TStewartfan

I love ICU. I came straight out of nursing school right into MICU. I wanted an overall part of the ICU and darn if I didn't get it. We get traumas, COPD pts on vents, cancer pts, in the past month we had three quadraplegics two from MV crashes and one from a freak fall. We do everything, turns Q2, oral care Q2, all meds and documenation, road trips from CT clear on the other side of the hospital to nuclear med to Interventional Radiology and the list goes on. Today I had a DKA pt, a blocked ureter with a right sides nephrectomy tube who had a 11mm and 5 mm stone in her kidney and several others that were blocking her tube she goes for a stent in the AM and she was nauseated and vomiting every two hours. Then we transferred three pts out so my whole assignment changed to a medical misadventure pt (OD on several different meds) and we were waiting for Police Officers to transfer her to the local psych facility for treatment and a poor lady who came to visit her son and ended up having a stroke and a heart attack and was vented for 14 days and now her vocal chords won't close completely and the nurse that I took over for had attempted to place an NG tube in place and the pt squirmed so much that her husband got upset and asked her to stop so then they had to call in teh charge nurse and things got a bit hairy so our charge had to put in a SBFT. When I went in to take over I introduced myself to the family and told them what my plans were for the rest of the day for their loved one. The pts husband was very apologetic but was very upset about everything that had been going on and he told me that he was very sorry for acting out and that I was to tell the nurse that he apologized. She didn't take him to heart because he had been through alot. I guess my main satisfaction has been recently. I have only been an ICU nurse for almost two years. Well recently they have been placing students with me to precept them during the day. I have gotten two accomodation letters from two students and lots of compliments from the others and have them now thinking about becoming an ICU nurse. My best compliment I think was today I was assigned a Paramedic student. Paramedic students are completely different then nursing students because they cannot give meds. So alot of my stuff for the day was explaining things to him. Right before he left he told me thanks and gave me a huge hug and told me that I was an excellent nurse and had a wonderful bedside manner. I think that was when I realized that I was where I needed to be. I am going to go back and get my masters degree in education. We need much more educators for nursing students. Whew... my husband says I have diarrhea of the mouth... I just love my job.... Jodi

Finished the class today. Got in late when they were going over possible study questions. I was the first to do my practical and passed that with flying colors and then took the exam and had never cracked the book and got an 86. I confused the types of head injuries and lost four points there the others were judgment calls and the instructor said I was overthinking it. Very interesting dass the most important think I got was the stressed imporatnce of doing a consistent head to toe assessment ABCDEFGHI is what you have to remember and you won't have any problem with the practicum. Good luck... jodi

I got hired directly out of nursing school to work in MICU. I am not a young nurse either was 40 when I got my license so I was apprehensive about being older than those who were training me but luckily I was precepted by a nurse who had been a team leader and an ICU nurse for 20 years and her immense knowledge was superb and I learned alot from her. I also learned from several different team leaders who were by my side when a pt was crashing and learned from them. Now I have been an ICU nurse for almost two years and am in the process of going back to school for my masters and have been asked to precept students on the unit. I am just thankful that I had a good preceptor and asked lots of questions and if you have educators on your unit utilize their resources and brains as well... you'll learn lots. I could never work the floors, I love the ICU and have loved it since the day I walked in there in nursing school. Good luck Jodi

Our head to toe assessments are done Q4 hours. If a new neuro pt its Q1 and of course we eyeball our patients every hour to record vitals, urine output etc. Sometimes the docs want other certain assesments done on a regular basis such as CVP, GCS etc. We don't have computer charting so everything we do has to be hand written, can take up LOTS of space....... we have every pt you could ever have, neuro, trauma, cardiac, GI, respiratory etc. Right now we have three quadraplegics on our unit and not one of them has insurance.... and one has been there for 10 months.... Jodi

I am taking it as we speak. Our test and practicum is tomorrow. It's not as hard as I thought it would be... let me let you know tomorrow.... But its all common sense head to toe assessment and think about everything and anything that you could do for that particular patient. Remember ABC's thats the whole basis for TNCC. A of course is airway and you must state ways to clear and airway and cannot continue until the instructor states that your airway is patent. You cannot leave this section without a) pt is intubated or b) pt is on 100% nonrebreather. Next is breathing, look at the patient, determine if the respirations are even and unlabored, is the patient using accessory muscles or retracting if a pediatric patient, the instructor will tell you the breaths per minute and if its shallow and if the breath sounds are equal. At that time you can determine if you need a chest tube or not. After you determine all that then you go to circulation, this consists of making sure the adult patient has two large bore IVS infusing with warmed IV fluid at a rapid rate and particulary with blood tubing, you can type and cross match and do labs at this time, make sure you check for a pulses, skin temp and moisture and color, and check for signs of active bleeding and what you do to stop that bleeding. Then you do the Disability (Neuro) and do AVPU (active-verbal-pain-unresponsive) and PERRL. Then the last step of primary assessment is Environment and Expose- strip em naked but keep them warm via warm blankets, warm IV fluids, warm lights and environment. Think of what can kill your patient and those are your primary assessments and the most important. It wasn't that hard, it was pretty interesting and you learned and should realize that assessment is the most important thing Don't stress about it... I'll let you know tomorrow if I pass...................... Jodi

