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CVVH's Latest Activity

  1. Just to followup with my earlier post: we're also running out of CRRT machines and dialysate. I work in two major academic NYC hospitals, and both have this shortage (see here for more info: New Covid-19 crisis hits ICUs as more patients need dialysis). I even witnessed an argument over whether a patient that was DNR should be put on CRRT because the hospital had a critical shortage, only one machine left, etc. Last night, a nurse had a very sick patient that was circling the drain, on multiple drips, CRRT, periodically maxing pressors, on 100% fio2 on the vent and desatting to the 60s, etc...plus another patient. Normally this would be a 1:1 assignment. Hoping things get better soon.
  2. Yes, I work at a major hospital in NYC. We exceeded our normal ICU capacity (and this includes 5 ICUs, three of which have two units each for a total of 8 ICUs) and had to open up new ICU beds in other locations, such as the Cath lab and ORs. Stepdown units also had a number of their beds turned into ICU beds. We also made single ICU rooms into doubles in two of the ICUs. ICU nurses care for anywhere from 2-4 COVID pts, sometimes with a helper RN (a stepdown/medsurg nurse), sometimes not. When a patient dies, once the bed is clean another ICU patient rolls in. There's at least 2 overhead pages every shift for a rapid/anesthesia. PACU, cath lab, etc nurses are now functioning as ICU nurses. It's really happening.
  3. CVVH

    Why did you choose to be an ICU Nurse?

    Could you describe more, I'm curious about that! I work in a CVICU now and thinking of doing per diem Cath lab next year maybe (though I'm assuming I wouldn't have the "full" experience there as a per diem), so curious to know how it compares to ICU, and the "perks". Thanks
  4. I'm finishing my MSN in management/administration this year, and I'm curious to know if there are any nurse managers/nurse executives that miss being clinicians? I know that leadership/management is the direction I'd like to take my career, but part of me is wondering if I'll miss being a direct care clinician (depending on the day the answer is yes or no, haha). As a nurse leader, do you maintain some sort of clinical practice? Or is there no time for that? I've read previous posters mentioning that sometimes they'll be pulled into staffing or stay after their "shift" to help out, and while I've seen our nurse managers/assistant managers help out here and there, they aren't expected to do that, and will never take a patient assignment (at the hospitals I work at the charge typically will not have patients unless we're short, and we have float pools/per diems, and will ask staff to come in for OT if needed, so leaders don't have to be pulled into the staffing mix as it seems to be the case at other institutions or in the past). So I'm wondering, how do you maintain clinical relevance as a nurse manager/executive? Is this something all leaders end up facing at some point or another? Sometimes I wonder if I should do CNS, but there are limited opportunities for that in my area, and although I like being a clinician, I also lean more towards management/leadership, which is why I'm doing that degree currently. Thanks!
  5. To me, it sounds like the main issue is continuing to work at the bedside when they're short. Hopefully in your new position there isn't that expectation. At my hospital, neither assistant managers nor managers are expected to take patient assignments when the unit is short (and none do whether or not it's expected). We have float pools, per diems, and can call staff in for OT. If all else fails, then the unit is just short (and fortunately it isn't a regular thing at my hospital), and there's just the understanding that we do the best we can. Sure, the ANMs and NMs will help out here and there during their day with ADLs, codes/rapids (and none of that is again expected), any conflicts, etc., but taking an assignment is unheard of. I also like the idea of calling the night staff at 9pm to see what's going on, etc. This is something that our attendings do with the fellows before they go to sleep, I think it would be great for the night charges to have the same interaction with the nurse manager so that potential issues are already discussed.
  6. Try to finish finish the year and your BSN in that year if possible, then transfer to one of the private hospitals in the city. I work at one of the major private hospitals in NYC, and having 10-12 pts in telemetry, let alone any inpatient unit, never happens (same at NYP, NYU, Mount Sinai, Sloane, etc). Max in med-surg at my hospital is 6. And the salary is a lot higher as well than the public hospitals (like 20-30k higher). Good luck!
  7. CVVH

    Help with post CABG pts

    I'm currently on orientation in a high acuity CVICU (ECMO, LVADs, RVADs, BiVADs, heart/lung transplants, etc). Three books that I find the most helpful are: 1) Fast Facts for the Cardiac Surgery Nurse-very quick and basic read, good for the basics 2) Cardiac Surgery Essentials for Critical Care Nursing-excellent book from the nursing perspective covering everything you really need to get started and get into details as well. This is the book my unit recommends to all new hires, and I strongly recommend it. 3) Manual of Perioperative Care in Adult Cardiac Surgery-another great, detailed book. It's not specific to nursing, however it contains very detailed information that fleshes out what you read in the prior two books. These three books are all you really need to have a didactic background to your orientation recovering fresh hearts. Hope that helps!
  8. CVVH

    Neuro to CVICU Advice

    Hi, so I'm grateful to be transitioning from a neurology unit to a CVICU soon. I'm pretty nervous, as our CVICU is very high acuity (we do everything-ECMO, VADs, heart and lung transplants, etc.), and it's definitely going to be a lot different from where I've been in neurology stepdown, so I'm wondering if anyone has any tips to help me get started. Thanks!
  9. CVVH

