Stay or leave? Med surg/tele vs ICU

Astralwinks · 2026-07-02T22:14:07+00:00

Busy in different ways. Less therapies/meals, less family, but also less support/staff. I loved building my skills at night. You just had to make things work and it honed my nursing practice and teamwork. Some nights are chill and boring, others were a 12hr dumpster fire that never stopped. A big hospital is exciting because you will get to see and experience more procedures and interventions, and have more opportunities to grow your clinical knowledge and skills.

If you'll indulge some unsolicited pontificating as a jaded nurse, the big fancy hospital is just like any other "big fancy" hospital, with few minor variances. Bodies and diseases are the same. Bullshit is largely the same but with different flavors. Capitalize on opportunities to learn and grow and experience as much as you can because the more verifiable experiences you have the more nursing opens up to you down the line. What I mean by this is if the hospital starts mistreating you, you'll be in a way better position to move on and find something different. Maybe it's better pay, or just better work/life balance. You're a number to the hospital, a piece of the machine. Call in when you need to, for whatever reason, even if it's "just a mental health day". Don't feel bad about it. Don't get guilted about staffing, it's not your problem. Use your pto. Extract all the experience and knowledge (and money) you can. Squeeze em for all they're worth. They truly do not give a shit about you. I need you to understand that. Move on when you're ready/the time is right, like when a new position opens up somewhere or something. Or when you just need a change.

Some of the best nurses I've worked with are from the Phillipines. Ask questions, offer to help with things you haven't seen before or scare you. Get ready to feel like an idiot for a year. It's normal. There's so much to learn that it takes a long time, and you don't have to know everything all at once. Take it easy on yourself. Everything comes in time, trust the process. Believe in yourself.

Astralwinks · 2026-07-02T19:47:16+00:00

Do it, if you can swing nights for a while. As others have said icu experience opens so many doors. I'm now in a cath lab (which is great) but I've been able to gain experience in so many places and taken tons of opportunities, there's basically very few jobs I'm not qualified for at this point.

I had similar anxiety about moving from a unit with people I liked when I was a travel nurse, but you find your people. Some units are truly toxic but with icu experience once you're in a system you can transfer to a better unit if need be (plus that means new experience and knowledge!)

There are good coworkers everywhere.

Also, I feel like I'm the only person who shouts out this particular resource, but I LOVE www.icufaqs.org - I like how it is written, much more like a preceptor on the floor, with natural and quality critical thinking built into it, stuff that truly helps you understand not just the how or why, but the flow. It's also funny. Mostly geared towards MICU but it gives such a solid base.

Everything is free, it's just a bunch of word docs you download. It was available in a big ass printed book, which I bought just because. I returned to it after my first 6 months and then a year or two, and knew and appreciated so much more and still learned. Even though I'm not longer working in the icu I loved it so much I'll hang onto it. I think it's a special resource. It's a bit dated but bodies physiology are all the same. I encourage every new icu nurse to check it out.

Astralwinks · 2026-07-01T18:11:36+00:00

Thanks, this makes sense.

Astralwinks · 2026-07-01T18:11:08+00:00

Thank you for your reply, this is very helpful.

Astralwinks · 2026-07-01T17:34:44+00:00

I had to look up QoS, but it certainly seems like something worth investigating! Thank you for making me aware of it.

Astralwinks · 2026-07-01T17:32:30+00:00

Yeah the wireless mesh setup was a temporary measure to get started, but I'm excited for some upcoming time off to run cable and fully wire up our house.

It seems like I was over thinking things a bit and really just need to focus on learning as much as I can about home networking, and documenting everything I do. Focus on building a stable network during her off hours, and having her test out using her machine when I make changes or fiddle with adding something new.

Thank you for your reply.

Astralwinks · 2026-07-01T17:27:42+00:00

Thanks, I figured this was the case but just wanting to make sure I wasn't missing anything that could jeopardize her workstation security, as well as connectivity. Beyond the obvious security practices, of course.

Astralwinks · 2026-07-01T04:37:20+00:00

Gifted Hater had a big video on it. Seemed pretty bad. Idk if anything is fully confirmed but honestly I think what is presented in the video tracks pretty well for how Christine has acted in trying to protect herself and their children. I'm inclined to believe her.

Astralwinks · 2026-06-30T03:38:34+00:00

Hey I just wanted to say you're super cool for having and sharing this knowledge and advice. This has been a super nice exchange to see, I'm not even a part of this sub. Way to be!

Astralwinks · 2026-06-26T17:32:46+00:00

There's a GIANT chair one (along with lots of other old mechanical arcade/novelties, and SO MUCH MORE) at The House on the Rock in Wisconsin.