I am an MICU nurse and there are a lot on our unit who are OCD but you just about have to be. The people I work with I absolutely adore and could not imagine going anywhere else. If I have two stable resting patients I go and see if someone else needs my help. When a new pt is wheeled into the unit at least six of us rush into the room to transfer the pt to the bed, take vitals, get leads set up etc. I am anal retentive about my patients room, I hate trash on the floor, I hate clutter on my med cart and excessive linens in the room drive me nuts. I have to have about 3 washcloths and two towels on the bedside table just in case and believe me I have had to use them. I date mark all my IV lines and label every line with what is infusing so that if I am in a hurry to push a med I am not pushing an incompatible med into a previous infusing line. I go through the top drawer in my med cart which is the so called "junk" drawer and clean it all out, I send meds which the patient isn't on anymore to the credit bin and straighten everything else up. If I need something I want to be able to get my hands on it within seconds, not minutes. time is of the essence in ICU's. Our patients are very, very sick and to be well organized is the best that you can be. Our SICU sounds like how you describe your unit. They are anal retentive and not one of them likes to help the others. Our CCU is like my unit but much more relaxed I don't mind being floated there because the nurses are helpful just like the nurses I work with. I have only been an ICU nurse for a year and if the people I work with weren't as great as they are, I would have transfered out after six months. In fact, I almost did had a team leader who was lazy, gave preferential treatment to two other nurses and ignored the new nurses and then I get yelled at during a staff meeting being told I don't ask enough questions, so I started asking questions even if I knew the answer and even if the question was dumb. But now I have a great relationship with our new team leader and she is fantastic, always asking if you need assistance and I feel like I can go to her with any type of problem that I have.

I prime with saline up to the secondary blood tubing and prime the filter with the blood itself then set it on 150 ml/hr and let it infuse. I have had nurses that I was with fill the filter up halfway with saline and then blood but I learning in nursing school to infuse up the the secondary filter with NS and then blood to prime the filter itself and then after the blood has infused I bump up the NS to 200 cc/hr to clear out the line of all the blood so the patient gets every last drop. And if it is rapid infusion I put it under pressure, prime the line with saline to make sure there is no air and then clamp off the NS and let the blood flow under pressure.

I had gastric bypass in 1997 and would do it again in a heart beat. I am no longer on blood pressure medications and my back and legs do not hurt anymore from the excess weight. Yes, I have to take B12 injections, and must take daily vitamins but thats about it. I do have problems if I eat too much or too fast, then it feels like I have to throw up. At the beginning I had to be very careful with that or I would throw up. I tried everything and anything to loose weight prior to the surgery but nothing worked.... its not a cure all its a life change and you still have to exercise and you still have to watch what you eat. I had a friend on mine have it done and then ate nothing but junk and gained back all his weight.

Our policy is that we have the family give a password and we appoint one of them family spokesman. If it gets too ridiculous I tell them to call the family spokesman for an update and that the constant calling pulls me away from the bedside care of their loved one... that usually gets their attention and they quit calling so much. Also, if they call at shift change between 7-9 pm and am I tell them to call back at 9 because I am busy assessing their loved one that I have just gotten there and I have no new information to tell them at that time. We have guidelines that we give our patients families when they get admitted to our unit and we stick by them. Our unit secretary even asks the password before she transfers the phone to us and before she lets them on the unit.

My hospital has us in either all black or all white or a combination of both. The hospital didn't come up with it so therefore they won't pay for the uniforms or the cleaning of them. The nursing governance organization came up with it citing that patients did not know who their nurses were. One gentleman said he was in the hospital for three days and never saw a nurse. He did see one he just didn't know which one was which. What happened to the days of going in and saying Hi, I am so and so, I will be your nurse this evening and if you need anything please do not hesitate to contact me. Also write your name on the board in your room if you have one. The problem with wearing all black is that I work in an ICU. How do you feel if you woke up in an ICU and someone was standing over you in all black? You would think you died...... I can agree with a solid color but black or white? We were allowed to vote for colors such as hunter green or ceil blue but 57% of the nurses voted and they voted for black to prove a point..... well its been since October 1 2007 that we have been in all black and patients still don't know who their nurse is because there isn't a color chart in their room!!! Environmental wears navy, transport wear burgandy, radiology wears gray, our PCA's wear brown and peach and our LPNs wear red.... nowhere in the hospital does it explain each color so how does changing to a solid color inform the patients in the hospital of who is taking care of them. What I want to know is why this pt did not open his mouth to ask who his nurse was

