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ixchel, BSN, RN 47,562 Views

Joined Jun 3, '11. Posts: 5,158 (75% Liked) Likes: 19,776

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  • Mar 24

    New Netflix show Bloodline -

    Character goes to ED for chest pain.

    "You didn't have a heart attack. Your heart was in atrial fibrillation. We shocked you back to normal rhythm. We're going to send you upstairs for an EKG and echocardiogram."

  • Mar 24

    When people pass their flattened hands down a face and the eyes of the deceased magically close.

  • Mar 17

    Quote from 2mint
    Oh no.....ixchel....you were on fire, but your momentum was too strong that it carried you over the cliff (psst, passerbys, we had a little back-and-forth on another thread earlier today).

    So sad that you can't prove the above quote....nothing in my first (response) post....nothing in my second response post. (Giving me an easy win to shut me up? Well played )--but then I won't be able to submit my new grad pay negotiation article for the Winter Contest....
    Are you serious?! THIS is your response?!

    Why am I always the last idiot in the room when everyone else's instincts send them running away from the trolls!!!!!!!

  • Mar 17

    Now, mint chocolate chipped iced cream with m&ms, you've stated that it's inappropriate for employed people to respond. I disagree completely. Those of us who are employed with successful resumes are in the BEST position to contribute valuable information to this thread, WITH YOU, growing a valuable resource. Open your mind to the possibility that rather than taking ownership of the direction this thread goes as though you are the expert, we are ALL able to contribute our own valid experiences as we all share the same goal: assisting the newbies with that daunting task of job hunting. Accepting you can grow with others opens doors to personal evolution, one of the best skills a nurse can have.

  • Mar 17

    My little minty delight, allow me to provide some feedback. I'm able to figure out your Xs, *s, and #s, so I assure you, I am understanding properly as I type this.

    My belief here is that you are positing your success with your job hunt has a lot to do with securing the interview with your resume. I'm inclined to agree, however, now that I am seeing it, I'm seeing good things and bad things. Allow me to share my thoughts as advice for future searches, not as criticism (I assure you, this is not criticism).

    First, some background on me - I'm a 30-something who came to nursing after trying other areas first. Like many people, my younger days were bartending and retail, but then I moved on to some unusual/unique roles, and more professional roles. I won't be more specific than that because the combination of unique and professional roles will quickly identify who I am to those who know me.

    For my track record on resume and cover letter writing, I have literally NEVER been passed over for an interview. Every single time I have submitted my own letter and resume, I have sat for an interview.

    Out of every interview I have sat for, I have been offered a job every time except twice.

    The first time, I was a tiny 19 year old hot chick who looked 15 applying for a job as a corrections officer. It was the right decision.

    The second time, I applied for a nursing scholarship/residency program at a tiny hospital that doesn't have women's health or pediatrics. The interviewers sized me up and thought I wouldn't stay there after my contractual obligation because these populations weren't served there. I was actually pretty angry over this as by this time, I'd decided against both specialties. But, their HR/recruiter called AND emailed stating that you normally get a Dear John letter, but they were so impressed by me and my resume that they really struggled to make the decision to not hire me. Ironically, I've been on an adult critical care unit very happily.

    My current job, first one in healthcare, I competed against 250 applicants for four slots. Some of those applicants already worked there. Since ICU wasn't taking on a resident nurse that year, my unit was the one to get. My resume got me in the door with 24 other applicants, my interview sealed the deal.

    My point here is that I am my only resource in the format and feedback I am about to share. I hope I am legitimized by my track record.

    Now, regarding your letter. You took the time to look up the organization. You stated an example of how you embody their vision/mission. That is a wonderful way to connect yourself with the organization showing how you are already part of their team. I find it may also help to look up something they're working on, or something that has been in the news. Show some enthusiasm regarding that goal or accomplishment.

    For the letter itself, it absolutely has to be one page. It needs to be strongly worded regarding how awesome you are, but how humbled you are to receive this opportunity. NO ONE will brag about you, so you should. Not in an annoying way, of course. But don't hold back. If you've achieved something, mention it. Don't be "that guy" though. If you ONLY brag, you're going to be that guy who is unwilling to learn, adjust to change, show humility, show vulnerability, make mistakes with some grace and transparency.

