peripateticRN

I would say the best vaccine is any one you can get at this point in the game. Where I live you don't have the option of being picky, and I am thrilled to have gotten dose 1 of moderna.

While not a fantastic habit to get into, vaccines can normally tolerate a break for a short period of time. The markers we use show the period in which the vaccines were out of range... I believe my organization is OK with a (small) warm deviation of 2-3 hours out of range before it becomes an actual cold chain break. Consult your organization to find out the acceptability limits and make sure to condition your packing materials next time!

Hey There, I've been up here for almost a year full time now (and another year of rotations before that). I'm really enjoying my work up here and generally pretty happy with life. There are challenges - probably similar to living/working in any small, rural community.. but so far it's worth it to me. The life (and work) isn't for everyone though! Community nursing has a lot of turnover in staff. Apply for the job.. listen to their speil and decide if its the right thing for you!

I am a nurse in the Yukon - I have a little bit of a different role in my clinic and I don't personally take call (sweetest deal on the planet), but the PCNs in my clinic can be very busy in the off hours - most nights they get at least one call if not multiple calls/clinic visits. Our clinic is one of the busier ones though - some communities rarely get calls. It really varies. Call and OT $$ are good, but prepare to give up about 50% of your nights/weekends. They seem to be always recruiting up here for both AOC (auxiliary on call) and PTR (part time rotation) positions (2/3 months in, 2/3 months out). There are also full time positions that come up from time to time. Most people do not start in any particular community and float to where ever staff is needed. Accommodations are generally provided. It's beautiful in the Yukon. I recommend you apply and further explore your options.

I've never heard of 'this RN'... we were taught to use 'writer'. Ie "Pt was placed in 4 point restraints after throwing fecal matter at writer"

Good luck on that... In my experience most places have little trouble finding part time staff and would not fill a FT line with a multiple part timers - they then have to pay benefits etc and train up two employees instead of one. You can apply of course, but don't expect that they will jump over the proposition!

Good Lord... that's just ridiculous... So.. ummm. good luck with that? :-/

Honestly, if as you say, they 'just don't seem to care' there is nothing you can say or do that is going to make them care. Dial back the lecturing and contests etc and focus on working with them on what their goals are - treat then as autonomous adults - its fully within their rights to feel *hitty but also acknowledge the fact that dialysis sucks - the treatment itself makes many people feel like crap. On an individual basis investigate why the patients are cutting: Do their pressures always drop when they stay, are they itchy, does their back hurt from the chair or do they simply want to go home? Some of these issues can be dealt with. If the barriers to care have truly been addressed there is little else you can do to make them come. Patients absolutely have the right to make their own health decisions and if that means not showing up or cutting that is their right. On our unit, the first time you cut you have to sign a form stating you understand the risks. After that we don't harp on it. It goes much further to develop a positive (non-paternalistic) relationship than lecturing/nagging. Honestly, we would rather people feel able to call us to cancel if they plan on not showing up, and that they show up at all even if they plan to cut. In order for that to happen they have to feel 'safe' to do so. Look at the stages of change - very applicable here.

Yes - by pinching up the skin you very likely will miss the muscle unless you are using a 1.5" needle. That's probably why it hurts less - it's not going in the muscle which does tend to ache a bit!

Public health nurse here - never been asked to pinch the skin, nor have I ever pinched... the RN who gave me my flu shot the other day flicked me a couple times first, which I found odd - presumably she does this to decrease pain?? who knows. I don't even really 'taut' the skin - more just brace the area with my opposing hand, and get very few complaints of pain with my technique. I wonder if previous nurses in your area all followed a certain way (that included pinching) and your clientele has gotten used to it that way or something - I still find the request odd...

Just to clarify - Shringrix - the new shingles vaccine - is not a live vaccine and should be administered IM in the Deltoid. I think you are thinking of Zostavaxx - the old vaccine that is live and admin'd SC. There is no reason both a shingles and Flu shot can't be given on the same day.

Honestly, blindly applying to every job on the board is literally what you have to do. As a new grad in Edmonton I literally applied for 100+ positions before getting an offer. Ended out getting a casual float position at the inner city hospital. Once there, I pretty easily secured a float line. I have more recently picked up a casual position in Dialysis - Within weeks of starting there they were literally throwing lines my way (which I turned down due to other commitments). It's all about getting your foot in the door. You are probably more likely to secure a casual line when starting within the system, so if you can't apply for EVERYTHING maybe focus on those. You can specify 'casual' in your search terms to filter out 'lines'. Good luck!

In our dialysis clinic we absolutely still use beef or chicken broth if pressures are too low post run.

Why does every incident have too be so punitive? Do you think that this PCA doesn't feel like absolute garbage about this and will ensure they never repeat the action? If they were cavalier about the incident that would be one thing .. but come on.

I graduated in the last few years and team nursing is all I've ever known. Seems to work pretty well to me - Honestly, I can't picture how it would have worked any other way (In medicine, at least). Our system works like this: Each unit typically has 3 teams of 1 RN, 1 LPN and 1 Healthcare Aid (for day shifts, that decreases for eves and nights). The RN is the lead, but you generally each have your own 5-6 patients, and knowledge about the other 5-6 from report. As the RN you may be expected to do certain tasks on your teammates patients if they are outside their scope (ie for us, LPNs cannot hang blood, TPN and others), typically your buddy will help you pick up the slack on your patients if you are helping them with something. AM assessments are typically done together on all 10-12 patients, one person assesses, the other records, in some cases the HCA may go on ahead to start vitals. The RNs are generally expected to do the MD calls and check the labs, but it's something that can be discussed between buddies. Routine meds are done by the patient's primary nurse (so you do 'your' 5-6 patients, and your buddy does theirs). What I like with this model is that you always have a partner in close proximity with at least vague knowledge of the team's patients and you have someone to bounce ideas/thoughts off of. For breaks you alternate off with your buddy and I have, the vast majority of the time, found that my buddy has settled all their patients before leaving, so you may be called on for a PRN or help to mobilize to the washroom or something but you aren't doing full med passes or anything. Its really not as bad as it sounds. Remember, your buddy is a nurse too and despite being you being the team lead their actions still fall on their license. The downside with this model (again.. at least for us) is that we no longer have a designated charge nurse. One of the RNs is 'resource' and covers the administrative unit stuff while having a full patient load. There isn't usually much as the team leads are responsible for most 'chargey' type stuff.. but some days it can be hell being resource.