I don't find his humor funny anyways... sorry to have gotten into the tail end of this conversation but the stereotype of nurses goes way back. Some of the first nurses were those who were convicted of crimes to repay their debt to society. Some of them were prostitutes and those who owed debts. Stereotypes continue in all professions. I worked in law enforcement for 17 years and never heard the end of cop jokes... things don't change from one profession to the others. You have to learn to ignore what is unimportant and attempt to change that which is important to you. Talking about TV shows (I know this is completely off subject) but I hate CSI- all of them. I was a crime scene technician for 10 years and it IS NOT LIKE THAT AT ALL.... I cannot watch that show without tearing up everything they do. Like the lady said earlier about her husband not letting her watch House, mine won't let me watch CSI. Everyone that I know who is a crime scene tech hates that show because although they say its realistic, its not. So stereotypes abound everywhere, we have to learn to attempt to change what affects us most and if someone was affected by Leno's comment, shoot him an email and let him know what you felt. I have done that many times, it may not make an impact, but it makes me feel a bit better and I move onto something else.

Well, I am still a student but an "older"one at that. I just turned 40 a week ago and I decided that I was sick and tired of being in law enforcement. I worked as a crime scene technician for 10 years and a paralegal for another 7 all at my local Sheriff's office. I got irritated with the way things were going so I decided to change my WHOLE career. My mother, who has been an RN for over 40 years was ecstatic to say the least although she did say I should have started earlier!!! At one time in my life I wanted to be an attorney..... after working with the attorney's I worked for and how they treat people, I SAID NO WAY...... I got out of there as soon as I could... Right now I am in the third semester of a five semester course.. will graduate next December. I did my OR rotation the other day and I LOVED IT..... the circulating nurse asked me what I wanted to do when I became a nurse and I told him OR work. I just found out today that they hire nurse techs in the OR, I am going to jump on that with both feet...

Our school has a policy of putting first and last names on our badges for everything except our psych rotation and they just blanked out our names and put a sticker over it with our first name and you could see our full name underneath it. One of the hospitals that I did my clinical at only had their first names on it with their designation, RN, LPN etc. Why couldn't you have a secondary badge underneath your primary one with your full name on it which you could show to authorities who asked. I had a friend at his last clinical and one of the women stalked him on the floor, I am glad that they didn't have our last names on those badges because she would have followed him home.

I am in the third term of a five semester nursing program. I have a couple of things that I cannot live without. 1. A GREAT COMFORTABLE PAIR OF SHOES.. I had a pair in the first nursing clinical I had and by the end of the day I couldn't walk, my feet hurt so bad. They finally allowed us to have tennis looking nursing shoes and I paid $80 for a pair of New Balances which I LOVE!!! 2. I bought RNotes, its a pocket guide that I stick in my pocket, it has typical lab values, antidotes, injection, it's really a good book, I like it alot. 3. I am anal about having study guides so I have the majority of Nursing Made Incredibly Easy, they are not a requirement but they help me understand stuff. They might have them in the library at your school, ours does. 4. A good pair or support hose. I don't care what anyone says about them, they have saved my legs many times. After the first day of clinical and being on my feet all day, my legs throbbed the rest of the night, after I bought a pair of them, I never have that problem. 5. Make sure you have plenty of pens, other students tend to "borrow" them and not return them so its a pain to have to track them down and get them back. Have a red one too, helps to track vitals. 6. A good stethoscope. I had a cheap one that worked while my Littman was getting fixed but I wouldn't trade my Littman for anything now. 7. Make sure your uniform fits, nothing like wearing an ill fitting uniform and worrying about how tight it is and pulling things down. I learned alot after my first clinical about what to have and what not to have, to me it was trial and error.

I agree wholeheartedly with the last paragraph. Just because there are RN's on the floor, doesn't mean they want to deal with students. We as students should know that from the get go. We have one nurse on our floor who does not like dealing with students, we all know this from day one so we adjust our interactions with her accordingly and coming to her only when necessary. The other RN's on the floor will call us in to view a procedure they might think we would like to see or will call one of us when they need assistance. I believe its clearly a two way street. We have little knowledge when we get thrust onto a floor with live patients when so far all we have been dealing with is manikins. These patients rely on us to take care of them and if something is wrong, we need to be able to go to the RN with that problem. After all, that is our responsibility as a student nurse, to look out for the patient and to advise when we see someone in trouble. I had a patient two weeks ago, whom I knew was on the verge of dying, I was right, she died two days later, but I did everything I could to make her comfortable and she thanked me when I left and grabbed my hand. THings like that make my day. I truly want to be a good nurse, I work hard at studying, I work hard at clinicals, and I just want someone to be there to help when I need it. I don't follow the RN around asking questions. But, if there is something that needs to be answered and my clinical instructor (we have two per 10 students) is not available, I would like to know the answer. Jodi Levins