oldnewnurse

Thank you for your reply. We use zinc oxide/bag balm (no dressing) when the buttocks are only reddened. We use Xenaderm cream (again no dressings) when we are at Stage II and Allevyn dressings (no creams) when we are at Stage III. We do OK at healing her up and if we have a good bunch of caregivers we do OK at keeping her healed up. She just hates to be wet all the time, especially when she is up and out of the house. She has a perception that she has an odor and while she is dressed to the nines, has full makeup applied, her hair coiffed (it takes the caregivers about three hours daily to get her ready to go out), a w/c that costs 20grand plus, a fabulous van where she can be changed while on the road and yet she is wet before she gets in the w/c. Of course we use both Depends and Attends (as a source of extra protection inside the Depends and then pull it out a few hours into the day). Barriers and peri care are of course the answer to the breakdown. I just wish there were something I could do to divert the urine. Thanks again.

I am a hospice nurse with a brain ca patient of 25 years survival. She has voluntary movement of her eyes, mouth and fingers on one hand. No voluntary movement elsewhere. She has had a foley for 10+ years and it has leaked continuously, even immediately after changing it, for the past year. I am using a 24fr with a 30cc balloon filled to 40cc. She has a large bladder capacity and without meticulous peri cares, she develops skin breakdown on her buttocks which goes from a small Stage I to a huge Stage III almost overnight from the contact with urine. She had three months of Ditropan which did not appear to make a difference. I have spoken with her oncologist, gynecologist, and urologist. All suggest we remove the foley and allow her to be incontinent as the only option. She refuses. She is up via Hoyer and out of the house almost daily with RTC care-givers. The oncologist says a supra-pubic is not an option and the patient also declines to consider one. I have searched unsuccessfully for a foley >24fr or with a larger balloon to try (is this a bad idea?). Any suggestions would be much appreciated. Thank you. oldnewnurse

Take a look at Wheeling Jesuit's online RN - BSN. Part of their BSN credits overlap into the MSN giving one an incentive to stay at WJU for the MSN. I have a BA. The only prereqs I had to do before jumping into the nursing courses were a statistics course and an ethics course and they were also both online. I have nurses in my online program from Arizona and South Carolina. The cost is $275 credit hour. There is one class where an on-campus visit is required.....but if you are more than 250 miles away you can videotape the required stuff and send it. Everyone has been very easy to deal with.

Hi there, Perhaps I can shed some light on this for you. After a 30 year career in telecommunications I went to nursing school and my first job as an ADN-RN was on an oncology floor in a 352 bed hospital with a 16 bed oncology unit. I stayed there for 18 months and then left to work as a hospice RN where I have been for 6 months while still working an occasional PRN shift at the hospital. Can't say I "love" either job, but I like them both very much for totally different reasons. I keep the PRN hospital job because I am working on my MSN and need an inpatient clinical site. As an RN on the oncology floor, we typically have 7-8 patients each along with a single NA, and a floor secretary. The NA and the secretary cover the whole floor. We do not have a charge nurse, we round with the docs and take off our own orders. Our NM typically is not around and confines her activities to administrative stuff like building the schedule and hollering at her nurses. The hospital has an IV therapy team so we don't have to start or maintain IV's. The IV team hangs and maintains all the chemos and the floor RN's just check them along with the IV team before they are hung. The floor RN's hang all other IV fluids and meds, pass the PO meds, do all dressings. We have an RT team who does all the breathing treatments. We draw our own draws from all central lines, but lab does all the peripheral draws. Most of this is hospital specific and will depend on where you work. As you can guess from the number of years I worked in telecommunications, I am old. In that job I made three times the money as opposed to what I make now, and now I work three times as hard. Floor nursing is not for the weak of body and 18 months there took its toll on mine. In my previous career all my peers/superiors were men and I was SHOCKED at the difference between that and having my peers/superiors be women. That is as much a challenge as the physical demands. I once had a preceptor half my age ask me why in the he!! an old woman like me would want to be a nurse. There have been a few times when I've asked that of myself. However, the potential of impacting a life as opposed to impacting shareholder dividends is quite an opportunity. If there are things you want to ask, please feel free.

Consider broadening your horizons. Most on line programs do not have different in-state/out-of-state tuition rates and welcome participants from states other than their own. I live in Ohio, and considered several RN to MSN programs settling on Wheeling Jesuit University. There are students in one of my on-line classes from N. Carolina as well as Colorado. I really liked the Indiana Wesleyan on-line program better, eventhough it was RN-BSN and then BSN-MSN. And why I chose Jesuit over it (it was a lot cheaper than Jesuit) was because it required a year of nursing experience before you could begin and Jesuit did not. In reality, doing the two components separately would have been just the same amount of time as the RN-MSN program. I think RN-MSN just looks faster to those of us who have little time (I am almost 60 and a second career RN.) Good luck with whichever you choose.

