dandelion9

Pressure bags. Always. That's an unspoken rule on our unit. :)

I keep mine in my pocket or my sicker pt's (I'm in ICU) room. I don't keep it on my neck, because I think that's just... icky. But I am also the nurse that wipes the whole thing down with disinfecting wipes every night before I put it in my pack. The only time I don't use my stethoscope is when my pt is on isolation - then I use the disposable one that hangs off the side of the pt's vent. I can't imagine not having access to one at all times... that is ignoring a very important tool for information about a patient's condition.

The pt was on pretty much every pressor - levo, vaso, dopamine, epi, dobutamine, and neo; bicarb for sure because I remember the pt was very acidotic. I don't remember the rest of the meds, but I had three Alaris "brains" at capacity (12 gtts total). One of my colleagues grabbed a fourth set for me because we thought we were going to need it. The pt was also getting IVF boluses because the gtts were nearly at max rates and there was very little wiggle room. This was on a post-cardiac arrest pt who had been struck by lightning. Needless to say, it was a busy night.

I simply *CAN'T* handle psych patients. They stress me like no other. A lot of our pts have underlying psych issues (I work in a MICU, we see a lot of suicide attempts, ODs, things like that). I am with others in that my most trying shifts are with psych patients. I think psych nurses are a blessing, and I am not sure how you are able to get everything done that you need to while dealing with patient behaviors and who knows what else! Don't let them get to you. You are valued!

I really don't know if one is "better" over the other, to be honest, because they are both so different! I have only floated to our SICU, but my home unit is a MICU, so I can tell you a bit about that... In MICU, we deal with a lot of chronic illness, and everyone is right who says that our patients typically stay a long time - that is, unless they die or are simply having an acute health problem but are healthy at baseline. We have an extremely diverse pt population with a lot of complex problems. We have a lot of really, really, really sick patients. A lot of... gross things... a lot of infection and enhanced precautions. A lot of gtts (pressors, paralytics, sedation, etc). I didn't see anyone else mention this, so idk if it is common - but our MICU (2x the # of beds of the other units) is the overflow for all of the other units (CICU, NSICU, TICU, SICU, and BICU). We get a lot of the mid-level ICU pts of all types and our nurses are more highly trained because of that (we do extra cardiac, neuro, and trauma training in addition to our own yearly stuff). We also get transfer patients from other ICUs that develop acute medical problems (so sepsis following a surgical procedure, and most s/p code patients). If there is an RRT or a code on the floor, the patient nearly always comes to the MICU (unless it is an obvious cardiac issue or something like that). We also staff the PFT lab when they're short, work as additional resource nurses (starting IVs, transferring pts, etc), and help staff the ED when those areas have short-term needs! If your facility is similar, it may be something that could sway your decision. I am all about the extra training and experience! I have floated to all of the ICUs, though, and I really love them all for how different they are! My dream job would be to be a permanent ICU float. :)

Wow, CRRT always 1:1? That sounds like a dream. We nearly always pair these pts (unless they're a "true 1:1"), and at times we do pair 2 CRRT/SLED pts (if they already have proven to tolerate it well). I don't mean to sound like an idiot (or a jerk, for that matter, if this is taken another way), but with these 1:1 pts - are you initiating the dialysis/changing out the dialysate/maintaining the machine (like a dialysis nurse), or just monitoring it and doing the required labs? I really don't mean for that question to sound hateful, I really am just wondering because I've only worked in one ICU. Here we have dialysis nurses who take care of everything except for the labs that coincide with whichever anticoagulant is being used. If an alarm goes off that we are unable to troubleshoot, we call and they come up and take care of it.

I love hearing about these dreams, it makes me feel a little less crazy when I have mine! :) My most frequent was one about LTC - the administration placed an Alzheimer's admission on my wing of the facility on day shift, and when I came in for my evening shift, the days nurse neglected to give report on the admission. Mid-way through the shift - a little after supper time - the medications are delivered for some random name that I had never heard of, and I go all throughout the facility trying to find out WHO had the new admit. Well of course, everyone knows about this but me, and when I find this out, I go searching high and low for my patient, who has (OF COURSE) at this time, eloped! I wake up in a panic at this point every time. I obviously had a lot of faith in the communication system at that facility!

Kudos to you for remembering all of that despite being so nervous, and it's very thoughtful of you to share with others. My interview process was such a blur that I couldn't bring any of my questions to mind independently, but after reading what you've posted - a lot of the questions you posted were ones that I also had to answer! However, I had a behavioral interview with more situational type questions, and then an interview with the manager that was very similar. No peer interview. I am pretty sure that I just forgot everything they asked/I said the second they offered me the position! Good luck!!

