Double-Helix, BSN 25,094 Views
Joined Apr 5, '11 - from 'New Jersey'.
Double-Helix is a Nurse, Children's Hospital.
Posts: 2,695 (50% Liked)
Because when someone asks a question they get told to search because their question has been asked before!
How are so many old threads being dragged up lately? This thread is from 2007 and last reply was 2008. All the posters have graduated nursing school by now.
My first question is- what text book is your INSTRUCTOR teaching from? That's the book that you should be using to study for the exam, as that's where the information will be based. The Saunders book may be good for NCLEX prep, but I doubt it is covering the exact same material in your syllabus.
Second, as your instructor if you can sit down with your exam and go over the questions that you got right and wrong. Evaluate what kinds of questions you're getting wrong and see if you can identify why. Did you not understand the content? Did you fail to prioritize correctly? Do you understand the concepts but fell down on applying the information in critical thinking situations? This might help you see where you should focus and adjust your study techniques.
I think this is the point. Smokers tend to less healthier then those who are non-smokers. Therefore, they take more sick days, and the group insurance rates go up.
I also think that fat people are just as at risk, but I'm thinking that so far, they cannot "discriminate" against obesity. At least not overtly.
As nurses, it’s our job to make patients better, to improve their lives in some way. For acute care nurses, the goal is to help patients recover from an illness, surgery, or accident. Rehab nurses help patients reach their highest level of functioning. Community health nurses promote wellness and primary prevention. Hospice nurses help a patient die with the most comfort and dignity possible.
As PICU nurses, our job is to fix children. Pediatrics is arguably the most diverse field of nursing, and we see a huge variety or illnesses, injuries and ailments. I’m very pleased to say that the great majority of children go home well. Kids are extremely resilient. A two year old who aspirated his scrambled eggs can be on ECMO one day and smiling and playing only three days later. I’ve seen kids overcome insurmountable odds on the road to recovery. I’ve seen the smiles from ecstatic parents, felt their grateful hugs, read their heartfelt thank-you notes. These memories make it especially hard when there is a child so sick we know they won’t be going home.
It doesn’t help that our unit has recently had several children with chronic conditions and hopeless prognoses: A few progressive genetic disorders, a fatal surgical complication, a routine procedure that ended in brain death. As PICU nurses, these are our least favorite patients. The ones that we cannot fix. The ones we cannot send home better, or cannot send home at all. These cases are hopeless from the beginning, but we run tests and do research and try new treatments until the question of their care changes from ‘What can we do?’ to ‘What should we do?’
Such is the case with the child who weighs heavily on my mind. A little boy just over a year old, the victim of a serious genetic defect who has already outlived his prognosis by several months. He is cherished by his parents. Though his face and body are severely malformed, his mother looks at him like there has never been a more perfect child. She wants desperately to keep her son with her, but he is nearing the end. A string of recent hospitalizations have left his body exhausted and unable to recover from this most recent respiratory infection. He won’t leave the hospital. It takes nearly a week and several family meetings to convince the parents it’s time to let him go. In that time, the child has nearly died more than once. A ‘Full Code’ order required that we compress, push medications, even insert an IO, and left the nurses frustrated and questioning the ethics of our work. It's heart-wrenching for us to process. This child has spent months with us over the past year and we have grown to love him. While we hate to let him go, we hate the thought of hurting him even more. We have reached the ‘Can’ versus ‘Should’ moment.
After several family meetings, a DNR is signed. The child is placed in the mother’s arms. Family is called in to say goodbye. This time, when the child’s heart rate and saturations begins to drop, the scene is different. The nurse doesn’t press the code button and sound the alarm. She doesn’t place the child on a back board, initiate compressions, push epinephrine or begin bagging. Instead, she holds the hand of the crying mother, she silences the alarms, disconnects the child from the monitor and steps out of the room to give the family privacy. In the eyes of an ICU nurse, she is does nothing.
It’s the hardest nothing she will ever do.
The parent’s see the difference now. Instead of facing their child’s death with fear and anxiety, they sense the peace in his body. He is exactly where he should be- being cuddled by his mother and kissed by his father. His last moments are free from pain and full of security and love.
The family spends as much time as they want holding the child, saying goodbye. When they are ready, the nurse places the child in the crib, removes his lines and tubes, washes his tiny body, makes handprints and footprints in ink and cuts a lock of hair as a keepsake. One by one, the family files out of the room. The mother is the last to leave. She turns back for one last look at her son before waddling out the door. She waddles because this mom is also 36 weeks pregnant.
In a couple of weeks she will return to this hospital, to the Labor and Delivery unit, and she will deliver another baby boy. The nurses in the newborn nursery will assess her new son and deliver the news that the baby is perfectly healthy. There will be no five month stay in the NICU. No barrage of tests and procedures. No hopeless prognosis. This baby will not come home with a trach and a shunt and a feeding tube. His mother and father will take him home after two days and he will thrive. A perfectly healthy baby boy who, by the grace of God, his parents will never have to bury.
Staff line up at the door to see the family out. There are tears in the eyes of the family, the nurses, even our attending physician. We offer condolences and encouragement: “Take care of yourself.” “Get some rest.” One nurse hugs the mother and softly whispers, “You did the right thing” and the hug gets a little tighter.
The mother saves her final hug for her son’s nurse. “Thank you,” she says, “for everything.”
But we know what she really means is, thank you for nothing.
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.
If you don't have the forms from the inservices, see if you can get a signed letter from the people who ran the inservices that states you attended and for how many hours.
As far as the bioterrorism one, try to get it as soon as humanly possible.
Oh, and please, keep all your tax documents. You never know when you might be selected for random audit by the IRS.
keep in mind is a "cartoon" therefore, don't let the "map 15" alarmed you...
Whether or not it is a HIPAA violation depends on whether protected health information was released to this teenager. It's possible the child was in the rooms performing tasks but not provided any health information. However, I'm sure this is a violation of facility policy. From a liability standpoint, the facility would be at a huge risk if something were to happen to these patients, or this child, while at the facility.
As you said, this is really a personal decision. But since you asked, I'll throw in my .
First, what are you plans for obtaining a nursing degree? From your post, it sounded like you were planning on taking pre-requisites and then applying to a nursing program. Since you have two years of pre-reqs and you said it will take 4 years to get your nursing degree, it sounds like you're thinking of applying to two year programs, which will get you an Associates degree.
Just be aware that for the great majority of educator positions, you'll require a BSN. Which means that, if you do go to an Associate's program, you'll need an RN to BSN bridge program in addition to the two years of experience (diabetes related) in order to become a diabetes educator.
How much research have you done into nursing school? It sounds like there are better options for you. There are direct-entry ADN and BSN programs, which will include the needed prerequisites in order to graduate. A BSN program will be four years, like you've planned, but will eliminate the two years of pre-reqs, as they will be included in the program. By taking to your local nursing schools, you may even be able to enter the program as a second-year student, as the first year of most BSN programs is solely dedicated to pre-reqs, which you may be able to transfer from your BA.
There are also Accelerated BSN programs for people with previous bachelor degrees. You'll need some pre-reqs to enter these programs, but once you're in the program is usually about 12-18 months. So even if you need two years of pre-reqs (which you could cut down on by doing summer courses and online courses) you'll still have a BSN in less than four years.
Now, as far as the pregnancy is concerned...
Family trumps career, in my opinion. Nursing school will always be there. There were several students in my BSN program who were in their 40's, and many students in their 30's. While you do still have many child-bearing years left, keep in mind that once you're in your 30's things can become a little more difficult. What it really comes down to is how much you want children right now, and whether you're willing to be a full time student while you've got a baby/toddler at home.
From a logistical standpoint, it's much easier to take a break from pre-reqs than it is from nursing school or your job. You can also complete some of your pre-reqs through online courses, which you could do while staying home with your baby. The difficult part will be when you are in nursing school and still have a little one to care for at home. But this is a task that many other nursing students have done successfully. This would probably be my choice, but I never could have waited until I was in my 30's to have my first baby.
If you do wait until you're out of school, then I'd suggest waiting until you've been working at least 6 months, so that when the baby is born you are eligible for FMLA and have plenty of PTO saved up in order to take a nice maternity leave without being strapped financially.
As I'm sure you know, there is no right or wrong answer here. There are pros and cons to each option, and whatever you choose, I'm sure you'll be able to manage it successfully if you are dedicated and have a strong support system. I like to use myself and my half-sister as an example of the different ways things can be done:
Me- I met my husband while we were in high school. I went to a BSN nursing program directly out of high school and got married when I was in my third year. Then I graduated, got a job as a nurse, and after about 6 months of work, am expecting our first child who is due just two months after I'll have been employed for a year.
Sister- She went to college right out of high school as well, but then spent some time working in a few different carer paths and traveling, met her partner, went back to school for her masters, got a better job, and is just now thinking of starting a family. She is 10 years older than me, and we are both having children at about the same time.
Different choices, different timelines, different priorities. Both right.
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