Dr. Kate

Over 30 years ago, I had a BA in biology, was in a MA program in History of Religion and needed a salable skill. A nursing program took a chance on me. And, I found that nursing suits me. Is nursing my passion? No, but I am passionate about nursing. The notion that one must be passionate about one's job is a bit misguided. Better you should think about what suits you as a person, what suits your personality, your needs, your plans for the future. If you are thinking that you will work days, Monday through Friday, with every holiday at home with your loved ones, go find something other than nursing. There are already plenty of nurses who have that as their goal. But, if you find that working with all kinds of people, people who behave in ways you can't even imagine, people who most of the time you will see at their worst, and many of whom will not thank you for what you have done for them--come on down, it's not a bad place to build a life.

So you know, within the state of California the public junior colleges are mandated by law to use some form of lottery system. It sounds unfair now but was a response to the perceived unfairness of individual programs setting their own standards. The pre-reqs are pretty much the same, so doing well on those will make the nursing program more understandable if not easier. I usually suggest that students apply to 3 to 5 programs. Be aware that you will be going to clinicals which are usually in the general area of the college you attend. General area is a nebulous thing, I've had students who drove over 30 mile to get to clinical. Not so bad at 0530 but a bear in the afternoon. The distance you have to drive to school and clinical can negatively impact your experience and time management plans. Selecting a school is more than just finding the one you can get into easiest or quickest. Be sure to investigate NCLEX pass rates, ask questions about the program itself, ask about how many students from the last year have gotten jobs, and where did they get those jobs. Good luck!

I really wanted Kathy, but that was taken. The only other screen name I use is what I used to call my dog and I didn't want that for a nursing board. I lack creativity. Some of my relatives call me Kate. When I got my PhD a friend playing off Dr. Quinn Medicine Woman addressed the card Dr. Kate Library Woman. That was more creative than I am so I went with it. This is the only place I use the Dr. and really should change it as I find it a bit pretentious. But procrastination is my best thing . . .

It strikes me that perhaps you could do with some time taking care of people in a setting where you have a bit longer contact with them than you do in the ER. I become concerned when I hear relatively new nurses sound like old veterans. Truth is you haven't seen enough on your own to be that jaded. More likely you have picked up on the reactions of your more experienced coworkers. Reconsider another area, some aspect of critical care can give you the excitement you enjoy and the contact with patients you need to be the nurse you want to be. Just a thought.

You might want to check your state's nurse practice act for the details of what constitutes RN practice. There should also be a board for the LVN/LPN group. There's a lot of hearsay that goes on among nurses regarding what they are and are not responsible for, your nurse practice act will clarify that for you.

Heavenly blue, if perfect eyesight was required we'd never get any new nurses. As long as you can see well enough, somehow, to be safe and are careful, come on down. And welcome aborad, it's a great ride.

Hard to tell. Within both corporations I work for the individual hospitals specify the length of new grad orientation. One has a standardized framework for the didactic, but total length is up to the facility and always negotiable depending on the individual new grad.

Sometime in the late 80s thought was that if we taught patients to give themselves their own insulin and not double check that there was no reason for nurses to double check. Well, times change, things happen (sentinel incidents) and what looked like "old school" practice becomes standard practice again. I have worked places where insulin, heparin, dig, and a few other things were double checked and documented. Here and now, the double check is done but there is no documentation. In Peds, Nsy, NICU they double check all drug calculations. It does make sense. With medication errors being a national patient safety issue, better safe than sorry.

While there is little that you can do to stop physician denying having given a particular order, reading back orders and documenting that you did it is little enough to do to make sure you as the nurse have done all you can to verify the order you took was the one given. I was taught to always read back the orders I took over the phone. I've done it when the doc didn't want to hear the orders again, when I was "too" busy to waste the time reading the orders back, and on rare occasion had a doctor change an order on read back. It's an unfortunate commentary that in my facility we have had errors because a nurse was obviously unclear on what was being said or heard and didn't ask for clarification or spelling. Does it irritate a doc to have to spell something, usually. Does it protect the patient and the nurse, yes. Also, despite evidence to the contrary, docs are made aware of these sorts of rule changes. And, in well run hospitals, they are held to following the JCAHO rules that have made their way into the medical staff bylaws. As much as a lot of what JCAHO requires seems silly or irrelevant, most of the requirements are ther result of a number of adverse events that have in some way put patients at jeopardy.

I truly hate it when nurses treat agency nurses like dirt then have the gall to make them DNS because they didn't do everything dumped on them. I also hate familities that let nurses get away with making an agency nurse a DNS because they don't like them (the nurse stood up for him/herself), he or she has green eyes (they don't say that but it's the only thing you can think of might be the problem), the phase of the moon is such that all agency nurses nust be made DNS. Having said that, you don't want to work at a place where you are treated so shabbily. You don't want to work at a place where the charge nurse does not respect your level of competence and your unwillingness to act outside your level of competence. Be glad you're free of them before they really put you into a situation where something bad could happen.

