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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. adventure_rn

    new job, new pay?

    If you're applying for typical hospital bedside positions, they'll probably have a pay scale in place which they may not be willing to deviate from. I'd guess you could try to take whatever base salary they offer and ask for a dollar or two more an hour, but I wouldn't get your hopes up. You may have more success trying to negotiate a signing bonus given that you come with experience.
  2. I do agree with other posters that at the core, you need to solve the staffing issue via hiring and retention. I also think you need to set boundaries: If you're short enough that you're regularly being pulled into bedside care, you need to be using travelers; however, nobody is going to think that travelers are justified if you're willing to come in any time, any day. You need to set the precedent that you getting pulled into staffing is the exception, not the norm. Once people start to expect that you're available all of the time (like you did in your last job), it's really hard to rein it back in; I think it will be easier if you to set those boundaries from the beginning at your new job. I get that you want your staff to feel supported; however, it will be worse for them in the long-term if their management turnover is really high. I'm not sure if this is feasible (because it's quite expensive), but something that has worked in my last two units is to create the position of Clinical Leads who function kind of like assistant managers. They assume certain management tasks (like staffing/scheduling, managing certain committees, etc.), but they also have clinical time (i.e. at least one shift per pay period where they have to be in charge). That way, if we're critically short-staffed, they get pulled out of administrative time instead of pulling away the actual manager. I almost think of it like they're delegating the 'jumping in at the bedside' task to somebody who is still on the 'leadership team,' but has more time to do it. I feel like it works well because it does seem as though management has our back, and it still makes it feel as though our management team is still accessible (since we work with those Clinical Leads quite often). For reference, my last unit with 80 core staff had two Clinical Leads (one day and one night), and my current unit with 250 core staff has six (four day and two night).
  3. adventure_rn

    Why bedside nursing didn't work for me....

    I agree that bedside nursing isn't for everyone, and that the 'one year of med-surg' isn't necessarily the best case for all people in all situations. However, I do think it's important for new grads to be informed about how starting their career 'non-bedside' role can seriously limit their future job opportunities should they ever decide that they want to try acute care. It's incredibly difficult for people with no 'bedside' experience to get acute care jobs later on since they no longer qualify for new grad residency programs. There are people on this site every day venting about how they started their nursing careers outside of the hospital, and now they can't find a way in. The truth is, nursing is a vast field, and you probably won't know what you want when you start (or you may think you know what you want and discover that you're completely wrong). The 'one year of acute care' rule doesn't necessarily make you a stronger nurse, and it isn't necessarily the right fit for everyone, but it does open a lot of doors down the road. I'd still recommend that new grads consider completing at least a year of acute care right out of school if for no other reason than it will give them the most options as they discern their interests and career goals.
  4. adventure_rn

    ETT Epi

    Ahh, @babyNP., I'm so glad you responded!! (I almost tagged you in the initial post so you'd see it, but I thought that might be too pushy...) What you're saying makes so much sense. It does make me wonder if we'll ever get to a point where ETT epi is no longer recommended. My thought is that even if most kids don't develop PPHN, the kids who are sick enough to actually require epi and compressions in the DR are probably quite acidotic and (initially) poorly ventilated, which sets you up for PPHN (i.e. the HIE cooling kids). It seems like ETT epi could help push them over the edge to PPHN, and even if the epi 'wears off' that doesn't necessarily mean that the pulmonary vascular bed will stop 'clamping down' right away. I agree that there should be a much bigger emphasis on ensuring effective ventilation before jumping to compressions, especially in the DR. My current institution seems like they're pushing to try to start compressions sooner rather than later, which seems like it isn't exactly well-aligned with NRP. Part of the challenge is that we're a large Children's Hospital with kids who stay for months and months, so the providers are trying to figure out when and how to incorporate PALS for codes in older kids (not in the delivery room). PALS begins chest compressions and epi pretty much immediately; however, ETT epi doesn't even exist in PALS (I tried to explain ETT epi to my old PICU coworkers, and they thought I was nuts). I feel like sometimes the providers draw from little bits and pieces of NRP and PALS, and it doesn't make for the most unified code.
  5. adventure_rn

    Tampa to Sacramento Nursing move. Is it worth it?

