kbrn2002

The Emergency room is for emergencies. If you are not having one go to your primary or urgent care. If you want to treat the ER like an office visit, expect a LONG wait before you are seen.

You have to figure out if the return on investment is worth it for a higher cost but faster result program. How much more expensive is the ABSN route? Would you make enough additional income in the 18 months faster timeline for the shorter degree path to make the increase in student loan debt a reasonable option? How much longer would it take you take you to pay off the higher total debt and/or how much higher would those monthly loan payments be than if you decided on a lower cost program? Also factor in income during the schooling. Would you realistically be able to work full time, or at least enough to cover living expenses while attending school and still be successful in the program? That might be more challenging in an accelerated program. Then consider the path to BSN, are you likely to find employment with a facility that offers tuition assistance for the bridge program if you choose the ADN path? Many employers will pay for all or at least a large portion of the degree. For most people I'm thinking the higher cost just isn't worth it in the long run. Apply to every program you could realistically attend. A long commute might sound OK at first but become a real burden in the reality of the daily grind. Choose the best school for you based on cost, program quality and location. Maybe it will turn out to be the ABSN works for you, more likely is a cheaper alternative will a be a better choice.

If the note was accurate to the patient there is nothing wrong with using a copy/paste template and adding/removing as needed. Have you read any provider rounding notes? They are usually copy/paste, the exact same note over and over again. with current VS and anything else new added.

It really kind of depends. How long would you work before retirement after finishing the program and how expensive is the program? How much of a bump in pay would an entry level NP be over your current wages? Do a little math and figure out if the return on investment is worth the expense. Unless of course you are financially well off enough that making less additional money over your NP career than the cost of the education is not a concern for you, if that's the case then go for it without reservation.

The only real impact of this is limitations on the dollar amount of student loans. I don't see too many graduate nurses needing $200,000 in loans to graduate. If any graduate nursing student is spending that much for their education they are going to the wrong school.

Those outpatient/clinic jobs with a Mon-Fri day schedule are pretty hard to get anywhere even with experience. In small towns it can be very hard to get in to a position like that, there's just no openings unless somebody quits or retires. Despite the fact that those roles usually pay less than in the acute setting nurses want those jobs for the hours and predictable routine. If relocating or a long commute is not an option you can consider you may need to accept a position that is not your ideal job until something that is opens up. There are a lot of options other than med-surg, you may find a different specialty suits you better. Then you can continue your search for your ideal job if you decide you still want to. It might then be easier to find that outpatient role if all those clinic/outpatient settings are affiliated with the area hospital anyway. Preference is usually given to internal hires and working for the hospital system will give you an advantage when those jobs do open up. Even if there are other places you would like to apply that are not affiliated with the area hospital system getting a job is easier when you already have a job for some reason. Plus at some point you will need to work to afford life unless your partner can and is willing to support you indefinitely.

Some corners can be cut, some can't. These are things you learn with experience, and that is something you don't have enough of yet to make that call. Definitely continue to do the right thing, follow all policies and procedures no matter how silly some of them may seem. You need to focus on your own practice and growth instead of worrying about what others are doing. Of course if the corner cutting is a safety issue report it using the proper channels but if not don't be so concerned with what other staff are doing. Unfortunately you are finding this out the hard way. Many smaller communities have limited options for employment and everybody knows everybody. Once you have a negative reputation in that community it can be hard to shake. Unless you are in a position to apply in a wider area or relocate it might be harder for you to find another position for awhile. Keep applying, take the first offer you get, Apply every place that hires LPN's. Look to assisted livings, clinics, etc. There have got to be more settings that utilize LPN's than just SNF's and home health. Continue to uphold your own standards but don't be so quick to report every little thing you feel is not perfect.

Well this might be the Captain Obvious answer but start with researching available programs and apply. Be prepared to possibly retake the prerequisites since they are three years old, especially if applying to different schools than where you took those classes.

Oh my. Run, run far and fast. The hygiene and infection control issues with rats, insects, mold and mildew would probably be enough for me to leave. Narcotic keys just laying on an open counter is going to be the most immediate risk for your career. Who's responsible for the count when there's nobody there? Everybody in that building who sees the keys just laying there would have access. Most BON's are going to nail you to the wall if that narc count is off while you are responsible for the keys, even if it's only because of shoddy record keeping and not because any narcotics were actually diverted, The responsibility and blame will inevitably fall on the nurse holding those keys first. I feel so bad for any residents living in that facility. If there's no nurse for entire shifts who is taking care of them? How are they getting medications? Who's doing needed treatments? Even if they are fully staffed with CNA's which doesn't seem likely to me given the issues there are just so many things a nurse is needed for.