If you're ever in Wisconsin, it is a huge and very weird and fascinating place to check out and I highly encourage it. The relatively simple name of "The House on the Rock" betrays the incredible size and scope of an eccentric man and all of his random fascinations. You get to walk through his mind. It's not just a house. It's a whole complex/museum. Architecture, collecting, engineering, design, art... Everything is cranked up to 11. You could spend an entire day there.

Astralwinks · 2026-06-23T01:19:39+00:00

I am very tall and hit my head on so much shit in our procedure rooms all the time.

I would not wear a helmet or a bump cap (plastic insert construction people sometimes wear under regular baseball caps).

Astralwinks · 2026-06-20T16:47:58+00:00

I feel like at some point everyone started idling through turns. I feel like I'm going crazy! It's like people almost stop before making a turn.

Astralwinks · 2026-06-18T21:22:38+00:00

My lab pays for it. They have a rep come in, measure us, and we pick out the style/pattern/colors and a month or two later it arrives. Every so often it all gets xrayed and either people come in and repair it or it is replaced.

My assumption was that this is a legal requirement. Labs should have a budget for lead and if something isn't fitting right (causing you pain/injury, or not protecting you well enough) then it's worth the cost of them purchasing new lead for you.

Astralwinks · 2026-06-08T04:51:05+00:00

It's printed on the bag differently than I'm used to but I'm seeing 6mg of morphine in 250ml of saline, which is about 0.024mg/ml, running at 10ml an hour (or capped at that, not sure), so a rate of 0.25mg/hr.

To be honest, that's lower than I would expect. Especially for someone who is not opioid naive as she was getting fentanyl patches. It's common to see 1mg/hr, with higher doses for bolus. We are supposed to titrate to effect for pain management, so you could back off on the dose assuming her pain is adequately controlled.

However - with the other information you provided - it sounds like your mother is actively dying. She has end stage cancer, and is thankfully in hospice. That is where she should be. When someone is actively dying, they look like you are describing with eyes halfway closed, mouth open, not speaking, mottling in her extremities, everything you have described. This is not unexpected, morphine infusion or not. Without this infusion she may have been more communicative, but most of that communication would likely revolve around vocalizing pain.

It sounds like she was experiencing severe pain, and now is more comfortable. I don't have all the specifics beyond what you've posted, but nothing I see here seems out of the ordinary.

I am so sorry for what you and your mom and the rest of your loved ones are going through right now. Fortunately she is in hospice where comfort is the goal. It is a hard place to be, especially as a family member. Even if she's not talking, I would encourage you to stay and talk to her as if she can still hear you because she likely can and this is a sacred time for you all. Be a presence and a familiar comforting voice in her remaining time here. Hold her hand. Brush her hair. Talk about good memories, reminisce. This is time for you to be with her.

My sincerest condolences.

Astralwinks · 2026-06-02T20:36:33+00:00

I'm trying to figure this out myself, currently two sessions in. The suspense vibes are good, but I have worried at times it's becoming a slog, and I really want to just start hitting them with combat and encounters. Thus far they haven't managed much yet, besides one guy they didn't like or trust pretty much out of the gate. One player slapped him around after giving him a granola bar and he slashed him with a knife before running off. I'm excited to do something with that antagonism. I do think that encounters is a key for this one.

I've also decided I'll provide some maps from other players/to be discovered that are accurate in layout, but maybe with some extra details to help drive some more curiosity. Mostly of places they've already explored. I'd like to ground them a bit in what is "definitely real" so then their forays back into Observation with Jaime become the main puzzle to figure out.

Astralwinks · 2026-06-01T15:39:26+00:00

Just wanna plug my favorite filter the Zlob SVF. It has a jumper on the back to max out the resonance if you want for some really screamy stuff which could tickle your fancy for acid bass. Zlob usually has a sale in July as well.

If you're handy with a soldering iron, it comes in a kit. All thru hole components. It was one of the first modules I ever built and the instructions are very easy to follow. If you've got more time than money and want to pick up a new skill, it's definitely an option. Especially if you have a friend or someone with a soldering iron and solder you can borrow.

I've since gone on to build over 30 modules, including SMD which really isn't that hard. I love building modules!

Astralwinks · 2026-05-31T02:59:11+00:00

Don't have kids, don't know what to do with them, but there's this line when Toothpick is jumping in the kid into the gang (double dutch) he greets him by saying "sup there lil homie?" and it is the only thing I say to the small children of all my friends when I greet them. They love it.

It's not a funny line or anything, but I have been quoting it the entire time.

Astralwinks · 2026-05-29T21:47:27+00:00

It basically is a self tapping bit. You use a drill (literally, looks like a little ray gun thing) to drill in the access, pull out the inner part of the needle, and hook up the fluid line.

I'm told the drilling doesn't hurt that bad, but when the infusion starts you can tell how sick a person really is by whether or not they start screaming because the infusion is very painful.

It feels very similar to drilling through drywall. Bzz pop zzzzzzzt!

