MsBruiser

I always got by with printing out out a copy and using that.

No direct experience in that hospital. I am more familiar with Phoenix Indian Hospital - which sucks. A lot. Challenging population (all that you mention above) with a horrible bureacracy layered into that milieu. Also, they are offering extensive relocation assistance for a reason. Tuba City is way out on the reservation - there is not much there. And the population you describe well above. Good friend of mine lasted one year as a teacher in Tuba City. I have been there many times. I would sooner pay for my own relocation and go straight to Flagstaff. Follow your gut - seems like you already know the answer to your question.

Your salary is a mere rounding error for one day's revenue. Just quit.

Just quit. They have nothing to come after you for other than a $50.00 drug test. Small fries.

I think you need a new job.

Oh. Wow. CV surgeons doing heart transplants do not make that where I work. Take that one with a grain of salt.

Well. I once programmed an IV pump wrong and dumped an entire bag of medicine into a patient in 10 minutes. In an ICU. Thank god it was 100 ml of insulin and not Levophed. The patient could have died. I felt so awful I wanted to kill myself. It happened the same day we converted from paper charting to electronic charting. No excuse - it happened. But how is learning about that mistake going to help you? When you make an awful mistake (not if - when), it will be something you never thought dreamed you would do. I would not focus on potential mistakes - but developing safe habits that will hopefully keep you on a safe path for as long as possible. Some advice: 1) Find nurses you admire and do copy what works best for them. Plagiarism is the most sincere form of flattery; 2) Develop / copy a "report sheet" that works for you - this is your paper brain and will keep you from forgetting things and / or making a mistake; 3) Try and develop a systematic approach to everything you do. And realize you cannot do this from day one - you will still be learning. Repetition is your friend - you will quickly develop a keen sense of situational awareness and know when something is not right. 4) If your gut says something is not right - it is not right. Stop. Deep breath. Think.; 5) Always ask questions - use your cooperative coworkers for the excellent resources they are. And finally, "trust but verify." There is sometimes godawful advice here. I am sure 100 nurses will tell you med-surg is where you need to start. Really? I started in an ICU and have gone on to have a great career. Take advice with a grain of salt and believe nothing until you have either heard or experienced something for yourself.

You should be terrified as a new nurse doing home health. But that is water under the bridge - where you are is where you are. Some advice: 1) Use your common sense - always. If something doesn't look right - wound, med, patient symptom - it isn't. Escalate at once.; 2) Know your resources. Have someone you can call if you have a question. Technology is your friend - if something doesn't look right, take a picture and show it to someone who knows which end is up. 3) Know where you are in the grand scheme of things. As long as you maintain some decent situational awareness about patients spiraling downward, you really can't screw up that badly. They are old and sick to begin with...

I don't know what to make of this post. I have 8 years experience and make more than that as a nurse working an overtime shift.

I feel your pain. I flipped in and out of clinical and more business-type jobs for the health system where I work. In fact, I took a $20,000 pay cut going back to clinical work, though overtime has more than made up for that. Believe it or not, I would just say find a place that is willing to hire you and go for it. There really is no course or magic bullet that can scratch the itch of a great clinical job. One person mentioned getting a part time job doing clinical work. That is great advice. When I was in my last non-clinical job I got a part time gig doing critical care transports. That kept me going for a good year before a great opportunity came up and I gave up all hope of every wanting to wear a tie again. It was EXTREMELY nerve-wracking learning how to do that job as I had not taken care of a critically ill patient for almost 4 years. But I got over that really fast. Once I got rid of all the extraneous "spaghetti" before a transport I usually had 2-3 drips at the most and a vent. Easy / breezy. Just jump in and don't look back. And I am a guy too - that is important and will give you a leg up looking for work (let the stone throwing begin, but it is true).

Good question and good answer.

Cardiac device nurse here. I will give you a simple answer. Generally, anything less than 10 beats does not really get my attention. That is a very simple rule of thumb. The most important way to look at this is by looking at the patient's clinical history. Do they have regular runs of ventricular tachycardia? If a patient has no history of ventricular tachycardia and then has 12 6-beat runs in a single month, I will kick these findings up to the attending, pronto. But lets say I was back in the PACU and a patient had a 7 beat run. With what I know now it would not get me very excited. And if the patient already has an ICD, well, what is the worst thing that can happen?

I am a cardiac device nurse. I took me until I was 44 to find my dream job. Better late then never, huh? EP is like learning a foreign language - very complex and abstract. I love knowing that I work with some of the best and brightest people in my facility - docs and nurses. I always feel like the dumbest person in the room, and the challenge is just awesome.

Beyond programmed ATP therapies, a skilled pacemaker RN or Electrophysiologist can do manual overdrive pacing. It is pretty nerve racking and I always carry a calculator in my pocket so I can do rapid VT cycle length calculations. There is always the risk that ATP or manual overdrive pacing can be pro arrhythmic and put a patient into VF. In that case, we just shock them back to Sinus. "Just" shock them. Check out Medtronic University. Excellent free resource. The only way to learn pacemakers is to go to manufacturer websites, so that is hardly a TOS violation.

