MDMBSNRN

I checked online first. Received an email a few hours later saying the same.

Just saw my status change online. I have been accepted to the program!! I'm so excited!

Mine too! Checked it when I got up tonight to get ready for work. I'm so nervous.

What kind of experience/certifications do you have? I have been a nurse for around five years, and have three years of ICU experience (including MICU, SICU, trauma/burn ICU, and neurosurgical ICU). I also have around a year of experience in an ED that was a level one trauma center, burn center, ECMO center, VAD center, and transplant center. I currently work in a level one trauma ICU. I hold CCRN, CMC, CEN, and TCRN certifications, and have been a charge nurse, a preceptor, and a founder/leader of several unit based committees.

Mine says the same thing. I'm checking it obsessively at least once daily.

As of Tuesday of this week, my application says "under review by decision committee," or something to that effect. I'm hoping to hear something within the next few weeks.

I work night shift in critical care, and yes, it is that hard. Three 12 hour shifts sounds like a breeze, until you realize the gravity of what occurs during those 12 hours. Also, even if your unit allows you to self-schedule, there is no guarantee that you will be able to work all three days in a row, so you may find yourself working Monday, off Tuesday, working Wednesday, off Thursday, and working Friday. This has happened to me many times, and I'm sure it will happen again in the future. In that case, especially working night shift, you feel like you are working all five days that week, because the only thing you can do is stay up all night, and sleep all day in hopes of keeping yourself on a night shift schedule. Also, I work nights by preference, and have done so for nearly five years. I don't see myself going to day shift at any point in time, however, the human body is not designed to naturally stay up all night, and sleep all day. I often find myself exhausted on my days off, and sometimes all I want to do is lay on my couch. I am sure that I would feel "more human" on day shift, but 12 hour day shifts are still physically and mentally exhausting. In your post, you mention a desire to work in the emergency department. Like you, I relished the idea of the excitement of the ED as a new graduate nurse, and I have worked in the ED as both a new and experienced nurse. The excitement and rush eventually wears off, and it did so for me fairly rapidly. You quickly realize that the majority of ED patients have no need to be in the department, and you rapidly tire of taking care of patients who could easily be treated at an urgent care, or in a doctor's office. In addition, the rush of high-stress situations will eventually also lose its appeal. I worked in a level one trauma and burn center, and I spent many nights in the ED seeing the worst of the worst. A good trauma team runs like a well-oiled machine, and this removes a lot of the rush from the situation. In addition, you will eventually notice that seeing the horrible things that can happen to the human body begin to take a mental, emotional, and spiritual toil on you. It was for this reason that I recently left the ED, and returned to the ICU. Critical care is an entirely different beast, and it cannot really be compared with the emergency department. The stress is different, the work is different, and the thought processes are different. In critical care you will also be routinely exposed to the many horrors that can befall the human body, but you will face that every shift for many shifts, as opposed to the few hours you must deal with it in the ED. I currently work in trauma ICU, so my nights consist of caring for bodies mangled and battered from various injuries both accidental and intentional. In my position, the biggest stressors are staffing and patient acuity. We are often short-staffed, and we find ourselves trying to do the best possible job for our patients with inadequate staff, supplies, and resources. My ICU does not employee techs (most ICUs don't in my experience), so nurses also find themselves bathing patients, changing sheets, cleaning up urine and feces, turning patients every two hours to prevent pressure ulcers, performing mouth care every four hours, helping patients who can walk do so, and performing numerous other tasks. This is done in addition to tasks that must be completed by an RN (administering medications, assessing patients, providing education to patients and families, inserting IVs, catheters, NG tubes, feeding tubes, performing wound care, titrating drips, managing invasive lines, and communicating with nurse practitioners, residents, and attending physicians). All of these responsibilities are more than enough to keep you busy for the entire shift, but they become even more stressful when coupled with inadequate staffing and resources. In addition, I frequently find myself physically sore after work. The combination of standing on hard concrete for hours at a time without sitting, walking nearly constantly, and turning, lifting, and moving patients all shift is a recipe for disaster. I work with numerous nurses who have required knee replacements, rotator cuff repairs, back surgeries, and other procedures as a result of injuries from work, or as a result of the many years of wear and tear on their bodies. I am in my mid 20s, but I often find that my back, knees, and feet are sore for days after my last shift ends. The job doesn't just entail physical stress on the body, it also involves a great deal of mental stress. In the ICU, I am constantly watching my patients for any sign that things are beginning to deteriorate. I am constantly focused, hyper-vigilant, and aware of even the smallest changes. In all areas of nursing, but in critical care especially, this is required. The small change that you miss may very well be the thing that goes on to kill your patient. This hyper-vigilance, coupled with frequent patient assessments, and nearly constant critical thinking is mentally exhausting. Finally, there are the many frustrations that come with the job. The understaffing, the lack of resources, the doctors that refuse to listen to you about patients, the family issues, the abusive patients (both verbally and physically), the demanding patients and families who cannot be appeased, the routine process failures which make your job unnecessarily difficult, and the list goes on and on. These things, coupled with the physical, mental, and emotional stress of nursing are what make the job so difficult. I would encourage you to look up the PTSD rates for nurses. There are many nurses who are permanently scarred from the horrible things that we see and do on a daily basis. I can tell you that after spending time in burn ICU, trauma ICU, and the emergency department, there are things I will never forget. Screams of agony, mangled bodies, inconceivable amounts of blood, the smells of burnt flesh and hair, the look of parents who have just lost a child, and the feeling of utter failure when a patient dies despite all of our efforts. This job isn't simply a nicely paying way to work three days, and get four days off every week. You also mention wanting to make a meaningful contribution to the world, and I think this is great. But I must also caution you. There are plenty of mornings where I come home feeling as though I have tortured a patient all night, as though I am helping to simply prolong their life, knowing that they will never have a decent quality of life ever again. There are also mornings where I come home, and feel that I have miserably failed a patient. Maybe they suddenly coded, and we could not resuscitate them, or maybe they suddenly deteriorated, and we desperately worked to stabilize them. In those situations, I come home wondering what, if anything I missed. I beat myself over what else I could have done, if I did enough, and if I could have caught an issue earlier, and possibly prevented the things that happened. I do not hate my job, and I really don't see myself ever doing anything else. I have always wanted to be a nurse, and I am happy with my decision, but I am a different person now. Nursing has changed the way I see the world, the way I think, and, quite possibly, my entire personality. I would encourage you to shadow a nurse in the emergency department, or the ICU. Both of these areas will give you the experience of high-acuity, life or death situations, and will allow you to see the true reality of nursing. This could help give you a better idea of if you really want to be a nurse.

