Double-Helix, BSN, RN 39,995 Views
Joined: Apr 5, '11;
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The hospitals probably require a valid license before they will look at your application. They offer the other choices to weed out people who don't have a license yet. They may also want a BSN.
I applied and was hired before I graduated, but be careful. Be sure to check the hospital's policy. There are some online applications that will not allow you to reapply. So if you apply for a job before you graduate and are rejected because you don't have a license then you will not be able to re-apply once you have a license number. You're basically forever banned from the job. So always check the policy first.
Btw, you would not be considered "New ADN graduate within 6 months." You haven't graduated yet. This option if for people who have completed their ADN program and graduated less than 6 months ago. So you should really be selecting the "None" option.
I agree that this patient, excepting the postpartum status, was an adult trauma patient. This entire situation likely could have been avoided by some open dialogue and by having a postpartum nurse come to the PACU to assist with monitoring for the immediate postpartum complications.
I just had to post this in response to the dozens of posts I see from nursing students or new graduates that want to work in peds because "kids are so cute," and "I want to take care of babies," and "I don't want to change adult diapers."
As anyone who has worked in pediatrics could tell you, peds nursing is not easier than adult nursing, and at times it is more difficult.
In peds, you might be assigned 5 patients, just like on a med surg floor. But your patients can't all speak for themselves. They can't press their call button to tell you when they are in pain, can't breath well, or their IV site is burning. You have to constantly be alert for these, and many other problems because our patients can't report them.
In peds, you have to care for the patient and the family. Some family members are great. Others are incredibly anxious, questioning everything you say and do and constantly asking you to check on little Jimmy because they are positive something is wrong. Other families are demanding. They think that because their child is in the hospital, so are they. They want meals, blankets, pillows, and expect you to supply them with Tylenol for their headaches and money for transportation home.
In peds, everything is tiny. Those veins you have to stick on an adult? 1/4 the size on a young child. Those urethra's it's so hard to find when cathing little old ladies? Microscopic on a newborn baby girl.
Peds nurses don't just have to know standard adult doses (650 mg of Tylenol), but we have to know mg/kg dosages as well. And we have to be able to calculate them quickly in order to catch a mistake in an order and prevent an unsafe dose.
Giving medications? 95% of your adult population will be more than happy to swallow their pain pill, or all 20 of their medications in one gulp. In peds, you're trying to convince a stubborn three year old to open their mouth so you can get the syringe of medication in them. They cry and kick and fight and more times then not they end up with half the medication on them and half on you. Don't even try to convince a toddler that amoxicillin tastes like bubble gum. They know the difference.
Finally, accidents in peds can be just as big and messy as adults. Spend three hours with a two year old with explosive diarrhea. Change the diaper 6 times, change the bed linen four times, change your scrubs once, and give the child three baths. Trust me, you'll be begging for an adult who can tell you when they need to use the commode, even if they do need help wiping.
Don't mix personal and professional. Ever. Just don't. I understand that you build relationships with these families, but more harm than good could come from inviting patients to have access to your personal life.
I'm sure your NICU already has mechanisms in place for allowing parents to keep the staff updated about their children, if they so choose. If they don't, maybe you can consider working your tour hospital leadership to organize reunions or a separate webpage where families can share their progress.
I suggest adjusting your privacy settings so you can't easily be found and contacted on social media. And if a family does request, simply say that you aren't allowed per your facility.
Actually, the belief that the heart is best heard above the breast is a misconception for a lot of students. The heart sounds are best heard at the Apex- which is around the 5th intercostal space. This is actually underneath the breast, not over it. So in order to listen to the heart, you need to place your stethoscope underneath the breast tissue- pretty much right where the underwire of the bra would be. You really shouldn't be listening through the breast tissue at all.
Your other landmarks will require you to listen around the left sternal boarder. Locate the sternum and move slightly to the left. You should find it very easy to move the breast tissue slightly and find the intercostal spaces and listen.
Since you're practicing on students, who are typically... "perkier" than older patients, it should be fairly simple to hear heart sounds if you're listening in the right places. If the person has really large breasts or you're listening to a patient, you'll need to lift (or ask the patient to lift) the breast slightly in order to put your stethoscope underneath.
You used in an invalid credit card. Using the correct card number and changing the expiration date does not make it a valid card. You can't go off about how something doesn't work if you didn't do it correctly.
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.
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.
Is there any way you could shadow in each role for a day and see what you like best? OR circulating is not for everyone, but some love it. PACU nursing will vary depending on the type of surgical facility. An inpatient PACU that recovers ICU level and pediatric patients will likely be more intense than one that recovers primarily elective, simple surgical adults.
There is something to be said for no weekends and holidays, but that also depends on your current lifestyle and living situation. If you have children or are planning a family in the near future, for example, there are many benefits to M-F. If your ultimate goal is to travel through nursing assignments, experience in a widely-applicable speciality like PACU May give you more options.
It's all relative. I'd start by asking to shadow and see what work environment feels like it's a better fit for you.
The student handbook says an average at or below 74.49 will not be rounded up. It doesn't say that 74.5-74.99 will be rounded up. The handbook doesn't address this situation all. You can certainly inquire to the Dean and ask for policy clarification, but there is still a very good chance they will tell you that rounding graded between 74.49-74.99 is at the discretion of the instructor.
I'm glad you take ownership for your ooor performance. I suggest you make a concrete plan regarding improving your study habits so you don't end up in this situation again. Best of luck.
Yes. It's very common in nursing schools. The average of your test scores must be above X%. Other assignments like projects and papers are only factored into your grade if your test scores are adequate.
This is because your ability to answer test questions is most definitive of your understanding of the content. Homework can be done with partners, using books or online resources so it doesn't prove that you really have a grasp of the material. If you can't pass the tests with the minimum amount of knowledge required, than the extra assignments should not be used to raise your grade over the passing mark. Of course, some people are poor test takers. Unfortunately successfully becoming a nurse is based on the ability to answer test questions, so programs try to identify this weakness early on.
PRN means "as needed" and it sounds like you're not needed so frequently due to the availability of others with similar skills who probably are full or part time. Your decrease in hours may be temporary or long term- that's the nature of per diem work. Time to start looking for another PRN position to supplement your income.
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