lifeLONGstudent

aug 06 grad -- we were the second class to do the program. great program don't freak about $. Talk to Financial aid - even with you working now, they have a form that you fill out that states you will have to quit your job to do the 60+ hr week commitment program... and that you will need $ to live on. I think the form is called an "exception" form. TCU is not going to let you drop out of the program because of $. You will be able to feed your kids and pay bills (but probably might eat some mac-n-cheese for 15 months... and no movies unless they are dollar movies). Pm me if you have more ?s. LilfeLONGstudent

i'll be there.... driving in from north richland hills (close to rufe snow)... if anyone wants to carpool i can't wait - the calendar is numbered (and so are the number of days left to work). i am sooooo looking forward to august - going to take 2 weeks off work before school starts --yeeeee haaaaa! i need to try to get on a permanent day-shift schedule. lifelongstudent see you guys on april 30th if you are attending. pm me for detail, but you should have received an invite if you are in the incoming class.

going to tcu got the letter yesterday.... big envelope (8.5 x 11) that says congrats on the outside... so that way no one is scared to open it !!!

similar experience here. was told they interview 180 for 75 slots --- why so many? why not weed more and interview less? apparently everyone wants DFW. Heard some got accepted on the spot if they took distant sites (Florida, Cali)...that is not an option for everyone who applies. If I could pack up and go to California, then believe me, I would have applied to every school in the USA (last year)... but I can't, so I applied here, WHERE I LIVE. It is a great feeling to work your ass off the last 5 years and then be told "there are 150 just like you... why should I pick you". Not much tact. feeling dejected, LifeLONGstudent ..... aka 1/150

Hey, I'm not a student (yet), but just read your post and wanted to say that I feel bad for ya.... wish I could make it better, but my magic wand is broken. Would it help to talk to the professor --> go to the source and ask for guidance? I have heard stories that his class/exams are challenging. One of my mottos is: I might not be the smartest person to ever do this, but I am far from the dumbest... and if THEY can do it, I can do it. Sorry you are having to go through this. I know how bad you want this (we talked earlier in the year). LifeLONGstudent

This is a nightmare for me, and no procedure.... so I want to know what you guys do? Do you get an air mattress to help prevent breakdown (First-Step)? RT and MD at bedside? How many RNs? change out EKG to back side (and in same order? White on right, smoke over fire.... etc)? extra tubing for your lines? just to give you some slack (like maybe 1 extention tubing per line). These are usually sicker patients with many drips. If they are on pressors, do you see big swings in their vitals? (not necessarily SpO2). prop with pillows? how do you turn q2 hours to prevent skin breakdown? and what parts do you turn or reposition? how do you position the pt before, during, after the turn? Use a towel roll? How long do they stay proned? 6hrs, 8hrs... do it twice a day? and for how long (usually) before VQ mismatch or shunts improve to where you don't need to do this anymore? Thanks in advance for your tips and pearls! LifeLONGstudent

everything is weighted. i don't know the secret formula (and if i did, i'm sure i wouldn't be allowed to tell ya...), but if it were not important, tcu would not require it. i am sure they use it as a tool to "measure" an applicant ..... and thin the heard. that being said, if they suggest 1100 as min score and you are > 950, probably not as big a problem as you are thinking.... but if you are 800's and below -> not so good. i really think admissions is a "package deal" - that is what the interview is about: getting to know you, see if you are a good fit, etc. they are asking themselves: does this person have what it takes to make it through the program, deal with the stress, perform well on the exam (school has a reputation to maintain), and represent us well in clinicals.... get the idea? sell yourself..... make them want you. personality and determination are very helpful (in the interview, in school, in clinicals, in everyday life). lifelongstudent

[ i would have tried tcu but i don't have my ccrn yet and i wont have time to take the test and get the results back ............. not true. you get your score the same day that you test. you'll get a printout of your scores after you test, and as a little bonus, each category is broken down and individually scored. this little piece of paper (with your individual and overall scores) is what tcu wants to see. the fact that you passed is not as important as how well you did in each system. so, not that much time left, but you do have time to take the ccrn. interviews aren't until 1st week in january. you could apply and state that you will test in december and they could give you a contingency interview. lifelongstudent

you can come bathe my patients !!!!!!!!!:rotfl: a n y t i m e !!!!

