NJNursing

The whole tri-state area is a hot mess for new grads despite their degrees. I have heard a lot of people who settled for nursing home jobs and doctors offices. I know with Virtua, the squeaky wheel gets the grease and their HR peeps are notoriously slow. Keep plugging!

That is a pretty complicated case. I have seen the stringy discharge with some pts with std's. She may have a small bit of retained placenta but she would normally just have a steady, continual bleed, not the heavy/light cycle. If the cervix is closed, its not incompetent. She probably needs an exploratory d&c just to make sure, The thing seen at the top of the cervix on the ultrasound could of been a clot that needs to be expressed.

I had a pt like this recently. Iupc put in, pit turned off O2 applied, pt turned in L lateral position with a knee up to try to help the baby descend. Mom was very slow to go from 2-4 cm dil. This went on for hours, at least 5-6. Iv fluid bolus. She I sat her up in a modified indian style, bottom of the bed down. Sht turned a corner and was 6 then 8 and then complete. Once the baby was past 0 station, the variables let up and were more like earlies. Baby delivered fine, nuchal x 1, mild terminal mec, 8,9 apgars. I thought she was going to be sectioned but she made change and the baby had good variability.

Lab gas never been able to access any central line for draws thus needing a Dr order to be able to get labs out. At the beginning of the year we stopped this practice at all from evidence based practice on infections. All labs must be drawn peripherally.

We currently use Hugs tags on the ankle right now. Where I used to work had the clamps on the cord. They stayed on until right at discharge. No problems.

We keep babies in L&D for 1-2 hours before going to the newborn nursery. They are bathed within an hour of getting there and gets the full head to toe assessment.

I work in a community hoapital. We only 6 labor rooms, 2 antenatal / mag recovery rooms, but in a squeeze, we can deliver in them. 2 or's/pacu beds, 5 triage beds. We can have 1 patient all night, we can have 13. There is usually at least one section a night, most was 7. We always have 2 docs in house but we have 4 ob groups who like to do their own deliveries, but if they don't make it to the hospital in time, the laborist will do the delivery. I don't mind doing vag exams, but if they are complete with pressure, i get a doc to double check. It's about learning a new skill and bringing the knowledge with you.

When I graduated in '06 we had to have our fingerprints done prior to the ATT. Good luck!

We are ortho-neuro and it can be 1:4-6 on days, 1:5-7 on nights. Aides depends on staffing and 1:1s throughout the house. We always have 1-3 aides for a 35 bed unit. We nearly always have a secretary and have mobile phones. However the acuity is high and even with great staffing, it can be rough.

I agree, avoid all isolation patients. We just do it as a courtesy to the preggos on our floor anyway.

Sx = surgery

It all depends. If they are a multip, I may have them push at 10 cm. It also depends on the station. I like to wait until they are +2 to push. If they have no epidural or not a well functioning one, I will push at 10/100/+1. If they are a prime with a good epidural, I may do some test pushes. If they can push well, I will let them push. If not, I will labor down an hour and reassess. Many of our doctors trust us to push with the pts until nearly crowning. There are a few who will actually stay for however long it takes because they want their own pushing assessments. The more you do it, the more comfortable it will become. Have a senior nurse in with you to give you help and guidance for your first few times.

We are an all female unit with the female to male doctor ratio being 3:1. There are cultures that insist on being female only and I know when I was in nursing school there were 2 male students and during ob rotation, patients would refuse them. I know myself, I was uncomfortable with a male residents checking me.

I agree, there can be genes on either side that can show up at delivery. I had 2 brunettes have a baby with shocking red hair, but apparently there was a great aunt with red hair and she was the only one in the family who had it. Both lineages were Irish as well.

We don't routinely do Leopold's other than to try to figure out if the baby is vertex and where we think FHT's will be. We have several rolling ultrasounds for the doctors to get a quick eye on the baby when they first get to the unit.

We have continuous monitoring with several centralized monitors at the nurses stations, break room, Dr on-call rooms, etc so if a baby looks to have an issue, there are many eyes on it. However if someone is in early labor with no issues then we will document q hour. Once pit is started or there's an epidural or transition, then we document q 30 minutes.

No, there's no state law other than California. Other than that it is based on the policies/union contract of each institution. I know at my first job, it was non-union and we sometimes had anywhere from 6-10 patients each. It was not consistant and it made work very hard. I very seldomly left work before 9am because I was doing most of my charting AFTER change of shift. Where I work now, IS union and up until last week we had up to 6 patients but now they're changing it to up to 7 with a very rare chance for one or 2 nurses to be up to 8. It's only for night shift and only from 11p-7a. We're trying to fight it because 1-2 patients really DOES make a difference in the type of care you can give to your patients and get all of your other work done - chart checks, education, POC, etc.... I hated the other job when I had such high case loads. It caused burnout and I started to get short/snippy with the patients because I was stressed. It's not a win-win situation.

No, staffing practices put the almighty dollar as #1, not patient safety. Our hospital is having this problem right now. Lets see how many pts we can pile on the nurses without killing people, causing a mass exodus of nurses and before the nurses break down....... a 1:5 ratio is fantastic, of course unless you work in ICU/CCU/PCU - then it's overkill. California has the right idea. But for med-surg, I think 5 patients is ideal to give really good patient care and give each patient really dedicated time. I agree, there is NO nursing shortage here in the northeast. New grads can't get jobs and many hospitals are on a hiring freeze. I agree that nursing school is nowhere NEAR real life nursing. Why do they do that? Because their goal is to prepare you for the NCLEX, not the real world. My professors would often tell us that our TRUE education would come in the first year or nursing and why they really push students to do med-surg for at least a year before specializing. When I was a new grad and went right into a speciality I thought, for what? But when I went from the specialty to med-surg, OMG, I had like NO skills. All of my med-surg stuff from school was lost for a while and time management? Non-existant.

