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sjalv

sjalv

RN, CVICU
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  1. sjalv

    What's your favorite thing about working in CVICU?

    We take care of a lot of renal patients, particularly when their hemodynamic system becomes unstable and they require pressors to maintain their blood pressure and therefore cannot tolerate their typical dialysis treatments. We often start CRRT which is a type of continuous dialysis that allows for lower volumes of fluid to be taken off per hour since it is a continuous treatment as opposed to just a few hours like HD is. I have never taken care of a patient being seen by a plastic surgeon so it's either our hospital or my unit, but regardless I don't see them. We see ortho patients pretty often. It's usually a case of an elderly person undergoing something like a total knee replacement and just crashing during surgery. We also often get patients who have recently had knee replacements or other such ortho procedures and then developed sepsis and just get worse from there. We see OB patients occasionally, usually due to massive blood loss during delivery or fatal hypertension during pregnancy. I've never had such a patient but I'm a 22 year old male so that's probably a factor in those assignment choices. When we have patients like these, an OB nurse usually comes up to assist us with our OB assessment since for most of us, we've either never had to palpate a fundus or it's been years. Also, if the patient is pregnant and fetal heart monitoring is being done, an L&D nurse has to be at bedside to monitor the fetal heart rate since they cannot see the FHR remotely while the pt is outside of L&D for whatever reason. When you mentioned ENT I just think of patients who have trachs. We frequently have patients who require prolonged mechanical ventilation and cannot be safely extubated, so they have to be trach'd. This is usually a joint effort between the pulmonologist and the general surgeon. Remember that the ICU is just a higher level of care. We see many of the patients that other units see, except the sicker ones come to us. So a dialysis patient can easily be on the floor, except when they require more intense therapy and need blood pressure support. Post-op ortho patients typically go to the floor and go home after a day or two, except when they crump intra/post-op. Pregnant patients typically deliver and go home, except when their delivery goes south. So, I think what you discovered about this unit is pretty typical, but it isn't like you're going to be getting the healthy patients of this type. They'll still go to the appropriate unit, unless they require the higher level of care that they can get in the ICU.
  2. sjalv

    What's your favorite thing about working in CVICU?

    What's your favorite thing about working in CVICU? This is probably applicable to all kinds of nursing, but you never know what you're going to walk into when you get to work. You might be walking into a fresh code where the critical care doctor is still in the process of placing lines, the nurse is mixing vasoactive drips to save his pressure, the RT is trying to make the image of an emergently intubated patient look presentable, and you're looking at the board hoping that you don't have a 2nd patient. It is either feast or famine. You might have a patient that's been there for a few days and you are just keeping an eye on them to ensure they don't go from stable to crashing, or you may be the one stabilizing the crashing patient coming from ER/OR. What do you find most challenging? Patients in the ICU, regardless of subspecialty, are at their sickest. The choices you make as a nurse can literally make or break a patient's recovery. Again this is is present in most types of nursing but the reality of it is amplified in critical care nursing because of how sick these patients are. You have to know the mechanism of action of the drugs you are giving, not just what they do in layman's terms. You have to know why calcium channel blockers are detrimental to patients with low EF's, you have to know why beta blockers shouldn't be given when patients are on some inotropes. You can't just know that "lopressor lowers blood pressure and heart rate" and be a safe practitioner. You need to know how it does it and what else the patient has going on that will affect their physiology. A tremendous knowledge set is required to be a safe and competent ICU nurse and as someone who is nearing the 2 year mark, I know I'm not even close to the tip of the iceberg. What do you dislike about the CVICU? I hate it when we get overflow from less acute floors just because we have the most beds in our heart hospital. This doesn't happen too often, mainly when there are no beds on the cardiac intervention unit and we have to take a stented [N]STEMI. I don't mind these patients. They're typically easy to take care of and it's not like we're tripled with them. However you get more demanding patients just due to their lesser acuity and it can really irk you. When you have one patient who has been on the vent for 6 days with no promise of being extubated, worsening renal failure new to this admission, can't keep a blood pressure for more than a minute of the levophed being put on hold, then you have a 2nd walky talky patient who really does not need to be in the ICU complaining that you don't have ice cream readily available on your unit (hello, it's an ICU; most patients can't eat), it really can be trying. For the most part, if you can use your call light to complain about your dietary options, you probably shouldn't be in the ICU.
  3. sjalv

    Nursing wages.

