Evolving_Nurse

This was extremely helpful!

I'd like to know more about the correctional nurses daily routine. Is triage criteria laid out & easily accessible? How do you go about passing meds? Are nurse visits scheduled every day or on a certain day? Walk me through one of those visits. Do you do blood glucose checks on all of your diabetic inmates or how does that work? In a typical week, how many emergent situations happen that require your attention? Are there time limits for passing meds or can I take as much time as I need? Anything that describes, in depth, your day to day routine, I'd love to hear more about. -------------- I'm a new RN & currently work home health. Earlier this year I worked on a med surg unit, in a level II trauma center, for 3 months. I'm intrigued with corrections nursing because I like psych nursing, I'd still be using my nursing skills, it's less customer service oriented, & I wouldn't have the doctor, xray, dialysis, OR, pharm, respiratory, ect., constantly blowing up my phone. It seems like corrections nursing is more cut & dry & straight forward, but I just have some reservations. (By Cut & dry, I don't mean it's easier, I just mean that there are known boundaries/rules & a consistent routine that's followed). ------------- I've experienced many different scenarios working med surg. My last shift I had a respiratory rapid responses while my other patient was hypoglycemic (& symptomatic). I've had septic patients, wound vacs, alcohol & drug dt's, psych transfers, picc's that needed cathflo, every respiratory condition under the sun, and various other random things. The things that slowed me down on the unit were toileting patients, answering call lights, customer service requests, & filling out paperwork.

Yeah, that's similar to how it was where I was working. We don't get a CNA unless we have 5 patients or more & sometimes we just don't get one. However, the CNA answers call lights for all nurses & not just my patients. So, sometimes it's faster for me to just do things myself than to go hunt down the CNA. Our med/surg unit is divided into wings, so there's a north, east, and west. Each wing has 24 beds or so. Basically that one CNA answers call lights on any of those 24 beds in our wing.

