RNDance

No one who has started out as a new grad in ICU ever agrees. Some do well but I am talking about the learning curve. Talking about the beginning, not "several years later." I can't tell you how many times I've had to start IV's, put in "difficult" foleys and NGT's, and countless other "tasks" that, IMHO, are basic and should be second nature to anyone entering the ICU. Need to be "nurturing," of course but I'll tell you, it's gotten mighty old. Frankly it's a pleasure to see the tide turn back to hiring experienced nurses in the ICU again. It's nice to be able to compare notes with experienced nurses, see how they've done things in other places. It adds real life knowledge to our communal data base and benefits us all. And honestly, having lived through the shortages and the gluts, the truth is that new grads were hired in the ICU because of sheer desperation, not because anyone thought it was a particularly great idea. No sense going down this road, again. We're all entitled to opinions and I imagine that there's no way some would be open to considering that hiring new grads in ICU might not the best thing.

Is there anyone who will admit to the fact that they really do believe that new grads should not be hired directly into ICU? It is such a horribly steep learning curve, from dealing with physicians and families to handling tremendously technical tasks quickly and efficiently. Take the time to learn the basics in a slower-paced environment. Learn to put in NGT's, PIV's, foley catheters, etc and become proficient at it and come on board with more than a "oh I did that in school" level of skill. Learn how to react in a code (through experience, not online tutorials) and learn how to deal with idiot residents who give dangerous orders (this skill may save your patient someday). Yes, it MATTERS. Sorry, I know this is not a popular opinion these days but what I see going on now (less so lately, since there is no longer a nursing shortage) is downright scary.

It just looks like "padding" to me. Hey, the recruiter knows that you're a new grad and that you had clinical experience during nursing school. LOL---if you didn't then THAT would be worth noting. You are what you are. You're not going to make yourself seem like anything special by fluffing out your resume with filler. You might even succeed in annoying a recruiter---they have tons of resumes and applications to go through and the rule is to keep it short and sweet and relevant. Nurse recruiters and managers know what kind of education you received simply by noting what program you graduated from. I honestly don't think you'd be adding anything by listing clinical hours, course by course. JMHO....

Because if you don't then you're not opening the path to the transducer and you can't get a reading unless the path from the particular port is open to the transducer. It's like completing a circuit. When you move the stopcock you interrupt one "circuit" to complete another. It's just a function of a multi-port stop-cocked system---not really a big deal if you think of it logically. Basically just a plumbing issue. I suggest that you go over the construction and function of the PA cath to really get an understanding of how it works. Once you grasp that I'm sure everything will fall into place for you. I've never heard the rationale for not infusing through the CVP port and frankly, we do it all the time---you obviously have to have the IVF turned off at the time of the CVP reading and for zeroing the transducer to complete the transducer "circuit" so I'm confused as to why that would even be an issue. We also use a CCO machine (Vigilance) and occasionally still do bolus CO's.

I would stick to the ones that are sold on the AACN site. They know what's on the test and they gear their learning materials to the test. Years ago, when I took it, they offered a floppy disk (do NOT laugh---LOL) that had questions related to all the different areas of the exam. You could take a quiz related to a specific area of the exam (cardiac, endocrine, etc) or take a 200 question mock test. It was a great learning tool because they provided rationales with each question and also told you why the wrong answers were wrong. Not sure if they have something similar now (it would NOT be a floppy disk, LOL) but if they do it would be really helpful. Good luck with your exam!