I used to, sort of. I was scheduled 12 hr shifts, did 3 on, 1 off, 3 on then 7 off. I loved it then, but I was also quite a bit younger and working a 72 hr week wasn't as physically demanding for me. Even several years ago I needed at least a day, sometimes two to recover before I had any energy. I wouldn't do it now.

Just talk to your DON and verbally give notice, they will likely ask you to stay on PRN but if not you can tell them you are willing to stay and transition to a PRN role. Then submit a letter of resignation and also specify in the letter that you are terminating that position but would like to explore staying employed in a PRN capacity. When you give your notice ask what the requirements are for picking up shifts to stay employed PRN, some facilities require so many PRN shifts including weekends and holidays that the obligation is more than I would accept, especially if it's a facility that requires any Holiday shifts but doesn't give PRN staff Holiday pay. My former employer was like that, staying on PRN was not happening with their expectations. Give adequate notice, at least 2 weeks. Stay professional throughout the offboarding process, don't call in your last day. Leave on good terms so if the new job isn't as good a fit as you hoped the door will be open to return. LTC is notorious for turnover, you won't be the first nurse to leave your current employer, you certainly won't be the last. Unless your current employer is fully staffed, and it's probably not, you can likely expect them to offer you a raise to stay, if it's significantly more money than the new offer you might consider accepting. If you do leave, don't feel guilty in the least for leaving for a position that whatever reason is a better opportunity for you.

Good luck with the interview! Staff will probably be on their best behavior during the job shadow but you'll still get a pretty good feel for clinic culture. By the way, dialysis is not at all monotonous, LOL. It can get crazy there. It was a strange feeling changing specialties though. I figured I'd been a nurse for 25 years so it would be easy. I had no idea how much about kidney disease and dialysis I didn't know. It took about a year before I felt fairly confident about what I was doing. Another plus is there are advancement opportunities. After only three years I was offered and accepted the job managing my clinic and had a whole new learning experience for management. Then it took about another year before I felt like I knew what I was doing.

If your goal is patient care and getting to know your patients an outpatient dialysis clinic is a good fit. The same patients are in the same chairs usually 3 times a week for several hours each time. There is a lot of regular scheduled interaction with the same patients and you will get to them and likely their families pretty well. I changed from 25 years in LTC to dialysis and I personally love it. Clinics and private practice offices you will see recurring patients but not on a daily basis. Plus at least in my area those jobs tend to not pay as well and it is a fairly competitive job market despite the lower pay. If patient interaction is your goal a remote job would have little to none of depending on the job. Plus again, these positions tend to be a pretty competitive job market, lots of nurses are looking to get away from bedside nursing so work from home and remote positions are popular choices.

Congratulation's on the new position. It's scary to transition to a whole new specialty, I did that when I flexed from LTC to dialysis It's like starting your career over again. Scary and exciting all at once. You must be excited for this new chapter in your career to be willing to take that kind of a pay cut, the wages are about half of what you are used to making. Unless you have a pretty large cushion that is going to require some careful financial management to adjust to that big of a wage reduction.

Unless you are an advanced practice nurse with prescribing privileges writing an order is outside your scope of practice. Since you are being investigated for writing a med order I am guessing you probably don't have those privileges. I would imagine a drug screen is just part of the BON investigation.

Many times. I've been punched, slapped, bit, kicked etc. But then I worked 25 years in a SNF and these assaults were from elderly, confused, scared and combative residents. I considered the occasional strike from a resident just part of the job. I've never been assaulted by an oriented patient, a family member or anybody else.

Like Nurse Beth said, every state has their own requirements. It might be as easy as paying a fee to renew, it might be as complex as taking the NCLEX again along with any additional education or other requirements that might go along with that. Check with your states BON to determine what you would need to do

It hadn't even been 24 hours when you posted this. Calm down a bit. Results are not immediate. Imagine the old school nurses that took the pencil and paper NCLEX, the test took two days, in person and results were snail mailed and took 4-6 weeks. My Mom was a nurse from those days. I took the NCLEX on the computer, back then there was a paid 1-900 number you could call to get early results 3 days after the test, I can't remember but I'm thinking the fee to call was for early results was $9.99 and most households had a 900 number call blocker on their phone land line, this was before cell phones were a thing and everybody had land lines. There was one student in my cohort whose family did not have the 900 calls blocked so we all went there and called, just gave her Mom the $10 for the call. Nowadays test takers seem to be expecting results immediately? There is a process that just takes a littler time. It's not just the test itself, your results are forwarded to whatever state you applied for licensure in and they have to review those results and determine if they meet that state's passing standard before they either issue you a shiny new license or decide you did not meet the standards for passing. Some states are faster at making that determination than others, could be the next day after testing, could be a few days. Where I live test takers have found the fastest way to get results is just going to the states license look-up page and stalking it with frequent refreshes. The RN license usually shows active there faster then the official results come from Pearson Vue

