Double-Helix, BSN 27,213 Views
Joined Apr 5, '11 - from 'New Jersey'.
Double-Helix is a Nurse, Children's Hospital.
Posts: 2,767 (50% Liked)
If you don't want or don't intend to fulfill the obligations in the contract, then don't sign it and look elsewhere for a job.
Contracts are common in nurse extern/nurse residency programs. It helps the hospital ensure that they are getting a return on their investment. New hires, particularly new graduate nurses, require a lot of resources (cost a lot of money) to train. If those nurses go through orientation only to turn around and leave, the hospital would be continually losing money. A contractual obligation for X years of service means that the hospital is minimizing their potential financial losses, and you get the benefit of a job as a new graduate (which, depending on your geographical location, may not be too easy to find).
Unless your facility policy prohibits giving ceftriaxone in the deltoid, the manufacturer's literature doesn't limit injection sites. The point is that you want it given in a big, thick muscle, and the deltoid won't be adequate in most patients, but it sounds like your guy may have been the exception to the rule.
Being a PICU nurse, I have taken care of lots of chronically ill children. Some are severely disabled and their quality of life is very poor. Some of these children are placed on palliative care and pass at home or on our hospice unit. Others pass away after we have exhausted all efforts to keep them alive at the requests of the family. I know which death I see as the 'better' one, if one death can ever be better than another. I pray that if I am ever faced with that situation that I would be able to make the selfless choice in the best interests of my child. And I pray so much harder that it's a decision I never have to make.
Does your current hospital has a peds unit? See if there's any way you can shadow or ask to be cross trained to that unit to pick up some experience for your resume. Network with the peds nursing staff. They may know who to talk to internally or externally to help you get your foot in the door. If no peds unit at your current place, see about shadowing at another hospital.
I've only been a PICU nurse for three months, but I have gained a huge perspective in that time! Being a PICU nurse is exciting, heart-breaking, frustrating, scary, and wonderful all at the same time.
Imagine taking care of a child on ten seperate medication drips who is on a ventilator, has three central lines, arterial line, a CVP and a foley. You're drawing hourly blood gases and blood glucose levels, counting all of your I&O's hourly, monitoring the ventilator settings, constantly alert for any changes in vital signs, making sure your syringes of pressors don't run out, hanging so many medications that you are running out of lines to use. You're giving updates to the docs and making adjustments to your drip rates based on their orders. You need to turn your patient every two hours, which requires two other nurses to help move the patient and keep the breathing tube in place. To top it all off, you have angry family members scrutinizing everything you do and demanding that certain non-essential things be done immediately.
Being a PICU nurse is never boring. There is always something new, something that needs to be done. I've taken care of kids with so many different diagnoses that I couldn't possibly list them all. Our unit is a 19 bed PICU that takes all different kinds of kids. Our hospital has a pediatric cardiac surgery program, so we always have at least a few cardiac patients with various congenital cardiac defects. Depending on the season, we usually have a couple kids with viral illnesses, particularly RSV in the winter months, one or two babies on observation for apnea, asthma exacerbations, ex-preemies with chronic medical issues and heme-onc patient. Most of the pediatric surgical cases bypass the PACU and we receive them directly from the OR. So we get tonsillectomies, thoracotomies, traumas, amputations, appys, cardiac cath's, neuro surgeries, etc, etc. Our general peds floor does not have monitoring systems, so any patient that requires continous monitoring of any kind (HR, rhythm, O2 sats, respiratory) comes to PICU.
Solid assessment skills are crucial. Kids can't tell you when something is wrong. You have to know what's normal and what isn't and be alert for any changes that might indicate the child is deteriorating.
Critical thinking: why is this patient presenting like this and what does it mean? What am I going to do if this kid goes south? What do I need to have on hand in the room in case of an emergency?
Prioritization and time management: You've got a lot to do. You need vital signs on all your kids at noon time and you also have three IV meds to hang, several po/GT meds, one kid needs an enteral feed and the other needs labs drawn and another has an infiltrated IV. What's most important? What can you get done early?
Communication: With docs, with parents, with the kids. Parents of sick kids are nervous wrecks. They have a lot of questions. You need to be able to explain what is happening in terms that they can understand. You need to explain things to the child. You need to convince a sick and scared child to swollow their medications. You need to explain to the doctor why you think one of your kids needs a different type of treatment. A big part of your job is communicating. And don't forget giving and receiving report.
My day begins at 6:45am and on a good day I leave at 8pm. Most days I eat lunch at the nurses station in five minutes so I am never far away from my patients. If I use the bathroom once I am lucky. But these are "my" kids, as I refer to them. They are my responsibility and whether I've taken care of them for an hour or three shifts, I love them. There is no other specialty like PICU, and there is no other place I would rather be working.
It sounds like you've got a good understanding of the material. In real life in the ER, your short-acting beta agonist (albuterol) is probably going to be administered via a nebulizer, concurrently with oxygen. But if MDI is your only option, then yes, you would give that prior to giving oxygen.
A spacer simply disperses the aerosolized medication into a contained air space to allow it to be more adequately inhaled into the lungs. First dispersing the medication dose into a spacer cuts down on the amount of medication that may become attached to the oral mucosa during inhalation. What kind of medication being dispersed (long or short acting) is not relevant.
It's much easier to research and write about a topic that you're interested in. My suggestion would be to use a peer-reviewed database like Cochrane, Medline or Ebscohost. Type in a topic you're interested in and search for articles published within the past 5 years. Choose a topic that has a decent amount of results so that you'll have enough information for your paper.
To help you develop an effective question, try using the acronym PICO. It stands for:
P: Population (who are you researching)
I: Intervention (what action or change are you researching)
C: Comparison (what is current or an alternative practice)
O: Outcome (what effect does the intervention have)
I'll give you an example using the topic you suggested:
P: Low income women
I: Access to free prenatal care
C: no prenatal care
O: decrease premature births
For low income women, does access to free prenatal care result in fewer premature births compared to women who receive no prenatal care?
In my opinion, "nursing staff resources" would include the staff nurses, LPNs and ancillary staff such as unlicensed assistive personnel available on the unit to provide patient care.
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