Go to the library. Ask the friendly librarian for help. To get this information you're going to need to get into some older material, 60s and 70s stuff, maybe older than that. See if you can get a hold of a copy of Thora Kron's The Management of Patient Care, from the 1970s. She does a nice job of describing the various systems of patient care delivery. And not to be too contradictory. While your instructor is right that these are antiquated systems of care delivery, they are very, very efficient means of delivering care when there is shortage of RNs. No one should be too surprised if we start to see these older systems of care delivery "reinvented" and/or reintroduced as the shortage of RNs becomes more acute. Oh, functional nursing involves having a specific nurse who does medications, one for treatments, one for orders/unit management, and some for direct physical care. IMHO, the greatest benefit of team nursing, and probably functional, is that they provide a way for nurses to leanr the skills of supervision while dealing with patient care. I am convinced that the wealth of bad managers we are seeing today are a direct result of no one having leaned supervisory skills at the patient care level. (No one has learned team nursing since somewhere around 1980.) I really think that to manage people you haev to learn the skills, and functional and team nursing helped nurses learn them. But that's just my opinion.

Back in the days when I was wearing a cap, my hair was always short. We had no option about wearing our cap and it had to stay on. The first thing I did was to tell my hairdresser I was going to need to keep a cap on my head. Richard was a genius with short hair and did something--left the top a bit longer I believe. Anyway, I always managed with two bobbie pins--one on either side of the back. I never had the right hair to make a comb work right--on me it slid right through my hair and the cap sailed away. When I started working in critical care, and ended up tangling myself by the cap in our ceiling mounted IV poles, my cap stayed on and I'd be caught by the thing still stuck to my head. I learn quickly, got rid of the cap.

It's been years ago and thigns were sometimes a bit lax in the safety area. In ICU we had fewer TVs than rooms. The TVs were on high stands and went from room to room. The cords were of varying lengths and depending on the room and the patient's visualy acutiy sometimes were stretched a distance and 12-18 inches off the floor. The plastic surgeon was at the head of the bed suturing the patient's face, the TV at the foot of the bed (door end of the room), cord 15 inches off the floor. I scurried in with something, tripped gracefully over the cord, slammed onto the floor elbow first, didn't knock the TV over, and had both the surgeon and the patient asking how I was as I delivered whatever I was bringing into the room and slunk out, pretending I was fine. Mostly embarrassing and beat when I slipped on water and fell on my orifice.

I also work in both a Catholic hospital and a for profit non-religious one. I concur with everything said above. The Catholic hospital where I work was bought 6 years ago by another Catholic system. The difference is the way those two organizations runs things is like night and day. That's a corporate culture thing. The biggest differences I see between the Catholic and the not is in the use of the Chaplain. Chaplains come in for those life altering things that happen in a gentler, less obtrusive, more humane way than do the social workers who do similar things and they tend to be less harried and rushed. The involvement of the ethics committee in care issues is greater in the Catholic hospital. It seems to help to have a defined tradition backing up the ethical decision making. I prefer working at the non-religious hospital because as I have grown older I have become less and less tolerate of hypocrisy. I find I hold the Catholic hospital to a higher standard--I expect them to really do those things they post on the walls about the mission and values of the organization to their employees as well as their patients. (Again a corporate culture thing.)

I agree that referesher courses tend to be focused on adults and that is not what you want to do. However, you have no acute care experience except for school, 10 years ago. It will be a challenge to find someone to hire you into NICU. I go back to the rest of what I said, get out there and talk to recruiters, NICU managers, and the folks in education--they're the ones who do and recommend the hiring. I can only speak for my hospital and neither the recruiter nor the dir. of ed. would pass you on without a more substantive commitment than I read the book and worked on calculations. The dept. manager might be more accommodating. It isn't that I don't think it can be done, it's that it isn't going to be easy. llg is right about the emotional aspects both of NICU itself and being a novice again. I had "romantic" ideas about NICU and went so far as to start an NICU didactic course. I knew I was in the wrong place when the instructor started talking about finding a baby in a puddle of blood equivalent to most of the baby's blood. Far too scary for this adult ICU nurse. I also know about being a novice after being an expert--that can be very, very hard on the self concept. What helps is knowing that you are able to become an expert because you have been one before. One last thing, if working with the sickest of the neonates is your heart's desire get out there and find a way to do it. Life is too short for regrets and wondering about what might have been. Good Luck