Has anyone else applied to the University of South Carolina for fall 2017 admission in any nurse practitioner track? I applied to the MSN program, and selected the acute care NP track. The application deadline was April first, and the waiting game has begun. I just wondered if anyone else applied, and what, if anything, they have heard from USC.

Not checking an oxygen tank is simply poor practice. I understand that we all get busy sometimes, and none of us are perfect as nurses or people. I also understand that mistakes are made, and things are sometimes forgotten. But checking an oxygen tank should not be something that slips your mind as the bedside nurse. Especially not when the patient is on 12 liters of oxygen, and has multiple pulmonary/respiratory complications/issues. At some point in the orientation process, it may be time to talk to your unit educator. If you are teaching, and trying your best to orient her to the department without results, it is worth mentioning to the educator. At all the facilities I have worked at, the educator was responsible for handling length of orientation, helping to schedule classes, and ensuring that new hires were growing in skill/competency during their orientation periods. I am sure it is much the same at your hospital.

I worked psych for a little over a year in between stints in ICU. My unit was primarily made up of thought disorders and patients too violent for other facilities, with a nice mix of geriatric psych thrown in. When I first started in psych, I felt as though it was my obligation to ensure that all patients took their medications. At times, I, like you, felt angered over a patient's refusal. Other times, I tried to bargain/reason with patients regarding their medications. As I progressed in my psych career, I realized that some battles simply can't be won, and aren't worth fighting. I also quickly learned the phrase "not the hill you want to die on." I got to a place where I refused to argue with patients, but I was also firm. I frequently had patients who attempted to refuse their scheduled sleep aide (normally Trazodone) in hopes that they could receive PRN Ativan or Xanax later on in the night. To these patients I would say, "it is your right to refuse medications, however, if you refuse to take this medication, and attempt to let it work, I will not be automatically administering Ativan or Xanax when you complain of insomnia in a few hours." For patients who refused all medications, I would explain to them (calmly) that this is part of the way we are trying to improve their condition, and that refusing medications only hurts themselves, and impedes progress towards being released from the inpatient setting. In the end, I simply had to learn to refrain from being reactionary related to the behavior of a patient, and to refrain from feeding into any ploys for attention.

