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calivianya BSN, RN

ICU
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calivianya is a BSN, RN and specializes in ICU.

calivianya's Latest Activity

  1. calivianya

    Leaving my comfy throne to go into LTC, comfort vs skills

    +1 I'm personally of the opinion that the best job is the one you're good at, that's comfortable, that you get paid the most money for. I'll move so a higher paying job is more convenient before I take a lower paying job because of location, but that's just me. Best of luck to you, OP!
  2. calivianya

    Your FAVORITE job

    My current job, for sure. With a few exceptions - the clique people - my coworkers are great. Our intensivists are really great, too. Good coworkers, good doctors, high acuity... love my MICU. Just wish we could get people to staff it!
  3. calivianya

    New Grad Qualification Question

    I was hired for my first job weeks before I graduated. Don't wait any longer. If you keep waiting, you risk all of the new grads who started applying earlier than you snapping up all of the new grad spots at most hospitals, and you will be left without a job. Don't do that to yourself.
  4. calivianya

    New nurse feeling hopeless

    The being so tired you can barely drive home part is concerning for me. Honestly, that may be a big part of a lot of this - just like with being depressed, handling any sort of stress at all is very, very difficult if you're not getting adequate sleep. It is not normal to be that tired after a 12 hour shift, even a night shift. I have worked 12 hour nights for all four years as a nurse and I have never experienced that kind of being tired. I know it's hard to fall asleep when you're anxious and upset about something, and I'm wondering if being that upset is interfering with you getting a full eight hours of sleep before work. Start taking sleep aids if you haven't already. You might find that things become just a little more bearable if you have adequate rest before you go in to work. Take a sleep aid every day at the same time so your body gets in the habit of sleeping at that particular time. Don't flip back to day schedule on your days off. I personally try to sleep during the day all of the time when I'm not in school. I'm off work tonight - I just woke up at 7 PM, and I don't plan on going to sleep until at least 9 AM tomorrow morning. I'm off tomorrow also and I plan to sleep the same way. Switching back and forth is much more difficult on your body than sleeping the same time of day every day, whatever time of day it happens to be. It sucks to do that when you have a significant other, but your boyfriend can always have breakfast with you in the morning before you fall asleep and then hang out in the evening with you while you're awake. Good luck!
  5. calivianya

    Is this reasonable or just over the top?

    This is very, very situational. I know there's research on it, but I can't help but wonder if the research was done on mostly educated people and not the blatantly ignorant general public. The most recent complaints I've heard have been: 1. "I'm a retaining a lawyer because you're trying to suffocate my husband!" - Husband was recently extubated, couldn't breathe without BiPAP, said the BiPAP was "suffocating" him... and the wife took that literally. She bodily threw herself in front of the patient to keep us from putting the BiPAP on, and he ended up having to be reintubated. I fail to see how going back on the ventilator when a less invasive treatment would work is improving outcomes. 2. "I'm suing because you're not feeding my mother!" Mother was NPO from belly surgery. Family detached the vent tubing from the ETT and tried to stuff a cheeseburger down her ETT. Fortunately, respiratory caught them and we called security and had them escorted out of the room. I don't see how aspiration pneumonia, or possibly a code, from a cheeseburger being stuff down a breathing tube is improving outcomes. Later on, family kept sneaking her food while she was off the ventilator even though she had no bowel sounds, and her bowels dehisced and she needed emergent surgery. I fail to see how dehiscing bowels is an improved outcome. 3. We had a family who refused to obey the two at a time visitor rule, and complained very loudly about that. They had six people in the room. At one point, the respiratory therapist couldn't get to the ventilator while the patient was desatting because all six were swarming around the bedside refusing to move out of the way. I fail to see how patient hypoxia due to family interference with care improves outcomes. 4. Related to the last... recently had a patient who wanted to lie down, but was satting 86% on nonrebreather while she was laying down. She was satting 92% sitting up. Family refused to let us sit her up because she was more comfortable lying down. How does desaturation improve outcomes? I could give a million more. I really want to see exactly what sort of people those studies use... because in my experience, 9/10 times what will satisfy my patient and their family members will also result in my patients' deaths or at least a massive complication, and while I really do believe death is an improved outcome for most of my patients, I don't think the government or the people doing these sorts of idiot research studies will agree.
  6. calivianya

    Is this reasonable or just over the top?

    I wish I was never late clocking out in ICU. Out of the past 10 shifts I've worked, according to my staffing software, I've clocked out on time three times. I've had patients where the report on one patient alone took greater than 30 minutes. Granted, day shift huddle typically seems like it takes forever, so I usually only have 20 minutes or less to give report before I'm "late" clocking out. We also have totally open visitation, so there are usually visitors in the room at shift change, so if we even remotely try to do bedside report it turns into a giant Q&A session. It is policy for us to give bedside report, and I understand why it's helpful - but I personally refuse to, and if they want to fire me for it, they can go right ahead and fire me. The one time I tried, the visitors asked so many questions that I was 45 minutes late leaving, and I'm not putting myself through that again.
  7. calivianya

    Unit Clerk Reading Allnurses.com ..

