Spiderella

When you are preparing your admit bed, get a bag of 1L LR and 1L NS ready. You never know which you will need, but if your patient has a low BP, it's great to have your bolus on hand and ready to go. Also when preparing the admit room, write your labels ahead of time. Even if you don't use all of them, as soon as you are spiking the bag of Fentanyl or Insulin, you can label without missing a beat. This way you won't bolus or give the wrong med for the wrong dose by accident. Have your suction canisters all set up and ready to go. Check the tubing and lines at the beginning of your shift. Make sure the pressure is correct. Especially with trauma admits or stat intubations; having oral suction is critical. If you are going down to CT, ask the doctors what CTs they want ahead of time. It sucks to take the patient down for a CT head, come back up, and then have to go back down 10 minutes later because the doctor decides to have a CT abdomen as well.

My biggest issue is delegation. It's okay to ask for help from other nurses, they aren't going to think that you are a slacker...

This thread is just the opposite of what I think. I actually left MSICU for Trauma because I got bored silly taking care of the same ol' ventilated corpses with myriad health problems that you can never get off the vent. And those dressing changes...ick to the stage 3 and 4 sacral ulcers...that takes about an hour just in itself. At least trauma dressings don't smell so bad and have worms growing in them....ugh. In trauma, like it was stated, the excitement is for the first 24 hours or so, but then you usually know in a couple of days which direction the patient is headed. On my unit we tend not to have those ventilated chronic patients who hang on for weeks and months in the ICU (to me that is so draining). Traumas tend to either get better pretty quickly or crap out pretty quickly...there is very few in between. And less obese patients! And no GI Bleeds. Oh my gosh I'm in heaven! I guess that is why nursing is so great, we each get to find our own niche.

Every trauma hospital has a different system. The one I work at now, there are regular ER nurses that support trauma admits but do not have primary responsibility in the trauma bay. The trauma bay is 3 rooms and is manned by 2 CRNs, which are resource nurses with more than 2 years experience in trauma. We also have a trauma ICU where the critical patients end up and a trauma floor that less critical patients go to. A new nurse could start in either unit, or even in the ED, and once you have the required experience to become a CRN, then you get the trauma admits into the trauma bay. On the trauma ICU floor that I work, you get the trauma admits but they go through the ED (in the bay) for the first 30 minutes to an hour before coming to your unit. Your best bet would be to ask the manager you plan to work for how they do things. Some might not hire new nurses into the Trauma bay/trauma ICU without extensive training first. Some might say you can dive straight in. It really does depend on the how the hospital is set up.

FYI you might run into some more financial issues when you file for divorce. A friend of mine was in the same situation, and the husband sued her for spousal support and won, because he had 'supported' her financially through nursing school, therefore she owes him 50% of everything she makes for the next 5 years. That was a deeper hole that she had to get out of. So make sure you have a good lawyer and cover your bases.

