Jedi

Sounds good, but... Make sure your orientation is based around your experience level. Have you been part of a teaching hospital situation before? If the level of care is higher, Level 1 trauma center and you are not used to this level of care, then I might want more of an orientation. If you already have ICU experience, etc. If you have never had ICU experience, then it is not enought time for a teaching hospital. I'm not sure how much is standard for teaching hospital ICU settings these days, but ask around. If you are new to ICU, I'd be looking to at least double that orientation period. Make them agree ahead of time. The old, we'll see how it goes usually means it's never extended unless you are considered a "problem" and sometimes it means the orientation is shortened. :)

HI - Back in nursing after 6 years out. I think some books are outdated. I'm not sure. I wasn't satisfied with the answers from my "newbie pharacist", he gave me to the more experienced pharmacist which I appreciated. Re: Gangcyclovir: The phcst. told me that I did not need to administer it with a filter. He also said that it's not really a chemo drug and that only older pharmacists put the "CHEMO" sticker on it. He said to wear gloves because if it got on your skin it it as irritant. This, of course, did not match my 2003 Davis Drug Guide. I have a new Nursing Drug Guide 2005, out in the car?, somewhere? What is your experience with Gangcyclovir? In this case, it was being used on a pt. who was s/p respirator arrest, +VRE, +MRSA, +C-diff. What a mess, eh? Yes, there was a rectal tube in place already, thank heavans. I believe it was for CMV, Epstein Barr, or prevention of infection by a virus due to immunosuppression. The guy's foot started bleeding after administration, in the area of a dry gangrenous toe that vascular surgery was monitoring to see if reperfusion would occur. I did mention this to the intern thank goodness. The guy had also had an alveolar hemorhage which had given him a pneumonia, he was status/post respiratory arrest w/ intubation and then BOOP, which, I think is the newest named pneumonia 2ndary to being on a ventilator. Needless to say, the pt. had a very involved differential diagnostics going on and he was on our tele floor 2ndary to Atrial fibrillation. Arrhythmias are listed as a side effect of Gangcyclovir. Do you see this occur with use of this drug? Please - all you hem/onc nurses out there, I'm very interested in your input and comments. What a case study, eh?

:yeahthat: OK - let's get back to basics here. If we're going to talk about losing a license, then it's best to think like a lawyer! First thing is this - Request a written copy of the hospital policy on floating nurses to other units. Also, ask if there are policies for the specific units that you would be floated to. I have heard that nurses that go to different units can act as "nurses". If they are not trained in a specialty, then yes - it would seem logical that you would be assigned a nurse to report to in the case that something came up that you did not know how to handle or if there was something that you were not trained to do, then that nurse would handle the procedure, assessment and determine how to handle the situation. But I wouldn't assume anything. I would want to see the policy for that unit in writing, otherwise, you don't know how to operate on the floor. Another note - If this happens, I think it would be best to NOT FREAK OUT ABOUT IT. I think it would be best to go back to the basics of nursing. You do your assessment, you pass the meds you are trained to pass (obviously, you can't give chemo if you are not chemo-certified) >>>>> BUT MOST IMPORTANTLY > > you are a patient advocate. If something goes wrong, you do something. If you don't know what to do, you go to a senior nurse or the nurse you are directed to go to for help (charge nurse). If her solution remedies the problem, you are fine. If it doesn't, let her know you are uncomfortable and want to notify an MD to cover eveyone (most importantly, your patient). If you can't get a doctor, get the AOC (Administrator on call). Above all, I would remember that your title is Nurse, Registered Nurse. It's not Super-nurse. It's not "Nurse - Alone Nurse", nor "Nurse that acts in a vacuum nurse". Healthcare is a collaborative practice. You are out there to monitor your patient. The decision was made to float you to an unfamiliar unit, therefore it is only logical to expect that you would need to lean on your ability to collaborate with other staff RN's, doctors, administators, when you are put in this situation. Whatever it takes maintain the health and welfare of the patient. Now, there is nothing wrong with giving feedback to people about how your assignment went. If you are telling people you are uncomfortable and they are giving you feedback that your performance was OK, then it's probably just your own jitters that you need to keep under control. If they think your performance was rotten on that unit, then make a written request for training in that specialty. You might want to request the training if they thought you did fine or not. Sometimes you have to be assertive and exercise your rights as not just a nurse, but as a basic employee in a hospital setting If you put something in writing that requests training and the hospital floats you without the training, then it makes the hospital look more liable than you, basically revealing that they make a practice out of making innappropriate float choices. Put them back in the legal hot seat. Believe me, they will understand when paper comes to them to deal with, but it's a position they put themselves in and the ball is in their court. They may not like it, but you can just tell them that you feel you need more training to properly care for patients on this unfamiliar unit. No more, no less, don't get bated into an arguement that could cost you your job if you want to keep it. Sometimes, if you say the same thing over in different ways, they might stop asking you the questions. You can always say, "I'm looking to expand my abilities as a nurse and I see this float situation as a perfect opportunity. I think it will only help me to be a better nurse on my current unit and a more experienced team member on any unit that I work on for this hospital. It's the best way I can serve my patients". If this prompts the hospital to re-evaluate their own floating policies, so be it and I'm sure patients will be safer in the end. If the situation gets to uncomfortable, I'd ask to transfer to a different unit. If you want training on that unit, ask to transfer to that one, because then you'll get the proper training. Always good to peruse the job ads and it never hurst to network and go on interviews, whether you intend on leaving or not. Hope this helps some. Word of caution - Be careful about boat-rocking too much if you can't afford to be out of work. But if you were to lose your job unexpectedly, I think another hospital would respect your choice. You just have to tell the story properly to make sure you look responsible and wise in your choices made.

