BrayaRN

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:

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?

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.

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.

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.

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.

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.

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!!

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. :)

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.

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.

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.

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.

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.

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 lady partsl 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.

They need to make sure that you have the prerequisites. I assume that they are incredibly busy at registration time. I am taking NUR 407 currently and had to wait to be cleared last semester to register for it. I wouldn't worry; I am certain that there will be an open spot. In fact, I have not been cleared for NUR 410, yet, but I assume there will be a spot for me.

I am currently in my 3rd semester of this program. I chose it because my credits transferred in nicely and I figured the U of M name couldn't hurt. After this semester I will only have 13 credits to take. I took 9 credits the first semester and worked a 0.7 to 0.8 FTE with no children. The next semester I took 7 credits and had a baby over spring break. This semester I am now working nearly full-time and taking 6 credits. I have gotten A's in all classes but one. NUR 300 is a bunch of busy-work and not like the other non-clinical nursing credits. Most classes focus heavily on the discussion board with around 4 posts required per week. Some have open book exams and usually a group project. It is very manageable. Let me know if you have any specific questions.

Congrats!!!

I agree. There were two main reasons why I chose UM-Flint. #1 is that it accepted my other credits much better than any other program I looked at. MSU looked to be the worst. #2 is that I figured the U of M name could only help me in the future, even though it is not the Ann Arbor campus. If you go to the RN-BSN completion sheet you should see that classes needed for the program. I would up needing one Fine Arts credit and took a very easy music class online. Then I need a 1 credit Nutrition update, and 1 credit Pharmacology update. I was actually able to jump right into the nursing classes first semester. Admissions was simple. I completed an online application and had my transcripts sent. There was one form to be filled out and mailed in by one of your supervisors. I started Fall Semester, but I'm pretty sure they have Spring starts too. Once admitted, you will be given a RN-BSN completion sheet filled in with the classes that you have already met the requirements for. It is pretty easy from there to see what you should sign up for when. There is an advisor for RN-BSN students who is helpful enough. I live in Marquette and chose this program even though NMU has a RN-BSN completion program for around the same price. I decided against it because of #1 and #2 above. I have never been to campus, but may show up for graduation.

I'm in my 3rd of 5 semesters at U-M Flint. I live in the UP, so it is all distance learning. I chose the program because the cost was reasonable, and because my credits from JCC transfered in nicely. I could have completed the program in one more semester, but chose to stretch it out. The program includes two clinical courses: management and community health. I line up the clinicals in my own town. I'll be doing community health next semester with the clinical with home health nursing. The last semester is management, where I pair up with a nurse manager or supervisor for the clinical hours. Pretty much, the preceptor just can't be my immediate boss. I have been happy with the program. This semester I am taking 6 credits and not having any problems keeping up. Let me know if you have any questions.

I was wondering if anyone could offer some insights. I have been an RN for about a year and a half on a Cardiac Floor. We get a lot of pacers, caths, MIs, arrhythmias, and the random medical patient that needs to be on tele. I do a decent job, but have no passion for what I do. I was recently offered, and accepted a part-time position on dayshift. This is the only floor in the hospital that you can get a day shift with only a year's experience, which says a lot. I also interviewed recently for a position in our Level II NICU. There is a nights and variable position available. Anyone that works over there loves it, and the chance of getting on a better shift would take MUCH longer. Word has it, that one of the open positions will be offered to me any day now. I am currently enrolled in an RN-BSN program with an anticipated graduation of December 2010. I then want to go on for my FNP, especially through Frontier. I am cross-trained to our medical and psychiatric units to get more hours and I believe the experience will be beneficial for the FNP. I would probably continue floating to such units regardless of the position I accept. Any words of wisdom???

I am currently in my 3rd semester of classes through U-M Flint. I am very pleased with the program. I could have completed it in 4 part-time semesters, but I decided to stretch it one more semester to not overwhelm myself. Everything is online, with a community health and leadership clinical arranged in your own area. I have already lined up a community health clinical for next semester without any problem even though there is a local RN-BSN program. I find Blackboard to be easy to navigate and getting high marks has not been a problem. I looked into the OU program but my credits would not have transferred in as nicely there. That is definitely something to look into. Most schools have a transfer equivalency site on their web pages.

I'm in Michigan. I believe I waited about a week from the "unofficial" from Pearson until I had a license on the state website. I do not know why it took that long. I agree with the PP, I did not sign RN until I actually had a license number. PS. Congrats!!!

I would say you are doing great. I averaged around 70-75% on most my qBank questions. Being an A student the scores worried me. Then I read that above 65% was considered good. I passed my RN boards with 75 questions in 45 minutes. This was last April.

If it is great, I would list it for sure. I would think like a 3.3 or above. Feel free to mention honors or high honors as well.