That's ridiculous. I've worked in ICU's for many years and there is no way that I couldn't get a group of co-workers together to help lift a heavy patient. And yes, my co-workers certainly do pitch in---if for no other reason than they know that the help they gave will be returned in kind when they need it. We routinely have patients weighing over 300 pounds and it is not unusual for us to have patients weighing more than 500 pounds. We alll help each other. On the rare occasions where we have a CNA on the unit he or she pitches in too. Yep, we have a few elderly ones who can't lift but really....some have been lifting for thirty or forty years and we treasure what they are still able to do but don't ask them to kill themselves by lifting a heavy patient. It's just human kindness, from one human to another. Try it once in a while, instead of being so incredibly angry about being so terribly wronged. BTW, I usually make a linen bedroll and wash the front of my patient myself, even if we have a CNA. Then I call someone (or several people if it is a bariatric patient) to help turn so I (yes, ME MYSELF) can wash the back of the patient (great opportunity to inspect the skin) and put on the new linen. We also do all our own labs, wound care, dressing changes, foley insertions, etc. Never worked in a place that had techs, LOL. Amazing what you can do when you have to. Frankly, I wouldn't want a tech doing my dressing changes or much of anything else beyond assisting me directly (that means with me in the room!) and stocking supplies. I want to know what is going on, first hand, and with a max of two patients in most of the ICU's I work in now I feel that it's my duty to know. Methinks thou dost protest too much, Girlygirl. :redbeathe

Rest assured, Girlygirl. There is no danger of you ever being accused of being a Super Nurse. And I'm curious---why would a patient have to be re-intubated after an ETT migrated 2 cm? Sounds like a matter of ETT adjustment and re-taping, if anything. 2 cm is not even an inch-worth of movement. Most ETT are anywhere from 22-26 cm at the lip. A movement of 2 cm is not worthy of re-intubation. Sorry, but this whole thing is just turning into a really weird b***h session with some really questionable posts here.

THANK YOU for pointing this out! We use Flo-Tracs fairly frequently on the critical care units on which I work and I can't tell you how many times medical personnel (including MANY residents) will point to the SVV and declare that a patient needs or does not need fluids based soley on that number. Sometimes this will be a patient who is not even on a ventilator at all, much less 100% mechanically ventilated. If you watch the SVV numbers on a patient who is 100% ventilated in control mode you'll see that they are pretty steady. With a patient who is not you'll see wild SVV number variations. Just not reliable at all. I carry a print-out from Edwards explaining what the numbers mean and hand out copies to anyone who wants them. What the heck....I work in teaching hospitals. :)

Huh? Your post makes the assumption that any nurse who has been a nurse for a long time is out of the loop as far as technology goes. Wrong, dear. It's not an "either/or" thing when you're talking about "young" (read that "inexperienced") versus "old" (and you can read that "experienced"). I have been a nurse for over three decades. And oh my yes, I can charge my own cell phone (@@). I can also set up and run CRRT and work with IABP's, HFOV's, independent lung ventilation, and have worked in CVICU's and with solid organ transplant patients. Oh....and a burn unit and as a crisis nurse and a Code Blue leader. I've had my CCRN for many years. And yes, I am one of those nurses who people LOVE taking report from. Newbies? I've gotten hugs from them after I took report (oh Lord were they EVER in over their heads but jeez....coudn't help but feel so bad for them), been named in the unit "thank you" board as being a huge help to them, etc, yada yada. I could go on but gee whiz, it might upset some who think we dinosaurs should pretend we don't know anything so the newbies won't feel inadequate. Rest assured that I do not need to validate myself by belittling any new nurse. My experience, knowledge, and expertise are validation enough and stand on their own as testimony to what I am as a nurse. And btw....nursing is not my life, LOL. Got a nice one of those, too. Generalization is a hazardous thing, going in either direction. Any nurse, young or old, is an individual and should be treated as such. Girlygirl, I am sure your true feelings shine through any facade of pleasantry that you might think you are projecting. How sad for you.

I would call it, politely, a "mixed unit." In other words, be prepared for anything. I've worked in mixed critical care units in the past and it can make for quite a wild ride, lol. Great learning experience, though, as long as you're working with other great nurses. The most fun I've had at work has been in mixed units, when I think of it. Specialized units seem to get really boring really fast, IMHO. When I worked strictly in MICU I thought I would scream if I saw another septic patient or another GIB. These days, though, we don't have as many choices as we did years ago when we could bounce from job to job, secure in the knowledge that the nursing shortage would allow us to go wherever our hearts would lead us. I like mixed units but in most larger teaching hospitals the units specialize. Sounds like this could be a little bit of everything. I'd take it. :)

Sometimes it's just time for a change. As others have said, have a new position lined up before you jump ship---with the economy what it is it's not a good idea to leave any job before you have another. Whenever I've left a job in the past I've made a list with two columns. One column lists "reasons for staying" and the other column lists "reasons for leaving." When the reasons for leaving number more than the reasons for staying or hold more weight, I put on my traveling shoes and start looking for a new job. Good luck to you! :redbeathe

So what's happening with the negotiations for the upcoming contract? From what I have heard the prospects are not good. Can you make me smile this morning?

