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adventure_rn BSN

NICU, PICU
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adventure_rn is a BSN and specializes in NICU, PICU.

adventure_rn's Latest Activity

  1. May I kindly suggest that if you're so inflexible about following hospital policy, healthcare may not be the best fit for you. There are plenty of other professions that are a lot more lenient, but healthcare is pretty standardized; you either follow the rules, or you're labeled as difficult to work with and get fired. Even if you think the rules are frustrating or don't make sense, you've got to find a way to make it work. You may find more leniency at a small privately-owned clinics or LTC facilities, but hospitals (and their ICUs/ORs) are bureaucracies; even if you make a fuss, it's not likely to change anything.
  2. I mean, there's no harm in asking your manager. However, there's a real possibility that you'll get an answer that you don't like. Even if you disagree with the rules, you have to follow them regardless unless you want to get fired. This whole argument seems like a moot point.
  3. Even with the elastrometrics, there'd be no way to prove that you're replacing the filters at regular intervals, and I also wonder about the ability to thoroughly clean them between patients/rooms/days. Also want to add that it's wildly impractical to get your own PAPR. They are crazy expensive, the filters are crazy expensive, servicing them is crazy expensive. If you're caring for a COVID patient, you can definitely ask your manager if you can use the PAPR if it's available. However, highest priority would go to people who have failed their fit tests.
  4. adventure_rn

    FNP-CRNA

    To me, the main takeaway from this forum is that it's unproductive for direct NP programs to allow students to commit to professional roles that they have limited exposure to. One of the main benefits to PA programs is that they don't limit their graduates to a specific area of practice, so as the students can discern their interests as they go through the program (vs. pre-selecting them). In my experience, what I thought I wanted when I graduated nursing school has been vastly different from what I actually ended up enjoying. I think the main difference is that the people who practice in both roles already have previous experience in one of the roles; like you said, they start out with bedside RN experience, and then pursue NP work. It's way easier to maintain a full-time role and a separate PRN role when you already have experience in the PRN role. The OP comes to the table without any experience. They'd pretty much have to start a full-time NP job, do it for at least a few years until they're competent to drop it down to PRN status, then continue to pick up NP shifts while they start a full-time ICU RN job. Not only does that sound completely exhausting (especially since ICU can be so draining), but it doesn't seem like it would make the applicant a better candidate? I don't really see it as killing two birds with one stone.
  5. adventure_rn

    Calling out any exclusively NICU RNs who became CRNAs?

    I definitely don't recommend it (and have heard some horror stories about NICU nurses in CRNA programs), but..... If you're absolutely sure that you want to stay at your current hospital, your best option is probably CICU, if it's a high volume center that takes a lot of complex defects. NICU tends to do things very differently from adult ICUs (different pressors, different vent modes, etc.) Also, most NICUs work along a spectrum, where not every patient is super-sick--most function as a joint ICU/step-down/floor, where some shifts you take a vented 23-weeker, but other weeks you take a bunch of term kids who are learning to eat and about to go home. CICU tends to see a ton of fresh post-ops, and use way more vasoactive drips, paralytic drips, sedation drips, etc. The PCICU where I worked actually did bedside heart surgeries where the bedside nurses administered all of the 'anesthesia-type' meds instead of an actual anesthesiologist. The treatments/meds/vents/resuscitations are still quite different from the adult mentality, but they have much more overlap than NICU. Even by working in PCICU, I had a much better understanding of the CRNA/anesthesia role than I did in the NICU. That said, if you're feeling drawn to the NICU RN route, you may get into NICU and find you'd be interested in the neonatal NP (NNP) role. There is a huge shortage of NNPs right now since so many programs have closed, so they're quite well-paid. They get to work closely with families, and get a pretty good mix of excitement (crazy deliveries) and downtime. Downside is that NICU is your only practice setting, so that means throughout your career you'll have to take turns with your coworkers doing weekends and holidays.
  6. adventure_rn

