Kssrn404

I worked so hard for my BSN. My dad, and my best friend, had just died from heart disease at 50 years old. My mom and I didn't have the money for my school and my dad's company did not give him his retirement. Still, we didn't qualify for grants or other scholarships so I worked full time AND took out loans that took me almost 10 years to pay back after I started working as an RN. I didn't have a very good educational background so math and chemistry were super hard for me in my pre coursework. (I ended up with a 3.9). I studied so hard! I was told by several professors that I really didn't belong in their classes but didn't let that stop me. I worked as a CNA at a veteran's hospital and it was super hard work but I realized it would help to have that experience when I started my first RN job. Just a couple of weeks ago I ordered a fleece with my name and RN embroidered on it. I wanted to add BSN so bad but would get flack at work. It is sad, but a reality.

i am in ICU/CVR and studying for the CCRN this year hoping to take it when I have enough hours logged in. I think that's the best way to go.

"Trach and PEG" over and over again. Why would a surgeon schedule an open heart surgery for a pt in ESRD, Malignant HTN, low EF requiring IABP post op (which the pt never comes off of) and COPD??!!!!! They will spend weeks in ICU then on to LTAC if they survive the transport. The costs are enormous and the family wants to know why we can't make them "better"and they remain a FULL CODE on top of that.

and somehow when these "clients" who don't care about their health for the last 30+ years and completely abuse their bodie suddenly want to know why we can't make them well and are the ones most likely to sue.

well, not sure why the photo is so large. Sorry guys

The old stereotype of a female entering into the nursing profession just to snag a cute wealthy doctor has long loomed over us. You would think by 2016 we would have come a lot farther, but to my surprise things haven't changed all that much. Below is a screenshot of a customer review for a pair of scrub bottoms on a very well known and large uniform website. I saw this while browsing for some scrubs. What makes it worse is this review was plastered next to the picture of the scrub bottoms as an advertisement. It was not in with the rest of the reviews. Take a look and see what you think.

I looked for a grad "internship " program and went into critical care right out of school. We were in the classroom for 4 months and had to pass all of our exams. Then we were in an empty unit with "hands on" from r another months. When we finally got to the unit (mine was CVR) we had a preceptor for three months. After that we were assigned a "mentor" from r the first year. I know this may seem like the perfect scenario, but they are out there if you do your research. It worked for me. I studied on my days off like mad and learned everything and anything I could about my new specialty. That was back in 1991 and I'm still in CVR/ICU today and love it. My best to you. You can do it!

Absolutely right. There are receptors in the pain control section of the brain called "mu" receptors. Using dilauded as a first line takes up and binds to these receptor sites and tolerance builds. That's why so many addictionologists use bupenorphine or suboxone for their patients. It helps heal the mu receptors and lower the tolerance level to where the person can get relief from opiated if needed in the future, say from surgery.

We too have a camera in our Med room. We also are required to draw up the marcotic in the Med room before going to the bedside. We have a finger print system. When doing a bedside procedure and sedation is required you sometimes have to draw up the entire vial say of versed in case the MD wants to use most of the vial. We then go back to the Med room and waste/witness in the pixis.

ABSOLUTELY!!! When you're assisting a trach or PEG insertion at the bedside there's no time to "dilute" Versed or Narcuron or morphine. I may dilute in a 10 ml syringe depending on how much the physician gives with each dose. IVP is all we do with the exception of PCA's.

yep and tamponade too. We have to "crack" the chest back open and the surgeon digs out all of the clots around the heart while I'm prepping them for emergency surgery. Beating heart exposed and all. Sometimes you just have to deal with it.

i am an ICU nurse also work in CVR. I too feel administration does not help nor understand us in any way. HCAPS are breaking us for sure. We do everything possible to ensure our patients are well cared for and still receive low scores for petty things beyond our control. I am a nurse paralegal working for a defense law firm. Making well over $125/hour from home I do participate in video depositions but do not have to go to court. It's sad I have to take on a second job just to make ends meet. But that's nursing today. Burnout and poor job satisfaction are the norm for most nurses who want to do bedside care. I see no relief in sight. It's only getting worse and the pressure becoming greater on nurses.

AMEN!!!!! Do it together. While I(being new to ICU) am not as fast as the other nurses on the unit , always strive to leave the room restocked, clean and clean patient, there are times where a mess can happen at shift change. Such an example is diarrhea from a tube feeding at shift change as we walk into the room for bedside report. I'll stay longer and we can clean and bathe the patient together and change the linens. No need for squabbling back and forth. We are a team and should act like one.

i have hypothyroid also and I bathe when I come home I work days. My skin would fall off is I showered twice a day.