I know this is a long post, but I kind of just needed to rant/vent and I also need some advice. I'm a new grad and I took my first job as an RN on a med surg floor in a level II trauma center, which is the only trauma center for hundreds of miles. Due to this being the regional center for critical patients, the patient acuity on med surg is somewhat higher compared to other similar facilities with the same designation because the ICU is constantly admitting more critically ill patients. Upon being hired I was upfront and honest and I let the hiring mangers know that I had taken a year off (I needed a mental break from nursing/school) between passing the NCLEX and finding a job and I felt that I may need a little bit more time on orientation. They assured me that I could take a few extra weeks on orientation if I felt like I needed it, they told me how great they are with new grads, and they just really reassured me. I would also like to point out that this hospital has a union. So, after the first 90 day probationary period, the union will protect their staff nurses from disciplinary action/termination. I would also like to mention that the charting system used at this facility is confusing and is reminiscent of windows 95. Providers use a different system than nurses but nurses have access to the system and can view assessments, print the h&p, and do med rec's. My orientation was set to be 12 weeks long, which included one week of computer training for documentation and how to use the MAR. The managers had me orient with a different nurse every shift so none of the nurses really knew where I was in regard to my skills and competency. Each time I went with a new person I basically had to start over. After 8 weeks on orientation the mangers pulled me aside and talked to me about how it was going and how many patients I had been taking (which was 2 sometimes 3). I told them I was fine taking 3 patients but I struggled if I had patients with scheduled procedure off the unit in addition to the patient being a higher acuity level (if I had total cares or if patients needed more monitoring). I had a hard time with integrating the patient preparation for transfer in between my other responsibilities because I wasn't familiar with the process or the paperwork or how long it took for me to complete the paperwork or get the patient prepped for transfer. (When patients have dialysis or a surgery, paperwork is to be printed and filled out to put in their paper chart. It's different for each procedure and I wasn't familiar with patient preparation or paperwork for specific procedures, I.e., going to the OR requires a CHG bath, H&P, labs, type and cross match, vitals & glucose within 30 mins of transfer, etc. Compared to a patient going to dialysis, only a transfer ticket needs to be filled out along with a set of vital signs. I also wasn't sure if dialysis patient were to be given morning medications prior to going. I just wasn't sure about things that an experienced nurse probably already knew.) After 8 weeks of orientation and being bounced around to different people. The managers said that they were concerned that I may not be able to take on a full patient load (5 patients) at the end of orientation and they thought it would be good to just put me with one person for the rest of orientation (the final 4 weeks). The girl I was put with was great at answering questions, but towards the end I felt like she was frustrated with my inexperience and was there just to observe me and assess my fate. Of course she would take over if I was falling very behind or if a patient's life was in jeopardy. Fast forward to week 11, which ended up being 9 days before reaching the end of my 90 day probationary period....... I was fired because I was having difficulty prioritizing and getting tasks completed on time. My manager told me she didn't think I was a good fit and that I struggled to take a full patient load. I mentioned that they told me I could stay on orientation longer and she said that she just had to trust her staff and their judgment. I asked if she had any advice for me or if she would give me a good recommendation. She said she would give me a good recommendation and suggested the rehab unit, inpatient psych, or working in a clinic. Despite her good recommendation, at this point I just feel like a failure. I feel like an incompetent nurse and I don't feel like I have the confidence to apply for another job right now. However, I also don't want to wait and potentially lose the skills that I just gained from this experience. This scenario is based off of my last day working med/surg: 1. patient transferred from ICU (the night before) who was previously septic. 2. Patient w/ respiratory prob, to be discharged. 3. Patient w/ influenza, to be discharged. 4. Patient w/ human pneumometavirus. 5. Patient w/ pneumonia. 6. Patient w/ scheduled surgery 7. New admit, acute cholecystitis So, I started the morning doing the usual. Checking labs, getting blood sugars & vitals, getting breakfast trays set up, giving insulin & then I started passing the 0900 meds at 0800. I told myself to start giving meds to the people with blood sugars so I could administer their insulin and then give meds to the ones I knew would be quickest. I get patient 1's meds and realize one of them isn't stocked in our omnicell, so I'd have to run to a different wing to get it. I told myself I didn't want to get behind on everyone else's meds, so I would give everyone their meds and then come back and get that last med after everyone else was all set. Patient 1 had a BP med, so I verified the BP (121/80) & HR (88) prior to giving. It was a little low but not concerning and it had been consistently trending in that range. I did a quick head to toe assessment and jotted down some findings on my report sheet. On my way back to the omnicell, I answered 5's call light since I was walking by. The pt had a BM that looked like brown (but almost black) tarry stool. I took a mental note of that and moved onto patient 4. Gave meds and did a quick assessment, verified new orders for patient 6 (a stat order for packed RBC's), and then went back to the nurses station to tell my preceptor that we had to give stat blood. I've only given blood 1 other time, so I'm not completely confident at this, so I'd rather have my preceptor guide me through the process than look up the policy/procedure. While at the nurses station, I notice the aide talking to the provider. The aide says to me, "did you give pt 1 their lasix?" I said, "yes, why?" The aide said, "well their BP is 50/80". I said, "umm what?! I looked at it this am and it was 121/80. Did you check the BP in a different location?" The aide said, "yeah". So I said, "Next time, can you please let me know when someone's BP is that low?" Then, the provider informed me they were going to put in an order for albumin. So, I tell my preceptor about the blood and that we could hang it after I assessed pt 1 and got the albumin running. I go to patient 1's room with the albumin. I assess the patient: neuro check, manual BP & HR, asked how they're feeling, any dizziness, taught them to sit up and stand up slowly and to call me before standing or if they needed anything. I explained that the albumin would shift the fluid in their body and that we were giving it because their BP dropped. While I'm in patient 1's room giving albumin, I have dialysis calling my phone about patient 5, saying they'll be ready in 30 mins. (keep in mind, I still have to fill out paperwork to transfer patient 5 to dialysis, the patient still needs morning meds & insulin, and I have to notify the provider about the stool). Then patient 5 calls and tells me they have to go to the bathroom. Patient 2 calls and asks when they'll be discharged. THEN my preceptor pops her head in and says, "hey the new admit is here." So....... WHAT AM I SUPPOSED TO DO FIRST? The thought running through my mind: - The new admit needs to be assessed. - Patient 1 shouldn't be left alone. I still have to grab their last med from a different omnicell. - My other patients morning meds need to be passed on time. - I need to administer insulin to a few patients after breakfast. - I don't want patient 5 to soil their bed, I need to get them their meds before dialysis, fill out their paperwork, notify the provider about the tarry stool. - Patient 6 needs those stat PRBC's. - I need to call PreOp back and let them know about the packed RBC's. Seriously. How do I learn how to realistically prioritize when I haven't really been taught how to do so? Sometimes prioritizing is common sense, but other times, like the above scenario, it can be very difficult. Especially because I don't have prior experience. I've only done an admission maybe 2 times, so I can't just whip right through it and go fast. Can you guys give me tips on how to plan and prioritize? How would you handle the above scenario? How do you organize/start your day? What type of patients do you see first vs last? When do you get your assessment charted? At what point do you perform your assessment? (I.e., During med pass, during report, after passing morning meds?) Do you write down your assessment on paper in a certain layout/format? What kind of questions do you ask during a quick assessment vs a head to toe or focused assessment? When do you perform daily care such as brushing teeth, bed bath/shower, catheter care, etc.? Realistically speaking, when it comes down to it, do you let a patient sit in stool or urine while you're getting more important things done? Any tips would be greatly appreciated.

