ac3070

Hm, I guess the major differences comes in patient population (really sick vs the spectrum of sick and not sick), continuity of care (do you like having the same patient for a whole shift or do you like to do your thing and send them away?), and your feelings on taking care of critically ill kids (almost) all the time or only occasionally. I worked picu and it was my best job ever. Unfortunately moved away to a small rural area serviced by a teeny hospital and will now be working in the ER with patients of all ages. Good luck deciding!

I must've copied the rate wrong off our board-it is 2.3/1000 days.

It sounds terribly frustrating. I have less than 6 months experience in the picu so this is the only way I know, but I can't imagine mixing drips on top of everything else-especially in the super sick kids on pressors! Our clabsi rate is 1.3/1000 line days; 65 and 303 days since our last two.

Also--I will check our CLABSI rate when I get to work tonight.

Replying from my phone-thanks for clarifying about the bigger solutions being drawn into syringes, that makes more sense. Our pharmacy would still say no way to us doing it ourselves though as I understand that's how it used to be done, many moons ago. As far as the standard concentrations go, the docs do it. We can ask them to change it but typically if the rates seem wacky pharmacy will call them and have it fixed on their own. Our heparinized pressure bags are 250units/500ml. We only use biopatches around port needles-the dressings I'm referring to are these: http://www.3m.com/product/information/Tegaderm-CHG-IV-Dressing.html We also do daily bathing with chg wipes for all patients (central line or not) over 2 months of age.

1) Do you prepare your drug infusions or does pharmacy prepare them for you? If pharmacy prepares them for you, you may or may not have responses for the remaining questions. Pharmacy prepares all our infusions. 2) If you prepare your own, how often do you change the bag or syringe containing your infusions? (We drew up our own epinephrine from a bag to syringes once and the pharmacist told us that med would only be good for 1 hour...though if we had hung the bag it would be good for 24h.) 3) If you prepare your own, do you have a variety of "standard" concentrations to choose from, based on the size of your patient? THough we don't prepare our own, the MDs utilize standard concentrations (A through E) when ordering based on the patient's size. 4) If you prepare your own, do you prepare a fixed amount of fluid and then decant what you'll need for the hang time of that infusion into a smaller syringe, discarding the rest? n/a, this seems like poor practice to me though as you will be entering the vessel storing the extra med more than once... 5) Do you use heparin in your pressure lines? yes, almost all the time 6) Do you use dextrose-containing solutions for your CVP and/or LAP monitoring lines? not usually 7) Do you run your pressure lines on pumps, and if so, which type - volumetric or syringe? pumps for patients under 10kg; and i'm not sure of which kind of pump as I have not actually had the less than 10kg patient with pressurized lines. 8) How often do you change the flush solution you're using for these pressure lines? q24h; tubings q96h 9) What would you say your CRBSI rate is? quite low, i think it's been at least 6 months. We also utilize CHG-impregnated dressings over our central venous and art lines (for patients over 2 months of age) and use curos green caps on all central lines.

Was this med to be given on an Iv pump? If so you aren't really giving fluids...the tubing is there, primed with NS, and I always thought of the NS as a kind of insurance to keep the tubing from running dry and forcing me to need to waste meds/fluids by flushing out air bubbles. As long as you are turning the NS KVO off promptly I don't think it's an issue.

I am still orienting in my picu but will be pulled to float to peds, peds hem onc, nicu, nursery, peds ed. Day shift nurses also go to peds same day surgery/recovery. It's a lot but not unusual, I think. Just make sure to protect your license and take only assignments you can handle.

Love a radial Cath! My favorite!

In my hospital (a bigger, 600-bed academic center) nurses from one cardiac floor are certified to pull and handle the pulls on the rest of the floors. That nurse is a resource nurse on her/his floor when not traveling around to pull.

Why aren't tube holders widely used? Is it a cost issue?

Texas children's?

Thankfully I have two young'uns at home (1 year and 4.5 years old) to keep me up to speed...it's the slightly older ones I have to research a bit more for! LOL

Hi everyone, I'm having a good time reading tons of old threads and wanted to introduce myself before I start actively participating! I've been hired into the PICU at the hospital where I currently work in adult tele/intermediate care. I've been on my floor for two years and spent five years before that in EMS as a paramedic. I couldn't be more excited (and terrified) to make this jump! I have a month left before I move into my new position and have started reviewing basic peds stuff as I don't have any peds nursing experience...yikes...what a new ball game. Anyway--it's nice to be here! -Alison

I'm new too, and I definitely look at other nurses' assessments--I think it's helpful to see how the patient has changed in the last twelve hours. Obviously if something is super different than what I've found, I check again and/or ask my preceptor too. I'm in my fourth week of orientation, taking four patients now, and sometimes I get confused!