I've worked in both ED and ICU, but I've only ever precepted in various critical care units. Usually for orientees who are unsure of rhythms, I take them into the room, and ask questions. "What rhythm do you see on the monitor? Do we need to immediately intervene related to the rhythm/rate/blood pressure? Do you have any concerns about the rhythm, or how it relates to the patient's chief complaint?" I try to be gentle with these, and not make my orientee feel like I'm belittling or insulting them. During downtime on the unit (which is seldom), I also tried to make it a point to show my orientee rhythm strips (especially of concerning rhythms like A. fib, A. Flutter, V. Tach, V. Fib, and various degrees of heart blocks). I would ask what the rhythm was, and ask my orientee what should be done if the patient converts into one of these rhythms. Together, we would review treatment algorithms for each rhythm. As far as giving her telemetry patients alone, I wouldn't feel comfortable with that. I would supervise, even if from a distance, until I felt that she was more competent with identifying various rhythms, and knowing what to do in the event of an acute cardiac issue.

If you're really dedicated to it, and you really want to do ICU, then I think the critical care orientation group is something you should consider. With you having no ICU experience as a bedside nurse, I would be interested to know how long the program lasts, if you will also be receiving critical care education in a classroom setting, and how long you will be percepting on the unit you are assigned to. Having just two patients in ICU does sound much easier than having 5-6 patients in a step-down setting, but, in reality, it often isn't. As you saw during your time in ICU, we only take two patients for a reason. Also, as you stated, time management is important in ICU, but flexibility is also key. You can have your day planned out nicely, and, suddenly, one of your patients decides to become acutely hypotensive/code/have an acute mental status change/experience a dangerous arrhythmia/desaturate/any number of issues. Before you know it, your nicely planned hours turn into a central line insertion, an intubation, an arterial line insertion, a trip to CT, drawing numerous labs, adding five new drips, and actively working to stabilize your patient. When you finally get out of the room, you realize you haven't personally seen your other patient (who probably isn't the picture of stability) in two to three hours, and you have multiple new orders/meds to give/labs to draw. I find that this need to have a formulated, well-organized plan for the shift, coupled with the frequent, and sudden, deviations from said plan is often what frustrates new ICU nurses. Experienced ICU nurses are by no means immune to this, but I feel like it is quite the shock to those who have never worked in a critical care setting. Also, I have never worked in an ICU that employed CNAs/techs. This means that in addition to all the nursing tasks you are worried about, you also have to find time to turn your patients every two hours, perform oral care every four hours, empty all drains as indicated, and bathe your patients. If you have patients that are able to eat/walk, you are also looking at ensuring they get three meals a day (on day shift), and ensuring that they are up in the chair/walking, and tolerating the activity. I love critical care, and it is definitely my favorite of any area I have ever worked in. With that being said, there are still nights that I feel as if I'm being pulled in a million directions at once, and wonder how I will ever get everything done. If you are truly passionate about critical care, then I say go for it. Time management is something that we as nurses, no matter how long we have been working, should strive to improve each day. More and more responsibility is being placed on bedside nurses, and, unfortunately, staffing often doesn't reflect these additional responsibilities.

Units like that aren't safe, and they certainly aren't conducive to healthy staff. There will always be bad nights in any ICU we work in, that's just the nature of the job. But in units like yours, every night is exhausting simply because of poor staffing/high acuity patients. I made really good money, and I loved my coworkers, but, in the end, the pay/unit environment wasn't worth it. Nursing is my passion, but it's just a job when everything is said and done. I refuse to sacrifice my mental and physical health and well-being just because a unit isn't properly staffed. At my hospital, it was a management problem, and the staffing issue needed to be fixed at the level of CEO/CNO, but no one was willing to address the problems. At some point, you just have to know when to look out for yourself, and realize when it is time to walk away.

When I moved to Tennessee, I accepted a position in a large (32 bed) medical/surgical intensive care unit in an approximately 700 bed hospital. I loved the unit, the acuity was high, and the staff was great. Staffing, however, was a nightmare. It was nothing to have a paralyzed therapeutic hypothermia, an unstable balloon pump, and a septic CRRT as one assignment. We sometimes ran the entire 32 bed unit with 8-9 nurses. The unit was constantly short staffed (imagine that), and I frequently offered to pick up overtime. I felt that I owed it to my coworkers to try and lessen the burden. In the end, I lasted around two years in that unit before I burnt myself out completely. I dreaded going to work, came home feeling beyond exhausted, spent much of my time sleeping, beat myself up over the caliber of patient care I provided, and often worried about the safety of my nursing license. Despite my love for the staff on the unit, I left that hospital, and took my practice elsewhere. I can't say that I loved the staff in the next hospital I went to work at, and I can't claim that it was the best job that I've ever had. What I can confidently say is that my stress levels went down, I never worried about my nursing license, I felt that I delivered much better patient care, and the feelings of being burnt out slowly began to recede. You may not have to leave the ICU completely, but it may be time to leave THAT ICU.