    I had literally the exact same thought about a year after I became a nurse, and I researched this extensively. Yes, Sacramento has some of the best nursing salaries in the country relative to cost of living (Phoenix is also pretty high up there because the cost of living is way lower). Yes, the cost of living is higher in Sacramento than Tampa (especially the state taxes and housing prices), but it's offset by the fact that many Sacramento hospitals share the same union contract as San Fransisco hospitals, so you make San Francisco pay on a Sacramento budget. However, the trade off is have you have to live in Sacramento (I'm only kind of joking). Take it from somebody who moved cross-country for a nursing job; moving to a place where you have no friends, no family, and no history can be incredibly lonely. I moved back home in less than two years, and the city I moved cross-country to live in was amazing (incredible outdoor activities, world-renowned museums, fabulous restaurants and nightlife). Sacramento is like a strip mall in the desert (sorry Sacramento...) Also, if you get all the way out there and realize it isn't what you hoped for, it's ridiculously expensive move back and forth (again, speaking from experience). However, you may have better luck than I did if you're taking a partner/spouse along with you or if you're extremely extroverted and will consistently put in the effort to plant roots. I second the idea that you take some travel assignments out that way to ensure you'll actually like it before you schlep your whole life cross-country; I really wish I'd done it that way, since it would have been way easier and a heck of a lot cheaper. Honestly, you'll make even more money doing it that way than moving outright. Also, be aware that sometimes Sacramento nursing jobs can be tough to come by considering the high salary and low cost of living. Just because you've got experience doesn't mean that you'll necessarily get hired right away. Traveling could help you make some connections.
  6. adventure_rn

    How soon did you move out after graduating (BSN)?

    It's such a personal decision (no two people are the same...) but here's my two cents. First, I think it's wise to rent in an area before you commit to a house. Renting allows you to try out different things and places before you make a huge, life-altering commitment. What if you buy a house near your current hospital, and it turns out that you absolutely hate working at that hospital? Are you going to want/need to move again after a year if you relocate to a different job? If you're looking to buy in an area that's reasonably close to where you live, then I think that's more understandable. However, if you're moving to a new region (or even a new part of town), it can help to rent in order to get a feel for the different neighborhoods and whether you'd want to live there permanently. I'm also of the opinion that your first year of nursing is challenging enough to begin with, so why add any extra unnecessary stress (including the stress of home ownership) into your personal life? Regardless of what you decide, I'd highly recommend waiting to rent or buy until after you start your new job if possible. When you're first starting out, it can be really hard to get a sense for exactly what your take-home pay will look like. Yes, you know your base salary; however, your deductions (taxes, health insurance, retirement, parking, union dues) can quickly put a dent in your take-home pay. For instance, my gross bi-weekly pay comes out to about $2800, but my take-home after deductions is only about $1700; that's over $1,000 less per paycheck than you'd expected if you only accounted for base salary and differentials. It may be helpful to spend a few months creating a budget based on your actual take-home and expenses so you know how much home you can afford. I think your idea of staying with your family for at least a few more months is very smart. I'm sorry about your situation with your mom. I'm sure it's frustrating feeling you have to be the parent in the relationship. Best of luck whatever you decide.
  7. adventure_rn

    Can an FNP work with just pediatrics?

    I could see working in a peds primary care setting, but you probably won’t have any luck working in a specialty practice type setting without going back for your PNP (unless you have extensive peds experience as an RN and very good connections). Many peds disease processes are radically different from adult disease disease processes, so I don’t think you’d have much luck finding specialty clinic peds jobs (even if they’re strictly outpatient), especially if you’re competing against PNPs. Having several years of peds experience while you complete your FNP would definitely strengthen your application. I have to ask—if you want to work with peds, why not just become a PNP? I have worked with peds nurses who got an FNP instead of a PNP, and they found that it did limit their peds-specific job prospects... In addition, if you’re between a peds inpatient vs peds clinic jobs, I think that inpatient would be far more valuable for the NP track (even if you want to work outpatient as an NP). Inpatient exposes you to abnormal assessment findings so you recognize them when you see them (vs outpatient, where you primarily see normal assessments).
  8. adventure_rn

    5 8s, no thanks!

    I agree. As a new grad, you'll probably just have to take what you can get. As another poster pointed out, 30 hours a week isn't truly full-time, even though you're eligible for benefits. You may find that there are barriers to starting out as a 0.75 FTE employee. On AN, we're always encouraging people to start at true 'full time' before pulling back on your hours in order to maximize your learning opportunities in your first year; hence the reason why most jobs (RN or NP) won't let you start out part-time. In addition, you may have a harder time finding a new grad job that will let you work 30 hours a week depending on the competitiveness of your job market. It is going to be very expensive for your new employer to train you (arguably far more expensive than it would be to train a new grad RN, which costs $50,000+). It's in your employers' best interest to make you work as many hours as possible (milking the most profit from you), especially if they're paying for your benefits. You'll be in a much better position to negotiate 30 hour work weeks once you have experience, but starting out, that could be a very hard sell.
  9. adventure_rn

