oicu8bacilli

If your facility is truly capable of cathing emergent cases, then they have a unit that functions as an Interventional Cardiac Care (ICC) unit. They will clear a stable pt to ICU, PCU, etc so your ED to cath pt will get appropriate s/p cath care.

I'll leave the topic with the comment that I am very glad I'm done having kids, scared for the rest...but at least I'm done. Please send your mom to me and I'll ensure my newest nurses takes care of her post CABG, we'll roll the dice like you have with your new grad. Then again, folks don't care when gramma dies, but they get pizzed when their kid croaks. Funny, I never thought of nursing as a crap shoot...but recent exposure to all of the different fields makes me wonder what we really get done every day.

You should show FSP and other clot degredation in 7 to 10 days. As a nurse you should know that clots are going to be resolved as soon as your body recognizes the need to eliminate waste products. Pain after months needs investigating.

See a doc. When nurses get licenses to practice medicine....you'll get better advice. Then you'll see an abrupt lack of advice online. Nobody in their right mind is gonna give advice without a pt in front of them. BTW, H1 and H2 antagonists are available anywhere.

ok

i'm not arguing the fact that all nic folks are superhuman and possess skills unknown to mankind (never been a nurse from day one or not...must be a super alien gene pool you get new grads from). what does concern me is that you say that no matter how many years...nor how many procedures...nor how much education....i have...i 'm an idiot if i were to walk into your nicu. sorry, but i'm pretty incredibly intelligent and i have to say so every now and then or folks forget. i suppose it's time to agree to disagree. i don't think new grads with zero minutes and zero seconds of experience are better candidates to work anywhere than i am and i think it is related to the bodies available. if the system were inundated with fully qualified folks, we would never look at placing zero days zero skill kids in our crit care units. sorry..but again...we all disagree. maybe the florist would make a better heart surgeon that the ones i work with...i don't know until we giver her a try...i for one am not ready to make that leap...even though we need a heart surgeon badly....any ideas?

I get that blank slate person every now and then and have fun teaching until I realize why I am teaching. I too like to teach them things, but I really find that it's because he knows nothing and I feel like I am imparting the world on him. Now, when I get a new transfer nurse...lots of experience...same crit care setting....I find myself disagreeing with rationales, drug admin, etc....but I know the guy is a seasoned thinker and he has reasons for the pathway. Seasoned nurses will typically disagree on the same crit care pts. Bottom line is: it's not about me feeling good as a preceptor; It's about us having the most highly skilled people in our critical care areas. Sorry, I just don't buy the party line that new grads that can't think past go are the best choice of nurse for a kid measured in grams. Again, I really believe it's because we don't have the labor pool we used to and we have to take anyone that wants a job. I've been called a hard *** and maybe that's just because I expect excellence from everyone. Letting a nurse that just passed boards and walked into a crit care job take care of my septic close-to-death kid ain't never gonna happen....sorry, but I'm a pt advocate and stubborn to boot.

The only reason I am amazed is because nursing programs don't teach to the critical care environments. I personally wouldn't have a new grad taking care of my 26 weeker, nor my mom with a fresh CABG. My kid has actually spent time in a crit care environment, but the nurses we had were seasoned and provided expert care. If they weren't, they would have had an upset educated parent getting the supervisor to provide appropriate staff for my kid. I have no problem asking my kid's nurse, "how long have you been an RN and how long have you been in peds crit care?" I actually respect pts that want to know my skill level and appreciate that I'm not fresh off of a turnip truck. BTW, the advice to go get adult med/surg experience is well founded and would be mandatory if we had the staffing to support it. The reason we have new grads entering such highly specialized areas is because we need bodies no matter where they come from. The nursing programs teach towards that med/surg floor goal. I think you'd be hard pressed to find a college that spends a few weeks on adult disease and the remaining semesters on preemies. The disease processes and experiences covered in college are designed to enable a new grad to go take care of those med/surg pts. I've never taught college, but if I do I'm sure I'll never propose that my med/surg trained students run out and take open hearts or 500gram pts. I'd hope that they have sense enough to go get some years under their belt and hone skills (not tasks) before considering a specialty.

maybe i should clarify between terms i use as "push" and "direct iv injection" - aka - "slow push". terms i keep in my head and derived from books. direct iv, slow, means 2-3-5 mins to me; whatever the books say. push, to me anyway, means squirt as fast as the catheter will allow. sorry to confuse, then again people get the term parenteral confused with iv. it's easy to see how that happens.

I'm not talking about "easy to orient because I don't have to unlearn anything". I'm talking about the mental checklist of a thousand things that I go though immediately and unknowingly because I have a deep and broad crit care background. I'm certainly not the smartest person on the planet, but having been around the block, I have a pretty good list of things I rule out and rule in when subtle changes occur. No offense to new grads, but they just don't have any of the depth and breadth I'd expect a person to have before entering a crit care setting like the NICU. Big changes in any ICU setting, anyone can pick up...but they are usually too late to meet the standard of care. If our standard is simply "prevent death" then we can get away with alot. If the standard is "maximize potential for return to normal function" then we may be best served by folks who have a keen sense of what gives them a "bad feeling" and what is benign. I wish I had a penny for every person that I told a doc..."I just don't trust this guy and I want you to see him now"..and he was sick sick sick while presenting fairly asymptomatic.

really? i saw another post by a new grad asking about the first day as a new grad in the nicu and i thought it was a joke. am i to believe that the nicu has new grads monitoring preemies for subtle changes that might warrant a call or intervention or simply end up benign and need a burp? i've been in adult crit care for a while and don't feel qualified to walk in and take care of preemies, so i was dumbfounded that new grads were the best choice. just curious. maybe i am as dumb as i look.

As mentioned above, it really depends on what and why you are giving it. Nurses are the experts at administration rates and routes. Docs are great at determining what drug to use. If you push Pepcid you could kill your pt, if you hang a bag to give adenosine you are defeating the reason for giving it. You have just entered the world of "nursing judgment"; not a happy place to visit if you don't understand the process and the why's and why nots. Short answer: it all depends.

I agree about experience issues to become an ARNP, but what about a PA who has no experience and 4 years of college? What makes him so ready to be a provider versus an ARNP with just a year or two of nursing experience? The PA doesn't have any nursing, medical, or anything experience, but walks into the same role.

I roll down the window and yell "someone call 911" as I drive off. If you have half a dozen certs and stop at a scene with supplies and you are asking to get sued. Make sure someone is calling 911 and move on. The guy collapsing with chest pain in Wal-Mart is no different. You can always walk by and say "he's kinda blue...why don't you (pointing to a person) call 911" and go home or the mall or wherever you were going. I'm reminded of a story I heard from a trauma surgeon at a seminar. When he was a resident, he was driving around and stopped at an accident scene and did a needle decompression on a guy. Years later (today), he says he now rolls up the window and speeds up when he sees an accident.

Distracting injuries can be more distracting than you think though. Good triage includes a gut feeling for sure, but you but if someone just doesn't feel right to me...I start looking for things...no matter how the MVA person tells me he "feels". I'd rather head down a pathway and be wrong...than ignore shoulder pain and have a spleen ruptured in the waiting room. Sure triage is incredibly individual and subtle, but I'm sure you get my point...sometimes MVA folks aren't your best resource or the best historians. We too get the folks that deny EMS, but show up later with a sore neck. They come in droves and I deeeep palpate them until I'm very satisfied that their pain is simply MS; you gotta be sure J