CarpeDiem'15

I attended an information session yesterday with the director of UMD's Anesthesia program, and he stated that their admissions committee DOES look at schools when considering GPAs of applicants. Basically, a GPA of 3.9 from an easier program will NOT be looked on as favorably as a GPA of 3.4 from a harder program.

Thanks for the advice, I appreciate that both of you took the time to respond! :)

So.... I'm currently finishing up my 13-month ABSN at Hopkins. It was absolutely the best decision to attend here and worth every penny. I've been able to learn from amazing instructors and professors who are literally at the top of the nursing field, and my classmates... gosh, where do I start? They are some of the most brilliant, down-to-earth and caring individuals I have ever come across, and I know they are going to rock their patients' and inter/intra-professional colleagues' worlds once they start working at whichever institutions are lucky enough to get them! :) I was able to participate in research, and my professor who's project I was working on actually presented my paper at a conference she was attending earlier this year! I've landed a job prior to graduation (which will be in about 50 something days, woohooo!!) at the CVSICU in my dream hospital, which I am so incredibly thankful for. Most of my cohort has actually been offered jobs prior to graduation. My end goal is to become a CRNA, and I know that my time here in THIS particular ABSN has opened doors for me that will prove quite invaluable! All of that said, I won't lie. This has been one tough year, especially since I'm doing this with kids, and I really needed to bring my A-game to do well. But like you, this is my second career. I live in a super-saturated area where competition is pretty fierce for new-grad acute care positions, and I knew I wanted to place myself in a position where I would be able to reap the most opportunities and benefits (both tangible and intangible, like the Hopkins alumni network and also the networks I've made with my professors and clinical instructors who can open doors for me later on down the road).

If you are truly interested in research, you should look into eventually pursuing a PhD in nursing. These PhD programs actually pay YOU to attend their programs!

Many in my cohort also have jobs, and we graduate at the end of July. I received a job offer in the CVSICU at my dream hospital, pending successful graduation and passing of the NCLEX.

ABSN is actually for students who already have an undergraduate degree in any field OTHER than nursing. So students with BS/BA in literature, history, biology, psychology, or even computer science (like me) would be able to enter ABSN programs.

Three years is a very long time to be in school for your BSN when you've got 3+ kids, more so if there's also a chance that you may want to go on to pursue advanced degrees in nursing. I would say to go with Linfield. I am currently finishing up a 13-month ABSN at Hopkins, I have four children and I went through 10 of these almost 13 months doing this without my husband. He's with the State Department, and was finishing up his overseas assignment. I won't lie, this was one of the hardest years of my life, but it was all worth it. Your support system WILL make or break you. In my case, my network consisted of my in-laws, my parents, and my brother and his wife who all chipped in to help watch the kids and let me focus on my studies. You and your family will have to make sacrifices, but it's easier to do when you have a definite end-goal of 15 months, versus long-term of 3 years. If I'm going to have to go through the pain, I'm the type of person who'd rather take it all at once and get it over as quickly as possible! Best of luck with your nursing journey!

Bump... Anybody??

I will be a new grad at the end of July (God-willing!), and have been offered a position at the CVSICU in my dream hospital. I'm beyond excited and totally geeked out, but at the same I'm a little nervous about my first 6 months (heck, let's make it 1 year) on the job. I'd like to ask any and all experienced CVSICU nurses on this forum to feel free to share your experiences / wisdom / advice for how you survived (and thrived) during your first time in a CVSICU.

Many large teaching hospitals offer shadowing opportunities with their CRNAs. If you live in / near Baltimore MD, the Johns Hopkins Hospital has a shadowing program for high-school juniors and seniors to shadow their CRNAs for half a day. Message me if you're interested, and I can give you the contact information for the CNRA-shadow program coordinator at the JHH. Otherwise, look into what opportunities are available at the closest teaching hospital near where you live. I have personally shadowed several CRNAs and found the experience invaluable. You can ask them all the questions you like in person, and receive a lot of good advice on how to proceed in your academic career towards a CRNA degree. You've got a good head on your shoulders, you're taking the right steps by researching your career options early, and your desire to help your family is admirable. Best of luck in all your endeavors!

Based off the ABGs, I would definitely say the patient was showing respiratory alkalosis. The patient must have had an episode of hyperventilation at some point prior to the blood draw. I need more info about the patient though to reason through why he/she was hyperventilating. The location of the CVA within the brain is a big determinant of how it affects respirations, so it would be nice to have some more info about the actual CVA (bilateral? mid-brain? low pons? medulla? upper pontie tegmentum?). Based off the fact that this patient has a near-normal paO2, I'm suspecting central neurogenic hyperventilation. The low RR is probably from the low paCO2 reflexively decreasing respirations via chemoreceptor inhibitory input into the patient's respiratory center. What were the patient's respiratory patterns like? Were they regular? If the patient had periods of apnea followed by clustered breathing (hyperventilatory pattern), that could also explain the low paCO2 and the mildly hypoxemic paO2....

If you haven't charted, you haven't done it. I get that. But I personally think it's a two way street: if you haven't done it, don't chart it! I totally agree with the OP that if you aren't going to give meds at that point in time, then don't prescan them and sign off that you have. And OP had a totally valid concern with the patient's reduced urine output, it's clear she was suspecting patient may be having contrast-induced nephropathy (and it didn't help patient was on vancomycin which also has potential for nephrotoxicity) based off increasing SCr, BUN levels and decreasing GFR + patient's self-reported assessments of urine frequency 24-hours post IV contrast. OP, only thing I can say is that there was nothing wrong with the contents of your thought processes or complaints with your preceptor's shortcuts. Maybe there was a different way you could have gone about getting those heard (soft-skills like rephrasing questions another way, etc), but honestly I don't see anything you've done that merits you being fired!

^^ THAT makes my blood boil! It's damn depressing and a shame that we have to live in a society where businesses/policies/economies are contingent on the suffering of our fellow man. But this makes me all the more determined to do something about this as a nurse, from making sure that my patients follow preventative care measures to being actively involved in public health policy making that will help increase access to preventative care. Fire's lit in my belly!!!

Oh, forgot to include the link for this little nugget: http://www.rcjournal.com/cpgs/pdf/06.10.0758.pdf --> these are guidelines published by the American Association of Respiratory Care, and it advocates hyperoxygenating patients pior-during-post suctioning. This applies especially to patients that may be hypoxemic / hypercapnic going into suctioning, which are basically your COPD patients.

This is indeed an interesting discussion! I haven't covered peds yet, so this information is definitely good to know for future reference when I do start learning about pediatric nursing care. I'l make sure to circle back to this thread when/if I learn something different to what was posted. I think the key aspect of everything is that not all patients are the same, and as nurses, we have to integrate our critical thinking skills, patient's specific needs, and the evidence-based research to provide optimal care individualized for the patient. That said, when it comes to the adult patient population, here are a couple of EB research articles supporting hyperoxygenation during suctioning: Updating the evidence base for suctioning adult patients: A systematic review Tracheostomy care: An evidence-based guide to suctioning and dressing changes - American Nurse Today Medscape: Medscape Access And these next two studies were interesting (albeit done in 2002 and 2004, respectively), because they found that many of their subject nurses did not know best practices for suctioning, or were using dangerous techniques.. and also disturbing was that it found no significant relationships between knowledge and practice (e.g. nurses were not doing what they knew they should have been doing) Tracheal suctioning: an exploration of nurses' knowledge and competence in acute and high dependency ward areas. - PubMed - NCBI [Assessment of practice competence and scientific knowledge of ICU nurses in the tracheal suctioning]. - PubMed - NCBI