clarkheart

I have been looking at switching specialties from critical care to dialysis. What do you all find are the advantages/disadvantages? I am CRRT certified from critical care. I am interested in either clinic or acute care.

I've done a little bit of everything: Med Surg, CVICU, CVOR, Cath Lab, and Quality and Risk Management. Currently a Clinical Coordinator on a Cardiac Telemetry unit.

Probably costs even less in Mexico. If they can charge it and you pay it then they will continue to gouge you. Not just drugs though..I still want to know why I have to pay $35.00 for ten disposable razor blades when they make them for literally pennies--again because they can.

The great thing about that nursing degree is it opens other opportunities if you want. If you are fed up with bedside care then use your clinical knowledge in other areas in healthcare such as quality, case management, risk management, informatics, etc. I worked in a quality department for a number of years to get a break from direct patient care and believe it or not I went back this year as a clinical coordinator on a cardiac telemetry floor because I missed direct patient care. Sometimes getting away for awhile can end up giving you new and different perspectives on things.

I would continue to look for other positions if you want. Keep your options open. There is nothing wrong about continuing your search while they are continuing theirs.

You need to find a new job. Life is too short to put yourself through torture every day you work. I have been there myself and left positions that became too stressful. Nothing is worth compromising your physical and mental health. I bet the moment the turned in your resignation you will feel a ton of relief.

I was a circulating RN in a CVOR for over two years and pulling up to 25 days a month on call. Then I went to the Cath Lab and pulled about 12 days a month and I thought I was in heaven! I now work in Quality/Risk Management for the last three years but I still get emails, texts, and calls from travel agencies looking for CVOR or Cath Lab assignments. I say go ahead and make yourself available for the travel Cath Lab assignments. Try a 6 week assignment and see if you like it.

I think one of the issues that we need to discuss is how the physicians discuss the care of these patients with the families. There are times when the most dignified care these patients could receive is to allow nature to take it's course. I don't want to get on the soap box here but it is just plain cruel to allow families to continue life support for hopeless patients for their own selfish reasons. I am fortunate that our intensivists are very proactive in keeping the families informed on the patient's condition and are very honest when it appears that there will be no purposeful recovery.

Our hospital got called out by The Joint Commission before and accused us of "practicing medicine" (they like to use that term) when our electrolyte protocols weren't "tight" enough. They didn't like that our protocol allowed us to continue to replace after subsequent labs have been drawn after the initial replacement. They insisted we call the physician after the first lab draw if the electrolytes still needed replacing. Do you have titration parameters in place? EX: "Levophed drip to tritrate for MAP >65. Maximum dose of 20mcg/min"? That was another issue with TJC. They said nurses were "practicing medicine" if the exact parameters were not ordered. So we played along and changed our protocols but in reality it did not change our clinical practice at all.

First question I have is whether the patient is stable or not. Patients with wide complexes can be stable. If patient is unstable and complex wide then CPR then defib. The AICD may be set to trigger at higher rates then just 112 regardless of the complex. Never wait or anticipate an internal defibrillator to shock for you especially if patient is unstable.

Thank you for the information. I am looking into crossing over into Quality after being in patient care for 20 years. Any advice of making this a smooth transition would be greatly appreciated.

I've been told by Intensivists that any PEEP over 5 will artificially give CVP readings on a one to one ratio. Example--PEEP of 8 will artificially raise the CVP 3 points. I've always been told to keep that in mind when accessing volume requirements.

Always have a notebook or paper available to write down notes or thoughts when they come to you. Then review them later and expand on them if you can. I ended up creating my own notebook that I still keep at my workstation and I will add to it even today after 13 years in CVICU. Open yourself up to the opportunity to literally learn something new every day. If you do that, trust me, you will learn something every day! CVICU is a great place to work but is very challenging academically and physically but I've never regretted my choice all those years ago to enter CV.

Never take the ECG machine interpretation as the final word. I have seen too many wrong explanations through the years from a machine. Trust the MD's interpretation first.

They may give you clinical scenarios that will require a knowledge of ECG interpretation or basic knowledge of pharmacology such as what drugs to use in what clinical situation or rhythm. Been a CVICU nurse for over 12 years and had an interview for a per diem position at another hospital and those were some of the questions they asked me. I had already taken a ECG test and basic calculations exam before the interview.