ICURN1980

Hey guys, just wanted to ask if there are any recent (within the last 2-3 years) that have interviewed @ Gonzaga. Finishing up my application and hoping for an interview in October, I feel like I look pretty good on paper and just wanted to be as prepared as possible for the (hopefully) upcoming interview. I've talked to a few former students and ex co-workers and have been told that it is a mix of clinical questions with some "get to know you as a person" type questions, with a mini "mock code". Any advice that current or former Gonzaga students can give me? I am applying to a few schools this year but Gonzaga is hands down my #1 choice. Thanks in advance!

Hey that's awesome to hear. I think I might be a little paranoid about the whole thing. One of my co-workers who I've talked (who is currently in ACNP school) has told me that he has no doubt that I'll do just fine. He has about 7 years of ICU experience in just about every ICU specialty imaginable. He has said that the ABILITY to learn and understand the concepts is (sometimes) better than experience. The CRNAs that I've shadowed have had a variety of experiences (trauma, burns, and only 1 from CVICU). Thanks for advice guys, much appreciated!

That's great advice, I appreciate the response. I guess my main concern is not really my level of knowledge and experience in relation to everyone else in my class, it is more the fact that I am well aware that there is a certain level of knowledge base and expertise require PRIOR to beginning to anesthesia school. I know that schools don't have time to teach certain ICU skills and that these skills are assumed to be gained before starting. On the other hand, like you said, I've heard that the school will teach you what you need to know. I also know that there are people who are admitted from smaller facilities with lower acuity than the hospital I work at. I really just want to be as prepared as possible and set myself up for success when I start.

Hey, thanks man that's good to know. I have heard from several people that I will be taught what I need to know in anesthesia school, but I just worry that I will be in class with others who are more prepared than myself and somehow my experience will put me at a disadvantage and therefore I'll be unsuccessful. There is absolutely no doubt in my mind that I want to pursue anesthesia and I am motivated to do whatever it takes to succeed. I've also been told that it is not uncommon in NA school to be told to (for lack of better terms) "forget what you learned in ICU" because while ICU provides some background knowledge, the practice of anesthesia is so vastly different. I guess I just want to be as prepared as possible and not somehow get accepted into school without having the proper training beforehand (ie: solid ICU experience). However, I suppose if the interviewers deem me an acceptable candidate and allow me into the program I should I just assume that they know what they are talking about and believe that I am worthy! Thanks for the pep, talk!

Hey guys, I know this topic has been posted several times, but I'm just curious about what my odds are of getting accepted and some of the concerns I have regarding my current level of ICU experience. Some stats about me: GPA: Overall 3.6, science 3.7, BSN 4.0 (although the RN to BSN program I completed was pretty fluffy, so a 4.0 was pretty damn easy!). I'll be taking the GRE this summer before I apply. I've taken a 2 class sequence of advanced (500 level) pathophys and got 2 A's. Certs: CCRN, TNCC, ACLS, PALS (soon). Shadowed 3 different CRNAs on 4 occasions, one is going to write a letter or recommendation for me (score!). Experience: 1.5 years of level I trauma center Neuro/Trauma ICU (although we take medical and surgical patients as well...not sure if this specifically makes us a SICU, but we get many trauma patients directly post-op). When I apply I will be at the 2 year mark, and if accepted will have 2.5-3 years when I begin the program. I do routinely care for pts on vents, CRRT, ECMO, and those on vasoactive gtts. Tons of experience with CVP/A-lines, barely any Swans on our unit (although I know they are going out of style anyway). Occasionally precept students and have signed up to be an official preceptor for students as well as new hires (I thought this would look good as far as being more active on the unit and taking on additional responsibilitites). My biggest concern is that because we are not a cardiac ICU, I will not have the experience necessary to be super comfortable with some of the gtts that are specific to the cardiac/open heart population. I routinely use (and feel comfortable titrating) levo, neo, vaso (although not really titrated, per se), occasionally Epi. Others include cardene, and I believe I've managed 1 esmolol and 1 nitro gtt during my time on the unit. I know that in the cardiac world, being comfortable with nitro, IV beta blockers, lasix gtts, etc...in addition to the pressors is more common place. Plus, in some of our patients we aren't actively titrating these drugs to specific hemodynamic parameters (ie: Swan numbers, CO/CI/SVR, etc...). I just don't want this to hold me back or put me at a disadvantage when I start school. So...do you guys think I am a fairly competative candidate?

