blood pressure increased. He said that both drips were not needed so the patient could transfer out of the ICU. I was of course surprised that this "technique" was his way of clearing a bed. He did not tell me either of his actions so when I inquired when he had turned off the drips he said I should have checked my medication verify on EPIC. He was clearly tense from the shift start... communication is not his strong point, but it did get me wondering about the way patients are " cared for" on the unit which is a fast paced SICU. 4 Impella pts yesterday, 2 triple A's with every med imaginable keeping them on the planet. Most of my experience has been positive with he and another actually making it difficult to practice. I will talk this out. Each preceptor has something to teach and yet I felt confused as to why he would be so strategically difficult.

Thanks All. Things are going better. I talked with my new preceptor and she confirmed that the hospital makes is challenging. Her comment was welcomed. And I do know my abilities,,,,thank you for that reminder. It helped.

I have been working as an RN for thirty years the last fifteen in ICU's. I recently was encouraged to work as an ICU float for a major medical center. It was not the position that I originally applied for but they wanted me for it. I will cover six units and orienting for eight weeks on those units. I have many years doing these hybrid jobs. But I am tired. It comes to all of us, I think. I am grateful for my career. I enjoy being a nurse. I am doing orientation and while I am engaged the medical center has limited ICU doctors in a large 36 bed unit. I had a terrible preceptor this week and it really knocked me backwards hearing her "objective" views on my readiness. It was.a blow to my confidence. She was harsh and incorrect in her assessments. I sent the manager an email to let her know my experience and she sent a simple "thank you". There are not as many intensivists now with health care changing e.g. more patients less docs. Not as much structure as I would like to have and a bully of a preceptor. I have had 3 so far and the others were satisfied with my work and performance. I am disillusioned slightly "down". I have never had an experience where my performance was criticized and it hurts. Looking for advise how to evaluate my next steps. Thank you.

First off you are not alone in your reaction and symptoms. Your response is a natural event related to a world wide pandemic. Talking talking talking is the recovery ticket. Like many you thing you can do it. Give yourself a year talking weekly, potentially groups as well. Get financial support any way that you can. I do not know if you have already done these but talking with a trained person can help you estimate when or if you want to return to patient care. Although you do love your position, there are many avenues in Nursing. Do not despair. You have given your heart and soul to people and now it's time for you to get well. This is NOT atypical or unusual. You have fought a world wide pandemic and more. Go easy of yourself, and I mean by that be good to yourself. OK? don't rush, take time and get completely well.

You probably know already that talking it out is the main way to recover from traumatic events. The other thing that will help is to understand that the world is going through a worldwide pandemic. It is real. Step back and just consider that for a few minutes. Many times in life events intrude into our lives this one is on a global scale. It is huge. There is no shame in being impacted and in fact seeking help is admirable. Until you find a personal therapist look for groups. The EAP at your work site may be helpful. Speak with your doctor about a trial of the SSRI antidepressants and be honest about your symptoms. I just returned from 4 months in a city where many people died from CoV19. It is a war so pat yourself on the back for working within it. You are courageous and dedicated. You are not alone in your role and your feelings and I think that you're taking the right steps o support yourself. Losing anyone to death is harsh, I take solace n knowing that their suffering has ended and love myself for being there to help them. Courage it takes, gratitude it yields. Keep talking....

I have worked critical care for 10 years and the last 2 years in a step down unit. I am considering taking one of the very high paying ICU jobs on travel. I can make 4x what I may now in one month. I can carry COBRA. May or may not be able to return to current job. I am vaccined up. So tempting. Thanks for your thoughts.

Yesterday I took care of a 96 year old man who was approaching hospice and scared. He was throughout his life able to control events, his work and his scope of responsibilities of which he had many. He began to who signs of delirium at risk of pulling chest tube, 3 way foley and central line. Haldol 5 mg IVP had little effect. Assuming pain, 4 mg of morphine was given with slight sedation. Finally Ativan 2 mg reduced his fear. We had to use wrist restraints only briefly and his family came and we found a personal sitter. You could see this man's legendary accomplishments in his face and his attempts to make sense of his next journey called on my many years of caring and knowledge to help him. I was able to embrace this complex situation and help reduce his fear and terror. It was not easy, seeing him struggle and it called upon our compassion and skills. That's why I became a nurse. One person helped.