    CTICU vs Neuro ICU

    Thanks for the tips. Yeah the mechanical circulatory support devices sounds pretty fascinating. I really want to work in a setting that is high technology. My hospital is having a CT surgery/ECMO conference soon, so I'm going to attend that to hear a bit about what goes on in the CVICU. That makes sense to me about independence and ACNPs. Interestingly, at my hospital we don't have NPs in the Neuro ICU (there are PAs), while the CVICU has ACNPs (the unit is split in two, with one managed by ACNPs in an "attending" role, though these are the less complicated patients (I believe they're termed "fast track"), while the other has the traditional medical team, though NPs are on those as well). We do have a neurohospitalist NP service, however their patients are on the neurology and neurosurgery stepdown units. Another hospital in my area is pretty progressive, and they have ACNPs doing both cardiac caths (I believe diagnostic for the most part though at least one is trained to do interventions as well) and diagnostic cerebral angiograms (NPs also assist on interventions). They also have NPs in the Neuro ICU. So there are many NP opportunities in both fields in my area now that I think about it. I'm going to shadow in both units soon and find out about potential opportunities in the near future, as well as attend the CT/ECMO conference.
  10. CVVH

    CTICU vs Neuro ICU

    Thanks for the reply! Cardiac has always been my interest, however I've come to love neuro as well. I think I've found a middle ground between the two by my interest in stroke (I do research related to stroke and I'm planning on getting stroke certified (SCRN) by the end of the year). At the same time, I'm very interested in heart/lung transplants, and working in a high technology/device area, and CTICU seems to fit the bill. Another option I've recently thought of is applying to transfer to CTICU then I could always do per diem at another hospital on a neuro unit.
  11. CVVH

    CTICU vs Neuro ICU

    Basically, I'm approaching a year in my first job as an RN, and thinking of next steps. I'm on a neuro stepdown unit, and would like to transfer to an ICU in the near future. In nursing school I loved cardiac, worked for a couple years as a tech on a telemetry unit, and did all of my adult clinicals on cardiac units, including a CTICU. When I applied for jobs, the cardiac units at my hospital didn't have openings at the time, nor did the two ICUs that hired new grads. I got a job in a SICU at another hospital, but for various reasons turned it down, and took a neuro stepdown job at my hospital. Almost a year later, I definitely enjoy neuro, and am doing stroke-related research right now. My unit is great, but I love "technology" and "devices", so I'm still interested in the ICUs, though I'm trying to figure out which one. I still do think about CTICU, as it seems to have the most technologies and devices out of all the ICUs (the CTICU at my hospital does heart/lung transplants, ECMO, VADs, artificial hearts, IABP, etc). ECMO also sounds very interesting to me, and all of the ICUs have ECMO, except Neuro ICU (though its mostly found in CTICU and MICU). Interestingly, the Neuro ICU recently started taking VAD patients that stroke, so the RNs there have relatively recently been trained on them. The neuro ICU also does multimodality brain monitoring, though when I asked one of the nurses about it recently, she said they don't do it as much these days, and its become more for research purposes. Another thing I think about is marketability and further opportunities. I may be wrong, but I feel that cardiac experience would go further as far as opportunities outside of the ICU (cath lab, EP lab, etc) or hospital, and that cardiac is more...."accessible" than neuro for RNs and APNs, as far as being able to carve out roles. In the future I think I'd like to do ACNP, though I don't plan on applying for a couple years (I plan on staying at the bedside and doing the clinical ladder, committees, etc), so that may change. Also, it seems that there are more opportunities for APNs in cardiac nursing than neuro, at least in my area. TLDR: I'm a neuro stepdown RN, almost one year down, originally wanted CTICU, doing neuro, like neuro, still think about cardiac, not sure what to do. I definitely need to shadow in both to see what they're like, but thought I'd ask here as well. Thanks!
  12. CVVH

    ECMO: Most Advanced ICU Technology?

    I guess what I'm wondering is, what are the most recent technologies available today that augment diagnostics/care/treatment of critically ill patients?
  13. CVVH

    ECMO: Most Advanced ICU Technology?

    Very true. What do you think are the most advanced critical care technologies available today?
  14. Two of the ICUs at my institution utilize ECMO. I have a very limited understanding of ECMO, including its value and prognosis of pts on it. I'm wondering though is ECMO the most advanced type of technology available to ICU pts?
  15. Hi all. I'm a new grad. Ultimately I'd like to end up in the CTICU, as I loved my CTICU clinical, as well as my experiences floating there as a clinical tech. My hospital doesn't hire new grads in the CTICU, so I'm looking at other units that would be good preparation and background for CTICU down the road. We have a cardiac telemetry unit, as well as an interventional cardiac unit. From what I can tell, the interventional unit manages patients pre and post interventional procedures (apparently complex interventional patients), while the telemetry unit manages chest pain, CHF, cardiomyopathy, and some interventional overflow. The interventional unit sounds interesting, however the telemetry unit sounds like a broader experience. Any help would be appreciated, as I'm supposed to give my preferences for units shortly. Thank you!
  16. Thank you both for the advice. From the interview it sounds like the unit has some turnover from nurses staying a year or two then going on to CRNA programs. Practically all of the hospitals in my area (including the "top" "nationally ranked" ones) hire new grads into specialties, with some having formal fellowship programs with set start dates in critical care/ED/periop/peds/etc). But yes, I definitely understand. I got the official word that I have the job, which makes the decision even more difficult, but I'm leaning towards staying where I am, as one of the managers of one of the ICUs that doesn't take new grads has offered to talk with me about opportunities in other units that could lead to his ICU in the future. My hospital heavily hires internally (the vast majority of the nursing student/grad assistants get jobs in the hospital, it's just a matter of how long you're willing to wait, with some getting it a month or two after finishing school, while others wait a 4-6 months). Thank you for the advice.

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