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CVICU, telemetry
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piperknitsRN specializes in CVICU, telemetry.

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  1. piperknitsRN

    Tonight's Boston Med: nurses featured!

    I'm guessing part of so many viewers' perceptions of this nurse's "rudeness" had to do with editing, as many have suggested already. I probably wouldn't have gone as far as she did--I personally find the "tough love" role not my own to take on, especially in the case of a "repeat offender." Rather, I would have said something along the lines of, "Sir, I understand that's important to you, but right now our priority is your health, and you can't go home until you are sober." And after I was done repeating said phrase thirty times in fifteen minutes, I would have shortened it to, "No, I'm sorry, sir, you cannot go home right now,". After another fifteen minutes of intoning that, I would have probably said, "No, sorry, can't." Another fifteen of that, and the answer would have been a very flat, "No." (Only half joking, but it does get very exasperating to say the exact same thing over and over again--sometimes literally for hours, if not your entire 8 to 12 hour shift--to someone who, for whatever reason, does not have rational cognitive skills to process what you are saying and comply with treatment, or failing that, quit making unreasonable demands/repeating themselves ad infinitum, all the while being abusive and combative.) I've taken care of many abusive, combative, non-compliant, intoxicated, demanding patients; I'm sure all of us nurses have. It's challenging--to say the least--to find a balance between delivering competent care through "therapeutic responses and interventions" and wishing you could just let them sign out AMA.
  2. piperknitsRN

    Nurses, Clients and Power

    deleted for duplicate post
  3. piperknitsRN

    Nurses, Clients and Power

    I wish to address the statement made by GEPDAR: "Many nurses do not deal with life or death on a regular basis in a hospital and the ones who do are paid even more, so to pull that card out is not going to work with me." I respectfully disagree with the above. I believe that hospital nursing--and any indeed, any job setting in which a nurse and medical team performs their assigned duties--is by its very nature, concerned with "life and death." One careless mistake or oversight--regardless of inpatient, or outpatient status or level of acuity level--and you could cause irreparable damage or the death of the patient. Also, I am not sure which nurses/specialties you are referring to in your comment regarding pay that is commensurate with acuity level of the patient, but in every hospital setting I've worked in, nurses are typically paid by years of experience, regardless of their specialty or its level of acuity as deemed by the hospital. For example, critical care nurses--whose patients are generally considered of the highest acuity in an inpatient setting--make no more than any other nurse in the hospital. (And, may I add, the perception that ICU's have the "highest level of acuity patients" does not hold true in all cases. I've seen patients just as sick on med-surg/tele floors as those in the ICU, and those nurse who "work on the floor" have much higher ratios, and a very level of high acuity patients to begin with. These patients often decompensate suddenly and quickly due to their disease processes, and require just as much intervention as those in an ICU until they are stabilized or sent to a critical unit. It takes a lot of savvy, knowledge and experience to take on a full floor load and manage a decompensating patient in addition to the rest of the patients you are assigned.) The reality is, almost all nurses in an inpatient setting are dealing with very high acuity level patients, regardless of whether or not these patients present to a critical care unit, ER, or any other area perceived to have the most "critical/unstable" patients; and no one gets paid more than another except in regards to years of experience.
  4. piperknitsRN

    Nurses, Clients and Power

    deleted for multiple posts; please excuse!
  5. piperknitsRN

    Job offers... stuck

    Call Facility A and say you are very interested in the offer but you are waiting on another facility's decision, and ask them how long they are willing to wait for your response. Call Facility B and ask for a time frame in which they anticipate finishing your background check, etc; politely tell them you have a job offer at another facility (you do not have to specify which one) and are trying to plan accordingly. If it seems appropriate, you may wish to let Facility B know the time frame Facility A has given you; the trick is to make it a plain fact without sounding pushy. Simply state the facts politely, i.e., "I understand I am being considered for X position with your organization; however, in the meantime, I have received another job offer, and need to give them notice soon. Is it possible for you to give me a time frame in which you anticipate making a final decision so that I can plan accordingly?" In both phone calls, you do not need to give out any time frame specifics unless you wish to/it becomes necessary. I would not give out hospital names/facility names at all. Human Resources understands that people have multiple job offers, have dealt with this scenario many, many times (it's their bread and butter) and will likely give you appropriate, direct feedback so you can make your decision. This was the advice given to me re: graduate school offers, and I think it works well. It is honest, direct, and courteous and should give you a better idea of which facility you will ultimately choose.
  6. piperknitsRN

