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marienm, RN, CCRN

Burn, ICU
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marienm, RN, CCRN has 6 years experience and specializes in Burn, ICU.

Second-career RN (since 2013) working nights in the Burn ICU.

marienm, RN, CCRN's Latest Activity

  1. marienm, RN, CCRN

    Shift Work

    No, as I said my typical shift is 1900 (7pm) to 0730 (am). I get report from the outgoing nurse between 19-1930, then they leave. I give report in the morning between 07-0730, then I leave. My state mandates a 30-minute meal break but does not require that it be paid. So I get paid for 12 hours even though, yes, I am required to be present for a duration of 12.5 hours.
  2. marienm, RN, CCRN

    Shift Work

    No, sorry, the shift handoffs occur at the top of the shift so I actually work 1900-0730. With 30 minutes of unpaid meal break, this is a 12 hour shift.
  3. marienm, RN, CCRN

    Shift Work

    I think it depends a lot on the unit, but 12 hour (0700-1900/1900-0700) shifts are common for inpatient units. 8 hour shifts (07-15, 15-23, 23-07) are also pretty common...some places don't allow nurses to work 12 hour shifts due to concerns about fatigue. In a procedural area (OR, Cath Lab, whatever, there's probably a mix of scheduled shifts and on-call time to accommodate emergency cases.) Is there a hospital near you where you could shadow an RN to get an idea about some of this stuff? I get the impression that you might like to be a nurse but have a lot of concerns about the schedule. While those are absolutely valid (everyone should have a good work-life balance) there are other difficult things about being a nurse too (you name it: blood, body fluids, death, people in pain, stress, angry patients, angry surgeons, whatever...). In my opinion, you won't be able to avoid some of these things but you probably *will* be able to get a schedule that mostly works for you. If the schedule is your biggest concern I think shadowing would give you a more rounded picture of the job.
  4. marienm, RN, CCRN

    Shift Work

    Generally, yes it would count as leave time. Again, we're getting into things that are very employer-specific! But I think it's safe to say that if you have a full-time job, you are expected to work full-time hours OR expend some type of accrual to account for the hours you aren't working. How those accruals are earned is employer-specific. In some cases, you might have the option of just not getting paid for hours you don't work...but your employer will hire you because they want you to work. They want you to fill in a set number of hours so that the unit is staffed. So it's most likely that to get a specific day off you'd either need to request to work a different day (or trade with someone) or use accrued time to "pay" for the day you aren't working.
  5. marienm, RN, CCRN

    Shift Work

    The details of how to switch shifts will be very specific to the hospital and the unit you work on. Generally, yes, you can probably swap around with co-workers to your mutual satisfaction. It requires co-workers who are willing to help out, and there might be rules that make it difficult (like, someone can't work more than X shifts in a row, or you can only swap inside the pay period, or there needs to be a charge nurse on every shift). Most places also have some way for you to request a shift off as PTO time, or maybe they have a fixed schedule so that you know you're always off on Tuesdays even before the schedule is published. As a new employee, I would say: don't expect to get everything you request, but your (hypothetical) manager should have a method to get you (and everyone) *some* of what you request while still staffing the unit safely. This is a good thing to (gently) ask employees about when you shadow a job...you can't spend *all* your time focused on it, because then it will look like you're not interested in the job itself, but try to gauge how happy people are with their schedules on the unit you visit.
  6. marienm, RN, CCRN

    Life in burn / trauma ICU

    My hospital has an adult burn unit. Kids go to the PICU or peds surgery unit as appropriate. Managed by the same medical team, but adult RNs care for adults only on our inpatient units. I don't know how many other places do it like this, but you might find one!
  7. marienm, RN, CCRN

    Shift Work

    Re: Holidays and weekends...you may need to lay things out for your family/friends/significant other: Hospitals operate 24/7. (I assume you're thinking about working in one.) *Someone* has to cover all those shifts. *Sometimes* it will be you. There will probably be a rota and a system for deciding who gets which major holidays off, but in most places, newer staff are likely to work the less-desired shifts. If everyone in your life has "bankers hours" jobs, it may feel like you're really missing out. You'll have to decide how much effort you want to put into, say, arranging a brunch date instead of a dinner, or celebrating a major holiday differently than you might have done in the past. I've worked night shift with alternating weekends for 6 years. I do miss some stuff. I also don't have kids or family in town other than my husband. So mostly we schedule stuff when *we* want to do it. We'll host a dinner on a weeknight that I don't work so I can cook all afternoon. None of our 9 to 5 friends can do that, but they all like eating! But the patterns in your life may be more or less flexible than mine.
  8. marienm, RN, CCRN

    What does it take to succeed in the ICU?

