AICU RN

You mean it ends? I'm kidding... I have been off orientation a year next month and somewhere about 6 months ago it started to get a lot easier. I am a new grad in the ICU and I think it depends, at least somewhat, on what unit you start on. ICU and ER are both notoriously high stress areas. Sometimes I still get anxious but like someone else said, it calms down after I start the shift. Hope this helps.

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 .

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.

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.

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.

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....

I would like to expand the drinking game to include the word "fomite" or any derivative thereof, in addition to the aforementioned "mean." We seem to be saying fomite more now. BTW, u r all a bunch of mean fomites .

Of course! Fomite fashion does not discriminate. Whether your overweight or underweight, over tall or undertall - we cover it ALL in fomites. Speaking of which, two patients last night: one with MRSA and one with VRE. I was feeling rather fomitilicious . Oh, and my friend invited me out for kegs and eggs after the shift but I was a good girl (or bad depending on your POV I suppose) and didn't go. Oh! Oh! Oh! I got a new one! Pulmonary Toilet Puce . Haha, yea pink and frothy tonight folks. Sorry, this is what happens when you don't sleep for 32 straight hours.

On an unrelated note, I want to petition to change the posters encouraging visitors to wash their hands from the ones with the creepy little happy germs to ones that say things like: "Please, mind your fomites." and "Fear the fomite." With a picture of a fomite underneath. Maybe even a fomite wearing sweatpants...

Which, ironically, ties right back in to the drinking in your scrubs off shoot. Just sayin....

I think it's time to learn. This is a gold mine! You should pitch it on that show with the investors. Could you imagine their faces when you tell them the color with the most promise is liver failure yellow ?

I want Fomite Factory scrubs WITH built in suspenders! I want one pair in tube feed tan, one in isolation gown blue, one in suctioned trach green and one in coffee ground brown. I think that should cover all my bases. Where can I preorder them???

Shots cuz wooh is mean!

:rotfl: :rotfl: :rotfl: that is all.

Sorry, this whole conversation reminds me of SCRUBS and Dr. Acula :rotfl:.