AKav8trix

I've been on night shift (12's) for a few years solid now. I love it! I've been blessed with being able to work my night shifts together with a good amount of time off in between. If I need to flip, it usually gives me enough time to adjust. On my first day off I've found I have a hard time just sleeping a few hours in the morning, once i'm down, i'm out for at least 6-8hrs. I'm usually able to get to bed by around 3am or so my first night off and sleep til 9-11. I try not to totally "flip" if possible, but just keep my "night" an 8-ish hour block somewhere between 0200-1800. Even though my sleep schedule is a bit different than my husband's (he works day shift during the winter), he's understanding on our days off together that I don't wake up very easily in the morning, and we adjust our plans for the day accordingly. If I do have to be alert and oriented early in the morning, I try not to have that day be right after I get off my string of shifts. Often on my first night back, I'll get a few hours of sleep in the afternoon, if I've gotten up early that day, or just sleep in til the early afternoon and stay up til I go to work. Usually works out okay. I've found keeping well hydrated is good, and being careful like others have said to make sure you have healthy munchies on hand so you're not tempted on a regular basis to go for the vending machine. :)

giving nebs: yes drawing own labs: yes, and run them most of the time, too starting your own iv's: yes running own blood gasses: i would if we did them here (hopefully soon!) cleaning own rooms: yes walking pt to radiology, ct etc: yes, and some of the nurses here are certified to take the xrays, we don't have a rad tech testing urine: yes--ua, uds, hcg mixing meds: yes all caths, ng insertions, trach suctioning: yes i do work in a very rural facility that's not big enough to be called a hospital, but we do provide emergency care and/or overnight observation if the person doesn't need to be medevac'd to the city. ancillary services we have not the nurses pretty much do it all. :)

Asking for more orientation is perfectly fine, especially as a new grad! I wound up asking for 2 more weeks, because I soon realized after a few weeks on my own (and some scary patient situations where I didn't have someone available to answer those questions when they were urgent) that I still had some things to figure out as a new nurse. I wouldn't have been able to learn as well, if I'd just done it on my own, because I didn't know enough yet to know what I was missing. Getting a few more chances to have someone available to look over my shoulder when things got crazy, helped me to build my confidence and refine my routine to better care for my patients. I'm sure in the end you'll be glad you did say something, and try to take advantage of every moment you have with your preceptor to learn as much as you can before you wind up on your own again. :) Kudos to you for having the courage to ask for more time!

Ooooo, professional world traveler, that would be a blast!! :) Hmmm, dream job...designing evening gowns or being a pilot for a flight-seeing tour company. I'd love to get paid to fly!

I've seen it both ways and IMO the best places I've worked have been where the NM stays active in bedside nursing, even if it's just one or two shifts a month. It seems to make a big difference in how the unit is managed because they are in tune with the realities of patient care and are strong advocates for their nurses and the patients with upper management. It seems much better though, when the charge nurse for that shift does not take a patient assignment, or at least has a lighter load. Gives so much more flexibility when things get crazy with admits or crashing patients. In the ER I'd worked in, it depended on the time of day whether the charge nurse would take an assignment or not. Usually it was only during the usual slow times in the early, early morning.

Some hospitals used to have (5-6 years ago) residency/internship programs that weren't restricted to just new grads. It's likely changed with the current economic climate, but perhaps there's still a few around? Sounds like in your area the requirements are pretty narrow. I don't remember exactly what the entrance requirements were, but it was a way that experienced nurses could move from a general area into a specialty (ICU, ED, OR, L&D) even after being out of school for a while. New grads could also apply, but wouldn't necessarily be given preference. Acute care exp was a plus, but not required. I know things have changed drastically since then, but maybe somewhere in the US something like that might still be available. I hope you find something soon! :)

Oregon has something similar with OHSU and the nearby community colleges. IMO ADN is a great way to start because you typically get a really solid clinical background (unlike many BSN-only programs that I'm aware of) and is much more affordable than doing the whole thing at a university. Once you finish the ADN, it's usually pretty easy to finish up the BSN with only one year (sometimes 3 semesters) of university tuition to pay for, instead of 4-5 years. :) As far as the nursing shortage, there certainly isn't one in the Portland metro area or most of the west coast! There are so many new grads still trying to find jobs, some even after >1 year from graduating. Even for experienced nurses, I'm finding that the openings are much less than it used to be just a few years ago. There are rural areas that are desperate for nurses, but it's a tough place for a new grad to start b/c you're often working on your own after a short orientation, and the lower frequency of patient encounters and lack of mentors, can make it difficult to get in the groove, so to speak, as a new nurse. The jobs are out there, though. Someone else mentioned getting a unit secretary job, a most excellent suggestion! I was able to do that through my nursing prereqs and nursing school and it gave me so much good experience, was a great thing for my resume, and it also helped me get an idea of what area of nursing I wanted to aim for once I was done with school. Wish you the best! :)

My shortest commute ever was 5 minutes. I used to drive 40-60 min one-way to one job depending on the traffic, passing several other hospitals, and it was totally worth it. I loved working at that hospital. If I get my dream job this winter, I'll be fine with driving 200 miles one-way and stay in "town" while I work my string of shifts.