A couple of nurses have already approached this from the nursing point of view, so I'm going to try a different angle. As a nurse with sickle cell anemia, I have the unique position of understanding the realities of both scenarios. Sickle cell primarily affects those of African descent, Hispanics of Caribbean ancestry and is found in those with Middle Eastern, Indian, Latin American, Native American and Mediterranean heritage. Most of the Sickle cell patients in America are black, but I have met those with other ethnicities as well. Think of the worst pain you have ever had in your life...perhaps childbirth, or when you broke something. Now multiply that pain by 100. Imagine someone pouring hot lava into your veins. How does that feel like? Imagine yourself being set on fire....how does that feel like? Imagine 1,000 men drilling holes into your bones. Imagine all these things going on at once, and you are cold, while an elephant is sitting on your chest. Okay...keep that image in your mind as you read the rest. I detest going to the emergency room or getting admitted to the hospital for my disease. I will manage it at home as much as I can, but if I need to go to the hospital, it is because the pain is uncontrollable, and nothing in my orificenal works. I do go to my doctor's visits, and have a healthy grasp of my disease process, but I still have to go to the emergency room when in an acute pain crises. Most of the time, even if I go to my doctor's office, it is just a waste of time, because he will tell me to go to the ER. So coming to the ER because one has a chronic condition is not a misuse of the medical facility. If a diabetic came in with a blood sugar of 45 or 545, would he be misusing the ER? After all, he understands his disease process and diabetes is a chronic condition, is it not? In my esteem, SCD patient coming to the ER with an acute flare-up of a chronic condition should get the same compassionate care as a diabetic coming to the ER with an out of wack blood sugar. Cold is not good for sickle cell, it exacerbates the painful feeling. And ERs and hospitals are kept very, very cold. Regarding using Oxygen...even I take off the nasal cannula after a few minutes. It's blowing cold dry air, into a body that is craving heat. I'm trying to stay huddled under this one warm blanket and get warm, but cold air is being pushed into my nose. I prefer a face mask, and have asked for one several times only to be told by the ER nurse that it requires an order from the physician, and I don't need it. And as much as I know that oxygen is good for me in a crises, it really does feel like a huge slimy booger at the tip of my nose. It drives me to distraction, and there is already too much on my plate, and so, I take it off. I know what works for me because I have been dealing with this condition for 29 years. So knowing what medications, the doses, the regimen, this is all natural, because I have been doing this pretty much all my life. I know that Morphine depresses my breathing and doesn't touch my pain, I know that Dilaudid helps a little but will make me itch like crazy, I know that Fentanyl works only for 5 minutes, I know that Demerol turns me into a delirious, blathering fool and will make me throw up. Therefore, asking for specific medication and doses given in a specific manner, should not be a bad thing, because the patient has a history that only he is aware of. You might have access to his chart from the previous hospitalization, but do you have access to his chart for every admission or ER visit that he has had all his life? It's better to collaborate with the patient and come up with a plan together, this way, you don't have to wade through the whole 'trial and error' process that does not work and just leaves your patient waiting in more pain. By the time I get moved to the inner sanctum of the ER, and get IV line is established (I'm a very, very hard stick), I have already been in excruciating pain for no less than 2-3 hours. With no relief, the pain keeps building and building until even the paltry first 2-3 doses of pain meds will not do anything to stem the tide. So you getting frustrated after giving me 2 doses, and my pain is still a 10, well this is partly because the pain has been raging uncontrollably for so long that small doses of IV anything isn't going to touch it. Regarding food: it's a comfort thing. When you are sick, and someone brings you your favorite drink or snack, doesn't that comfort you on some small level? So therefore, me asking for Lorna Doones (my favorite cookies), or peanut butter toast and hot chocolate is not to be rude or to turn you into my personal waitress, it's because, food brings a level of comfort into a painful existence. And not eating the food when it is brought, it is not to waste food, it is because probably right then, I am in more pain, and can't really focus on anything but the pain at that point. Or I'm nauseated. Or...hospital food tastes like crap. Regarding your point about pain scale, right now, my pain level is a 3. When I have a mini-crises, it's a 5. When I have a major crises it's a 8. When I have pain so bad that it's all encompassing, all over my body in a tidal wave of excruciating fire...that's a 10. And the 2mg of Dilaudid shot you gave me 15 minutes ago barely took it down to a breathable 9.5. My pain score is high not because I'm a drug addict or want pain meds, it's because I'm in an acute pain crises, and at that moment, the pain is really, really, really bad. But the other nurses are right, pain is very subjective. So if the patient states their pain is a 10, treat it like it's a 10. Why does it bother you so? Are you paying for the medication or their medical bills? A person with chronic pain might not have the same posturing that you expect with a 10/10 pain. With my 10/10 pain, I can't do anything, I don't even want to talk, I just want to cry, curl into a fetal position and pray for a quick, merciful death. However, my sister at a 10, watches TV to distract herself and keep her mind off the pain. At a 9 she can even talk on the phone. And when my parents or family call me on the phone, at a 9/10, I talk and act as 'normal' as possible because I don't want them to be worried. How one deals with pain is should not be the yardstick for the pain scale or your decision to administer or with-hold meds. Regarding the power play issue you mentioned, there is a huge power-play between the patient and the nurse. The nurse feels like she knows everything and can pretty much decide how miserable she will let her patient be, while the SCD patient who has been dealing with this condition all her life is thrust in the role of the supplicant, begging for water, help to get to the bathroom, pain meds etc.. You also have to bear in mind that many SCD patients have had negative and bad experiences with medical professionals pretty much all their lives. Having experienced painful crises and several hospitalizations, I can tell firsthand the negative attitude that health-care practitioners exhibit towards sickle cell patients. It is common for SCD patients to be labeled as malingerers, manipulators, or even defined as drug seekers by nurses and physicians. So the patient is coming to you with BAGGAGE from all these previous hospitalizations. And you have BAGGAGE from all the hordes of frequent flyers you have taken care of. It's like a toxic relationship, no trust, but tons of baggage on both sides. SCD patients frequently report dissatisfaction with care they receive, which is often related to inadequate pain relief (Dorsey & Murdaugh, p. 45). Inadequate pain relief results in a poor quality of life, passivity and aggressiveness when dealing with care providers and heightened distrust between SCD patients and their providers (Strickland et al., p. 37). I have had a nurse tell me, "Don't expect all your pain to go away." I have been discharged in pain and had to crawl through the ER to the waiting room on my hands and knees, while nurses looked on. I have had to wait for hours for someone to help me to the bathroom, and it was the woman who came to mop the floor of my room, that walked me to the bathroom. I have had a doctor tell me "shut up, you don't know anything." I have had a nurse say to me, "Why are you crying, you should be used to this by now." These are just my stories...and I am a nurse myself, and have been exclusively only to the ERs of the Hospitals where I have worked in. So I imagine that your patients are coming to you with the same history---or worse. So I come to you, with all this baggage, in pain, and I'm asking you to help me. What you do, well....that's all on you, but realize that as a nurse, you are supposed to help people...and not harm them.