I hope everyone gets a kick out of this. I just finished a refresher course and had this great instructor who worked in ER for a long time. She told us certain things should always be in our daily plan of care for a patient and if they were you could not go wrong. Someone else made an acronym of the points that goes like this: S 'n' M Excites Frank! Ha ha ha ha Safety, Nutrition, Maslow's, Mobility, Elimination and FluidsIt's more like S 'n' M(squared) Excites Frank! Frank must be a pretty kinky guy! Can you tell that the nurse who made up the acronym had been a psych nurse for many years! Anyway, from a practical point of view with nursing, it works. It gets the patient through the shift. Safety is always priority, because if your patient isn't safe, then you will be writing an incident report and too many of those means you won't have a job and your patients are probably walking around with a lot of bumps and bruises. Mobility is huge. Even if a patient is bedridden (say a stroke patient), then you better be rolling them around to make sure they have good lung expansion on both sides. (ABC's!!) Think circulation when thinking mobility also, in regard to risk for blood clots (possibly another stroke, heart attack, DVT and PE- pulmonary embolism). Circulation again - in regard to potential bed sores. You may not see the damage to tissue, because it's happening below the surface. Next thing you know, whammo - decubs! Turn, use pillow logically and use the bed booties. If the patient can be mobile, even up in a chair, then get them there as long as you have a doctor's order to do so. If you aren't sure because the patient just came in or they are getting weaker fast, then get that MD to order a physical therapy evaluation. Until then, have that patient turning. There are always those difficult calls, say an Alzheimer's patient who has a history of falls and is weak, but you don't want them to get weaker by keeping them in bed. The last clinical I had recently, the RN wanted the patient in a chair, so did I, the care assistant wanted a posey on that patient if they were going to be in a chair. I cringe at using restraints, but sometimes they are warranted. The doc knew the patient from the nursing home and ordered a posey while in the chair and an order for PT. Other option, get on the phone and have a family member stay with patient so they don't have to be posied. Now, you just have to see if they try to climb out of bed also and get an order for posey in bed if you have to. Ahhh! I hate restraints! It's a difficult balance, but I have to always remember that my shift is not the only shift of this patient's life. It's a collaborative effort, so do what is good for the patient now with future goals in mind. (In this case, PT). Nutrition is very related to strength and diagnosis. In the case above, you'd see how you need good calorie intake to keep a skinny little old man from becoming more weak. Then, what do you always need for old people? - If their diagnosis doesn't contraindicate it, fiber doesn't hurt to keep the bowels rumbling around. Mushed up food is not as palatable as regular food, so give it to them if they don't have any swallowing issues. (ABC's - A&B apply to people who can't eat well because of a stroke, no teeth, etc. Speech evaluation if you notice coughing. Don't want to give anyone an aspiration pneumonia!) Water is a part of nutrition that overlaps with fluids. Cleans your palate, and your mouth, prevents nasty infections in your mouth (along with teeth and gum cleaning in the morning), prevents dehydration and keeps the bowels rumbling once again! Do they need supplements. Is their neutrophil count low, (so they can't have fresh fruits, salads, and no flowers in the room because they are on reverse isolation). Do they need free H20 or juice (depending on their sodium level, are they vomiting or having diarrhea). Can they hold the fluids and food down. Do their bowels need a rest with a liquid diet (i.e, acute colitis). Do they have the gag reflex? Do we need to get their bowels woken up from anaesthesia by starting them on a clear liquid diet. If they need potassium, can you give it to them orally. If their potassium won't come up, do they need Magnesium? If they have asthma, do they respond to magnesium supplementation. How's the Calcium level? K+, magnesium and Calcium are all absorbed well in the gut. Their levels are all related and contribute to good muscle contraction and heart rhythms. Do they need low vitamin K, because they are on Coumadin. In this case, get a dietary consultation for patient teaching, give them a hand out and teach, quiz, etc. Use your common sense and learn as much about nutrition as it applies to the particular diagnosis. You will learn a lot here and it very much relates to fluids (riders and electrolyte balance). Maslow's always needs to be included. You need to see what level your patient is at and then get to that level with them so you understand how you will communicate with them, give them what they need and do your teaching appropriately. Elimination is very related to mobility and nutrition and fluids. How are they going to get to the bathroom? and getting there safely?, or do they need that commode or a bedpan. Think logistics and need for mobility tempered with safety and reality. They are not going to be in the hospital forever! Are they eating enough to even make a bowel movement? (I hope so, if not, then that is the goal). Do they have enough fiber, oral fluids and mobility to keep them regular? Do