Latest Comments by nickos

nickos 5,870 Views

Joined: Aug 6, '08; Posts: 173 (44% Liked) ; Likes: 263

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  • 3

    When I reminded her to punch out for her lunch break, this isn't what I meant!

  • 0

    I'm sorry that you had that experience! I am a first year RN student, and we have HESI exams every term at midterm and final. Last midterm I got an 86, every other score previous to this term I got between a 72 and a 77. I am generally an A student, and this was especially upsetting because at my school, you can have a 99.99% in everything else, but if you don't get at least a 70 (or 72?) average between the midterm and final HESI you are out of the program. Our program has lost a few people this year just like that.

    SO. This term, after seeing more people disappear due to the HESI, I went to a review class held by a 2nd year student, and used my Saunders review book pretty intensely, but only for about 8 hrs prior to the HESI and I scored a 98.5%! I almost cried, I was so relieved.

    The main, important points of the HESI review class were this:

    1.Is it appropriate? - often you can eliminate an answer or two based on their ridiculousness/inappropriateness.
    2.Safety of the patient - safety is the first priority!
    3.Airway - comes first!
    4.Breathing - comes second!
    5.Circulation - comes third!
    6.Nursing Process - after you have worked your way through the above, the use the nursing process to whittle down your answer. Sometimes the question says "what assessment...?" Make sure you categorize the answers - which ones ARE assessments? Which are interventions? Eliminate the wrong ones.
    1.Patient centered - think about what answers are pt-centered.
    2.Maslow - if you get this far, make sure that physiological needs are considered before psychosocial.

    I hope this helps!! Best of luck!!

  • 2
    sandanrnstudent and lala1016 like this.

    based on this information i grouped the significant symtoms and with the help of my nursing diagnosis handbook, came up with the possible diagnosises of ineffective airway clearance, imparied gas exchange, and ineffective breathing patterns. after that i am asked to give a complete diagnosis with the "related to" and "aeb". i can not decide whether to use impaired gas exchange r/t ventilation-perfusioninequality aeb abnormal breathing, cyanosis, tachycardia, hypoxemia, anddyspnea, or ineffective airway clearance r/t hyperplasia of the bronchial walls and asthma aeb adventitous breath sounds, cyanosis, and dyspnea.

    i realize that both might apply to the patient, but i need to pick the one that is most accurate/ more serious. which diagnosis is it most likely to be with the senerio?

    first, i want to say congratulations on starting your program! i am just a few weeks away from wrapping up my first year already, and i can't believe how fast it has gone.

    secondly, case studies are *hard*. they are time-consuming, and can seem quite tricky until you get the hang of them. i imagine that the "rules" are different from school to school, but it sounds to me like you have good handle on what they are looking for. i am thinking that either impaired gas exchange or ineffective airway clearance r/t copd as evidenced by (s/s) might be your best bet. i have found that our instructors haven't necessarily been looking for a specific answer. they just want to see that you are using the right line of thinking and covering your bases.

    i just kind of skimmed the info you gave, but i am curious about the "hyperplasia of the bronchial walls". it may very well be correct, but where did you get that information? (sorry if i missed it!)

    good job showing the work you have done. while i may not be the most helpful person to respond, i know you will find fellow nursing students/nurses much more willing to help when you show the work you have done when asking for help (and you're totally on the right track as far as i can see!)


  • 0

    I think I understand where you are coming from. I am currently picking up shifts left and right at a job that I both love and feel I am ready to move on from, and am trying to scrape pennies to make minor improvements to my first house (which I bought when I was 21 and engaged; I'm now 30 and divorced) to try to sell it in a crappy market so I can move and start the nursing program in September that I *finally* got into.

    I have mixed feelings... I curse that darned house that feels like a potential money pit, I get frustrated at my lack of skill usage at work, I daydream about moving forward from both.. but I think I'm gonna cry my eyes out when the big change time comes.

    I don't know if you like country music, but if you do, check out Trace Adkins' "You're Gonna Miss This". :heartbeat

  • 2
    J.e.n.n and LTCangel like this.

    Tears here! Wonderfully written. You sound like a great nurse.

  • 1
    meghan91 likes this.

    See if you can make a few laminated cards (maybe each side of one = one floor w/departments?) and hole punch them and clip them onto your nametag. I have done similar for frequently used phone numbers, door codes, etc. Good luck!

  • 1
    Pixie.RN likes this.

    I love reading these
    thanks for sharing!

  • 0

    I am not a nurse yet, but work in the ED with mental health patients. It is standard practice for our RNs to do a basic domestic violence screen, alcohol/drug abuse screen, ask if pts have thoughts of self-harm, etc. Generally I hear them use the approach of "it is our policy that we initially speak with the pt alone, if you have questions or concerns I can come and speak to you afterwards" and direct family to the lobby or family room, etc. As I am not an RN and don't work on a "floor" I wonder, is this approach possible?

  • 2
    NurseB_ and chicagonurse2b like this.

    Hey punky,
    I'm not sure how you should handle the situation, but definitely TAKE THAT SLOT in the program!
    It is clear that you respect what has been invested to hire and orient you for your current job, so make that clear when you discuss your desire to go PRN or quit or whatever. The guilt you feel for changing your committment to this job will pass, and be easier if you handle it with honesty and integrity. Congratulations on getting in! You will be ok

  • 24

    Facebook isn't the problem. Camera phones aren't the problem.
    Lack of common sense and disregard for morality evidenced by a chain of beyond poor decision-making is the problem.


  • 2
    gonzo1 and cherryames1949 like this.

