coco317

I love the prismaflex. Everything is color coded and the machine has step by step instructions with color coded illustration for set up and any alarm troubleshooting.

If your hospital does not have a walking report element to shift change, I would get in the habit of going into your room and meeting the patient/family and checking your lines and placement of suction, etc. (do this with the nurse from previous shift). This will give you a chance to have a quick visual assessment of the patient and location of supplies and equipment in that room. If the patient is awake/alert or family is present you then have the opportunity to introduce yourself and determine their most immediate needs. I like to do this because if I get caught up in another room I have peace of mind knowing I already visually assessed both or all three of my patients before I really dive into work. This will help you prioritize care and usually will help get the first hour or so organized a little better.

IABP always 1:1. Fresh open hearts are 1:1 usually until the next morning when the swan is removed. Sometimes they are 1:1 longer if they are unstable.

My advice is to get your kardex/report sheet organized in a way that facilitates your workflow most efficiently. The information you will want to have at your fingertips is probably going to be different than when you were on medsurg. I always get to work at least 10-20 minutes early so I can at least write down my meds and lab work or tests in the am. I have an area to write down totals from foley, ivs, tube feed, chest tube output, etc. I have a specific area where I write my vitals and important lab results. When I was first starting out, if I knew I had more abgs to be drawn on my shift, I wrote the normal range for all the values somewhere on my paper so I had a quick reference when I got my results from my RT. In report I like to grab the chart and look over orders with the previous nurse so I have a quick view of what's been going on today and if I can't decipher the docs writing haha. Then I like to go in and meet the patient/family with the previous nurse so I can check lines, drips, suction, and room set up. You get a chance to eyeball your patient real quick, so it becomes easier to prioritize cares in the first hour or so of work. I think it's helpful to make lists and write down notes to help with charting and giving report. You will find a system that works for you. Good luck and ask lots of questions!!

I applied for basically every open position at the hospital I'm currently employed. I did my preceptorship in a CVICU so I definitely wanted that unit or another ICU or tele floor. On my initial phone interview it came up that I applied for every open position and I just said I loved my time working in the CVICU and I ideally see myself working in critical care but I was not opposed to starting in med surg or tele and developing / honing my nursing skills first. While it was a true statement, it was me also saying I'm desperate I will work anywhere!!

In my experience if I'm charting what another nurse is doing I state in my charting "J. Doe, RN applying manual pressure to right groin" during a sheath pull. I would imagine its the same way charting meds on a flow sheet. " 1mg versed iv push administered by J.Doe,RN at 2145" I'd ask other nurses or your manager what is expected for this type of documentation if you're still uncomfortable.

Sounds like you're a great fit for an icu setting! My hospital is in the process of switching to meditech 6.0 with the point and click interface. We have a recall feature (an actual button that reads recall) to replace the f5.

I worked as a STNA at age 17 in the Cleveland area. Just depends on the employer!

Talk to the nurse manager in the icu and let them know you are interested. Try and see if you can set up a shadow experience with an experienced nurse if you're hesitant to transfer. You sound like you would be a good fit and it's normal to be nervous of codes. In the icu everyone is acls so codes run smoothly and everyone falls into their role with ease.

I work in a combined ICU /step down. Our posted visiting hours are 11-2 and 5-8. Exceptions for patients going for surgery or an invasive procedure. Limit 2 and no one under the age of 12. Unfortunately, it seems the only ones to follow the rules are the pleasant family members. There are constant interruptions at change of shift and its very frustrating. Family members like to hang out at the desk and are appalled when we kindly shoo them away because we are discussing private information on other patients. Recently at a staff meeting, our nurse manager said we are going to have unlimited visiting hours due to JACHO policies. We will still be able to limit 2 visitors. And just to vent.. Seriously families- please tell me why anyone would think its appropriate to have 8 visitors in a room at once??? It's hard enough to maneuver around with 2 visitors. I'll be damned if they go downhill or code and you're in my way!! Ugh.

It could be a number of other factors as well. It sounds like your charge nurse doesn't want to set you up for failure. He/she may be considering the acuity of the patients on the floor vs how many seasoned nurses and newer nurses are staffed. My advice to you, help out the other nurses with the more critical patients. Offer to suction and do oral care for their vented patient or draw their labs. Even if you're already comfortable with these skills it's good practice and shows the more seasoned nurse you're comfortable caring for sicker patients. It also doesn't hurt to ask your charge nurse for sicker patients!