they have a history of bowel obstructions? Look at their baseline, complications, patterns of output and goals. Are they post-surgical. If so, do they have bowel sounds, gas, cramping? Have they urinated?, Is the suprapubic area hard, distended? Do they need to be straight-cathed to see if their kidneys are making urine output? Do they need fluids, are they 3rd spacing? ** I have learned how important 24 summaries of I's & 0's are! Review them. Learn their importance. This is a primary nursing responsibility. You are the first person to notice changes and should try to recognize situations where I&O problems are apt to happen so if they do, the problem gets moved on right away. It never hurts to have a doc review this if in doubt. You'll end up learning more when you ask the questions also. *** Do you see how this all has moved very to Fluids? - OK, be aware, I went off on this subject. Stick to the basics. Fluids are complex. It's good to poke your head in books, talk to the nephrologist, talk to the cardiologist, read about endocrinology. This is the cellular level of nursing and medicine, but there are also some basics to always remember and that's what goes into your care plans. Always know why they are getting fluid and why THAT PARTICULAR TYPE OF FLUID. Ask the doc if you can't figure it out. No use beating your head against the wall, right? We are here to learn and no one is a brainiac 24/7. The part about care partners will not affect you until you start working. The stuff about SIADH, try to learn it at some point. The inter-relation between the endocrine system and fluids is very interesting and really comes into play in cancer and post-op patients. Learn about antidiuretic hormone at some point and understand its importance in fluid balance.) Fluids include ORAL, G-tube, NG-tube, intravenous, intra-arterial, intraosseus, intrathecal. Per my Med-Surg book, 2002 Ignatavicius and Workman, Med/Surg Nursing, Critical Thinking for Collaborative Care. . "These solutions and medications may be administered for therapeutic or diagnostic purposed, including the following: Replacement of fluid, electrolye, and nutrient lossesAdministration of anti-infectivesBlood and blood product transfusionsAdministration of enhancing agents for diagnostic imagingMy notes from class say are more general:1. Maintenance/ of daily fluid requirements Learn the difference between crystalloids and colloids. Understand what isotonic, hypertonic and hypotonic is in terms of osmolality compared to the osmolality of plasma. Memorize what kinds of fluids are isotonic, hypertonic and hypotonic. Begin to understand what fluids are used in what situations (chronic and acute situations) and learn why. Learn the different blood parts/products, when they are used and why they are used. 2. Replacement/ of loss of fluids - drains, insenisble loss, diarrhea, wounds, bleeding. 3. Treatment - used as a medium to deliver therapy, e.g. (K+, antibiotic, hyperalimentation.) 4. Diagnosis - used as a medium to deliver diagnostic dyes 5. Palliation - used as a medium to deliver pain medication, nutrition. Do the 24 hour review of fluids. It is every nursing shift's responsibility. . Do not getting the habit of slacking in this area. Too many things are missed due to this and they can be things that are critical. If things look imbalanced, investigate why and ask yourself if the problem is being addressed. If it is not, then do what you can to correct a problem and/or notify a doc for further evaluation. Just remember to think of what a typical patient that has same diagnosis would look like. If you don't know that, now is your time to find out, so look in your med/surg book. Then make sure your care plan addresses whether or not the patient is "balanced" fluid-wise or not. If yes, then you can always write done "potential for fluid and electrolyte imbalance" if that is a common problem for this type of patient. Then you just write - monitor labs results for electrolyte abnormalities and monitor I & 0's for imbalances (over or under hydrated), or you can write "take off orders for blood draws to monitor fluid and electrolyte status and make sure they get drawn and lab gives me a result. Report abnormalities, institute oral or IV therapy as appropriate or as ordered." Then or course, give every way you can do it orally before resorting to IV if oral is not contraindicated. Here are some typical I & O situations:Think about who is at risk for dehydration and why? Think about who is at risk for a fluid overload and why? Is the Na+ level high or low. If they are dehydrated, is it because they are putting out too much fluid or have diarrhea, or because they are not taking in enough fluid. Their mental status and energy level is very affected by fluids. When was the last time you were hot and didn't drink water regularly for a few days. Did you feel like doing jumping jacks, doubtful. If they are post-surgical, watch for adequate urine output and mental status changes. **Learn the dangers of D5W post-surgery and in general, how it can contribute to cellular swelling and increase intracranial pressure. Read some cases studies on this.