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I really wish this was the case, its really that its just a small market for those positions and they fill either internally or through direct recruitment (nursing students -> RN -> hired). Sure my less than one year there doesn't look stellar, but it sure beats what a vast majority of nurses are doing these days. I can't tell you how many I've talked to that stay in positions less than 6 months before finding a new position (echoing what others have said about retention issues). If my situation was better I'd have no problem staying, but I've literally been told that "there's nothing I can do about it". Kind of a good reason to re-locate.

At my hospital, the ICU nurses lead the rapid response teams and the doctors may or may not show up. We are able to order tests, imaging, give certain medications under protocols, and transfer / admit to ICU. Even if the patient doesn't quite need it we will stick around and reassure the floor nurse what to look for and what to do if the patient suddenly changes. At my hospital nurses actually get in a lot of trouble for NOT calling a rapid response. Had a physician recently decide to intubate on the floor before transferring to ICU, he got in a lot of trouble for not calling us and allowing us to assist in what we do best.

Any decreased LOC is an appropriate time to check a bed side blood glucose. The number "123" was simply given to indicate that it was not what was causing the issue.

I'm an ICU nurse, and it was my first position in nursing. I'm actively looking for a position in my town (I drive an hour to work) and I can't get an interview. Mind you i've only been there for almost a year and I'm motivated to find other work because of distance driven and scheduling issues (I might get 1-4 day off block per month....) but they aren't even considering me with my experience. I'm probably going to have to take a telemetry position and then step back into ICU or ED. Aside from a short orientation to a unit, I already have the critical care components down, but don't have that magical 2 years experience that they're all looking for (and that the stupid applicant tracking systems look for).

Meh, "immature" isn't quite the word I would use considering the mess is just getting re-cycled from the patients rooms to other areas. Day shift has an equal part and management doesn't want to hear about it. I simply displace the mess they make into another area to keep them accountable. Hardly seems unfair.

I sleep well at night knowing that day shift had the same level of inconvenience that they placed on me, plus I'm in complete and total compliance with the medication. Remember, they could have stocked the syringes and needles too. Plus lets look at it from this point of view: The day shift nurses make a mess, and the night shift cleans the mess. What does that tell the patients? Oh the night shift nurses must not be as qualified so they have to clean.. It goes beyond simply cleaning the mess. Hey if day shift has 2 patients each and they're admitting someone and intubating, and a central line is getting placed in another room yeah okay you didn't have time. But if I come in and your googling recipes for dinner, yeah no that's not okay. You need to refer to my original post, if day shift could have cleaned and they didn't, that's when all bets are out the window.

I have quite a few issues with baths during the morning myself. The day shift nurses consistently complain that we aren't giving our patients baths and we aren't getting our patients up. I pretty much always bathe at least 1 patient, but I can't create more time in a shift, just ain't happening. As for admits, day and night have about equal, but day shift does do more transfers to the floor obviously, to THEIR benefit (the quicker in your shift you can transfer, the less you have to chart/do... We night shift have to hold them ALL throughout the night so that day shift can do a transfer at start of their shift...). It just gets to the point where we are bugging these poor patients every hour starting at 0400 (the final physical exam for the shift), then at 0500 for labs, then at 0600 for meds.. At this point we've now kept these patients up since 0400am....... Sleep doesn't matter I guess...

What do you mean by Pl?

If family silences an alarm, they get asked VERY sternly to never do it again. If they do it again, they are removed from the ICU until we deem it safe to have them again. We edit the alarm values per the physicians okay so that patient A's HR of 50 isn't tripping the brady alarm, and that 89% SpO2 on patient B (a COPD'er) isn't doing the same. If its alarming, its because its supposed to be.

Unfortunately the day shifters are, and will forever be, the golden children. They are the ones that "have it so bad" and doctors "hover over them unlike night shift"... Yeah right.. All the night co-workers feel the same, but we have very little say. If I find my rooms are messy and the day didn't seem that terrible (I can look at the intervention lists and the orders and know that it was a low maintenance day) I might "accidentally" forget to stock things such as needles, syringes, flushes, ect.. in the med room. I've also been known, when day shift has really crapped on me, to wait to give my 40mg lasix right before end of shift (doc likes to round at 0600 and orders it as IVP Now x1 at 0630, giving me a 30 min window). Never do I do things that would remotely harm patients, but I find a little satisfaction knowing that I might have inconvienced them a little bit.