    I started in the CVICU as a new grad at a hospital in Tulsa at $23/hr base, and went up to $25/hr base after a year of being there. I can't speak to OKC hospitals but can't imagine it would be too different. Shift differential for me is $3.75/hr for nights and $4 for weekends, give or take some.
  4. There are many rural areas within an hour of Tulsa, such as Skiatook, Collinsville, Sperry, and large swaths of land between these towns and the city. I'm not sure about OR jobs specifically but there is no shortage of jobs for nurses in the Tulsa area, especially for someone with experience. If you were wanting to work closer to home, you're going to be limited to small towns like the ones I mentioned and I am honestly not sure what the job scene is like for a specific specialty like surgery. I know that wasn't very informative but I just wanted you to know you should be able to find a housing opportunity like the one you want within an hour of Tulsa, where finding a job won't be an issue if you don't mind the commute.
  5. I'm an ICU nurse and am always enthralled when I get in report that the patient already has a PICC or central line, but I don't expect it. I do expect that the patient have two IV sites though. We have critical care nurse practitioners that work overnight who sometimes see the patients in the ER before they get a bed in the ICU, in which case they usually start the lines. The ER physicians rarely do unless multiple pressors are needed.
  6. She is not telling her to take the discussion elsewhere, she is giving her additional places to get feedback. The Facebook groups that I am a part of have over 20,000 members. You get at least 5-10 responses within the first hour of posting something, and the discussion can be had in real time with notifications when there is a response. The same cannot be said for here but again she did not say to disregard this forum altogether, just to add other avenues of research to her repertoire.
  7. sjalv

    Nursing Dreams and Nightmares

    I've dreamt before that a patient of mine started coding and I knew they were, but my body couldn't perform compressions. I could yell for help, push the code button, position the bed supine, but my arms were like jelly when I went to do compressions. It's like that stereotypical dream where someone is chasing you but you can't run, or you fall and can't stand up.
  8. sjalv

    How do you get into the ICU?

    CCRN is a certification, nothing to do with any board. 'board certified' tends to refer to physician certifications upon completing a residency and passing their respective boards. I think to say getting your CCRN makes you 'board certified' is misleading. I would also strongly recommend against going into flight nursing with just one year of ICU experience, given that 2-3 months of that year are spent in orientation.
  9. sjalv

    How do you get into the ICU?

    I got hired into an adult CVICU before I even graduated ADN school without any tech experience. It really depends on where you live.
  10. I keep my stethoscope, headphones, a phone charger, some nonperishable food as previously mentioned, and an IV drug reference book, although each med room on my unit has one so I rarely use that.
  11. sjalv

    Quitting my 1st RN job

    I'm not sure if you are asking me or if you were just clarifying that that was the question you were trying to figure out, but in case it's the former, I'm not too sure. On one hand, you have ICU experience, but it's not pediatric ICU experience. They may want you to have pediatric med/surg experience just like a lot of adult ICU's require applicants to have adult med/surg or stepdown experience. Just apply and you'll get your answer.
  12. sjalv

    Quitting my 1st RN job

    Disclaimer: I'm speaking as a nurse who started in an adult CVICU, and that's still where I am. Obviously our hospitals' orientation programs and environments differ, as we don't even do transplants at my hospital and I'm guessing y'all don't do open heart surgeries in the transplant ICU But, I know that even though I didn't die of anxiety going to work after being there for a year, I know SO much more now just 6 months later than I did then. And I am sure in June, when I will have been there for 2 years, I'll look back and realize I've learned even more since then. However, if you are currently working with adults, but you want to do peds, it's gonna be a big transition regardless if you have 1 year or 2 years of experience, given that the pathophysiologies you'll be dealing with differ so much between the two population types. If PICU is your ultimate goal, and you are not bound by a contract, I don't think you will be doing yourself a big disservice by transferring after a year. If you were wanting to switch from one adult ICU to another, I would definitely recommend staying the 2 years as the skillset you acquire will more than likely transfer without issue. I can't say the same for going from an adult ICU to a pediatric ICU, regardless of the type. Perhaps someone who has worked both can chime in on the benefits of 1 year vs 2 years.
  13. sjalv

    Missed H.R call

    I know someone has already said this but whenever HR calls you, it's for a reason. Voicemail or not. Keep that in mind for whenever you do work for a hospital.
  14. sjalv

    CABG recovery ratios?

    At my hospital, hearts are 1:1 for the first 6 hours. Hearts are never doubled before this point, and if they have an IABP, they're kept 1:1. Even if the heart technically goes off 1:1 during day shift, they won't typically give you an admit. This is because the hearts usually come back at 11:00 at the earliest and instead of giving you an admit, they just double the night nurse with a patient that's already on the floor.
  15. sjalv

    Do you pre-inflate the balloon on a foley cath?

    I was taught to not inflate and I never do. I also do not know any nurses that do.
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