Tri4kids

What area do you work in? Adult or pediatrics or both? Just curious generally in pediatric to place a peripheral IV that is a hard stick we use a transilluminator light which works great but you need a few hands to hold the light and the paitent. To use the ultrasound for a peripheral tells me you are looking deeper that peripherally. Ultrasound takes practice to use but is generally better for larger patients and even better for Central line insertions.

I am a PICC RN in a hospital that does not pay per: any placment it is charged on for what supplies are used and my time is charge accordingly... very sneaky way for the hospital to pay less for the service provided by a skilled nurses. hmmmm

Thunder: I think this says it all... I love being a nurse!!! But administration keeps taking taking taking and leaves us no other choice except jump ship because we can't stand it anymore. Every decision is made based on $$$$$'s and even unit managers are being asked to cut back thier hours they must work one lest day a week and claim it as vacation and the assistant maneaers are now the Charge nurses and so on it goes. Do you think Donald Trumps business are run like this???? I think not, I think a great business takes care of it's employees. It makes sense, you treat your employees like gold and they will give back a fortune and we might even act like our Hospital is Disneyland, and then business would be so great because the nurses and physicians would have a say in hospital policy.... I'll keep dreaming.......or maybe I'll become a hospital administrator and try and change things, hmmmmm doubt if that would work they would fire me as soon as opened my mouth:rotfl: .

Ya I do feel that way more days out of the week lately. It is truly easier doing everything yourself. Then there is no one else to blame for he mistakes...

If you were to step into someone elses shoes you might have a different perspective on the role of a nuses assistant. I am a pediatric nurse of 6 years and I do not remember the good 'ol days without nurses assistant. Our hospital recently decided to cut a little budget and got rid of ALL our assistants throughout the childrens hospital and they are working on removing them from the adult hospital as well. O.K. so I don't really miss the days of frustration when I couldn't find my assistant or she was sittin' in the hallway drinking her coffee while I wiped away my sweat and complained every running step of my day that they just don't know what it's like to walk in our shoes...well let me tell you, now that they are gone every nurse is now crying a new song on daily basis because not only did those assistant sit once in a while the good ones, really contributed in the overall care of your paitents. They took care of all the tedious stuff that consumes our time. They were on poop patrol day in and day out, changed stinky, soiled linens sometimes without me asking :) assisted with difficult feeding pt's, helped transfer some and walk others in the hallway...took others to radiology or CT scan when a transporter wasn't available.... I asked some of our long gone assistants if they could have changed anything while they were working with us, you know what most said, "the respect we got from our nurses" and "being treated like a team player instead of a gopher" O.K. so I felt like *&%# ! If only we knew then what we know now, and possibly take a closer look at what they really DO for you and not focus on all that they DON'T, and once in while give them the ackowledgement they deserve, they might work harder to be your partner and not your enemy. They might even work with you instead of pissing you off all day long just for the entertainment of seeing your eyes buldge with rage. Take it from someone who now must wipe the poop off the walls and the patient too, and now has deliver all trays, feed the patient and change all linens too, empty urinals and whip up the rest that spilled all over the floor,....need I go on. Take it from someone who now must juggle the critical thinking and true nursing care of patients with what most patients view good nursing care.......bedside assistance with ADLs. They truly make a diffence in the world of nursing but they must be nurtured and treated like they matter to you and your patients. They are task oriented and need guidance in their daily schedules. But they also MUST be treated with respect. You scratch thier back...watch out, they might surprise you and scratch yours back. Someday you might have to work without them...be careful what you ask for. P.S. this doesn't apply to those that need to just find a new profession altogether. Some are just not fit for nursing.

It sounds like your deciding between reputation and size...Well you will probably have a better opportunity to experience caring for more acutely ill children with an array of dx's in the larger hospital with a great reputation. But reputation definately has it's expectations for nurses too. I have been a peds nurse for 6 years and was having the same dillemma when I graduated... PICU or PEDs I wanted the status of being a PICU nurse and having the knowledge of taking care of critically ill pt's, but as a new grad I didn't feel I had the assessment skills necessary to care for those patients, even with a long orientation. So I decided to work in general peds first. Now I do both and really really think that was the best way to go. Working as a general peds nurse first allowed my skills to build with experience of caring for children at all levels of thier illness and it made my assessment skills much sharper. I know what a child looks like through the progression of their illness. Newgrads who start in PICU usually have an excellent orientation and the nurses will most likely hold your hand until you feel o.k. to stand alone. Either way you go you will have a great experience and learn more than you ever imagined. I think as a new grad you should begin your career with stepping stone. Don't be in such a hurry. Learn everything aspect of Pediatric Nursing possible. You might find that neither one of those departments is not quite what your comfort zone is and decide that your better suited in another area such as NICU (which is an extremely controlled environment and very structured, more so than any other dept) or maybe even L & D. Always keep your options open and be flexible to learn something new. Children are amazing and caring for them, no matter how sick, will change your outlook on life. Where ever you start in your career will not be your ending place, it is just the starting point with an endless journey, so follow your gut feeling and go for it. -Dawn

We have a CNS who helps track the infection control of our PICC lines. Unfortunately, my hospital considers thier budget more important than anything else. I am a floor nurse that wears Many hats. Sedations, PICCs, Procedures and anything else that may arise. But in Peds our outpatients will preschedule PICC placements as a Short-stay admission because most will usually require sedation then they get to go home after confimation with Homehealth followup. The number varies with the season's I usually do about 10-20 a month inpatient and out patient combined. You are very lucky to have a set schedule and actual position, our hospital just thinks I have a free open schedule... YOU ARE VERY LUCKY!!! Keep up the good work:balloons:

One more thing. The most important part!!! Sedation! In my personal opinion, no one not even adults should have to be anxious, scared or have sugnificant pain related to the insertion of a PICC line. So in addition to our peds pt's getting picc lines placed the success is due to two things: 1. an experienced PICC nurse with excellent IV skills and 2. a cooperative patient (that does not move during insertion) which is very difficult in children...so we schedule the insertion with our Sedation Team and our ChildLife department, together with distraction and either the use of moderate to deep sedation for the insertion we have become highly proficient and hugely successful in PICC in children. The use of sedation has so many benefits which ultimately out way the risks of the sedation itself and the pt experiences less trauma, decreased insertion attempts, successful insertion and the family is not stressed out! -Dawn

Well this is a very HOT topic where I am from. I have been a Pediatric RN for 6 years and have fought tooth and nail to have RNs certified to insert PICC lines in our pediatric population without having to go to Fluro. We have in years past had a couple PICC RN inserting line with poor success rates and the patients ended up in Fluroscopy. Our Fluro dept has a rule that any Peds patient requiring a PICC line must have previously unsuccessful attempts by the PICC RN, and then they will accept the pt AND ONLY the Radiologist will insert the PICC with Tech assistance. They do use a "ritesight" (ultrasound) sometimes but most of the times they only use contrast and xrays for Tip verification. But now back to the RN placing PICCs. over the past 3 years I have been placing PICC without the use of ultrasound and now use a MICROINTRODUCER! Which has changed the world of PICC insertion in the pediatric population. We have 10 PICC RNs for Pediatrics (not including NICU PICC RNs) We have a 98% success rate for insertion and have decreased the number of attempts because the ease of the Microintroducer. I can give you more information if you would like it. Hope this helps!! -Dawn