steu

Unbelievably she's in ICU back in SR - intubated on a vent not doing so hot of course - that was as of 0800 this morning when I left the hosp. Anyway, thanks for your responses folks. I just needed to get it out to someone who knows what the heck I'm talking about. Trying to talk it out with my friends while watching their eyes glaze over just isn't working for me. I love this forum. I'm going to bed. I have the next four days off and its about 80 degrees here in Florida. When I wake up I'm gonna work on my tan - preferably with frosty beverage in my hand. :) Happy holidays guys!

So, I had my first code last night that was MY patient - I worked xmas eve 7p-7a and xmas night (last night). It was my second night off orientation... I initiated TPN on a malnourished HIV+ patient - one hour after the monitor tech (I'm on a tele floor) yells at me to check on the patient - she's torsades on the monitor - I run in the room, shes unresponsive. Its 0230 in the a.m. and I've had four hours of sleep in the last 48 hours. I call the code and everyone is in there in about five seconds. I felt helpless, shaking so bad trying to prep NS flushes and answer the doc's questions - definitely questioning in my mind EVERYTHING I did throughout the shift that could have lead up to this (did I push the dilaudid she's getting for pain too fast, did I initiate the TPN too fast, maybe I didn't pick up on subtle clues that a more experienced nurse would have...etc. etc.). And its christmas night for crying out loud. Got to know the family pretty well (had them both nights). They had just thanked me for being there for their mom on christmas night. I felt awful. And incompetent. So fast forward to now...It's 11:00 a.m. and I still haven't slept yet - I've been researching online to try to figure out what happened to her. She was SR all along, I start TPN and she goes into torsades? Is it refeeding syndrome, or sepsis? Could I have prevented it? and on and on..... I hope everyone is having a good holiday. As always, would love to hear anyone else share their stories/opinions/etc. re: first code experiences, tpn complications.

Had a patient code tonight approx. one hour after initiating TPN - went into Torsades on the monitor - unresponsive when I ran into the room and called the code. I initiated at 50 cc/hr for 20 min, then went up to ordered 80cc/hr. K was 3.1 prior to starting TPN. Mag levels WNL. Could patient get refeeding syndrome that fast? Or poss. sepsis? Patient was HIV + and Hep C+, malnourished and being treated with IV antibiotics (vanco/Unasyn) for infection of lap chole incision. Anyone experienced TPN complications - would love to hear your stories, feedback or opinions. I'm perplexed. Happy holidays.....

Just curious....on my unit its 4/5 nights. Sometimes it gets pretty hectic.

Thank you TRUERN - that website is awesome. I've been struggling with the lab results of some of my patients. -steu

Thank you for the information. I've chosen a facility that is not making me sign one of these contracts - for obvious reasons. Tenet was very hesitant to give me the details of the agreement, and the recruiter was very shady in my opinion.

Has anyone had to sign a one or two year contract agreement for employment as a new grad RN? The contract stipulates that I would need to pay them (the hospital) a sum of money ($5000.00) if I break the contract before the two years is up. They say that the reason is that it costs xx amount of dollars to train a new graduate. My second question: How binding is this agreement? Has anyone had to break it? If you break it, does it affect future employment? The contract is with Delray Medical Center - a Tenet organization. Thanks!

