Halinja

A lot of the clinics around here have their nurses full time by having them work 4 9's. That way you still get a day off for those pesky doctor's appts.

I always feel that way in a new job. Just the way I'm built, I guess. But then, it's the same way I feel when I get people's fantasy Christmas letters saying how WONDERFUL their children are, and what a FABULOUS year they had. Take everything with a grain of salt and concentrate on your life not theirs. If you can't relate, you can't relate. Just do what you need to do, be yourself, and it'll all fall into place soon enough.

Compared to San Francisco, Santa Barbara, or LA/Orange county, Modesto has a "low" cost of living. Compared the rest of the united states...not so much. It is in the central valley, and the central valley, especially the lower portion is a pollution trap. The air quality is amongst the worst in the nation from south of sacramento to Bakersfield. There are some nice areas to Modesto. You would be within easy driving distance to things like Sequioa National Park, and just an hour (or two?) to the coast. It would be an easy day trip to go to San Francisco, hang out, and then go home. It is not a pretty area. It is dry, and hot, and dusty. When the wind blows you have the dangers of coccidioidis mycosis (valley fevery), a pernicious fungus that can be inhaled and disseminate system wide. More dangerous to people moving to the area than to people where born and raised in the valley. Hope that helps!

One of the best nurses I know was fired from her first job...as a waitress. Hating to make mistakes is probably a good thing. You're less likely to make them in the first place. That being said...everyone makes mistakes. There are job aids that can help you remember meds, there are people who can help you with time management. You're not going to know if it'll work for you until you try.

I worked L&D. The first few times the actual birth was an emotional thing. And there were times right up until the end where I'd made such a connection with the family that my eyes would get damp at the birth. But you get used to it, mostly. You concentrate on getting the technical parts of the job done. The family is relying on you to help them. So you do. If you ever get to the place where you aren't moved at all by a birth...that would be a sad day. Yes, it's a biological function. But that doesn't mean it isn't still a moving time. You may see hundreds of births, but for your patients this is a once in a lifetime deal. That baby is only born once. I know L&D nurses that have been nurses for many many years who still stop at the end of a day and say, "wow, I helped at an amazing birth today!" So...pontificating aside...go with it. Do your job and do it well, remember there's a difference between sympathy and empathy, but don't cut yourself off from the joy of that moment.

Not exactly what you're looking for, but one of our surgeons wears his scrub pants a bit loose. One day in surgery they fell to the floor. They stayed in a puddle around his ankles until he finished surgery.

For our care plans we always had to have a nursing diagnosis. A nursing diagnosis would address the patients functional condition. So, it would be something like ...impaired mobility. The impaired mobility can be related to the arthroscopy, but the arthroscopy cannot be the principle dx. Are you using a book that gives nanda approved nursing diagnoses? LOL , I've forgotten how to do them, I remember there were three parts to a diagnosis.

I'm sure we all see how it would benefit the patients to save money. Maybe nothing would ever happen and the patients would be happily saving money for years. Let's consider a scenario. Let's say the doc writes it. And for some reason, one or the other actually takes the prescription as written rather than as intended. Or even if the two patients take it as intended. Then lets say an adverse event for either patient, whether or not it was truly related to the medication. The doctor would be sued. Big-time. This would not be a case of an honest error. This would be considered deliberate, no matter that his intentions are to be helpful. Legally he would be wrong. Ethically he would be wrong. Morally he would be wrong. Today on Allnurses there was a post regarding the number of people who take their medications incorrectly. That's with prescriptions written for one patient. With the correct dose on them. And people still make mistakes in taking their meds. There is no way I would do it. And yes, I know what it is like to have very little money, to scrimp and save to get to the end of the month. I would sympathize. But this is a matter of law. The law seldom makes allowances for good intentions. JMHO

I work as an advice/triage nurse in a clinic. We do S-Bar now, though we didn't when I started. Used properly, it is SOOOOO much more effective than the narrative charting/messages we were sending

I found this post kind of ironic. Last week three fresh LPN's were hired at my clinic. Today I was told my RN position had been eliminated. So...I'd say there are still jobs for LPN's.

The one thing I remember from my labor and delivery interview was that a L&D nurse needs to be strong. Able to keep a frightened mother on task, and back a doc down if need be. Work well under pressure. Hmmm...that's about it, but that's probably just my memory going.