I had a tamponade as a new grad. It was terrifying to say the least. But I was able to stay focused and order stat labs, CXR and page the surgeon. We cracked the pts chest at the bedside and the liver looking clots were removed and the patient was rushed back to surgery. Note: the patient was a first post op day CABG. In our unit we are 1:1 until all pressers are off and of course weaned from the vent, then we can pick up a stable patient.

I like your post. It's pretty simple to me. Critical thinking is the "WHY" behind the task. Know why your doing what you do and also "creative latitude" would fall under this category.

The anesthesiologist should have explained to you exactly what it was you were getting in your IV instead of just pushing a drug and saying "it's supposed to do that". I recently had a bladder implant placed under general anesthesia. As I was wheeled into the OR, not one person acknowledged my presence or said hi this is so in so and I'll be your nurse. They started pushing drugs and then placed the inhalent mask over my face without a single word. They didn't know I was an ICU nurse. It shouldn't matter though. I was very nervous and I was relying on the OR team to help me through my surgery. The circulating RN never even said a word to me. I was treated like a case number.

This reply is so helpful to me. I work in ICU/CVR. I can't believe that one family sued all the way up the line, nurse 1st, because they said maw maw 88, who was brought back to life but needed permenant dialysis after cardiac arrest (because they said the CPR was not good enough quality to perfuse her kidneys). The family WON the case because it was not documented that a Femoral pulse check was done on a regular basis during the code. Keep in mind that Maw Maw's ribs were probably sooo osteoporotic and brittle, but the nurse performed such good quality Compressions despite this that the patient retained full brain status after the code. OMG!!!! Not only was the nurse that was performing compressions sued, the hospital insurance did NOT cover her since she did not go exactly by hospital protocol, which was stored away in some office somewhere in a book probably a mile thick and in fine print it said to check a femoral pulse during pulse checks even if you get a carotid pulse. You can be sure that I will ALWAYS carry coverage. I will also get the max amount I can and make sure it covers my needs. I have been a nurse paralegal in the past and I can tell all of you that you can NOT cover yourself enough thru insurance and narrative documentation. It takes extra time that I know y'all don't,but have, but if you learn to do it well you will be covered. Don't say too much, be concise, but be sure to follow up on anything you document that warrants it, Also use narrative to document the outcome and if you corrected the issue. #1 thing is patient safety.....ABC's. Unfortunately after taking care of that we have to worry about HCAPS lol!!!! Patient satisfaction. It is a special calling for sure. We don't make anywhere near enough money for the amount of work we do and the liability we carry on our shoulders!

You know it's gonna b a hot mess when you get report on your fresh heart CABG who already has an implantable defibrillator goes into VFib and the defibrillator shocks her 12 times. Yes, 12 before you can even finish receiving report. Just pull up a chair and bedside table I the room. You're gonna be in the "cave" awhile. Or you walk into the unit to get report and the surgeon is standing over the post op heart your taking, cracking the chest at the bedside dumping something resembling clotted liver into the kick bucket fast as he can go, so you start prepping for back to OR and haven't gotten report yet. still love it though!!!

i am in MS and we are a very overweight, unhealthy and high morbidity state. The nursing profession itself is NOT helping us live a healthy lifestyle for sure.

i am in the Deep South and I've not ever personally heard a health care professional acting or speaking this way. I'm not saying it doesn't happened just never encountered it. Sorry you have had to endure this nonsense. I work with a lot of African American, Indian and many other ethnic background wonderful healthcare providers and there's never an issue. Too bad this type of thing is still around. I can tell you for sure that it exists everywhere, no matter where you live in this country. Really sad.

This is such great information! Congrats on passing the exam!!! I have heard that Barron's is the best. Going to purchase it for sure. I just started back in the cardiovascular recovery unit after being off a long time. I started with the AACN Essentils of Critical Care Nursing and it's been a valuable resource. Almost finished with it and ready to start my journey to CCRN. Thanks for sharing!

I just started back to nursing after a long break raising my three kids. I am returning to the cardiac recovery unit. Often I will float to ICU. Don't be afraid to ask questions and keep a note pad handy to write down points to remember and study on your days off. I love the advice from the previous posts as ICU nurses do enjoy sharing their tips and are generally very helpful as long as they see you want to learn and are willing to work hard and help them out when you can. RT's are a valuable resource when learning the vent. A good one will always back you up. Get a few good books to study aside of your preceptor program. The AACN Essentials of Critical Care Nursing 3rd edition would be a good place to start. Worth every penny! Best of luck to you!!!!

Even though I get that its policy. I feel bad for you getting flagged by the pharmacy. You were just trying to do what was best for your pt. by not constantly waking them up. We are allowed to scan the bed label instead of the armband if we choose to. But after reading your post I think I'll be a bit more cautious about doing so. Thanks for your post!

i love this!!! I'm working 6 straight 12 hr shifts then 8 off. I don't have good shoes. I'm about to buy some Danskos Pro XP's about $150. That is a splurge for me lol!