If you look at our policies, it says that within 2 hours of end of shift we only have to do the admission vitals and a physical exam and the oncoming shift has to finish the rest. I can't tell you how many times the ED has called us with 30 mins till end of shift telling us we have an admit.. I finally got to the point where I tell them, "You either need to wait, or you can call my supervisor and get another RN in to do the admit". Still to this day they haven't pressed to admit the patient within the 30 min time frame when I do that, and I still haven't gotten talked to about it. Makes me feel as though they know they are in the wrong. I've had a few day shift nurses give me crap about it, and the simple line I give them is "per the policy I did the physical exam and got the vitals..." and that usually shuts them up really quickly. I don't have the time within the last 2 hours to get patients up, get them toileted, get the last vitals, pass the pre-AM shift meds, tally I's/O's, do my careplanning ect... The last 2 hours of night shift are a nightmare.

Didn't read through the entire thread, but I have to say that as night shift I'm often times the one who gets to clean up after day shift. It drives me nuts too because its simple things like linen piles in corners, cords, lines, and cables that are a tangled mess, commodes in the middle of the room, ect.. When I do come in the day shift nurses are all on their phones texting and whatnot so its not like they didn't have the time to do so, but they just don't. I don't say anything, because I know that should I need the ammunition against a complaint against night shift (which happens all the darn time because we get the "easy shift" - pfft yeah right). When day shift complains that I didn't get a patient, who isn't a fresh post op or who is trying to sleep after being woken up every hour by us all throughout the night, up out of bed and into a chair, I can remind them that I was too busy cleaning up after their shift yesterday. I should also add: If you are day shift, leave the room how you want to find it in the morning. If I'm busy, and the patient is trying to sleep, I simply don't have the time to tidy up and its not like I'm going to be doing a lot of things that will mess up the room. So often times I have no contribution to the mess, its just how I found it when I came on shift.

I work in a smaller ICU and when we do not have patients we simply take over telemetry and stay at the hospital. We are considered "essential personnel" so we never get called off, but the poor telemetry technicians do. We respond to all rapid responses obviously, but we also respond to all codes and to major trauma activations. Have to have at least 1 ICU nurse in the unit at all times, so have to have nurses.

Couple different sides to it to think about.... I was directly hired into an ICU position straight out of school. It has been awesome, mainly because the staff was supportive and taught me very well. That said, and I know it only holds so much weight, but I graduated top 5% of my class and came to the table with an advanced understanding of ICU concepts as a new grad. The way I sold myself to my hiring manager was that: A: They will have a brand new nurse that doesn't have bad habits from other units / departments and you will be able to shape me as you see fit. B: I am a self driven learner and I am willing to undertake anything and everything to learn and grow as much as possible. C: Med/Surg or Tele are specialties of their own and my goal and passion is critical care, therefore I feel it would be in my and everybody else's best interest if I apply my knowledge-base to learning critical care from the start. It of course helped that I had done my senior practicum in that particular ICU, but I still beat out other applicants as a new grad. That being said.... ICU is not for the weak of heart. I was expected (not "encouraged") to advance through my competencies extremely quickly, be able to demonstrate that I understood concepts after only seeing them a few times (pressors, chest tubes, sepsis, DKA, ect..), be able to take my own patient load after 1 month of orientation (I was still on orientation, but they needed to see that I could handle it), and be able to jump into the foray when a code or major trauma was called. I could only watch the first time, the next time I had to do the job I was assigned during codes and traumas. I would spend hours researching ICU topics and learning about the medications, the conditions, the critical thinking process, and how to navigate through any situation without losing my cool. I feel that to be successful in the ICU as a new grad, you have to continually press yourself to learn more and more and more. If you do make it into the ICU as a new grad, listen and take advice, even if what is being said isn't the best practice or totally correct. You can always address it with your manager as a hypothetical situation and see another side without getting your preceptor or another nurse in trouble. We all have things we are lenient about, but none of them endanger a patients life. (I've been known to let a patient with an NG tube and suction have an ice cube, but no free water, when they are NPO). ICU nurses, at least at my hospital, are the nurses that anybody in the hospital knows they can call because we can do it all. I've floated to OB, ED, SDS, Med/Surg, you name it. Its an extreme amount of pressure, but if you are a type of person who does well under pressure, then go for it. Crazy situations made me learn even faster, and although I'm nowhere near an expert, I am now confident in what I know.

Just read this, seems like nursing schools need to quit pumping out students. It seems absurd the amount of excess nursing staff, here's looking at you Ohio with your projected 75K+ abundance of new nurses. Whats with that? The other side of the coin is that by 2025 nobody will be able to afford going to college, so those that can will be assured a job simply by default. Scary, but more of a reality than any of us want to admit.

