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Content by sjalv

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. sjalv

    Foley Cath Insertion

    An incontinent patient who is A&O x4 and can vocalize that they are soiled = not a reason to catheterize. A patient who, regardless if they're usually continent or not, is sedated and cannot verbalize they've soiled themselves = reason to catheterize. At this point, it's a dignity issue. I don't really care what the CDC says. If someone is intubated and sedated, they need a foley.
  13. sjalv

    Move from Medsurg to ICU?

    Did he say that his unit was a 'special snowflake' unit? Is your passive aggressive assumption warranted, or does it contribute anything to the discussion?
  14. sjalv

    Foley Cath Insertion

    Please, for the love of God, if I end up intubated/sedated in an ICU, catheterize me so I don't keep urinating on myself out of lack of awareness/control. To not do so would be ridiculous in my opinion.
  15. sjalv

    Living in San Diego

    Hi all I plan to take my first travel assignment in May and want to go to San Diego. Do you feel that I can live comfortably by myself (no kids, no pets, no SO) somewhere like Hillcrest or North Park on my own salary without a roommate? I've heard that wages for travelers are about the same as core staff when it comes to California. As I have not yet taken a contract I can't give specifics as far as monthly net income, but was hoping to hear from some who had BTDT if possible. Thanks
  16. sjalv

    Central line compatibility

    Did you clarify what you know to be the truth, i.e. that the lumens are separate and even if the medications are incompatible, they are fine to infuse through separate lumens?
  17. sjalv


    This is exactly what the OR nurses tell us when calling report on a heart and it's all I need to know, for what it's worth. I feel like if the nurses want to know the nitty gritty of the surgery, such as where the bypasses were etc, they can read the operative note which gives a complete start to finish of the surgery.
  18. sjalv

    Health Unit Coordinator/CNA

    Is it possible you can post the job description here? If you are not a nurse and do not have experience in leadership/management, I don't see how feasible it would be to get a job in this position based on the name alone.
  19. sjalv

    BP cuff over a PICC line

    Is there a reason you can't use the other arm? If so, I would use a radial cuff below the PICC line. I would never use a brachial cuff over a PICC line.
  20. sjalv

    showering: before or after work

    I usually shower before work. I don't change into regular clothes before entering my house, nor do I have work-specific shoes. I'm more worried about catching a communicable illness at the grocery store than I am at the hospital.
  21. sjalv

    Bed Baths Washing Post Op Heart Patients

    On my unit, intubated patients/continuous bipap are bathed at night, everyone else is bathed in the day. By bathe, I mean 'chg bath'. This is irrespective of their surgical status. If they are so hemodynamically unstable that they cannot be turned to bathe, it will be put off until they are stable.
  22. sjalv

    Yep. Nurses do "eat their young"

    I don't agree with this mindset. I expect to see patients in distress due to their situation of being hospitalized, but that does not give them the right to be disrespectful. I tell patients when they are disrespectful that it is a two way street. There's no way I'm going to bend over backwards for a patient who is talking to me like a dog. It may not coincide with the ivory tower of nursing's ideology but my give-a-damn and care factor drops considerably when a patient is A&O but being a jerk. There is no excuse for it. I will still care for them, intervene when medically necessary, treat their pain, etc but there is a stark contrast between my demeanor with a rude patient and with an appreciative one.
  23. sjalv

    Hardest things we tell family

    I've only been a nurse for a few months now, but working in a CVICU, I've been in some very somber situations. I knew I would be experiencing this as a critical care nurse, so it's not like it has come as a shock to me, but it doesn't make it any easier. Twice this week, I've had to tell the families of patients that their loved one has suffered an anoxic brain injury and has an extremely slim chance of ever recovering. Did the neurologist tell them that? Yes, but you know families always ask the nurse who is there for 12 hours what they think. At least, that's been my experience. It's somehow easier to tell someone that their loved one has died rather than, as we stand on either side of the patient, say that they will never be able to breathe again on their own, or feed themselves, or know what's going on, while they look on at the patient's baby-doll eyes. It's even more heart-wrenching to hear family discuss amongst themselves how they can't believe it's happening, how it isn't fair, how there might still be hope. Again, I knew I would be faced with these situations as a nurse, especially in the ICU, but nothing can prepare you for how emotionally taxing it is. I'm pretty good at separating work and my emotions, but even the most detached personalities are affected by the despair that some families feel at their most desperate times. Compounded by that is the fact that as a new nurse, I'm not yet jaded or hardened. It doesn't keep me up at night, but it makes one's heart heavy. Thanks for reading what probably should have been a blog post.
  24. sjalv

    Type B in a Type A world

    I strongly disagree with this advice. Why should the OP brown nose some nurses who are being catty towards her? Constructive criticism is welcome and should be encouraged. Nitpicky behavior should not. I don't think the OP should flat out tell these nurses that they are wrong, since she is still on orientation. However, she does not have to pander to their ego and be fake. She can remain professional and cordial without having to go the extreme.
  25. sjalv

    Would you report possible diversion?

    Please use the 'quote' feature where you can cite another member's post and subsequently write your reply. I do not understand your logic. Refusing to witness something you did not actually witness is best practice. For all the OP knows, it could be Normal Saline or even water in that 3 mL syringe and the Fentanyl could be in the nurse's pocket.

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