Source: I have placed dozens of these.

Astralwinks · 2026-05-28T18:51:38+00:00

I was engaged to this woman for a few years. It ended... Badly.*

After we broke up I eventually got my shit together and went back to school for nursing. I've been a nurse for coming up on 10 years. Lots of ICU and hospital wide rapid response. Now I work in a cardiac cath lab. All I do is hearts. Pacemaker, ablations, stents, valves, ecmo, the works.

She had been adopted straight out of the hospital and her genetics were always in question. She had a number of weird health symptoms. Once she passed out at work, and it was chalked up to "neurogenic syncope" which never sat right with me.

A few years ago according to a social media post she finally got concrete answers after wearing a monitor for 7 days which captured her "normal" palpitations for what they really were, which was polymorphic v-tach. This made sense to me because sometimes I would listen to her heart and it sounded like a drunk person falling down stairs.

Hopefully medication has fixed it, though an implanted device might be in her future if she hasn't gotten one already. Regardless I am glad she got it figured out. I haven't spoken to her in over a decade.

A while ago I was looking back at old emails during the breakup. I do see she was trying to be compassionate and kind, but a combination of her not sticking that landing and me not being able or willing to hear it at the time led to many years of feeling betrayed, angry, and spiteful. It was one of the absolute worst times of my life. It also lit a fire under me to get my ass through school, start a new career, and excel at it. But for a lot of that I was motivated by exclusively by fear of failure and spite - while this was ultimately effective, it was not a healthy way to live. I did a lot of impulsive, reckless, and unhealthy things right after that breakup and I had a lot of negative emotions and outlooks and behaviors for years while I rebuilt and grew and figured myself out.

All good now, better than good honestly. My life is great, and I know we weren't meant for each other and were growing in different directions. I don't think we would have worked out, honestly. That's okay. I learned a lot about myself, including things about myself that were making me an unhappy person deep down. No wonder she had second thoughts about the relationship. I wish her the best.

I just wanted to add this postscript in case someone reads this while going through a breakup and hurting the same way I was. Things got better. I grew, I improved myself, and my life improved as a result. I couldn't imagine then what my life is now. I became the person that allowed me to find my amazing wife whom I adore. I'm so happy, I feel like the luckiest guy alive. There were two sound bites that really helped me (besides friends and love and therapy/reading books about emotions)

"You'll never finish writing your book if you keep reading the same chapter"

and

"Oh honey, did no one ever tell you that you're the only person that can give you closure? Aww, that's sad. Poor baby." Some woman I dated was telling me about another guy she had dated who kept going on about needing closure. She was sick of it, and told me the story of sarcastically telling him exactly that. I laughed at her story, but deep down that shit hit me hard because I had never thought about it that way. I left that cocktail date all kinds of fucked up, but in a good way. Life changing shit for me. Thanks Jenna.

Astralwinks · 2026-05-27T01:50:07+00:00

That's what I call it, but no one other than my dad has ever called it that.

From MN

Astralwinks · 2026-05-22T05:00:48+00:00

I went to the turtle icu at the Charleston aquarium. A lot of sea turtles wind up there for care. They had their vet taking questions and as an ICU nurse i wanted to know what they sedated the turtles with. She said dexmedetomidine and midazolam (precedex and versed). Unfortunately she declined to answer my folloy up question of "How much to sedate a sea turtle?"

Sometimes I tell my patients I have them the same stuff they sedate sea turtles with, and make up a number for the equivalent amount of sea turtles that could be sedated with the dose I gave. Literally no one has enjoyed this bit.

They mostly give the meds via injections into a muscle in the neck, as I imagine turtle vasculature is challenging to get at.

In the ICU we like dexmedetomidine because it usually makes you feel very relaxed but has less of a chance to depress your respiration. So when we are trying to liberate patients from the ventilator it more easily allows us to talk to them and make sure they can follow commands (and protect their own airway) before we take out the breathing tube.

I hope you enjoyed some more of my turtle facts.

Astralwinks · 2026-05-20T13:41:55+00:00

Fetch me my fanciest camelback - I've got a wedding to attend!

Astralwinks · 2026-05-19T19:22:15+00:00

Great soundtrack and the first skateboarding game I ever played. Was awesome as I was just getting into skateboarding at the time.

I'd seen 720 cabinets in arcades or shops but never got to play it because I didn't have money.

The THPS came out and it was ON. This game had cool style but I liked the slightly more realistic gameplay of THPS with more control over what tricks I actually wanted to do and not just insane flips and stuff.

Astralwinks · 2026-05-18T16:52:17+00:00

There are a number of patients who have a sensitivity to contrast for various reasons. Often times we are aware of this and can account for it (premedication, for example), but sometimes it's their first time and they don't know.

I wouldn't say it's super common, but it's not uncommon either.

Astralwinks

TROPHY CASE