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RNingaround

RNingaround

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  1. RNingaround

    Are these yellow flags or red flags?

    Update! I just had my follow up interview with the DON today. Down sides- he was 30 minutes late to the appointment, couldn't find my paperwork, overall disorganized. Plus sides- very nice/gracious and helpful, didn't feel like he was trying to rope me in but genuinely hoping we'd be an employee/employer fit They were working on swapping around a few nurses (night shifter moving to eves, eves moving to supervisor, another eves leaving to pursue a hospital position, supervisor stepping down) And he told me that likely there'd be both a night and eves opening. Hourly rate was not discussed since an offer wasn't officially made/available, I didn't press it because I don't think I'll be taking the offer if one is made in 3 weeks (which he implied would be the likely outcome). He said he really liked me and I seemed kind articulate and knowledgeable, that he'd like to have me on the team but even if I find work somewhere else in the meantime to take his card and call/email him any questions and he'd be happy to help me if I ever needed advice. What I learned from this whole experience watching how they run is that management cared very personally about their nurses at this place and I think that plays into what makes them get such high medicare quality scores. They don't strong arm their staff into staying and it seems those who want to stay have opportunities to grow/shift as they grow in the profession, those who want to move on are encouraged and the bridges aren't burned. Mostly what's keeping me from feeling like this is the one is that it's in a dense urban area an hour away from where I live I don't know that the commute is worthwhile.
  2. RNingaround

    Are these yellow flags or red flags?

    Thank you so much for these comments! It was hard for me to discern between the lines of the interview and this really helps give me some perspective.
  3. I interviewed at a rehab that I got a good impression of on the whole but there's a few things that flew yellow flags in my head. On the one hand I'm a new grad and I hear my dad's voice going "A job's a job you can't be picky in this economy!" But on the other hand I don't want to be kicking myself for ignoring the things that concerned me about this place... The good stuff- Ratios: 30 pt, 2 RN or LPNs, 1 unit supervisor, 4 CNA's. (Pretty Reasonable) 3-4 weeks orientation with extra time given if needed especially for new grads. Not bad turn over rate, they said typically new grads come for a couple years experience and then go to the hospital and some stay for many years. Their average is about 5 years and their longest standing employee is an aide who's been there for 50 years (!) 2 LTC floors and 1 subacute floor, I expressed my interest in wound care/future certification and they said the subacute would be a good fit for me as they have many dressings and fairly frequent wound vacs, they have a wound nurse on site as well 2x a week. She wasn't sure what shifts were available or what the pay would be b/c the DON who was supposed to interview me was sick and he does those calls, she's the QA nurse and fills in for supervisory roles. The bad news - They don't use an EMR, they only have computerized assessments. MAR and treatment documentation is all by hand on paper. I asked her if they would be updating to EPIC or Powerchart/Omnicell, ect any time soon and she basically said "No, our older staff really is pushing against making the switch even though the state is pushing us to convert. This gives me a secondary concern that the older staff is unwilling to change and this may lack evidence based practice relying on "the way we've always done it". She also mentioned that on this subacute they're mostly walkie talkies but the call lights never stop because and I quote "The patients want what they want and won't stop calling til they get it". (???) This makes me concerned that management will view patient satisfaction over nurse judgement/education. Last bad thing mentioned was that as far as admissions/discharges it wouldn't be uncommon to have up to 3-4 in one shift. How does one do 4 hand written admissions with 10 patients' med passes and treatments? Do you think this place would be a good place to get wound care experience or should I keep looking? Please advise...
  4. RNingaround

    Answering Call Lights

    I try to answer any call lights I can, the NPZ makes me feel a bit more compelled to answer my non-assigned pt call lights. And often it's "Can you turn off the light", "My pump is beeping" or something simple which is always nice to be able to fix quickly for someone. But as others said water, pain meds, ect. these are more common requests and the nurse needs to answer those. Don't worry too much about it, it's really just something to make the floor seem proactive, it's not enforced so don't worry that if you miss one you'll get called out. It's really more marketing than policy. :/
  5. RNingaround

    alcohol withdrawal-Ativan

    I'm in the med-surg setting and we cared for a patient who tried to detox at home and ended up finishing out his detox with us due to the seizures/vomiting at home. I had him on day 3 of detox CIWA 2 No tremors, headaches, nausea, ect. His only issue was anxiety and being fuzzy on what day it was. I asked him what he was feeling anxious about if it was generalized feeling or specific and he said it was specific about his body/illness, his life, ect. and that he had anxiety even before the detox. I think this is a similar situation as you have. I told him to talk with the provider when she rounded about ordering a oral/scheduled anti-anxiety, but that I couldn't give him the IV ativan because this was no longer a detox agitation symptom but a general life psych symptom and it wouldn't be appropriate for me to give him this IV medication when it was indicated for this specific use. It would be like giving benadryl for sleep when it was ordered for hives. The purpose of the med is part of the order and I can't give it for an "unordered" reason. Lucky for me he was understanding about this, I was proud of how mature he was about it.
  6. RNingaround

    New Grad, Many Interests, What to do?

    Sorry in advance for the length of this post, I'm trying to sort through my thoughts as I get veeryyyy close to making some important choices! I am a few weeks away from finishing my RN program, by February I'll be sitting for the boards. AAH! I've been job hunting, and even applied a couple places... A community hospital, LDRP maternity, 11p-7a full time, My "home base"(3 rotations and my senior preceptorship) hospital's medical floor, 11p-7a full time, and an Internal medicine job in my local town. I know a lot about addiction, homelessness, and psych from personal/work life since high school and it's a big passion of mine, but doesn't tend to be open for new grads. I love women's health/OBGYN/L&D but have less expertise in that area, and again not so new grad friendly. I work well with the elderly, but rehab/LTC doesn't appeal to me because of staffing, low pay, burnout, ect. The only specialties I'm really opposed to are OR and ICU because you don't talk to the patients much in these specialties and it's a lot of technology and high stress. God bless yall who work in those areas, I'd burn out faster than a campfire marshmallow. My preceptorship was in med-surg on the same floor I did acute care on. We get a lot of CMO's, bariatrics, GI surgical and Renal patients (hello TURP city) and I love this floor, but they aren't hiring at this time. I love med-surg, but I like taking the time to talk to patients more extensively than a 5 patient load typically allows for. Love me some medsurg but the community setting appeals to me more because of the continuity of care. Hopefully this doesn't sound like I'm being picky, I'm completely willing to work anywhere that would give me an offer! I'm just trying to give you an idea of my values and skills. Now the twist is that I have a personal networking connection for a school nurse position through one of my professors, the clinical overseer. My mentor/friend started school nursing at a different school this year (got back into nursing this year after many years of raising her chilluns). I'm going to shadow her for a day in 2 weeks so that I can get a field for the specialty, but I think if I wanted it, with a little elbow grease, I could get it. Especially because of my school nurse friend who would recommend me and my instructor who referred the job to me in the first place who also would be willing to recommend me. What do you think? Do you think school nursing for a new grad is a terrible mistake? Do you think for someone who likes continuity care it could work? Would I miss the old people, the hep drips, the wound vacs and PICC lines? Would I be able to do any drug/addiction counselling with the adolescents? What do you do over the summer with your time off? Is there continuing education opportunities for school nurses to do skill checks/training? My mind is whirling with questions and options. The world of nursing is so vast...Thanks in advance for your advice and expertise!
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