    This is becoming boring

    Good for you! Versatility is part of what makes the nursing profession so awesome. People always say that money doesn't buy happiness--if your job is making you miserable, even if it's well-paid, it's totally OK to pivot and find something that you enjoy. Some people would be too afraid to walk away from the CRNA route due to the high pay, and I think is awesome that you're prioritizing doing what makes you happy. Keep us updated. 🙂
  7. @Davey Do you are a treasure. Please never leave us again!
  8. adventure_rn

    Working with an unlicensed RN

    I wonder if the regulations have been temporarily relaxed due to covid. My state temporarily extended the amount of time that a nurse could work as a 'graduate RN' since our testing centers were so backlogged, and people would have had to wait for several months before being able to work.
  9. adventure_rn

    Chaining Stopcocks instead of Y-Siting Multiple Lines?

    I appreciate that. You make a lot of great points, and it's clear that you've given this a lot of thought. It would be awesome if you could create a practice change on your unit (like I said, I think that the manifolds make a ton of sense.) Unfortunately, as you probably know, sometimes in healthcare the policy simply doesn't align with what makes the most sense. 😕
  10. adventure_rn

    Chaining Stopcocks instead of Y-Siting Multiple Lines?

    I think that manifolds (the pre-made multi-stopcocks) make the most sense in practice. All of my ICUs (NICU and PICU) have y-sited, and it can get really confusing really quickly. That said, I would not go rouge and start making DIY stopcock manifolds yourself. The unit practice is to use y-sites, and if people start using different practices (especially practices they haven't been trained on), there's a higher risk for error. IMO, there's probably also a higher risk for central line infection if you're stringing a bunch of stopcocks together rather than using a pre-made manifold, since each connection point between stopcocks poses a risk for bacterial entry (vs. a manifold, which is a single, plastic closed system). I could see you getting in trouble if you were to just start doing this, since it isn't in line with the unit policy/practice. The experienced people on the unit might also take offense if they think you're telling them that your way is superior to the way they've always done things (regardless of whether or not it is). If you really feel strongly about it, your best option is to bring it up to your unit leadership or practice committee. That said, it will probably take months to get it changed, if you can get support for it at all. Product supply chain changes can be difficult to enact, especially if the product is going to be more expensive than what they were previously using. For what it's worth, I never remove my drips from my y-sites even after they've been discontinued. I simply turn off the pump and clamp the line at the y-port, then stick a note on the pump saying it's clamped. That way you have a smaller risk of infection with a lower risk that you'll accidentally bolus something in the process of disconnecting the line, and the drip is still readily available if it turns out you need to turn it on again. Granted, that's always been my unit practice/policy.
  11. adventure_rn

    Posting Styles

    WOAH, @Davey Do is pulling out the old school insults!! Watch your language, sir! We have snowflakes who might get offended!
  12. adventure_rn

    Be honest, when do you start working on your CEUs?

    LOL, mine is probably the weirdest. Two of my three specialty certifications (neonatal CCRN and peds CCRN) must be renewed every three years, and they each require 100 hours of CEUs. When you renew your CCRN certification, it's cheaper to buy an AACN membership and renew as a member than it is as a non-member. As a member you have access to their CEU library, which has over 400 free CEUs. Whenever my renewal comes due, I buy an AACN membership, renew all of my specialty certs at the same time, and then knock out 100+ CEUs in the next 3 months while my AACN membership is still active and I can get free classes. I only renew my AACN membership every third year when my certification renewals are due, so I have to complete all of my 100 CEUs during that year. It boils down to a rotating 3-year cycle where I do 100+ hours over the course of three months, then don't need to do any CEUs for two and a half years (besides random classes at work). I figure that way, if I get audited for my CCRNs, all of my CEUs will come from the organization itself, and they already have a transcript of my classes. That way, I won't have to track down 100 separate credit hours worth of random CEU certificates. Plus, it's really cost-effective, since I pay for the AACN membership every third year, anyway.
  13. adventure_rn

