Runningnurse

Exactly. Don't know anything about Duke's other signing bonuses or lack thereof. I only know that as an ABSN grad I will receive $33K (minus the huge taxes) in three installments if I work for Duke for three full years.

What on earth? That is really bizarre. Seriously go for the infection control side, not to mention the needless pain. Ports are there for many reasons, one of which is to REDUCE needle sticks. Would he have you placing a brand-new IV every day? Or a new PIC/C? I doubt it. Crazy.

Just remember that just because someone appears to be sleeping soundly (even if they're snoring like a chainsaw) doesn't mean they're pain-free. I work with cancer pts and often they're so used to the pain that they will sleep through it, so if they request meds and then are asleep, I wake them up. Exceptions of course if the patient has respiratory issues, unstable vitals, already a bit too sedated, etc. But waking them up gently at midnight to give an oxycodone is, in my opinion, worlds better than dealing with pain 10/10 at 6am when they wake up because I was trying to be "nice" and let them sleep. Other posters had a good idea...making a plan with the pt before they go to sleep. I'd bet that 9/10 of my folks would tell me to -please- wake them up.

Our floor generally has a decent number of offservice patients on it, and those are always the docs that act like idiots. Maybe we're just biased, but "our" docs always call back right away, and if we say "Could you come over here?" they come quickly, and if the patient just wants some Sonata, they get some Sonata. Off-service docs, on the other hand...ugh. There's one particular service in particular that we HATE. They are always in surgery (all night long) without coverage for their pager. Or if we -can- reach them in the OR, their response is typically "They can wait." This to a patient that wants pain medicine. Whatever. We get snappy.

Not from a patient, but we have a CNA who...bless her...isn't very swift. She does her job and is sweet as can be, but...you get the idea. One of our patients had cervical cancer, with quite a lot of pain in that general area. On the flowsheet where the CNA was charting pain score/location/quality/associated symptoms, she charted that the woman had pain 6/10 in her fojimer. No lie. Fojimer.

The fast answer would be "yes, in most circumstances". But I think the better question is...why are your orders unclear enough that you need to ask? The MD or ordering provider should provide clear guidelines as to how much pain medication you should give and when. For example, we will often have 5mg oxycodone ordered if the patient states pain 3-5/10 and 10mg if pain is 6-10/10. The hospital actually just made a rule that each has to be a separate order, because having the dosage as "5-10 mg (see words)" was too confusing. We have the same issue with narcotic drips for end of life care and patient-controlled analgesia. The orders will clearly state that if pain stays above a certain level for a certain time, the nurse can increase the dosage by a set amount. If pain remains unresolved, the orders state that the MD must be called. So I'd encourage you to clarify orders with whoever wrote them and see what they want for that particular patient.

I work at a big teaching hospital on the oncology floor, and I'm a new grad. I did my final big preceptorship in school on the same floor I work on now. It's the same as any other...you learn as you go! I love my floor, my patients, colleagues, the docs, you name it! Of course there's a learning curve of things that are specific to oncology...but there'd be a learning curve no matter which floor you're on! Yours just might be about chemo instead of pressors. EricEnfermo had a good suggestion...see if there are any hospitals offering internships for new grads in oncology. Mine does, and it's been great! If you want more info or specifics, feel free to email me. Good luck! Oncology is an awesome field.

Our floor is similar...we're oncology, so if these folks don't have a port, chances are their veins have been torn up. (As an aside...I love ports. Love love love. Makes the patient's life SO much easier.) I'm pretty new, so if I look and don't see anything within reason, I'll go grab someone experienced. Our hospital does have a fabulous IV team, and usually we end up calling them, but if it's truly time-critical (ie the blood's on the floor but the IV just blew, or the chemo needs to be given NOW and you can't find a blood return even if you stand on your head) we'll try once or twice ourselves. The policy with us seems to be that one nurse (maybe two) will try a max of 2 times each, then call IV. The first IV nurse will try twice, if he or she can't get it they send up someone else. If he or she can't get it, it goes to the MD or they try for a PIC© line. (But then again, getting a PIC© can be nearly impossible as well...in addition to not having veins, these folks tend to have really twisty turny veins.) No lie, if I ever get cancer or some chronic in-and-out of the hospital type of thing...I want a port placed.

