chef2rn

I'm female, but I highly recommend adderal or ritalin. that's what got me through. Also, sitting in the front row & having my textbooks open to the lecture material while the instructors were lecturing. My experience is that they lecture and test directly from the books. If you highlight what they are saying, you'll be able to find it easily when it comes time to study for exams. good luck, but you'll be fine. Nursing is a varied profession & you can fin a niche.

Scrub up to your elbows! I've had it happen where I washed my hands 3 or four times, but could still smell it. Found a tiny smear on my forearm.

If you wanted to, would they support you while you bridged to RN? I realize it's probably hard to contemplate at this point in your career, but it seems to be the way CA hospitals are going. I'm sorry this is happening to you & hope your situation improves. In any case, I would try to gather letters of support from RNs you've worked with over the years who support your current role in the unit. Good luck!

If I have a hep lock that flushes easily & there is no pain or sign of infiltration I use it.

Hmmm, well, I spend most of the time in ICU. I like the continuity & seeing what happens with my patients. I've just learned CRRT & want to do more of it--fun! I like being able to focus on 1 or 2 patients. I don't see quite as much of the psych stuff, which is fine with me. And again, no kids--I am not PALS certified & not too confident with my pedi skills. Also, I work in a very supportive, team-oriented unit. There's a lot of collegiality among the RNs, docs, RTs, etc. On the other hand, I do like the "never know what's coming next" action in the ED. It's a great place for me to learn to focus my assessments & prioritize. There are days when it's fine with me to see a patient for a couple of hours & then be done with him/her. Since I don't spend as much time there, the "system" & pace can be a little frustrating. there you go...

I started in ICU a few years ago as a kind of stepping stone to ED, and I sometimes float there. After I had a baby last year a couple things changed: I realized that I was going to have a really hard time seeing babies & kids in bad situations. For the most part it's all clinic in our ED (urgent care stuff), trauma goes to another hospital, but occasionally there's abuse or a SIDS case. Before I had a baby I could put some distance there. Now I'm a wreck when I here about the burns, drownings, car accidents, etc from a friend at the trauma hospital ED. Of course, it is probably possible to develop healthy coping strategies, but I'm glad to be with just adults for now. Also, I liked coming back to something familiar to get back up speed. I was kind of spacey & distracted for a while post-partum & my brain couldn't take in the same volumes of new info & make it stick. Again, that's MY experience, but I felt pretty challenged with the new skills at home. This is my first kid, though. I still like being able to float to ED & now that my baby's a year & things have settled down, I'm considering spending more time there. I hope that input helps. Good luck.

I'm glad they put that bit in about Purell, et al. In the ICU where I work, we all share phones, computers, clipboards & plenty of other fomites without having outbreaks. We practice universal precautions & have healthy immune systems. I wish they would talk about pathogens and not just "germs." There are "germs" everywhere & the constant bad press & phobias have led to the "antibacterial" hysteria that is making us sicker !!! One of the Infectious Disease docs I work with thinks that the asthma epidemic is caused in part by kids being exposed to too few germs. Won't be a problem for my kid!

I am an ICU RN in Northern California considering moving back to Vermont to be closer to family in New England. I am an ADN prepared RN with a liberal arts bachelor's. I have worked in a small community teaching hospital (200 beds, but ICU has 16) for the 3 years since I graduated. I am studying for CCRN & hope to become an ANP sometime in the future. In CA we have a very strong union & strict 2:1 pt:rn ratio in ICU. We are well paid (started at $42/hr out of school on nights) with free or nearly free health benefits. There are also a ton of nearby educational opportunities. These are difficult things to contemplate leaving (and let's not start about weather!). Despite all that, it is still a stretch to buy a house here & still be able to get the car fixed or go on a vacation. Cost-of-living is quite high. If you are an RN in Vermont, can you please tell me where you work & then about general conditions, pay rate, ratios, benefits, educational opportunies, things that need to change, etc. I am particularly interested in hearing from critical care area RNs (ICU, ED, PACU, Cath Lab), but any perspective is welcome. Also if you are working out of state, NH, MA, NY, can you tell me about those places & why you chose them? We are looking mostly in the Brattleboro area, where I lived for many years, but are considering other areas as well. Thanks in advance! Laura

I'll try to make a long story short. Our med-surg unit is the 2nd home to a chronically, congenitally ill woman in her early twenties. She has a complicated medical history and multiple problems including renal failure, gastroparesis (she has a g-tube for self compression & drainage), neurogenic bladder, and chronic pain. Emotionally she is about 13 although she is quite intelligent and sophisticated regarding her medical care. Recently she was admitted to the ICU for sepsis secondary to a UTI. She got out on the floor after a day. One of her meds is an antibiotic to be instilled into her bladder, held for an hour, and then drained. Because she self-caths, and because the staff knows her, and because she can be a very "intense" patient, she is allowed to keep the medication at the bedside and administer it herself. She just tells the RN when she did it. Then I come along. I have a pretty good rapport with her, although I had not yet cared for her during this hospitalization. When I questioned her, she said she'd done it, but the volume of medication was unchanged & the irrigation kit untouched. I called around to the other units where she'd been & NOT ONE RN had ever seen her do it or even seen the drainage in the 3 WEEKS she been hospitalized FOR A UTI!!!:smackingf I told her I'd need to either watch her, see the output, or administer it myself. Otherwise, I'd have to chart it as refused. Needless to say she freaked out. She's also been allowed to have a box of saline flushes by the bedside because she likes to flush the ports of her port-a-cath herself. I suggested to staff that JCAHO or the state might have something to say about that. The flushes disappeared from her room for a day & then were right back. Then I got into an argument with a nurse who thought we were giving her the idea that we didn't trust her. Um, I don't. Does anyone else have experiences like this?

