MGMR

We also use filters at the end of each line, using Alaris pumps. The infusion pump lines don't have them, so we add a small one on at the end, but the syringe pump tubing automatically has the filter in the line. The only thing we don't filter that I can think of is albumin, and lipids have their own special filter.

I work in peds cardiac ICU, so the environment is obviously different than with adults. But we have open visitation 24/7. Technically only two family members are allowed into the room at a given time, no children under 7(?) are allowed without showing their vaccination records, and they're allowed food and drink (even though nurses can drink water at the computers lol). People usually come in for short bursts of time and then leave anyway, so it usually isn't a problem - especially for night shift. Since it's a pediatric floor, we have security at the front allowing people in and keeping tabs on how many family members are at the bedside. If family members are not cooperating with the bedside or charge nurse, we can ask security to escort them out. Although this has never been needed in the years I've worked there.

I completely agree. I think that one of the main downfalls of the CNS profession was that it tried to be too "flexible" as a general APRN able to perform in many roles, including provider. I think the CNS degree in itself is a flexible APRN role, and didn't need to muddy the waters by creating confusing with the NP degree.

I have this same problem in terms of choosing between the two degrees, except I still do want to perform patient care at the bedside. Without a doubt, there are many more job opportunities for Nurse Practitioners than for Clinical Nurse Specialists. Even in areas that utilize CNS's, there is usually only one per unit at most, or one per specialty service. For example, there might be one neonatal CNS for the entire NICU, but they may also employ a handful of NNP's. Also in areas of the country or hospitals that don't use CNS's, they typically will fill those roles with NP's (or anyone with a MSN) because most people feel that the NP degree is a catch all: provider, educator, etc. It's a shame because I believe in getting the education for the job you want to perform in, and getting your NP teaches you how to be a provider, but it might not prepare you well for roles in education, leadership, etc. But if the jobs don't exist, people are going to just get their NP because they don't want to waste their time and money.

If you're interested in CLABSI/CAUTI prevention and best practice implementation, CNS would be a great choice for your APRN degree. You can get your Adult/Geriatric, Pediatric, or Neonatal CNS degree, but you don't sub-specialize further than that at the academic level. I would say specialty practice beyond your degree is determined by the job you take after graduation and the training they provide you in that specialty, and also any knowledge and expertise you bring from your RN practice previously. If you're interested in invasive procedures, but little to no patient care, you could also become an NP working in IR. My friend does this. She was a SICU nurse while getting her NP, got a job in IR after. Her day consists of placing CVLs/PICCs, chest tubes, etc. Very little patient contact beyond the line or tube placement as they go back to the unit immediately after.

You also have to think about the type of lifestyle and environment you want to work in. Do you want to do ICU or acute care? Inpatient or outpatient? With your NNP, you'll almost always be working in hospitals in some type of ICU or step down environment. It may require weekends, holidays or nights. Some people get their NP to escape that schedule. PNP gives you more flexibility depending on your state and local hospital's use of PNPs. You could work primary care, outpatient specialty clinics, and some even allow them in NICUs and PICUs depending on the person's RN experience - although that is a fading trend. I would also look to see how your local hospitals use PNPs.

I hope that the CNS role is making a comeback because it is probably the route I will take for my advanced degree in the future. It seems like in NYC (where I'm located) it is getting more popular, but slowly. If you are set on not going the NP route, I think that a CNS degree would be a good fit as it fills many roles - not only CNS positions (obviously), but also positions such as unit educators, service line providers such as wound care clinical nurse specialists, etc. But maybe I'm too biased/optimistic.

Sorry to hear PICU isn't working out, but better to try and find out than to never know! I think you should talk to your ANM even if she isn't approachable, or maybe your ANM along with your NM together. At my institution, they usually help the nurse find a place in another unit if it isn't working out since the hospital spent money in training you. The sooner the better in my opinion, so they aren't wasting time and money on your orientation.

I would say your PCU deals with more acuity than many units that are considered intensive care. I'd say to put "yes." You can elaborate more about your experience during the actual face to face interview.

My hospital will reimburse your exam fee, and then you get a $2000/year bonus put into your normal paycheck in December.

It's pretty common, at least for my unit, to get a relatively inexperienced nurse for your night shift preceptor. Unfortunately there's not enough of a balance of experienced nurses on night shift to give all the incoming nurses on orientation, so they typically settle for the most experienced among the inexperienced. But I definitely echo what NotReady4PrimeTime and SICUMurseCCRN said. It's important that the educators know because you need to ensure you're getting the best orientation as possible. It's also important because if nothing is said, they'll start giving that nurse more and more orientees since, as far as they know, it went so well with you. If you phrase it as a safety issue to your manager and educator, I think it will go over best.

You can see the actual amount each medline tubing is on the package before you open it. The ones we use are about 0.8cc, plus the very small amounts in the back check valves on either end (each being about 0.05cc maybe). So, if the medication is 1cc or less, we push that entire amount into the line and run the flush to deliver the medication over the correct amount of time. The flush is 1cc to ensure the entire line is flushed through.

At this moment, I don't think there actually is a certification exam for a CNS in Women's Health. I think that the Association of Women's Health Obstetric & Neonatal Nurses have proposed that curriculum for a hopeful certification exam, but have not been successful in approving it officially.

While I agree about the huge difference in turning an intubated preemie and adult, that still doesn't explain the rest of the OP's situation: not being able to start a peripheral IV, titrate Dopamine, or check a blood sugar on your own is extremely restrictive. Especially for an ICU nurse.

I've only worked peds cardiac ICU, but from talking to many of the nurses who have come to my unit from adult ICU, it appears that there is huge difference in nursing autonomy in pediatric versus adult ICUs. I think the NICU has the least autonomy out of the three units at my hospital (NICU, PICU, PCICU), and that PCICU has the most. And that's not saying much because I feel like I don't have much autonomy most days. I titrate anti-hypertensive drips like Nitroprusside and Nicardipine to stated BP goals, and some sedation like Precedex as needed. But we typically need to ask to go up on Fentanyl drips (even though we bolus as much as we need), and we never touch Epi drips without an order. Obviously we don't titrate Milrinone, and we don't use Dopa or Dobutamine on my unit. The adult ICU nurses told me that they could titrate pretty much any drip, and give fluid up to a certain amount before calling the provider. We would never be allowed to give fluid boluses on our own, even if their pressures are 40s/30s with a CVP of 2. I think it's ridiculous you can't start an IV on your own, and don't get me started on giving intermittent IV meds sterilely or NICU's lack of sedation/pain management. Even our NICU isn't THAT bad. Yours sounds particularly stifling. I think that if you love the specialty, stay and get the experience you need and go elsewhere. I have many friends who have come to my unit from a NICU background where the nurses re-taped tubes on their own without asking the medical team, went to deliveries and put in their own PICC lines. So it definitely can be done. I also believe that, sometimes, if you earn the respect over time, you gain more and more independence to do things as long as they're correct things to do. For example, even if it isn't your unit culture to check a glucose, I think it would not make your resident explode in anger if you did it with sound clinical judgment. Something like, "Hey, I noticed that the blood sugars have been trending down, so I checked and their sugar is 20. Do you want to give a D10 bolus?" Or something along those lines. It shows you have an idea of what's going on, and they can't be mad really because, well, you're right.