mandomania

Greetings fellow nurses, I have been a nurse for 25 years and am experiencing severe burnout. I am a caring person and want to continue to help patients. I find I really excelled in 1:1 encounters when sedating patients and when I was a PICC nurse, but eventually wanted to do something else. My hope is that there is someone on this forum with an idea for a single nurse to start or become part of a business in the Chicagoland area. I was thinking a foot care business would be good, but I'm not sure. I'll keep doing research, but I am hoping someone can help me save a ton of time and help a brother out. Thanks. Armando

I used to work for a mobile PICC service, mostly difficult IV access and some midlines and PICCs. At the time 3CG from Bard had just come out ( which helped to guide the tip of the PICC to the distal 1/3 of the SVC. That would appear to be the document you want in the chart, otherwise, the patient needs a chest film. I imagine you would want a document that has insertion site, etc to include in patient's chart. Hope it works out for you. Watch out for MDs insisting PICC line placements in inappropriate patients (ESRD, Sickle Cell, etc.). Good luck.

Maddog, There is good new for your situation, however it may depend on the market you live in. There are large hospitals (Like University Medical Centers) that may present a good entry point into that particular medical system. That directly translates into, get your foot in the door somewhere. Let me explain...there are large hospitals that perform a myriad of surgeries like open hearts (CABG), pacemakers and then treat a host of other treatement modalities that support patients that are recovering from strokes and major surgeries that require observation and a lot of support. That means nursing! Doctors don't want their patients going to some hole in the wall someplace only to degrade and decompensate over time, especially considering our aging populace. People are getting joint replacement surgeries, pacemakers and other treatments at an older age and a LOT of them can't go home right away. So here's a possible plan...figure out a commute that works for you and your family. If your young and single, great. Identify hospitals in your area that are larger medical systems with a diverse workspace. One strategy is to get into a rehab unit where there are patients recovering from open heart surgery, major transplants, strokes, etc. You get a job there and then keep an eye on the hospital's job board. Be good to everyone you meet, be industrious and keep your patients in good shape. Work on your, "Brand". We all have a brand and you have to build it. Of course you will meet the low lifes in our profession who gossip, bully and all of that other stuff, but you have to believe that the sky is the limit. Bide your time and have a plan. What interest you? Don't just pigeon hole yourself into one role. In my humble opinion, stay away from, "Floor nursing". I'm not a hater...I did that for four years before I did surgical ICU, IR, Cathlab, EP and PICC nursing. The thing is you need an, "IN". So...I'm trying to save you from being short staffed, working crappy hours and the need to work a bunch of weekends and holidays. If you choose to work the typical grind, you WILL evenually get side-lined by a psycho patient, a back injury, exposure to sharps or biohazzards and/or experience significant mental health issues related to coping with copious amount of baloney that nurses have to endure in the everyday spaces of their work place. That does NOT include dealing with the maladaptive drama from other nurses that are miserable, passive agressive etc. Thankfully, they are not the majority and we are lucky that nures usually come from the part of humanity that is kind, caring and genuinely altruistic. Here is a possible trajectory. 1. Get your foot in door wherever in a hospital like the one I mentioned above. If you don't get in right away, don't worry...you will because your'e not a quitter right? Volunteer if you have to. Mother baby units are looking for "Cuddlers" all the time. Who says they have to be old grandmas? So get in somewhere. Next, do that for 6 months (The HR department will know how long you have to be on that unit. At my last hospital, it was 6 months). Find out on the DL though. That's not something you have to advertise. 2. There are a lot of departments. What's your jam? You could do wound care, work in radiology like where they do imaging studies etc. Find out what you want to do. 3. If you want more options, work ICU for a year or two, preferably surgical or a CVICU. After that you can learn procedural sedation and get a job in OUTPATIENT. Yes, I'm shouting! With ICU experience, you have more options. If you can do ICU sedation, you can learn procedural sedation, and guess what...Cath Lab, EP and GI Lab circulators and skilled and different in a lot of ways, but it's Fentanly and Versed all day long, unless it's a MAC case and anesthesia does that. You could work doing stress tests, learn to do PICC lines, blah blah blah. The above jobs come with call though. You will have to carry a pager but usually, you get get like $5 bucks an hour, plus time and a half if you get called in. Cath lab, your going to be called a lot, EP may not have call, GI lab, not so much depending on where you live, IR...they will usually push their weekend consults to Monday docket, which is why Mondays in IR are busy. 4. It starts by saying adios to the long term care. If you want to go back and do that later because that's what feeds you then great. Otherwise you can eventually transition to work in an allergy clinic, rheumatology clinic, diabetes clinic...see where I'm going with this. Monday through Friday and maybe even four days a week, no holidays or weekends and NO CALL. While you are young, get an MBA or NP degree or just figure it out. Maybe you will find you want to go into administration...Hay Dios Mio! 5. In all, just do what feels right and have a plan because the years go by super fast. Your body will also suffer if you work the bedside for too long ( See warning above). Be careful to not climb the ladder for so long doing something you hate only to find out your ladder is agaist the wrong wall! Good luck. Lengthy, but something I travel back in time to give to my younger self. But it's sad and it's sweet and I knew it complete when I wore a younger man's clothes". Billy Joel...Piano Man. Good luck to you and all those entering the nursing profession. Be kind to yourselves and surround yourselves with things in your life that help you escape what you see and do in your work lives. Kind regards, [email protected]

I'm picking up hrs in ICU at large medical center in Chicago for extra money part time. ED dropped off elderly patient on a vasoactive drip and left. Didn't notify ANY RN at all. No report, no communication of any kind at all. I'm like, *****? Really? I'm so pissed about this pt abandonment issue and the lack of urgency about it. I'm supposed to work today but I've already applied to 3 other positions. I have almost 20 years experience working with high acuity patients and I have never seen the equal to the unsafe practice issues that I have seen at this hospital. It's even a national safety patient safety goal. Initially, I was going to post to get this off my chest and get feedback but I'm so f**&king pissed that I think I need to leave this place.

