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I would write up an incident report against that nurse for sure! We have all had those days where you are so busy, you cannot do everything you are supposed to...so you must prioritize! That nurse should have pulled you aside and spoken to you with some maturity if she had something to say to you. Your colleague behaved live a child and there is no excuse for publicly attacking someone. She needs to be educated on the proper way to interact with colleagues. I have had some similar occurences (none quite this awful though), and it creates a negative work environment! ICU nursing is a team effort. Although turning a patient is important, I think we can all agree that it comes after hanging blood or administering an important medication like levophed. Some patients who are really sick can take up all of your time....they are unpredictable, that is why they are in ICU! I want to apologize to you on behalf of that nurse! The truth is that she is the bad nurse. Transitioning to ICU is hard and even the most experienced nurses need help when given a difficult assignment. We are all humans and we need to work together and kindly help eachother...we owe it to our patients! If the day or night shift did not do something (as long as it is within reason), we should not yell or scream, we man up and pick things up where they were left off! I think you are doing a great job and your assignment sounded very challenging. We have all had those! I can guarentee you that at my facility, that particular nurse would have been fired for sure...if she was screaming at you and calling you names in public. I mean are we in the first grade? There should be a zero tolerance policy. Ignore this nurse and keep working hard! And learn from the experience. Now you know to delegate to others and make sure to follow up on what care was given to your patients.

Hey Everyone, I was wondering if anyone could provide some light on the CRNA programs in California. I have been doing research for some time now and I know quite a bit about the schools. I was hoping some current SRNAs could share some pros and cons of the programs they are currently in. What do you like/dislike about the program? Also, has anyone applied to or been accepted at National University in Fresno? I know it is a new program and if anyone has any info, it would be greatly appreciated!

At my old facility, the RN would always push the emergency meds granted the physician was at the head of the bed ready to intubate and RT was prepared as well. We pushed etomidate, succ, vec, atracrium, versed...you name it. The only medication we were not allowed to push was propofol...it was in our hospital's policy. For some reason, the doctor had to be the one to push the medication. I would suggest looking up your policy on the matter, that should give you the most accurate information on the subject for your specific institution! Hope this helps!

Anyone else have any opinions on CRNA acceptance and ICU experience in a Level 1 Trauma center vs. Level II Community Hospital? Thanks everyone!

Hi bloomRN, Thanks for the encouraging words! I was wondering, would you mind sharing how many years of experience you had when you applied/got accepted to CRNA school? I hope to apply either this year for next year start or the year after...I would have a total of 2 years ICU and 3 years nursing experience. If I waited to the year after, I would have 3 years ICU. Thanks!

That is exactly how I feel! I used to give a report pretty much exactly how you detailed...but now when I do...the nurses just look at me and then cut me off...like what I am saying is not important. They do not even want to know when the patient was admitted to the ICU...I mean if the patient is 1 day post surgery or 6 days post surgery makes a big difference! They do not write down any past medical history, and when it comes time for them to give report...they do not know any of it! At my old job we would present the patient in rounds the way you described...but at this new hospital the nurse is not even included in the process. Nurses never know the plan or why things are being done...it is almost like nurses are not supposed to think. Of course this is not true, but this is just how I feel.

Hi getmethisnownurse, If you don't mind me asking, what about the hospitals did you not like? Are there any other hospitals in this area that you really did like? Thanks for any info!

Hello everyone! I have been in the ICU for a little over a year and I recently changed hospitals, from a community hospital general ICU to a level one teaching hospital in the SICU. I loved working in the general ICU. I always did my best to know everything about my patients, to critically think about their illnesses and pathophysiology, and to work closely with the intensivists. At this hospital, the nurses were highly relied on to report any trends, and I felt valued. At my new hospital in the SICU, the atmosphere is different. Nurses give short reports at change of shift with no detail, they never write anything down (PMH, labs, meds, etc.), and they never know the plan of care/goals or what has happened to the patient since admission. Even though I now work in a level one trauma center, I feel unhappy and lost. So my question is...has anyone gotten into CRNA school by having ICU experience in a community hospital? I know CRNA schools prefer the SICU from a large teaching hospital, and that is why I made the switch. However, I am constantly thinking of leaving. Do you think if I worked at a 400 bed community hospital I would blow my chances of getting into CRNA school. My GPA and GRE are good, and I have shadowed CRNAs in the past. I want to get another year or two in the ICU under my belt before I apply. Any thoughts would be greatly appreciated!

Hello everyone! I have been in the ICU for a little over a year and I recently changed hospitals, from a community hospital general ICU to a level one teaching hospital in the SICU. I loved working in the general ICU. I always did my best to know everything about my patients, to critically think about their illnesses and pathophysiology, and to work closely with the intensivists. At this hospital, the nurses were highly relied on to report any trends, and I felt valued. At my new hospital in the SICU, the atmosphere is different. Nurses give short reports at change of shift with no detail, they never write anything down (PMH, labs, meds, etc.), and they never know the plan of care/goals or what has happened to the patient since admission. Even though I now work in a level one trauma center, I feel unhappy and lost. So my question is...has anyone gotten into CRNA school by having ICU experience in a community hospital? I know CRNA schools prefer the SICU from a large teaching hospital, and that is why I made the switch. However, I am constantly thinking of leaving. Do you think if I worked at a 400 bed community hospital I would blow my chances of getting into CRNA school. My GPA and GRE are good, and I have shadowed CRNAs in the past. I want to get another year or two in the ICU under my belt before I apply. Any thoughts would be greatly appreciated!