    Items You Carry Daily in the Hospital

    I keep it simple, and the number of things I carry around while on the floor has dwindled since I was a student. Since I work in an ICU, most of the supplies are (in theory!) supposed to be stored in the pt room, my scrub pocket invariably contains: -Black ink pen -black sharpie -my nurse "brain" (report sheet) -sometimes alcohol swabs and flushes -rarely, I'll clip my hemostats to the hem of my scrub tops I use my stethoscope, but tend not to wear it around my neck after I'm done with my assessments-it gets caught in the many, many lines connected to the patient. Same with the hemostats, hence, the reason I rarely have them. When I worked tele and we had to measure our rhythm strips, I used to keep a pair of calipers in my pocket. I store a set of extra scrubs and some toiletries in my locker, and some tylenol. Otherwise, just a water bottle and a small snack kept at the nurse's station. You'll learn most nurses "eat on the run" a lot, and I get cranky if I get hypoglycemic.
  7. piperknitsRN

    Why are some nurses so rude to students?

    Katy: You sound like a conscientious student who wants a good clinical experience, and I do not take umbrage at your statement that you feel as if you are there to "take the load off of staff nurses." You are a student, and I believe you mean well; it's hard to be precise and accurate about every single thought expressed on these message boards, and it's wonderful when you are able to help us, and when we have the time to teach. Take heart; I've worked many different units as a traveler and staff, and some units are understaffed and/or have dysfunctional way of coping with stress, to say the least. There are also some days where an otherwise wonderfully patient staff nurse with more-than-capable teaching skills is up-to-her-eyeballs in a rough assignment and, as much as she would like to teach, simply doesn't have as much time as she would like. These factors don't excuse the rudeness you may be encountering, but they do explain why it may be happening. I think the great majority of nurses would love to have time to teach students--heck, we'd love to have enough time to do everything we need to do for the patients and families themselves--but we are often faced with far-from-ideal circumstances, the monkey's wrench of sudden-emergencies, and so forth, as a given part of our regular shift. Try not to get too discouraged. When you graduate and apply for programs, find the strongest clinical-skills emphasized orientation you can find, if you feel you are not getting enough practice in clinicals now. And don't worry about being proficient in every skill when you graduate--that's what orientation and experience will teach you! Trust me when I say this is true ;-). Realize it takes many months, even years, to become proficient as skills, time-management, and integration of the skills you will need to become a competent nurse. No one expects you to do this straight-out-of-the-gate. You are learning--and so are we, every day. Soak up what you can, offer to observe what you can, help with procedures when you can (even if it's not your assigned patient) and talk to you clinical instructor about your feelings about your clinical experience in the most professional way possible. I would frame it something like, "I would like to learn more, and practice more skills; what are ways you suggest I approach nurses to facilitate this?" I would avoid placing blame or negativity on your clinical site unless you've experienced outright verbal abuse or other intolerable conditions--then that definitely needs to be addressed with your CI. Most of us really do want to you learn, and feel badly when we can't teach as much as we'd like. Best wishes to you. Being a nursing student is difficult, but now is a good time to learn to get exposure to the clinical experiences you need to master eventually, while juggling the politics of the floor/staff as delicately and professionally as possible. This is a skill set you will find invaluable when you become a registered nurse! We wish you well!
  8. piperknitsRN

    Done, can anyone relate and share?

    Bless you. Yes, I completely understand where you're coming from. Completely. There have been great suggestions on this board as to how to deal with your burn out, including transitioning to another specialty or going back to school, and/or renewing personal interests, hobbies. Whatever you do decide, and however you proceed--use your support system. The burn out is there, yes. Sometimes, I find ways to psych myself up for work/talk myself into going in; I think of the other nurses, and how understaffed they will be if I don't go in; I think of how many good friends I have made in nursing over the years, and mostly--I think I am lucky to have a paycheck and health benefits in a time of lean economy. If you ever have to absolutely bow-out of a job because you're mental and physical health precludes you from doing a competent job--view that as a strength, rather than a weakness. I struggled with this, and while I worked the better part of a year to re-establish contacts and work up to the career I have now--I salvaged and rebuilt my career, and most importantly, I saved myself. Find your own way, and let the rest of us illuminate your path with warmth and guidance.
  9. piperknitsRN