** Is there some kind of problem that affects them in which they cannot eat or drink (mental or phyical problem)? If so, when are the fluids going up. Watch the K+, Ca+ and Mag+ levels. Always remember that K+ is a drug - too much can make your heart stop. If a K+ rider is needed, best given through a large vein with a small gauge IV catheter to prevent pain at the IV site. If lidocaine is added, realize it can mask pain, so watch that IV site. Lidocaine is a drug too. Become aware of it's affects. If K+ needs to be given, can you do it orally or through a G-tube rather than through an IV. If the K+ level will no come up, get a Magnesium level. (K+ will not come up if Mag is too low). When will this happen? In patients with lots of watery diarrhea. Get a fecal incontinence bag on those patients. You need to know how much fluid they are losing in order to replace what they are losing AND give them their daily requirements. Look at the output. Is it "sick" looking? Diarrhea, bloody stool, steattorhea, solid as a rock, C. diff green and smelly, yuk. Urine - is there enough? Is it smelly, is it concentrated? Does it have while blood cells in it? Is my patient eating any fruit (water content?), drinking, do they have good peri-care if that foley is in. If they have a suprapubic, is the site red, tender, distended? Is my patient so big, peri-care is difficult? If so, get however many it takes. Do they have to have that foley? Does my patient have a fever? Are they losing fluid in sweat, insensible losses. Do they need replacement fluid on top of that? Lungs - does my patient have CHF? are they coughing? Do they have crackles or rhonchi? Make them cough. Does upper airway congestion clear? Does the crackling clear? Do they need some Lasix. Are they edemetous? Are they on fluids and getting overloaded? These are the extras: ----- If a care tech isn't getting it done, tell them it is imparitive for care. Is this a problem for all the nurses? If so, maybe all the nurses need to bring this up at a meeting. If it's just one care tech for everyone, let the super know. If it's just that care tech with you, let them know that your nursing care needs to look good, if they are not being responsible and in doing so, make you look bad to the docs and your supervisor, let them know you're going to have to say something to someone because you can't put your job on the line. (You can't let negligence to duty go and letting it go makes you negligent and on the hook for it). If there is a legitimate excuse or you can estimate output, put something down rather than nothing, but put the reason why it is not exact. (Used the toilet before hat was given. Pt. took hat out of toilet.). Try to write down the number of voids at least. But don't completely guess at cc's and never make up anything! Let the next shift know exact I&O's weren't obtained and that you have told your partner you need exacts now. Write an order for strict I & O's if you can. Get a doctor to order it. Get those I's and O's going. always, if you empty something, record what you emptied and communicate it to the partner somehow, flowsheet is the best way. So many patients need I's and O's and considering how sick most patient's are, it's unusual, in my book to see someone who doesn't need them. (At least on a med/surg floor). The patient didn't just come in with nothing going on. If they were well enough, they'd be at home or somewhere else. If they can't be somewhere else, then things are out of whack. -------------- **Learn about SIADH** Syndrome of Innappropriate ADH, watch for low Na+ levels. It is complicated, so take some time to undestand it and read some case studies. I had a patient with this and then his mental status went bad. He was taking Ambien at night, so I thought he was just tired in the morning, thought I'd let him wait to do that wash up. Nope, bad idea. He was actually becoming somnolent. When someone is falling asleep right in front of you mid-sentence, it's a problem. EKG showed heart block, we sent him to telemetry. By the way, his foley looked like a Mai Tai with Oxi-clean in it!) This guy had been on a fluid restriction the night before and had a 250cc bag of 3% saline up over the day prior. Not .3%, 3.0%. In the morning, I did notice that no one had taken the water pitcher out of his room. (That should have been a clue to me right away that the care was not on track. When I asked him about his fluid restriction, he told me no one had told me about it. Here's another clue.). This guy was a confabulater. He would tell me anything to make things seem OK and was not concerned about anything despite the fact that he had been in the hospital for days, hadn't eaten well for awhile and had cancer. Hmmm... something was wrong here. Yes... it was his mental status. Sometimes it's hard to get a grip on. When in doubt, ask your peers, a more senior nurse who has time to help, if not available, a supervisor, if not available, a doc. What did the nurse who gave you report say? Read the chart, when in doubt, call the doc. Sometimes you don't have time to figure things out on your own. Call the doc. Make sure you have an assessment to report before calling and let them know that you aren't sure if this is their baseline if that mental status has changed. Better safe than sorry. You do work for the patient, remember that. This guys was starting to have mental status changes due to cellular swelling in his brain. Yikes, that's a situation that deserves a monitors if not the ICU. Remember, I'm a nurse with just 3 years of experience, or just 3 years of experience, however you want to look at it. Geez - I better get off my butt and start working on my resume and looking for a job, eh? Good luck. Hope I was helpful. (and not confusing. Things come with time. Just learn it as it applies for your care plans. Learn it like a lecture/class when you are in class and studying for tests. ??‍⚕️

