Nurse-please

I think you will hear before that. I heard within two weeks after their deadline of Oct 1st. I submitted back end of August. that does seem like it’s pretty close though, there’s a lot of stuff that needs to be done prior to starting like up to date titers, physical exam, background check, drug screen, etc., it’s time consuming. If you’d like a list of everything we need for our profile in CastleBranch I could give it to you so you can start preparing once you are accepted.

The fact they keep moving the start date back is questionable. Makes me wonder if they haven’t received many applicants

What is GW? I just received notification end of last week that I’ve been accepted. Hopefully we will be classmates! ?

Hey guys, Wondering if any of you applied to the PMHNP program with University South Alabama for this upcoming Spring 2023 term? I submitted my application after the priority deadline in late August but before the extended deadline of Oct 1st. Wondering if anyone has heard about acceptance? They say 8 weeks from deadline and that seems SO long and brings us to the first week of December! Impatiently waiting and looking forward to working with some of you!

Were your classes at USA asynchronous?

I didn’t make the priority deadline but the extended. Initially it said Sept 1st, then I noticed it changed to October 1st. I submitted everything the last week of August. anyone else in my boat? Still haven’t heard. If I have to wait 8 weeks past October 1st, that seems SO close to start of the term

Brandy1017, Wow, what an incredibly hard thing to go through with your coworker! I am glad you were able to have a memory of her being happy with her family. I too, tend to feel emotional when I hear or read of a nurse dying, even if I had not known her personally. So it is reassuring to me that other nurses may feel this way at times too. In another scenario, I remember when RaDonda Vaught was in the media and going through court after she gave that fatal dose of vecuronium instead of versed. Although I agreed with her losing her license, I empathized with her as I imagined what it would be like to go through such a horrible event and the regret/guilt you would feel for the patient and the family. We work in such an emotionally demanding profession, and although some nurses may be better at “turning it off,” I really do believe that even those nurses harbor those feelings deep down. They may not surface immediately but I believe they will manifest in other areas of their life at some point. I also believe that those nurses who empathize with their patients and allow themselves to feel the emotions of the situation (professionally and possibly privately) tend to be more heartfelt nurses.

Yes, I think this hits the nail right on the head. It is incredibly sad to see someone who has an incredible wealth of knowledge and someone who is a great nurse, receive such a terrible diagnosis.

Thank you, and sorry for your loss. I appreciate the input of your personal experience. That was the intent of this post, to see how others cope with these difficult situations involving coworkers. I work at a small facility, everyone knows everyone so that may have some influence over the situation. My coworkers are like family to me and I know a lot of others who feel that way as well.

I didn’t mean I would go to therapy for this particular instance, I mean in general as a way to help cope with the ups and downs of the profession itself. I did not make that clear. I was not trying to make her situation about myself, and would never do that in any situation like this. I was just curious if others had trouble with these situations as well when you know the person through work. Clearly you do not, so good for you I guess? Thanks for your input, you definitely are a sour lemon LOL

Last night at work, I had a fellow coworker and fellow nurse seek care in our ED. She’s relatively young and the night ended with an admission and what’s going to be, more than likely, a terminal diagnosis. I won’t get into any details because she is a private person and I want to respect that. She ended up relaying the info to me herself because the doctor had updated her prior to me reading the CT. I felt like I had been smacked in the face. I kept it together at the bedside and then cried in the bathroom immediately after. The only thing I wanted was for my shift to be over and go cry in my car. And now I sit here tonight with the entire scenario creeping into my head. I knew her husband when I was younger, he used to be my manager when I first started out in healthcare, super nice guy which only made it harder. I kept telling myself in my head, “you can’t be emotional right now because you gotta keep it together for your patient,” which I did very well at the bedside but I found it hard to concentrate when I was with my other patients. Does anyone else feel so deeply when “one of our own” is on the other side? I have known a few older nurses that have passed on and I always feel it so deeply that’s it’s uncomfortable. I think it’s because I look up to them so much, it pains me to see someone who has given their whole life to this profession, succumb to it. It’s hard to explain, but I know other nurses will know what I mean. We are all human, it just feels as though we are invincible sometimes. How do people deal with watching “our own” on the other side of the bed? I think therapy may be in order.

Has anyone else experienced their patients get really hot (Subjective to the patient, not fever) or like a full body “heat rush” (as one patient explained to me) after giving calcium gluconate? It last for maybe 45 seconds and gets better. Patient at no point appears flushed or red. I have had this happen with the past 3 patients I’ve given it to prior to insulin and d50 for hyperkalemia. At first I though I was giving it too quickly so I looked in the MAR and Micromedex to see administration time but there wasn’t any listed. So the next time I gave it slower, approximately over 1 minutes and it still happened. I’m now reading a peer reviewed journal that states both calcium gluconate and calcium chloride should be administered over 5-10 minutes. Has anyone else had this happen? How fast do you yourself administer and any ideas what would cause the intense “hotness” the patient experiences? After reading the study I’m going to start administering over 5-10 mins.