Louise - sent you a PM

I understand.... I do feel for you. For me, the best thing was to just let it go (get over it) and work some OT (look for staffing bonus in SICU -- they always have staffing bonus available - it is $150 for a 12 hour shift - plus you get OT.).. and get my loans paid off asap. I had 40K to pay off from a private university, so look on the bright side -- you are way less than 40K. Make no mistake, I am sure PHHS is well aware of the rules and regs....this is just not important to them. They talk a lot about improving morale, etc. but the important things that matter (like this).... just seem to move farther and farther to the back burners. Good luck to you, LifeLONGstudent

I too work at PHHS -- and the chief nursing JERK has just left (hurrrrrray~) Funny how they don't tell you this when you start the residency... and they all play dumb knowing damn good and well that you will be ineligible. Also, it just irks me that the NIPS get to train in all the ICUs for 7 MONTHS (and we residents train in our unit for 3 months), yet their contract time starts from the DAY that they start their program (ours starts from when we FINSIH the residency and start taking pts on our own). Their penalty for breaking contract is PRO-RATED so it drops as their time there increases -- not ours. If we leave 1 day early, we still pay 10K. Not fair - we residents actually WORK 4 months longer on our units as independents, but we are screwed in the end. sorry, just venting. I too asked the CNO to help me with an issue and he told me "Your ____ (problem) is of no concern to us at Parkland" -- what a guy! I believe what goes around, comes around and I hope he is enjoying his! Spread the truth about PHHS -- it is a great place to learn, but you should know the truth up front: the good, the bad, and the ugly. LifeLONGstudent

Call the lab and ask them to LOOK at the sample and see if it was hemolyzed. You are right - they should have documented it, but things happen when you are running 100 samples an hour. INTRAcellular potassium is much higher than EXTRAcellular (which is serum). For K+, I think it is something like 5x - 8x more concentrated intracellularly. If it was hemolyzed, ask them to put a comment in the result so everyone knows the scoup when they look at results 4 days from now. If the sample was hemolyzed, red cells broke during poor collection, then they spilled all their INTRAcellular juices (K+) and that is why the K was falsely high. Clotting doesn't affect the labs sample for these tests - they don't run WHOLE BLOOD glucoses. They all run either from SERUM (red tube or red tube with gel) or run it from PLASMA (has anticoagulant - usually lithium heparin). So, FYI - you really don't have to SHAKE or INVERT these samples -- and doing so can actually cause more hemolysis. And there are very few tests that matter if they are clotted... mainly purple tubes [EDTA: CBCs, ESR, etc] and blue tubes (CITRATE: coag studies]. As far as it not being as accurate in someone with edema, that is also true. Someone with 3+ edema -- you can press on their hands and see the fluid shift... so imagine sqeezing a finger that is full of edema -- your sample will be contaminated with that same fluid, thus lowering your glucose and K+. You can do capillary sticks from feet, if they are not diabetic -- if they are diabetic, any kind of feet sticks are not good practice..... AND... you can do them on earlobes! Takes a little more effort, but less likely to be contaminated with tissue juices. "Tissue juices" -- that is why you are supposed to wipe away the first drop of blood when you do a fingerstick glucose (but a lot of people don't do that).... Warming any target (fingers, toes, earlobes) with a really warm washcloth for 2 minutes will help vasodialate capillary beds and make it bleed better --- less risk of contamination or hemolysis... and less work for you. lifeLONGstudent -- 1st bachelors degree -- laboratory science -- 2nd bachelor -- nursing.