    Nursing jobs outside of a hospital or LTC

    To Liles: Registered Nurse would probably be your best bet if your goal is to become a travel nurse; there may be some LVN positions out there for travel, I don't know, but my guess is most hospitals--and acute care hospital needs make up the bulk of travel assignments--want RN's. Travel nursing requires a *firm* foundation in the basics. I recommend at least 1-2 years as a staff nurse in whatever specialty you choose if working the floor, and at least 5 if you are an ICU nurse, before you travel. When you work as a travel nurse, you have to "hit the ground running" in 2 days or less of brief, "down-and-dirty" orientation. You will really, really really have to know your basic nursing skills down pat in order to cope with the new-to-you, different charting systems, policies and procedures at the same time you are taking care of patients. It can be extremely frustrating. Charting, policy procedures, paging systems, work-flow etc, will typically vary widely from assignment to assignment, as well staff dynamics--some are more friendly to travelers than others, and some working conditions are... well, let's say, "better" than others in this regard. You will need to be flexible, quick-to-learn, and have a "go-with-the-flow" attitude, and not get caught up in the "we did it this way at my old hospital" mentality. In addition, the extra stress of navigating your way around a new town is another factor to consider when choosing a travel assignment. Most travel agencies will not accept a nurse without 1-2 years experience prior, and some hospitals will not consider a traveler with less than 5 years experience for certain ICU/OR/PACU positions. Also, one must realize that in general, travel nurses are needed "for a reason"--extremely low staffing (and then you've got to wonder why the turn-over and lack of replacements!) being among the top reasons. Also, you are contracted to be a traveler for a certain amount of time (typically 13 weeks) and if, for some reason, it doesn't work out, you are often obligated to reimburse your travel agency for any-and-all costs associated with travel stipends, housing, and even pay. You have to be committed, and you also have to know your limits, and be quite savvy about the market and offers you will receive from travel agencies. Ask around, get info from other travelers, and be cautious when you approach a first assignment, especially. I was a traveler for about 1.5 years before transitioning from telemetry (as a new grad) to ICU. It was an interesting experience, and gave me a good idea of where I did and didn't want to work as a nurse, but my best advice to you is to get a thorough, solid background in your specialty before attempting to take on an assignment. This is not to discourage you from pursuing your dreams. By all means, if this is what you have your heart set on, go for it! But as a nurse who's "been there, done" that, I offer you the perspective for what it's worth to you. Good luck!
  10. piperknitsRN

    cheating at nursing school

    The students have lawyers? Good grief. Whatever happened to accepting responsibility and the subsequent punishment and consequences for your wrong-doing? These students better hope if they ever do wind up with a license to practice nursing, that they continue to have excellent attorneys on retainer for any and all malpractice lawsuits that might come their way. Oy.
  11. piperknitsRN

    Is it anxiety?

    p.s. Another suggestion when you speak to your manager and/or preceptor is to ask for feedback on your performance, "It would be helpful for me to have feedback on my performance in orientation so I can improve my skills." A statement like this shows you are committed to the job, open to constructive feedback, and really want to do the best you can. Oh, and I forgot to mention: try to get sufficient rest and sleep, especially the night before you talk to your manager.
  12. piperknitsRN

    Is it anxiety?