    I'm actually a very open person - I literally haven't said anything on here that I haven't probably said to my coworkers or unit leaders at least a few times before. Even the very snarky comments. I snark and cuss a lot in real life... even in front of managerial sorts of people... so I personally wouldn't care if anyone figured out who I was. To be honest, my language is way cleaner on here than in real life because cussing gets filtered out... so people actually might think I'm a better person than I am if they figured out who I was here.
  8. calivianya

    Religious accommodation means no Saturdays....ever?

    I wanted to make one point I hadn't seen yet (though I admit I haven't read through everything). It's not this person's fault she got hired and management acquiesced to her religious exemption. However, what IS a major problem is that she took up an available FTE that someone else could have been hired in that would have been willing to work weekends. If the manager was only hiring one person that round of interviews, and it was this person who had to be off on Saturdays, it was terribly unfair to the other staff to hire her in the first place. I work in a unit where most people are tripled every Saturday. Just ONE extra person coming in makes a huge difference. It takes a triple away from two nurses. If there were only two triples in that section to begin with, just one extra body coming in gets rid of all of the triples. Fortunately, our manager has finally agreed to start blocking beds. That's the other solution to this problem. OP - have you approached your management about blocking beds? I've made the recommendation to lots of people to go to the Joint Commission with documentation of your shift if you're working with four ICU patients. We had someone do that last year and my hospital almost lost accreditation. Once that happens, management tends to be way more friendly to the ideas of hiring travelers and blocking beds, because they will lose their jobs too if the hospital shuts down, so all of a sudden slightly more appropriate ratios start to matter to them, too. We were so bad off last night that we blocked 11 beds out of 30. The other 19 beds were already full when we walked in. Three of the patients were 1:1s, and there were still two sets of triples, but if we hadn't blocked beds we would have had a situation where everyone that didn't have a 1:1 was tripled, so there would have been nobody available to help anyone else. Blocking all those beds saved our butts last night.
  9. calivianya

    Older nurses

    Everywhere I've worked, the age gap has been more like OP is describing. I'd say the vast majority of my coworkers are under 40, with at least half under 30. I think bedside nursing is just too dang demanding, and I don't mean that in a condescending way. I'm 29, I've only been a nurse for four years, and my back already hurts almost every day. Nobody can do this forever without a ton of help. Most of the "lifers," shall we say, on my unit - the ones that haven't transitioned to management roles yet - have had at least one joint or back surgery. Several have had multiple spinal fusions/knee replacements. I've worked with people that openly wore their back braces on top of their scrubs. Several say their Oxycontin and Baclofen are the only things that get them through a shift and I watch them pop pills all night. Legal, prescribed ones if you're curious, with zero indication they are altered in any way. No thanks! I will be getting out of nursing before that fate befalls me. There are many things in this world that can make money, but the back I have now is the only one I will ever have, and it's not worth giving up for a paycheck. Not to mention, raises in nursing are terrible. I work with a nurse with 35 years experience and she only makes $9/hr more than I do. NO THANKS! That much experience in any other field, I'd expect to earn at least double the salary of someone with less than five years of experience, but that's not how nursing works. It's horrible how nursing treats its experienced workers.
  10. calivianya

    Former ICU nurses - I need your help

    Just saying - you don't have to work somewhere that residents and fellows are. Nobody has to steal your spotlight. My favorite intensivist used to not only teach at a major top medical school, he also was the medical director for a number of their units and was pretty much in charge of just about everything related to critical care. He moved to my "less fancy" non-teaching hospital (that's actually LARGER than the teaching hospital, a fact lots of people who work at the fancy teaching hospital conveniently like to forget), and he says that on most days, the acuity in my MICU blows the fancy teaching hospital out of the water. So, there are places you can work as an ACNP where you're not fighting the residents and fellows for the fun stuff. Not all critical patients live in teaching hospitals. There are non-teaching hospitals with higher average acuity than teaching hospitals. :)
  11. calivianya

