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Cardiac, NICU, ED
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BrayaRN has 2 years experience and specializes in Cardiac, NICU, ED.

BrayaRN's Latest Activity

  1. BrayaRN

    Floor nurse to ER nurse. Help please!

    Thank you everyone for your constructive feedback. To clarify: I certainly am seeing my patients more than every 4 hours, or 2 for the Level IIs. In fact, like I previously posted, sometimes I spend to much time. My initial assessment is always on time and the most thorough. Everytime I enter a room, I am reassessing just not necessarily charting at the time. My problem is being late with the charting, even though the assessing was certainly occurring on time. I have yet to understand why there needs to be people who lay into you especially for an innocent post. I do not post frequently on this site. However, when I do it is always where I feel I have knowledge that would be especially beneficial. I answer the question that is asked to the best of my ability. I have never entered on in a post to belittle somebody or start some kind of war of words. I believe my initial post was asking about improving my skills in the ER. I would assume that posts that would follow would answer that initial question. Sure I could get on my high-horse and judge somebody not asking for it just to "improve" my self-esteem and to create some drama. Thankfully, I have better things to do than hide behind a computer screen and make negative comments about people who actually exist behind these screens and come here for advice. I would ask: A physician is able to determine the patient is faking a seizure in front of him. However, I am to believe it, because heck it's the right thing to do. How about the fact that the patient was in fact being treated as a seizure patient until the physician determined otherwise. A gentleman comes in with a sore wrist. The physician orders some ice and an x-ray. The x-ray shows nothing. Computer records, however, show that this patient has travelled to at least 8 other ERs in the vicinity in the last month with the same complaint. During this month he has received Lortab prescriptions on nearly every visit. Sometimes filling a bottle of 6 one night and going back to fill another bottle of 20 the next night. So clearly this patient is not faking pain, this time it is true, and I had better advocate for this patient to make sure that he has another 20 Lortabs to hold him over in case he already used up his other 100? How about the patient faking somnolence? Hmmm.... nothing is found in the blood work and she is stable to go home. She will not wake up. Then ammonia is held under her nose by my preceptor. Not only does she wake up, but she walks out the door and even apologizes on her way out. :uhoh3::uhoh3::uhoh3::uhoh3::uhoh3:
  2. Hi everyone, I am completely new (8 weeks into orientation) to ER nursing. My previous experience is mostly cardiac/telemetry. I also did a short stint on a general medical floor and in a NICU. I see many of the threads on this particular board are devoted to new grads. I have been a nurse for a little under 3 years, so I am not a new grad but still a fairly new nurse. I am curious as to what experienced ER nurses to see as floor nursing habits and how to break them as well. My typical floor patient load was 4 patients and this is the typical assignment in my new job. My difficulties appear to be: Getting too attached to the one patient that is respectful and actually sick. I tend to dote on them more and meet their needs probably more than I actually have time for. Yet, I find the care part fulfilling. Not getting assertive enough with the "faking" patients. These include fake seizures, fake pain, and the patient that fakes somnolence as well. I do have a quiter temperament, but I think my whole 100lbs holds me back as well. Not being anywhere close to organized. Assessments are due at different times on all patients. I can look and see a patient is not due for 2 hours, but when I think about it again 4 hours have passed and I have to backdate. Any suggestions or other things to watch out for?
  3. BrayaRN

    Charlottte hospitals w/ on site daycare

    I work for a Novant Health facility but not the main campus. However, I looked it up one time on our intranet (can't do it from home) and I remember thinking that the hours perfectly coincided with RN dayshift hours. I can't verify this, but I believe the hours were 6am-8pm. There is also daycare services for sick kids as well.
  4. BrayaRN

    Vacuum Assisted Delivery... ugh.

