theliman

Worked ICU for Centura for two years, at the U now for 1. 100x happier at the U.

I did a direct-entry MSN for my nursing degree and there were no issues with CRNA schools. After finishing the MSN, you will have done everything that is part of a BSN, but with additional masters classes. To get into the program, you had to have a bachelor's, so that takes care of some of the non-nursing requirements, and then the MSN includes everything you need for nursing. Not sure about associates -> MSN. To the OP, I wouldn't think twice about doing direct-entry MSN instead of BSN, I think it only helps, but if you have only a few programs that you will go to, you might as well chat with them if it will reduce stress.

at St. A you will probably start around $25-26/hr. and likely roughly that for the other hospitals, except healthone

I disagree, if this is where you want to be. I interviewed for UCH new grad residency, didn't get it. All the calls and emails after to the many hospitals in the area didn't help. It wasn't until I moved to Denver and could show up in person, resume in hand, that I was able to get hired.

it doesn't matter at all. no program will look at the CNL and say "actually this MSN won't fly, you need a BSN." an "entry level" MSN, which the CNL programs are, includes all of the courses that would be required for a BSN, except for maybe a few non-nursing ones which is ok because you already have a bachelor's in something.

Thanks - was hired there as new grad and got a few months of orientation, just feels like less than two years is a tad short, though there was no commitment or anything. and to leave for another place in town? just feels like it would be awkward at best, but maybe not

hello, i work in an icu of a community hospital. we are level-1 trauma so it looks good on paper, but i'm not thrilled with my experience. maybe a third of my patients are intubated, haven't had more than two pressors but a handful of times, don't titrate much more than levo, neo, fent/versed/propofol/precedex. no antihypertensives except occasional cardene. we often step-down within the unit because step-down is full. i have the opportunity to move to an academic hospital's icu. i've always wanted to be in the academic setting - love the teaching on rounds, research i can be involved in, etc. i have 1.5 years at my current job (started there as new grad) and would like to go to school next fall, so applications will start this summer. i would be much happier at the new job, but would likely not get a letter from my current manager and certainly wouldn't approach my new manager 2 months into the job for a letter. of course if i stay, i will be able to get a letter because i'd be leaving after almost 3 years. i'll be calling the schools i'm interested in to discuss the letters (without bashing my current experience, of course). i know some will allow you to have a charge nurse or someone write your letter instead of your "reviewing" manager. any thoughts on the importance of the letters of rec in this situation vs the better experience? getting into school for next fall is the first priority to me but i also feel like i want to be comfortable managing crises and sicker patients and in that case, the move makes sense.

Thanks to you both. llg, my thinking was definitely in line with your main point. my charge likes to be able to show the manager that they were able to save money by sending someone home, but there's no record or easy, direct tie to an extended LOS or re-admission from poor care. it's all about where the incentives are, and it seems that the highest levels of leadership have to be ok with a more lenient "productivity" rate in the pursuit of cost savings (better outcomes) mbarnbsn i agree about the "please-everybody" types. we had a charge who refused to triple nurses without a step-down or floor order because she believed she was making a judgment against a doctor's order (since there is still a standing ICU order) and it would make her liable. she is no longer asked to relief charge.

Hello all, I'm hoping those involved in management can shed some light on a frustration I've had with my hospital's staffing decisions (I know I'm not alone here). I fully understand and accept that hospitals want to make the biggest profit they can. However, it seems that there is a lot of evidence that lower staffing leads to a number of bad outcomes - most of which cost the hospital money. Falls, med errors, extended LOS, etc. Then of course there is nurse dissatisfaction (higher turnover = more money/time to train, more issues with new nurses), which also affects patient (dis)satisfaction. In my ICU the charge nurse regularly takes patients. If we have an open charge and one nurse with only one patient, they might be sent home 2 hrs early (additional handoff) and if we admit in that window, someone is tripled or the charge takes the patient. We've had numerous nights where all of the units seem to be scrambling, yet we had nurses on "push-back." I'm trying to understand more of why this is and what is going into these decisions and how hospital finance works. They're already paying us a huge amount in benefits - why send a nurse home early to save $60 when you have so many potential negative consequences? Do these incidents not harm the hospital financially as much as I think? (I can't imagine - think of the cost of one bad fall!) Is staffing only operating to demonstrate concrete, clear savings (nurse hours), while ignoring the much larger effects of low staffing? What's going on? Thanks!

