JonSnowedSRNA

Yes INDEED! BigPappa has hit the nail on the head. Chill out and drink some beer and breath. Breath... Offer your classmates an enema because they are full of ****. When people aren't confident they feel the need to act like they never struggle...they lie. -Clinical 2 days a week is nothing. You often forget what you learned the next time you are in clinical. Also, this is your first semester. You need at least 100 intubations to feel comfortable. Once you are in clinical more regularly, you will begin to put things together. -You have a good point about nerves and performance, they definitely play a major role. Mike Tyson said everyone has a game plan until they get hit in the face. That being said, yes you still have some skills as an ICU nurse, but anesthesia is a COMPLETELY different discipline. There are so many things like timing, flow, etc that you cannot learn in the classroom. Try learning some breathing techniques to relax before stressful procedures. As someone mentioned the Emcrit episode is awesome. -So timeline of where you are at: You are I'm sure further along now and hopefully putting things together. Just relax and know that everyone has struffles just keep getting better everyday

Great advice! I am not yet attending, but everyone I spoke with said go as soon as possible. There was not one person who recommended more ICU experience. As someone previously stated you are not going to school to become a better ICU nurse. Also as it's obvious the more challenging aspect of being SRNA is time management and balancing the school work. Best wishes to everyone and thanks so much for everyone's input.

Go to emcrit.com and watch these 2 videos/ podcast. The first is called "dominating the vent" and there is a part 1 and 2. The second is called "vasopressor basics". Watch them both at least 3 times a week each. Understand basics of ABGs and Vent status to correct ABGs. Know these following things pretty well: 1. What resp distress looks like 2. Treat pt not monitor, vital signs are often a late sign of crap going bad 3. Adding on to number 2, screw the monitors how does the pt look? Are they about to take a stroll through the zoo or do they look like they ate some really bad Mexican food in Mexico and washed it down with some warm Mexican tap water 4. Know sepsis 5. Know DKA. 6. Know ARDs 7. Watch every line that you have things going through regularly. 8. Know your A&P. Best wishes

ICUFAQS.org I believe or .com. Also "emcrit.org or .com haha. Also, the emcrit podcast. Look up a lecture called "dominating the vent 1 and 2" I listen to these at least once a month. Also "vasopressor basics" that should do you well for a while. Everything you touch in ICU is powerful meds/machines and patient population is much more sensitive to everything physiologically so when in DOUBT DONT just ask. ALSO never flush a line that you don't know what was infusing in it. Blessings on your new step. The ICU is awesome and very rewarding. Learn something everyday.

Everyone's coming in with "sepsis" these days . Pt tachy 114, SBP 88 sepsis. Early recognition most definitely saves lives, but often times formulas and protocols remove common sense and actually looking at the patient at bedside. I wise healthcare provider knows when to use formulas / protocols and when not to. Recently heard a study quoted that looked at ACS EBP. They looked at the definitive study for things live heparin or aspirin admin in ACS and the average length of time is took from the publication of the study to implementation by 75 and 90 % of hospitals and for guidelines to be published. This is staggering but it took and average of 16 years from the time of the definitive publication to implementation. That gap is too big and I'm afraid many of our protocols fall into things like that "well this is the protocol, this is how we do it here". BUT WHY?

Hi everyone. I had a patient recently in ICU GI bleed attempted fix in OR, 2 years post liver transplant, hep C, ESRD. Patient came back from exp lap surgery 3 am(stitched a bleeding area). Had dialysis 4L off during day shift, along with many loose dark stools. H&H 11/33 appx at 3pm. 11pm that night H&H 8/24. Only IV fluids are Levo and prograf. Some MDs were concerned with another active bleed. Surgeon in AM was not impressed and though H&H drop was due to fluid shifts. I admit fluids and renal are a weak point, but can someone explain this or post an article that addresses dialysis affecting H&H like this? Thanks in advance.

The OP did not ask about "warnings" they asked about the last situation and that only. They owned up to the first 2 and to bring them up again to say she deserved them or such is unnecessary, she knows she deserved the first two. They only were asking about the last situation. It's simply my opinion that many of the responses on here could of been handled with a bit more understanding and grace. Nothing wrong with saying the third offense was warranted. To be quick to mention comment on a fault of someone without offering some advice or encouragement seems to be a bit harsh to me. We all have had moments in school where we were terrified and doubted ourself, felt stupid and needed encouragement. Once again this is simply my opinion. I have noticed in my career there are 2 very general philosophies of nurses. Those who believe nursing is like the marine core hell week and we should make it as tough as possible and drive people till they break, because after all if they can't make it in school they will never make it in the "real world". Secondly there are those with the heart of a teacher that will take patient safety serious yet offer encouragement to people as they struggle. Sometimes people need an "attaboy" you can do it. As a side not I'm not gonna call out individual posters and tell them that their post was rude or wrong. I believe I can state the atmosphere of a thread with out calling names, which I've noticed usually does nothing beneficial for anyone involved. Take care all, I truly believe this thread is filled with awesome nurses who have only the best of intentions, just may have different ways of expressing it. :)