I have worked in both teaching and non-teaching facilities. In fact, I just ended my job at one of the largest, and most prestigious, teaching hospitals in the country. What I found was that I had significantly more autonomy at non-teaching facilities than I did at the teaching hospital. In terms of physician relations, I had much better relations with my intensivists in the non-teaching hospital than I did with the two to three ACNPs, two residents, one to two fellows, and at least one attending that were constantly present in my ICU at the teaching hospital. Physicians consulted from other services darted in and out of the room without ever even acknowledging the bedside nurse, so I rarely even knew their names. I can say that the teaching hospital had a bigger focus on evidenced based practice (to a degree) than the non-teaching hospital did. However, a lot of the nurses in my ICU leveraged this as a tool they could use to brag, and it became a competition of who could throw the most impressive academic study in someone's face. At the non-teaching hospital, I felt like EBP was truly implemented to attempt to improve patient outcomes. In my ICU at the teaching hospital, I felt like EBP was a tool used to make oneself look intelligent, and put others down. I enjoyed the time I spent in the teaching hospital environment overall. However, I enjoyed the greater autonomy afforded to my nursing practice by working in a large non-teaching hospital. I also felt that the nurses in the non-teaching facility were friendlier, and that we worked more cohesively as a team. The poor attitudes of nursing staff most likely don't hold true of every department at the teaching hospital, but I have seen more rude, hateful, and arrogant attitudes than I have seen anything else.

I have a theory that it either gets better with time, or you get used to feeling so exhausted that it becomes your new normal. I'm not sure which end of the spectrum I'm at currently. I started my ICU career in a busy 32 bed MICU/sepsis unit. From there, I moved to neuro ICU, trauma ICU, surgical ICU, and burn ICU. After nearly three years in the critical care setting, I moved to the ED, and was a level one trauma nurse on night shift. Every ICU I worked in was incredibly high acuity, busy, and demanding. I often left work feeling like I had nothing left to give, whether that be physically, mentally, or emotionally. Trauma, I found, was no different, and, in some ways, was even worse. The ED never slows down, and it wasn't unusual to work 10-20 level one traumas each night. The tragedy, and constant scramble, that is trauma was also absolutely exhausting in every way possible. For me, the best thing to do is cluster my shifts. I have always been a night shift nurse, and there is nothing I hate more than not having my three or four nights in a row. I would rather come into my last night feeling exhausted than have only one day off, and spend it sleeping continuously. Another thing that helps me is staying on a consistent schedule. No, I don't always stay up all night, and sleep all day, on my days off, but I try not to swing wildly back and forth between a night shift and day shift schedule. I also try to make time for myself, and I no longer allow myself to feel guilty about it. If I'm exhausted, and I spend all day sleeping, or sitting on the couch reading/binging on TV, who cares? If my house isn't spotlessly clean, or I could stand to wash one load of laundry, so what? Sometimes you just have to take time for yourself. I also find that spending time with my family and friends helps tremendously.

I got the job in the MSICU at Centennial! I was called around two hours after the interview, and offered a night shift job, which I happily accepted. I was very impressed with the unit, and the staff that I spoke with, and I am very excited to get started. February 9th will be my first day, and I will do orientation Monday-Thursday. Friday will be my first time on the unit. I can't wait.

Twinsmom788, It's actually not Vanderbilt, although my room mate will be working as a new graduate nurse there.

I have about 1.5 years of experience as a float nurse working ICU, ED, telemetry, pediatrics, oncology, and neuro. I also have experience in crisis and inpatient psych, so I'm not starting out as a new grad in this unit (thank God). That being said, it's going to be a huge unit, and I am somewhat nervous, but incredibly excited. Good luck on your interview! Let us know how it goes. What type of setting are you interviewing for?

