SoldierNurse22, BSN, RN, EMT-B 52,819 Views
Joined Mar 29, '10.
Posts: 2,234 (67% Liked)
It's certainly an art mixed with a science. Cervical exams take lots of practice. When I was a new L&D nurse, my preceptor would often check the patient, then have me check her. Within a few months, I was pretty confident.
The Mystery That Is The Cervix – Cervix With A Smile
The market's tough in general. There are some areas that are better than others, but don't be fooled into thinking that just because you have your BSN, you'll be able to find a job. You'll still be a new nurse without pertinent nursing experience. That seems to be the kicker.
There's physical skills and then there's critical thinking. Critical thinking fits into everything you do, including physical skills.
For example, when accessing a port--especially one of an oncology patient--what if you break sterile technique? Of course, you know as a nurse the importance of keeping the procedure sterile in order to protect the immunocompromised patient from illness that could potentially kill them. Beyond that, you know about how chemotherapy affects the patient on a cellular level from the immune system to the gut to solid organs such as the liver and kidneys. Sure, you could teach just about anyone to do this skill--but someone less-trained than a nurse likely will not have the extensive knowledge to go with it. This is central to keeping patients--especially your vulnerable onc population--safe.
And absolutely, the big thing they're probably talking about is assessment skills and critical thinking. For example: you come in on at the start of a new shift. A patient has some faint rhonchi in their lower lobes, which you can see is a new development that the nurse before you did not hear. You teach them about the incentive spirometer, encourage them to get out of bed and walk. However, when you do your noon vitals, the patient has an elevated temperature and is displaying subtle signs of confusion according to his wife. What do you do? That is what nursing is about--catching signs of trouble and alerting the appropriate folks in order to secure early treatment for your patient. Someone who was unfamiliar with the signs and symptoms of early infection in an oncology patient may not put those things together. That's what your skills and knowledge allow you to do. You see the patient as the whole person down to the molecular level and can act accordingly.
It could be. It is at very least a sign of a brewing infection. In a patient like this, you'd want to do a few things:
1) Check the NG tube. Is it actually on functioning? What's coming out and what color/how much is there?
2) Check the abdominal wound dressing(s). Is it clean? Saturated? Dirty? How long has it been in place? If you can see the skin around the wound on the edges of the dressing, is there redness, discharge, or other symptoms of infection? If you're able to remove the dressing, what does the wound itself look like? Are there signs of infection?
3) Assess your patient's LOC. Are they fully with it? Are they showing any signs of confusion or disorientation?
4) What is the patient's urine output? (most surgical patients have foley catheters and this is really easy to measure).
5) Patient's pain scale and description.
That info and the vital signs are what I'd call the doc with. I'd expect to be getting orders for
5) Labs (CBC and cultures at very least). That will tell you if there's an infection present and what you're dealing with.
6) A culture of the wound if possible.
7) Possible radiologic studies, especially if the patient is presenting with severe abdominal pain as this may indicate a ruptured intestine.
As a SANE, you may work regular shifts at your place of employment just like any other floor nurse. For instance, a SANE could work the regular three 12 hour shifts per week in their ER, but then be on call on their time off as a SANE. Some places with multiple SANE certified RNs may rotate call so that one SANE isn't overstressed, but that depends on the location/number of SANEs.
-Diabetical for Diabetic (a nurse actually said diabetical and was serious)
I had a patient who referred to NS as "Celine", as in, Dion. Regardless of how many times I correctly said "saline", she never did get it.
SVEs can take time to really master. There are several blogs out there that can add the personal experience/tips/tricks of current L&D nurses to your preexisting experience/textbook info. If you haven't already, take some time to cruise L&D nursing blogs for advice in addition to getting feedback from your preceptors. Here's one of my favorites to get you started.
The Mystery That Is The Cervix – Cervix With A Smile
That really depends on the patient's underlying disease process(es) and the extent of the bleed.
Generally speaking, if you're giving methergine to a patient who is experiencing a hemorrhage and has contraindicating factors for the drug) such as preeclampsia, gestational hypertension, etc.,), a hypertensive crisis is going to be the least of your worries. Typically severe hypotension is more the concern in a hemorrhage.
However, to answer your question more directly, a drug given IM is generally going to start acting 10-20 minutes after administration, so that would be the earliest you'd see symptoms of hypertension. The half life is 3.39 hours, so if you are dealing with a hypertensive crisis, I would imagine the severity of the HTN would begin to fade at that point. If you've got a patient hemorrhaging, BP should be cycling at very close intervals (every 1 minute in my hospital), so you should be able to catch it pretty quickly.
We used to do LP chemo as well. Lying down for 30-60 minutes post-procedure was required and absolutely standard--no exceptions.
It's really not that unbelievable. Hospitals hire based on their needs, and if they need an experienced L&D nurse, they will often wait it out until they find one instead of trying to leverage time and resources they don't have to train a new one. I agree with Rose Queen--start looking in other places for a job in L&D.
Jenni811, you mentioned that you are 24. Everything is much simpler when you are 24.
Your employer should be investing the time and money to get you certified in EFM, NRP, STABLE, etc. I wouldn't invest any money in anything at this point as that should be taken care of and you will end up paying out of pocket for what your employer should be paying for.
Personally, I'm a fan of L&D blogs. Even in some of the blogs that are purely anecdotal and not intended to "teach", you can learn a lot.
Tales from Labor & Delivery
Adventures of a Labor Nurse – The Highs and Lows of Labor and Delivery
Cervix With A Smile – Walk the floor with an L&D Nurse!
Either BAMC or Madigan would be good choices. Unless things have changed in the past few years, the ICU course is offered at BAMC (I know it was previously done at Madigan, though I'm not sure if this is still the case). You might consider looking into where the ICU course is located and see if you can get stationed at that base to further decrease logistics for you and your family.
Both hospitals are medcens, so they are going to be fairly similar in terms of experience available to you. Consider weather if you have a preference of hot and dry vs. foggy and wet or if you/your family has specific interests that pertain to either location (closer to a summertime beach in TX, lots of great hiking and scenery in WA).
Best of luck!
And suddenly, HR's Halloween costume contest as a morale-improving measure took an unseemly turn...
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