    Great post!
    When I first started working as a ward clerk on my hospital's busy med/surg floor a few years ago, I had the pleasure of being trained by a very competent coworker who taught me a couple of very simple, yet effective things:

    1.) "If you don't know the answer, FIND IT." All of our hospitals calls went straight to one of two ward clerk desks on our unit (and most of the time, we only had one working). All KINDS of questions were asked. She told me my job was to give people answers and make things happen. My question to her was "If you don't know the answer, what do you do?" She said, "If you don't know the answer, find it." This one baffled me for a long time, until I realized I would rather call lab (or x-ray, or CT, or dietary, or the nurse, or the doc etc) a million times to politely and patiently make sure I was entering orders correctly rather than guess without confidence; at the least delaying treatment and at the worst, injuring or even killing them.

    2.) "There are almost no mistakes you make that cannot be fixed." Just knowing that most of what I did, although very different from nursing, was reversible (even if it wasn't easy) let some pressure off. Hand in hand with this information, she also taught me the same things your post discusses. If you make a mistake: recognize it, acknowledge it, and immediately find a way to rectify the situation. I have tried to do this in all of my work (as a med/surg floor CNA, a med/surg floor ward clerk, an ER mental health tech, an ER tech, and an ER ward clerk) ever since.

    I am very grateful for her (and your!!) advice, and I hope to always keep these main ideas in mind as I will hopefully soon be starting a nursing program and most likely making lots of new mistakes!

  • 1
    etaoinshrdluRN likes this.

    Quote from OHSUstudent
    Hi there,

    I am a nursing student in a BSN program with one year left. My goal is to work in the ED. But, I also have found I love mental health nursing. From what I gather, someone who enjoys the mental health/illness population is much-needed in the ED setting. I'd like to combine the two by gaining extra training or certificates in mental health. I also would be interested in working with sexual trauma victims. Being that I am still a student, I wondered if there is anything I can do to beef up my resume in addition to regular certs (ACLS and the trauma courses) in order to gain an interview. Thanks for any advice you have to give!
    Hello OP I am currently employed as a mental health tech in a smallish ER in Oregon. While we don't have nurses that specialize in psych, our staff nurses sort of take turns working the "psych side" of the ER. Certainly an ER setting isn't ideal for long-term treatment of psych pts, but we do what we can to stabilize and care for pts while we determine what our goal is (whether it be placement in our inpatient psych unit, placement elsewhere in the state, outpt treatment/referrals, medication administration for control in a crisis situation, etc. I can't speak for other ERs, but our "psych" nurses do not hold special certifications (beyond whatever is required of them to work in our ER in general). However, we do have an inpatient psychiatric unit where I work that employs both nurses and CNAs. From my understanding, the CNAs do not necessarily need special certification (there is definitely training involved, but not a special degree or certificate based outside of the place of employment), but I do not know about the nurses.

    As far as sexual trauma victims in our ER, I am not aware of a program (volunteer-based or otherwise) where I work that provides individuals for the victim to speak to/be consoled by. We do have a number of ER nurses that have also voluntarily gone through SANE (sexual assault nursing education, I believe) certification to be certified to participate in SA exams and evidence collection and documentation.

    I hope this helps!

  • 0

    Quote from Fiona59
    I've participated in a similar scenario when a patient coded in an elevator near my unit. One unit (staffed only by RNs) didn't respond at all because they were on workplace accomodations (we couldn't believe that was their reason).
    What are workplace accomodations? (apologies if this is a dumb question)

  • 0

    Quote from bree*
    Who in the world said I'm not willing to clean up messes? That doesn't bother me at all. I'm totally ok with the physical demands of the job..the craziness..but the way it's going (overall)...well, I hope I'm wrong about it. I'll be ashamed to say I stuck with a field that doesn't really have the opportunity everyone claims it has...and in which the workers are treated like modern day slaves--again, could just be where I had my clinical rotations..maybe it's really as "wonderful" as so many nurses are saying.
    What was the opportunity you expected as an LPN new grad? I'm sincerely curious to know.

  • 13
    Irinauer, SENSUALBLISSINFL, Maseca, and 10 others like this.

    Quote from bree*
    Now that I have your attention..I have to say that I am a LPN. I turned down a RN program because of the way I see health care (particularly nursing) going. Seems to be slipping down hill at a sad rate...... I left an eeeeeeassssssssy $48,000/year desk job to pursue nursing .....I literally would work anywhere. I have applied at 100 places, so far. Yes, you read it right..100. Before I started nursing school I had no degree..and I LITERALLY had 2-5 employers/agencies calling me, per day, for work..all ranging from $30,000-$65,000/year depending on the position.
    I am actually surprised to see that I will be the first (and only) person to question both your apparent attitude towards nursing responsibilities and your expecations of what nursing is. Congrats to you for deciding to stop at your LPN. If you think nursing is going so far "downhill" that you don't want to put in a couple more years of schooling to make a higher wage and be more employable as a new grad, I will gladly take your RN program slot. I am really wondering what you thought nursing entailed, since you seem to be personally offended at some of the tasks one often undertakes as an RN (I believe you said something similar to "virtual slave"? Are you kidding?). Granted, I am not a nurse. I have not even started a program yet. However, I have worked in caregiving and healthcare settings for over ten years, and while I know I have a LOT to learn, I expect to work hard. I expect to do things I don't want to do, to clean up icky messes, to work under pressure, and to deal with the "politics and drama" that can potentially be found in any workplace or field.

    I understand that it must be incredibly frustrating to not find a job as a new grad. From what I gather by following the news, reading this forum and talking to my nursing friends (all over the country) and coworkers, the shortage lies not in new grad nursing positions but rather experienced nurse positions (creating a bottleneck). If you aren't willing to clean up messes, be pushed and put under pressure, and you want to make MORE than $60,000, at a job that's easier than your "eeeeeeeeeeeeasy $48,000/year desk job", well, good luck to you. It might be time to start buying lottery tickets.