    My unit has had a couple of nurses transition to us from acute care areas. They have done well! Some thoughts: 1) You need to be really willing to learn all over again. There is a lot of new gear & procedures in the ICU that I don't expect you to know how to use, but I'll expect you to become proficient with pretty quickly after being shown how. 2) You'll have fewer patients, but I think the expectation of the level of nursing care is higher. For example, we do mouth care every 2 hours with vented patients and change sheets 2 to 8 times a day (with our burn patients who have wet dressings). Some perform & chart a full assessment q4. You need to take the initiative to do these things. 3) Use your resources! You've been a nurse long enough to have a feeling when something isn't right. If you're not getting what your patient needs, talk with your charge nurse to see whether your 'radar' is on point or not. (I'm at a teaching hospital. I spend a fair amount of time teaching the *residents* what to do, or at least when to call their chiefs!) 3a) On the other hand, learn what you are allowed to do independently and then DO it! You (probably) don't need the charge nurse's approval to titrate a vasoacitve drip, and delaying doing so because you feel like you need permission could hurt the patient. (Definitely ask charge if you genuinely aren't sure what to do, though.) I never worked on the floor, but I have a lot of respect for the nurses who do. If you decide to transition, I hope it goes well!
  9. marienm, RN, CCRN

    Clinical Experience with "Clog Zapper" for G-J Tubes?

    I have used pancrelipase & bicarb as a clog zapper, but always in a situation where it was safe to push the dissolved clot into the patient's GI tract. I've never instilled it down a separate catheter...just dissolved them both in 15mL warm water and pushed as much as I could get down the clogged tube, let it stand, push-pull agitation to try to get things moving, etc. However, I don't think I'd want to push a week's worth of congealed TF and meds into anyone! What did you wind up doing?
  10. marienm, RN, CCRN

    They want us to give drip meds on med/surg

    I work in ICU, but in my hospital a rapid-response nurse would stay with a patient when starting many of those gtts. (These are also our code-team nurses.) I'm not trying to nitpick, because I think your concerns about monitoring/titratimg are very valid, but the gtts you list are very different. At my hospital, we don't titrate vasopressin at all. We do check vitals frequently (and maybe stop the gtt if VS are improving) , but otherwise we just change the bag when it's empty. Diltiazem is sometimes titrated by providers outside of the ICU (but definitely needs frequent vital signs while actively titrating). Epi is a third-line pressor in many cases, so unless it was started during a code I would never expect it to be started in med-surg. See what I mean? It sounds like the gtts they're proposing don't even make sense. On the other hand, if a pt needs an epi gtt, you'd better not wait to start it! But I say that with the luxury of knowing that the RR nurse would be with the pt until the pt was transferred.
  11. marienm, RN, CCRN

    Drips

    I don't work in PICU, but I am procrastinating on doing my homework so... what drips? I would hope that your unit would be pre-stocked with the most common gtts in the correct concentrations. This is important because not every medicine is 1mg/1mL. If you use an IV pump that has a drug library loaded into it (like Alaris Guardrails) then it will only have library entries for your standard concentrations. Example: Leovophed (norepinephrine) is 8mg in a 250mL bad...and is commonly dosed in mcg/minute (maybe mcg/kg/min for peds...can anyone confirm?) Either way, you *really* want to be using the correct concentration *and* using all available safety measures before starting a gtt like that, especially in an urgent situation. In the event that you need to mix a bag of something on the unit (like dilute a vial in a bag) you really need a reference (either a list of your standard concentrations, or call the pharmacy for help). For true "code blue" meds I don't think of these as "drips" (and I'm not trying to quibble about your word choice, it's just that most code meds are given by IV push). Your frontline drugs should be in a code cart...stuff like epi, amiodarone, narcan, D50, etc... (Our hospital puts much more than "just ACLS drugs" in these carts, but every hospital is different! Our code teams carry intubation drug kits, but these are not in our carts.) For peds I understand that most of these drugs are weight-based, so your unit should have a protocol for how you know the right dose of each drug for each patient. (Our EMR lets us print an emergency med sheet for patients with these doses, since sometimes we have tiny adults who are less than 40kg.) Your orientation should include some code blue drills so that you have a bit of an idea where to find the drugs in the cart. Some drugs will be in preloaded syringes (Bristojet is one name) where you have to remove the caps and screw in the plunger...get your hands on one for practice, because they're not completely self-explanatory in an emergency! Does any of that help?
  12. marienm, RN, CCRN

