CMSrn2009

Working in 140ish bed hospital in a PA city (but not in center city, more suburban-y).. One 10 bed ICU - but now they just opened up a second ICU for the overflow. PCU is packed, ED is packed. Staffing is horrible, 3 to 4 ICU patients per nurse - sometimes without any help on weekends or nights (ie extra set of hands from OR nurse or CNA). It seems very unsafe and I feel like we are providing the minimal amount of care (breathe, keep vitals stable and have some fluids and calories, oh and stay sedated), just to keep someone alive due to lack of time in a 12 hour shift, having to stop and refocus on emergencies, and just inadequate staffing (obviously a sad reality). Apparently several codes and a death or two this week. Lots of covid patients, no spearate units for covid vs noncovid or rule out.. Running out or low on some specific tube feeds, IV/feeding tube pumps, vents... We have the IV pumps outside of the rooms now to prevent us from having to gown up and go in frequently. No staff have gotten sick from being exposed yet that I am aware of. Discussions regarding to trach or not to trach- OR vs bedside procedure. No covid patient have trachs yet and some have been intubated for awhile now. Knowing the illness can last 2 to 3 weeks is giving families hope that their loved ones will recover. Stressful.

I think docs not going into rooms has regularly been a trend prior to this but is more prevalent now that its literally hazardous for anyone to go in due to the current environment (lack of PPE etc..). Where I work they only go in if its an emergency, to place a line etc but do not go in for rounding (some consultants do). Interesting only fellows and attendings can go in where OP is at, though. Where I'm at plus at another health system nearby- the attendings do not go in the room, but residents do.. so its like they're throwing their young to the wolves. I feel bad for THOSE residents. I've confirmed death before so that's not surprising.. However I do feel your sentiment. Nurses are literally up in peoples business more than anyone else, and are probably the most exposed just because of the nature of the job. More PPE and adequate staffing would make me feel less expendable...

I go to a school in the same city and some of my professors work there, I heard they ARE going to be offering one "soon", not sure when..

Hello, where I work there were a few instances (two I can think of) of new grads getting jobs in the ICU right away, which was rare and shocking to me.. So you're not hopeless. Also, I currently am working 2 12s, every weekend, mostly because I am going to FNP school and need my weekdays for studying/clinical. Also, my husband works every weekend anyway, so it gives us more time during the week together (in theory). Downside is (obviously) if I ever want to attend a birthday party, anniversary party, baby shower, ANYTHING, or God forbid a wedding or out of town event, I either have to switch with someone, or work a 16 one day and go in late the next, or just be tired (I work night shift). I get a minimal amount of vacation time. But- the payoff is a regular, predictable schedule, and I make significantly more money than I did as a "weekday" nurse. So, right now, it's worth it. If I weren't in school and were to continue as a regular nurse, I would ask my manager if I could switch to three 12s three weekends a month instead of the two 12s every single weekend. For you, if offered a position, I would take it for now. You never know, you might enjoy it (and the pay)! If you don't, then there will no doubt be an opening for you to transition into a regular schedule. People switch schedules all the time.

I work 2 12 hour night shifts, Friday & Saturday as a weekend staff nurse. I also have a per diem night shift position at a second location but I rarely work there anymore, maybe one night a month. I am in my clinical year so it is a challenge but I managed to pull of an A- for my first semester of clinical. I know one person who is working a Monday-Friday management type job and she has been lucky enough to find flexible preceptors and is trying to use some vacation time as well. I don't think I could handle that but if you want something that bad I'm sure anything is possible!

I've worked at a few different hospitals, one Magnet and a level 1 trauma, one in the process of getting Magnet (also union and level 2 trauma), one small community hospital .. And now I work at two hospitals, both level 1 trauma and one is magnet, the other is not. I found no difference between level 1 or level 2 trauma - except for a more organized trauma team. We had to respond to traumas with the level 2. Personally, I find that magnet status helps. Nurses need to be satisfied in order for them to get the designation, and secondly, I find it imperative that the hospital I work for be academic as there will be residents and fellows that can be there 24/7 to help when something goes bad or if you have questions. Or alternatively, a NP/PA on night shift to run the unit. Other things I consider : does it have a good charting system (like Epic) or some outdated chartig/ordering system for two decades ago. Does it have techs or PCAs or PHLEBOTOMISTS.. a unit clerk. What's their nurse to patient ratio on the med surg floors (hopefully not 7 or 8 to one nurse). Little details like that. I wouldn't go by this but do either offer tuition reimbursement if you decide to get your MSN? And lastly, I find that there's always a group of coworkers at every hospital that absolutely hates it and spends a large amount of time complaining about how horrible it is. At every hospital. But, I have always had a group of people I get along with who were mostly positive and made working more fun. Also I wouldn't feel guilty backing out of the first offer. I know a lot of nurses who get a job as a new grad then transfer units or quit to go to another hospital after a few months or a year and that's a worse situation for the hospital since they would have spend so much money training you.

Thanks for the tip. I guess next time I should ask for help- but it seems as though I'm a little too aggressive with turning the first drops off! Should have just gone slower..