I thought I'd revive this thread since it's been a while and things may have changed. I never did make it Anchorage a few years ago, but now I will be going there for sure, and so I'm applying for ICU and ED jobs. I've heard that the Providence ICU has a new manager? Is it a good or a not so good change? Does Regional have CVVH? What are the typical patient to nurse ratios at either place? I'm also looking at the Mat-Su Regional ICU, though I'm wondering if the acuity is high enough for what I'm looking for. Do they send their really sick ones on to Anchorage? I've heard though, from several people that it's a really nice place to work. I'm also interested in working in their ED. Thanks!

Even though this thread was from last summer, I thought I'd chime in if someone else was wondering about this. I know several ppl with AT&T up here and even in remote areas they get decent coverage. I kept my Verizon plan when I moved up here and since they have an agreement with ACS (the largest AK cell phone company with the best coverage in the state) to use their towers, we get really good coverage without roaming charges. I hear Verizon will be moving up to AK sometime in the future. Data coverage is decent too, even a long ways from the metro areas. I've only been on the Kenai peninsula, Anchorage area, Matsu, and up the Glenn and Richardson highways so far. Except for the scattered expected no-service areas b/c you're down in a big hole in the middle of nowhere, I've been able to use my phone in most areas along the highway corridors.

General US wholesale prices for primary gravity drip tubing can be around $3-6 each. Pump tubing sets vary widely, on average $7-12 ea. Secondary sets are around $1-2 ea. :)

What problems are you running into with priming the tubing? I think I've used most of the different brands out there at one time or another for primary drip tubing and they all seem to prime about the same. What's different about the tubing for these pumps?

Wow, I guess I've been pretty lucky in the places I've worked so far as a nurse. I've never had any trouble if I called in sick (a rare occurrence). Most of the time I was required to call the charge nurse and the staffing office. The policy was usually to call at least 3-4 hours before shift start, to give staffing a chance to find a replacement so they would not have to call in the on-call nurse at time-and-a-half.

Hi Deemalt, Have you found any new info since you last posted?? We're still searching, though I think we might be leaning towards the Cidex line of products, but we don't really have a good reason for it, other than it seems to be what some of the larger hospitals in the state are using. I'm still having trouble finding evidence-based info for a small clinic like ours. Sales reps haven't been much help because of course they want you to buy their product and of course "it's the best out there". I'll let you know if and when we get some good information. :)

Hi All, I'm looking into purchasing new IV pumps for our small, very rural clinic/urgent care/ED/Obs (4-bed Obs and ED combined). :) We're leaning towards the new Baxter Sigma pumps, as they look user-friendly and I like the fact you can use standard IV administration sets. If you use them in your facility, what do you think of them? We need something simple to use for basic abx infusions, saline boluses, or the rare titratable vasoactive drip until medivac arrives. Not having to buy "special" pump tubing would be wonderful. I like the small size, too. Thanks!! :)

I have had a very positive experience working in 2 different SDA facilities. The environment was very caring and holistic care was really emphasized. Not everyone I worked with adhered to SDA beliefs (or more broadly, Christian viewpoints of any denomination), but at least on the units I worked on (primarily Med/Surg and ED) we were all accepted and respected for who we were and not forced into anything, but we did have the opportunity to be openly supportive our patients spiritually, if that is what they desired. The managers I had were great to work with. They really looked out for their employees. Though I'm a diehard meat-eater, the vegetarian cafeteria wasn't too bad. My experience was several years ago now, but if the opportunity came up to work in an SDA facility again I think I'd seriously consider taking it. :)

I recently was given the task of ordering supplies for my clinic/urgent care/rural ED (but not a hospital) and I'm starting to do some research into current evidence based practices for steam sterilizing instruments with an autoclave. Primarily I'm looking into what cleaning agents we should be using for prep. Currently we use a detergent product (do not have the name in front of me) for initial soaking, and then use LpH to scrub prior to rinsing, drying, and autoclaving. We're wondering if LpH is more than we need for simple instruments (lac repair kits, forceps, etc) and we're finding it's doing damage to our instruments over time. We're currently using it because that's just what we've been using for years since someone way-back-when ordered it...we don't really have a good reason to back up why we use that particular product. Does anyone have suggestions for where to start looking for info or have examples of what they do in their facility?? Thanks!! :)

There's a good chance I'll be moving to Anchorage in the next year or so and am trying to figure out which hospital might be a better fit for me. My background is in Trauma/Neurosurg ICU in a Level 1 Trauma Ctr and I love it. I'm thinking I'd like to continue to work in a Trauma unit but am open to working CVICU too to get some post-open heart experience. My ultimate goal is to get into flight nursing (probably also in AK). I'd love to hear from anyone familiar with any of the ICU's in either hospital to find out more about them. Thanks!

