tbpmom

I like the work til 70! I am considering doing primary Adult- Gero NP & going to Senior Clinic or ECF when I retire from my 40 years in acute care. I also want to teach water aerobics to those seniors!

I am ACNS-BC from ANCC as that is what my program offered in 2010. Now it is the the Adult-Gero of course.

I am looking for how other hospitals do staff nurse orientations- new grads vs experienced nurse. yes, probably would be better suited for staff/ professional development. But I am. CNS and I am utilized heavily in the onboarding & orienting of new nurses, and the vast majority are new grads. Thanks.

Would you please share how your hospital does nurse orientation please? How do many days for general orientation and how many for RN's? How is it done? In simulation lab and copmuter labs? before going to the unit for precepotr orienttaion? Is is a combined process? Do you mind sharing your orientation agenda please? Thnaks so much. TBP

Coluld you please send me any polices and literature you may have supporting the practices you mentiond please? I am having trouble finding any literature regarding guidelines/best practice with drawing blood cultures fro the pICC line. Our system says to remove the end cap and flush before drwing any blood. Also staff are to draw 5 mls for waste, then draw the 8-10 mls for each aerobic and anaerobic bottle, place a new endcap and flush with 20 mls. I question why flush before, and why draw a waste with blood culture samples. Thanks.

I took the ACNS exam Dec 31st and passed ! I felt the ANCC study Group was helpful. I also used several NP review books, as well as my pharmacolgy and A&P books. I had a lot of questions related to leadership, learning theories, consultations, interpreting research articles and also on developing research projects. I felt comfortable with the clinical and disease related questions but the research and leadership ones were what made me really anxious. I was very grateful to read "congratulations" because I really thought it was tough.

In our CVICU--we have very different treatments depending on the surgeon, and it appaers that this inconsistent trend is everywhere from reading the above posts. Does anyone know of any evidence-based literature that will validate or provide standards and guidelines for the use of fluids, and what type, when and how much for the immediate post-op open heart patient?

Also i just read on the Bard Power PICC web site that vamps and CVP monitoring are OK for these lines. I just do not believe that is in the step-down policy though for our facility. Maybe that is something the unit needs to look into as a vamp would certainly be safer for the patient than a constant interruption and frequent,repeated blood wastes.

The PICC's in our hospital are placed only by specially trained RN's, and placement is verified by PCXR. Staff RNs change the dressings per policy q week or as needed. I work in a CVICU, but some of our long-term patient's will go out to the step-down with PICC'c, and there was where my question regarding frequent blood draws came from, as a nurse from there told me that the RN's out there draw off the PiCC's q 2 hr.s for the patients on insulin gtts. And some of these pat's are on the insulin gtts for days, so i was concerned of the huge blood waste with each draw, and the increased risk of infection with so frequent of interruption.

But these are patients on the step-down where vamps are not used. Plus I have never seen vamps used on PICC's. These are power point PICC's and are Vamps OK to use with them? Thanks. :typing

I have a question regarding PICC use? What is best practice regarding checking glucose levels q 2 hrs ( or more often) because the patient is on an insulin gtt? A nurse was telling me she thought another nurse was lazy because she would do fingersticks on her patient rather than draw off a PICC and waste blood every 2 hrs for accuchecks. I told the nurse I also do fingersticks as I think it is too risky regarding infections and also loss of blood as many of our patients are fresh post-open hearts, and are already with hgb.s in 8-9 ranges, and are at great risk for iatrogenic infections and that fingerstick would seem less invasive than q 2 hr 10+ ml blood draws off a highly risky, potential infectious source. Thanks

I had no desire or thoughts about being a nurse in HS, but at 25 yrs. old, I decided it was silly not to try Nursing, and I have been at it now for 24years. I tell all the new nurses that hospital nursing is very hard: whether in an ICU or on a floor, and the long hours, poor-pay and lack of respect you get from the general public is all part of it. But I am damn proud that my daughter is a freshman in a BSN prgram. I am damn proud that I am an RN as well, and I have the bad back of a 20+ years of night-shift and poor-staffing to prove it! :wink2: THE JOB IS TRULY REWARDING IN WAYS ONLY A NURSE CAN UNDERSTAND.