suanna #1 no need to me a smart a$$ #2 this is a MICU and SICU forum, not CVICU... so yes, Cushings IS (or should be) BASIC knowledge for any nurse in this type of unit. #3. I work in a level I / teaching hospital. We have an excellent training program for nurses and docs (Parkland). I also do agency work in "smaller" (500 bed) hospitals which don't manage as high acuity patients. All this being said, it doesn't surprise me at all that YOU don't know what Cushings is (plus you work in CVICU) #4 quit looking for a fight. Once he said he was still in orientation, I replied with a different view. Go back and reread. I commended him. LifeLONGstudent

Still in orientation -- then that makes more sense. As your preceptor, I would have asked you to tell me what you know about Cushings... and we would have gone from there. Remember times like this when you are precepting the new ones in a few years....teach, teach, teach. Double cuddos to you for looking it up after your shift. Strong work. You are on the right track, doing the right things, asking the right questions and taking it upon yourself to look for the answers :-). LifeLONGstudent

my thoughts: HR of 40s - not pretty, but how is your patient? Does he look grey and dead, or NOT? Good peripheral pulses -- perfusing all tissues? then leave it alone. Good pressure - leave it alone. You mentioned pressures were fine, even high. This about what is happening. Think about hemodynamics: Heart is in sinus, and just reallllllly slow. So there is a LOT of time for the chambers to fill, you are getting a really good stroke volume and hence a good pressure. He isn't low on volume, so good preload --> good pressure. Contractility a problem? Doesn't sound like it. So, if you speed up a sick heart (and I say sick because most hearts don't beat 30 x minute -- so it is either sick or professional athlete healthy [doubt it is #2]).... speed up a sick heart, which is doing it's job just fine, just to make it "normal"... then you are going to screw yourself and your patient. Basically, don't fix what isn't broken -- and right now, it is working ok. So what would happen to his BP if you gave some atropine --> probably go way higher. You mentioned cushings and that you found out this triad after you looked it up. I am not bashing you, but I think this is basic knowledge for any ICU nurse and should have been covered in your training (or at least school - I cannot imagine you never covered this in school). Waiting 30 minutes for a CT read is also not acceptable. Your ICU docs should have looked at the CT... and then called radiology. If the pt was exhibiting signs of cushings, then he had a high risk for herniation and interventions would be warranted -- and sternal rubbing a pt with pending herniation is not a good idea. As you probably know.... high ICPs need HOB 30 degrees, MINIMAL stimulation (suction, turns, agitation, keep nice dark/quiet environment, ADEQUATE sedation, ICP monitoring and management) and maybe some mannitol or 3% NaCl. If the docs mentioned cushings... these COULD be life saving measures. I would have put on pacer pads -- just to get ready :-)) So, these are my thoughts. I work in a medical ICU (not cards, not neuro). Others with more specialty might have more insight. I think you are doing a good job by looking up more info ... you are responsible for you now (no professors encouraging you to study). Take all the free classes you can. GET ACLS (press your manager) and they say no, get the books from AHA and start studying on your own. Buy some CCRN study materials -- that will help you alot (not for the exam, but for everyday when you work). Read about ALLLLL the drugs you are giving. Pick your peers brains and absorb all you can from rounds with your docs. These are some of the things that will make you a good nurse. Happy learning, LifeLONGstudent

Wow - I know exactly where you are coming from. I would advise you to get your financial life in order before you even think of applying to school. School is a huge undertaking and you don't want financial stresses hanging over your head.... that will SINK you in school (and the schools know it --- some of them ask if you are financially prepared to start school). You wouln't believe me if I told you how much debt I have paid off in the last 24 months (it is well over 6 figures in the last 4 years). We are debt free except our house and I will have cash saved up to pay for school by August. You CAN do it, but you will have to be disciplined. You have to make a budget and then LIVE off that budget. Use cash envelopes in the areas you are weak in --> those areas where you tend to overspend. Stop eating out. Stop impulse spending. No vacations. No $4,000 for Christmas. If you really want to do school, then downsize your car (and pay it off in 6 months). Work A LOT OF EXTRAS (overtime and/or agency). Buy and use Quicken --- it will help you a lot. ASK FOR HELP from someone who has done what you are trying to do and WON. I am not talking about some financial advisor where you serve to meet his quotas, but find someone to be accountable to, possibly someone in your church. If you become willing to "live like no one else" now, you will really be able to "live like no one else" in the future (and for the rest of your life). Don't let debt and overspending steal your dream or your life. Children do what feels right, adults devise a plan and follow it. Grow up, be disciplined, fight for what you want, and make it happen. You CAN do it, if you WANT it bad enough. PM me if you want more details, LifeLONGstudent