    You need to close this letter as though you've already got the job, and all the interview is is an opportunity to talk about it. I think it's very strong to end with, "I look forward to meeting with you soon and discussing our future together!" It tells the reader you already see yourself as part of the organization. It says you're committed to this opportunity.

    Now, for the resume. Again, concise is good. If you need two pages, make the second page education and awards. The fact that you have a degree in nursing is obvious if you're applying for a nursing job. And, we nurses tend to be overachievers, so awards are nice to add, but not as important as the professional experiences you've had and your personal statement.

    On the work experience, list your relevant job experience. No one wants to read through the 19 restaurants you blew through in your teens and early 20s. Relevant jobs should leave little to no gaps in employment years, go back a minimum of ten years, if applicable, and every job experience should be able to be described with strong nursing buzz words. Time management, leader, delegation, organization, responsibility, prioritization, customer service, multi-tasking, high-speed environment, management, management of employees, engaging, development of interpersonal relationships, budgeting, etc. Many jobs can include these buzz words. Heck, one of my unique jobs, you'd NEVER imagine I could relate that to nursing buzz words, but I did. Gotta think outside the box. You can't by obvious about it, of course. You just need to fit some of those words in and trust me, they'll be noticed.

    So for jobs, you briefly describe your duties, and then you briefly describe the skills you gained. After all, we are all evolving as we start every new adventure.

    Now, this individual post is enormous already, so I'm going to put the end result of all of this rambling in my next comment.

  • Mar 14

    Had a young guy ambulate to the hallway to let us know he needed help ambulating to his bathroom (which was closer to his bed than the hallway).

  • Mar 1

    Quote from Leonca
    Today I learned not to try to medicate a patient outside while it is jumping up and down in a puddle of its own urine. A big dog can splash that stuff right in your face.

    Still not as bad as the time I tried to clean a broken kennel drain full of sewage with a high-power hose. Sometimes I feel like such a dufus.
    It's not nice to refer to patients as dogs and patient rooms as kennels.

  • Feb 25

    I just introduced my little people to the X Files. Episode 3(ish), they find a girl who had gone missing. Scully shouts out, "She's alive! She's just unconscious!" All the while she's doing chest compressions (horribly shallow and slow ones at that).

  • Feb 15

    Jan, your post was beautiful and thorough, and I very much appreciate it! Sloughing of bowel was actually one thing that happened with my now deceased loved one. It was hard to understand just how much she had deteriorated in only a few days. I was thankful the nurse was candid with me, though. Any site I have read so far with the position that Jahi is not dead has cherry picked comments left and right. You can tell because the people who are crying out for prayers and miracles are slinging profanity at comments that no longer exist. I'm blown away that in one sentence they ask for and offer unconditional support, but they immediately follow it up with a bunch of eff yous and insults.

  • Feb 15

    So, physiologically..... What is going on inside her right now? She's had no nutrition, and meds are keeping her going, right? But what's happening in her body? A dear family member passed on in November after a pulmonary embolism in a pulmonary vein, which stopped her heart and she never did wake up. She was sedated (only because she'd seize when they tried waking her up), had vasopressors, and was on a vent. Now, she was facing cardiac death, not brain, but ultimately, her organs started failing. Her kidneys stopped, her intestines stopped, they stopped feedings because her residuals indicated nothing was moving beyond her stomach. She was mush, pretty much. Jahi has extremely different circumstances, of course, but 3 weeks with nothing going in but meds, and no basic brain function .... Wouldn't she essentially be mush as well?

  • Feb 9

    Quote from BrandonLPN
    But, in this specific scenario, it really wasn't feasible to obtain an order for PICC draws right at that moment, in time for that blood draw that needed to be drawn at that time.

    I think adressing it in the morning, to be taken care of that day, is fine and being an advocate and a prudent nurse and all that.

