Little is Definate, 100% of the Time

Policies and procedures vary widely. By state, by facility, by unit. What is "common" for one facility, is not always common in another. Acute vs. LTC is apples to oranges. So as part of orientation, or as part of precepting a new employee, it is important to talk about and become familiar with policies and procedures that affect nursing practice. 

There has been a few threads popping up regarding "questionable" practices. Generally speaking, as nurses, we know what a "general rule of thumb" is. We have comfort zones, levels of ethics that we adhere to, safe practices. We are prudent. Everyone's intent is safe patient care, with the best patient outcome as possible. Even nurses who are burnt out or overwhelmed, we go to work everyday with an intent to cause no harm. Sometimes, some of us are confused as to how to deliver care to patients in a way that may be different than what we are taught, generally know to be true, or how we have practiced in the past. Read More

What would you do?

I'm a still very new nurse and have been working in a CTSICU for a little over half of my short nursing career. I like asking hypothetical questions that could very easily happen and one just occurred to me...it might be a really weird/stupid one or maybe has been asked already, but what would you do if your patient coded in a chair? Our surgeons like the patients up and sitting in an arm chair we keep in the room by POD1...so what would I do if my patient suddenly threw a PE or just went into v-tach or something? My initial reaction would be to pull them onto the floor (probably ripping out art lines/PA catheters in the process) to start CPR immediately. But have also thought that maybe it would be best to scream for help and wait for someone to come help me pull them to bed. The problem is a lot of these patients are big people (as you probably all already have experienced) and sometimes it can take a good three to four nurses to even help them stand up, let alone pick them up and move them somewhere...so my question for you: what would you do?  Read More

Supplies are missing!!!

Don't you just hate it when you can't find something? Does this happen a lot at your place of work? Is anybody doing anything about it? What are they doing about it? Share your suggestions...  Read More

Becoming marketable to a neuro ICU

Hey you critical care RNs! I recently started an internship on a cardiac PCU and am wondering what skills I should develop to eventually become successful in a Neuro ICU. I did my preceptorship in nursing school on a Neuro PCU and I miss the patient population. I love the cardiac thing and am really learning a lot but would love to eventually get into critical care and think Neuro is where I'd go (in a few years). Any advice is appreciated! Read More

Psych NP Programs - When & Where?

As an older nurse, coming from a previous career in the mental health field, I want to become a Psychiatric Mental Health Nurse Practitioner. I have 10 of my 14 yrs as an RN in psych and addictions treatment. Recently I (finally) completed my BSN, knowing that I had to have the BSN in order to get an MSN. 

My problem is the lack of schools offering Psych as a specialty for NP. The closest school to me is Florida International University in Miami, which is an approx 2 hr drive for me, one way. Another option is University of South Alabama online, or a few other programs that offer the program online, but with a short residency. I've also noticed that these schools (including FIU) are revamping their programs to eliminate the MSN and only offer the DNP. Any thoughts or suggestions? Read More

A Good Week

I recently had a great week. It started with me taking my boards. I got 265 questions and left feeling I failed. However, I used the PVT and got the good pop-up and that settled me down a bit. The next day I interviewed at my ideal job at an outpatient surgical center. The interview lasted about 2 hours and was able to interview with the doctors I would be working with. They confirmed my desire to work there and I left feeling pretty good, just worrying whether or not I had passed my boards.

When I got home I checked the BON website and my name was active! A couple of days later I got the job offer. Within an hour of accepting the position a couple of the doctors had called me to welcome me to the team and tell me how excited they were for me (Seriously, how often does that happen!).

After months of anxiety about not finding a job, doubting myself, questioning my decision to go back for nursing, I can honestly say it was all worth it to be where I am at now. 

So, take hope. It can all turn around in the blink of an eye. Or in my case, over the course of a week. Good luck to all of you as you pursue your dream.  Read More

Critical Care: Acute & Chronic Renal Failure. HELP!

Damaged tubules can't conserve Na+ and therefore urinary excretion of Na+ will INCREASEand thusly the Laboratory data will show a Normal to decreased level of Na+. My book lastly warns against high sodium consumption as it can cause fluid expansion and CHF. 

However; if the insult is due to decreased renal perfusion as in CHF or blood loss (as in Prerenal); wouldn't it make sense that the body would detect the decrease in blood pressure and initiate Angiotensin I > Angiotensin II (which help of ACE). Angiotensin II will then cause release of aldosterone from the adrenal cortex; consequently water and sodium retention will occur. 

SO is the elevated SODIUM in the urine ALWAYS true? Wouldn't NOT be applicable to Prerenal etiology? Read More...

What draws non-nurses to allnurses.com?

Just saw a thread from a fairly distressed RN who fears losing her first nursing job. The very first response was from someone who stated "while I am not a nurse, I think ...."

It made me stop and think - I wonder what draws non-nurse, non-medical people here? And to give advice? I can't imagine being interested enough in an engineering forum, for example, to hang out on it, let alone offer advice in an area in which I have no experience or training. 

Don't get me wrong, I have no issue with anyone posting on any forum. I just find it curious. Perhaps my worldview is too limited and I need to expand my Internet browsing beyond AN.com?  Read More

Professional/Personal relationship with patients

I work in a hospital and see patients (usually) just a few times when they are inpatient and I have no follow up with these folks after discharge. Occasionally there are those people who you just seem to form a bond or connection with almost instantly. 

Over the past week or so I've had one of those situations. Met the patient and his significant other and, for whatever reason, just hit it off from the start. He's going to be DCd this week and I won't be involved in his ongoing care. She (significant other) gave me her phone number and asked me to get in touch with them - if that's appropriate with my job. She did not ask for my personal number, which I found very considerate...just another reason I like these folks. 

So the question is, am I crossing some professional or ethical line by striking up a friendship with these people? Read More!

Help! I don't "get" vents!!!

Very recently I left MedSurg after 7 years for critical care. Thank goodness I have years of experience and knowledge of what "normal" assessments are. So far things are going very well. Titrating pressors, measuring CVP, working with A-lines, etc. are still very foreign to me but I understand what I'm doing and just need practice. However...

I don't understand vent settings. I feel like when people try to explain them to me, they are speaking Bulgarian. I feel like a total moron because all I comprehend is FiO2. I write down the settings and pass them along, but I don't know what they mean!  Read More

The Florida job market cannot be this bad?!

I am still applying to jobs and to no avail! The 27th will make it 1 whole year to the date that I have graduated as a FNP student and Sept will make it a year since I have been certified. I have been on interviews, contacted recruiters, called all physicians that I know, hooked up with all current ARNPs that I know, and revamped my CV. What gives?! Most jobs have passed me by because I only speak one language although I am working on learning others. Another factor is that I do not have experience and I keep getting the "I do not have time to train" phrase. I can't relocate either because of family dynamics and I am beginning to give up. My other classmates are not doing so well either. The managed to get into PT positions but the pay is horrible. Is this what advanced practice nursing all about? Read More

Quick question from a new grad floating to ICU

I have three months of training on a med-surg floor and two months of working on a very busy tele floor. Today my charge called and asked if I wanted to float to the ICU for a couple of days (which happens to be my dream job). My question is what should I study over the next two days to prepare myself (as much as possible) for the upcoming experience. I was thinking drips and ventilators would be a good start. Any other advice will be much appreciated. Read More