    Types of Encephalopathy | Knowledge Brush-Up

    Kernicterus, aka bilirubin encephalopathy. It occurs in newborns, and results from high unconjugated bilirubin levels (20+). It's technically considered a "never event," like wrong site surgery, since all babies should be routinely screened for jaundice and hyperbilirubinemia. If untreated, it can cause cerebral palsy, hearing loss, seizures, and death. The biggest risk factor is an ABO or Rh blood type incompatibility between mom and baby, where the mom's ABO/Rh antibodies attack the baby's blood cells and cause profound hemolytic anemia. We usually treat hyperbili by laying the babies under bright blue phototherapy lights, which look just like baby tanning beds. If the baby's bilirubin levels are still high despite phototheraphy, we'll perform an exchange transfusion where we remove all of the baby's blood and replace it with new, transfused whole blood. On autopsy, the brains of babies with kernicterus are stained a jaundicey-yellow color.
  14. adventure_rn

    Decisions...Decisions

    IMO, it kind of depends on what type of graduate program you want to do, and what you're interested in. I'm kind of surprised that you're leaving peds CTICU for adults. The only people on my unit who left peds CTICU for adults only did so to apply for CRNA school. You might get better feedback about the differences between the three units you listed by posting in the critical care or ICU specialty forums. https://allnurses.com/nursing-specialties-c1/
  15. adventure_rn

    NICU Nurses who use NIRS?

    I've only ever seen them used in PICU. Once in a blue moon, we'll put them on a term baby awaiting a transfer to PICU. In my opinion, the biggest barrier to use in NICU would be skin integrity. NIRS are so sticky (and so expensive) that they're designed to stay on for 24-48 hours at a time, and can't be routinely rotated. It makes sense that they have to be super-sticky since they're applied to a flat surface can't be wrapped circumferentially, like a pulse ox. With most preemies, if you left on a NIRS for more than about six hours, they'd start to experience skin breakdown. They'd be at especially high risk for breakdown if they had pressure on the probe, like laying on top of flank NIRS or wearing a CPAP hat over cerebral NIRS. They're so sticky that routine removal and replacement would probably cause even worse skin breakdown (much like when we remove EKG leads). You'd have to use an adhesive removal wipe, which would destroy the integrity of the probe. In preemies, I also wonder whether or not the trends would be very helpful? Unlike peds patients, whose vitals are generally a bit more consistent, many preemies are prone to frequent brady/desat spells. It might be hard to trend NIRS on kids whose vitals are so labile. Maybe you'd find the them in big, stand-alone children's hospitals that don't have their own OB/delivery services; they'd have kids who are sick enough to need NIRS, and tend to have very few micropreemies. Let us know if you find some. I'm curious to hear other practices.
  16. adventure_rn

    Pediatric CCRN

    I passed! I used the AACN review module and practice question bank, and supplemented with the AACN Core Curriculum textbook. I didn't feel great about it going in (the practice questions were hard!), but the test actually went really well. I had a harder time than expected registering, though. 😕 The dates I wanted were readily available (I was able to schedule as early as two weeks out), but the registration process was a mess. The online system kept locking me out from registering at my preferred testing center, and gave me a message to call the office. I called as soon as they opened, and still had to wait on hold for over an hour to get my exam scheduled. Two weeks before my exam date, I got an email saying that my exam had been cancelled due to covid, and I had to reschedule. Again, I got locked out of the online system, and again, I had to wait on hold for over an hour to reschedule; the second time around, the hold system actually hung up on me because there were too many callers and told me to try later (even though I'd already been on hold for half an hour). Fortunately I only had to push my exam back by one day, but I did have to change my work schedule around this week. I'm just so glad it's over with, because I was worried that they'd cancel my exam again due to further covid restrictions. What a mess.