I have two hospice patients with new trachs, one for esophageal and the other for bronchial ca. Both have Passy Muir speaking valves, one sounds just like he did pre-op and the other sounds as if he is just belching and is extremely difficult to understand. These are my first two trach patients. I can't put the physiology together to understand why their abilities are so different. (The bronchial guy is the better speaker) The second part of my question involves O2 via n/c. If there is an interruption in the airway as in a trach, how does the n/c get air to the lungs? The third part is just a personal aside. The one with the better speaking ability is a smoker who inserts the lighted end of a cigarette into the stoma while the n/c is in place. During my 90 minute visit (the first post-trach) he smoked two full packs despite my teaching (which he has heard and which has been well documented a million times) and my pleas that he not smoke due to my personal disdain for smoking. As is obvious, he isn't going to quit for himself or for me. (Family issues are yet another aside you can of course figure out). Would you suppose I can professionally, morally, and personally refuse to see this patient? While there have always been a plethora of warnings about O2 and smoking as it aids combustion, do you professionals have the same position on the danger inherent in mixing lighted cigarettes and O2 as we have always been educated? Thank you for the information.

I also would encourage you. But even more I would envy you. The opportunity to work at a place like Vanderbilt (MD Anderson or St. Jude's is my idea of a dream place to work oncology) just seems too wonderful to pass up. I work on an 20 bed oncology unit in a community based hospital. We send our BMT's out. We do no peds oncology and we just sent out two mantle cell lymphomas this week to a large metropolitan facility. I love oncology (have never done anything else) and hope I am never forced to look for a job in another speciality. The only down side I can see for you as a new nurse is that you may love it so much that you will not want to leave to try another speciality. I do not remember the last patient/family I had who wasn't overwhelmed with the level of care and support our unit provided. If you are in nursing to make a difference, you can't go wrong in oncology. Good luck with your decision.

The report I have to give on my one and only naso-pharangyal patient is not ultimately very good, even though it initially appeared to be. I'll give you the option of PM'ng me if you want to hear the story rather than forcing you to read it here in a post should you not want to read negative stuff. Either way, I will include your BIL in my prayers. agtwnki

I'm working on my MSN (nursing education) at Wheeling Jesuit University. It's all on-line. Six credit hours a semester is all I can do with working. As suni said, (and also in my case) there is no financial incentive to this. I will actually take a loss when I leave the hospital with my MSN in hand. The difference is that I am getting tooooo old to pound the floors and need to have something else waiting in the wings.

I had my first THR in 1997 and the other in 2000. Currently age 57 working full time on an Oncology floor. Have never had one iota of trouble with the hips on the job other than being unable to run. I take no pain meds. Actually I had more trouble recovering from a torn meniscus repair than I did from either THR! My job is a little different from yours, however, as I can avoid some positions that you would be forced to use. I know I cannot bend to lift someone off the floor, for example. And if I get down on the floor (as in checking chest tube chambers, I do not make a pretty sight getting up, but it doesn't hurt. Those are the only limitations I can think of at the moment and as I said, I can pretty much avoid the one. Feel free to PM me if I can help you.

The 2 day biotherapy course was also a requirement of my Oncology department. But....my hospital arranged it for me through the ONS. One of our NM's is certified by ONS to teach and she did the two day class. The manual is really good and I learned a lot.

The 2 day biotherapy course was also a requirement of my Oncology department. But....my hospital arranged it for me through the ONS. One of our NM's is certified by ONS to teach and she did the two day class. The manual is really good and I learned a lot.

In the hospital where I currently work (350+ bed acute), midwest, new RN's are started only on days. Starting rate is $15.85/hr and the rate is the same with or without taking their benefits. The thought as far as starting on days is that there is always enough staff/support personnel around to help a new nurse out of a jam. It takes about 5 years before you can even ask to be considered for full time nights. Now, saying that, a new nurse still gets scheduled about four night shifts a month, they just aren't together. So maybe where you are it isn't so bad?

I work oncology and have not encountered this before. We have an end stage non-small cell lung ca patient with a cardiac hx and an implanted pacer with an AED. Medtronic is the brand. Today we made him a DNR. I asked the doc what about the defibrillator in the pacer should the man arrest. He told me to call Medtronic. I did. The company rep said they cannot come into the hospital and reprogram the pacer to deactivate the AED. What can anyone tell me about this? Thanks

30+ years with various generations of Ma Bell, retired to be a farmer. Loved all the tractors and the dirt and even the work, hated being with my husband 24x7. That was way too much togetherness after 30 years of traveling all over the country with my job. Went back and got my ADN and passed NCLEX in 2004. (My original BA was from 1972!) Had several months of chemo/radiation for breast ca and started working in March, 2005, full time, at the bedside at age 57.