I am a cardiac device RN. First, you have to work at a facility that has cardiac device nurses. These places are kind of few and far between. I live in the 6th biggest city in the US (metro area of 3.5 million people) and we are the only hospital with dedicated cardiac device nurses. I honestly got the job because I became friendly with a cardiac device RN, and the manager's mantra is they would sooner train someone who gets along with everyone then hire a cardiac expert. I had no cardiac experience beyond ACLS. That said, the field is brutally difficult to learn. I liken it to learning how to speak a foreign language by being dumped in a foreign country (that happened to me too). Electrophysiology is extremely abstract. There is simply no go-to place to learn all of the devices / companies. It takes lots of time and hands on experience to learn the job. 18 months into the job, I am finally comfortable doing most interrogations and troubleshooting. Or at the very least, I know what I don't know and know how / where to get help as needed. So the only way into the field that I know about is networking. Or you can apply directly to one of the device companies and see if they will train you.

The most challenging part of nursing school for a lot of folks is getting your personal life in order. Pick whichever program puts the least amount of stress on your family. I would seriously consider a more intense year rather than a lingering 2 year experience. But that is probably a decision best left for you and your spouse. Nursing school is a time consuming experience - not too academically challenging for someone who has been through graduate school. So long as you have somewhat of a support system for child care and studying, you can have this all done fairly quickly.

At this point you should be doing foolish things like pushing meds in a clamped line. Good god! You are human...give it a chance and find another teacher if it does not work. Trust me - this is nothing new for a unit manager. You will learn. You will finish your training. You will not be homeless.

I would take some of this advice with a grain of salt. Thousands of PA(s) graduate without any inpatient / floor experience beyond maybe shadowing or volunteering. You do not need to work as a floor nurse to be an effective NP. That said, you will have to find a way to network your way into an inpatient environment. Perhaps a formal fellowship program is the way to go. My employer offers them in a variety of fields for new PA(s) and NP(s) and people relocate from all over the country to intensively learn a particular field for 12 months. Or join some local societies and start meeting the right people. If you know the right folks they can set you up safely to do whatever you want.

Yes. Yes. YES. YES. Best money I ever spent. I could hear all lung sounds clear as day in both inpatient and field (transport) environments. I can't go back to the old way. Worth every dime but BE VERY CAREFUL OR IT CAN WALK. I keep mine on my person at all times. You will not regret spending the $$$.

I actually did something similar to what you did. Found myself working ambulatory and then taking a detour into administration. After 3.5 years, I was bored to tears. I managed to talk my way into a PRN job doing critical care transports (my background was ICU/PACU before ambulatory). By the time 5 orientation shifts were over, I felt pretty confident about taking care of critically ill patients in a little bouncing box racing down the road. Your inpatient skills are still luring inside of you - they just need a few shifts to make their appearance. Stop doubting yourself and give it a whirl - if it doesn't work the chair / telephone wills till be waiting for you at the ambulatory clinic.

Interesting older thread. Nursing school was like a goofy summer camp. The academics are pretty easy. You will be given a very intimidating reading list, and then learn within 15 minutes that you cannot read 10 chapters per night and possibly retain any of it. Unless you are brilliant in which case (for God's sake!) go to medical school. Take good notes and get used to NCLEX style questions. I only studied my notes and used the texts to reinforce as needed. Show up on time, do as you are told, and do not hurt any patients. The 30% of people who dropped out of my original class simply could not reconcile messy personal lives with the time-intensive reality of nursing school - or they learned quickly they did not want to pursue a nursing degree. Again, time intensive does not imply academically difficult. But you will log long hours at clinical and wade through meaningless busy work. Your real learning will start after school - during orientation. I have had an incredible ride so far being a nurse for 9 years. Nursing school was completely forgettable.

First name, last name: "Susan Smith."

I came to nursing as a second career, and I notice something that many RN(s) don't - nurses have an unerring ability to make their lives difficult. Many times what they perceive as a "mandate" can be solved with a small checkbox - but they will create a multitude of needless forms and paperwork. When attempting to streamline said paperwork, management will throw up their hands and say, "The Joint Commission told us to do it!" Furthermore, if today's focus is UTI(s) and other preventable readmissions, something will have to give. And it will give...

Cut them every way and in every way. You cannot constantly heap more work on someone's plate without taking something away. "Managers" like yourself are the easiest to deal with. Make the charting nice and neat, the patients happy - and the corners will be cut, and cut, and cut. Easy. And then the mangers go their meetings, and run around with their clipboards, and propose more idiotic work - and the corners will continue to be cut over and over and over again. I probably work where you work. Or rather, there are lots of nurses like myself. We keep our mouths shut, the charting complete, and shake our heads and laugh. Yep, no corners cut in your hospital! Wouldn't be a post worthy of this site without a few of these:

It is not academically difficult but very time consuming. Make sure you have a supportive partner and rock solid daycare plans. Reread previous sentence. No one will give you much sympathy if either home/childcare hits the rocks. Most people dropped out due to personal issues that effected their school performance. Seems kind of harsh but when you start working as an RN you really can't bring your troubles to work -- too much is at stake. I found the vast majority of reading to be next to useless. They will assign you 5 chapters to read a day. There is no human way possible to do that and recall much of the information. Take good notes and study the NCLEX questions. I recycled all my care plans, so they were initially very time consuming and then kind of a joke. Most everyone I knew were barely able to work. 1 very naturally gifted guy worked full-time - but he was really the exception.