Hi. Looks like an older thread but thought I would share my experience in hopes it will help you somehow. I am one of four nurses that provide vascular access services at the 250 bed community hospital where I work. We only do about 50 to 60 piccs a month and I probably do most of those. It can be challenging when you work in other cost centers, areas, etc. For example, 3 of our PICC RNs work in Cath Lab, and I have ICU and IR background. Lately, I'm doing most of work because our hospital has gutted our budget, and pay has been gutted as well. Here are some thoughts and I hope they help: 1. Recruit people that are dedicated and detail oriented. 2. Have a physician as part of your team, even if its an IR Doctor that can back you guys up. There will be times when some other physicians will try to pressure you into placing lines in bacteremic patients, chronic kidney disease patients, or crumping ***** patients in ED/hospital that just need a central line asap. I mentioned IR docs because they usually hate doing PICCs and by helping your cause, they help themselves. Plus, other MDs will be less likely to be pushy when they know one of their peers backs you up. 3. Look up and keep a copy of articles from National Kidney Foundation, Fistula First, etc. That way you can be a good ambassador for helping other nurses learn why a PICC line isn't always such a good idea. 4. Develope a plan or protocol for placing ultrasound guided peripheral IV. That way you can offer good service..."sorry bud, a PICC isnt the best idea for this patient, but maybe we can place a very reliable IV for him instead". There are some longer IVs in varying guages that are perfect for this. 5. Hours...well, to start, maybe offer a 7am to 3:30pm with a last call at 2pm. Will you cover weekends? If your coworkers carry pagers for other departments, this will be a muy grande headache. Maybe get going for a while and then offer weekend coverage. 6. Charges?....good question. Im sure there are many opinions out there, but I think Bard is an excellent choice. The Sapiens with 3cg is awesome. Bard kits have good quality wires, peel away sheaths, etc. You can pair the sapiens and 3cg w an ultrsound you already have also. I just mention this because I use a different US paired w Bard equip and its awesome. Your bard rep will help you put together a kit for the stuff you want in it. Also, get all of your IV start stuff and figure out your charges. Well, I sure hope this helps. There are some bright people posting on this site and they are very helpful. Good luck. I just want to mention that you will work a lot with radiology folks. Many managers and people in leadership positions in these areas, ie...IR, Interventional Cardiology, and PICCS, have radiology tech backgrounds. They are awesome people but will view things 100% different than a nurse will. They usually see vascular access as placing device in patient 1234 blah, blah, while nurses see the bigger picture...ie: human component, God, I hope the nursing home doesnt jack up this line,etc. My manager has a masters, but thinks like a tech. It can be very frustrating at times. These are peple, not widgets. Anyway, hope this helps. Im excited for you and wish you the best.

great transcript of your discussion. i'm glad i ran across it. both of you bring up some very good points. i have had the opportunity to work with some very good techs in an i.r. setting. they were/are very strong professionally, however, techs are not trained to deal with a lot of the intricacies that surround really sick people getting piccs. to be fair, nurses that are placing piccs have usually worked in the trenches so to speak and are intimately familiar with seeing patients as a whole. what i mean by that is you can see a patient's info (age, diagnosis, medical history, medications, labs, current overall condition, body habitus, etc.) and you immediately know how all of these things are going to interplay with a line placement. on one occasion, i was going to help with staffing in an i.r. and with placing piccs in a hospital that was affiliated with the hospital i work at. the tech placed the piccs at this hospital. we grabbed the cart and ultrasound, etc and went to the icu to place a picc. i was just helping out opening things on the sterile field, etc. and tech placed the picc. super nice guy, but after watching that picc placement, i was like, no way. the short story is that it's more than just a procedure or act. i walked away from that assignment. i understand that hospitals need coverage etc. all things being equal, i'll take the nurse. "in the end, picc placement is a task, one that hardly encompasses the wide breadth of skills and knowledge that defines nursing, so i don't see it as a huge blow to nursing to lose something that really best falls under the role of a "tech"." like i said, great discussion, but this particular point made by munrorn above is completely contrary to my experience assessing for and placing piccs. i have noticed similar trends in working in/around unionized hospitals and could not agree with you more.

Hey, I know this thread is a little dated, but I hope you don't mind me trying to encourage you in this stressful situation. I too have worked with my share of toxic personalities and weak management types. It definitely sounds like you realize that this work situation is having a negative effect on you. Be careful. It's a bummer when you are dreading going to work. You described a situation that can have severe mental health consequences for you. This work environment will also have negative consequences in terms of patient outcomes too. Hang in there. It sounds like your moral compass is telling you to get the heck out of there. The tough part is learning to trust your instincts. Leaving this toxic work environment will not make you a bad person. Plus, I would encourage you to find a good mentor. Is there anyone who's professional practice you admire? If you find one, stick to them like glue. It's okay to emulate good practice. These people can be a breath of fresh air. Unfortunately, you cannot control what other people do. I totally get being an agent for change and all that, but maybe it's time to update your resume. It sounds like working part-time is not an option while you look for something else? I have a lot of questions regarding why infusion reactions are on the increase and all that, but it sounds like the bottom line is your work environment is toxic to you. Short answer...get out, find a good (or more than one) mentor. Hope this helps. Take care.

It's interesting that flushes can be considered a device. I had not heard that before. Thanks for posting this thread. Asystole, in your response did you mean "thrombolytic" properties of Heparin? Thanks, take it easy.