    ETT Epi

    I have a random question about the physiology of ETT epi, and I'm wondering if you lovely folks (especially the providers) can help me out. I meant to ask in my NRP renewal last week but forgot... The goal of transition is to decrease pulmonary vascular resistance and increase systemic vascular resistance. Epi is a profound vasoconstrictor. I understand that, theoretically, ETT epi should be absorbed into systemic circulation; however, if your kid is so sick in the DR that they need compressions and epi, they're going to be at very high risk for PPHN. It seems like the last thing you'd want to do to a high-risk PPHN kid during transition is to sprinkle their lungs with a vasoconstrictor... Especially when the actual treatment for severe PPHN is inhaled nitric as a selective pulmonary vasodilator and systemic pressors (up to and including epi) for systemic vasoconstriction in order to compete with and overcome super high PVR... ETT epi is the literal exact opposite of that. I understand that ETT epi is relatively ineffective, that absorption can be hit-or-miss, and that we only give it as a last-ditch effort while we're trying to establish IV access. In theory, I get the idea that 'some epi is better than no epi' when you're profoundly bradycardic, and that you're in dire straits if you're giving ETT epi at all. However, physiologically, putting epi in the pulmonary vascular bed during transition seems like it would make the problem so much worse instead of making it better. Isn't ETT epi just going to throw fuel onto the dumpster fire that is PPHN? Thoughts?
  10. adventure_rn

    NP vs FNP

    To clarify, there is no such distinction as 'NP vs. FNP.' That's like asking, 'Should I be a doctor or a pediatrician?' Nurse Practitioners are the overarching role, and FNPs are a type of NP. Therefore, an FNP is an NP. NPs in every specialty category (adult acute care, family, etc.) are all considered 'NPs.' I only want to specify because at first glance your question is very confusing. You mention in the middle that you're interested in acute care; therefore, the real question is 'Acute Care NP vs. FNP,' not 'NP vs. FNP.' As an FYI, adult acute care NPs are sometimes abbreviated as AGACNPs (Adult/Gero Acute Care NPs). As for acute care NP vs. FNP roles, the biggest distinction IMO is that acute care can work in hospital settings, whereas FNPs (and primary care adult NPs) technically aren't supposed to under the Consensus Model, although it does happen. FNPs do more outpatient, primary care, clinic type work for patients with stable conditions, whereas acute care NPs have patients with acute illness (obviously). In addition, FNPs can see patients of all ages (peds and adults), whereas adult acute care and adult primary care NPs can only see adults. While researching your options, you could also consider adult primary care NP programs as a third alternative. You may get more helpful answers in the Nurse Practitioner forum on the specialties page. However, like I said, make sure to clarify that you're asking about acute care NP programs...
  11. adventure_rn

    Immunocompromised Loved One

    Honestly, I think that the common areas of the hospital (elevators, cafeteria, lobbies) are so much more gross than iso rooms. Patients in iso are confined to iso, with tons of precautions. However, patients on isolation have family members who come and go as they please, taking the patient's belongings to and from home, not always abiding by the isolation precautions the hospital puts into place. If your c diff patient's wife visits daily, who is to say that she'll diligently wash her hands before taking the elevator down to the cafeteria (and how often are the elevator buttons, bathroom door handles, or cafeteria tables ever disinfected...)? Even nurses' stations can get pretty grody, since how often do people sani-wipe those work stations? I agree that it's unrealistic to expect never to be put in iso rooms. Even pregnant women are only restricted from a few different types of pathogens (like CMV, HSV and varicella), and their condition is time-limited. In addition, labor laws protect pregnant women against discrimination by their employers, but that wouldn't extend to significant others. Also, as others have pointed out, you often don't know a patient is sick until after the fact; it's totally possible that your patient will be put on droplet for flu after you've already provided several days worth of care without the benefit of your iso garb. If you're super worried about it, your best bet might be to seek employment in units that are hyper-cautious about infection prevention. One that comes to mind is bone marrow transplant; their patients are severely immunocompromised, so all of those patients are on protective isolation and they take significant precautions to prevent infection. Sick family members rarely visit because they understand that an infection could kill their loved ones. NICU also tends to have relatively low infection rates, as the kids have never been outside of the hospital, and most people know enough not to visit if they're sick. OR might be another low-risk choice given the sterility considerations. Just a thought...
  12. It sucks that the oncoming nurse handled the issue in that manner. Honestly, I do think that report is a great learning opportunity for newer nurses; it can be helpful for someone coming behind you to mention if they see something that you could do to improve (whether it's related to following a policy or a nursing judgment call). If I'm doing something wrong (or even if my action wasn't 'wrong,' but could be done better), I'd rather have the on-coming nurse mention it than not know at all. Unfortunately, some nurses who do this are entirely tactless, and make the off-going nurse feel like an idiot. That sucks because a) it's rude, b) it affects the confidence of newer nurses, and c) it undermines the learning experience. What I mean to say is this: even though the nurse was a jerk, try to re-frame this as a learning opportunity. It's possible that you didn't do anything wrong. However, there are a handful of things that you could do differently in case you experience this again. First: investigate whether or not you have a policy or standard of care about this issue. As you've seen from the responses so far, some units might call this a rapid response situation, while others think nothing of it. Second: as @lifeatthebluffs said, if you're ever in a similar situation again, always always always try to remember to ask the provider at what point they want you to notify them again (i.e. systolic > 200? a change in symptoms?) This covers you in several ways. First, if something goes wrong with the patient, you'll cover your butt. Second, if your jerky coworker gives you a hard time, you can respond that the provider only wanted to be notified for certain parameters. Third: you don't have to waffle back and forth about bugging the provider again in the middle of the night. In a perfect world, it's best to get this ordered in writing, but in a pinch you can just note the parameters discussed when you chart that you notified the provider. Third: if you're second-guessing something like this again, your charge nurse is a great resource. They have been around long enough to have a sixth sense about what's worth escalating and what can wait. That way, if your coworker gives you a hard time, your charge nurse can back you up (and they'll probably have a bit more clout with your grumpy colleague). Again, I know it's hard, but try to think of this as an opportunity for improvement and learning rather than some personal failing. I don't think that you did anything wrong, but you can still turn this unpleasant experience into an opportunity to grow as a nurse.
  13. adventure_rn