Thanks Nancy! It's very hard to let that bad experience go. It really does haunt me. I'm very lucky in that I have a very supportive boyfriend who tells me I am brave to go back. He had a bad experience in his industry, and despite the fact that he loved what he did and was rated #3 in the country for operating certain types of equipment, he can not find it within himself to go back. I think more nurses should not only be good nurses, but "good people and coworkers" while at work. One thing is for certain, if you changed careers to get rid of office politics, forget it, because office politics are everywhere! Best to take the high ground 100% of the time and always stick up for yourself and look out for your own best interests (in the way of your career).

Thanks Brian - I had my own bad experience with Celebrex. I stared having problems breathing and had the "impending sense of doom". It was very frightening. I called a friend who lived close by. She came and stayed with me until I started feeling better. I never took the drug again. That was years ago. I hope that nurses who use Bextra at work talk this issue up with doctors to see if there is a different drug that can be used. It's not worth it to wait and see if something bad happens. We should all pay attention to these kind of warnings and try to move to different drugs that are safe and get the job done. Thanks

Hi C - I switched careers to go into nursing. My regret in regard to nursing doesn't have to do with nursing, but rather my choices after graduation. I went from a very good nursing school to a community hospital with dangerous RN to patient ratios. This hospital also did NOT contribute to RN's furthering their educations. I did this in order to get the best rate per hour, free parking and a great view. I also wanted to experience working in a Catholic hospital. Some of the experience that I got was great. I really enjoyed working in a Catholic hospital. I experienced great autonomy and a great working relationship with doctors. My boss was incredible. (This is part of the reason I took the job also). I ended up staying in med/surg too long, after my great boss left. I should have stayed 1 year, then moved on to a specialty area. I had the smarts and motivation. Unfortunately, I didn't work at a hospital interested in cultivating their RN's by furthering their education. In fact, the hospital I worked at was involved in a financial scandal that involved tax evasion and embezzlement by the CEO. That all unfolded after I left. So, I moved to a hospital that was unionized to get higher pay and educational benefits. I liked the unit manager. Unfortunately, she was not my supervisor. In fact, I had THREE supervisors who should have been named Moe, Larry and Curly. (Can we say "too many chiefs, not enough Indians"?) I did not like that scenario at all. I'm sure it works for some, but I did not like management crawling all over me for silly reasons, e.g., asking questions during report, "giving someone a dirty look when I walked down the hall" - (I mean, come on, you call that management?, kind of funny, because I had absolutely no idea when or where the "look" happened, and the manager had no idea either). It didn't help that I got a preceptor who was not interested in teaching me anything. (It came to light per her later report, that she thought that I already had the experience on this type of floor). Kind of scarey that she had been on the floor longer than any of the other nurses and was the union rep.) I ended up quitting after six months of hell. I loved the patients and most of my fellow nurses. I also learned a bit, but not as much as I would have liked. The managers were a little horrified when I told them my preceptor would not review my charting, would not go over protocols with me, would not teach me how to use the monitors to calculate drug dosages, despite my repeated requests. All in all, it was just a really bad, very unfortunate experience that turned me off to nursing for the last 5 years. After being in other fields, I took an RN refresher course, and am readying myself to go back in. I can't stand desk jobs. I did some managing for awhile, but really feel that I have the heart of a nurse. I like helping people. I haven't started interviewing yet, but if I go back to the hospital, I will only go to a Magnet hospital (known for educating RN's) and I will listen to all of those around me who have something to say about different hospitals reputations before I make my decision on where to go to work). I may actually go to work in a non-hospital environment for a short time to get comfortable again before going for the gusto. Nursing has a lot of rewards, but you have to be motivated and stay on top of what is going on in the industry. I highly recommend reading nursing journals and chatting (this is a great forum). If you are a person who excels in a very structured environment, I recommend going with a hospital with "clinical ladders", any place that recognizes continuing education. It may be more satisfying. I wish I would have started out like that. I guess you live and learn.