FYI: There is no blood test that can tell if someone is having a sickle cell crises. The lab work that is checked, is their H&H levels to see if we need a blood transfusion since we are usually anemic. Their Coags are checked to make sure they aren't about to throw clots. Another thing is the retic counts to see what percentage of blood cells are sickled, but this does not define a crises. You can't tell someone is in crises from lab work. So if someone comes to you in sickle cell crises, contesting this because of their 'labs' doesn't make sense and is not true. To keep it simple, if someone tells you they are in pain...believe them.

Found this quite insightful. 25 Things You May Not Know About What Nurses Know They just forgot to add Superman strength for pulling and moving patients around, and an iron stomach for all the gross things we see and smell.

She better not pay a dime! American Mobile always has these ridiculous rules tryna rip people off. I once worked with a traveler that was with AM who had her contract terminated by the hospital because they were not 'fully utilizing her'. AM charged her some kind of 'cancellation fee' and with-held her last week's pay. There is no such thing as a verbal contract. If she hasn't signed a contract she is free and clear to walk! I cosign what badladyrn said...get a lawyer involved!

I was in the same situation last year. I applied to several ICU positions and kept getting rejected because of my small community hospital experience. I finally stopped applying for jobs that required experience, and just applied for new grad ICU positions. I got into a hardcore ICU by telling the manager during that interview that although I didn't have advanced ICU knowledge, I needed to grow and learn beyond what my current position offered me. I told her that i wanted to be the best ICU nurse I could be, and the only way I could do that is if she accepted me into the ranks. She eventually agreed to hire me on as a novice nurse, which means I get a portion of the new grad training program and lengthier orientation than an experienced nurse would get. I think you just have to persevere and keep trying until you find the right ICU/manager that will train you. Show enthusiasm, sincerity and honesty in your interview, and don't come off like a know-it-all.