With all due respect, you are NOT a nurse (yes, I looked at your other posts---not even a nurses aide) and most certainly do not have the knowledge to evaluate what was going on that night. Others here have given you possible explanations for the issues you found so deplorable. And if you were so concerned why didn't you bring up your concerns, right there and then? A few simple questions at the time might have addressed your worries. Nope---instead you had to run to a public message board to condemn a "rotten" nurse. And you just sat there for an hour while Granny "vomited violently"? Most people would have at least gone out to the nurses' station for help. Nah....I don't buy it either.

Okay, probably going to get smacked for this one but here goes. Yes, I am one of those "older nurses who should retire" and who no doubt has been accused of "eating the youngun's." PUHLEEZE. As previously stated, grow a pair (or bulk your pair up if you are a male) and go on. Seriously, I attribute some of the whiney stuff to the newbies having grown up in an environment where continual praise was the norm. Kinda like the GCS---you get a "3" just for showing up but it doesn't mean much. It seems that everyone gets an award for just participating whether or not they actually do an award-winning job. So when someone points out that perhaps they are not all that wonderful (you may read this as "downright dangerous") they get their feelings hurt and blame it on the messenger. After all, nobody else ever has told them that they weren't shining stars. Then again, real lives were not hanging in the balance. Actually, I've never been accused of bullying, never been reported to a NM for making someone cry. But I do know some who have and I've been an eyewitness to the events surrounding the reports. In all instances I was totally amazed that the "injured" party thought that the situation was reportable. In all instances the "offender" was trying to STOP the newbie from doing something that would have caused harm to the patient. Was the "offender" abrupt. Hell yes---had to be, to prevent harm that was imminent. As far as the newbies being innocents in all this? I've had more than my share of derogatory age-related terms tossed my way. Did I report them? Nah. I consider the source, file it, and pull out that file when the time is appropriate. Paybacks are hell.

The facts: Hawaii is overloaded with nurses and jobs are hard to land, even for experienced nurses who already live here. Residents get preference and here's why: mainland transplants are notorious for staying here for a few years and then going back to the mainland. Hire our local nurses and the odds are they will stay forever. I have held FT positions in several hospitals here on Oahu but I have also worked in other hospitals and done agency work too. The use of travel nurses has gone way down and is avoided if possible. You will find them working in the units and floors that are hard to staff (mostly because of poor working conditions or management issues---you can read that as "nobody in-house wants to work there and travelers are a captive audience"). They also lose hours when the census is low. From what I have heard from travel nurses the housing provided by the agencies is sub-par. There is much crummy housing on Oahu and you will certainly not be put up in luxury accommodations as are often shown on the travel nurse ads. I am new to this forum but I took a while to read the boards and especially the Hawaii board. Why do people from the mainland seem to have such a hard time believing that things are the way they are here? It's amazing to me. Makawiliwili, a question if you don't mind? Where do you work that they are still using travel nurses and hiring? In my hospital we no longer use travelers on our unit and are not replacing nurses who leave. We are using more call-ins (occasionally agency nurses) to fill in. We are also sending nurses home when the census drops (without pay if they have no PTO left). Those with the lowest seniority are sent home first. They often have the least amount of PTO and I have seen more than one go back to the mainland when this happens consistently. The cost of living is extremely high here. New grads are not able to find jobs here and I know many who have had to relocate to the Mainland to find that first position. The unemployment statistics do not apply to the nursing field here. It is a unique situation and it is real. Sorry for my very long post, LOL, but after reading so many posts where people seem not to believe what's going on here I think I had to vent! :)