    Geisinger Pseudomonas Outbreak

    What a mess. I agree that this was entirely preventable, and that the process does seem unbelievable given our focus on infection prevention in the NICU. So very sad for those kids and families. Tangentially related, this is one of the reasons I hate using Dr. Brown bottles. I understand that research finds that the Dr. Brown nipples are the best option for preemies (compared to disposables). However, they're so expensive that most places won't just throw them out after each feed. Every place I've ever worked has had the nurses hand wash and air dry the bottles. They take forever to clean because there are so many bottle parts with tiny nooks and crannies; consequently, they don't get cleaned well enough (since nurses are busy), and they get so disgusting. Then they sit out to air dry in a nasty basin with wet paper towel in the bottom, where they very well could be brewing bacteria. Even if you sterilize them daily with the microwave bags, that's still a full day for bugs to grow, and if you don't manually clean them well enough they're still covered with a sludgy film of MCT oil and breast milk fat even after microwaving. Also, it's not like people are sterilizing the plastic washing/drying basin every day, and people don't think to change those out daily. I feel like it's only a matter of time before kids start getting sick from inadequately cleaned bottles.
  14. adventure_rn

    stethoscope recommendations?

    I love the Welch Allyn Harvey DLX, which I actually got based on the recommendation of @PeakRN last year. I personally like it better than the Littmann Cardiology or Master Cardiology; it's a smidge softer, but it's way clearer. Littmann is super loud (especially the MC), but amplifies everything including ambient noise, so it can actually be harder to tell the heart sounds apart. I've trialed pretty much every brand through my coworkers (Littmann classic/cardiology/MC, MDF procardial, adscope, etc.) I even had a few NPs with their own Littmann Cardiology scopes comment on how much then loved my scope after borrowing it. It's usually pretty cost prohibitive (they retail at around $400), but Steeles.com sells them with the 'Student Kit' for $160, the same price as a Littmann Cardiology; when I purchased mine, I didn't have to demonstrate that I was actually a student or use a student email.... I agree; an experienced person can hear a murmur with a $10 disposable stethoscope better than a rookie with a $200 scope. However, the best way to learn is to actually hear what the experienced person is describing, and that's definitely easier with a louder, clearer stethoscope.
  15. adventure_rn

    Sitter to escort patient during smoke breaks.

    Um...what?? Seriously OP, my sympathies, that sounds incredibly frustrating.
  16. adventure_rn

    Help!!! New grad military spouse

    I'm definitely not an expert on the topic, but I think I remember reading a few years back on AN that many overseas military installations no longer staff their own healthcare facilities and instead of subcontract with local hospitals because it's way cheaper (in which case I guess you could look at getting your license endorsed in Germany to work in a local hospital, but getting all of your coursework endorsed is a steep bureaucratic hill to climb, plus you have to speak fluent medical German). Again, please take my feedback with a grain of salt since I'm definitely not an expert... OP, there was a similar post a few months ago by a nurse in a similar situation at the end of the deployment (moved overseas with her military husband as a new-ish grad, asking for advice about getting into the hospital a few years later when she came back). Not exactly your situation, but perhaps it can be helpful? You could even reach out and send that OP a private message if you have specific questions. If you haven't done this already, you may find some helpful prior forums by using the search bar to search for "military spouse" or "military deployment overseas." I sincerely wish you and your spouse the best of luck! Your family's service is greatly appreciated.
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