Dah Doh – I think you may be right. I really don’t think they are being too critical and they are absolutely helping me learn, although sometimes I guess I just get frustrated that I am not yet at their level and so maybe I unjustly interpret their feedback as too critical. I always humble myself and try to ask as many questions as possible. We even debrief at the end of each shift (and throughout the shift) about possible “worst case scenarios” that could occur with my patient. What would you do if he became extremely hypotensive? Bradycardic? Tachy? De-satted to 80%? Thank you for the advice, I think I was maybe being defensive and harsh on myself and therefore saying they were being too critical when they are actually just helping me to learn. I think what it most frustrated is that they almost seem disappointed or surprised that these things are not instinctive yet. They do take time, and 5 months may not be long enough to have these responses hardwired into my brain. I honestly haven’t had a lot of experience with vomiting trach patients or IV lines running dry. Now that I’ve had these fumbles, I feel like I’ve learned how to better handle the situation. Trust me, I go over these situations over and over again in my head at home and try to prepare better next time…therefore, I doubt I’ll be making the same mistake again (and heck, even if I do, at least it won’t be the first time and I can correct it). SubSippi thanks for the advice as well. I actually have a great set of co-workers that I have no problem asking for help. Everyone has been super welcoming and helpful, so the teamwork aspect you mentioned has been astronomically helpful, and will continue to be helpful when I’m off orientation. And yes, because I am so new, I tend to be hard on myself because little mistakes or fumbles make me feel completely incompetent and I assume people are looking at me like, “This guy doesn’t know what he’s doing!”. If I had more experience and confidence, I may not be so critical of myself, take the advice, and move on (like your examples of labeling your IV pumps). Thanks you guys, this helped put things in perspective. I think I was more frustrated with myself than my preceptors.

Hey guys, I've been doing a nurse residency program in the ICU for the last few months. It has been a combination of general nursing orientation classes, critical care classes, and days on the unit orienting. Overall, in the last 5 months I have had about the equivalent of 3 months on the unit (around 36 shifts). I feel as though during this time I have had my share of challenges, but things still come up that I "fumble" on and have a difficult time with. I try to remind myself that I still have very limited experience, but my preceptors are usually very critical of me. Don't get me wrong, I absolutely appreciate hearing constructive criticism and want to improve. I truly value their feedback and take it into consideration and work on these areas of weakness. However, occasionally I fumble on certain tasks or make minor mistakes that shatter my confidence and my preceptors are especially harsh on me. I know that as a new grad and a nurse in general, mistakes can (and will) happen. However, I also know that in the ICU where patients are extremely sick, these mistakes can have much worse consequences than in other areas. Some of these mistakes are so simple that I feel like they should not be an issue in my practice at this point in my career. Granted, 5 months of experience is not enough time to be completely comfortable or confident in my skills and I try to remind myself of that. However, when certain things happen it makes me question my ability to be an awesome, competent ICU nurse. For example, a few day ago I had a very sick 1:1 patient. septic shock, 2 pressors (levo, vaso), sedated (versed for sedation and fentanyl for pain), vented, insulin gtt, and chest tubes. I felt like I had a pretty good handle on things, measuring q1h urine output, chest tube output, urine output, CBGs, etc...assessments and meds were on time, turns and oral care were on time, and I was vigilant monitoring my drips in accordance with vitals. However, the Levo bag ran dry and air got into the tubing (my mistake for not switching out the bag sooner). However, this is usually a quick fix. I just used the first 'Y'-site from the IV tubing to pull some fluid from the new bag to prime the tube. Somehow, the air got past the pump and so the pump was no longer alarming. However, I had never dealt with air passing the pump and was not really sure how to get it out. Obviously with Levo, there is very little time to mess around and a few minutes without the med and the patient would become dangerously hypotensive. My preceptor stepped in to fix the problem by clamping the IV tubing, removing it from the pump and aspirating some fluid from the Y-site to reprime the tubing. I had never dealt with this problem, and luckily I learned from it, but it just made me look completely incompetent and unable to troubleshoot the situation. I'm glad she stepped in to help me out, but I feel like mistakes like this cause my preceptors to lose their confidence in my abilities. Another situation that arouse with a patient a few days ago. A neuro patient, PEG tube, trach, otherwise pretty stable. All of a sudden while we were in the room he vomited a pretty large amount. My preceptor went into "go mode" and asked, "Alright, this is your patient. What are you gonna do?". Obviously with vomiting, aspiration is a worry. So I sat him up and suctioned what I could out of his mouth. My preceptor immediately pulled all she could from his PEG tube and was asking what else I should do. I couldn't think of anything else, and she finally instructed me to suction his trach. All of these things make total sense when we talk about them, but in the moment and under the pressure of my preceptor drilling me, I tend to draw a blank and can't think. It definitely shakes me confidence. Does this type of critical thinking and ability to act quick in emergent-type situation calm and collectedly come with time? Does experience really instill the reflex reaction that my preceptors seem to have? I know they have been nurses for 9 years and 14 years, and I have a measly 5 months. I am definitely slower to act, tend to think things through slower, and lack some of the critical thinking necessary to work in the ICU. It doesn't seem realistic to me to be at their level, and I know it's crazy to think a new grad with 5 months experience would be where they are. However, I feel like they expect me to be at a level that is unrealistic. I really do want to get to that level, and I really do appreciate and understand their concerns, but should I expect these skills to get better over time? I study at home, look up meds and patho of diseases I don't know, and really do my best to soak up all of their advice. What else can I do? Sorry for the rant. Any advice?