    I definitely agree with the OP. I was very anti-medicalized birth. However, as a nurse I did feel safety in delivering in the hospital. I did, however, arm myself with a CNM and doula to try for a "natural" un-medicalized birth. For the most part, I got what I wished for. Unfortunately, my 8# son decided he wanted to be delivered with his hand alongside his head. Not only did this cause a larger presenting part, but when finally "free" his hand slapped back and gave me a 4th degree laceration. I do remember the pain involved and it was terrible. The lidocaine was not giving much relief. They decided to establish IV access and administer a healthy dose of Stadol. Unfortunately, this Stadol essentially made me crazy. I could not focus my eyes to see my new son, I became extremely irritable, bordering on hysterical. I was swearing, couldn't appreciate the passage of time, and became extremely PO'd that I was not seeing my son. But then when he was brought to me, I could not focus on his face and became even more hysterical. My first BF attempt was far from magical (at least I don't think since I barely remember it). He was delivered at 0200 and repairs continued until 0400. We had saved his gender for a surprise, but there didn't end up much fun in that at the time. Then I was too "drunk" to even choose a name. I sent him to the nursery and just told them to reintroduce him to me in the morning. After trying so hard for a natural and bonding birth, I feel I was robbed by the medication that was administered. On the same note, though, I do not anticipate I could have handled the repairs without additional analgesic. I think the major problem was that an agonist/antagonist was chosen for the medication, which is known to have a more "drunk-like" side effect. I had been anti-epidural for my birth, but looking back, that would have saved me from the hysteria that followed IV administration of Stadol. I will think long and hard about it next time. So, I guess that is a different take on the situation.
  5. BrayaRN

    New Grad Jobs in Charlotte

    I moved to NC just his April. Thankfully, I had 2 years of RN experience behind me. I would say that I applied for around 15 CMC jobs and never even received an interview. They also took forever updating the application to "not hired." I would say for you to focus on Presbyterian and its affiliates and also Gaston Memorial. I actually ended up with 2 interviews at Presbyterian and one at Gaston. I was offered one and took it without looking back. My neighbor searched around for a long time as a new grad and eventually was hired at Forsyth. We are both making over 30 mile commutes each way. However, the ticket is just to get hired within an organization. It is much easier to then move about. Anyway, good luck.
  6. BrayaRN

    What do you do as a Psych NP?

    I am not a psych NP but did consider that route and did some research. From what I understand, psych NPs only account for 1% of APNs. They are also at or near the top for pay (around $90K). The job outlook is supposed to be great since there are so few trained psych NPs. I would agree that family PMHNP would probably make you the most marketable.
  7. BrayaRN

    NP dual curriculum

    I am currently attending University of Michigan - Flint for BSN completion. I have looked into continuing on with the school for APN training. They just recently started a DNP program and phased out the MSN. I believe all of their specialties are online/distance learning. Unless something has changed, I am pretty sure that they only offer the adult PMHNP along with ANP. I believe it is a 4 year, 81 credit DNP. Once finished with the degree you are eligible to sit for both boards.
  8. BrayaRN

    No prenatal care?!

    I can understand your frustration or confusion. I was a NICU nurse until very recently and would ponder such questions too frequently. I do believe that the decision to not receive prenatal care can be based upon values, beliefs, and a lack of knowledge of resources. However, in the same sense, (and of course these were all NICU admits) nearly all these infants were experiencing withdrawal. I believe that most of these infants had mec screens just because of the likelihood of drug abuse.
  9. My husband and I just relocated to the Charlotte area a month ago. I am currently looking for a NICU position in the area so I have done a bit of research. All of this has just been through my computer, I do not have first-hand knowledge. The Charlotte area has two major hospital systems: Carolinas Medical Center and Presbyterian. Both have very large main hospitals in Charlotte including children's hospitals, and then also have smaller hospitals they run in Charlotte and neighboring cities. Both the downtown Children's Hospitals have Level IV NICUs, CMCs is around 50 bed and Presbyterian's is around 30 beds. Northeast in Concord also has a Level IV I believe. Many of the community hospitals including CMC-University, Gaston Memorial Hospital, and CMC-Pineville have Level IIIs. However, I do not know the level of III. I do not know about the other areas so hopefully others will chime in. However, I am fairly certain that Brenner's Children's in Winston-Salem has a IV and I would assume that Duke University in Durham would as well. Good luck in your search. The job market in NC is tight just like everywhere else!!
  10. BrayaRN

