Nurse_Ratched

Thanks Youtube, I am on the east coast, in Delaware. Where did you go from CDU? What drew you back?

Try major private insurance companies - many have positions for NPs doing pre-insurance physicals, as well as chronic disease follow-up. Definitely look into the healthcare provider shortage areas (HSPAs) as often that results in loan repayment.

Anyone working in an ED OBS / ED Clinical Decision Unit? I recently accepted a position in CDU & would like to hear from you! Tips & tricks, common pitfalls & frustrations, your favorite reference (hardcopy or phone app), and what you wish was different/improved in your CDU/OBS unit. Thanks!

Thanks Youtube, I was hoping to use that time as my practice with a collaborating physician, since I need X amount of hours working with a collaborating physician before practicing independently. I don't mind "following" protocols in the beginning, for me, that kind of "auto-pilot" allows me to focus on everything else (the underlying patho, what complications to expect, what meds are they on, what's the long-term plan and what was the thought process behind the admission).

I have been investigating the possibility of a job as an NP for an ER Clinical Decision Unit after graduation. I currently work PACU (close to 2.5 years by the time I am done with school), and prior to that I worked for 5.5 years in various ERs (peds, adult, mixed) and interfacility critical care transport. This CDU is looking for an NP with ER experience as an RN or NP (ding ding ding! ), to top it off I am already familiar with the hospital layout, policies/procedures, turn-around-times for common tests, and the EHR system. I will graduate as an Adult-Gero Acute Care NP, which is fine for CDU since they do not do peds observation. The CDU provider always has access to an ER attending physician downstairs for consults, questions, etc. Can anyone give me an idea of what your typical day is like in an observation unit? What are you responsible for? How much help do you get/expect from your attending? Do most of the patients get discharged home or transferred within the hospital to an inpatient bed? Are you reprimanded if a patient LOS is longer than 23 hours? Thank you!

Hello all, I am an RN with almost 8 years of critical care experience, and I am 10 months away from my AC-AGNP. I am trying to decide on where to go from there. My interests include, in no particular order: - ICU NP - the hospital closest to my house cannot justify an intensivist for an 8-bed ICU but it would benefit very much from a dedicated provider located inside the ICU. Right now they are relying a hospitalist, who is often pulled in 10,000 directions (ER admits, floors, inpatient rehab, post-op management, and the ICU). - Trauma Surg NP - help augment trauma coverage for either the hospital close to my home, or the big "mothership" 45 minutes up the road. - Cardiothoracic Surg - work with PAs who currently provide care and run the CVSICU - Cardiology NP - we have 2 NPs that work in the Cath Lab, I'm not sure if a position can be carved out for a 3rd. - ER - while I've worked in both hospitals' ERs, I'm not an ideal candidate because I don't have FNP training. This ER would not be my top pick anyway, mostly due to management issues. I'd love to hear from anyone that works or has worked in these specialties, and the pros/cons for each one. Thank you, Allie

RainMom, we've tried, all of those suggestions, but we are still butting heads with the floor. No there is no actual numbers in the policy. Strangely enough we only have this problem with the ortho floor, which is managed by an RN who oversees the ortho surgical floor and the medical-surgical floor (hernias, colons, appys, etc.) - we don't have this issue with the medical-surgical unit. Ultimately, the ideal solution is to have the surgeons optimize their patients prior to surgery; but clearly that's not going to happen, so we're trying to figure out how to get the ortho floor to take the patients who fall into their vast area of expertise. It would be a huge disservice to the ortho surgical patients to go to step-down, who have limited experience with ortho post-ops.

The PACU nurses seem to be the only ones sharing this concern "my facility is more concerned with dropping them too quickly,". The floor nurses want them picture perfect or off their floor (to the point where they tried to tell me to take my patient back to PACU because the BP was elevated and they considered the totally asymptomatic patient too unstable for their unit).

Does anyone have any policies to share for how they manage post-op HTN? What are your cut-offs for "abnormal" vital signs before the patient has to be transferred to step-down? I am a PACU nurse and we are running into roadblocks trying to get ortho post-op patients to their floor because their pre-op BPs run 160s/90s, 170s/90s on a good day and the ortho floor will not accept them unless the BP is below 160/90. The floor can only give IV Hydralazine (10mg max) or IV Vasotec (not sure of max dose). Most of our BP management comes from Anesthesia, and they are (just like we are) reluctant to drop a patient's BP too low. 9 times out of 10 our HTN patients are asymptomatic with the elevated BP (no headache, no dizziness, no chest pain, neuro intact). Our options in PACU are vast, ranging from IV Lopressor, IV Labetalol, IV Hydralazine (20mg max), IV Vasotec, IV NTG and Nitro-paste, but it depends on what the Anesthesiologist wants to give. Overall, our approach is "if it ain't broke, don't fix it" - if the patient is at least at pre-op baseline, they will leave well enough alone and let tincture of time work it out.

I LOOOOVE paper (no sarcasm, I really do). It's short, concise, and there is a strange sense of nostalgia and peace in the unit when we're on paper. But so far it's been a decent launch, the EPIC trainers are very helpful.

Hello everyone. I work for a medium sized Magnet health system. We are 4 days away from a new EMR launch (switching from McKesson to EPIC). Does anyone have any suggestions, tips, tricks, etc. for making the transition smoother? I am a super-user and I'm looking for ways to encourage and empower my co-workers so we can all survive this.

I've been in the AG-ACNP track for the last 6 quarters. I have no complaints. Do not expect any help from advising, especially for finding preceptors. Know your deadlines and give yourself 4 extra weeks to meet them: my paperwork for clinicals is due at the end of this month; I finally found a preceptor 2 weeks ago who would take me on for the primary care rotation, after looking for 3 months. If you are in a highly populated area with lots of medical practices obviously your chances may be higher. This program requires you to be highly self-driven and motivated, no one is going to hold your hand through this. You are basically expected to teach yourself by reading the books and completing the assignments. Looking at the class roster, I see we usually lose 2-3 students each quarter; each online class is about 20 students. Overall the Walden experience seems to be "you get what you put in". I'm curious to see what their post-graduation employment rate is.

I thought nurse-to-nurse report was part of EMTALA law for inter-facility transfers. I also agree, that nurse-to-nurse report, with adequate time to ask and answer questions, is the professional thing to do. That being said, unless the reporting nurse volunteers the information, please stop asking if a consult was called. Unless the consultant physically saw the patient in my ED, I could care less. If the secretary did call in the consult, she left a secretary note in the chart to indicate that. If the note isn't there, I would have to ask the secretary, just like you can ask her. Also, please stop asking about the size and location of the IV: you will find out when the patient gets to you. If it's a 24 in the finger, that's all you're getting, and no, I can't "get you something better than that", I'm happy I have some kind of access. The purpose of report is to obtain information, not to argue back and forth about what was done and what wasn't.

Exactly! All the more reason that long-acting narcotics should be given intra-op, instead of having the PACU nurse playing catch-up.

I hope I'm not coming off as calloused when I say "rolling around in pain", while many ACDF patients were previously chronic pain patients, I am not trying to say they are faking their post-op symptoms. Coming out of anesthesia after a procedure that lasts several hours, I honestly don't think they have much energy left to do anything but remember to breathe and try to wake up. I don't doubt that their post-op pain is very real, I just don't understand why more long-acting narcotics are not given during the case.