Ask yourself if there are any aspects of the job you like. If the people who are criticizing you were not there, if you were on your own, do you like anything about the work? The patients? Also, if you can get through the first two years, your options expand. There are other places, other supervisors, some of which actually have a clue. And sometimes its just the wrong spot altogether. My first job out of school was L&D. I would cry on my way to work, and on my way home. Switched out to a different job and loved it, but what amazed me was the lack of upset stomach! Of course...then I gained 20 pounds. LOL

Another reason I can think of is a visitor going in to the room, not knowing that the patient is in the hospital might think that the patient had passed and be distressed. (depending on the mobility of the pt) When I worked in L&D we had signs like that. It usually meant either the mother was napping, or the mother was so involved in heavy labor that casual visitors were not really wanted.

Have given IV decadron PO. Haven't heard of doing it with Zofran. And of course, it was done with a doctor's order.

Well, no family in either OR or PACU. I prefer PACU. But part of that is I just don't like the thought of wearing a cap and mask ALL DAY. I'm not really fond of some surgeons attitudes either, so I do better in PACU where we seldom see them. Yeah, I know. I'm bad. I have friends who work the OR. They prefer it. Will you miss direct patient care? People who respond to you? Not much patient interactions in the OR.

I think email is fine. In fact, that is how I got my first job out out of nursing school. My first contact with my nurse manager was with an unsolicited email from me to her. I agree that being direct is a good idea. Also, leaving out tentative language in any writing situation is a good idea. I think we're taught (we females anyway) to temper our language, to be tentative. But honestly, it reads much better if you leave out phrases like "fairly certain". Take a stand. It makes you look stronger, and an RN, especially an ER RN, needs to be strong.

I've heard that complaint before in hospice. In fact, I tried hospice for a whopping two months, and decided my license wasn't worth the risks my particular administration pushed. I do know, however, that not all hospice companies are the same. Some are better. That being said, Medicare is reducing its funding for hospice, which is going to mean the hospice companies are going to be pushing even harder. The best one around here has private funding, from several grants and bequests. Their nurses work sane schedules with sane patient loads. Pt safety is of course a huge concern. Your health and welfare is also a priority. Take care of yourself. Do what you need to in order to enjoy your life and stay healthy.

At the surgery center I work at, we push Reglan all the time. I can't remember the last time we had a bad reaction. We don't use Compazine much at all. And I would never administer a drug one way and chart it another. What if something goes wrong? Then people are working off of one assumption, when really it was another. It's your license that's at stake.

Is it legal to discriminate based on pregnancy status? Ooh, had to edit to add this (I'm in an evil frame of mind) You likely would hire another person to mow your lawn. But you might not hire another nurse, just work the other nurses a little harder and longer to make up for it until the nurse returned from leave. Believe me, it happens.

At our junior college you had to be an X-Ray tech before you could take ultrasound. To be an X-ray tech you just had to go through the junior college's x-ray tech program, then pass the national test. But as the others have said, the best way to find out is to go in to a local school and ask.

I distinctly remember that overwhelmed feeling the first day...week...month after being off orientation. Busy L&D, high risk, scarier than all get out, and I kept forgetting things. Needless to say, I was too hard on myself, I hope you can keep from beating yourself up over any oversights. At first you make sure you get the biggies, later you'll get the little details too.

Um...just a thought. Was it a three check month? Last month was, for us. In that case they do not take out benefit payments on the third check.

It was my first couple of weeks on my own in Labor and Delivery and the patient had delivered. The doc wanted the bag of LR swapped out with a bag that had pitocin in it. I knew we wanted it done quickly, to prevent excess bleeding. This was a doc that made me nervous on any given day anyway. So I quickly grabbed the tubing and yanked it out of the nearly full bag of LR...that was still hanging near the patient's head. Sigh. LR showered the head of the bed, a little bit of the patient, and totally soaked me. Luckily, both the patient and the doc thought it was funny. In fact the doc was laughing so hard he almost fell off the stool.

I had a harder time hearing with the dual stethoscope than with my own. If it is hard to hear, it is perfectly acceptable to ask everyone to be quiet. You NEED to be able to hear. And once you pass (you will, I think instructors like to scare students, but usually it all works out fine) get a stethoscope that you can hear with. I spent quite a bit of money in nursing school to get a GOOD 'scope. It was worth it, I didn't have to strain to hear. Good luck!!!

One of the big advantages of Per Diem is being able to say no. It SHOULDN'T be held against you. However...grin...just because it shouldn't, doesn't mean it won't. You say you've got other places that would be interested in you on weekends. So you have the power to say no, and then whatever happens, happens.