Ok folks -- Took NCLEX 8/19 for the second time and passed. First time around I only used Saunders to study and failed at 203 questions (I ran out of time at 6 hours) Round two I passed at 75 questions in 2 hours and walked out pretty much knowing that I passed. So since I spent A LOT of time on this website seeking help while studying for the second time, here is my way of contributing back to the forum. So, here's what I recommend for everyone: First of all, take Kaplan (and listen, I don't work for them - I'm just that stoked on it because Kaplan is the reason I passed nclex!) The Question Trainer Test 6,7 are closer to nclex than anything else you can buy - I got a 65% and 68%, respectively. Also, the Qbank sample test #3 is good for priority questions. Qbank was a little easier than my actual nclex exam, but a LOT of the same topics were on nclex, so its good for studying. Make sure you know how to answer the following types of questions: 1. Prioritizing (think ABC's, but don't always go for airway, be careful!) 2. Delegating (RN does assessment -that includes first set of postop vitals people! Thats an assessment, don't give to the LPN-, teaching, IV meds, chemo; LPN takes stable patients with predictable outcomes; NA takes basic grooming and care....) 3. Infection control (Someone put a website on here that saved my life, here it is again: http://info.med.yale.edu/ynhh/infection/welcome.html If you know this you can answer any question they give you about this stuff - I got four. Example: "A nurse is caring for an infant with H. influenza pneumonia and there are no private rooms available, which patient would the nurse place the infant with?") 4. Floating ("The nurse is working on a med/surg floor. A nurse floats from the maternity unit, which patient do you assign to this nurse?" You assign stable patients with predictable outcomes to float nurses - like LPNs.) 5. Assessment stuff (For example, "The nurse is caring for a patient going to have a colonoscopy. What is the MOST important thing for the nurse to assess? a. respiratory b. fluid and electrolytes c. comfort level d. nutritional status -- Thats just an example of the type of question of course, but you get the idea.) Bottom line guys -- you went to nursing school, you graduated, you KNOW the information! What you need to do at this point (if you graduated in the last five months or so) is learn how to answer the questions! I graduated May 2006 so its been about four months....when you do the practice questions, it really helps to jog your memory. I spent all my time the first time around studying information and was seriously thrown for a loop when I sat down for NCLEX and they were asking me "what is the MOST important....what would the nurse be MOST concerned about blah blah blah" This time around I answered about 2200 Kaplan questions (didn't study ANY content!), and I knew what NCLEX was looking for. If anyone wants any more info, send me a email and I'll try to help. Keep your eyes on this forum especially - I spent so much time during study breaks reading the threads for moral support. This is a great network for information and help. Good luck to everyone. If I can pass, I know you can too!

Have my eyelashes ripped out... Run across the state of Florida - from Miami to Jacksonville - without stopping - naked - in the middle of the day - in August. (I'm going in for round 2 this month and I would SERIOUSLY do any of the above if I could opt out it :)

Have the nails on my fingers ripped off... Wax my entire body... Eat a cockaroach - alive....

Hey there, this is to the original poster, as well as anyone else who might have failed I guess. I too failed NCLEX approximately 45 days ago. It was pretty much one of the top five worst moments of my life. Basically, I went in a little overconfident because I had a 99% chance of passing NCLEX according to the ATI predictor test we took in school. I studied Saunders half heartedly and scheduled the exam as soon as possible. When I got question 76 I started having heart palpitations (no joke) and pretty much sank like a tank after that. I second-guessed every question I had and every time the computer flashed a new question and I knew it wasn't over I pretty much lost my mind. I was also taken back by the way the questions were worded. Nothing straightforward like "What are the s/s of heart failure" - Instead I got application-based questions which I had no practice answering in school. Ultimately, I ran out of time at question 203 at six hours and walked out of there with my heart pouring out of my mouth - I nearly vomited. I knew I failed. But here is my advice to anyone interested. Take Kaplan. In the least, buy the qbank. I purchased the complete package and I've been studying with it for about three weeks. I'm doing every single question they have and spending a lot of time reviewing the rationales. The questions are more similar to NCLEX questions than any study book I've seen. And it really helps you understand what the questions are asking, which as far as I'm concerned was the most difficult part of NCLEX. I wish I had been more prepared for the way the questions are worded the first time around- I was completely taken off guard - sometimes I didn't even know what the question was asking me. Anyway, I'm expecting to take NCLEX in august and I feel so much more prepared this time around. I'm crossing my fingers. Good luck to everyone taking NCLEx - and to anyone who has failed - there is hope! Besides, all this extra studying can only make us better nurses!

Thank you everyone for your positive energy and valuable information re: Kaplan. I am purchasing the package today. The questions I saw on their website were more like the questions I got on the NCLEx than ANYTHING I've seen (Saunders, ATI, Mosby, etc.), so I think this is a good decision. Thanks again for your replies!

Does anyone have feedback on their success with Kaplan? Please include which plan you used (Comprehensive or Supplemental packages). I failed NCLEX last week and I am considering Kaplan, but would like to know if it helped anyone. BTW - According to the results of the ATI predictor test I took in my nursing program, I had a 99% chance of passing - I'm skeptical about the accuracy of their tests! FYI. Thanks!

Grew up in West Palm Beach - thinking of returning as a new graduate nurse - anyone have new graduate starting salary information on St. Mary's/ Good Samaritan hospitals - Tenet Healthcare systems? Also working conditions - I have heard mixed reviews about Tenet. Thanks!

Hello CompassionateNurse....Re: salary in Florida based on city - what about West Palm Beach - Tenet Healthcare systems? Any idea? I grew up in West Palm and am considering returning as a new graduate RN but have heard the salaries are low (probably they were referring to N. florida. -Thanks!