    If this had been passed on from shift to shift with no one owning it, and the patient getting poked over and over, that'd be another story.
    Thank you, Brandon. And yes, that's what I'm saying. This patient facility hops and has a ton going on with her. The PICC was placed a hospital 30 miles south of where I work before she was discharged to a short term place. When she was admitted to my hospital, my understanding is the admitting hospitalist received from the MD who placed and is managing the PICC that we are allowed to run meds through it ONLY. I don't know why, nor was I given the opportunity to ask. Based on the way that shift went, the thought didn't even cross my mind until lab was there, telling me I needed to draw the labs. The order and note specifically said the PICC was for meds only. At 4:30 in the morning, no, I was not going to contact the hospital's ONE night time hospitalist (who specifically is only there for symptom management, not plan of care issues, unless the patient is unstable or newly admitted - neither applied to her) to tell him he needed to call a doctor who consults for a neighboring hospital to change the order.

    Yes, I understand advocating for patients. A million and one percent, I understand advocating for patients. I also have a realistic understanding of what is possible. We are not a large hospital with residents in abundance. I work for a small rural community hospital without access to everything we might want right then and there. It's a skeleton crew on night shift. Unfortunately it does mean that there will be times when we have to give things to day shift. I didn't get her back, so I don't know if the order changed. Genuinely, I do hope it did.

  • Feb 9

    Quote from Been there,done that
    "Not sure why" doesn't cut it. Your patient is lying helpless in an ICU bed, repeatedly being stuck with needles. You need to speak with the doc (that does not give a rat's pattooty that their patient is receiving multiple invasive and painful procedures) and get their rationale as to how this benefits the patient. Unless the PICC is used for TPN, there is NO reason it cannot be used for blood draws.
    PLEASE advocate for your patient.
    Because the doctor said so.... is never a reason to carry out any order.
    It was 4:30 in the morning, we were short staffed (5:1 on a stepdown unit) so I didn't look at her labs ahead of time, and the MD who placed the PICC is an outpatient doc without hospital privileges. I included the issue in report that morning. I don't just blindly follow orders or like excessive, unnecessary sticks. It was not something I could change for the purposes of that lab draw.

  • Feb 9

    Does this happen at your hospital?

    Recent examples:

    #1:
    Radiology tech: "this patient has q0600 portable chest X-rays part of his old ICU order set. They normally DC these but they didn't DC his. Do I really need to do this?"

    #2:
    Me, to a different radiology tech: "we just discovered he might have foot fractures and I'm putting in orders right this exact second. Do you mind grabbing images of his feet while you're here?"
    Rad tech: "the order wasn't already in so your, have to get that later."
    Me: "the order is in right now."
    Rad tech: "no."
    Two seconds later, does the images anyway, because she realized it meant she'd have to come all the way upstairs again.

    #3:
    Respiratory: "Earlier MD asked for a different patient to have ABGs done at 0800" (after RT's shift would be over) "so we can just do this patient's in a few hours, too, right?"

    #4:
    Lab, after walking the whole unit to find me: "that patient has a PICC, why can't you draw her?"
    Me: "I don't have orders saying I can."
    Lab: "I saw her get drawn off that line last week, you need to draw her."
    Me: "her line isn't being used for labs. I don't have an order saying it can be. I CAN'T use it. You need to draw her."

    If it weren't the same people trying to get out of their orders every time, I'd figure they were just confirming things, but I am absolutely convinced they're trying to get out of doing their job, and they're trying to get the RN's "okay" so they can pass the buck to us, I am so done with this! If they want to questions orders, they should call the people writing them. :\

  • Feb 9

    Anecdote.....

    I have spondylolisthesis, which was discovered in 2012 after a fall. I fought muscle spasms for nearly a year before turning to acupuncture. I believe that should be long enough to discount placebo effect. I had noticeable improvement after my first treatment, incredible improvement in quality of life after the second, and have had my pain under control 90% of the time since my third or fourth.

    I initially turned to acupuncture, though, after trying IVF and having an unsuccessful embryo transfer. The second transfer, I started acupuncture at the same time as starting meds. On the exact same medication protocol, and changing absolutely nothing else in my life, I had a 25% thicker endometrial lining than at the first transfer. Perhaps it was a coincidence, but I only tried it at the suggestion of my midwife, who handed me a newspaper clipping saying that studies were showing acupuncture to be effective at boosting IVF success rates. My first treatment ever, I was laying on the table thinking, "okay, really.....? There is no way this actually does something...." It did, though. (As evidenced by two little monkeys )

  • Feb 8

    Had a young guy ambulate to the hallway to let us know he needed help ambulating to his bathroom (which was closer to his bed than the hallway).


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