Agreed, Ruby--this individual left an odd reply to one of my posts as well including the "trust no one" line. Looked at all his recent posts and they make me wonder why he continues to nurse if nobody can be trusted and the other things he says of his job are true.

My advice comes with the disclaimer that I haven't started my RN job yet, but... Can you ask for some help re: computer charting? You be the big one, mention that you've had some problems, this is the problem you were having, do they have any tips to keep it from happening again? That way you are both bringing up the problem and hopefully finding out how to fix it. As far as the skin tear--you did what you could re: the aide; I wouldn't worry about that part of it. She should have known she had to do a statement (right?) so that onus should fall on her. You documented to the best of your ability.

anyone? I'm leaning towards taking the nights position. It's totally new to me, I may love it, and if I do it would help me be "that mom" who can always pick her kid and friends up from school, chauffer the really cool field trips, etc etc etc. If not...I'll deal with it then.

Just wanted to say I'm sorry things didn't work out and that you're getting the runaround from HR. Be persistent and hopefully you can get the answers you need. Good luck!

Hi everyone, I have been reading the forums for a while now and I was hoping you could share some of your experience with me. I am a new grad RN, transitioning from life as a paramedic. I have a job offer and am supposed to begin orientation in the coming weeks on a telemetry unit. The position I was offered was nights and I took it, even as a day person, hoping that either a) I'd love it or b) I'd slip into a day spot sooner rather than later. The unit I was hired for just posted a day shift opening. I'm not even sure if I should call to ask about possibly being able to take the days spot. I don't want to be whiny and needy from day one! (Really, day minus 10!) I can see pros and cons to both sides, and I was wondering if you think that one shift vs. another would help in a smoother transition to nursing? On days, while the units are busy with admissions, discharges, doctors, tests, procedures, etc, I feel there may be more opportunity to interact with educators and CNS. My floor orientation will start on days, for at least two full weeks, before I go to nights....having the same preceptors for my whole six+ week orientation would be beneficial, I think.... On the other hand, perhaps the nights environment would be a smoother/easier transition with less administration and ancillary people around? Or would it be worse, with a slighty higher patient load (I believe they said 5:1 at night as opposed to 4:1 during the day)? I'm all ears for suggestions. I have never been a night owl but somehow I think that working nights in a hospital (as opposed to in the dark ambulance) would be totally different and doable for me. The scheduling kind of stinks for me either way, as I have a preschooler and a husband who works 12-hour shifts too, so that point is not all that important to me. We have childcare arrangements either way, including arrangements for childcare before/after my shifts if I take the night position. Thanks in advance!

Personally I think if he does not want to take the job, he should gracefully back out. Contact the person who he spoke with when he verbally accepted, explain that due to personal circumstances, or a change in ________, or whatever, he does not believe the job will be the best fit for him. Thank them for their time and consideration, "I feel flattered to have been offered the position," "I'm sorry to cause you any inconvenience," etc. and walk away. The hospital does not want to waste its money orienting and training someone who doesn't want to be there and will think better of him for backing out now than they will if he gets started and leaves. Good luck to your friend!

Yes, 1 tablet (6mg) per dose. 6mg/dose x 4 doses/day = 24 mg/day which is what you were ordered.

What did you read, or wish you had read, before you started your first nursing job? I see a lot of books on Amazon about your first year but did anyone find interesting/helpful info in them? I will be starting a position on a cardiac floor next month and am looking for stuff in addition to reviewing meds, conditions, etc. I worry that prioritization and organization are gonig to be hard for me as I'm going from one patient at a time (as a paramedic) to multiple patients. Thanks! Alison

Happy to report that I am officially an RN! Sent application in August 2. Fingerprinting paperwork received on August 23 and completed September 6. ATT issued on 10/5. NCLEX on 10/19. License issued (BON website) 10/31. Almost three months from start to finish but it's done and I don't really care anymore!!!

Finally got my ATT on 10/5. Scheduled NCLEX for 10/26 and hopefully it's all smooth sailing from there. It was hard to get a date in central NJ--my usual centers are Somerset and Princeton; Somerset had nothing until November and Princeton had only the 14 and 26.