Greenclip

Welcome ? Expect pay to be lower than you're used to, unless you're coming from the rural South. I think there isn't a bad place to work in the Lou unless you're looking at Kindred or Select, which don't apply to you. BJC gives expert pay in some areas (ED, ICU, periop) but I'm not sure if it applies to GI/IR/cath lab. Expert pay = more $ to nurses with more than 2 years of experience in those areas. BJC does NOT start health benefits at day 1 of hire, which can be a negative. SSM and Mercy both have a good benefits package. Barnes is a great place to work if you do not mind the commute and the parking issues. You need to use Metrolink or expect to walk half a mile from the garage, must allow plenty of time to park. Barnes definitely has a get-there-early culture for clock in. Mercy has a just-in-time culture, they would prefer that you appear at the time clock at 0659. Mercy and SSM are both considered nice places to work, all the supplies you need and easy to make things happen. SSM has more aggressive pay incentives. None of SSM's hospitals are big, I'd say the biggest has less than 500 beds. Mercy has two very big hospitals, the main one on Ballas and Mercy South, formerly St Anthony's. The main hospital is very easy to get to from almost anywhere in the metro area and it's easy to park and walk in.

We have a tech. Our larger (16 bed) ICUs will sometimes have two techs, which is really nice. Blood sugars and baths are their main tasks. Nurses get all vitals and manage Foley output. The techs also help with turns and help to set up the rooms for new patients. A good tech can make your day!

Other parts of the US pay far less. Where I live, a nurse with 3 years of experience makes about what you do.

Interesting. My experience was that the questions in Barron's were very close to what was on the test. Pass CCRN was helpful for having more practice questions, but as you said, many of questions were more in depth than what was on the test.

Upon admission and once per shift. We are also supposed to do it if the patient has been off the unit for more than 2 hours (for example, coming back from surgery).

Sorry. I'm still stuck on the part where you are in Missouri and make $43.70 an hour. I was going to say where in the world, but where in the state can you do that? I haven't seen salaries like that in the KC or StL areas. The ICU nurses I know at that experience level are hitting the mid to high twenties an hour. Good luck with your future move.

No call. Our unit educators have taken patients maybe twice in two years (critical care areas). Both times have been for only a few hours, until more staff nurses could come in.

I agree 100%. I found the NCLEX easy. It can't possibly assess the critical thinking capacity of a new graduate nurse. I don't even think it assesses knowledge very well. I passed with 75 questions; I know that 15 of those were test questions. Therefore, 60 questions were considered an adequate gauge of whether I was safe to practice. That's laughable when compared to the standard expected in other professions. How can we demand respect under those circumstances? Among other things, I think it would be more meaningful to have a longer general exam and to score the specialty areas separately. I believe that in the "old days" boards were more like that? Older nurses have told me that there were separate exams for peds, maternity, etc. I had only one peds question on my NCLEX, no women's health questions at all.

The first one sounds like med-surg, maybe "complex med-surg" and the second one sounds like stepdown. At the big academic hospital where I work, several of the stepdown units are one big room with beds divided by curtains.

In our ICU, many nurses go there intending to stay for no more than 2-3 years because their real goal is to become an NP. For this reason, there is no incentive to get CCRN. 75% of attrition in our ICU is from NP grads.

We use a fitted sheet and a large blue absorbent pad (cloth, not paper) as our standard. We use the blue pad as a draw sheet to turn patients. We have superb skin outcomes. Patients at high risk for skin breakdown get different treatment, including a special mattress or special bed.

I really don't think it would help your chances. If you get hired into an ICU, the unit will pay for you to take the ECCO program. The program isn't meaningful without the clinical experience to go with it. It's designed to help you assimilate and understand the clinical experiences that are unique to critical care. I would suggest that you continue working, which can't possibly look bad on your resume, and keep looking around for openings. If you can consider moving out of the DFW area, you will have more options. I would also suggest that you keep your desire to go into anesthesia very much to yourself. The ICU manager who interviews you would much prefer to hire someone who is going to stay in the unit, not someone who plans on a minimum amount of time before moving on to CRNA school.

I have never heard of a hospital/health care system that did not cap nursing hourly rates. We are capped at a level FAR lower than yours. I couldn't dream of making money like that (I assume that in the NY metro area you need every penny of it).

In our older patients we see UTI and pneumonia as the most common factors behind sepsis. Other causes are much less common. Regardless of cause, older patients and immune compromised patients are much more likely to present with sepsis. Our docs started using the vitamin C/thiamine/steroid protocol pretty much the week the news broke.

The test will NOT show you a 12-lead printout, although you may have a question which shows a simple strip. But you will have questions which expect you to know the significance of elevations in groups of leads. I echo what has been said above.

A new grad going into PACU? Wow. That would be a very steep learning curve. Read through past threads for the last several years (that actually won't take too long, many threads are short or repeat the same questions). Lots of good advice in there. Assume nothing and keep an eye on the airway until the patient is no longer yours. Your job is to keep an eye out for things that go wrong. It sounds like you haven't had ACLS yet. Take that very seriously and get everything you can out of it. I continue to pick up occasional shifts in the ICU. The PACU is not really like an ICU. Most of the time, things go right in the PACU. In the ICU, things go wrong far more often, because the patients came in headed that way. So, because things are "right" most of the time, it's easy to become complacent. It all depends on your patient mix and what type of surgeries you recover. Good luck!

