violet87

Something to also take out of this is the importance of monitoring chest tube output. I always check charting and notes to see how much has been normal in terms of drainage amount, and make sure that I'm getting relatively similar amounts throughout my shift. I check the drainage at least every 4 hours, and seeing no drainage at all would be cause for alarm, as it could be clogged, dislodged, or clamped. And it's really only up to us to monitor for these complications. I actually did make a mistake once and left a chest tube clamped. There were 2 clamps on the tubing in different places, and the MD told me to unclamp the chest tube now and he will come to the bedside in 2 hours to reasses him. I took off one clamp and didn't see the other one. Until I went back into the room an hour later and noticed there was no drainage in the collection chamber and he was known to drain large amounts. After trouble shooting, I found the pesky second clamp. I called back the MD and told him NOWW we're unclamped. He laughed and rescheduled his assessment. Moral of the story, checking drainage frequently can save your butt. I hope you don't get in any trouble. I think every mistake is an unforgettable learning opportunity.

Hey everyone, just thought I'd make an educational thread about how everyone is handling taking care of their covid patients in the hospital for some shared knowledge. What are some tips you have on getting and staying as ahead of the game as possible? And for staying prepared when anything can happen and your patient ratio is practically impossible? Any tips on keeping your patients saturation up? For me, I collect and give all meds with my first assessment. I also place the next up oxygen level in the patients room if possible (unless next is intubation ofcourse). Not groundbreaking. Anyone have any other tips on preparedness and time management? When my patients are desatting, I've found laying anyone and everyone on their belly to be helpful. I haven't found chest PT very helpful though. How about you? Anything else you try? What kind of focused assessments are you doing? I've found it helpful adding a rating system for shortness of breath, and asking them to rate every time I'm in the room. Any other things you're assessing that you don't normally do with your usual patient population? Also, what treatments are your hospitals using? Mine is giving remdesivir, and I've been giving a lot of Q4 albuterol asthma inhalers. I'm unsure if either is working because I'll only have a patient once and never see them again due to rotations, but we do have only a few ICU acuity out of 70 covid patients so it may be working, although I'm not sure if that's why. Any other advice or words of encouragement? These are definitely tough times, hitting us yet again, and too soon. We were hit hard in March with almost 200 covid at our peak, but most were ICU acuity. I'm use to either a max of 3 burn patients or a max of 3 ICU patients (during crisis), and now I'm being thrown into med-surg and step down with 6 and up to potentially 8 sick patients at a time. We're all being faced with coming out of our comfort zones so any and every word of advice or different perspective is appreciated. Thank you all in advance and good luck out there!

We currently have over 70 covid patients in my hospital, and had about 180 at the height of the first wave. Some covid units are opened from empty floors and staffed entirely with floats who are pulled from various other floors each shift, and other units are converted into covid floors and staffed with pre-existing staff from that floor. Some other floors are closed down entirely and the whole staff is sent to a new assignment on a new floor every day. Because of this, some nurses have it harder and for longer than others.

I also have to wear a papr because I failed fit testing with every mask. Occasionally I turn off the machine before removing the hood and forget that I'm essentially suffocating myself. It's also difficult to breathe in the hood when the hose isn't attached, even though there's a hole in the back for the removed hose. I remember the first time I wore one, I did have a little panic attack inside of it but I felt I had to suck it up because I was so bullied over the N95s not fitting. I panicked for a bit but did get used to it quickly and now I love it. Maybe if you could ask for the opportunity to try wearing the papr again. Under not so stressful circumstances, you might have a much different experience. Good luck and I'm sorry this is happening.

I have to say, nothing I did or saw in clinical was really anything like actually being on the job. In clinical, we hardly got time with patients, barely gave meds, and didn't do anything like start IVs or do Foleys. It was all thought process and care plan based. When you get hired, tell your leadership and preceptor your concerns. They should understand and be able to get you up to speed. A lot of those nursing skills taught in school are really simple to get the hang of. And the rest are only taught on the job, so you're honestly really not missing much in my opinion. For the touch and seeing a patient, it's the scariest thought yet you'll laugh about the fear quickly after starting. I find that when I do something repeatedly, I learn it and become comfortable. Like the first time I had an a-line with multiple blood draws. Did it 6 times in one shift and I'll never forget how to do it. You interact with patients allll shift long, so the skill comes quickly because its practiced pretty much non stop. Not saying you'll get the hang of it in one shift, but you'll get it way quicker than you think. One more thing, try to start in a teaching hospital, or large hospital. They take more time to train you and typically don't let you "learn by fire". Good luck! *edit: this is my response to the original poster only

I think that my whole idea is to not put all of my eggs in one basket. Going for my MSN in education would be doing just that since I understand my chances of getting the job are small (however, not impossible or I wouldn't even think of it). I was asking what I could do increase my chances besides the MSN because I'm going to be working as burn nurse for another few years regardless of the getting the educator position or not, because my long term goal is to stack ICU experience before applying to CRNA schools. I heard about the educator position opening and figured it wouldn't hurt to try and go for it in the meantime while I stack experience. If I were to get the position as burn unit educator, I would go to school for my MSN in education and pursue a career doing that instead. And it would be perfectly aligned with when I'm ready to go back to school too. I'm really trying not to put all of my eggs in one basket, or set myself up for disappointment. Now, enrolling in a difficult MSN program while still having to work full time, and while still getting my future outside of work set up, would be one he** of a disappointment if the job was given to someone else. So, simple resume ramping suggestions are extremely appreciated! If I achieve this goal, awesome, I get to pursue a career doing burns. If it's given to another employee, awesome for my coworker! And I'm still on track for CRNA and might even have some more cool stuff on my resume. Thank you to everyone who has commented and all future suggestions.