I work on an ortho/neuro floor and we have a dedicated stroke unit, but we also get the MS patients, seizures, syncope, change of mental status, etc. Not as intense as above, but we're not like a huge metro hospital either. It's neuro checks q 2-4 depending on how acute the stroke is and how severe the symptoms. It's a NIHSS q 8 if not q 12. I agree with RainClover, it's really being able to pick up some subtle changes in a patient or having like a 6th sense about patients sometimes. It can be frustrating if there are communication problems depending on what part of the brain the stroke affected. Either they don't understand you or you don't understand them or they don't speak at all or it's so slurred/garbled that it can be hard. It's patients having to suddenly deal with massive physical limitations when they were completely self functioning the day before. It's a LOT of education, sometimes more for the families than the patients themselves. Plus you have to have cardiac knowledge as well because they're on heart monitors and you have to see if there's any weird changes going on there as well. The rewarding part it to see someone who is improving. Who couldn't move the day before, who had global aphasia who get TPA and gain their functionality back. It's amazing. Or when the brain starts to build collateral circulation and you see improvement. Things like that rock.

I didn't really choose it, I kind of got plunked into it, but I've stuck with it for over 2 years. It's busy with high turnover. People seldom stay more than 3-4 days for elective hips and knees. Hips are generally over 73 and knees are generally over 50. They can be needy depending on their pain tolerance, they can be resistant to therapy, they can get lazy and not do their incentive spirometers or their in bed PT's or be compliant with their anticoag therapy and end up with DVT's. It's a LOT of education and teaching and reinforcement. The anesthesia/pain meds can make them confused or crazy, especially in the elderly. Back patients are the worst and they're usually younger and needier. Then you'll get an occasional person with "intractable pain" or some BS like that which is apparently drug seeking because they're allergic to motrin, tylenol, morphine, percocet, vicoden and darvocet. And they need Benadryl with their Dilaudid, thank you very much. It can be aggravating, but when people come and they tell you that the surgical pain is far less than the pain that they were living with their degenrated hips/knees day to day, it's rewarding to give them that mobility back. To see the hope in their faces that they'll be able to walk their child down the aisle or attend their grandchild's christening or even just be able to function with family again is great. I agree the hip fractures are tough, especially when they just fix them and not replace them. They often have a lot of extensive histories and you're treating a lot of stuff. It's a lot of pain management and keeping on top of hemoglobins, bun/creatinines. However, I know our floor is very esteemed amongst other med-surg floors because unlike the other floors, our pts are generally there by choice and not necessity. Joint replacements are elective surgery and it's not like the person who's in with cellulitis or appendicitis or clogged A-V fistulas or anything else like that. We work hard for our Joint Certification and are the bread and butter of med-surg. Not to toot our own horns.

Baylor programs are people who work only weekends. I know at Robert Wood Johnson Hamilton, they worked at least Saturday/Sunday if not Friday/Saturday/Sunday or Saturday/Sunday/Monday. They got paid about time and a half for doing these hours, but they didn't have to do holidays unless it fell on the weekend. However, it came with some limitations like they were only allowed 2 call outs per 12 month revolving calendar year and 1 vacation day a year or something like that. But in short Baylor is working weekends and only weekends.

Look up your local community college. Get your ADN and then go on for your BSN if you want to. I don't know anywhere that you can get your RN strictly online.

I would go for the ADN, personally. I got Pell grants that paid for the whole thing. I did have to pay for books out of pocket, but when my tuition was paid, whatever was left of my Pell grant got refunded back to me and it was often enough if not MORE than what I paid for books. Go to fafsa.gov and fill out the stuff. It is part of the reason I quit my job when I went to nursing school. The less I made, the more money I got from the government to pay for my schooling. Now if I were to go and get my BSN at that same time I would of had to take out a student loan and that's what I was avoiding at ALL cost, if possible. Now I have my job paying for my BSN and I take my time with it. In all reality, some places PREFER a BSN, it's not required. I have never had a problem nor do I know anyone who was passed over a job because someone had a BSN and they had an ADN. I was even assistant manager and was chosen over people who had more experience than me and who had higher degrees than me, so really it's just a piece of paper. As long as you keep your nursing license clean and you do a superb job, it's all just semantics.

Stop beating yourself up over it. It was your FIRST night off orientation. You're still getting the time mgmt thing handled. I, personally, think what you did was appropriate. I probably would of had someone retake that blood pressure - manually and in both arms before I called it a gospel number and I would of asked the aid to do that while i was in with the lady with the chest pain. Had you gone to see the low BP, the lady with the chest pain could of ended up with a major MI had you not intervened so soon. The low BP is also a concern and in the scale of ABC's both were C's, but 80's over 50's and non-symptomatic, I also would of let go a little bit. I would of quickly encouraged PO fluids while walking to the call light. After the repeated signs I probably would of asked another nurse to handle that pt while the other crisis was going on. You're talking stable vs. unstable pt and you did the right thing. The issue about the glasses - that's just a learning experience. You can pretty much guess that pt's past the age of 60 aren't wearing contacts, most of the time. Yeah, the hospital hates to have to fork out for anything they don't have to, especially glasses and dentures which will probably cost them $1,000. It happens, though and it could of been lost anywhere along the course of their stay, and not necessarily just on your shift. If there was an aid in there an the wife brought it to their attention, they could of looked for the lens just as much as you could of. Don't beat yourself up. Learn from it and move on. Tomorrow, after all, is another day!

I agree, I would of notified the doctor. Apresoline or Vasotec would of been good alternatives that don't decrease the HR. Perhaps a one time dose of IV for the instant lowering and then po for slower release.