Thanks, that helps to hear it from someone who had to "relearn" a lot of stuff going into the ICU. That's one of the main reasons I love the ICU: I learn so much each and every day! Rounds are amazing...sometimes if the MD goes off on a tangent with the residents I get to sit there and soak up all that knowledge. Plus, as you mentioned, treating the whole body and anticipating what could happen (or reacting to something completely unexpected). I know I'm being hard on myself but I just want to be the best I can be. I guess what it boils down to is that after 8 weeks (approx 18 shifts) I feel like I should be farther along because of what my preceptors are saying. I don't want them to NOT give my constructive criticism, but are their expectations too high for me at this point in my ICU career? I feel like I'd rather hear more bad than good; it drives me to improve even more. I just want to feel like I am on the right path and am making progress to where I need to be. And btw, this is a level 1 trauma teaching hospital so we do get some pretty sick people. I did my senior practicum in an ICU, but nothing compared to the types of patients we get here.

Hey firstlight, Yeahhh I know I should stop all the negative thinking. I honestly felt like things were going well (at least given my lack of experience) but it was a major bummer hearing otherwise from my preceptors. One of my preceptors has 9 years of experience, the other has 14 years. Clearly, with my 17 shifts, I am not going to be anywhere near their level. Obviously they don't expect this, but I feel as though they could cut me a little more slack. I'm completely open to constructive criticism; believe me, I want to know what I'm doing poorly and where I need to improve. However, I just left that meeting with the sinking feeling that I'm letting down my manager/preceptors and that in the their head they were thinking, "Geez why'd we hire this guy?!?!". Crazy, I know. Guess I'm just too hard on myself. On a more positive note, just got done with a 3 day stretch and all went well. Confidence is slightly restored, but not I am determined to ask more questions, gain more knowledge, and be hyper-alert to areas I need to work on...and succeed at them!

Hey everyone, I just wanted to vent a little bit and maybe get some words of wisdom. I know I am not the first to feel this way, nor do I think this isn't a normal feeling to have being a new grad (especially in the ICU). I graduated over a year ago and couldn't find a job in the hospital right away, so I settled for a job in long term care to get some experience. Now believe me, I fought tooth and nail to land that elusive job in the hospital but the new grad job situation isn't the best right now so I had to take a less-than-desirable job to at least call myself an employed RN. Unfortunately, being out of school for over a year left my critical thinking skills (as well as some basic nursing skills) a little rusty. Luckily, I was able to land a new nurse residency in my desired area (ICU). It is a total of 22-26 weeks of orienting, as well as 18 weeks of "general" nursing training (combined with critical care specific classes). Overall, a pretty sweet deal! I was ecstatic to get accepted and have been loving it thus far. However, some days more than others, I definitely feel like I am behind in terms of my ability to critically think and use some hospital-specific skills that I never utilized working in LTC. If you don't use it, you lose it! My preceptors and manager are super supportive and we have regular meetings to discuss how things are going. They are more than willing to work with me and help me become the ICU nurse I need to be, but it's hard to not feel a bit disheartened after hearing that I am not quite where I need to be yet. They are well aware that this year out of school has left me a bit unprepared to tackle ICU, but are sure they can get me where I need to be. I am about 8 weeks into my orientation and have worked a total of 17 shifts. I KNOW this is normal to feel a bit overwhelmed and I haven't had the exposure to feel total comfortable in my new role, but I feel like I am at least doing "alright". They don't think I am doing poorly, by any means. They do feel like I am playing catch-up after being out of school for a while and unable to get into a hospital. Naturally, I want to succeed and I feel like they are here to help me. I have until mid-February on orientation so there is still time to improve and get where I need to be, but it's tough to feel like I am doing pretty well but have my preceptors/managers have a different opinion. I am passionate about ICU and really have found my niche in nursing. Everything about ICU is attractive to me: focusing on one patient, more autonomy, critically thinking about pharm/patho, being more a team atmosphere and working closely with the MDs/RTs. I love it! I just wanted to vent and maybe get some words of wisdom from those in similar situations. I desperately want to succeed in this job and will do whatever it takes to get there. It is not in my personality to let anything stand in the way of my goals. I know I am smart enough and hard-working to succeed in the ICU, but right now (and especially after recently meeting with my manager/preceptor) I just feel a little discouraged.