It's about impossible for somebody with a substance abuse disorder not to harm another person, for all the very good reasons posted above. I am not an addict, however my husband is. Many years of volatile behavior, missed work, lost jobs, 3 DUI's before he just stopped driving because he knew the next DUI would be mandatory jail time. These caused both an emotional and financial toll. He did stop drinking, and then 9 months later went into liver failure. Fortunately he had been sober long enough to qualify for a transplant and even more fortunately received one when he was pretty close to end of life. It's been almost 5 years now since he received his transplant and he's a much better person sober. My story is not unique. Every addict hurts people in some way. We are just fortunate that nobody was physically harmed by his behavior except for himself.

The not going to management with every little thing like a 5 year old running to mommy and saying "mommy, look what she did!" I can totally agree with. That's just immature behavior from somebody who should be expected to behave like a professional adult. The same with the gossip girls groups that act like a bunch of petty high schoolers. Unfortunately that's also human nature, I've dealt with one or both of those types everywhere I've worked, not just in the nursing profession. As for expecting all nurses to encourage and mentor new nurses, that is a crock of the brown stuff. Mainly because most workplaces we are already overworked, understaffed and underpaid. Partly just because not every nurse has the personality to be an effective mentor. We are too busy running our tails off to get our work done, who has time to mentor that new nurse? If employers expect new hires to be properly trained and yes, mentored in their role they need to first assign that new nurse to work with one experienced nurse that is a great preceptor for long enough that the new nurse is reasonably proficient and ready to practice independently and they need to pay that preceptor extra for being willing to take on that role.

I was a cosmetologist in my former life, life before nursing that is. I wasn't quite 30, I was 27. Nursing was also a bump in pay for me coming from a close to minimum wage job where I relied on inconsistent tips for the majority of my income. With your background utilizing a nursing degree within a non-nursing role is a great backup plan if you decide direct patient care is not for you.

Not a Home Health Nurse here but it's no better working in a setting without an onsite provider. It is a hair pulling time suck, no way around it. I have the backline phone numbers to my frequently called offices and it used to go directly to that office, now after yet another health care system expansion all calls, even the backline numbers are routed through a call center. I hate it, I have to go through everything at least three times, first for some non-medical call center staff that has no clue what I'm talking about or what my actual needs may be, then again for the front desk person in the office who also doesn't have a clue and ends up saying "let me transfer you back to a nurse," and when I am finally transferred to the person that can actually help there's often nobody at that desk so I have to leave a message and hope that somebody calls back within a reasonable amount of time. More often than not if it's anything I need an answer to somewhat quickly I end up going through the on-call provider phone tree which is another challenge but at least the on-call provider responds pretty quickly and so far none of them seem to be too bothered by these calls that are important but clearly not an emergent need.

The giant health care companies are going to be the downfall of not only nursing but the populations they serve. I'm seeing this develop now where I live. Every hospital/clinic with the exception of one income based community care clinic are part of the two provider systems in my area. They can both spend multiple millions of dollars on expanding. New construction, renovation of older properties, parking ramps, etc. But they sure can't invest a dime in nursing wages, benefits or improved ratios and working conditions. Plus the poor patients have to work their way an ever increasing level of confusion and hold times because every call is routed through a short staffed call center just to schedule an appt with a provider that will likely be months down the road. If there is a need to see a provider sooner the call center just directs the patient to the already overloaded urgent care or ER which even with decent insurance is always a more expensive option than an office appointment,

Yes, you can work in multiple states. Either through being licensed in those individual states or by working in multiple states under one license as long as all locations are compact states. I live on the MN/WI border and many nurses in my community maintain licenses and work in both states, MN is not in the compact so this does require separate licenses for each state. But a few miles commute across the border to another town is not a big deal. A commute from IA to WV is obviously not going to work. It is very unlikely you would find employer's in both states willing to hire you with a plan of moving back and forth between states every few months. The only option I can think of that might work is looking for a job as school nurse in your primary state and picking up a per diem position in the other state if you need to work during the times school is out, that would allow travel during school breaks and the long stretch off for Summer break. Otherwise you could look for a job with a travel agency but you really should wait until you have at least a couple years experience before attempting that. Plus there's no guaranty you'd find reliable contracts in both communities. Travel positions are still plentiful, but not nearly as much so as they were a few years ago.

If she has been a nurse for 3 years and a full year of that has been with your employer and she still needs 1:1 support I would say it's time to cut her loose. It's pretty doubtful in that situation that changes in orientation would benefit her. There has to come a point where it's obvious that no additional changes to orientation are going to result in a better outcome.