Hey Plum - Did you realize that your hospital is the one that INVITED JACHO to come into your facility? I just learned that in my refresher class. Hospitals do this for reimbursement and monetary reward. Sooo... if a nurse answers incorrectly, it's a direct reflection on how the hospital may not be educated their staff enough. What a different way to view things, eh? Now I look at JACHO differently when I'm reentering the field. I think I will always be looking for articles to see what JACHO is looking for. They change what they are looking for based on scientific study, so I'm more apt to keep up with reading Nursing Journals (as well as medical journals related to my specialty also. Pretty cool, huh? Jedi May the force be with you!

I considered being a dental hygienist before I decided to be a nurse. What a coincidence. Glad to be helpful. When choosing between professions, I think it is useful to look at the lifestyle you wish to have, along with the diversity of work settings that you can work in. Professional responsibility and of course, stress level of the job should all be considered. On another note, do you happen to know what the difference in pay is? I'm curious. Is there as much of a shortage for dental hygienists as there is for nursing? There's a lot of cost/benefit ratio to be looked at when making your choice. Jedi - May the force be with you!

Please excuse my spelling and grammatical errors. Guess I need to slow down a little! Jedi

Zenman! Great response! Post the personality test when you find it if you do! I'm reentering nursing after being out for 5 years and I'm trying which specialty I'll start it. I've already done med-surg and cardiac and now I'd like to head toward ER, OR or ICU. I want to work in an atmosphere that is really teamwork oriented. Any comments, suggestions, etc? I'd love to hear from many RN's about what areas are seem to be team oriented. Thanks! Jedi

Thanks for the info. Sounds like about 3-4 weeks more "orientation " than what I had. Glad to hear it. I'm told that orientations are longer than they were when I went into nursing in the past. Thank goodness. They were way to short when I first started work as an RN in 1996. I've been out for 5 years and am taking a RN refresher course before going back to work. Jedi

When getting ready to go into anything new, you are going to be impressionable because you have healthy anxiety about knowing whether or not you are making the right choice. This person may think they are doing you a favor based on what he sees in the industry and how he feels about the industry himself. For every one person who thinks you should leave, another will tell you to stay. I wouldn't let one person have a great influence on you. It's OK to listen to what people have to say, and it sounds like you should investigate your own feelings. I wouldn't take one persons words as the "gospel truth". If you really want something, then go for it. "You have to stand for something, or you will fall for anything". Jedi :balloons:

It's about time they are zoning in on the care of ventilator patients. I'm returning to nursing after being out for 5 years. I used to work on a med/surg floor that had special ICU capable rooms that housed "respiratory" patients, some on vents. For the most part, there were only certain nurses that worked in that roomed who really wanted to work there, but sometimes I had to go work that room and did not feel qualified to work with vent patients. I can't recall if I had to work with a vent patient or not, but I had no special ventilator training. I hope these types of situations are declining. What is standard today out there in the field. Are RN's required special training prior to working with ventilator patients? I'm very curious. Jedi