Last week, I travelled to Nashville, TN where I interviewed for a position in a 32 bed medical/surgical ICU. Approximately two hours following the conclusion of the interview, I got a call back, and was offered the job. I will be relocating to Nashville, and starting my new job, soon. I'm so excited! The unit is a mixed bag, and takes almost everything (save for post CABG patients). Primarily the unit deals with sepsis, especially in the oncology population (the medical center has a large oncology hospital), pneumonia, respiratory failure, and post cardiac arrest patients. Overdoses, hypotension, hypovolemic shock, extreme hypertension, some arrhythmias and heart blocks, therapeutic hypothermia, and many other diagnoses also populate the unit. The hospital also performs kidney transplants, among other organs, and my unit receives these patients. In addition, all general surgeries, trauma surgeries, vascular surgeries (carotids, AAA repairs, etc), large orthopedic and orthotrauma surgeries are received in my unit. We are also the overflow unit for neurotrauma/neurosurgical, so we sometimes receive patients who are postop with ICP bolts, ventriculostomies, and the works. Nurses run CVVH at the bedside, and the unit deals frequently with vents, A lines, central lines, PA lines, chest tubes, NG tubes, JP and hemovac drains, and Foleys. The nurse educator told me that they had seen and done everything in the MSICU (including delivering babies). I made a 95 (missed one) on the EKG quiz, and I feel that I have a solid understanding of basic, and many advanced, arrhythmias. I plan to study more on bundle branch blocks, heart blocks, ischemic changes, and the areas of the heart affected by various MIs. I already have a copy of Marino's The ICU Book, and I have made it a near constant source of review. Is there anything else I can do to review in the few short weeks before my job begins? From my understanding, the hospital will be offering critical care courses, and there will be a lot of personalized education (which I'm grateful for). However, I want to have as much of a jump on this as I can. This is going to be a serious unit.

Juan, I have also read that CVP measurement is not a highly reliable indicator of intravascular volume. Would it be safer to say that a PA line, and the numbers obtained from it, are better indicators of volume status, as well as the functional ability of the patient's heart? My current hospital does not utilize PA lines, but in the trauma center I spent some time in, we occasionally placed them before sending the patient to ICU or an outside hospital. Because of this, my exposure to them is limited at best.

Thank you for the great information! This was a right subclavian tripe lumen central venous catheter. I thought it was incredibly odd that the line wasn't in the right position for CVP measurement, yet no action was taken, and was still being used for vasoactives and parenteral feedings.

I feel like this is a really stupid question, but I'm going to ask it anyway (because you never learn if you never ask, and I really want to understand this). While floating in ICU, I was recently assisting with a patient who had metastatic cancer (started as breast cancer and metastasized to the brain and lungs). The patient suffered a perforated duodenal ulcer, and underwent surgery for this. Following surgery, the patient developed severe ARDS, and landed in ICU for several weeks. During her ICU stay, the patient had a central line and arterial line placed (she became severely hypotensive, and was placed on a Levophed drip). While transducing CVP and arterial waveforms and numbers, I noticed that the CVP numbers didn't match up with the rest of the clinical picture. Since I float, and ICU isn't my home unit, I'm not guaranteed to come back there. I kept up with the progress notes, and noted that the surgeon had written a note the next day stating "since the central line is not placed in the superior vena cava, we will no longer use it to obtain information regarding the CVP." I thought that the SVC was the termination point for central lines, and that this was basically a given. I could see that centrals might work in other locations, but I always thought that SVC placement was standard practice. Is it common to place a central in another location, and continue to use it? The line was never moved, and the patient was receiving Levophed, TPN, and Lipids through it. The surgeon never specified where exactly the line was, and I didn't have a chance to interact with either him or the ICU staff again while the patient was still in ICU. Just wondered if someone could shed some light on this issue. Thanks.

First, I would say consider if you really want to be a nurse or not. Nursing school is hard for everyone, and is harder for some than others. It's a very stressful time, and it's incredibly time consuming. You may not be able to spend as much time with your family, which may be a concern with your wife's pregnancy. Also, I would want to know that it was a good financial decision before starting the process. If you are convinced that nursing is something you want to do, and that you really care about the patient care aspect, then go for it. The aspiration to become an NP is great, but I don't think that nursing should simply be a means to an end. You will have to work as an RN, gain experience, and save up money prior to NP school, and it would be horrible to hate every minute of your job just because you eventually wanted to become an NP. In fact, I know a chiropractor (was in school with him) who is attempting to do this. He is an ED nurse in the ED I work in from time to time, and he seems greatly dissatisfied with what he is doing. I haven't come right out and asked, but he appears unhappy while at work. Also, most institutions that provide assistance require a commitment to work for a specified period of time, and sometimes this must be fulfilled prior to any tuition assistance that may be provided. While this is a great asset, it all goes back to whether you think you would enjoy the work you would be doing or not. If you feel like you would love nursing, I say go for it, and wish you the best of luck! I am also always around to offer any advice that I can!

That's how it is done at my hospital. If the patient is in restraints, I have always been told that the door must remain open. For some reason, seclusion generally isn't ordered at my facility. It tends to be that the patient begins escalating, staff attempts to calm them, medications are offered, and the patient escalates to the point of having to be restrained. I have only seen seclusion used one time. In the crisis ED, we have no seclusion room, and restraints are done inside the patient room, as there is no designated space for restrained patients.