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marienm, RN, CCRN

Burn, ICU
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marienm, RN, CCRN has 7 years experience and specializes in Burn, ICU.

Second-career RN working nights in the Burn ICU.

marienm, RN, CCRN's Latest Activity

  1. marienm, RN, CCRN

    HELP be a nurse or another career opportunity?

    I agree with all the cautions posted here but I'll also point out that I know a lot of nurses who have some type of side-gig going on...nurses who work in hospitals but also do home infusions, nurses who also sell MLM products, etc. I even know one who is a mortgage broker and another who is a realtor. So, OP, I'd say pass your NCLEX, get a nursing job that gives you health insurance and access to a retirement plan and whatever, and maybe consider this other career as an adjunct after you've got your feet under you as a nurse?
  2. marienm, RN, CCRN

    Graduated in March, Cannot Find a Job

    Central NY is hiring new grads into hospital positions. One heads-up: the way my employer words the ad, it asks for 1 year of experience but stipulates that RNs with less than one year may be hired for a lower-salaried (still an RN) position. It does this for all RN positions but we are definitely hiring new grads. PM me and I can send you more info if you like.
  3. marienm, RN, CCRN

    Is it responsible of me to try to become a nurse?

    I haven't been where you are, OP, but I do work with some nurses who have mental health diagnoses and are succeeding in their careers. One thing I would add to the advice above about having an active treatment plan/good support system/having enough insight to at least know that you *aren't* able to work on a particular day is: consider the stress level of a new RN job and how you respond to stress. You might wind up working night shift, but having orientation classes during the day (a few days apart, but still...) at a hospital. Your manager might question you why you didn't chart the vaccination history of a particularly uncooperative patient. You might have to see 30 patients a day at a clinic and keep up with all the charting. You may have co-workers who don't understand that mental health is real health (it happens a lot). I'm not saying you can't be a nurse because of stress...it affects all of us and I get home from a busy shift and feel anxious/irritable/exhausted. I'm saying you should consider whether environmental stresses are likely to be a trigger for you and think about how you would cope with this. Some options that would work in an office (take a break in a quiet room, call your therapist, or whatever) simply aren't sustainable in a busy hospital environment but could be feasible in a clinic. With this in mind, plus some job shadowing when quarantine restrictions are lifted, maybe you'd have a better idea of what kind of nursing would be a good fit.
  4. marienm, RN, CCRN

    Full time jobs hard to find ?

    If jobs are scarce in your area, are you willing to move? Are you willing to work any shift? Would you be willing to work in a hospital/at a clinic/at a procedural center/at a school/at a SNF with 40 patients assigned to you/at a jail? Like, how flexible are you willing to be to get a job (keeping in mind that some of those options probably won't...and really shouldn't...hire new grads). On the topic of age: are *you* willing to be trained and supervised and evaluated by people younger than you? I would say that the "average" charge nurse at my hospital is under 35. Some of them have been nurses twice a long as I have...I'm early 40's but nursing is a second career for me. Other new grads are early 20's and I definitely have days where I feel like we were raised on different planets! (Of course this could be true in any job but I imagine that as an admin you have a particular niche and this will be a complete change of environment for you.)
  5. marienm, RN, CCRN

    Low census and COVID-19?

    Us too: elective surgeries cancelled, huge push for telemedicine wherever possible so we're taking fewer transfers, lots of beds open and waiting... Staff who get called off can use accrued time or decline to be called off (someone else will be happy to take their spot, especially since requests for using accrued time are being declined right now and some of it expires annually).
  6. marienm, RN, CCRN

    Setting up Manifold using 3 way stop cocks

    I don't know what your preceptor showed you, but I typically prime each stopcock with a NS flush syringe...attach syringe, prime the "straight" portion (with the lever OFF to the side port) then prime the side port (lever OFF to the straight port), then attach it directly to the patient's IV and hook up med lines. You could do the same if you were setting up a brand new line...attach stopcock(s) to the tubing before you prime it and then systematically prime each port. Redcap (or whatever your policy is) any port you won't be using right away. As to double pumping...I don't do this for adults. If I have all my stuff prepared (line already primed with new stopcock on it, already made sure that the tubing is loosened, etc...) I genuinely think I can change out a line and restart it within 10-15 seconds. For most adults, that won't drop their BP too much. But if it's your practice for kids to have the redundant pump set up and ready, then just make sure it's really *ready*...line all primed, any new hardware already attached, concentration and dose programmed correctly, old line loosened...before you stop the old channel and swap them. You probably swap *all* the critical lines at the same time as well as the clave if the goal is replacing the manifold, right? It's all about being organized ahead of time and maybe asking for an extra set of hands/eyes when it comes time to swap (and you should be double-checking all critical infusions anyway!)
  7. marienm, RN, CCRN

    Midlines and Nephrology Sign off

    The PICC nurses at my hospital place midlines as well. I've always been told they don't want to risk damaging the vessels on a patient who might, in the future, need a hemodialysis fistula placed in that arm. They simply won't do it...we can't even have nephrology sign off on it. These patients get CVCs (placed by an M.D. or PA or maybe an APRN) or PICCs in the IJ placed in the interventional radiology suite. The conservative approach probably comes down to money and liability.
  8. marienm, RN, CCRN

    Night Shifters - Hobbies?

    Might not be your cup of tea, but I like doing something quiet with my hands...I'm currently working on a big embroidery project. It's not too taxing mentally but it keeps me more focused/awake than reading. See also: model-making, knitting, tying flies, putting all the old photos in an album (or taking them all out and scanning them!), drawing, etc...
  9. marienm, RN, CCRN

    Code Blue: Just Trying Figure Out What Happened?

    This case is going to be on your mind for a while, sorry. The discussion about patho here has been good! The one idea I'll add is that it sounds to me like the ED provider may have been out of their depth. Elevated WBCs, hypotension, elevated lactic, febrile all sounds like sepsis. Poor EF, extensive medical hx, hypoglycemia all make it more complicated. I'm just not buying the lasix...Sat of 95% on 4L does not make me want to give lasix to a hypotensive patient (even with pressors fixing the numbers on the screen). If she had crackles that were audible without a stethoscope, lasix might have been appropriate to give in the ED, but otherwise this makes me think the provider didn't have a strong plan. What were her electrolytes pre-lasix? In my hospital (which I'm not saying is perfect so I'd welcome any input!) this patient would have gotten an ICU consult and probably a cardiology consult while still in the ED. As you've unfortunately seen, this is not the kind of pt you want to keep in the ED...they need a primary team to start managing their case. As the nurse, you can push for this when you know your ED providers. Would it have changed the outcome? Maybe, maybe not; it sounds like she went south fast. Right now you're training your "eyes" on patients who make you nervous. These are the patients you want to be transferring out...get their labs, their stat ABC interventions and antibiotics, their tests, and get them admitted!
  10. marienm, RN, CCRN

    Home Oxygen Deaths Higher in U.S.

    Burn ICU nurse here: I've taken care of a couple of patients whose oxygen was ignited by e-cigarettes as well. I don't have the specifics about what type of e-cig, but basically anything that heats up doesn't belong near oxygen tubing! All of the e-cigs with a battery have a heating element inside. Notably, one of these patients was *in* a local hospital, on their chronic oxygen, with an NG tube placed for bowel decompression. When they secretly used the e-cig it ignited their oxygen tubing and it also burned off the external part of the NGT. So the facility intubated the patient and then had to retrieve the NGT via endoscopy before transferring the patient to us!
  11. 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.
  12. 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.
  13. 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.
  14. 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.
  15. 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.
  16. 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!
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