I have been an ICU nurse for a little over a year and I recently made a switch from a 450 bed community hospital to a SICU in a large teaching hospital. At the community hospital, I felt like change of shift report was very detailed, explaining when and why the patient was admitted and the main occurances through the patient's hospital stay. I would thoroughly check the orders, write down all my meds, and read the doctors notes from admission and the most recent ICU note to get an idea of the main diagnoses and plan of treatment. I would write down all the results and from days prior to critically think about trends and why certain labs would be altered. At my old hospital, nurses gave the intensivists detailed rounds explaining everything about their patients, and the doctors relied on the nurses to tell them pertinent information and critically think about what should be done for the patients. The patient population was mostly medical with some surgeries (mostly severe sepsis, stroke, GI bleed, respiratory failure...etc, some GI surgeries, cranis...). At this job I felt competent and I was used to knowing EVERYTHING about my patient, including all PMH and pre-admission medications (even when the last BM was, how fluid positive or negative, and when centrals were placed). I enjoyed putting all the pieces together and working with the doctors to ensure the patients got the care that was needed. At my new job, the nurses give report with almost no detail, leaving out dates of surgeries. They never go over PMH, they write practically nothing down, and they just glance over labs and tests. There is no way of really knowing the plan of care for the patient. I mean shouldn't the nurse know when the patients GI surgery took place to track progress? I guess it is just a very different atmosphere. Coming from a hospital where I wrote everything down and critically thought about the plan of care and pathophysiology of my patient's condition, I am having a hard time adapting. It is almost like the nurses don't think about their patients. It makes me really nervous and I start to feel overwhelmed and panicky. I feel stupid. I just wish report was more detailed. I don't know how the nurses care for such sick patients and not write anything down. Report is short and SOOO much pertinent information is left out. Sure, you can read the doctor's notes, but at this new hospital they do not go over a plan of care. I have been told at this new hospital that when I get more experience, I won't have to write things down. But that is just not how I operate. At my old hospital all nurses wrote detailed reports, even the nurses who had been there for 20 plus years. Are my feelings crazy? Maybe I am just not cut out for the teaching hospital atmosphere. Any thoughts would be greatly appreciated. Sorry for my super long rant.

I used to work in a general ICU and we always ran FFP free flow, never on a pump. Some nurses would run platelets on a pump and some would free flow. Everyone always ran PRBCs on a pump. Now I work in a bigger hospital in the SICU, and at this hospital, everything is run free flow, even PRBCs. I was told that the rationale is the pump can lyse the cells.

I used to work in a general ICU, but we mostly got MICU patients (severe sepsis, GI bleeds, ARDS). We almost always used levo, then vaso, then neo. Sometimes we would use dopamine if the patient was brady or if we needed a pressor fast because we stocked dopamine on the unit. We would use neo rarely if a patient was having a lot of PVCs or arrythmias. But for sepsis, we almost always used levo until we got to 20 mcgs, and then we added vaso at 0.3 units. If the patient was still hypotensive, we would add neo, usually up to about 300 mcgs. We would also use dopamine and dobutamine up to 20 mcgs. Rarely we would use epical also.

Hello all! I am new to the SICU, past general Medical/Sugical ICU (more toward the MICU). I am transferring shortly to the SICU at a very large hospital. I was told a good amount of the patient population on the unit are post transplant patients. No heart and lung transplants, they go to the CTSICU. However, we get all abdominal organ transplants. I have no experience with transplants at all, my old ICU did general surgeries , cranis, and CABGs, but that is about it. Is there anything in particular I should know about the treatment of a patient after a liver or kidney transplant. I heard post livers are very unstable and come to the ICU with a swan and multiple pressors. I also read that these patients are at high risk for developing sepsis/some type of infection because of the immunosuppressant drugs. Also, if all goes well, are these patients up and moving with PT quickly as in a CABG. For kidney transplants, do most require CVVH/CRRT post op? I was told the RN has to exactly match intake to output and adjust IV fluids accordingly. So basically I was hoping you all could impart your knowledge, anything you feel is worthy to know about caring for a transplant patient. All of your thoughts are greatly appreciated!

The free water is also used to decrease serum sodium levels in someone who has high sodium on the morning chemistry.

Hi everyone, I was hoping I could get some input from people who live in the LA area. I have about 1 year experience in a medical/surgical ICU and I am looking to change hospitals for various reasons. I actually applied to both Cedars and USC and believe it or not, I actually got interviews with both. I am applying for the Neuro ICU at USC and the Surgical/Trauma/Transplant ICU at Cedars. I want to get the best experience possible to advance my nursing practice and broaden my ICU critical thinking skills. I have seen both units at my interviews and they are both amazing. I eventually want to go to CRNA school after I get a few more years of ICU experience. So my question is, which hospital/floor do you think would be better experience to both learn more and pepare for CRNA school. I live closer to Cedars. Both openings are for night shift which is not a bid deal to me. Overall, I was more impressed by Cedars, but I know both hospitals are great. I also have been told that if you work at USC for a year, then you can go to USC University for free. That would be a big plus if I go to CRNA school. About the floors: USC: Neuro ICU- Mostly neuro-surgical patients with craniotomies, ventrics, lumbar drains, etc. I was told they get some overflow from the abdominal transplant ICU as well. The turnover rate of patients is supposed to be fairly high. Cedars: SICU- All types of trauma. All general surgeries like GI, vascular, and some Neuro. I was told the SICU gets Neuro ICU overflow. All transplants except heart transplants which go the the Cardiothoracic ICU. Thanks for any input!