Gotta keep calm in any ICU setting! :)

In the area where you list your skills I would say "managing and titrating gtts" and during your interview they will ask what gtts you've managed.

When we have a positive d dimer there's a message that auto populates stating clinical correlation recommended.

I instruct them to suck in, take rests, coughing is good, keep the little bobber in between the arrows ( I call it the strike zone for those into baseball- that works well with men haha). I then throw out incentives : this will help you get off of oxygen because your lungs will improve ; prevent pneumonia; help you cough up all that gunk. If I hear crackles on assessment I tell them and reinforce IS teaching and tell them I will be reassessing during my shift. Patients really seem to respond to that.

Trying listening to a meditation recording. "Meditation oasis" is a free podcast I downloaded on my phone. It usually does the trick in de-stressing me and knocking me out haha. I will also take melatonin 3-5 mg as needed as a sleep aide. It's over the counter sold in the vitamin section of the drug store. I don't know if it interacts with any prescription meds so double check at the pharmacy if need be. * also-- I would try this first on a day where you don't need to be up real early. You need to allow yourself to get plenty of sleep so you're not groggy all day!

In my personal experience with codes in the hospital, the family is called in because we don't know if they will continue to code again and again during the night. If the outlook for the patient is looking grim the physician will usually discuss it with the family and open up discussion regarding changing the code status. If the patient does not make it there is also paperwork the family needs to fill out.

My hospital does this and it's proven to be very beneficial to our patients and has brought our average door to balloon time down -- our record is 9 minutes! We call it a 'Code STEMI' - it's paged overhead. Cath lab is paged in from home during off hours. The ER RN is to remain in the room up until the cath lab team takes the patient. Our surgical house doctor who oversees the CVICU responds and assumes care for the pt collecting a quick H&P and gives the ER nurse verbal orders on titrating NTG gtt or administering heparin or morphine. The CVICU RN records vitals, labs drawn and the results, history, allergies, meds given, presenting symptoms and talks with the patient and family about what to expect during their hospital stay. The CVICU RN is the messenger in a sense and we also get a solid rapport with patient and family. A respiratory therapist always responds too for the occasional respiratory compromised/real sick STEMIs. As soon as the cath lab team and cardiologist arrive we are wheeling down to cath lab.

I've been working in a CVICU as a new grad for a little over a year now. Have a good relationship with your manager and preceptors with an open and honest line of communication. You need to voice your needs and try to get a wide variety of patients during orientation. Don't be afraid to ask for constructive criticism! Just remember you can never ask too many questions-- it's when you don't ask enough that your coworkers will be concerned.

My nursing school utilized ATI practice testing to prepare us for the NCLEX. (If you're not familiar it's online testing designed to simulate the NCLEX test) I used these practice tests to gauge my knowledge in the different care areas and then brushed up on the subjects that I was weak in. I didn't over do my studying but I also didn't forgo it completely either. It also depends on how much time there is between graduating and sitting for your boards. I also checked out a Kaplan book from the library and read their strategies for analyzing a NCLEX question and that helped me a lot. If you weren't exposed to many 'select all that apply' I would practice those in a NCLEX book!! Good luck!

At my hospital we hold manual pressure in the groin for 25-30 minutes or longer until hemostasis has occurred. We always have a second RN in the room (or occasional our PCA) to document q5 vs and check the pedal pulse and groin. If a hematoma is forming while holding pressure a second RN applies manual pressure to the hematoma. We have had as many as three nurses holding pressure on one patient. Definitely not fun! To answer the "why" it has always been my understanding that it helps to diffuse the hematoma.

I would have expected someone to consult an EP doc for possible pacemaker insertion. With BPs that low you have to worry about all of his vital organs being perfused even if he is awake and alert.

I work in a CVICU (which is half step down) and we rarely give anyone a water pitcher. Our pts are strict I and O's and most are on a fluid restriction. We use a new styrofoam cup every time someone needs a drink. So wasteful.

I did my preceptorship in the CVICU and I actually got hired on the unit as a brand new RN after I took my boards. I was in contact via email with the nurse manager before I started my preceptorship. I just asked her what drips were most commonly used at their facility and any other things I could review prior to starting. I was able to brush up on the most commonly used medications and she also gave me an idea of he patients they take care of. Good luck and just take it all in and ask lots of questions. Ask for honest feedback at the end of the day so you can improve on your weak areas. Any down time (haha like that exists right?? =p) ask for the rationale of why something was ordered-it will help you understand the whole picture better. Be assertive- let your preceptor know your needs and what you expect to gain from your experience.