Thank you both for your time and advice!

anyone? or would i have better luck asking for what percent chance i have for getting into schools x, y, and z based on my gpa and gre? :-D

Hi there, I have some questions for all those who have been through CRNA school. I am hoping to get into school next fall, at which point I will have been a nurse for almost 3 years. All of my work so far has been in a surgical ICU at a level-1 trauma hospital. Sounds good, right? Problem is, we also have a trauma ICU. It's a community hospital, and the acuity is not regularly super high. My concern is not as much about getting into school, but rather doing well in school. I feel like I mostly have stable patients. Often on a vent, sometimes on a couple pressors, but not a whole lot more going on. We also get a ton of medical ICU overflow, and also float to neuro/trauma and cardiac. So I see a good variety, but not a ton of acutely critical patients. Occasionally I get that sick post-code admit, but not frequently. There is one academic hospital in my area, and I've been trying to make a move there, but it's very difficult. Assuming I have to stay with my current system, what can I do to be ok in school? I'm trying to supplement my learning by reading and such (studying for CCRN, taking that soon), but I know patient experience is so valuable. Should I switch to the CICU? I doubt I'll be oriented to open hearts (I've already told my manager that I'm interested in going back to school relatively soon, so they probably wouldn't want to invest in me - oops), but at least I'd see more vasoactive drips. Am I in trouble if I stay where I am? It seems some think you need crazy-sick patients all the time. While others say that CRNA school is a completely different learning/occupation and "re-set" - giving me hope that I can do fine. I definitely think I'm smart enough and good with science, I'm just concerned about experience. Thoughts?

Thank you for your reply. I agree about her material. Definitely can't trust blindly, but I enjoy her presentation. I am still curious though, just to understand how it all works together - what about mitral stenosis will alter the PAD but *not* affect the wedge? What is her rationale for wedging? Wouldn't it also be affected by mitral stenosis?

Hi there, On Gasparis' DVD she talks about a number of situations in which the PAD is not an accurate indicator of LVEDP - such as mitral stenosis/regurg, aortic stenosis, RBBB, etc. She goes on to tell the story of how a doc was angry that she wedged her swan, but she said she had to because the PAD wasn't accurate since the pt. had mitral stenosis. How does the wedge work that it can give you useful information that the PAD can't? TL;DR: when is wedging indicated, and what is the physical reason that it can be helpful in some cases when the PAD is not? Thanks!

ugh, post deleted for some reason. thank you Greenclip for your help, I did some more looking into this last night and what you say falls in line with the main ideas I gathered. This website was especially helpful, and the graphic 2/5 down Electrolytes and Acid-Base Balance - UCSD Lab Medicine "renal reclamation of bicarbonate." other useful ideas were that the increased bicarb is also a marker of H+ excretion (see graphic). also, acids/bases/etc. are constantly associating/dissociating so it's not like all of the bicarb floating around is immediately "used up" or bound to H+ to buffer. thanks again

Hi there, I've always thought I had a reasonable grasp on ABG's, but I frequently find myself coming back to the same question, thinking I've resolved it, then thinking about it again. If we get into an acidotic state and our kidneys are functioning, after some time they will be able to help compensate by holding onto/secreting bicarb (in addition to excreting H+). We seem to mean a few different things when we say bicarb sometimes (serum CO2, ABG HCO3-), but in the context of the gas it would be specifically HCO3-. So, with compensation, we will see elevated HCO3-, yes? Now, my main question is, if the buffering system involves this equation: CO2 + H2O H2CO3 HCO3- + H+ then I would think that HCO3-'s buffering action is to combine with the H+ to create H2CO3 (and perhaps then move towards CO2 + H2O?). Which would use up (bring back down HCO3-), wouldn't it? I haven't taken chemistry since 10th grade (15 years ago) so I need to brush up on that and plan on taking it soon. But, in summary, I'm wondering: If our kidneys increase HCO3- to compensate, why is it elevated in the blood if its mechanism of compensation is to combine with H+ and form something else? Or do I have the mechanism wrong? Thanks!

Hello all, After years of browsing, I think this may be my first post. I will hopefully graduate in May 2013 as a CNL from an accelerated program at a good school. I would really like to move to Denver, and I understand that it may be an especially difficult job market. I'd like to work in an acute setting, preferably an ICU. When I graduate I will have over 1,000 clinical hours precepted 1-1, but no other experience (I'm registered as an NREMT but never practiced). I understand that I will have an MSN but that it means almost nothing in my job search. I'm wondering - is there anything I can be doing this summer? I've heard there are some hospitals there with new grad programs. Would it be a good idea to email some of the recruiters and see if I can arrange any informal meetings during a visit this summer? I certainly don't want to bother them, but I'd also like to do anything reasonable that I can. What resources should I look into at my school (it's not close to Colorado)? Many thanks!