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calivianya BSN, RN

ICU

Content by calivianya

  1. calivianya

    NP or Physician for men?

    In general, yes - doctors work longer and for less freedom. Definitely during training, especially. Four years of undergrad (need a bachelor's to get accepted to med school), four years of med school, variable length of residency, variable length of fellowship - pretty much can't work much during med school, and getting paid less than a nurse during residency and fellowship with up to $400k in student loans hanging over your head. Anywhere from 11 years to 15 years, maybe longer, from the start of a bachelor's degree to becoming an attending. Even starting at year one of college, getting your BSN, a year of working as a RN, and then a DNP would probably only take eight years (maybe longer if you work as a RN for longer in between), so it's faster to become a NP by far and you graduate with far less debt. Astronomically less debt. Where I work, NPs also seem more likely to work the 9-5 jobs while the physicians tend to take more overnight call, but this varies. If you just care about knowing enough to get the job done, NP is fine... but if you want the extra depth and breadth of education, MD/DO is where it's at. IMO, the science load is vastly different, too... so it depends on exactly how much science you want incorporated into your practice and what type of science you want. Many MD/DO schools require research projects to even graduate now, and the top tier programs want to see significant amounts of bench research before you can even get in. My friend did her research on the effects of hypoxia on the resistance of prostate cancer cells to certain chemotherapeutic agents, as an example. Since you will have to do some research for DNP as well (assuming all programs are DNP by the time you apply), it would be worth investigating whether nursing research or medical research fits your interests better. If you are less interested in research, NP would be the way to go IMO.
  2. calivianya

    This is not what I thought it was

    Haven't seen you in forever - hope you're doing well.
  3. calivianya

    Furosemide med error

    You almost always have to give the Lasix "late" in this case - in general, the provider has no idea what time you're going to be finishing up the blood and just throws the order in, assuming you'll know to give it after. You know, now - and you'll know for the future. I don't really think it's fair to really think of this as you screwing up - it's more of a systems error that there isn't usually a better way to order this so it would be clearer that it wasn't due at a specific time.
  4. calivianya

    This is not what I thought it was

    Haven't been here in forever - glad to see you landed a job! Sorry it sucks, though. Can't really advise about the knee pain beyond what everyone else has been saying (Danskos and Sockwells are my jam), but I wanted to say I feel like most acute care jobs are crap until the unit is done "breaking you in," "hazing," whatever you want to call it. The only reason I stayed at my current job past the three month mark is I'd worked at my first job less than a year, and I felt like I'd get labeled a job hopper if I left my new one after three months. If I was staying in nursing, I'd hit my four year mark on that unit this August. Things tend to get a whole lot better if you can stick a year out... around then, people start realizing you're serious and stop being evil just because you're new. That's just my personal experience.
  5. 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!
  6. 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!
  7. calivianya

    How to deal with a bully patient?

    Since I was the first on who mentioned dumping on the travelers - to be fair, when I am charge, I end up spending half the night in everyone else's patients' rooms. In the case of the very difficult patient mentioned earlier, I was there whenever he had to be held down again. It just made it easier to deal with when I was only in there once every two hours instead of every fifteen minutes like the primary nurse. I don't let anybody drown. But, I still need a little bit of a break from the difficult ones. I will also say - it's not a few extra dollars at my place. We are offering critical pay to the travelers. Based on traveler self-report, some of them are bringing home $1900 a WEEK. One literally makes over $8,000 a month after taxes where I am lucky to take home $2700. It's not an insignificant difference - it's more than threefold staff nurse pay. I realize this is not the norm everywhere, but it is where I work. Higher hourly rate goes for a whole lot when it's like getting paid triple time, all the time. Plus our hospital lets the travelers work overtime if they want to because we're so short, so there is potential for them to take home almost $10k/month after tax if they want to.
  8. calivianya

    Did I harm the patient??

    I've placed an IO in a code situation before... but that's totally different, because it's last ditch, and the patient is pretty much already dead anyway (hence the code) so it's less pressure. What I can tell from that guy's reaction is it really, really hurts. And hurts when you first start infusing medications, even if you primed with lidocaine, even if you push extra lidocaine before starting meds.
  9. calivianya

    Did I harm the patient??

