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.

I worked CVICU for over 12 years and found the best 12 hour shift schedule for me was every Tue and Thur and every other weekend. That way I had a day off after every shift except my biweekly weekend shift.

I work in cardiac surgery and call report to CVICU recovery nurse 30 minutes before we go up. Anesthesia and myself transport patient to unit monitored.

I've been a nurse for over 17 years now and I don't regret for a moment my choice to enter nursing. I understand and appreciate some of the comments regarding our profession such as the long hours, disrespect, and feeling that we don't make a difference. But we do make a difference. Just when I get discouraged I will meet a person I took care of in a store and they say thanks for all the hard work I had done for them. I don't remember their name but they remembered mine. Even though I was only involved in their lives for a short while I made enough of an impression that they wanted to thank me months after they left the hospital. There are many fields to encounter in nursing if you so desire but all of them require you have the desire to want to help people and if you have lost that desire than perhaps you should be out of nursing.

Bojar is an excellent stand alone reference. I allows remind myself what the best cardiac surgeon I have ever worked with told me once:"Never get complacent, there is no such thing as a routine open heart recovery." Every recovery is different.

I work in a 12 bed CVICU in California. Our director has begun to talk about increasing our ratio to 3:1 in our unit if we have too many floor patients awaiting transfer out to med/surg. I thought Title 22 and AB 394 in California prohibited increasing the ratio in a critical care unit regardless of classification of patient. I thought that as long as the patient was "between the walls" of the unit the ratio could not be changed. I would appreciate any thoughts or comments please. Thank you.

It's plain insane to use Precedex as an induction drug. Etomidate and versed/fentanyl usually work much better with another paralytic if needed. Precedex can be hit and miss but we use it exclusively to wean and extubate our open hearts. We also use Precedex when we want to change to shorter acting sedation in anticipation of weaning to extubation on our med/surg patients. Have extubated many times while still on Precedex and even continued while patient was either on BIPAP or on simple mask. It doesn't suppress respiratory drive and can seems to be the right combination for patients who are still anxious or going through drug withdraws.

milrinone ntg nipride levophed dopamine dobutamine insulin albumin amiodarone lasix hard to keep it at just 10--off the top of my head these are the meds I use the most

Wouldn't cheat on tests for a number of reasons: The ethical side of me felt that if I wasn't prepared enough for a test and ended up getting substandard results then that was my fault and hopefully next time I can do better. My practical side always said the possible ramifications of getting caught would never justify the cheating. I also could never trust someones work over my own. I know some won't confess to their practical side, but lets be honest, it's true. Not every issue has to come down to morality.

Our hospital has a policy that requires the admitting physician to acknowledge and actually sign off on a list of their home meds that was obtained at admission. The pharmacy follows up on this and flags the physician if there any interactions or questions regarding past home meds and current inpatient meds. When the patient is discharged the discharging physician and nurse have to sign off on a list of those active home meds again. This policy can be a real pain sometimes but it has maintained better consistent care.

RN's only--I am ultimately responsible for that line-not a tech. Where I work only RN's can get blood samples from art and central lines. This makes sense to me--I have the experience to troubleshoot that line not a tech.