arnwest

Most neurosurgeons I've worked with would not let us sedate our patients unless they had ICP issues or were seizing (we might get low-dose dex or prop). Patients can be awake with an EVD and even ambulatory with an EVD. (I had a guy trying to take calls for work with an EVD in!) I feel like float pool is different for every institution. At my first job, the float nurses always got the low-acuity or annoying patients to allow unit staff to take care of the sicker patients. At another hospital we almost always gave them 1:1 patients in the MSICU, usually ones that were vented and pretty tucked in (no traveling/procedures). But I know that in the CVICU they got the sickies - fresh hearts, IABPs, ECMO. This hospital gave them a couple weeks orientation on each ICU. Bottom line, I'd say what kind of assignments you'll see depends on your hospital, and you'll probably have to prove yourself before they give you high-acuity assignments. I'd say voice if you're uncomfortable with an assignment, and definitely speak up if they try to stick you with the bad patients repeatedly.

I used to work at Upstate in one of the ICUs. They're a level-I trauma and burn center, so it's definitely the best hospital in the area for trauma (in fact, they're the only trauma center between Albany and Rochester, besides level-IIs in Utica and Binghamton, I believe). The health department mandates that RNs in NY have at least a year of experience before working in the ED, so you meet that requirement. I'm sure they'd hire you. Upstate is a state hospital, so as an RN there you'd be an employee of the state, which comes with competitive pay (at least for the area, which isn't saying much), union representation, and benefits/pension. The night shift differential is a percentage, not flat, so that's pretty legit. You should be warned about the scheduling though; full-time is 80 hours, which means you're working a mix of 8s and 12s. And everything is seniority-based. They are public, so you'll deal with a lot of underserved patients, both from the inner city and the outlying areas. From what I remember, though, the staffing is pretty good and, at least in the ICUs, they had good ratios. Upstate also has a designated pediatric ED, although I'm not sure if staff cross-train or float between the two. Overall a good place, definitely gave me a solid foundation as a new grad. There's also St. Joseph's on the north side, which is big on cardiac and psych. They just opened a new ED a few years ago. It's the only Magnet hospital in the area. Then there's Crouse, which just got bought out by another healthcare system. Their ED seems to have the best reputation amongst EMS. They're big on stroke, PCI and L&D with the area's only level-IV NICU.

We don't use caps/claves on our pressure lines or our continuous low-rate infusions (i.e., dilaudid, vaso). I'm not sure of the brand our caps, but our venous access team has been cracking down on dressing bundle adherence as the biggest source of CLABSI.

I'm the process of researching CRNA programs and have noticed that a lot of schools are switching from masters to DNP programs. Besides the advantages of being well-suited for research and teaching as a DNP, how advisable do you think it is to try for a DNP over a master's? I'm asking more in terms of being a competitive career candidate. I ran into this issue when I graduated with my ADN. I was able to land a great position out of nursing school in an underserved area, but when I decided to move to the west coast, most hospitals wouldn't even look at me until I had my BSN. Do you foresee a trend toward hospitals and anesthesia groups being more preferential to candidates with their DNP versus their masters? Thanks!

Get an ICU assignment. Most places will just float you to the floor anyway.

Our CVICU uses an anesthesia stopcock system - kind of. They stopcock all of the compatible drips together (one is always a carrier) and tape the line of stopcocks to the IV pole so it's just one line running to the patient's central line. Fewer tangled lines, easier to keep your drips from getting mixed up, and everything gets to the patient faster (or at least you see your titrations faster). So much of a better system than what we use in the MSICU - putting all the stopcocks directly to the hub of the central line with all the different IV tubings going from the pump to the patient. Everyone has their own thing I guess!

I got hired into the SICU right out of nursing school, but as you said, your area sounds like it has a greater abundance of experienced candidates to choose from. I got a call-back on an application recently whose qualifications weren't completely clear (BSN preferred vs. required). I asked the manager during the call-back if they hired people with their ADN (even though I'm enrolled for my BSN) and she said not without approval from the CNO. Long story short, I saved both of us the trouble of the interview by being up front about my qualifications. It seems like a lot of times HR screens the applications and forwards them to the hiring manager and the manager calls without an in-depth evaluation of the application/resume. Good luck!

My understanding is that it depends on what kind of shock the patient is in. According to Surviving Sepsis, levo is the first line pressor, followed by vaso, to decrease levo requirements. Sometimes I see Neo used if the patient doesn't have a central line. But I would think inotropes would be preferred in cardiogenic shock.

First off, congratulations on the job offer. I must say that I'm a little surprised that you were offered a position so far in the future. What does your cadiothoracic and neurology experience consist of? Do you have tech experience? I started as a new grad in an ICU and so have many of my coworkers. It can be done. It's difficult because there's such a huge learning curve from what you've learned in nursing school to what you have to know on a day-to-day basis. Some of my coworkers have found the ICU Book to be helpful - it's got lots of practical information. I'd say go into it with an open mind and a positive attitude. Be willing to try new things and go beyond your comfort zone. You definitely will have to. The first year is tough. But if you work hard you'll get through it. Good luck!

Like everyone else said, it probably depends on the company where you're applying. My experience, however, was this: I applied for, interviewed and secured a job about a month before I graduated from school. The nursing recruitment department was happy to get me through the hiring process before the huge influx of new grad applicants in May/June. Having a position secured gave me a lot less to worry about during finals/NCLEX time. Good luck!

Before traveling to MRI, make sure your patient is small enough to fit in the machine. (If they're on the heavy side, I always call the tech up to measure them beforehand. It's saved us both a lot of trouble). For that matter, before traveling anywhere, always make sure you have enough drugs to get your through the trip. Always expect the unexpected! Double check your drips. I always follow tubing from the bag all the way to the patient. I've caught high alert drugs erroneously running in fast as secondaries, and frequently find fentanyl drips y-sited in with Versed drips that have been turned off, which, at 2cc/hr through a central line, means the patient isn't getting any fentanyl at all. Do bedside report. Or at least have a face-to-face with the previous/next nurse and the patient. Quickly review drips, vent settings, bedside safety equipment, etc., with the other nurse. This holds them accountable, and shows that you're accountable as well. If your monitor alarms, don't get excited before first looking at the patient. Always assess the situation before calling the doc. Always check for consent - blood, bedside procedure, etc. And don't witness a consent without physically hearing it. That's my two and half cents.

We've done it with a couple of patients who were on CVVH for weeks, once they were stabilized, but just couldn't tolerate hemo. We didn't get them up to walk, just slid them out of bed to the chair. It's kind of like getting a vented patient out of bed.It's by no means practical or easy, but anything to increase mobility.

Most of the Upstate hospitals hire ADNs, at least to my knowledge. I had no issues getting a job. Good luck!

I would recommend waiting at least a year, especially if you have an ICU position. I applied to several ICU positions throughout Seattle/Tacoma after about a year and a half of ICU experience (in NY) . I only heard back from the University of Washington. I interviewed with them, and they asked me to try back after I had obtained more experience. So my two cents: wait it out. Get your specialty certification (I could have done myself the favor of getting my CCRN BEFORE interviewing there). And I should mention that I only applied to staff positions, and only have my ADN. The pay wasn't that great either, especially considering the high cost of living. I obviously had my NY license, so I just endorsed. The process was really quick and easy (maybe 6 weeks before I got my temporary license, which Washington automatically gives you while your fingerprints process). Hope this helps! Good luck.

I finally filled my gas tank to full! I had been working for a full month before I got my paycheck and you better believe both my checking account and car were running on E!