I have not placed a female foley for 15 years. Nothing happens if I'm not there. I routinely request a female colleague to place it. I do this to protect my practice. It only takes one allegation of any kind and my income is gone. It is simply not worth the risk.

Trust your gut and yourself. Walk the unit. Meet the people. Are they friendly? Do you like the physical layout? Do people smile or do they look away...? Of course you're nervous. There are techniques to manage anxiety. Work with a Psychologist to learn those skills.

Is the OP still here?

Does your pump have a med library? If so it should have prevented this rapid infusion of lasix.

A solid story. Congratulations. Hard work (and in your case very hard work) pays off.. Well done.

Yes Get an IV drug book I think Gahart's in one choice which I like. Study critical care drips vasopressors, sedation to pain. Many times these drugs will be used with patients continuously. Knowing their actions will help you understand how they work. Get to know the steps in rapid sequence intubation meds. Study the mechanics of ventilation and the most frequent settings on ventilators and why they use those settings. If they have a classroom component to your training that would be very helpful and will guide you. Know your medications.

Do they have an orientation to the various ICUs? It a different animal that Step Down.

https://www.amazon.com/Gaharts-2019-Intravenous-Medications-Professionals/dp/0323612725 If it were me I would look at jobs at major hospitals with commuting distance. An ICU training program can be a big commitment and frequently they will expect you to stay there for 2 years post training. I would also pay a personal visit to each of the hospitals who are recruiting or have such a program. If you can walk the unit. If you bump into a supervisor be prepared to say hi, who you are why you're there and what you're looking for. Face to face is always a good way despite the emphasis on on line applications which can also do e.g. "I put in an application....". Your edge up is your two years of experience (what type of med center was the med surgical in?) You're not a new grad....you're studying the drugs will help get you ready to talk with them. Finally, trust your intuition on your walk throughs....If the ICU door is locked you'll have to get a bit creative...

You will want to get your stroke cert. I think that your application should be refined to get attention. Your 2 years of nursing will look strong with written or phone references from those supervisors, charge nurses or managers. Those will be very important. It was a good idea to get your BSN. Critical care is very exciting. It demands a lot and forces you to be very organized and fast while remaining situationally sensitive to families. I also work closely with doctors and that collaboration is good for me and I think for other nurses. If your previous employer has records of your varicella TB etc get those. Study an IV drug book and review vasopressors, sedation and pain gtts. Finally look for an ICU training program. Are you wiling to relocate?

How many months of nursing experience did you have before taking a break? What units?

What have you been doing while earning your BSN?

If you stand on the train tracks for a living, from time to time, you get hit by the train. Keep your chin up. You have courage, smarts and love to move you through this....

I think the key thing is be able to speak about and document how you have grown and changed since you committed the crimes. The BRN is California is one of the toughest. I think that your self reflection and your ability to speak about that along with a proven employment history will argue for advancement. However, you state you have been convicted of hurting or attempting to hurt other people. You would have to show documentation of anger management therapy and lots of testimonials as to your growth and character since the events took place.

What happened and has anything like this occurred prior?

Frequently it requires that you find a program who has a proctored ICU training program. Does your hospital have that? If not, I would look around.

It's a gift. take it. 3 patients in ICU for a new grad is silly stupid. Bound to make any nurse tired. Follow the man to your new home. I would say while I am so grateful for the opportunity my husband got his dream job close to home. I am sorry to have to say good bye but this is a chance I cannot refuse. I am grateful and thank you so very much. Then hit the road with a smile. Interview and establish new priorities. ER can be very helpful to growing your career in the ICU.. You'll learn to move faster transfer its quicker and bring that ICU experience to the ER which they can certainly use. Best of Luck!

Every clinician makes mistakes. It is impossible to know everything. You learned not to use the port. Lesson learned. Pt is ok. After 30 years I can tell you so many stories. Here's one. At the ICU VA Anesthesia established an epidural and used ported tubing. The patient had two central lines. The pt became unstable and I looked for the line to give neo gtt. Thought that I had the right tubing and rechecked. It went to the epidural. It would have killed him. Drilled a new rectum into the Anesthesiolgoist, but it has stayed with me. I made the error. I rechecked. I was milliseconds away from giving the neo. So count your stars that nothing went wrong....and you LEARNED. Take a deep breath. It will not be the last one you take when working as a Nurse in ICU.