FutureRNArk

Yup. I was just talking to someone about this the other day. I've only been a nurse 8 months, all in the same unit, and it just feels like we hold on to these patients way too long, providing care that is futile. And I'm already starting to get burned out on it. We're a 20 bed Coronary Care Unit in a 450 bed hospital in the south, about the same size city as yours. We also get overflow from our MICU/SICU and Neuro ICU. We've had patients in the unit for months, one particular that's been here since I started. These patients need to go to step-down or LTAC, but often, these are Medicaid patients or uninsured, and we can't get them anywhere, and so we sit on them forever.

We do not do CHG baths at my facility, except for patients who are expected to have an orthopedic surgery or CABG, or with known colonization with MRSA or VRE. Studies have actually been mixed on whether there are any benefits of using CHG baths compared to regular baths. There have been studies that show that CHG baths cause resistant bacteria that are harder to treat. So at my facility, we still do the soap and water bed bath. All patients in the units get a bath once a day unless they refuse. Vented patients are bathed at night, non-vented are bathed during the day.

I work in an ICU and have seen it given as well. I had a fresh CABG patient come out with orders for beer with dinner and 30ml of brandy HS. The beer was sent up from the kitchen with his dinner tray (who knew we had beer on premises - might need to raid the fridge on my way out!!) and the family brought the brandy and we kept it in the med room, slapped a patient sticker on it and what not. There was no point in detoxing him, he was in his 70's, and had no intention of doing away with his beer or nightcap. Don't blame him either - you've lived that long, enjoy yourself! On an aside, my mother is a nurse trained in Ireland, and they used to give the patients a pint of Guinness every night, as it contained vitamins. Probably didn't hurt for an easier night for the nurses either!

I am so sorry that you had this experience, however, there are a couple of flags for me as far as your manager being correct in that maybe ICU was not the best fit for you. I may get some negative flack for this post, but I feel it needs to be pointed out. First, you admit to being a passive person, and your actions with numerous preceptors highlights this fact. But working in an ICU, you can't be passive. Passive nurses tend to get eaten up in that setting, both by other nurses, doctors, and patients. The worst patients and situations are thrown at you, and you have to be able to speak up and be heard above the fray. It seems like your preceptors and peers picked up on this passivity early on, and jumped at it. I am not one of those people who thinks that lateral aggression/bullying doesn't exist - it absolutely does. And in this case, it seems you were a victim because you were too passive. As a relatively new grad myself in an ICU setting, I have been fortunate to not have experienced that myself, but I have seen others fall victim. The second flag for me was the levophed gtt. You stated that at that point in your orientation, you were already taking the full patient load of 2/3 patients each shift. I'm assuming taking on the full workload, this should mean management of critical gtts. You went back in the next paragraph and seemed to blame the preceptor for the gtt running out. If those patients were your responsibility, you should have noted the volume of the gtt, rate of infusion, etc, and anticipated the need for another bag. At that point in your orientation, you may not have known the exact pharmacology of the gtt, but you should know the basics - it's a pressor to keep BP up, and it's important to not let run dry! They are critical gtts for a reason. Even if it wasn't a critical gtt, you shouldn't have infusions running dry anyway, whether it be fluids or antibiotics. Part of the assessment of a critical patient should include an assessment of the IV medications/fluids, pump settings, etc. What this highlights to me is you aren't accepting responsibility and that you may not have the critical thinking part of assessing a patient down yet. You seem to mention numerous times in your post how good you were at tasks and charting, but critical care is measures beyond just task-oriented nursing. You have to assess the situation, anticipate interventions and responses, know medications and what they are for, etc. You can't just approach it from a task-based front. Accepting responsibility is also important. You have to own your mistakes and shortcomings. In this situation, things certainly seemed stacked against you, based on your view, but that doesn't necessarily mean you were without fault. Having said all of that, that does not mean you aren't a good nurse, just that ICU is not the right fit. And that doesn't mean ICU won't be a good fit forever, but right now, it just doesn't seem to be a good fit. You mentioned several times in your post that you felt that your skills weren't up to par or were behind others. Find a position and facility where you can get those skills up to par. Look into hospitals with a residency program for new grads. They tend to offer classes and longer orientations with weekly feedback reports, as well as mentoring. Best of luck to you in finding your fit!

