RN_jess

I am not a NICU nurse manager either but just recently transitioned from the adult critical care world to NICU. Based on my experiences, I would suggest taking the position in the well baby nursery simply because you will start to learn what a healthy, "normal" baby looks like. When you get to the NICU, you will start to see the "sick" babies. Having a background in normal newborns would probably help you more than a background in adult ICU. When I became interested in NICU, I started taking any and all classes offered through the hospital. I kept my adult critical care job through this process but the manager was happy to see that I took the initiative to get certifications. Perhaps you could work on getting NRP/STABLE certified during the slow nights in the well baby nursery. It is a HUGE learning curve going from adults to neonates and the ICU would have few similarities. In my short time in the NICU, I've realized just how different the neonatal world is compared to adult nursing. Time management, diagnoses, medications, etc are all very different and I think the exposure in the well baby nursery would be way more beneficial for your career. Just my two cents but good luck!! I have never been happier than I am at work in the NICU. Our babies are special, special people.

I just recently made the transition from adult to neonatal nursing. I graduated with my BSN in 2014 and started on a cardiac stepdown unit fall of 2014. I had no previous experience with peds but during my interview the manager said that having the acute care experience is a bonus. Many of the nurses I now work with in a level IV NICU have been on the unit for 20+ years and/or have never worked in an area other than NICU. It is possible to get hired to a NICU straight out of school, especially if you do your senior capstone/practicum in the specific NICU where y ou want to be hired. However, don't be surprised if you are turned down straight out of school due to lack of experience. Stay persistent and keep in touch with the nurse manager. As a previous poster stated, many large hospitals offer NICU residency programs for new grads that give you a longer orientation including class time. Maybe there are also volunteer opportunities in the NICU near you. Getting your foot in the door that way would work in your favor. Good luck!! I have never been happier with my job.

In an episode of Nurse Jackie, she diverted a bunch of fentanyl patches. At the very end of the episode, they show her wearing one of the patches on the back of one of her arms (in the tricep area). The patch very clearly said "Fentanyl 100mg" -- you better hope there's not 100MILLIgrams of fent in that patch or she'd be dead!! 100 MICROgrams sounds more like it.

Favorite unit: Critical care/stepdown of some sort- monitors, multiple lines, higher acuity. Favorite patient: Sick, sick, sick patients OR walkie-talkies that are self sufficient/independent that we're monitoring for med loading or something. Least favorite unit: general med surg- from my experience, a lot of noncompliant, unmotivated pts who take advantage of nurses. No I will not wait on you hand and foot when you are completely able-bodied. Hmph. Least favorite patients: Dialysis/renal patients or ESLD patients- we get TONS of dialysis pts on our tele unit d/t the electrolyte abnormalities (that happen when they repeatedly miss their scheduled dialysis apts). Same with ESLD pts and electrolyte changes. I don't know what it is about these pts but it seems like they are all demanding, picky, wonky and non-appreciative. I know I am stereotyping and occasionally there are outliers who are real sweethearts but 9 times out of 10, I encounter rude pts in this demographic.

One I'm sure ya'll are familiar with (and rightfully so) is "CYA" -- cover your ***, in relation to charting your butt off when it comes to protecting your license. Besides that one, we use LOL, walkie/talkie, DRT, circling, etc. Some of these though are awesome. Good laugh!

Did the pt say that the morphine actually relieved the pain? I understand that she complained a lot/was hard to please but maybe part of the problem was that her pain was unrelieved and that was why she's setting her alarm (I'm being the devil's advocate here- I'm more than aware that there are alternative reasons for setting an alarm for pain meds ). When you called the MD to update him/her, it may have been worth asking for an alternative analgesic if you think the morphine is not effectively treating the pain. Also, depending on your hospital policy, what about a low dose PCA? I know some MDs at my hospital refuse to prescribe PCAs unless the pt is comfort care or an oncology patient. As far as giving the dose--Since her vitals are stable, I would have given it and just monitored her closely. I would try to space them out as far as I could/she would allow but you're going to be fighting a losing battle against her. As you gain more experience, you'll learn to pick your battles. Also, just a thought-- was she actually sleeping?? If her personality is truly as persnickety as it sounds, maybe she was just faking it?

I feel your pain. Nothing against day shift but sundowners have become my worst enemy (I work evenings). One of the PP's mentioned meds, including ambien and trazodone. I don't know about trazodone but ambien is on the Beer's List and our MDs rarely prescribe it for anybody over the age of 65 due to so many adverse reactions, including worsening agitation. I personally don't like giving any sleepers to my older adult patients unless they have been taking it for years and years. I'll let night shift make the call if they want to give anything like ambien. I'm also cautions with benzos with this population. But haldol and zyprexa? They rock.

