johosa12

I was getting my patient up to the chair, POD 1 CABG. After I got her settled into the chair, I let her daughter back in. The patient was stating some discomfort to her lower back and she asked if I could gently massage her lower back. I swiftly obliged and started to ever so gently massage her lower back. After 15 seconds or so, she quietly lets out a deep, soft moan and I ask her if shes okay, and that I am not exacerbating the discomfort. She quickly replies, " Honey, you've obviously never heard a woman moan before."

Save yourself the headache and ask if they can get it PO? Down the NGT/OGT or pills...if they can't, our pharmacy always mixes it up for us if it's going peripheral. 40/250mls of NS. That being said, in my ICU, I feel like almost EVERY patient of mine has a central line so I'm always running the high concentration peripheral potassium through those - 20meq/50 and 40 meq/100. To be honest, when someone orders it PO, I'm always like "woah, woah, woah....can we give that through an IV? I'm not dealing with PO meds!" haha

Yeah I would have liked to see the vent settings on this patient. With a pco2 of 75 and a bicarb of 18, it seems like a quick fix - just up your rate. I've had patients on rates of in the 30's when on AC/PC. Curious of the pa02 as well. Now, if this patient already had a rate in the 30's, then like one of the posters above - you might be looking at paralyzing this patient, iNO, going prone, or screw it just take the lungs out of the mix and just put some VV-ECMO in (which I've seen wayy more lately over the past 12 months!). About the dialysis - yeah, like someone already mentioned, just because someone isn't voiding, doesn't mean they need dialysis. Normal cr? That's odd, calm before the storm? What's their K? Get those MAPs up, give them some fluid---Bumex maybe? Bladder scan?

The unit I work on can have anywhere up to 9 cardiac surgery cases/day. I agree with one of the posters above that 95% of them come out from the OR with them in. I would say that the team usually has us pull them within 12 hours of coming out of the OR as well.

That's awesome and good luck! That's where I started 10 years ago, and now have been an ICU nurse for over 7 years. It's definitely going to help you out if you plan on starting off in the ICU as a new grad (which I did). I have a few tips for ya: 1) leave your phone in the break room! You're 20 and just starting out in a career that may last for the rest of your life. You want to make a good first impression. The connections/networking you make now can help you land jobs in the future. I fee like this is a no-brainer but I feel like nowadays EVERYONE has their phone out and it bothers me so much. You're at work. Work. 2) Always look for something to do and ask if anyone needs anything. Don't get caught just sitting around. If you are always like this, the nurses/doctors will see that and will be more likely to want to teach you! 3) that leads me into this point: always ask questions! "whats this, whats that why are you doing that?" You will learn so much over the next few years if you are actively asking questions! 4) know the names of everyone you work with and greet them (i.e. housekeeping, pharmacy techs, material management). Some of these may seem like common sense, but I think they are important! Good luck!

I like the way you put that; "equal parts thinking and doing". I really do think that I would miss that. I also think that I'd be happy with either one, just want to do what I think would fulfill me most. Thanks for the response!

Interesting. I'll definitely look into that! Thanks for the insight!

