kmarieCCRN

So, this past week some coworkers of mine had gotten into a heated debate as to whether or not it's okay to run an infusion of something other than NS (3%, sedation, etc.) with your CVP line if you've run out of access. One of the arguments was that you could possibly bolus your patient with whatever gtt you were running with the CVP line. What do you guys think? Do you ever run fluids/gtts with your CVP? Do you have policy on this?

I'm finishing my ACNP this summer and was fortunate enough to be offered a NP position in the ICU where I work (SoCal). And from what I can tell the contract looks ok. Are there specific things that I should be looking for in a contract? What, in your opinion, is essential in the contract? Here's what it looks like.... 113K/year Malpractice insurance covered 20 vacation days Quarterly "incentives" for billing/helping out... etc 10 sick days 5 CME days $3500 CME allowance Hours and shift are not included: Apparently mostly day shift and approximately 2-3 NOC shifts depending on when/how many residents rotate through. Hours vary weekly- depending on census and staffing. Thoughts? Advice?

Juan de la cruz, Are you very familiar with the NP job market in San Francisco? If so, how does it look for new grads? Also, what hospitals do you like? Thanks!

I'm finishing my 1st year in my ACNP program and am starting to think about where I want to live/work after I finish school. I currently live in SoCal and would love to move to San Fran once I finish. I know that getting a job as a new grad NP is highly dependent on networking, so my question is how do I go about getting a job where I don't have any connections?? I have a good job now and could probably transition to a sister icu @ my facility (don't use NP's in my MICU, but do use in SICU & Neuro ICU), but I want a different experience and want to find my 'forever home'. Any recommendations/suggestions?

Once again, I wasn't intending to offend anyone using the terms "baby" or "seasoned" nurses. I was just curious if other units were having the same issues with staffing. I enjoy teaching new grad nurses because 5 years ago I started out in the ICU as well. If they're willing to learn, I'm more than happy to share my experiences. Case and point... this weekend one of my coworkers in the same pod was a new grad. His pt was initially ok, but starting to decline.. I don't know all of the specifics, but I saw that he was busy so I asked if he needed help and to just let me know if he needed anything (my list was pretty chill). The pt was tachycardic and hypotensive on a levo gtt, so I gave some suggestions (to ask MD for). They ended adding vaso gtt to try to get the levo down to help the HR (150s) and either doubled or quad strengthed the levo gtt (HD pt as well). The RN changed the bag without switching the tubing and the pt's BP bottomed out and he couldn't figure out why. I offered help as soon as I saw the BP, and after I walked into the room and quickly assessed the pt I figured out the pt had gone into PEA. This pt was DNR so we didn't code, but I feel like the outcome may of been hastened by the lack of knowledge. Everybody has to learn... I get that, but when you don't know what you don't know.... what happens to patient safety? The experienced RNs can't always be there every single minute.

Ok folks, relax. I'm not using the terms "baby and seasoned" nurses in a derogatory manner... Only using those terms to describe experience. As I said, I don't have a problem with new nurses, but so many at one time on a high acuity unit is not a good idea. I feel as if it's the "perfect storm" brewing. We have new residents each month, so it's the blind leading the blind. I totally agree that it's a disservice to the new nurses... they don't know what they don't know and they don't have many experienced nurses to lean on. I just found out that my manager & educator have in fact shortened the orientation period because we are so short on night shift... I don't know what they are thinking... I guess they're just wanting warm bodies to man the floor. I don't think they're too interested in trying to retain, because there is the thought that they can just scoop up all the new grads from across the street (they also have a nursing school). And yes, all of the experience is on day shift... Maybe they should come up with incentive for PM shift. What have your facilities done to retain RNs?

We do have a new grad residency, but at the rate they're coming out of the gate... They out number the seasoned staff. There's 25 beds in our MICU and 6 in our NICU, but I've been on shift where I was the only seasoned RN on the floor. We also get new residents every month, so I'm worried that's it's the perfect storm brewing :/

My particular unit has had such a huge turn over even in the last year that it is now mostly staffed with new grads on my shift (night shift). Baby, baby nurses are being thrust out and literally learning thru the trial by fire method. I have nothing against new grads in ICU, as I started out the same, but so many at once?? It scares me to death because it's a high acuity unit (level 1 trauma & teaching center) and it's the blind leading the blind! I've got 5 years ICU under my belt so I'm considered the seasoned one, but the thought of leading a unit full of babies freaks me out. It's a huge safety issue! Are you guys having the same problems & concerns??

I've just started my NP program and I'm wondering why others become np's? I also want to get a better picture of what my future as an np may look like.. Why did you become an APN?How long have you been an APN? How did you get your current job? Does your job require national certification? Is your current job what you thought it would be? What do you wish you had learned in school to better prepare you for the real world? What advice would you give to a new np student? What do you like the best/least about your np job? Thanks