That's awesome! I hope that whenever I encounter my first (and also, unfortunately, inevitable) code that I am able to handle myself with assertion and a clear head. You should be proud of yourself!! :)

Geographic location - Midwest city with around 100,000 pop Pay rate - $20/hour In which area / specialty do you work? - ICU What type of license do you have (RN or LPN)? - RN What type of degree and/or certification do you have? - ADN, taking BSN pre-reqs How many years of experience do you have? - New grad RN, 1.5 years as an LPN Are you full-time, part-time, or casual / per diem / PRN status? - FT What shift do you work? - Nights, 12h shifts Do you receive any shift differential? - +$3/hour for nights; additional 25% for weekends Are you a manager or supervisor? - No

It's possible. I am a new grad, ADN-RN, and am starting soon in the MICU at a teaching hospital, level 1 trauma center, with multiple ICUs. Tips: Research the new-grad programs in your area and if possible, job shadow, do observations, or do your preceptorship there. Work hard, ask good questions, and make good contacts. Network DURING nursing school with the nurses on your assigned units, and prove yourself to be a worthy candidate through grades and clinical performance.

I love nursing with the Geri population. LOVE IT. However, I had to leave LTC because of all of the barriers to providing quality care that were imposed upon staff in the attempt to save a nickel. I am not green enough or naive enough to believe that healthcare isn't about money, either. I realize that. But it says something when you are ashamed to run into the patient's family because of the fact that you can't deliver the quality of care that their parent deserves. Not safety or anything that should be reported, per-se (because I would have reported it in a heartbeat) but pretty much every other aspect it seemed like (at the end anyway). But, then again, I have extremely high standards for myself, and a lot of respect for the elderly. This may not be the case in all LTC facilities. I am sure there are wonderful places out there. But that is what I experienced in two facilities in the tiny little corner of America in which I live. If it were different, I wouldn't mind going back. Maybe someday I'll be in a position to invoke change. RN's absolutely have a place in LTC, and not just administration.

To be honest, I think that it would be a difficult situation to understand to a person who does not have experience in the area. I mean, opiates simply by themselves are very misunderstood by a lot of people. This is a great educational opportunity for the OP (kudos for initiating discussion about something you were unsure about/something that stuck with you), and probably should have been for the patient's husband (as the patient was making her choice, or before - not during the death process or afterward). I can honestly understand how the OP could make the judgment she did without understanding the whole picture (medication patho, rationales, etc). I have LTC experience and like many, many, others have personally been the nurse who has given the patient's "last doses" of PRN morphine/roxanol. The very first time, as a brand-new LPN, it was difficult to work through in my head. Morphine sulfate is a double-effect med, as others have said, so while I understood that what I was doing was best for the patient (increasing her comfort/reducing pain/reducing the struggle for air), it was still unsettling to know that I was giving her a medication that reduced her hunger for air and affected her respiratory drive. The cessation of respirations is associated with death, so I guess in a round about way, it could be seen as a medication that could hasten death. It certainly felt that way to my shell-shocked newbie-LPN brain as I tried to fall asleep that night, even though I knew I did the right thing for my patient (and still do). In my attempt to deal, I educated myself over and over about the dying process, the pharmacology behind roxanol, and everything else I could think of that pertained to the situation, which helped me reinforce my understanding of everything and sort of cope with all of it. I also talked to veteran nurses who also helped me understand things from other perspectives. The one other thing that helped me to take it all into perspective was witnessing what could have been a "bad death" and seeing what comfort and positive effect the administration of the medication truly did achieve for the patient. Another nurse, with a different patient (also a newbie at the time of her first) was reluctant to administer the PRNs. We heard the death rattle/cheyne stokes halfway across the building. That is something I will never forget. We entered the room and the patient was displaying s/s of pain and air hunger (restless, anxious, VS all indicated such), the family was distraught, the nurse was a wreck herself.... it was just awful. Thankfully, a more experienced nurse was able to step in and educate the newer nurse regarding the administration of these PRNs and the patient was able to achieve comfort before he passed. Coping with patient deaths is something that is very individual. Personally - I'm not a crier. I don't get emotional. That said - Every patient death that I have witnessed has affected me. It is one of the most tender, delicate moments of the human existence, and I feel like if one has a respect for the fragility of life, then they are most definitely affected by it's cessation. Its a nurse's job to support the family and take care of the patient during the transition. This is my own opinion, of course, but we have absolutely no business being emotional, though we MUST empathize in order to be effective support for the family and therapeutic caregivers. Sometimes that is tough!