    I think you are taking the right steps, and would suggest you also try to make an appointment with a mental health counselor or EAP to help "talk it out" and devise strategies for you to cope with your stressors. I agree that speaking with a physician would be helpful as well, in case there are other medical issues contributing to your symptoms. Sadly, what you are describing seems to happen to many new grads (and more seasoned nurses as well). The job is very tough and stressful. While you are awaiting your MD appt, etc, I would start to think logically about your symptoms. Do this when you are calm and relaxed; maybe talk it out with your SO or a friend sympathetic to your plight. Some questions that might be helpful during this exercise might be: Do you have specific triggers for these "anxiety attacks"? For example, is there some situation or person at work that is causing you to feel anxious? What makes your symptoms worse? Is there anything that helps alleviate them? How long have you been working there? If you are new and on orientation, it can be extremely overwhelming and I think I am not overstepping my boundaries to say that in one form or another, we've all been where you have been. Get as much ancillary support as you can; you may wish to talk to your preceptor about your fears and anxieties, if you've established rapport with her, and definitely lean on other nurse friends (you'd be surprised how much empathy you'll probably receive!) and use this bulletin board to vent. Also, it goes without saying: eat healthy, get some exercise, spend time with friends and family, and devote some time to hobbies and recreation. Think of times when you've had stress before, and what you did to cope, and try those methods. I would be very careful in how you approach your manager. Try to keep it positive, succinct and brief. Maintain eye contact and be as confident as possible. Perhaps you could try something along the lines of: "Thank you for taking time to speak with me. I enjoy my job and am learning so much. However, I am feeling a significant amount of stress with my transition as a new grad. What do you think are some strategies that would be useful for me to become as successful as possible at my job?" This will help your manager give you feedback, support, and open the way for a dialogue. If your attendance issues come up (and I would not bring them up unless this is a central concern to your manager), I would perhaps say something like, "I apologize for being absent without advance notice; it will not happen again." And then keep your word. Do not go on and on apologizing and making excuses; that should be sufficient. Think about what you are going to say, write it down, and memorize it if you need to. Practice it in front of friends and your significant other. That sounds silly, but it will help cement the words in your brain, and help you to practice your tone and delivery style. Perhaps you are also feeling stress from your partner's lay-off, and this is contributing--but I think I would keep it focused to issues re: your job when speaking to your manager. Please try to take care of yourself, and give yourself a break-- taking two days off will not ruin your career. Let us know how you are doing, and take care!
  13. piperknitsRN

    New RN hating night shift

    I sympathize! I cannot tolerate nights, since I cannot sleep during the day when I have been up all night. I felt exhausted after a night shift, but once my body "caught sight" of daylight, I couldn't sleep properly. And I tried everything under the sun: darkened room, sleeping mask, fans to block out street noise, relaxing music... whatever tips I gleaned from 3rd shifters (and this board!) I made a point of experimenting with. Even with medication, however, I would still wake up after 2-3 hours of sleep and not feel rested, and feel like hell when I got up for a shift. Lke you, I would feel nauseated and what I can only describe as "hung-over"--without the ETOH consumption. My days off were no better--I was constantly sleep deprived, cranky, and "not myself." In addition, I eventually began to become physically ill; not only was I constantly coming down with colds and GI issues, I even broke out in a rash from the stress and strain on my system (no kidding; never happened prior and never since). I firmly believe you either "are" or "aren't" a night shift person. As much as I liked my job (and I do like certain things about night shift better than days!) my circadian rhythm does not allow it (and I spent at least a year working the shift, which should be plenty to "adjust.") I finally had no choice but to listen to what my body was telling me and find a job that allowed me to work day shift (evenings would work, too--just can't stay up past a certain time at night without feeling like crap the next day). It wasn't easy, but I transitioned with agency work and eventually found a per diem job which lead to a part time job on days. Of course, per diem does not offer benefits, and COBRA was spendy, but I did what I had to do. I'm not suggesting you quit your job to find a day shift job (if possible) because that may not work for your present situation--but my feeling when I was at the end of my rope was, "If you can't take care of yourself, how on earth are you supposed to take care of sick people in a hospital? As others have suggested here, I would not hesitate to bring up my concerns with your manager and get on a "wait list" if there is one available, for days. I suggest during this conversation you stress to her that you like your job, want to continue working there, but simply are not physically tolerating nights. I would also speak to a doctor and see what adjunctive treatments/medicines (if you're comfortable with that option) are available to you, and see if that helps. I also would continue to look for day position jobs (you never know). Do you have enough time to take a little "stay-cation"? You sound like you need a little break. I know I felt unable to make clear judgments about my situation when I was that exhausted and sleep-deprived; you may benefit from that as well. In the meantime, try your best to exercise (hard when you feel like crud, I know!) eat healthy foods, get the emotional support you need from family and friends, and try to plan a few social activities to keep what balance you can. You have my full sympathy; I wish I could offer a "magic bullet"--but then we'd all probably want to work nights!
  14. Do not worry about being "behind the curve" or "not finding your niche"--some nurses hit the jackpot straight out of the gate... but honestly, I think most of us end up doing several different specialties before finding one that "clicks." I have been a hospital nurse for 5 years; started out in tele, did travel nursing, and went on to ICU eventually. I am probably happiest in ICU, but it took awhile to find a unit that was a good "fit" for me--both from a specialty point-of-view and from an "environment/culture perspective" (there are some units that are better than others!) As to scheduling and 12s: I do not know if you have been offered a day or night position, but typically, you will orient during days, and then rotate to nights afterward--and it can take a long time (a year or more) to rotate back to days. Have you worked full time night shift before? I could not tolerate nocs; they made me physically ill, and I had no choice for awhile but to work them. I cannot imagine working nights in the state I was in, and raising a family. People do it, but I don't recommend it. Some people love night shift, but you have to know yourself, and your circadian rhythms, and realize that even people that work night shift and wouldn't work any other shift generally had a "breaking in" period--some up to six months. That's a long time to go sleep deprived ;-). Also, please realize your schedule "will not be your own" during orientation, and regardless of which shift you are assigned afterward, scheduling managers vary on their policies for requested scheduling patterns, and as "low-man on the totem pole"--your requests may not be heeded. You also have to think about accrual of sick time, vacation time, etc. It takes quite awhile for that to add up, and as you say, you need to worry not only about your health, but your children's, too. Take into consideration also how you feel about working holidays--how important is it for you to celebrate with your family? Often, you have very little choice in what holidays you work... and you will work some of them, and sometimes not the ones you'd choose. In other words, yes, you may be lucky and get a shift and scheduling pattern that is compatible with your family life--but this is probably not going to happen your first year in hospital nursing. In my experience, as junior staff, you have the least control over your schedule. If you do not need benefits, I would seriously consider why you wish to pursue hospital nursing at this point in your career. While I can understand your eagerness to learn acute care skills, you are just starting out, and trust me, there will be time and opportunity for you to become a hospital nurse. The home health care job sounds like it has the perfect amount of flexibility you require to maintain your family life. Family is important! Hospital nursing, as others have attested to, is extremely difficult, stressful, anxiety-provoking, exhausting, and being a new grad exponentially raises the ante on all of those emotions. The practical reality of hospital nursing is that it will take at least 6 months for your to feel somewhat comfortable in your new role, and at least a year for you to feel proficient. I am not trying to discourage you from becoming a hospital nurse, if that is what you wish to do; only suggest that this is not a decision to be taken lightly, and in today's employment economy, it might be more prudent to hold off on the job offer and commit at a later date rather than "jump in" and have to quit because it isn't working for you or your family. I also think you should not worry about "being too old" to start a hospital nursing career if you wait a couple years--there are plenty of people of all ages who come to the profession and do just fine. Follow your heart and do what seems best for you; my suggestions are only that... just points I've gleaned from my own personal experience in nursing that I think might be relevant to your situation. Let us know what you decide, and congratulations on your new career!
  15. piperknitsRN