Let's start off by saying I love what I do. (long winded rant?/explanation of my life incoming) I've been in critical care nursing for 7 years now and I still find my self on off days reading/learning about drugs and advanced patho/pharm because I'm one of the people that love to try and know as much as I can. I love to teach; being a preceptor/mentor to new hires gives me even more reason to read/learn so I can be the best preceptor possible. I love to help people find comfort when they have a loved one that's on the brink of demise. I love to help other nurses out when they need it. I never say no to a turn. When appropriate, I always try and make the day light by singing my best Creed karaoke underneath my breath at the Pyxis. When is someone is having a bad day, I make sure I help them out, even if it's just grabbing them a coffee or passing their other patient's morning meds, if I can. I guess I get my sense of service/helping others out from my CNA days and from my mother (most generous person I've ever met;Happy Mothers day mom!). BUT....I am having a problem. I guess you could say, I am missing something; a higher "need". As a nurse, I've always worked hard at becoming the best nurse I could be. From training to be a charge nurse as soon as possible, taking the CCRN when I was immediately eligible, being on committees, preceptor, and other extracurricular teams;I tried to be the model nurse. Right now, I am at a "Top 10" hospital and see the highest level acuity patients. Although I feel like I am getting stimulated from the complexity of these cases, I just still feel like I am missing something. My mentality of trying to be the best nurse I can be feels like it is being capped out right now, hence this long rant. At my hospital, it's like a revolving door for CRNA hopefuls. Not even CRNA hopefuls, but grad school students in general. The saying at this hospital is if you want to do CRNA school, being in my unit is the best place you should be. Not to dog my once fellow co-workers, but they just come through, get their 1.5 year/2 year experience and go to school. I mean, good for them, but I don't know, maybe I'm just jealous because they have a goal/purpose and are working towards it and I'm just stuck here at Starbucks drinking my coffee and reading about Stewart's strong ion difference. People at work tell me that I should go back to school, and I usually have just scoffed and said I am happy doing what I am doing now,but that has increasingly been becoming more and more false over the last year. So, I reached out to my CRNA educator and got in touch with someone and set up a shadow last week. Going in, I had my thoughts and ideas about what a CRNA does, which turns out, was a little different. I think it had to do with the CRNA that I shadowed. He was very impressive. He blew me away with his pharmacology knowledge and his demeanor. From his bedside manner/approach to fearful patients, to his skill set in the OR, he had me admiring him by the end of the day. Turns out, he is the Chief CRNA and even teaches at a few of the local universities. We left with a few pleasantries and he told me to come back for another day to get more of an experience (which I am hopeful will be this week). The whole idea of being at the head of the bed and in charge of someones hemodynamics and being like "hey, you see that bp/heart rate? yeah, I did that" gives me a sense of worth/power (not that I don't have that now, since in our unit you have A LOT of control over hemodynamics (gtts/ECMO/etc.), just a different type). On my way home I was like, "Yeah, I could DEFINITELY see myself doing that." But after that shadow "high", I was like, man....I might miss the whole bedside interaction and all of the "pow-wows" we have with the fellows/residents on we should do that and we should do this. I truly do love the ICU rounds, listening in/learning, and chiming in here and there when appropriate to help out. Over time, I've gained that trust with the attendings/fellows/residents; it's fun to talk about complex cases. It got me thinking; yeah I think I would miss the "whole" picture critical care portion of my career. Managing a really sick patient and all of their systems is something that I would love to do. With that being said, why don't I just become an APN and get a job as a critical care NP and round with the ICU team and help them out? Yeah, I think that would be really fun, but I still feel like I would be missing out on the whole " I am in charge of their airway/hemodynamics" because the residents/fellows would steal that spotlight in the ICU. I have heard of people eventually getting DUAL NP degrees (eventually) so that they could do both OR stuff, in addition to an ICU roll (which sounds AWESOME, yet terrifyingly so much school). SO. Here I am. On allnurses. Looking for anything. Any type of guidance/experience/pearls of wisdom you can give me. Obviously, any and ALL feedback/thoughts are appreciated but specifically, I am looking for that RN that LOVED the ICU and everything about it, but decided to go back to CRNA school. How are you feeling about the change? Thank you all for coming this far and reading this entire post. Thank you so much!

Thanks for the words and support everyone. I am back to work tomorrow so we will see what comes of it.

Hey everyone. I'm sure in this forum, everyone here has been apart of or seen withdrawal of care, but I am having a difficult time with one this week. I have been working in the hospital setting for 12 years, and about half of that as an ICU nurse. I have withdrawn on multiple patients in the past, probably over 20, but never like the one I am encountering this week. The patient is on VV ecmo support, and has been for many, many weeks. The patient has had their up and downs, but has finally run out of options and has been given the news that there is nothing else that can be done (due to multiple reasons). The thing that is bothering me is that this patient is alert and orientated! I have NEVER withdrawn on someone that is alert and orientated that is being solely supported on a device that, if shut off, would pass within minutes. The patients family has been fantastic and impossibly strong throughout the patients stay. Has anyone ever encountered this unique scenario before? I am just concerned about the patient going peacefully and how that might be difficult to achieve.

I personally don't understand why this is still a thing. I generally reply with a "I love helping people and science and figured this would be a perfect profession for me".

My travel recruiter told me the process of getting your license verified by the IL State Board of Nursing takes forever. I am about to start on it because I want to travel out to California or WA state...I just started my first assignment so I hope it takes less than 13 weeks....My recruiter also told me, if you go there in person to the state board of nursing, the process is much quicker...so if you live near Springfield, that might be your best bet. I am 3 hours away, and might be just driving there in person if that gives me a better chance to get the license verified quicker.

Hey guys, new to this website, but firgured this is the perfect place to ask the question. Can I really afford NP school? I am single, not married, no kids, and nothing holding me back. I am almost finished my BSN (done in July), and have been an ICU RN for almost 3 years now. I really would like to go back to school next year, 2014, and start getting my NP. The thing is, I live by myself, so I am paying for my entire apartment by myself. Even if I find a roommate to cut the costs in half, will I be able to possibly work agency part time and still afford it? I have student loans, but can put those on deferment while getting my NP. I have no credit card debt, but I do have a car payment each month of $300. How much can I work while still attending NP school? Possibly work more during the first half, but work less towards the second half of school? Are the loans/scholarships out there for me? Should I save for a few years before starting school? Should I/can I get loans to help pay for rent? Is that even smart? Any input from experience, or tips would be very greatful. Thanks!