    Relocating to Charlotte

    I have recently relocated to the Charlotte area. I am an RN with two years experience. The interview I went on today gave me a base rate of about $22/hr with $5 differential for nights. It sounds like that is pretty average for the area. As for NICUs both Presbyterian and Carolinas Medical Center have Level IV NICUs, some of the smaller hospitals outside of Charlotte have Level III. I hope someone else can chime in to help. :)
  11. BrayaRN

    What kind of scrubs do you wear?

    Our hospital has a mandated color for RNs to wear. It is galaxy blue, which is not that easy to find. On top of that, we also have the large red RN letters to wear below our badge. The aides and LPNs are free to wear what they want. The NICU is a slightly different story, though. We change into hospital provided scrubs when we get to work. They are a generic blue color. There is no distinction between LPNs and RNs by color. We also wear a fabric yellow gown over our scrubs when holding a baby. I have never liked the "kid-friendly" prints when working adult floors. They seem improper for that age-range. However, I do think that they are great for NICU/pediatric floors. I would love to have the opportunity to wear them.
  12. BrayaRN

    Info on CMC and Presbyterian

    Thanks for the replies. I'm currently working on getting my license endorsed in NC. I think it would be kind of pointless to apply for jobs prior to having a North Carolina license. We'll financially be alright for at least 6 months for me to find a job. It does seem that the new grads are the one's particularly having a hard time right now, though.
  13. Hi, My husband and I may be moving to NC in April for his new job. The company is located in Mooresville. I am an RN with 2 years experience (telemetry and NICU) and will probably look into applying to the two hospitals after the move. I am currently in Michigan working at a 335 bed, unionized hospital, making about $22/hr. I was hoping I could gather more information on the two major health systems. They both look like they have similar sized hospitals and similar specialties. I guess what I am wonder the most would be: pay, shift differentials, pay for per diem nurses, parking, on site daycare, benefits, how the hiring process is, and most importantly how happy the nurses are. I did see that Presby is Magnet, but I've also heard that it doesn't mean a darn thing. I do know that nurses are having trouble finding jobs and I do know it may take a while. Thankfully, my income is mostly supplemental so we'll be able to relocate on his job alone.
  14. BrayaRN

    Question for U of M Flint RN to BSN Students

    I just finished my 3rd semester in this program. From what I understand, the clinical credits you will receive from you previous program will actually be given as UM-Flint credits. No need to take extra unneeded classes to get the 45 credits.
  15. BrayaRN

    Low Census

    Our NICU is usually staffed for 8 babies. We have been having anywhere from 14 to 21 for the last two months at least. The overtime has been getting excessive. Where we used to have a few methadone babies a year, we have been having 5 at a time. So definitely no low census in my neck of the woods.
  16. BrayaRN

    RN duties in the NICU

    Hi, I am just finishing up my second week of orientation in our level IIIB NICU. Prior to this postion, I worked as an RN on a cardiac/telemetry floor. I am really enjoying the new position already and am amazed at the scope of practice for the RNs. I was wondering if this is common in other NICUs. A NICU RN attends every C-Section whether scheduled or emergent to be the baby's provider until deemed stable. A NICU RN attends any vaginal delivery that requires assistance or there is meconium present. Two RNs and one RRT go on neonatal transports with the nearest hospital being fifteen minutes away and the furthest nearly four. Seasoned RNs are trained in intubation, PICC lines, and UVCs and UVAs, and may be required to do them either on transport, on the unit, or post-delivery. After leaving a unit where I had to call a physician for Tylenol, I am amazed by the autonomy. Of course, there is much training before an RN performs any of these skills without assistance. I am wondering if this is the norm. Thanks.