Drain's is fantastic. Both of these books are available in current or previous editions on many sites. Check Ebay, Amazon used listings, etc.

That looks like coorifice flutter to me. Yes, I've had at least two patients who had rates in the 30s and were completely asymptomatic. Both men. Good for you for being curious and asking questions!

We change the needleless connector/clave every 7 days. I have never heard of changing it after a blood draw. Our policy for blood cultures, though, if we're drawing off a central line, is to either draw directly from the hub or to put on a new connector and draw through it. Policy is also to change the connector if it has old, visible blood in it. I think that an adequate flush after drawing is crucial. I've seen some nurses skimp on that. Given the length of the catheter, I think it's very important to flush with at least 10 cc of saline after every draw.

The PACU nurses have a signed handoff report that is completed electronically when a nurse hands over a patient within the PACU, whether it's a permanent handoff (the first nurse doesn't expect to care for the patient again, for whatever reason) or a temporary one like a lunch break. There would be a brief verbal review of systems before the handoff. I think this is because the expectation around staffing and break times is completely different in the PACU. A PACU float might have your patient for 25 minutes before you arrive for shift at 10:30 am. She hands off to you and takes another patient, or helps. All lunch breaks are taken outside the PACU. ICU is another story. Handoffs are like what others have noted, "Can you watch 6 and 8, 6 is on levo, titrating down, we just rounded and Dr X is getting the last few orders in. 8 has transfer orders to tele, probably won't have a bed for a while, I just updated his wife." The nurse is gone for a brief time, and usually eats lunch at a computer while catching up on charting or reading through notes. I'm not sure what the sentinel event was. If it's a critical event that happened suddenly, then yes I'd expect the covering nurse to catch it, but in that case probably several nurses would be around to see it on the monitors too--for example, if my patient's sats dropped into the 70s. If it had been building for a while, I might expect the primary nurse to own it, especially if she had been careless, for example, not watching a cardiac rhythm carefully, or a patient climbing slowly into tachycardia. We had a patient who had been on levo most of the day. The nurse covering while the primary was getting food, got the patient cleaned up after a BM and found two fentanyl patches stuck in a skin fold. The primary had not done a good undress and assess.

We have that in our PACU but not in our ICU.

Two shifts in is way too soon to judge. Give yourself a little time. You won't have every shift with her, and if your orientation is anything like ours, you'll have some time doing critical care modules and other classes. In other words, your brain will be challenged to work in different ways which will give you time to assimilate what you need to work ICU. Coming from dialysis, you'll already have a good understanding of fluid balance and kidney disease, which will be so helpful in the SICU (probably more so in the MICU, but even so). I think your preceptor sounds like the kind you can learn a lot from. I had a very tough preceptor. It made my orientation to ICU very hard, but when I look where I am now, I'm so grateful for her. The nurses in my residency group who had the easier, kinder preceptors are the ones who have made sloppy mistakes, and that exacts its own price. Also, after I had been out of orientation about 4-6 months, I realized that because I had made it through with my preceptor, she really had my back. She is a very strong nurse and to this day I can go to her with questions, requests for help, anything! Towards the end of orientation, people were saying to me, "We wondered if you were going to make it with xxxx. She's so tough, that's why they never give her an orientee if they can help it...but looks like you've done ok!" If you get midway through and you are certain that there is a serious personality conflict, then I'd encourage going to leadership and asking for a different preceptor. They want to see that you've genuinely tried. Good luck and keep us posted!

My PACU bays have three walls. Only the isolation bays have doors that can close. The bays are really not big enough, however, for visitors. I agree with Rose_Queen, above. Patients are really out of it for most of the time they are in PACU. Recently I had a patient who boarded with me for a long time. Her husband came back for several 15 minute visits, over the course of about 5 hours. As I was getting her ready to be transported upstairs, she said to me, "I don't even remember the first couple of times he came, and 15 minutes is a long time when you're down here. All I really want to do is sleep, not talk to him. Now I understand why you limit the visits!" In my opinion, apart from special circumstances (kids, special needs patients, long boarders), it doesn't benefit the patient to have their spouse/support person present in PACU. It doesn't ease their mind, it doesn't help them rest and recover. It does help to tell them that their family member/friend is nearby, or will meet them up in their room. Having worked ICU, I'm going to put it out there and say that most ICU nurses feel the same way. It often makes the patient more anxious to have family around in ICU. They sleep better, for example, when they feel like they don't have to be awake for family. Can family visit? Of course. Should they be there 100% of the time? I don't think so. Not only that, it generally does not benefit the family members. Virtually all of them feel overwhelmed and are made anxious by the environment. Our Phase 1 PACU is hopping. I am trying to make sure my patients have good airways and stable heart rhythms when they are at their most vulnerable. I do not have time to spend doing extensive education (again, same day surgery is a different story). We don't have room for chairs in the bays. No, you can't bring in your soft drink and Burger King meal. You can't go out that other door that you think would be closer, because it leads to the OR. There are no bathrooms available. I could go on....

There are lots of threads on this topic, if you scroll through. I and many others would agree that Pass CCRN is a great resource, but perhaps not the best test prep. The questions did not accurately reflect the exam. I recommend Barron's CCRN Review by Pat Juarez.