Two different situation that I have encountered in the past few weeks have left me questioning my clinical skills.. The first was a patient (seizures, found down, etc.) who was on dopamine and I believe levophed, and he was going into junctional rhythyms, with a very labile pressure. The doctor ordered for the levo and dopamine off, start an epi drip. I don't have much experience with turning off drips, and starting new ones, so I started the epi low and obviously starting titrating the others down. I think I started titrating the levo down first, then the dopamine. Eventually the dopamine was off, but I had trouble turning off the levo without his pressure just tanking. So I called, and they ended up saying it was ok to leave the levo on, and eventually (at 6AM), I had it off. The second situation was last night, the patient was in cardiogenic shock (STEMI following an orthopedic surgery), and he was on a CAM 65%, issues with oxygenation, hooked up to a flow track, good cardiac output, good index, gave him some lasix, wasn't making urine.. etc. So, his pressures dropped, they had him on levo when I came in. Then of course the cardiologist wanted him on dopamine instead, so we started it at 5mcg, his levo was at like 12.. I got him down to 6 of levo, and after a half his HR jumped up, so I turned the dopamine up little by little since I thought it would help his pressure and they wanted the levo off- why turn it back up?.. (later I figured his increased HR (110s) was actually exacerbating his low BP).. he wasn't able to handle it and his pressure tanked so we ended up turning the dopamine off and resuming the levophed.. I'm just questioning myself now, am I turning the first drips off too fast or something? Or is every patient different, and there is no easy solution and I just need more experience? Or should I ask the doctor specifically, like in the first case, straight away, which one do they want off first? Any tips would be greatly appreciated.

I work 7p-7a, ICU.. - if patient has peripheral IVs that expire, I try to replace at least one site if not both - order new bags of drips that the patient is on - hang new bag of fluids (or just keep extra on pole) - throw out and replace things that are used just for a day (like suction catheter, graduated cylinder) - Make sure the supply cart/COWs are refilled (especially with syringes, flushes, etc) - Make sure diapers are dry and patients look presentable (usually make sure they are bathed on night shift) - Do labs early to ensure e-lyte replacements can be started before next shift - Make sure the orders are all acknowledged and legal (i.e. make sure there is an order for that fentanyl that has been hanging all night, or make sure restraints are ordered) - Make sure IV tubing/bags are up to date and change tubing if they expire in the next 12 hours (also applies for tube feeding) - Show up on time for change of shift report when coming back in at night

I know this is probably totally different, but I completed my RN to BSN degree on-line and found it hard to motivate myself. I am currently attending a FNP that has the option to complete a few core courses on-line but all of the classes are offered on campus which is about an hour away from me. I am very excited to actually interact with live, warm, breathing human beings, but I suspect I will take one or two of the core classes on-line. This is only my opinion, but some of the on-line programs I applied to seemed to want to just churn out NPs, and I want to take this slow and really get a grasp on the content. One program required you take two classes a "quarter" (four quarter in a year), so you would be done very quickly, but I just don't see how I could digest all of this in like 18 months when I need to continue to work at my current job (at least until clinicals begin..). I prefer a traditional school for my NP degree, I think people will take my degree more seriously, although what someone described above (live chat sessions) seemed to be reasonable and shouldn't be discredited..

Geographic location: Lehigh Valley Pennsylvania Pay rate: About $32/hr (this includes shift differential and float pay) In which area / specialty do you work? Critical Care Float (float to trauma/neuro ICU, CT surgical ICU, general medical ICU, and step down units as needed) What type of license do you have (RN or LPN)? RN What type of degree and/or certification do you have? ASN, BSN, as well as BLS/ACLS/PALS/Trauma and Critical Care cert. How many years of experience do you have? 5 Are you full-time, part-time, or casual / per diem / PRN status? Part time (36 hours a week is considered Part time at my place of employment, 3 12 hour shifts) What shift do you work? 7pm-7am (I will move to 3pm-3am-once my position is filled :/) Do you receive any shift differential? Yes, there is a $5 "bonus" for being a float nurse (so my base rate is less than $28/hr), there is a $1.00 shift diff for working a 12 hour night shift, 7pm-7am. (For 11pm-7am, I believe it would be 75cents an hour). Are you a manager or supervisor? no

Hello, I'm in my last year of an RN-BSN program and for this last semester we are required to explore advanced practice roles. I really want to go to grad school to become a nurse researcher. For this class, we need to pick a role (nurse researcher) and interview and possibly observe at least 2 people currently in this role. I have contacted three hospitals that have research programs, one has gotten back to me and said sorry we can't help you because your school is not involved with us (my school is on-line but based on the other side of my state of PA). The other two have not gotten back to me but I know for a fact they have nurse researchers (UPenn and Thomas Jefferson University Hospital). I am feeling very frustrated because this class has deadlines and I have need to find people to interview. Is there are nurse researcher out there who would be willing to answer some questions or does anyone have any leads of nurse researchers in PA who could possibly help me out in person?? I guess my next step is to attempt to contact UP and TJUH AGAIN and then try pharmaceutical companies or something but I wanted to try to find someone here as well just in case. Thanks - Crystal