Hey Guys...me again! Man, I love this group. So I picked up a casual ER position about 1 hour from my house in the middle of NOWHERE. It's a small facility...7 bed ER. I think 15 bed inpatient.. normal ER census is 14 a day. Two RNs staffed in the ER during the day, with 1 RN at night with med surge charge RN to call as your back up. Physician in house. No RT after 9pm. There lies my problem...Every facility I've worked in I've always had RT to rely on. I'm mostly hesitant for intubations and managing a vent. They will be training me in on this...but I'm still nervous to not have an RT to rely on! While I have been around plenty of intubations and vents.. I have not had to solely manage one or be second assist during intubation. My hope is that they have solid providers.. fingers crossed or I am out. But you know how that can go at these small-time hospitals. I have just about 2 years ER experience in busy ERs. I suppose a solid ICU nurse would maybe feel comfortable in this situation. I plan to travel nurse in the near future and one of the reasons I thought this would be good experience is if I land an assignment in some rinky dink ER, I'll have had that exposure as staff and see the ins and outs of working in small facility. I want to kind of push myself into feeling comfortable managing these patients solely on my own. Is this crazy thinking? Would you guys take a position like this? Thanks again!

Do you assess gag reflex by touching the pharynx with a tongue depressor? I would be so cautious to do that, especially in a patient that’s on a substance or has ETOH on board... I’d be afraid for them vomiting then aspirating and then for sure we would be intubating.

I guess I wasn’t thinking of assessing the gag reflex as putting in an OPA or NPA.. I was speaking more of tongue blade to the pharynx.. An NPA would have been very suitable for this patient thanks for the response!

I work ER. I had a patient that came in high on methamphetamine. The patient was flailing all over the gurney and having a hard time controlling movement, very out of control. We gave 2mg Ativan IM, with minimal relief. So followed with 1 more mg Ativan IM and 7.5 zyprexa IM. Patient fell asleep, I was able to obtain labs, ekg etc., I swabbed for COVID in which she fought me off. I placed another IV, in which she kneed me in the side of the head (LOL) and I transferred her up to ICU shortly after this (pt with rhabdo and multiple electrolyte abnormalities/blood gas not obtained in ER) She was the same during transfer of care. She would open her eyes slightly in response to name (not answer) and would respond to painful stimuli, but not much more since she was sedated on the meds I gave her. RR WNL, mid 90s on 2L. Patient was obese and obviously had sleep apnea. I know I’m rambling... but my point is... my patient was intubated shortly after transferring to the ICU. The RT said she had no gag reflex. To be honest, I have never checked a gag reflex on a patient. Literature that I’ve read it seems checking a gag reflex is old practice and not a good indicator of protection of airway because up to 30% of population has no gag reflex and it’s most likely not present in people with sleep apnea or those who have had multiple intubations in the past. I have never worked ICU, and have not seen a provider or any other nurses check gag reflexes in the ER setting to indicate need for intubation. Is this still common practice as indication for intubation? My concern would be causing an aspiration by checking a gag reflex in an obtunded patient. I know the ICU is a very different approach to care than that of ER. I just kind of feel like a butt about it... having your patient intubated so fast after transfer of care makes you feel like you did something wrong. Now the other aspect to this.... I live in an area with a VERY high drug and alcohol population. We have multiple patients that come in during the day/night to “sleep it off.” Some that are high on meth, we sedate and they sleep it off. The ER I worked at prior to this in a different state, I would see providers intubate for airway protection for the substance abuse altered patient that had adequate SpO2. It just doesn’t seem to happen here as much and I wonder if that’s because of the high volume we see of that population.. thoughts/feedback greatly appreciated!!

Thanks for this advice! I’ve been trying to keep my head down but sometimes it is hard because I have to ask questions due to being inexperienced in labor. I always put my patients first and enjoy the opportunity to take part in their care. But it does make it difficult when you have such a negative environment around you. Not only does it get to me myself, but it bothers me to see others treated poorly as well. Thank you for pointing it out as a short term problem. It’s easy to forget that when you are in the midst of it, everything is temporary