It's not that I don't want to advance my education, it's that I don't want to be going backwards if I don't get the position. I wouldn't even have the degree by the time the position is available. Also, there are no burn nurses with their MSN. We all have our BSN and I'm currently second senior in experience. My plan was to keep working on the floor for a few years and then apply to CRNA schools. But when I found out the educator was leaving, I absolute love the idea of taking over and might as well try for it while I stack up floor experience and get all my ducks in a row before CRNA school (house, school loans paid off, car note paid, ect). It really doesn't hurt to try.. unless I throw all my eggs in that basket by going for my MSN in education and it doesn't work out. Thank you everyone for your input. I've been trying to 'join forces' with my educator and he's really liking the idea so far. I appreciate all of your time!

Thank you for your replies. Esp the parts about following and helping the current educator, and getting into any soft leadership roles that I can within my hospital. I'm especially looking for ways to combat the fact that I will have just under 4 years of experience by the time they will be hiring. Things that will show that I'm very serious about the position. (ex: courses, certifications, ect). As I'm not privy to what is out there for pre-educators. The reason I don't want to start my MSN is because the only educator job I'm interested in is the one on the burn unit at my job. That is what I'm passionate about teaching. I don't want to get an MSN in education just to be turned down and have wasted 50-80 grand and 2 years of full time coursework for a job that is no longer available.

The Nurse Educator on my unit is graduating with his NP in a year and a half and is leaving the hospital. I want to know what I can do in that time to increase my chances of being able to take his place when he leaves. This is a rather new idea of mine because I only just found out that he is leaving. So I'm beginning my research journey here. It is a burn unit in a level 1 trauma center/teaching hospital. It's a step down with ICU capabilities and all RNs are ICU competent. It's also important to note that my educator does not have his Masters, just a BSN. The burn unit is specialized and I assume he was accepted for the position due to being a skilled burn nurse for many years, trumping the masters degree requirement. I have my BSN (and would like to skip the masters degree for now since it appears to not be required), and have been working on the unit for 2 years. Due to a mass exit, there are only two RNs with more burn experience than me, so even though I'm still rather new, I think I have good enough odds to get my hopes up and start aiming for this position. I have my ACLS, ABLS (advanced burn life support), and currently in the process of getting my CCRN. Is there anything else that I can do to really make my resume stand out and increase my chances of taking the unit educator job in 1.5 years? Thank you all for your input!

Thank you I really appreciate your response. It made a lot of sense and was very helpful. I'm going to ask a lot of questions at the interview to assess the true acuity of patients and what I would be working with.

Thank you all for your advice. Any one with additional advice is still welcome to comment! I'm going to attend the interview next week and weigh my pros and cons after getting more information about the facility and patients

I'm sorry if this has been asked before. I tried shuffling through past posts and didn't see anything for the last couple years but maybe missed something. I'm having conflict with what I should do as I'm currently at a cross roads and looking for advice from people who have experience with this. So I currently work on the burn unit at a major trauma level 1 teaching hospital and have cross training to SICU. I have the opportunity to work in SICU full time here, and I also just got a call for an interview at a smaller trauma level 3 hospital with a 16 bed mixed ICU. My goal is to be accepted to CRNA school in the next couple years. My question is how much does it matter if I take the level 3 job over the level 1? And does a "mixed ICU" work for or against me? The reason I'm so conflicted is because the level 3 hospital will pay me almost 20k more a year. I'm willing to stay where I am and just move to the SICU full time if that's more worth it experience wise. Thank you in advance for your input!

HouTX, Thank you so much for your response. I feel a little silly for not having known that about the vasovagal response, but I did a little extra research after reading your post and now I'll never forget it! And thank you for the great advice. You're right, next time I'll step back and take a few breaths. I was afraid that if I made it apparent that I was feeling ill after seeing the blood that I would be looked down on and that my ability to become a nurse would be doubted. However, upchucking into an open wound as you said would be a problem, and now that I know it's a normal response I won't feel so embarrassed if it happens again. Horseshoe, Now that I think about it, I probably was holding my breath and doing a valsalva! I tend to do that a lot when I cringe. I'll be much more conscious of that next time. Thank you both for your responses, I really appreciate it. I didn't think this would be such a learning experience. I'm going to share it with my class on Monday :)

I had a bagel and a cup of orange juice about an hour before the incident, so it couldn't be related to blood sugar. Would have been my first thought too if someone was telling me this happened to them.

I'm currently in my first semester of nursing school and today was my last clinical day. I've seen and done a lot already, and I'm feeling great about the experiences I've had so far, except about what happened today which made me a bit concerned. I was watching a nurse change an IV in an elderly patient and she missed the vein and infiltrated the flush causing a rather large bubble under the skin. I'm still a little sensitive to peoples pain and things that look painful so it made me cringe, but then came the blood. The nurse put the gauze right over it but I could see the gauze soaking up a good amount of blood (he was on a heparin drip) and suddenly I felt my face get flush and my stomach literally turned upside down and I began silently holding back the urge to vomit. Along with it came this intense feeling of weakness and dizziness. I fought through it squeezing my own hands off and praying that I didn't pass out right there in the room and embarrass myself. I ended up making it through the procedure, and color came back to my face within a minute or two after fanning my face and taking deep breaths, but I had a stomach ache for a good 20 minutes and felt like garbage for about an hour and a half. My reason for this post is because I'm wondering if this is a normal reaction that happens to new students. I always knew this could happen but always thought it would never happen to me. I have no problems with blood (except getting my own blood drawn) and I have never had an issue seeing blood in the clinical setting before, or on television, or in my daily life. So, what do I make of this? How do I handle it appropriately if I'm not able to fight through it and end up having to leave in the middle of a procedure?