Just my:twocents:. We purchased Dave Ramsey's Financial Peace University two years ago and when I start school (in 3 days) we will be completely debt free with exception of school loans. It is a great feeling and when you have only a mortgage/rent payment and utilities to worry about, you can really sock away the money fast. Now, to each their own......but it sure worked well for us! Good luck. I too used this program and have paid off 6 figures in debt over the last 4 years. We are debt free. We WILL have 60K saved to pay for school IN CASH. yes it can be done HOW? Discipline, planning, and spending with a purpose. ... and work some OT! LifeLONGstudent

ohhh yaaaaaa.

excellllllllllllllllent! that sounds much better - i thought they left you hanging all this time.

are you just now finding out about north tx schools? thought they made decisions months ago (jan - feb)? congrats.

Criticare is a very good agency. They hire ICU nurses mostly (some ER, OR, and recovery also -- I think). I am an ICU nurse. Hiring is pretty much by referral only and you must have the extra certs to get hired (ACLS, PALS, CCRN, etc). top pay take up for their nurses --- you don't "have" to float and you don't "have" to take 3 patients pay is weekly very nice staff. Never messed up any of my pay. Always friendly and helpful when I call. no minimum time committments BEST PART: they don't call you every day to ask you to work. You tell them the days you are available and then they will find an assignment for you for those days. WORST PART: They staff mostly Dallas area hospitals. Send me a PM if you have questions, LifeLONGstudent

well then, if that is the case, i would recommend the 3 month residency. both programs, you will have exams, but the internship you will do journal club, papers, a research based presentation for your peers (including preceptors and other nurses/managers in the hospital -- a bit stressful). again, both are great programs. you just have to decide which fits you better. good luck with your decision. lifelongstudent

I work in one of the ICUs at Parkland and I know now it a very busy time for the NIPs (nurse intern program--- we call the nurse interns NIPS). They have completed all their rotations and they are deciding where they want to work. They will turn in their choices on Monday, and depending on which ICUs offer them jobs, they will be placed. All this goes through the NIP program coordinators. Let them get through the next week or two, then try to call again. Parkland is >900 beds and there are a few RN recruiters (as you can imagine). I would go through the ppl in the nurse intern program and if they refer you to a recruiter, ask for a specific recruiter name and extension number (or better yet, an email). One more thing -- the nurse interns are under the depart of education. This department is hosting TNCC today and tomorrow. They do all the continuing ed, CRRT training, IABP training, recredentialing of ALL nurses in February (can you imagine this nightmare???), BLS, ACLS, and nurse residency programs (for Burn ICU, Medicine ICU, Cardiopulm ICU, ER, OR, Trauma ICU, and Neonatal).... basically, the department is very small for the amazing amount of work that they do... .and ALL the ppl are SUPER NICE! If your name and phone number got missplaced, give them the benefit of the doubt. Call again. Let them know you are just wanting to follow up to make sure things didn't get lost in the shuffle. Ask them to let you know if you aren't being interviewed for the internship, and ask if there are areas that you could improve to be a stronger candidate later (nice way of saying WHY DIDN"T YOU PICK ME). One other thing --- consider doing the nurse residency at Parkland. You only train in the department where you will work (interns rotate through every ICU and then choose where they want to work). Residency is 3 months, intern is 7-ish months. Call and ask the recruiters what the other differences are. I did the residency and am very pleased. You will be an excellent nurse regardless of which program you do..... and you WILL know your stuff if you work at Parkland LifeLONGstudent