NrsBtrfly2005

Hi everyone, I think I have read something about this topic on a previous thread, but am unable to find it, so I apoligize if this is a duplicate post. I work nights and on night #1, I recovered a patient that had just had a large portion of his bowel removed due to necrotic bowel (ileostomy, jejunostomy) Well the patient comes to me from the OR intubated with NO sedation OR pain management orders. Only order is to contact intensivist. Patient starts to wake up very quickly; intensivist called, order for Morphine and Ativan; max out on doses; patient still wild and fighting vent. Re-paged intensivist and got a Diprivan order; everything MUCH better for patient. (By the way our intensivists like our patients at -1 RASS Score, not zonked, which I feel is sufficient) I am a new nurse in the ICU, but my thought process is that although the Diprivan is a sedative, it is not a analgesic, therefore, patient still needs Morphine to help with pain..... so, I continue to give Morphine (as ordered) PRN when patient vigorously coughs during suction (or on own), gets turned/reposition, grimaces, gets restless, grabs belly, etc. Night #2, I come in to find that the day shift RN (12 hours) did not give the patient morphine all day... only kept the diprivan gtt running... I continued my routine of PRN morphine during times described above (I only gave 4mg doses about 3 times during my 12 hours). When I gave report to the oncoming day nurse (not same nurse), she did not seem bothered that patient didn't get morphine the previous day and seemed surprised that I was concerned. My question is do many of you see this happening in your ICU, where some nurses feel diprivan is adequate pain relief for fresh post-op patients? Am I over reacting when I feel frusterate about this? Since I am a new ICU nurse, your input is really appreciated. NRSBTRYFLY2005

I bet you feel like you are on the top of the world right now and that is a great feeling to have! Congratulations to you!! :yelclap: I had an similar experience as a nursing student. My nursing school allowed certain students to participate in an extra "internship" (in the unit of our choice) through our local hospital. Not only did we receive elective credit for this, we were paid $10/hr by the hospital for the semester. I chose the SICU and am so glad I did because after graduation I was automatically hired, no questions asked! Recommendation: start looking for good ICU textbooks now so you can start reading up on certain issues and cases specific to the ICU environment. So far, as a new grad/nurse in the ICU, I have purchased: 1) Fast Facts by Kathy White (found @ www.kathywhite.com; GREAT RESOURCE! Many nurses in our ICU have this book) 2) AACN Essentials of Critical Care Nursing (found @ www.AACN.org) 3) Thelan's Critical Care Nursing Textbook, 5th ED just released this month (Mosby) (found @ www.us.elsevierhealth.com) 4) Pass CCRN! (Robin Donohoe Dennison) I know it seems like a lot, but believe me as a new grad in the ICU you will be referring to reading material very frequently!!! Everyday you will learn SO much and I am truly excited for you! Good luck in your future endeavors!!! :cheers: Nrsbtrfly2005

Thank you all for your input. I really appreciate it! NrsBtrfly2005

Hi everyone, I am a new nurse working in the SICU and feel that every night I work is a challenge - but, I love it! I learn so much every day! Just wondering, do you find in your hospital that physicians routinely ordering lasix in between units of PRBCs (or following administration of PRBCs)? Does your ICU have standing orders for blood administration which include lasix administration during blood transfusions? Lately, I have noticed that some of our physicians are NOT ordering lasix in between PRBCs, causing two recent patients to go into failure/pulm. edema due to fluid overload. Obviously, this causes chaos! The nurse and RT place the patient on high flow NC/non-rebreather (if not already vented) to maintain optimal sats, order a STAT ABG, and call the MD in the middle of the night asking for a lasix order. (**Not to mention the undue distress caused to the patient**). I have seen this happen to two patients in the past two weeks (unfortunately, one happened to be my patient - which I felt horrible about for days - luckily I caught it early and intervened in a timely manner). Bottom line - LESSON LEARNED. I will be calling to ask for a lasix order from now on!! Also, while you are running a transfusion, do you routinely shut off the routine ordered IVF during that transfusion (in hopes to prevent fluid overload)? Any input would be greatly appreciated, because as a new nurse in the ICU I am constantly seeking new approaches and methods to maintain SAFE, EFFECTIVE, and OPTIMAL patient care. PS. Both of these patients where 70-80 yrs. old. THANKS NrsBtrfly2005