Hey guys, Once again I am faced with the throes off a bad unit. Why, in this profession, is it SO hard to work with a group that is PROFESSIONAL. I have returned to my old unit that I worked as a new grad and I have a totally different outlook than I did before. Two major differences: First, I used to work nights and now I rotate days AND nights, second, now I'm trained to labor and delivery whereas before I was special care nursery. It is DRAMA MAMA 24/7. I have never in my life seen a group of women backstab and talk behind each other's backs as much as they do. Now, not everyone is like this of course, but a lot of the long-time core staff is. And I find it SO ANNOYING. They are constantly judging the new staff members and making comments about them behind their backs, so I know they most likely are doing it to me as well. I have yet to have anyone make a comment to my face but you know when you fit in and when you don't. I refuse to sit around and gossip about others with them and I truly believe that makes me a target. Because I legit don't participate or even encourage it whatsoever if it's brought up to me. CASE IN POINT: This is a negative/hostile work environment that is not very supportive. Yes, the newbies take the brunt of it, but these women will not hesitate even slightly to crap-talk other senior staff members and then turn around and go to breakfast with that said person. It's just INSANE to me. Here lies the problem: I've seen all three of my managers up at the L&D desk talking with some of these women about other staff members. They ALLOW this behavior. I'd say 70% of their staff is new, and of that 70%, half of them are new grads at that. I've asked around if I were to bring up to management any of the instances which I've witnessed, what they'd do-- the response I got was that they would tell those women exactly what you said (and not in a constructive let's make this better way- a derogatory way). I'm SO discouraged and want out ASAP but let me tell you about my track record. I've job hopped, partly because I ended up in a negative/hostile work environment and I feel I deserve better, partly because I moved back across the country for family reasons. I worked at above unit for 1 year and 2 months(loved it then-different staff on nights), then NICU for 7 months (left because of hostile environment/1 hour commute), ER for 1 year (loved this job, super great teamwork and fun) now back at my first job (we moved back for family reasons). I've been a nurse for just over 3 years now and I feel like I've jumped ship too many times but honestly, what is up with this seriously broken system? Why is this SO common? I hear about it from other nurses as well. I'd like to think I'm not being a big baby and that it's just ridiculous that this is even tolerated. I want to transfer departments (specifically to ER with a shift or two prior to feel their unit out and make sure I don't once again end up in another situation like this) but I've only been back at this unit for 6 months, and I JUST got off L&D training last week. I told myself I'd stick it out for 6 more months and then transfer. If I were to transfer now, one, everyone would be pissed at me for labor training and leaving right away. Two, my manager may try to hold me in the department for months before transferring because we don't have a set policy in place for that and per our contract, they can hold us until a replacement is found. Which sounds like a delightful situation right? BUT I don't know man, it seriously drags on my mental well-being outside of work and I DREAD going to work. I PRIDE myself on being an effective member of the team and I love going to work when everyone is positive and helpful. I can't stand this. Advice please? Anyone else experience this crap more than once?

Oh and 8-12 weeks orientation is what I'm going to get too. I'm on the schedule for 6 weeks of orientation and then they are going to reevaluate if I need more time. I think it will be enough if you really utilize your time on orientation and try to learn as much as possible. That being said, it's also hard to see everything (you never will) on orientation because ER is so varied. Everyday will be a learning experience, even after you're off orientation. Utilize your time well and I think you will do just fine!

Hey Well I can't answer your question fully because I just completed hospital orientation this week. I start on the floor next Wednesday. It will be a big learning curve for you as it will be for me. I was a CNA for 6 years in various nursing homes and they liked that experience. They didn't ask much about my NICU experience. I know ER usually likes nurses experienced in pediatrics because that's a big hurdle for a lot of ER nurses who've only ever worked ER. Here's what I am doing and my best advice to you 1. Read your Saunders NCLEX book and take notes 2. Order ER nursing books off amazon. I got a ER pocket guide, TNCC manual, ENPC as well as fast facts for ER nurse. Bring them with you to work. Keep them in your locker but study them outside as well 3. Take as many extra courses as you can that your hospitals offers 4. Last, and most importantly. KNOW YOUR BOUNDARIES. Know what you do know and don't ever be afraid or ashamed to admit what you don't. Even if you think it's stupid. This helps put the safety of your patient first. Never stop asking questions and show them that you want to be there! I'm really intimidated by the ER and hope I have what it takes. I am going to throw myself in 100%. I feel like it's somewhere I can really grow as a nurse. Like you, I need to feel more autonomous as a nurse. NICU was slow and painful death by boredom. Good luck to you! Post an update in a few months and let me know how things are going for you!

Hey guys transitioning from the NICU to ER and wondering what supplies I should get to carry on my person. Scissors, tape, watch etc., in the NICU I literally carry one pen. Lol

Is there an allnurse app? If not, is there one in the process? I feel like it would be much easier than the website!

Update: They called yesterday, I got the job!

Pixie, They said 12 weeks, give or take a couple