A couple of nurses have already approached this from the nursing point of view, so I'm going to try a different angle. As a nurse with sickle cell anemia, I have the unique position of understanding the realities of both scenarios. Sickle cell primarily affects those of African descent, Hispanics of Caribbean ancestry and is found in those with Middle Eastern, Indian, Latin American, Native American and Mediterranean heritage. Most of the Sickle cell patients in America are black, but I have met those with other ethnicities as well. Think of the worst pain you have ever had in your life...perhaps childbirth, or when you broke something. Now multiply that pain by 100. Imagine someone pouring hot lava into your veins. How does that feel like? Imagine yourself being set on fire....how does that feel like? Imagine 1,000 men drilling holes into your bones. Imagine all these things going on at once, and you are cold, while an elephant is sitting on your chest. Okay...keep that image in your mind as you read the rest. I detest going to the emergency room or getting admitted to the hospital for my disease. I will manage it at home as much as I can, but if I need to go to the hospital, it is because the pain is uncontrollable, and nothing in my orificenal works. I do go to my doctor's visits, and have a healthy grasp of my disease process, but I still have to go to the emergency room when in an acute pain crises. Most of the time, even if I go to my doctor's office, it is just a waste of time, because he will tell me to go to the ER. So coming to the ER because one has a chronic condition is not a misuse of the medical facility. If a diabetic came in with a blood sugar of 45 or 545, would he be misusing the ER? After all, he understands his disease process and diabetes is a chronic condition, is it not? In my esteem, SCD patient coming to the ER with an acute flare-up of a chronic condition should get the same compassionate care as a diabetic coming to the ER with an out of wack blood sugar. Cold is not good for sickle cell, it exacerbates the painful feeling. And ERs and hospitals are kept very, very cold. Regarding using Oxygen...even I take off the nasal cannula after a few minutes. It's blowing cold dry air, into a body that is craving heat. I'm trying to stay huddled under this one warm blanket and get warm, but cold air is being pushed into my nose. I prefer a face mask, and have asked for one several times only to be told by the ER nurse that it requires an order from the physician, and I don't need it. And as much as I know that oxygen is good for me in a crises, it really does feel like a huge slimy booger at the tip of my nose. It drives me to distraction, and there is already too much on my plate, and so, I take it off. I know what works for me because I have been dealing with this condition for 29 years. So knowing what medications, the doses, the regimen, this is all natural, because I have been doing this pretty much all my life. I know that Morphine depresses my breathing and doesn't touch my pain, I know that Dilaudid helps a little but will make me itch like crazy, I know that Fentanyl works only for 5 minutes, I know that Demerol turns me into a delirious, blathering fool and will make me throw up. Therefore, asking for specific medication and doses given in a specific manner, should not be a bad thing, because the patient has a history that only he is aware of. You might have access to his chart from the previous hospitalization, but do you have access to his chart for every admission or ER visit that he has had all his life? It's better to collaborate with the patient and come up with a plan together, this way, you don't have to wade through the whole 'trial and error' process that does not work and just leaves your patient waiting in more pain. By the time I get moved to the inner sanctum of the ER, and get IV line is established (I'm a very, very hard stick), I have already been in excruciating pain for no less than 2-3 hours. With no relief, the pain keeps building and building until even the paltry first 2-3 doses of pain meds will not do anything to stem the tide. So you getting frustrated after giving me 2 doses, and my pain is still a 10, well this is partly because the pain has been raging uncontrollably for so long that small doses of IV anything isn't going to touch it. Regarding food: it's a comfort thing. When you are sick, and someone brings you your favorite drink or snack, doesn't that comfort you on some small level? So therefore, me asking for Lorna Doones (my favorite cookies), or peanut butter toast and hot chocolate is not to be rude or to turn you into my personal waitress, it's because, food brings a level of comfort into a painful existence. And not eating the food when it is brought, it is not to waste food, it is because probably right then, I am in more pain, and can't really focus on anything but the pain at that point. Or I'm nauseated. Or...hospital food tastes like crap. Regarding your point about pain scale, right now, my pain level is a 3. When I have a mini-crises, it's a 5. When I have a major crises it's a 8. When I have pain so bad that it's all encompassing, all over my body in a tidal wave of excruciating fire...that's a 10. And the 2mg of Dilaudid shot you gave me 15 minutes ago barely took it down to a breathable 9.5. My pain score is high not because I'm a drug addict or want pain meds, it's because I'm in an acute pain crises, and at that moment, the pain is really, really, really bad. But the other nurses are right, pain is very subjective. So if the patient states their pain is a 10, treat it like it's a 10. Why does it bother you so? Are you paying for the medication or their medical bills? A person with chronic pain might not have the same posturing that you expect with a 10/10 pain. With my 10/10 pain, I can't do anything, I don't even want to talk, I just want to cry, curl into a fetal position and pray for a quick, merciful death. However, my sister at a 10, watches TV to distract herself and keep her mind off the pain. At a 9 she can even talk on the phone. And when my parents or family call me on the phone, at a 9/10, I talk and act as 'normal' as possible because I don't want them to be worried. How one deals with pain is should not be the yardstick for the pain scale or your decision to administer or with-hold meds. Regarding the power play issue you mentioned, there is a huge power-play between the patient and the nurse. The nurse feels like she knows everything and can pretty much decide how miserable she will let her patient be, while the SCD patient who has been dealing with this condition all her life is thrust in the role of the supplicant, begging for water, help to get to the bathroom, pain meds etc.. You also have to bear in mind that many SCD patients have had negative and bad experiences with medical professionals pretty much all their lives. Having experienced painful crises and several hospitalizations, I can tell firsthand the negative attitude that health-care practitioners exhibit towards sickle cell patients. It is common for SCD patients to be labeled as malingerers, manipulators, or even defined as drug seekers by nurses and physicians. So the patient is coming to you with BAGGAGE from all these previous hospitalizations. And you have BAGGAGE from all the hordes of frequent flyers you have taken care of. It's like a toxic relationship, no trust, but tons of baggage on both sides. SCD patients frequently report dissatisfaction with care they receive, which is often related to inadequate pain relief (Dorsey & Murdaugh, p. 45). Inadequate pain relief results in a poor quality of life, passivity and aggressiveness when dealing with care providers and heightened distrust between SCD patients and their providers (Strickland et al., p. 37). I have had a nurse tell me, "Don't expect all your pain to go away." I have been discharged in pain and had to crawl through the ER to the waiting room on my hands and knees, while nurses looked on. I have had to wait for hours for someone to help me to the bathroom, and it was the woman who came to mop the floor of my room, that walked me to the bathroom. I have had a doctor tell me "shut up, you don't know anything." I have had a nurse say to me, "Why are you crying, you should be used to this by now." These are just my stories...and I am a nurse myself, and have been exclusively only to the ERs of the Hospitals where I have worked in. So I imagine that your patients are coming to you with the same history---or worse. So I come to you, with all this baggage, in pain, and I'm asking you to help me. What you do, well....that's all on you, but realize that as a nurse, you are supposed to help people...and not harm them.