I am a new-grad/new-hire into the MICU at a local teaching hospital, so I can't pretend to know really anything about MICU nursing. What these experienced nurses have said covers about all of my understanding of it, but here's some additional (probably very basic, probably also repetitive) information from my own, humble viewpoint: Getting the job: I think what got me an interview over other candidates was a great impression during an observation for one of my nursing classes. My grades were definitely not a detriment, as I graduated first in my nursing class, but basically I listed that on my resume and that was the end of it. That is obviously not to say you shouldn't work hard to learn and do well in nursing school - it's SO important to KNOW your stuff and always keep learning! I developed a contact and maintained it throughout the remainder of my nursing program, and when the time came to apply, I let my contact know. I also have a couple years worth of experience as an LPN, which probably helped as I have basic nursing care, time management, etc. skills and am not a "super-green" new grad in terms of basic nursing. I don't think it is usually so simple to get into MICU, and I still sometimes think it's some sort of fluke/stroke of luck, and thank my stars that I got in. Getting into nursing school, well... It depends on the school. Generally, I think if you get the grades, you get in. Some places have interviews as well. I personally didn't make the grade due to my GPA from my first time around at college (10 years ago - nursing is my second career) to attend the nursing school at the university, so I attended a local community college with a great nursing program. I am applying to earn my BSN from the university once the tuition reduction kicks in and I can afford it. If you want to do something, you have to work hard to find a way. Math in nursing is actually pretty simple (I think). You do have to be able to understand and apply basic algebraic concepts with accuracy, and you always, ALWAYS check your work - check yourself, and have someone else check you, as well! Just google "med calculations practice questions" or "IV calculation practice questions" to give yourself an idea of the type of math that is necessary. I am sure there is a lot of other information about this in the "Students" section of the site. Work hard, study hard, be resourceful - those skills will pay off when you get into nursing school and on the job. I haven't started on my unit yet, but what I observed in my time there was a very team-oriented environment with nurses, RT, and physicians working closely together to care for critically ill patients with severe/exacerbations of medical issues as their primary diagnosis. It is total-care nursing of 1-2 critically ill patients in the unit that I will be working on, which means you will likely do absolutely everything for your patient - including bathing, peri-care, turning, etc. Not a lot of delegation for the "dirty work" - several nurses I have worked with don't like total care for that reason. It can be a very physical job because of the "total care" aspect, so there is always a potential for injury. Very close and frequent patient assessment and management of parameters, as mentioned by others! Management and administration of multiple IV infusions with lots of interactions. Multiple, multiple comorbidities and exacerbations. Many of the more "intense" procedures are performed in the MICU (chest tube insertions, Swan-Ganz catheterizations, intubations, etc. - not to mention codes) but that comes with the territory. It goes without saying (we are talking ICU, of course) that these patients are often in very fragile states, and that is something that some people can't handle looming over their shoulder as they work. People do die in ICU environments, and a lot of people don't deal with death well (no shame in that). It can be a major source of stress. You have to be able to cope, as well as think and act effectively in stressful situations, and be able to be assertive for your patient's benefit. These skills are very important in a lot of areas in nursing in general. I don't know if it's helpful to share, but...the reason that the MICU environment appeals to me is that I have a tendency (need?) to understand and concern myself with EVERYTHING that is going on with my patient and how exactly their comorbidities or their various medications are interacting. I am very detail-oriented by nature. My interests have always gravitated toward pathophysiology and critical care - even in the first semester of my practical nursing program (I was an LPN before becoming an RN). There are multiple other reasons, and I am sure everyone could give you a different reason why it is interesting to them, why they started there, etc. Like I said, these are just my basic perceptions as I prepare to start on my unit. I know I have SO much to learn, and I am super excited and a little nervous/intimidated. I am sure my perceptions are going to change or be clarified very quickly once I start, though I hope that I have gotten a pretty good idea of what I stepped into from my observation. I think that would be the best recommendation I could give - In order to learn more about the unit, take your observation and preceptorship experiences seriously once you get into school. Maybe call and ask about job shadowing, like Grizzly20 said - I agree that you won't really know until you see it with your own eyes! I hope this has been helpful, and I hope I am not filling you full of glossy-eyed, new-grad, poppycock. I am counting on the veteran MICU nurses to help me keep that in check (haha). :) Good luck!