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AICU RN specializes in ICU.

Happily married mother of two. I work in the Adult ICU of a busy Level I Trauma Center.

AICU RN's Latest Activity

  1. AICU RN

    New Grad RN - ICU

    I started as a new grad in a Level I Trauma ICU last November. My 20 weeks on orientation flew by and I can't believe it's almost a year since I started. Things that I studied: 1. Vent Settings (including oscillator, bivent, etc) 2. Common "ICU" drugs and their side effects (prop, vec, succ, versed, fentanyl) 3. Brushed up on Sepsis, lactic acid, etc. 4. Got to know ABGs very, very well 5. Pressors for sure There's more, I'll probably think of some more as soon as I finish this post. As far as general advice (I didn't read all of the previous responses): 1. Preceptors want you to ask questions. Take advantage of this and ask even if it seems stupid. 2. You will make mistakes. Learn to forgive yourself, learn from them and move along. 3. Learn your team. At the beginning of each shift try to identify one nurse who you can go to if something arises during your shift that you need help with who won't bite your head off. 4. Someone else said it, but a good respiratory therapist is priceless. Know yours. Ask them questions. Usually, they appreciate someone's respect and they are really great teachers (IMHO). 5. Know your support staff. We don't draw labs unless pt's have an ALine or a central line (and sometimes not even then) so I like to get to know our phlebotomists and one just commented the other day that she's so appreciative I took the time to learn her name and don't just call her "lab girl." You never know how far a little mutual respect might go. One of these staff members may be able to really help you out one day. 6. Get yourself organized. Do whatever it takes to keep yourself that way. That's about it for now. Maybe later I'll post more about staying awake on night shift. I do love nights though .
  2. AICU RN

    Sedation in ICU... your opinions/ experiences?

    I had a pt over the weekend who was nasally intubated after a radical neck surgery. ENT wanted him pretty snowed but that was easier said than done. First night I had him we were up to 150mcg of Fent per hour and 50 of Propofol/hr. He was still sitting straight up in bed and trying to kick his feet over the siderails. I had to wrist restrain him unfortunately. Finally talked the docs into believing it wasn't working and the next night I had him on the same dose fo Fent with 12 of Versed. That didn't touch him. The next night I had him we were trying boluses of KETAMINE...that didn't work either. Finally started Precedex but after 24h that started making him brady (of course). So the last night before I was off they had me wean him off Precedex before I left and ordered bolus doses of Haldol. Sheesh....don't know how it finally worked out. No history of drug abuse either. Honestly, in our ICU, I'd say it's about 50/50 as far as whether our patient's are sedated while intubated. If they are, Prop is usually our first choice. We have been using Precedex more. Also started using the Fent/Versed combo someone talked about earlier. The people who are vented but NOT sedated that amaze me. Just lying in bed all calm, just amazing. Not me. If I'm tubed I better have some major sedation on board . Anyway, we did just start using the ABCDE bundle. It seems pretty useful so far.
  3. AICU RN

    How to promote tolerance and support teamwork,

    We had a conversation about this the other day at work. One of the nurses I personally look up to reccomended When Nurses Hurt Nurses: Overcoming the Cycle of Nurse Bullying by Cheryl Dellasega, PhD, RN, CRNP. It's supposed to be helpful when dealing with "Queen Bees." I can't wait to read it.
  4. AICU RN

    How to say no when someone asks for your stethoscope?

    I had a preceptor who had a stethescope with earpieces so worn down and uncomfortable I could barely stand using it the one time she loaned it to me. I told her they sell replacements and she said, "I know. I leave them like that so no one will borrow it." LoL I am very picky about who I loan mine to and how far it goes. I am also very careful to always wipe it down. Basically, like everybody else said, if you don't want to loan it out, don't.
  5. AICU RN

    Patients that made you go "How are you even alive?!"