    Bed Assignments

    I'm guessing you don't use a computer system for documentation? Often, we get called - but we usually know before we get called if we're paying attention to the computer. The unit manager in Epic shows all pending transfers. Before a bed is assigned, we can see that someone is pending in to the unit, but doesn't have a room number. There is a conversation between bed control and the unit team leader, who has been in contact with the different sections' charge nurses, to see what room it makes the most sense for the patient to go into. Bed control then assigns the room in the computer. The receiving nurse, or whoever is helping with the admission/transfer, drags the patient into the room in the unit manager and that completes the transfer once the patient arrives. It's not terribly uncommon for me to have thoroughly reviewed my chart, to the point that I tell the nurse who calls me report that I'm good and don't need any more info, I'll just see her when she gets there, before whoever's doing team gets around to telling me I have a patient coming. I can't imagine anyone as high up as an ADON being involved in bed assignments. We have 70+ RNs on my unit alone; I imagine we have at least a couple thousand working for the hospital. How could the ADON possibly assign beds appropriately to the appropriate staff, and know exactly what other patients are in that particular nurse's assignment? That just sounds nuts. No wonder you're having problems.
  12. I have no intention of staying in nursing until I retire. However, I could see myself staying exactly where I am for the rest of my nursing career. If I get into my first choice school for my next career, which is close by, I'll be able to. I love my specialty, I love the acuity of my unit, I love a LOT of my coworkers, and I absolutely am passionate about most of our physician staff. There are other specialties I wouldn't mind learning, but I'd have to pick them up as a PRN job because I love my specialty that much.
  13. calivianya

    Low Census

    Low census doesn't affect us at all. At this point, we're up to ten nurses short some shifts - so low census just means that we get to have the appropriate number of patients instead of having way too many. Most of the time the only reason we're "low census" is because we've blocked beds because admitting a single patient means that we would start having assignments with four ICU patients, and even our ridiculous manager, who almost never allows beds to be blocked, realizes a four patient assignment is unacceptable. Out of the five 12 hour shifts I worked last week (at least half of the unit staff is working 60 hours a week right now because the opportunities for overtime are limitless), every shift that I didn't have a 1:1 I was tripled. That's pretty much what my unit looks like right now. We are fighting each other tooth and nail for the 1:1s because we're all tired of three patient assignments. They're not appropriate three patient assignments, either. :/
  14. calivianya

    Can Nurse Practitioners Become Doctors?

    Anybody, NP or anyone else, can go to med school if they take the classes required beforehand. Most NP programs won't have you doing the classes you need to do well on the MCAT, and they won't have been recently. I didn't have to learn physics or organic chem for nursing school, and my local NP programs don't require them either. Some med schools themselves don't technically require you to take all the hard science classes any more either, but if you don't have a competitive MCAT score, you have pretty much no chance of getting in anywhere. Even the people who took organic, physics, etc. in nursing school probably won't remember it well enough to do well on the chem/phys section if it's been long enough since they've taken those classes. The chem/phys section was a nightmare and I took those things very recently. Most med schools actually have a two step application process... you apply initially, they screen you for a decent MCAT score, and then you're allowed to complete the secondary application if your MCAT score is good enough. Unfortunately for people with good, competitive healthcare experience, like RNs, NPs, PAs, etc., they don't even see your healthcare experience if you don't pass the primary application stage because your MCAT score sucked. So, experience means absolutely nothing if you don't do well on the MCAT in the first place, which is a broken system if you ask me because they'll lose GOOD, competent people with relevant healthcare experience, but that's not what they're interested in up front.
  15. calivianya

    12-Leads on CCRN Exam

    Cardiac, as others have said, was a huge portion of the test for me. But honestly, I am a little concerned you are worried about knowing 12 leads for the test, implying you don't already know them. Maybe it's just me, but I think that's 100% absolutely, positively need to know right now as an ICU nurse. I think that's right up there with knowing what propofol is used for. For example, let's say your patient develops chest pain and some ST elevation. Your chest pain protocol includes giving nitroglycerin. You are waiting for your physician to call back but it's been 20 minutes, you're getting nervous because your guy is sweating and clutching his chest, so you're implementing the protocol orders without physician guidance... and you give nitro, the patient's blood pressure drops, and he codes. If you don't know what an inferior MI vs. anterior/septal/lateral looks like, you could do that very easily by mistake. I work MICU, for the record, so I'm not just saying that as a cardiac nurse. Learn your 12 leads because you will not only save your patients' lives... you will also save your coworkers' patients' lives when your coworkers who haven't bothered to learn to interpret ECGs go to make a serious mistake and you can intervene. :)
  16. calivianya

    My Mom passed away. Did I do the right thing?

    Yes, and yes. People who are tremendously unstable and imminently near death often pass away after very minimal amounts of stimulation, like turns. The key thing here is they have to be extremely near death. It happens all the time. So, if she died right after you turned her, she probably would have died within a couple of hours anyway if you hadn't turned her. She was dying regardless. That had nothing to do with you. The only thing that had to do with you were the maybe couple of extra hours she could have lived. Think about if you hadn't turned her and she'd lived an hour more - what would she have been doing? She was minimally responsive already. She wouldn't have been at a party. She wouldn't be having a conversation with you. She wouldn't be listening to her favorite music. She wouldn't have been doing anything meaningful to her; she'd just be lying there dying even slower. She didn't lose anything that would have been meaningful or special to her losing those potential hours or minutes. Lying minimally responsive in the bed is ZERO quality of life. Extending that for what? A couple of hours, tops? A couple of hours of being unresponsive? There would have been no benefit. I'm so sorry for your loss.
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