I work in a teaching hospital where the residents and experienced MDs depend on my ongoing assessments of our patients. We're a team. I do see my self as a medical professional. As nurses are expected to do more and more, and with expanding Advanced Practice options, the lines are becoming less distinct. I try to think like an MD when I'm reviewing orders--anticipating. I ask a lot of questions. I also try to educate MDs to think like nurses while they're writing orders. When I advocate for a patient, I am advocating for nurses also. I've had doctors suggest that I go to medical school, which I take as a compliment and vote of confidence. The truth is, I don't want to have to study physics, O Chem, and calculus to do what I love, which is patient care. On the flip side, I've told doctors who are particularly thorough in their assessments and orders that they should have become nurses. Nurses have more respect and responsibility than ever. I think the perception of nurses will shift even more when: 1) The pay rates continue to rise which will lead to 2) an increasingly talented and competetive pool of nursing school candidates and 3) more men entering the profession. The other thing that needs to happen is a standardization of the profession, ie RN = bachelor's degree. After all, we all know that an MD means college + med school. If an MD could mean 2, 3 , or 4 years of school, it would sound like a quack profession. Anyway I love nursing and medicine, and I wish doctors could do more of what nurses do, and that I could do more of what they do. Anything that would make it easier on the patients.

ADVICE & A BIT OF VENTING Hey, I'm a New Grad (well 6 months out--RN II next pay period, God help us!) on a mixed Med-Surg/Tele Unit. On my unit we can't take tele patients unless we are ACLS certified. Take the time to do it ASAP--it's invaluable. I haven't had your kind of experience, although there is definitely chaos & we have our own set of problems. I offer the following advice, but I am older new grad (37), with a pretty high level of confidence in myself (not neccessarily in my nursing skills), and a history of working in high end restaurant kitchens, which are their own special brand of hell. In other words, I don't take much ****, I don't take it personally, and I am very good at working with teams and asking for what I need. I am also very direct & (mostly) very diplomatic -- both learned skills. Things to remember: 1) (All together now!) There is a nursing shortage--if you have to, go find another job where you will be supported & will be able to learn without burning out immediately; 2) learn to say, "No." I say "no" in several ways: "I am a new grad, and am uncomfortable with that;" "This assignment is beyond my skills, I am going to fill out an assignment-under-protest." Call the nursing supervisor and say that the acuity level is inapprpriate for the skill level, and let them share some of the responsibility. I've had nights with a full patient load (5 pts--thank you California Nurses Assoc!)) 2 of which are restrained & on ETOH withdrawals (and both admitted on my shift), 1 dying from CHF (a DNR, but actively dying & needed my attention more than the others), 1 post-op & one getting blood on contact precautions with only another new grad & a float (both with full pt loads) no charge, no aide, no CSA, and a first year resident writing orders. I've called the Supe and said, "So you are aware that I am a new grad, this is my patient load, this is who is on the floor? I feel this is an unsafe situation. Patient safety is jeopardized, are you going to do anything about it? Who can I call for a resource?" Remember that our first priorities are patient safety, but PROTECT YOUR LICENSE!! DOCUMENT EVERYTHING!! Every phone call, ("2225 Call to MD, awaiting return call. 2240 2nd call to MD awaiting return call. 2245 rapid response called, pt stabilized, MD aware. STAT ABGs per MD order...etc") If you're in a place where you can't maintain patient safety, and no one will back you up, get out. If an MD screams at you, learn to hold up your hand and say "Stop, you are screaming at me." That's all you have to say. Let them try to justify it or have a tantrum, but at that point they should just stop. You may be scared or shaking, but they won't hit you & they can't fire you. Go to your charge or manager or supe and have them document the MDs behavior. Complain loudly about that to the administration. We've made our prima donna cardiologist go to anger mgmt classes, write apologies, etc. He may not change, but at least it wastes his time. Also, if I am constantly in a room for pain meds, I call the doc & say that the patient's pain is not satisfactorily controlled & can I have orders for a LA med & something for breakthrough or a PCA if appropriate. Alternatively, I may negotiate with the pt that I will give them their PRNs as often as scheduled & they don't need to call. I will still assess every time, but it keeps them off the light. We're a public hospital, so we get a lot of those patients. I don't care if they're med seeking as long as their resp rate is safe & there are no other contraindications to medicating them. It's not my job to get them unaddicted. That's for rehab. I disagree that tele/step-down is not appropriate for new grads, but it sounds like your unit is. My co-workers and I are super supportive of each other, but the administration sucks. I make them pay for every second of my overtime, every missed break/lunch that is due to short staffing & not my flawed time management. If a med is late because I was too busy cleaning **** off the floor & doing a complete bed bath/linen change down the hall, I chart that as the reason. (We have electronic med administration, so we have to justify all our late meds.) One of the older nurses today advised me to get out now, move around, don't feel obligated to stay. He said mobility was easier at the beginning of his career. Good luck!