Bown is awesome!! Had her for my biology classes years ago. Came across this thread and just had to post something when I saw her name mentioned. :)

Thanks for the replies. :) We haven't used another since then, but the ER I work in just started stocking them, so I'll probably have more opportunities in the future to get more experience with them. It's great that it's become more mainstream to have IO's available for adults, and not just peds, when it's near impossible to get a badly needed IV on a really sick patient. :)

My EMS agency recently started using the EZ IO drill, and not too long ago we got to use it for the first time on a real adult patient (Code 99). It was very easy to use and we had definite bone marrow return, but as we tried to get fluids through it it appeared to be leaking which then made us question it's patency. It was also very difficult to give fluid boluses. Has anyone had much experience with the EZ IO yet? We're wondering if it's common to have fluid leak from the site...the IO itself seemed very secure and when the hospital later started dopamine through it the patient responded well. Thanks :)

I can't say I really work in a truely rural hospital, it's more a community level on the outskirts of a metro area, but our ICU is often staffed with only 2-3 nurses and we get just about everything but trauma. Overall, it's around a 40 bed hospital. It's encouraging to read your comments about marketablility. This past year I've wondered if I made a mistake starting my career in a small hospital where we ship most of our really sick patients (especially cardiac & renal) to "town" and the overall acuity isn't as high as the big medical centers with specialty ICUs. Eventually I want to work in one of the big centers to specialize in trauma and/or cardiac and was worried my experience thus far would be looked down on as insignificant. Now that I think about it, I have learned a ton by having to know how to take care of any type of critical patient that comes through the door, and with a lot less resources than the busier big hospitals have. We don't have the luxury of the latest and greatest in technology, and I've learned to rely heavily on my assessment skills and critical thinking. So maybe it's not so bad after all that I started in a small hospital.

I wish you well with your CCC application. They have a great program and it's so worth it to jump through all the hoops you have to to get in. That way you get to go through school with a group of students that worked really hard to get in and intend to keep working hard through the whole program, group projects were hardly ever a chore. Clinical opportunities are awesome and so are the instructors. 'Course I'm a little biased because I graduated from there.:) Good luck! (btw, the scrubs are navy blue...they're notorious for attracting the lint off the white hospital linens like crazy. )

Hang in there...I'm a new grad in ICU as well, but with one year behind me (whew!). I can so relate to your frustrations. I actually had very supportive preceptors, BUT sometimes I think they would forget what it was like to be a new nurse (not on purpose, they weren't trying to discourage me, it just happened.) Most of them have been nurses for 20-30 years. I do have a baseline problem of not being very good at time management...I tend to get bogged down in the details. Finally after a good talk with my manager (bless her!) after feeling like I was still drowning and wondering if I had chosen the wrong profession, she was able to pair me with a nurse who was very good at time management AND could give me helpful constructive criticism including identifying specific ways I could do things differently instead of just telling me I needed to "kick it up a notch" constantly with no additional information. I think it's safe to say it takes a while to get the routine down smoothly, and even then all it takes is for one of your two patients to crump, or require closer supervision and the whole shift routine seems to fall to pieces and you are there at the end of it hoping you didn't miss anything really important. Nope, I don't think you're going wrong and give it some time. Depending on your preceptor try to communicate that you need more specific feedback than just "step it up". If you feel like you are still hitting your head against a brick wall, talk to your manager about your frustrations and if possible have a list ready of what you still feel uncomfortable about and maybe he/she can put you with a preceptor that will help you learn what you need to do to be successful and grow as an ICU nurse. It's not a put down on any particular nurse, but some nurses are just better at teaching than others, I think it's a personality thing. I look forward to when I've been a nurse for several years and can confidently handle any assignment I'm given without inwardly quaking in my shoes when things get crazy and no one is immediately available to help me. Good luck, and don't give up...it's so worth it. It really does get easier the more experience you get. I love being in critical care and can't imagine starting anywhere else. RNlove2fly

One of the best things I ever did was take my years of general office experience and get a job as a unit secretary (aka: ward clerk, unit coordinator, etc) on a hospital floor. My administrative assistant background and familiarity with healthcare as an EMT and nursing student got me right in and I learned so much. It was a great way to get my foot in the door and become familiar with orders, medications, how things work in a hospital and learn tons from the nurses and doctors. The pay is not too bad either, depending on where you live and the facility. You might even be able to get into a busy ED or ICU. I ended up on Med/surg but it was still a great place to learn. good luck