    I agree that 99% of meds are given IV... but when I'm giving IMs to a patient, I'm giving a lot of them. I'm usually giving IMs to the totally out of control violent delirium/psychotic patients... so when I do give IMs, I probably give 10+ a shift. One recent night it was 4x IM Ativan, 3x IM Geodon, 4x IM Haldol... patient had been running precedex but had pulled out his central line and promptly spit in the face of the IV team nurse when she tried to get a peripheral, and swung at me when I tried, so no dice on getting IV access. However, the last IM I gave him (Ativan), he pulled the syringe out of my hand after I stuck it in his leg and started swinging it at me, needle and all. He would have gotten me with it if it hadn't been for our intensivist doing a ninja move and bending his arm around backwards to get the needle out of his hand. He bought himself an IO insertion to start the Precedex back *while he was awake* after that. Never IO'ed an awake patient before. Heck of a lot more intimidating than giving an IM. I've never heard anyone scream like that, either. For the record, I almost always give IMs in the vastus lateralis. Ventrogluteal, especially, requires careful landmarking... if someone's swinging at me, ain't nobody got time for that. Not to mention, you have to be a lot closer to the patient's arms for dorsogluteal or ventrogluteal, and if they're violent, that's a no go. If someone else is holding the patient's shoulders down, you can get to the vastus lateralis without risking getting hit.
  10. calivianya

    How to deal with a bully patient?

    Rationale was none of the rest of us could stand him. He was with us for over a month and we just couldn't do it anymore.
  11. calivianya

    Running into former patients

    Then I don't think you were inappropriate. I probably would have handled it the same way you did. In general, I don't drink with my patients - but I can think of one or two I would have made an exception for because we were just about friends, not just patient/caregiver, by the time the patient left. I've got one right now like that who's been with us for a month - but I'm 99% sure this person's going to die before discharge, so I'm not going to have the opportunity to anyway. I'm very sad about that.
  12. calivianya

    How to deal with a bully patient?

    We had a detoxing meth patient who just got out of jail for assault with strangulation and kidnapping. Demons and swastikas everywhere on his body, and outright violent with us. After he returned to his normal and was healthy enough to move out, he still got a free ride in ICU for multiple WEEKS until they found him a behavioral health placement. Rationale was "they couldn't handle him on the floor or in stepdown." Since when does ICU qualify as the place where it's okay to stick patients too violent for other floors to handle? None of us were very happy about that. We only gave him to male nurses, and usually only to the male travelers or members of the float pool, and he spent most of his time with us in restraints with a mask on so he couldn't spit in our faces. That's how we dealt with him.
  13. calivianya

    New nurse having a hard time with coworkers

    Give it some time. I won't use the NETY phrase because everyone here hates it so much... but it wasn't until I hit about the 1 year mark at my current job that my coworkers became tolerable. Mine are famous for just about ignoring the new people to the point of being rude until you've been there a while, because they don't want to waste their time on you if you're just going to turn right around and leave. Hmm, I wonder why people started leaving so quickly in the first place...
  14. calivianya

    "I Narcanned Your Honor Student"

    I think my attitude here is just a product of the type of environment I was in during high school. The parents who had the "honor student" bumpers on their cars were typically the same people who paid for the expensive private tutors for their kids... the ones that their kids bragged did most of their homework for them, so the kids could spend their time going to their lake houses/beach houses with friends or driving their fancy new sports cars they got for their 16th birthdays instead of writing papers. I hardly ever saw the people who actually worked their butts off for the grades throwing it around in everyone else's faces. Funny how that works.
  15. calivianya

    "I Narcanned Your Honor Student"

    I think it's hilarious. A dear friend of mine was a C student at my private high school, kept bouncing in and out of academic probation because she'd get occasional Ds... then she transferred out to a public school and all of a sudden had a 4.0 and was an honors student. "Honors student" at a public school means you're just going to class and doing homework instead of skipping classes to smoke weed, and certainly isn't a point to brag on IMO. At least that's how it is in my geographical area. I guess that's why I'm so annoyed with all these "honors students" bumper stickers. It literally means nothing. You could maybe interpret it as that child's IQ is slightly greater than that of an earth worm if you're being generous. I do get amused when these god-like epitomes of perfection (according to their parents) screw up. That's good humor to me - when these special snowflakes turn out to be just as human as everyone else, much to their ignorant parents' shock.
  16. calivianya

    If you could redo it....would you choose nursing?

    A plague to the profession? All of the people I've precepted say they like working with me because I'm enthusiastic and a perpetual learner. I stay on top of the latest journals in my specialty area and love sharing things I've learned. The new grads aren't afraid they're going to get eaten alive if they ask me something... unlike what happens when they ask some of the other experienced people for help. I am the first person they run to when their patients are in trouble. I get glowing thank you letters from my patients and their family members. I'm fair when I'm charge... I don't give myself the easiest assignment and kick back my feet all night unlike some of our staff, and I don't crap on the travelers, floats, and new grads. I usually piss off the experienced people because I don't give them the easiest assignments just because they're in the old boys/old girls club. I usually end up in every single room in my unit by the end of a shift, because I like knowing what's going on in my section. I always help with baths, poop clean ups, and complicated dressing changes. Clearly, I'm a plague to nursing. xD
  17. calivianya

    30% of Nurses Leaving the Workforce - 2017 Salary Survey Results Part 2

    I agree with NC being on the list of places feeling the shortage the most. For those complaining about not being able to find jobs as new grads... come here! 90% of the hires on my unit this year have been new grad RNs. We'll take anybody with a pulse and a nursing license. Really. It's that bad. My manager states she ends up hiring most of the people she interviews. The problem is that we don't have applicants. Nobody applies, so nobody gets hired... so we stay short.
  18. calivianya

    If you could redo it....would you choose nursing?