Whoa...that totally freaked me out too! Thanks for keeping it real foraneman!

I cosign on what the previous poster said. I don't know how the OR works, but at all the hospitals I have traveled to, I usually get 1-2 days of orientation and then I hit the floor running and am expected to function optimally. Try to get a circulating position, but if you can't then you might have to work perm until you can train to be a scrub nurse.

I worked at the Oakland Kaiser. It was really shabby and dingy, but since then they have moved across the street to their new building which is much better. Most of the nurses do 8 hour shifts, so for your 12 hour shift, you will have 2 assignments, and get floated at least once. Your first hours are a filler shift, and then you might get floated somewhere else. Besides that, it's tolerable. I've worked other Kaisers as well, and I would give this one a 6/7 out of 10. I recommend living in Alameda. It's just around the corner from Oakland, but really pretty, and generally safer. Stay away from East Oakland period. But Jack London square, piedmont etc. are really nice and generally safe during normal hours. Lake Merritt is quite lovely too. Oakland has alot of culture and beauty. But you have to look past the hard edges of it's reputation to find it.

Yeah, each BON makes it completely confusing. Of the states listed, I only have a Cali license, and I got this before the new restrictions. Since you have your license originally from AL, you are eligible for licensure by endorsement from all the other states. This means that you do not have to retake the NCLEX, the states just have to verify that your license in AL is in good standing. Unfortunately, you cannot do this online since AL is not a member of the NURSYS system. You will have to apply using the mail in form for each state. NJ and NY I believe are compact states, which means if you get a license in one, you can work in the other one with the same license, no problem. The only loophole here is that your original state of licensure must be a compact state as well (not sure if AL is). You will have to mail your application form, fees, transcripts from your school, and a release from the BON in AL to the states you are requesting. They will process this, and then give you either a temp license (which is effective immediately for up to 90days), or a permanent license. CA now reviews transcripts, and if you do not have the educational requirements, they might not give you a perm license until you have all the courses necessary. You also have to do the LiveScan fingerprinting, which crosschecks your prints against the criminal database. Usually, your recruiter can walk you through the details. Hope this clarifies it a little bit more.