Perfect way to express idea about the OP's question regarding the THIRD situation while offering encouragement to a nursing student. The OP owned up to first 2 situations and admitted it was their fault, so there is no need to address the first two as many have done. Thanks for being a light and encouragement to people. We were all there at once

I am not so much referring to the clinics instructor as much as I am the way people react on here. There is a way of saying something without completely being degrading about it regardless of the fault of the person involved. As I stated in a previous post. Was the OP unprepared, of course they were. Could they have prepared better or course. However do we know exactly what type of preceptor they have? Do we know what the of prior clinical experience this person has? Do we really know any other details? No. Bottom line, they forgot some stuff and froze up first time during patient care. No one was injured and it was a mild mistake. Everyone one of my classmates got spoken to numerous times in clinical and received warnings, this instructor was clearly unprofessional in murmurous ways and later was almost booted out of the program due to her incompetence as an instructor. If this person deserves the verbal lashing that so many have dished out than in sorry for my post. People say thing online that they would never say in person.

You said it soo perfectly. We are one of the few professions that eat our young soo quickly. We all forget the struggle that nursing school was. Like we have never done anything wrong or not known something.

Hey bro a couple things to think about. Number 1 you have to have tough skin as a nurse and sometimes nursing instructors can be absolutely ridiculous. Number 2 and this is a freebie, First impressions last". Meaning the first impression you give someone will stay with them and you will most likely be judged by it. Unless everyone else in your class forgot to bring their stuff and show up for class than the instructions were fairly communicated you just didn't pay attention to them. So in her eyes you are someone who is lazy and does not take this seriously. Once again probably not the case but unfortunately in life you often get only a few times to make your mark on someone. To remedy this you probably should just apologize to her for the mistakes you have made and just say that you are trying harder. To all the people saying this and that about someone being 3rd or fourth semester should know their way around IVs and such. Now I know we would al like to think that all nursing schools are created equa but they are not and this is a huge problem with nursing education today. For example we had a 5 semester program: 1 semester we have no clinicals, 2 semester we are nursing assistants pretty much MAYBE AND I MEAN MAYBE give 1 or 2 oral meds, 3 semester we were thrown into medsurg taking 3 patient will all the paper work and pushing IV meds. This has since been reevaluated after myself and a few others have brought it up. BUT for its unfair to slam someone who has maybe never worked with IVs and has limited experience in a hospital to question what would seem like such a routine procedure, don't forget where you come from. Actually I give you props for doing nothing and freezing up instead of just doing something you didn't know how to do. I have seen many a new nurse not know how to do a procedure and just do it anyway. Look over all relax its not the end of the world, study learn stuff that's important try to prepare your best for clinicals, ask questions t nurses in clinicals that will answer and hang in there. You certainly messed yourself up in the beginning but it's not the end of the world. Don't fight it, you probably won't win, just suck it up and try to put your best foot forward.

There are so many things I would like to say but for the sake of people being easily offended i will say it nicely. Man up. First of all if you come in in a car crash or accident you are getting naked... Completely naked. Not in front of everyone but at least me so I can see that you dont have a rib or bone poking out. Also like one poster said how do you listen to heart or lung sounds in female patients who have large breast? do you get someone else to do your assessment for you each time and then do you get them to chart it ? Additionally after your female patient has their foley do you always have another nurse do your site checks to make sure there is no bleeding involved or discharge? Also when you get an admit do you not strip them down to make sure there are no preexisting wounds or sores that your hospital does not foot the bill for? Or more importantly that their wounds are not getting worse? When you assume care for a patient the first time do you not also do a full head to toe to make sure they do not have wounds? This attitude or stance simply does not fly nor is it practically in almost every nursing setting. There are some settings such as a clinic or something similar where this may work, but by and large it doesn't. I am a male nurse i see male body parts and female body parts regularly. I know it, my wife knows it and my coworker knows it. I can count on a hand the number of times a female patient refused any sort of care. I have worked in OB settings. Also ive never had a husband or male family member say anything and i have worked with younger patients my own age and younger, im 32. I would also like to add that there are tasteful ways to perform complete patient care on the opposite sex without making anyone uncomfortable. I would also like to add here that I am straight and I am attracted to the female form ( my wife's), I have never had one sexual or off thought EVER while attending to a patient. What if female nurses didnt care for male patients, as you see his could never work out. If you are a fire fighter you put out fires, if you are geico you save people money, if you are a male nurse you see female body parts. Its what you do. One last thing as a bit of a career advice if you ever worked at a place where they gave you the job without an interview, everyone else you are working with didnt get an interview either. These may not be the most competent co workers. Anyway my friend I wish you the best and say all of this only to add a viewpoint to this discussion, take care and God bless.