    Currently in the process of applying to MD programs so I'm glad you put that there. xD I don't regret being a nurse, though. It allowed me to get my foundation before going on to do other things. I think I am a more well-rounded person and have better life experiences and more of an idea of what I really want to do from having been a nurse first.
  19. calivianya

    Experienced RN's cannot get new jobs!

    Have you thought about moving? Plenty of areas of the country where they'd love to have nurses with experience, even older ones. We can't get any experienced nurses to apply here. We hired more than ten new grads this year... our nurse manager says we only had one experienced applicant recently and she took another job. We hired one with experience - an older nurse, more than 20 years of experience - last fall and she left after three months. We are having to hire tons of travelers at critical staffing pay to fill the holes, and between the travelers and the float pool, my unit is still regularly down five or six nurses. There are jobs even for older experienced nurses... but they are not in super desirable places.
  20. calivianya

    ED or ICU

    How about messy to the point it's nonfunctional? xD I can keep an organized work space, but not an organized house. I keep telling my fiance that we seriously need to invest in a housekeeper because neither of us can keep things clean to save our lives, and we are constantly losing things.
  21. calivianya

    Chewed out from family

    This is reason one of ten million why I work night shift. More often than not, I can convince people to leave, because "He's sedated and the ventilator is breathing for him now; he'll need you to get your rest so when he wakes up and we take the tube out, you can have the energy to support him." I fervently promise to call them if anything changes, and they get out of my hair. If they don't actually leave the hospital, I can usually convince them to sleep in the waiting room, at least. Even better are the times I go days without seeing any patient family members at all, because they get there after 0700 and leave before 1900. I feel like people are like this more often than not these days. I can remember one time I snapped at a customer service person who didn't deserve it because I was having a horrible day, but it's only happened once in my life, and I came back and apologized later. I don't see how these people who constantly beat everyone else around them down just because they're having a bad day can look themselves in the mirror. I don't care how bad things are going for them, basic human decency should still be a thing. There is no excuse to treat people like those family members treated you.
  22. calivianya

    Frustrating... ED is Not Critical Care

    Our ED nurses are absolutely critical care nurses. My unit (MICU) stays full all the time. It's daily that there are vents on pressors being boarded down in the ED... and a single ED nurse might be watching four unstable vents down there. They have a way worse time than we do, and get none of the credit.
  23. calivianya

    Futile ressusitation

    Most CPR is futile. I'd say 90%, at least, of people that get their pulses back either code again within a couple of days and we can't get them back, get withdrawn on and die, or spend the rest of their lives in a LTACH. But. We had someone recently who was in her 30s and went into a lethal arrhythmia at home. Unresponsive when she first got a pulse back, posturing and seizing within a day of arriving up on the unit with us. She arrested something like five more times, all v-fib. We did the hypothermia protocol, put her on a boat load of seizure medications, etc. Most of us thought it was a wasted effort. She bought herself a defibrillator for her tendency to go into v-fib, but was otherwise perfectly fine. Woke up and started following commands, and was extubated within a week. I mean ZERO deficits of any kind - not even slow speech. She talked as fast as I do and that's pretty dang fast, moved all extremities, was walking to go to the bathroom, etc. She told me before she left that she was going to "quit her f'ing job because her boss was a f'ing a-hole that was trying to kill her" and that she was going to pursue art instead, which she'd always wanted to do but had been worried about making ends meet. She decided since she'd already died once that life was way too short to be in a high powered job that she hated. Several weeks later she came back and took pictures with us and brought us food, and showed us pictures of her paintings, which were actually very good. You really never know. The thing about working in the ED is you don't get to see any of the long term outcomes, so I imagine it's especially disappointing for you guys. ICU staff at least get to see the patients wake up, if they're going to.
  24. calivianya

    Renew ACLS?

    I would definitely renew it. If you struggle with rhythms, use this: SkillStat ECG Simulator It's how I learned my rhythms. They have a study option and then a game option where you see the rhythm and have to pick the right one. I'm of the opinion that quizzing yourself makes the knowledge stronger. Go over this a bunch of times and you'll be a pro at rhythms soon. :)
  25. calivianya

    Compensation for BSN?

    One place I almost worked offered a $0.75/hr differential for a BSN. These unicorns do still exist. From what I understood from people I knew who worked there, it did not change their base pay - it literally just added a new line on the paycheck in the same way that night/weekend/holiday differentials were accounted for. Something like BSN - $0.75 - 72 hours - $54. If it's accounted for this way, it also doesn't count as a "raise" because your base pay doesn't change, so you could still be eligible even if you already got a pay raise this year. It's definitely worth asking about.
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