I am a new grad in the ICU and based on what I have seen, regardless if you are a new grad or a new ICU nurse with previous nursing experience, making it in the ICU depends upon the person (and the internship/education provided from the hospital). I have started in the ICU as a new grad (along with 4 other new grads from my University) at the same time as other "experienced" nurses (m/s, step-down, ER, etc) and seem to be catching on to the ICU just as fast, if not somewhat faster, than the experienced nurses. As a matter of fact, one of the experienced nurses was just sent back to orientation because she "wasn't catching on". Whereas I just received my first evaluation as a new nurse (7/2005) and am already receiving a 5.5% raise based on my "outstanding performance"... All the new grads in our ICU units are performing excellent. In regards to the original post, I don't understand the nurse manager's thought process because I believe that ANY nurse (rather new grad or experienced in MS, SPCU, MPCU, ER, etc) can florish in the ICU if that is their true passion. The key is: ASK A MILLION QUESTIONS, utilize your resource nurse, read/read/read/read/read, lean on your coworkers (and allow them to lean on you), learn from your (and others) mistakes, and BECOME A TEAM PLAYER. With that type of attitude and the determination to suceed, ANY nurse can become an excellent ICU nurse.

Hi Tamm1 - I too have encountered dissuasion from certain nurses when speaking of pursuing a career as a CRNA. In fact, the tension has become so bad within our area that new grads wanting to enter the ICU CAN NOT even mention that they are considering CRNA school - 1) You may not get hired (because the hospital spends a lot of $ to train you; then you leave). 2) You become an outcast among some of your peers. In our hospital, there are many ICU nurses leaving the bedside to attend CRNA school and as they do, some nurses ridicule them (behind their backs, of course ). I say that those who ridicule and speak poorly of nurse anesthesia are either envious because they do not have the means to pursue the career or uneducated/misinformed. Fortunately, I have had many encounters with CRNA's and have also had the opportunity to shadow; therefore, I highly encourage you to do that. Tune out all of the negativity from those who are inexperienced so that you can make a honest decision on your own. Also, if your area is anything like mine, (unfortunately) you might want to keep your aspirations of becoming a CRNA on the "down-low" when trying to get a job on the unit following graduation. Best of luck to you!!

Very, very, very well put! I am a new BSN grad in the ICU and can't wait until I have the opportunity to attend CRNA school. I did have the opportunity to shadow a CRNA and now I know for sure that's where I want to be (hopefully, in about 4 years)! Thanks for the great post!

Our healthcare organization requires: 09/15/05 0900 "Ativan 0.5 - 1.0 mg PRN anxiety" R.B.V.O. or R.B.T.O. from Dr. John Doe to Jane Doe, R.N. RBVO = Read back verbal order RBTO = Read back telephone order

Good morning, I am a new grad (RN) in SWFL and am currently finishing up the internship/orientation. In our 3-unit ICU, we are pretty short-staffed, so some new grads are being offered day and night-time positions. I chose to work nights due to the $4/hour shift diff. Also, nights seem to be without as many interruptions, which (in my opinion) creates a better environment for the new ICU RN to learn. Also, the entire staff (whether you have 1 or 30 years of experience) is required to rotate weekends and holidays. Yes, as new grads, I am sure we will get the brunt of it, however, everyone is expected to take their turns. In our area, you cannot work PRN as a nurse (anywhere) without having atleast 1 year of experience. This makes sense because our PRN program allows you to float between departments, sometimes within all 3 of our hospital campuses. In my opinion, it is important for you to have experience before taking on this task because when you get to a unit, they don't always have time to train you, so you should have atleast some experience to make it through the shift! To make extra money, I agree with the other posts in that you should pick up extra shifts on the unit. If you hospital is anything like the majority, your unit should have plenty of opportunities for overtime. Best of luck! :balloons:

I am a new grad and new RN (passed boards July 2005). I have been training during my internship in the SICU and OHICU. As a new grad (and with preceptor assistance), Iam taking 12-24 hour post-op hearts (pretty much on my own) and assisting with fresh hearts. I am also taking IABP patients (without touching the machine, yet!) and plan to attend an IABP inservice through DataScope in September. I am also being trained in sheath and fem-line removals. The other day, I assisted with an IABP pump removal, as well. I have yet to be trained in CRRT, however, I am sure if the opportunity arises, my supervisor would be more than willing to train me. Our ICU director and supervisor are both very willing to train their new grads in these skills, so I do not see why you are being denied the opportunity. It sounds like it may be time to have a serious talk with your supervisor - you are entitled to some answers! Best of luck! -J

Hello everyone, This is my first time posting on allnurses.com, but I have learned so much from all of you over the past couple of months! This website is fab! Currently, I am working as an intern in SICU and will graduate as a RN in May. I just bought a Tungsten T5 and am looking for ICU software for it. Someone suggested kathywhite.com (Fast Facts for Adult Critical Care). Has anyone bought this book or used the PDA software? Thanks in advance for your feedback! NrsBtrfly2005:nurse: