Dela RN 2,933 Views
Joined: Apr 30, '11;
Posts: 44 (23% Liked)
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how about private clinics like plastic/cosmetic surgery? i have a scheduled interview next week but i forgot to tell them i dont have that certificate,,
I hope you've found something by now, but I figured I'd share my experience anyway.
I just finished school in April and was really stressed to find a job. The unit I did my preceptorship on was a no-go (it was LDRP - I loved it there, but they were laying off 4 RNs and hiring LPNs instead, or so I was told...). I should mention that I was already an internal candidate, I'd worked as a NA at a local Edmonton hospital, but my experience wasn't great and my manager had no idea who I was which almost COST me a job offer.
I treated applying for a position as a full time job itself. (I do wish I'd spent more time studying for the CRNE, which I may regret in about 3 weeks). I made long and completely tailored cover letters for each position I applied for. My 3 page resume included all the basics from school plus any courses, projects, or papers I did that gave me a specific edge (eg. I took a motivational interviewing course as a part of my 4th year elective; did a presentation for teen parents on infant safety, safe car seat use, talked about specifics of nursing I am passionate about like family-centered care, etc). It was ridiculously organized and I made sure it sounded perfect.
I applied for anything that interested me, but I really made sure to put extra emphasis on those positions I really, really wanted. I also included my future goals with time lines for when I plan to achieve them, and how the this position was integral to a successful, long-term career.
Using these strategies, I managed to receive about 15 calls for interviews, I actually went to about 8 interviews, and I've had 6 offers - one of which is in Calgary in maternity - literally my dream job and the entire reason I went into this profession. The managers told me it was my passion and enthusiasm along with my knowledge that made me stand out. I hope I can live up to what I conveyed in my interview, but I'm not really giving myself a choice, either.
That being said, two of my first interviews were TERRIBLE. I fumbled on the basics, blanked on things I should have known because nerves got the best of me. I analyzed and replayed those interviews over and over, and I made so many notes on what I said that was good and not so good, I watched videos and read numerous articles/blogs/forums on the important things to make sure you do and don't do in an interview. In the end, you still need to be yourself - you may do everything right and still not get the position because you just don't fit. It sucks, but it's usually for the best. I actually had one unit turn me down, and I thanked the manager for the opportunity and asked if she had any advice for future interviews - two months later, and she just offered me a position. Be professional, be confident but humble, and share your knowledge and experience and why it makes you perfect for the job (but don't compare yourself to others, you don't know who you're applying against, all you know is what you have to offer).
I also wanted to emphasise what others said as well; when I first started applying and things looked bleak, I emailed the HR recruiters with coventant health and they got back to me within the same day. They told me their northern sites, specifically Bonnyville, desperately needs nurses. You may need to look at packing up and leaving home for a bit to get some experience, but at least it's something. You may even find a new "home". (Plus you get a nice living bonus for working up north). I'm uprooting my entire family to move to Calgary now, but I haven't had any calls for interviews for any of the positions I *really* wanted in Edmonton so I'm going to where the offers are instead.
All the best of luck to you, I hope things start to look up. Feel free to ask me any questions if you like.
I hope all you nurses in Ontario are able to stir up your friends and family. You REALLY don't want Tim Hudak having ANY control over your futures. He's Alison Redford's evil twin. The main difference is that he's being up front about what he has planned for the public service where she conned enough public servants in Alberta into believing she was an ally so they'd vote for her... then went for the throat. Bills 45 and 46 last fall, followed by Bills 9 and 10 this spring revealed her true colours. Lots of money for party faithful, slash and burn everybody else. Alberta Health Services pays more for executive salaries, percs and severance than they do for direct patient care. Don't let Ontario go down that road!
Your entire shift should be putting in the OT forms for missed breaks!
Nobody works for free, especially our esteemed higher ups in AHS.
Hot tail your body over to your UNA steward. That's what they are there for. Your manager is dire need of a whack around the back of the head.
I can give you from my personal experience as an LPN who immigrated to Canada from the US. Yes Calgary is hiring. If your thinking about it now is the time as they have a brand new state of the art hospital that is opening. I will tell you this forget about a LMO for LPN. Alberta is not in desperation for LPN's. Your best bet is to do what I did. Go on the CIC website and see if LPN has reached the cap. As now for skilled worker there is a cap on all professions. Next do the paperwork which by the way you can do yourself! No need for an immigration attorney trust me! It does require you to do some work such as employment letters, school transcripts, FBI clearances etc etc. And of course apply to CLPNA. My original license was from NY and I know that it did not recipricate with California. So not sure about what your education in that state is CLPNA will look over your transcripts and tell you exactly what is needed. I would do this first especially if you have to wait with immigration. That way when immigration is done you will not be waiting on a registration as it takes a while to process. I had mine a year before I came here. Another thing I will share is its not easy peasy coming from the US. They see your education and job experience and immediately focus on that your American. When I applied I would get responses to my resume's with "we are not in a position to sponsor at this time" which told me they did not even look at my cover letter explaining I did not need sponsorship and that I held PR. I have been here since 2010. I started out with casual then went on to a temp. part time which turned into a perm. part time. I just got a full time perm. position here. And I will add I am experienced. Everything is union here and senority based. So be prepared to pay your dues here so to speak. I prefer Canada over the US as far as nursing goes. The documentation is way less here. Pay I can guarantee is more as well. I make more here then some RN's where I lived. Cost of living is higher but you are in California so might not be that much different. If you have any questions feel free to ask. Hope it helped!
Have you considered relocating? Other areas/states may be more willing to hire new grads. Also, many hospitals will hire internal applicants over external applicants. You may end up having to work a year in med/surg or another unit just to get your foot in the door of an institution. Then, you can request observation days in the OR and get yourself known that way.
Come on guys, lets be a bit more supportive. Yes the OP did a mistake, I am sure we have all made mistakes both as students and as nurses. We learn from them. There has been some good advice in this thread
Why do OR nurses continue to give the suck it up advice???
This student is being bullied. This get a thick skin attitude has to change. It's why went back to the floor. I still help out in the OR since they are short staffed but about an hour into the stift I can feel the toxic forces overflowing.
To the OP, document what is happenening. These toxic people are allowed to stay because to get someone to change there has to be documention. Surgeons stopped thowing stuff after it started to be documented....No one is ever fired or repremanded if there are only "stories" going around.
So yes, maybe toughen up, but toughen up where you stand up for yourself!!
Good luck with the rest of your program then look for warmer waters.....
Ah yes, the joy of learning suture.
::cracks knuckles:: Let's talk some suture, shall we?
First and foremost, allow me to disclose that my place of employ utilizes Ethicon suture (as have other OR's in which I've worked), therefore I will do my best to generalize where possible. I will also try to keep it simple. I can ramble for hours about suture.....it's a problem. And you know what they say, acknowledging a problem is the first step to recovery.
And away we go:
What the devil is the difference between the sutures?
Well, sutures are comprised into three different varieties: Natural, braided (multifilament) and non-braided (monofilament).
Examples of multifilament:
Sutures are then further categorized by whether each is absorbable or non-absorbable.
Okay, before we get too far into our discussion, let's pause and break this all down as far as what this means to you as a circulator.
~~ When a patient has an infection, most doctors will not use a multifilament suture when closing an infected wound. Why? Because the braid in a multifilament suture is a lovely little breeding ground riddled with nooks and crannies that allow the bacteria to breed like crack riddled bunnies.
Sub point: Monofilament lacks these nooks and crannies and therefore tends to be favored. Infected patient? Think monofilament sutures.
~~ When a patient is "spitting suture" it tends to be a non absorbable or slow absorbing suture (we will get to that in just a sec. Hang with me).
So, let's talk absorption info, shall we?
Plain gut: 70 days
Chromic gut: 90 days
Vicryl: 55-70 days
Monocryl: 90 - 120 days
PDS: 180 - 210 days
Nurolon: loses something like 20% of it's mass, if you will, per year, if I remember correctly. ::nudges sleeping brain::
What this means to you: Well....honestly? Not too terribly much. Just some good info to know. I've only used this piece of info twice in my career and both times it was in answer to a surgeon who then stared at me as if I had three heads.
Well, Ms. Potato, you say, that's all find and dandy, but where on the body are the various sutures used?
Well, my friend, before I can answer that question honestly, I must introduce you to one more of two additional determining factors that marks where in the body a suture goes: needle type.
There are then six types of needles: Cutting, reverse cutting, taper, trocar, blunt, and side cutting.
Don't panic. Here's the breakdown of each and what they are typically used for:
~~ Cutting: Triangular shaped needle (if you were to stare down the tip) with the cutting or sharpened edge found to the inside. (more superficial closing sutures. Needle call letters or code example: CR)
~~ Reverse cutting: Triangular shaped needle with sharpened edge found to the outside. (also more superficial closing sutures. Needle call letters or code examples: FS, PS, M, LR, KP-3)
~~ Taper: round needle tapering to a point (this is the most atraumatic needle type, hence it is used in deep fascia closure as well as on bowel, vessels, nerves, tendons, etc. Needle call letters or code: CT, CT-1, SH, UR, BB, BV)
~~ Trocar: rounded needle ending in a cutting point. My facility does not use these needles. Alas, I am unable to provide further info. I apologize.
~~ Blunt:....yeah....blunt. Um...we don't use blunt needles at my facility. Ever.
~~ Side cutting: Flat needle with cutting edge to front. (eye surgery only). I'd be lying to say I know. The last eye case I worked on was an enucleation. So. Um. Yeah. We didn't fix the eye.
Moving on! So what's the last determining factor (other than surgeon preference) that determines what we hand them?
Why, size of course. After all, it always comes back to size.
And I'm not just talking needle size. Pause.
Although that is a factor. If I'm working on a finger, giving me a veritable harpoon to use isn't going to work so well, ya know? It's all about common sense with this one. If the work is delicate--think eyes, plastics and the like-- are you going to offer the surgeon the biggest, gnarliest needle in your arsenal? I would hope not. Small and delicate for well...small and delicate. Mmhm.
Size is also a reference to the density of the suture or what is called tensile strength.
It's written on the outside of each box and you have heard it since the day you started. It's that pesky numeric coding in big bold letters: 0, 1, 2-0, etc.
So what in the devil does that mean?
Here's how it works: think of it like learning negative numbers in school. The Higher the positive number, the bigger the suture. The Higher the negative number, the smaller the suture. Example: Which is bigger: 3 or -8.
Also, sutures that do not have a 0 to follow are commonly referred to as a "number XX".
A number 5 Ethibond is going to be the suture world equivalent of twine rope where as a 10-0 Nurolon is as fine if not finer than a human hair.
Any suture that is a positive or high number without an 0 to follow is thick. Anything with an 0 to follow is fine. As the front number rises, the thickness of the suture grows more fine.
More examples, in case I completely lost you:
Number 2 Nylon: thick
2-0 Vicryl: Fine
2-0 Nylon: Still fine.
2-0 Monocryl: ....you guessed it. Still fine.
Number 1 PDS: thick
3-0 Vicryl: More fine than a 2-0 Vicryl. Thicker than a 4-0 Vicryl.
Okay! Time out to put this together before we get to putting it all into the working world:
Just like needles size, suture thickness is a matter of common sense: You do not use a 10-0 Nylon to hold together the fascia of an abdomen or sew together the muscles in a knee. Kinda wouldn't work.
So where do you find the thick suture? In the deep parts of the wound and where there is going to be natural resistance and pulling put on the suture by the living body.
Exceptions: nerves and vessels. Again, common sense. To sew the little walls of an artery in a bypass, are you going to use a Number 2 suture? God no. Think more along the lines of a 7-0. Fine suture for fine work. Big suture for big work.
So when the doc is sewing deep, he's going to ask for that Number 1 suture or an 0 (typically called an "o" in our little corner of the OR globe). When the doc is sewing the shoulder closed and is working on sub-scap or cuff, is he going to want a 5-0? Nope. Those muscles are going to PULL on that suture. Number 2 it is then.
Now a quick note: remember, the number is not only an indicator of size but of tensile strength. Higher the number: stronger the suture. Higher the number with an 0 to follow: weaker the suture.
Now comes the fun part:
Let's put it all together. With some practical application discussion. Heheh.
:: poof!:: I am now a doctor. Not just any doctor--the one in your OR. And I'm bored so I'm working on a belly case. I'm rooting around in the bowel and I want to suture some bowel together.
Suture of choice? 2-0 (delicate suture for delicate work. Not too weak, not too strong) Silk (non absorbable). On an SH (Taper needle: atraumatic. Won't do me a lick of good I'm slashing my bowel to bits to try to sew it together, ya know? P.S. This needle is also called a GI needle by some scrubs)
And this is how the scrub will ask for it, "I need a 2-0 silk on an GI". Some scrubs have the actual suture catalog numbers memorized, which is fine, but I prefer to know my needles and suture types. I digress.
Great! So my bowel sewing has gone wonderful and I think I'm done because I'm hardcore like that. So I want to close. I'm just starting to close so I'm going to be sewing deep.
Suture of choice? 0 (Strong! Those belly muscles tend to pull.) PDS (I want this suture to hang around for a looooooooong time to be sure the wound closes well) on a CT-1 (again, taper needle. I don't want to cause undo trauma if I can prevent it. Quick note: some scrubs refer to a CT needle as a "general closure", as in, "I'll take an 0 PDS general closure" ).
What's that? You're out of 0 PDS? Well drat. I guess I'll take a 0 Vicryl on a CT-1.
Okay, so that's done. I'm going to close my next layer of fascia.
I'll take a 2-0 Vicryl on a CT-1. (The tissues are getting more delicate as I work towards the surface, and therefore my suture should follow suit).
You know what? I'm going to put a drain in my patient. What should I use as a drain stitch?
How about a 2-0 silk on a FS (Non absorbable so it will still be there in good shape later and reverse cutting as I'm going to go through skin and cutting/reverse cutting makes it smooth like silk).
Wow. Almost done. Let's close skin.
I would like a 4-0 Monocryl on a reverse cutter or whatever you got like that. Yeah, that will do. Skin is delicate and I'm going to do a lovely plastics closure so my patient doesn't scar as badly. I need something fine and sharp with a capital S.
Things to take away from practical discussion and various other sidebar comments:
~~ All boxes/suture packets are labeled with all the information that you need: needle type (including picture as well as written description), number of size and type of suture.
~~ As you work deep to superficial, suture tends to be come more fine. Remember the exceptions mentioned before.
~~ Popular drain stitch tends to be silk or Nylon. Depends on doctor preference/specialty. Where I come from General/Neuro/Cardiovascular surgeons tend to use silk. Ortho uses Nylon.
~~ Ortho tends to use more cutting needles as what they are working on is less delicate.
~~ Ortho tends to also use Nylon to close skin. Again, surgeon preference.
~~ When in doubt of needle type (you will be surprised how many doctors don't really know the difference), grab one of each and bring them close to show the field/surgeon. Let him choose. Choices are good.
~~ Always read/consult surgeon preference cards/confirmation sheets as any good circulator should. Know what your doctor tends to favor normally so you know what to offer when he throws you a curve ball.
~~ Some suture does not have a needle. Umbilical tapes and tie sutures do not. Ties come mostly as either Silk or Vicryl. In spite of this, they follow the other rules listed above: " I would like 0 silk ties" . These sutures tend to be used in the tying off of vessels to large to be bovied into submission.
~~ There is such a thing as a straight needle called a "Keith needle". Can be found on Silk and Prolene, just as examples, and is a straight "traditional" looking needle. Looks just like what you think of when you think of sewing. Why is it used? Mostly used in the securing of central lines and art lines superficial through the skin.
~~ Some sutures come "double armed" (meaning there are two needles connected to one suture): Prolene, especially. How to know? The box as well as the package will show an image of two needles with a fine line between them.
~~ Sutures, mainly Monocryl, Nylon, Vicryl sutures can come as both dyed and undyed. Again, it's on the box whether the suture is dyed or undyed and most scrubs will specify as will the docs. "I want a 2-0 undyed Vicryl on a FS-1"
~~ There are sutures known as "pop off" sutures or "poppers". They tend to come in packs of eight and will be labeled on the box as "controlled release" as well as circled in an oval shape with the letters CR followed by the number of sutures in a package. In a package of eight this looks like, "CR/8". Example of dialogue: "I need a pack of 2-0 silk pop offs, please." They are used in places that need multiple sutures to close an area (mostly bowel and abdominal as well as spine) and allow the needle to be released and removed from the field for the surgeon to tie easily.
~~ The size of the needle image on the box is the exact size/shape of the needle in the package.
~~ Some suture comes "looped", meaning that the suture literally loops back and reconnects to the needle leaving no true dangling end. The way to identify this type of suture quickly is through the image on the box: it will show the needle with a loop at the end of it. The box will also be labeled accordingly.
~~ Take time to look over a suture cart/boxes and become familiar with where on the boxes the information described above is located.
~~ And, as always, never forget to add your needles to the count.
I hope this helps. I'm sorry for any forgotten details or confusion; between call, espresso, and sleep deprivation, I'm afraid I'm a touch scatterbrained today. Any questions/comments/ etc, let me know. I will be more than happy to help in any way I can.
Good luck to you and welcome to the world of OR nursing.
~~ CP ~~
Hi Everyone. I graduated from my BSN in May and I just started working on a medicine unit and a long term care unit. Most of my shifts are on the LTC unit and I really enjoy it. I find it challenging, since I am a new grad, but I am able to get through the day and learn something new everyday.
My shifts on the medicine unit are a different story. The unit is very busy and there are so many skills to be performed everyday. Most of these skills I have never done on a real patient before and I am having extreme anxiety everytime I think about having to go there to work. The staff are not very helpful. The other day they assigned me four cardiac clients with telemetry/chest pain/IV meds, etc and a post-op client with a trach. When the nurses gave me my assignment they started to laugh and said "good luck".
I was so upset after this shift I called and cancelled my next shift. I do not know what to do? I want to be there for all the learning opportunities, but at the same time I feel so unsafe practicing there. I have brought up the issue to my manager, but was refused more orientation at this time. I just feel so lost. It took me a long time to find a job and I don't want to quit, since I love the LTC unit I am working on. I just feel so lost on what to do about the medicine unit and practicing there. When I am on my days off all I can do is think about work. I am constantly looking up information or practicing dosage calculations, so I don't have to ask for help from an unfriendly co-worker. I have never felt so alone at a job and the worst thing is this is a job that I need some guidance at.
Sorry if I sound annoying. I just don;t know where to turn to for help. If anyone has some advice I would really appreciate it.
Are you looking for the maximum safe volume? Like myfavouritescar suggests, in most infant situations there isn't a set amount that we draw.
Rather than "drawing a rainbow" as a standard practice, with infants we usually figure out exactly what the orders are going to be and then draw the minimum amount needed to accomplish that testing.
Do you use Microtainer tubes or something similar to them? With this type of system, 0.5 mL is usually plenty for a green top (chemistry) or a purple top (hematology). Accurate blood cultures seem to require at least 1 mL, even from the tiniest patients.
If you're using a Microtainer-type collection system and only collecting the blood required for ordered tests, needing to draw potentially unsafe volumes of blood shouldn't be a common problem.
The toxic negative nurses-eat-their-young culture. Basically the way we treat one another (that often stems from the way we have been treated since day 1 as a nurse, or even day 1 in nursing school for some).
The way our hospitals will so often blame a nurse and throw her under the bus rather than take responsibility for a systemic problem.
Call it what you want, bullying, lateral violence, etc, it is rampant.
Everybody has their theories on why this happens: too much estrogen in the field, too many people promoted to management who have great clinical skills but no managerial or people skills, not enough clinical hours/experience in nursing school, lack of a unified nursing voice, the fact that we tolerate it, etc. I think there's a bit of truth to all of those things.
What I can tell you is that when I made the jump from bedside care to case management for a managed care corporation, I didn't do it because I was tired of the pace, the patients, the families, the intensity of the work, etc. I did it because I needed a break from the culture, and the people who perpetuated that culture. And sure enough, you don't find that same toxic culture in a workplace with a good mix of both genders, where people are promoted for their management skills, and where staff know what to expect from their schedules, and don't have to fight between themselves to get days off. So far, the grass IS greener on the other side (out of the hospital).
Ehh- mediocre article at best. Too bad, since it seems like it would have been a good platform to educate patients. Nurse Jackie??? Really? That's the most relevent thing they want to talk about? MY list would include-
1. Keep an UPDATED list of your medications, as well as your medical dxs- There is NOTHING more annoying than trying to figure out what meds a patient takes- "Some white pill for my heart" IS NOT THAT HELPFUL!!!! NO- we CAN NOT just "pull up the records from your MDs office."
2.You will NOT die from constipation or an upset stomach if you've only been having sx for an hour....and NO- if you come in to be worked up, DO NOT ask for a turkey sandwich and cop tude with me because "You haven't eaten all day..."
3. I'm a nurse. Not a waitress. I try to make everyone happy, and if I have a minute (ha!) I will actually ask your visitors if they would like a coffee- but don't EXPECT it. YOU are the patient, and you are my concern-not everyone else.
4. Leave children home, or supervise them when they are there- do you have any idea what kind of yuck falls on the floor they are crawling on?
5. No- it is NOT my responsibility to find you a ride home. You are an adult. Seriously...
6. You are in the hospital because you are sick, and I am very happy to help you care for yourself...but please don't ask me to do things you can do yourself. This includes fluffing your pillow, handing you the remote, and cleaning your tush after you poop! Your arms aren't broken, you wiped perfectly well before you came in...DO IT YOURSELF!!!
7. Standing in the doorway to the room giving me dirty looks will NOT make me move any faster- I will get there just as soon as I possibly can...
8. When you put your buzzer on, and they ask you over the intercom what you need.PLEASE tell them within the constraints of your privacy. If you need pain medication tell them- that way I can get it to you faster. If you need a towel, or need help walking to the BR- PLEASE tell them that. A CNA can do that, and often they don't answer lights because the pt says "I need my nurse..." This will help you, since you will get your needs met quicker.
9.Be civil! Don't order me around like I'm your personal slave for the day. I treat you with respect, a simple please or thank you is very appreciated.
10.If I can't get to you right away, it isn't because I'm sitting on my butt watching TV and eating bon-bons. I'm probably helping another patient, and I will be there as soon as I can.BTW- I can have several other patients as well as you, and some might be very ill-I'm only one person, and believe it or not, I HATE it when I go home feeling like I didn't get to help my patients.
11. We LOVE to hear from you after you go home. Very few things make us feel as appreciated as a short thank you note letting us know we helped.
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