We've got a neuro ICU as well, but it's always called the neuro ICU (I think the NeonatalICU came first). In addition, we have a totally separate ICN...generally for the older tiny babies. Plus the PICU. But I don't work in any of them...:) Just had clinicals in all of them. Now I'm working upstairs with the grownups.

We say nick-u, along with mick-u, sick-u, etc. We've got lots of intensive care, lol.

Another Dansko fanatic here. I have the black mary-jane style and I love them. I had some Nursemates for school and really hated them, actually. The Danskos feel fantastic for all 12+ hours, and I agree that when worn with support hose you really hardly feel the day. The hose, to me, are not stifling. They do add a layer, but I don't mind it. I actually find that the pressure around my lower stomach/back feels good...not to mention that my legs don't feel tired after 12 hours. I'm 24 years old and in good physical shape, and I'm still a die-hard support hose fan. I don't usually wear them when I work nights because there is (usually!) more sitting down, but I wear them almost every time I work days.

The hose just keep my legs from feeling tired. That little bit of pressure really does wonders. Give them a try for a day...see if you like them. They can hurt your toes though, so what I do is put them on and then yank on the toes to give myself a few inches of extra room, then fold it under my foot. It makes a lump for a bit, but then it evens out and just leaves your toes some breathing room.

No clogs? Well, there goes my vote. Danskos are by far the best things I have ever discovered. Period. They're pricey, but they hold up forever and they're amazing. My feet haven't hurt one bit since I started wearing them...as opposed to sneakers where my feet hurt like the dickens after 12 hours. There's a mary-jane style...maybe those won't count as clogs? People say crocs are comfy, but those probably fall in the clogs category as well. If you do nothing else, wear full-length support hose...all the way to the waist. You may think they're only for old ladies, but let this 24-year old tell you...they make all the difference in the world. And twenty years down the line you'll thank yourself when you have far fewer varicose veins!

I draw the line if they become abusive towards me personally. If they're insulting me as a person ie "You stupid ^$(@#!, why don't you just shut up?" or threatening me, I'll ask for a change. If they're angry because they had to wait forever in the ER, or because they don't think the MD is paying them enough attention, I'll call our patient-visitor relations folks or call the MD and explain the situation. It is a very fine line, but I think nurses have a good sense of when something is "off". Sure we all take more than our share of crap if we can stand it in order to give the patient good care, but I'm not there to be abused or threatened. The moment that happens, some kind of action gets taken. Whether it's changing assignments or not going into that room alone, we do what needs to be done.

In my experience, family members can either be a nurse's biggest help or biggest hindrance. I had one patient who would continually soil the bed...10-12 times per shift. The urges were simply too quick for her to have time to get on a bedpan or bedside commode. Her family cleaned her up -every single time-. They would only tell me after the fact, and sometimes not even then. I'd only know because I'd walk past and the door would be closed (it was otherwise left open). I told them numerous times that while we appreciated the help, they should not feel at all awkward about asking me or the NA for help. The lady felt bad asking and being "a bother" and I told her again and again that she was no bother at all, that I was more than happy to help her. I think they eventually got it, but...still never called me. I felt a little guilty, honestly, like I was falling down on the job. But they were so sweet and kind and honestly just wanted to do this for the lady so...of course I let them! They were doing phenomenal skin care, etc. The whole nine yards. On a day with 4 other very busy patients, they about saved my sanity! On the other hand, there are the families who just make you want to have a no-visitors policy all the time. Yes, they are going through a really tough time. I get that. But I also think there is a line that gets crossed sometimes...just because you're under a lot of stress and grief does not give you the right to verbally abuse someone who is only there to help. One family on our floor "fired" their nurse for the day because she couldn't give out information about their family member who was down in the OR. She didn't -have- any information but they didn't believe her and asked for a different nurse. That was a bit out of line, because before they "fired" her they called her into the room and berated her. She had done -nothing- wrong...I'd been down by that room all day and she's one of our best nurses.

I think it also depends on whether the patient is a first-time recipient or not. I do run first-timers blood a bit more slowly than our folks who come in and are getting their fifth unit in two days. I know each unit of blood is different, but in my experience someone "experienced" with transfusions usually does not react as often as a first-timer. Even then the reaction frequency is very low. Nobody on our unit does anything that isn't approved in our organization's policy and procedure manual (being a newish nurse I have -definitely- checked), so while our rates may go against published guidelines for other institutions, we're well within our bounds at our own hospital. :) And I know the question wasn't whether the IV can handle the rate but whether the pt can handle the blood...but you might be amazed at what a puny little 20 gauge PIV can handle. Over the past few days I've been running in chemo pre-hydration at close to 500/hr and the IV held up beautifully. (Doesn't mean I was totally happy about running it in that fast, but chemo orders are chemo orders.)