I work at St. Vincent (SVI). It's a level 2 trauma center. UAMS is the only level 1, but they both see high acuity patients. SVI is the only Magnet hospital in the state. It's LGBT friendly, and the insurance covers domestic partners/spouses (it's actually really nice in that you can cover any one adult living in the same household as you no matter marital status, so like an adult dependent child that's past age 26), and our hiring policy protects against sexual orientation discrimination. SVI also has a nursing union. Pay is good, probably some of the better pay in the area plus they are offering sign-on bonuses. I'm not sure how Baptist is as far as being LGBT friendly. They are a level 2 trauma center as well. I've known several nurses at Baptist and they like working there. Every hospital has it's ups and downs, but people seem to like working for each of the hospital systems, so I think anyone is a safe bet. You might also look at AR Heart Hospital. I don't know much about them, but I've heard good things.

UAMS has the more specific pre-reqs like Development Psychology and Nutrition that other nursing programs don't tend to require prior to starting. It used to have a more difficult Chemistry requirement as well when I was evaluating school choices, but looks like they've dropped that to match other schools and only require Fundamentals of Chem w/ Lab. Also, for anyone comparing schools, I've heard that Baptist now requires students to sign an agreement stating that they will not work during the program. So if you work, you should keep that in mind.

They do not have an RN to BSN option, only diploma. For the BSN, you would have to transfer to either UALR or AR Tech I believe.

Every class contains dosage calculations, including drips and critical drips, and pharmacology.

Classes are difficult. There is a lot of material and a very short amount of time to cover it. Once you get past the summer class and first semester, you pretty much have a test every other week. You have to be dedicated and flexible. I haven't seen anyone get dropped from the program for minor mistakes, but a lot of people don't make it through due to grades. As far as retention, they usually start the summer with approx. 260, and end up graduating approx 150, which includes the LPN transition class of approx 30-40. So out of the 260 who start, around 120 will graduate on time. This may sound like a lot of people failing, but think about if you want that "F" nurse caring for your family member. Nursing school is hard because you will have someone's life in your hands, and you need to know how to take care of them.

This class is exactly that. It is designed to weed out those who aren't committed to putting in the hours of study, or practicing of clinical skills. A good number of people don't pass the class. It's pretty basic information, at least compared to what you get in later courses, but it is a lot of material. You also have clinical skills and check-offs in order to pass the summer course.

Y'all should really get a Facebook group started for your class. We have one for our class and it has been super helpful as we post questions and get answers, share study materials, reminders about deadlines. We have a few of the upperclassmen in the group that help answer questions about future classes and share their experiences. I know that your summer class is starting soon and you'll definitely want to get that started before class starts.

UAMS is the only program in the LR area that offers a BSN only program, so if that's your main goal, then UAMS would probably be the best program for you. However, getting an ADN and then doing the one year RN to BSN option online allows you to work while finishing the bachelors. It's really a personal preference.

It is not the same as a rejection letter. They do flat out reject some people, while some get wait listed. Here's how that process works: within the next couple of weeks, they will accept some wait list students based on the number of people who accepted. Then they will admit a second round of students for the last summer class based on the number who fail out of the first one. My class had 30 or so fail out. So they then admitted 60 for the second summer session and roughly half of those failed out. So it's really a wait and see based on the numbers of who accepts and who passes the May/June fundamentals course.

I was wondering how your UR department was set up at other hospitals. In our hospital, we have a team of five RN's who do the Milliman reviews for all inpatients and OBS. Then we have 2 payor specialists (that's my position) who interact with the insurance companies faxing clinical information or doing telephone reviews for auths. We just started using Milliman at the first of the year (we used InterQual before) and they want us to begin only sending the MCG reviews to insurance companies as our clinical review. Does anyone else's hospital do this and is it successful? We are worried that it won't be enough for most of our payers, and additionally, that the reviews are usually not completed within 24hrs of admission and so we wouldn't have anything to send. I'm just wondering how your hospitals work this side of the UR piece.

My schedule does allow me to work. I work full time (40 hrs a week) and still attend school as well. It's difficult, but doable. My schedule this semester includes class for 2 hrs on Monday and Friday and then I have 2 6hr clinical rotations each week on Wed/Thurs nights. My employer is flexible so I'm able to come in and work around that schedule. Flexibility is definitely key in working through nursing school.