    When you have students on the floor...

    "LPN's are not RN's and shouldn't be allowed to pass meds while doing clinicals, either" Perhaps the poster who stated "LPNS are not RNs"(quoted above) and the response (I'm assuming) that followed re: LPN training in regards to meds conflated two separate issues. I assume that LPNs are not practicing under their LPN license while in clinicals--they are RN students and therefore practicing under their clinical instructor's license. During clinical, therefore, just as any other student, they can and should pass meds, while supervised and within the confines of and clinical instructor discretion/school policy. When LPNs are practicing under their own license in a facility at which they are employed, however, they are trained and licensed to give meds per scope-of-practice and facility policy. Just a thought--or perhaps I am stating the obvious ;-).
  16. Hospitals do not generally offer per diem to new grads; it costs a great deal of money and time to train a new grad, and some hospitals even require new grads to sign a contract stating they will be responsible for committing to at least a year of full time employment, with various consequences for choosing not to do so. Overwhelmingly in this post I am hearing you say that you wish to be at home with your children, and that the demands of child-rearing, lack of family in the area to help, and incompatible--or at least less than ideal--scheduling issues with your spouse will not allow you the option of full time employment at present. If this is the case, I would choose the more flexible job (home health care job), continue to study, gain certifications and CEUs, and revisit a hospital job when you have more time to devote to training and, ultimately, a full time job. It sounds as if you already have your plate full, and hospital nursing, 12 hour shifts as a new grad can be overwhelming and very exhausting. Please don't stress yourself out any further if you're feeling "tapped out" even before starting. My advice to you is to revisit "hospital nursing" when you have more flexibility with your schedule and require less time commitment with your children. Hospital jobs will be there in the future, and for now, remember you do have an employment option that sounds like a much better overall fit for your current lifestyle, and invest your time and energy in that specialty (it sounds like you enjoy it--a huge bonus for a new grad!)