I guess it's a bit different for us...we're a pretty big teaching hospital, so there's always an intern on call overnight. During the day, the interns are always your first call. Our problem is who to call if we have off-service patients. I'm on an oncology floor, but we get a lot of gen meds if those floors are full...and there are nine different gen med teams. So depending on which number team your patient is on, you have to figure out who the intern is that day. But it's all online, and at night the pagers all roll over to the covering intern.

I think the clinical hours are a really important factor...I can't imagine going into my first job with only half of the hours I had. I needed every last one of those clinicals! Especially when you consider that lots of those hours are taken up with things like gero (ie watching your nursing home resident sleep), psych (ie watching folks at the state mental hospital do crafts), and community health (ie driving around the really awful parts of the city trying to find residents to answer your survey questions). Despite me poking fun, I am a huge fan of the Duke program. There are some fantastic faculty members over there...a number of whom I consider my professional role models.

Our rule is check BP/HR 2 minutes after the position change. A 'normal' person will have compensated by this point. Our folks are considered orthostatic with a drop in SBP of 10 or more and an increase in HR of 10 or more.

I work in oncology, with many elderly patients. That said, we normally run our blood over 2 hours. We run all PRBCs on a pump, same with plasma. Sometimes platelets are run straight in, but usually on a pump just for good measure. We stay with the pt for the first 5 minutes, come back and check vitals at 15 minutes, then they're good to go. We generally give 2 units at a time, so sometimes folks will run the first unit in over an hour and 45 minutes, then use the same tubing for the second unit, since tubing is good for 4 hours. Depending on the patient and the IV, I'll sometimes run the saline in at 300 just to get the blood to the patient, then slow it back down to 175 or so.

Very true...it's four years of -nursing- coursework. Minus some little stuff. :) I did do loan repayment. Figured I had no pressing need to go elsewhere...might as well stay at Duke and let them pay me back a little.

I think the most important thing to remember here is that every Pyxis machine is probably programmed a bit differently. So to the original poster, don't look here for exact answers on your Pyxis...ask one of your instructors or a nurse on the floor. Otherwise, you risk getting misinformed!

I was also taught to always give Lovenox in the abdomen, at least 2 inches away from the belly button. My patients have told me that it does indeed hurt like the dickens, but that the pinching trick seems to help a little.

Hi all, I'm pretty new to the forums and to nursing. I went through Duke's accelerated BSN program and now I'm working at Big Duke. Glad to join the rest of y'all in the land of allnurses.com...

Hi Nancy, congrats on getting into UNC! I've lived here in Durham for two years now, and I'm enjoying it. To answer some of your questions...since you'll be commuting to Chapel Hill, I'd recommend southwest Durham. It's got a lot of new stuff going on (like Southpoint mall) and I've found it to be very safe, easy to get around, and it has a good number of newer communities. Check out the Southpoint area for sure. The Hope Valley area is also very nice. It's a bit more of a trek, but Brier Creek is a new community on the west side of Raleigh that is absolutely beautiful, very up-and-coming, and quite popular with the medical set (especially Duke nurses!) I don't know anything about Hillsborough, but Cary is lovely. Definitely the best area around, in my opinion. It might be a bit of a drive to get to Chapel Hill, but as far as family-friendly and safety...Cary takes the cake. I'd love to raise my (theoretical) family there. I'm a nurse at Duke (not in OB, though), and even though I'm a pretty new one, I think it's a great place to work. The girls (and guys!) on my floor are wonderful people who love their jobs (most days!), they've been more than kind to me and willing to answer all my questions, and our manager is close to a saint, I think. They don't pay as much as UNC, but their benefits more than make up for it...plus I'm learning so much being there. The LD unit at Duke is very new, very clean, and gets lots of very high-risk pregnancies...there's a C-section rate that would blow your mind. We did our L&D clinical there. I hear that Durham Regional is the best place to -have- a baby around here, so it may very well be the best place to work, as well. Can't really help you with the specifics, since every floor at Duke seems to do their staffing differently. Best of luck with the housing and job search...feel free to email me if you like!