I work night shift and there are just two doctors that we can't ever impress. Unless they are already up admitting the patient, calling them is sure to have disastrous results. Only time I didn't get an ear-full or attitude is when I called about a 52/28 BP on a septic pt with 30mcg/min of Levophed and 0.02u/min of vasopressin. Got that order for push dose phenylephrine real quick. Recently I got hung up on for calling about a 39 glucose, told him I treated with an amp of D50 and BG was 157 after the amp and just wanted to let him know. He was mad because the hypoglycemia protocol is in place so we don't have to call for orders. What he didn't realize is that there was also a "notify physician if" intervention that had "Any critical lab value" as a reason to call. Can't win em all, and makes you mad, but oh well. Edit: Can't remember what the dose of the vasopressin was, know it was half the maximum rate per min or per hour. Oh well, we almost never use it.

Ha, if you call that hostile you have a much different view of hostility than most people do. And disagreeing with what? Your opinion? Opinions mean nothing. There are people that have linked peer reviewed nursing and medical literature published in medical and nursing journals. Those are facts. Please get yours straight. Either that or lip off to a doctor about his practice and see how far that gets you. I'm certain they'd love to correct you in front of the other nurses and the patient / family. Plus who says Gosh?

This is totally my opinion but mental health nurses are indeed in high demand, but the pay is just fine.. some places the pay is far better than hospital nursing.. But they are in high demand because there is often no incentive to stay (No practice autonomy / no trust). Turnover is a big issue. I worked in substance abuse / detox and I can honestly see why people don't stay long.

Nothing against you wanting sterile procedure over clean, but something to consider: With all of the I&D that are being performed daily throughout the US, if we had to switch to 100% sterile technique how much would that raise the cost of healthcare? Sterile technique, to include the supplies AND preparation of the field / staff preparation takes more time and time = money. Pretty sure ED stuff is charged by the 15 min interval at my hospital. Insurance companies wouldn't want to lose money so consumers would eat the cost.. Just food for thought, healthcare in America is the most expensive there is.

Haha, please tell me your kidding? An NP vs a new grad with no experience outside of a clinical rotation? Pretty sure an opinion pales in comparison to years of real experience.

Nobody touched on it yet but MRSA colonization on skin is extremely common. In fact we stopped swabbing nares to test for MRSA because it is A: extremely common, and B: usually has no significant impact on patient outcomes. I'm not saying MRSA doesn't cause issues, because it does, but simply testing positive for it may or may not have clinical significance.

I would seriously hope that someone wouldn't be dim-witted enough as to readily give up info like that, but I'm guessing it happens pretty frequently. Golden rule about law proceedings: don't speak unless spoken to, and only answer the question being asked. If they don't SPECIFICALLY ask about the journal, then don't talk about it. Also, and not sure if this is commonplace, but in nursing school several teachers gave us advice about CYA in charting and law suits. Sad that it has to be a focus, but its the reality in a lawsuit happy society / culture.

Honestly just write somewhere in the front of the journal that "All writings in this are factitious works of art and are not to be taken seriously. Any likeness to any individual is purely coincidence, and any and all stories are fantasy." But for real just don't write names or anything that could be specifically tied to a patient and your golden. I could write something like this: "He was incontinent and had to be changed a thousand times. He also was demented and tried to get out of bed constantly. The hypotension was an issue, hope he doesn't fall and hurt himself, discharge is calling his name." How many people does that describe? Just don't give a date and what does it matter?

Wonder why the chest tubes didn't show anything that would have given the hint of a hemothorax. Honestly with an ABG showing no hypoxia, clear head CT, no excessive drainage in the Atriums, and decent pressure off support I wouldn't have thought anything of it, and yes ICU delirium would have been the suspicion. I don't work in CV-ICU, but as a MICU/SICU nurse this case sounds pretty out of the ordinary. Is it possible that the PEEP on the vent was acting as a tamponade, and removal from pressure support caused the bleeding to start? Clinical review: Positive end-expiratory pressure and cardiac output Losing a patient sucks, and feeling defeated happens, but take it as a learning experience. You seem to know your stuff, just add this to the list of things to remember and keep saving those lives. Edit: I should also add that our RASS/Vent worksheet has "Increased agitation and or Pressor support" as an absolute contraindication for extubation or weening attempts.

I just wish that the others in this thread would have the same view. Trust =/= respect. I respect people for being human and attempting to do their best. I trust people for showing me their best and doing it consistently. The only type of respect that is earned should be disrespect. I don't immediately trust new people or those I haven't worked with, but I also give them ample opportunity to earn that trust.