    I think I'm tapping out...I hate nursing :(

    This opinion may not be popular or may not resonate with you, but I think it's okay to be a nurse and not be passionate about it. (This topic has been well-discussed in other posts, in fact!) It feels antithetical to the academic perspective that (I feel) overemphasizes passion and deemphasizes things like a reasonable salary and good health benefits. Am I telling you to suck it up and be a nurse even though it doesn't ring all your bells? No, you're in charge of your own life! I am saying that it's okay to work - and I do mean *work* and try hard to do well - at a job that is, fundamentally, just a job and a means to an end (which could be paying down some debt, or saving for a vacation, or getting family health coverage, or whatever). If you require passion from your job and can't see it any other way, can you identify areas of nursing that spark that passion? Refugee health, mother-baby care, HIV prevention, working with the chronically disabled, etc? Some of these niche jobs might require some acute-care experience first, but honestly some of these are probably less-desired or lower-paying and might be open to new grads? If caring for refugees is your passion, would you be willing to do it in an after-hours busy clinic? Would that feel like an acceptable tradeoff? Good luck with your decision! It's okay to acknowledge that something isn't what you thought it would be.
  13. marienm, RN, CCRN

    Air in Line

    I agree that an in-person demo is probably best...but I'll take a shot at explaining it! The Alaris pumps at my facility (and everywhere?) use Primary tubing (the piece that you actually clip into the air-in-line sensor; it has a blue removable cover around the part that goes in the pump door) and Secondary tubing (which you screw on to a needleless connector above the pump). If that doesn't sound familiar, stop here because none of the rest of this will make sense! The primary tubing also has a one-way valve in it between the spike and the connector for the secondary meds. This prevents your secondary meds from flowing back into your flush/main IV fluid. It also prevents you from chasing air bubbles back up the primary line and into the bag. You can remove them with a syringe at the secondary port, before they hit the air sensor. It is prudent to disconnect the line from the patient first! Then, scrub the port with alcohol and screw on a clean, empty syringe. The goal is to remove the air at the same rate the fluid is flowing...watch as the air approaches the port and gently pull back on the plunger. (If you pull too hard, you'll pull air in from the distal end of the line...you can fix this by allowing fluid to flow to the end of the line before re-connecting. If you don't disconnect your patient you will pull their blood back into your line & maybe blow their IV.) If the air is already down below the secondary port and it's a lot of air, I usually disconnect the patient and re-prime the line over the sink if the med/fluid is safe to disconnect. It takes a minute, but better than constantly silencing alarms! The reference in hherrn' s post to backpriming is a good way to chase bubbles out of your secondary tubing and back up into the secondary bag. It may also be the way you prime your secondary tubing if you don't prime it with the medication. Good luck! But seriously, ask a co-worker. Soon you'll be the one showing new folks the tricks.
  14. marienm, RN, CCRN

    Hypochlorous wound cleansers

    Is anyone using these in their Burn ICU? (One brand name is Vashe, but there are others, I think.) How do you use it? How often do you use it? What did you use before hypochlorous? Are you seeing fewer infections than before? What about pseudomonas infections (for which the Vashe rep claims Vashe is superior to chlorhexidine gluconate)? I am....not totally sold on this product, but I wonder whether we are using it as effectively as we could be. (Yes, we have reached out to the reps and our infection control department. I'm looking for some solid bedside anecdotes here!)
  15. marienm, RN, CCRN

    Cardioversion without ECG leads

    This is not my primary area of expertise, but if you wanted a synchronized cardioversion you would need the ECG leads *from the defibrillator* on the patient. (The bedside monitor might help you make a decision about initiating cardioversion, but it won't allow the defibrillator to sync.) Wuzzie (above) is right to point out that some pads incorporate a 3-wire ECG.
  16. marienm, RN, CCRN

    Omnicell vs Pyxis

    I'm at a hospital that uses Pyxis for meds and Omnicell for disposables. I'm sure there are different models of Omnicells but our current ones are over 6 feet tall and about 18" deep...I can't see the practicality of storing tiny pill packets in one! Are there drawers inside yours? Granted, they'd be great for IV meds and bags of fluid. Our pills and syringe meds come from Pyxis where they are in nice flat drawers; each compartment within each drawer has its own electric lid so you can't accidentally pull from the wrong pocket. Our IV fluids, on the other hand, are loose on shelves with no inventory control.
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