I'm a new grad RN applying to several jobs. One job I'm unsure about applying for is as a registered nurse in the cardiac imaging dept. It's a full time position, but the job description doesn't really describe the job. Obviously it has to do with cardiac, but what exactly does this type of nurse do? Does cardiac imaging refer to the cath lab?

I'm a new RN grad. I passed the NCLEX in February, & recently applied to a position on med surg. I applied and 2 days later I got a phone interview with the nurse manager and she discussed wages and benefits at the end of the phone call. An in-person interview was scheduled 2 days after that & I perceived the in-person interview to go very well. I was interviewed by 2 different nurse managers of the unit, & in the beginning of the interview they asked if I had any questions for them. I said that I did & proceeded to pull out my list of questions that I had typed & printed out. I asked them what made them want to be a nurse and why they like working at the facility, among others things. They said, "oh wow! We've never been asked that before." & they joked about how they weren't prepared to answer the questions (But they still did). It seemed like it was going well & they were impressed that I wanted to learn about them and that I was so well prepared. Also, by asking them questions, it opened things up and the interview went more like a conversation than an interrogation. At the end of the interview I asked if I could try night shift a few times to see how it went and she said she didnt see a problem with me picking up a few night shifts. Then, she went more in depth about wages for overtime, night shift differential, and benefits. She also told me the color scrubs that they wear and she asked if I wanted a tour of the unit, to which I definitely said yes to. Following the tour I asked what the next steps were and she said that they would put in a recommendation to HR and that HR would contact me in 1-2 weeks depending on how busy they were. It's been 2 weeks & I still haven't heard anything. It's making me anxious not knowing my fate and I keep rethinking about everything in the interview. I perceived it to go well, but maybe it didn't? Why would she tell me the color scrubs that they wear, discuss wages, and give me a tour of the unit if she didn't want to hire me? Should I contact HR or should I just keep waiting to see what happens? It's a big facility (a level II trauma center), so maybe HR is just swamped? I'd like to know your experiences and how long it took HR to contact you.

In order for the DNR to be honored, the patient would have to be mentally stable/competent and be presented with information he can understand to make an informed decision about what he wants. Kind of similar to how a patient can’t be sedated prior to signing informed consent for a surgery. The questions I have about this case are: Does the hospital perform a mental assessment on patients before allowing them to make changes to their advanced directives? Does the hospital have policies/procedures for suicidal patients and whether that person's DNR is honored or dishonored? Is there documentation showing the current advanced directives compared to the previous advanced directives? Were there any drastic changes in these advanced directives after his wife died? If so, what were the changes? Is there a history of suicidal ideation or mental health treatment, and is it documented in the medical record? (documentation that notes his mental status before his wife died, compared to after) Can the family attest to his behavior before his wife died compared to after; did they notice any drastic changes in his behavior? Was he trying to give away his personal belongings? Was he unusually happy/hopeful? Is there a living will? A next of Kin?

I have BLS, I agree with you on the ACLS & PALS. I've seen hospitals pay for new staff to take those courses, so I'm going to wait to take them. I kind of figured clinical experience was going to be a key factor. I was looking into taking some FEMA courses, but I'm not sure if it would really be that beneficial.

I took the NCLEX on a Friday at 2pm. My computer shut off after 76 questions and my mouth literally dropped open. It had been 8 months since I graduated & I hadn't opened a book until the week before my boards were scheduled. I was DESPERATE to find out my fate and felt so much regret that I hadn't properly prepared for this ridiculous test. Of course after the test I resorted to Google and started reading people's experiences with the NCLEX. That's when I discovered the PVT. I tried it at least a dozen times over the weekend, & finally on Monday my quick results were available..... I passed the NCLEX! I just want to hear other people's NCLEX experiences and what you all think of the PVT.

What are some certifications / credentials / specialties that new nurses can easily earn quickly? I'm newly licensed and I'm not sure what specialty area of nursing I want to work in. I'm preparing to apply for jobs, so I was wondering if there are any certifications I could earn online that could set me apart from other candidates.