    I had two patients like that two nights in a row... The first was a 500lb+ COPD patient who had severe undiagnosed sleep apnea. He would doze off and his SAT would drop to 27%. I would wake him up and it would come right back to the nineties and all he wanted to know was why I kept waking him up. He also had a CO2 of greater than 80 on his ABG.... The next night I had a sweet LOL who was in her 80s. I had to give her PO contrast for an ABD/Pelvis CT. Every time I gave her a sip of contrast she would go into full on VTACH. Not just a little bit but 26 or 30 beats at a time. It was insane. She was just sitting there cute as could be talking to me. I started freaking and she's like "oh no sweetie, I'm fine. Are you okay (lol)?" Anyway, I told the doc. He thought the VT was a coincidence and the fact that I was having her drink made her vagal down and break. Coincidentally, she was the first patient I ever had who enjoyed the contrast. She may have but I sure didn't :uhoh21:.
  6. AICU RN

    Stupid things that nurses say

    The other night it was the end of my shift (6 AM) and it seemed like the shift would never end. I grabbed an NA to help me turn my patient who was requesting to be repositioned. He also happened to be a prisoner. We turn him and I notice that the pillows I had him propped on had gotten rather flat. Me: "Let's get these pillows out from behind you. They look like they've done their time ." I turned bright red, finished what I needed to do and got out of there hoping no one had noticed. Of course, the NA who was with me will never let me live it down. I've never used that phrase to describe pillows and don't know how it managed to slip out that time....
  7. AICU RN

    I Love My Job Because...

    These are great! Keep them coming. These are the reasons we do what we do and we need to not lose sight of them (even though it's hard at times). I know, for me, I've now had 3 straight days at work of not feelin completely overwhelmed and that's why I'm loving my job even more. Yea, I have a little piece of paper taped inside my locker. On it are the reasons I used to start this thread, only my friends know it's there but after a bad shift there they are staring me in the face and keeping me focused. Who else? Why do you love your job? :redpinkhe
  8. AICU RN

    Sense of Dread....When Will It End?

    Babs, That was an awesome story. Thanks for sharing.
  9. AICU RN

    I Love My Job Because...

    Ha Ha. I work 4 days but hear what you're saying. Honestly though, being that so many new grads don't have jobs at all, I am very greatful for the one I do have. I like only working 4 days though... Better than our cafeteria, for how big of a hospital it is, their food sucks...but I like your answer :yelclap:
  10. AICU RN

    I Love My Job Because...

    disclaimer: i am finally starting to feel like a real nurse after starting my job in november. therefore, i wanted to start a *grateful* thread about what we love about our jobs. now, there are enough negative threads about why a certain job sucks so *please* *please* *please* don't turn this into another one. i'm begging you! just tell me why you like your job. now, i am really beginning to love my job. here's why: 1. the preceptors. i said it before and i'll say it again, i love the preceptors at my hospital. they are wonderful. they enjoy their job and they help make mine a 1000 times easier. they are patient and understand that i'm new and don't hold it against me. being a preceptor takes a lot out of you and i'm just glad that these wonderful people were kind enough to volunteer for it. 2. the staff. the overall intelligence level blows me away. even during a chaotic time like a code, their team work leaves me in awe :bowingpur. they barely talk during a code yet each member seems to know what the next needs. on top of it all, they teach during codes. this is why we're doing this. that's why that happened. just wow. 3. my managers/educators. yes, i even have love for management today. what can i say? the hospital goes out of its way to make sure my orientation experience is a positive one. for that, they deserve props. 4. all the people i work with know how to laugh at themselves. the icu can be a rough place to start (see my other thread) but ya know what? i work with nurses with great senses of humor. they mock and tease each other (lovingly for the most part) but they also know how to laugh at themselves. that's my gush fest. and remember, keep it positive
  11. AICU RN

    New Grads, then and now. What has changed?

    Okay, I'm a new grad and try really, really hard not to act like the ones you just described. I didn't have helicopter parents and I try *really* hard not to be one to my own children. I got pregnant at 19 dropped out of college because of complications with my pregnancy. Continued working as a dietary aide at the hospital I was working at since I was 17. My amazing daughter was born and I continued working at the same hospital. A position opened up as a UDC on telemetry and I fought for that job. I worked that job to pay for my own wedding when I was 21. I cross trained as a nurses' aide because I wanted more patient contact and learning experiences (plus my unit kept losing aides). Got pregnant again and kept working as a UDC/aide. Went back to nursing school at night and worked my butt off as the president of my class and mother of two little kids. I still kept working full time hours until I graduated. I worked at my hospital for 10 years before I took a job with my current employer. Yea, I ended up with a great job but not because my parents removed all my obstacles but because I fought through them and had a resume that knocked the socks off my employer. So yea, there are new grads out there like the ones you described but honestly we aren't all like that. I have a few friends that are. I have a lot more that aren't. So with all due respect (your lesson in Acid-Base balances changed my life), don't make broad generalizations about all of us . Yea, I made a post about how much I worry in the new grad forum recently. I, however, mentioned nothing about anyone being mean to me or "eating me", quite the opposite, I have been blessed with some amazing preceptors/teachers. I am in awe of the ICU nurses around me and do everything in my power to learn from all of them. I have been on my own since I was 18. I became a mom at 19, bought a house and married the love of my life at 21 and graduated nursing school at 27. Sure, I did some things out of order, but hey, I never had a dang thing handed to me. Now, I work hard to make sure my children will be strong and independent when they get out on their own some day. Susan P.S. Please don't be upset about my response. I just don't like being lumped in with some of these kids. Also, I realize that she asked you your thoughts on new grads as a whole, in which I don't disagree with you. I just wanted you to know that we're not all how you described (though I'm sure you do realize that).
  12. AICU RN