I'm coming up on my 1 year "anniversary" and I definitely agree with several previous posters. A couple of things to add: 1) If you know where you think you want to end up, give it a shot instead of starting out in med/surg. For me personally, I would be absolutely miserable if I chose to not specialize first and had to stick it out for a year or two in med/surg. I am already thinking of switching specialities because my current position on a tele floor is too med/surg-like for me. So, if you know you want to do, go for it. If you're undecided, there's no harm in starting in med/surg. Ultimately, it really comes down to personal preference. 2) Keep your patients and their rooms clean. I get really aggravated when I have to follow "dirty" nurses. Extra and/or used supplies, wrappers, dirty linens, old food trays, empty water glasses, old IV tubing, etc really gets in the way during the middle of a code!! Not to mention that it looks bad to family members (and the patient) if their rooms are cluttered. 3) Try out different routines for the start of the shift and see what works best. Some of my coworkers get bedside report and go right in to start assessments. I prefer to look at labs, meds, MD notes, orders etc before seeing the pts (if time allows) so I get a better picture of what's going on. You'll quickly learn who you like getting report from and who you would rather not follow. Sometimes the report from the off-going RN and what's actually going on with the pt is a night and day difference. That's all I can think of for now. Good luck.

I don't remember the circumstances clearly, other than he/she was admitted for 3rd degree AVB and bradyed down to 23 at one point, only feeling a "little woozy." The strip we printed out was crazy. I spent a good part of that night watching the monitor to see if there was going to be another QRS on the monitor. Needless to say, he/she went down for a permanent pacer in the morning. MD said they were OK to wait for a reason I don't quite remember...

The hospital I work in does this for EKGs. A hard copy is also printed out and kept in the patient's "soft chart." The EMR we're using is EPIC, so I don't know how it works for other EMRs.

I was just having a conversation with a coworker tonight about geropsych nursing tonight. I agree with many of the previous posters--I could not do your job but am so thankful for people like you to take care of the mentally ill. What a great post to remind everyone that everybody has their own niches, and one is never superior than another.

The lasix+foley that camillusrn brings up is a good option. I know that morphine can also help with the SOB/air hunger feelings but I am unsure if morphine (for those purposes) is usually reserved for comfort care and/or DNR patients. What's the code status on this patient?

I'm pretty sure Sacred Heart Medical Center in Spokane, WA just got upgraded to level IV.

As a recent BSN graduate and newly employed RN, I definitely agree with what's been said by PPs. I was always a diligent student and quite frankly it drives me crazy to see students trying to use this site to complete their homework assignments. The interview posts don't frustrate me as much as the critical thinking case studies. Being new to the floor, my critical thinking skills have improved exponentially since graduation and I thought my program did a decent job preparing me through assignments and scenarios. It worries me that some students choose to come to this site to probe for answers instead of applying what they've learned. Makes me worried about what's going to happen once they hit "real world" nursing and don't have the foundation because they cut some corners here and there. On the other hand, since I am a recent graduate, I can also (kind of) see this from the students' side. I frequent this site because of all the knowledge being passed around. I can understand that students want to learn from seasoned RNs. HOWEVER, I definitely don't think this justifies taking the easy way out by not working through the assignments first. Speaking strictly from experience, I would be struggling significantly if I did not put in the work to build my critical thinking skills. Just my two cents...

Small sticky notes -- I have my "brain" that I carry around on the floor but every now and then I need to write myself a reminder (ex: draw PTT at 2215) but I don't want it on my actual brain. I can throw the sticky note out after I'm done with it, and since the sticky notes are different colors than my brain, it draws my attention to it.

skill stat ( ECG Simulator - SkillSTAT ) is another fun resource to quiz you once you get a better understanding. It's hard to learn them in school-you'll find you get better with experience. I am 6 months post graduation and have been working on a cardiac ACU for 3 months. I have gotten a lot better at reading EKGs in those 3 months. It takes a lot of exposure to finally start getting comfortable with reading rhythms. Stick with it!

I'm a new grad and was hired into a cardiac advanced care unit (ACU) which is basically an ICU step-down. All of our patients are on telemetry monitors and some of our most frequently seen patients are s/p heart caths, ablations, stress tests, etc. Starting in the ICU straight out of nursing school can be difficult because most ICUs require experience (unless you get hired through a residency program like someone above me mentioned). An ACU is a great alternative to get you the critical thinking experience and depending on the hospital, your unit will send you through ACLS training. After a year or so in an ACU, you can move onto an ICU or CVICU and eventually to a cath lab. Good luck!!