    Sense of Dread....When Will It End?

    Thanks. I always try to learn. I think that a preceptor/coworker who saw me make a mistake and didn't tell me about but only told my nurse educator would bother me way more than someone one who told me about my mistake up front. I'm new. I'm in my unit to learn and if people don't tell me what I'm doing wrong or even if there's simply a better way of doing what i'm doing then how am I supposed to know?Thanks for the compliment, too.
  13. AICU RN

    Sense of Dread....When Will It End?

    Ah, I get that. Just a tough situation to be in at anytime, especially as a neurotic newbie. There were things that made it tougher that I can't get into here for fear of breaching my patient's confidentiality. Suffice it to say, it was a terrible night.
  14. AICU RN

    Sense of Dread....When Will It End?

    Oh, and I didn't take your previous response as being grouchy at all. Just honest and that's what I need. A little dose of reality never hurt anyone.
  15. AICU RN

    Sense of Dread....When Will It End?

    She was no compressions and no defibrillation. We did both. She was a 76 yo with broken ribs and chest tubes. She was only intubated for airway protection d/t rib fx's and deteriorating MS at the scened. I was on a 12 hr dayshift and extubated her that AM. Got her down to a mist mask and then 4 L NC. She was doing fine and talking to me. Went in at 6:30 pm to do meds. She was talking and then just stopped. That's when we coded. While she was down she seized and lost a lot of what she had. Family was okay with the situation as a whole and made her comfort care. It was just messed up. I guess I wasn't thinking about her code status because she was alert and talking. The way I've come to cope with it (at least in part) was that the doctor who ran the code was her CCM attending. So, yes, my preceptor and I should have remember sooner what she did/didn't want but her doc should have, too. It was the first time my patient coded and, yea, I took it hard but I know I will always pay attention to code statuses. I know it sounds silly, but I think sometimes we end up taking care of patients for a reason. She definitely taught me a lot.
  16. AICU RN

    Sense of Dread....When Will It End?

    I get what you're saying. I just don't want you to think that I'm going around to my preceptor like, "OMG I was 20 minutes late with my Colace! Is my patient going to die?" Because I'm not, honest. My preceptor knows my personality and he actually has a similar one and I guess he was like me when he started so he understands. He hasn't said anything negative about my time management or prioritization. He even recommended that I be moved to Stage II early. He just tells me things like a lot of you guys have been. Basically, that if it isn't going to harm our patient then it just isn't that big of a deal. The mouth care thing happened but it's not like I still freak out about missing it. It's more of a matter of the next shift coming in and being like, "Your orientee didn't chart her (insert some inconsequential thing here), didn't you teach her anything?" Not like they would actually do this because they are ICU nurses and know that's not a big thing but still, all of my preceptors have been so great that I don't want to make them look bad. I guess in that sense it does have a lot to do with the culture of my unit because there are about 12 new grads that started the same time as me and I'm sure the preceptors and educators compare us to each other. My husband is good at keeping me grounded, too, and always has been. I don't usually think I'm a terrible nurse, though, honestly. The previously mentioned day that I wanted to quit nursing wasn't because of something as stupid as mouth care. It was because we coded a patient who was a limited code and saved her life (although not the quality of it). I didn't realize she was limited until after the code was finished and if we had carried out her wishes she would not have lived. I played it over in my head because she was my patient the day before as well and got in report two days in a row that she was limited. However, we are not trained to watch our patient die and my preceptor and I just went into full on crisis mode. So, yea, that day I felt like I had let my patient down but I dealt with it and didn't give up. Thanks for worrying about me though.