HillNPStudent

I had a patient return to see me that I had given a steroid injection to a couple months ago. She returning complaining of dimpling in her gluteal muscle where the injection was administered. I know this is a potential risk of steroid injections, but I have never actually had this happen to a patient before, this was my first. I had used a low dose (40 mg IM) so I was surprised to see this. She denied pain or disability, but concerned about comestic appearance. It was a nickel size area of atrophy. I discussed with her that this always a potential risk but I had never seen it occur before. I referred her to her PCP for further eval and treatment (we are a urgent care center). My concern now is potential liability on my part for this adverse reaction? Anyone have any ideas or advice? Am I liable if she pursued legal action because of this adverse side effect?

Has anyone went from working in the unit back to working a cardiac telemetry unit? The reason I ask is that I am beginning my final year of FNP school this fall. I have been working nightshift in our CCU and while I LOVE the unit, I HATE nightshift! I have been offered a move straight to dayshift in one of our telemetry units. I am tired of nightshift and am seriously considering this move. My question-has anyone here ever went from working the unit back to the floor? I see a ton of posts about the oppositive move-but how is it going back to the floor?

I am an FNP student with two semesters left of school. The majority of my graduate education I have financed with student loans. I would say upon graduation I will have roughly $20,000 to pay back. I work in Kentucky where the state will pay back student loans for nurses and NPs IF you work full-time in an eligible setting. Right now that is no problem-hospitals meet the eligibility criteria. However, upon graduating next year with my NP, I will either have to find a "public or non-profit private entity" or work in an "independent county health district or non-profit independent agency." All this jargon has my head spinning. Basically I know I will have to be selective in my choice of NP jobs IF I want to receive the maximum loan repayment possible. Can anyone tell me what types of jobs would qualify as public or non-profit private entities? The rationale behind this program is to increase the number of nurses in shortage areas. I have already been promised an interview with the director at my current clinical site which is an urgent treatment center for when I graduate. I would love to take it, my only concern is of course, whether this qualifies for loan repayment. My other thought is that maybe it would be worth it to continue working full-time as an RN in order to get my loan paid back before starting work as an NP. Any thoughts or help?? My area utilizes NPs must more now than ever before, the trick will be just finding out which jobs will qualify me for loan repayment.

Oh my! Well I'm SO glad to know others are out there like me! I have seriously considered in the past that maybe I DID have a mental health problem and should go be put on medication. I do believe it's stress from working with so many sick people and dealing with illness and death on a daily basis. It's so hard to not fall into that trap of thinking "what if..." I just don't want to continue always doing this and having it interfere with my daily life. I hate having to always worry about something.....but it really helps knowing other nurses do the same thing.....GREAT thread!

Well let's see...since beginning nursing school years ago I have been self-diagnosed with lymphoma, MI, colon cancer, brain tumor, basically anything that was in the textbooks we discussed in class. If I could find a similar symptom, I had it. Also, whenever I had a patient close to my age I became paranoid of "getting" whatever they "got." Crazy! :icon_roll Now, my husband thinks I'm nuts as does my doctor I'm sure, and my husband never takes any symptoms to heart, he just laughs it off as another "episode." Just the other night a couple nurses in my unit decided to hook themselves up to the heart monitor b/c it was a slow night. Of course I did it too and was worried about my ST segment for ischemia. Normal. BUT...a nurse friend of mine AND myself did find a RBBB on our EKGs of which I will probably have to go see one of our good 'ole cardiologists just to make sure its insignificant....here I go again!

Anyone work with any of these? In both hospitals I have worked I have seen nurses of all ages hooking themselves up to monitors-telemetry, EKGs, pulse-ox, BPs, worried over the smallest things. How common of a practice is this? One nurse I work with now always has a "problem of the month." One month she'll think she's diabetic, the next is CHF. It's absolutely crazy. Wondering if anyone else had these same experiences with nurses?

Yes, I LOVE powerpoint. I am actually using it for this presentation. I have done presentations before and I usually do fine other than the nerves-it's just the dread leading up to it that gets me.

Ok, so in about two weeks I have to do an oral presentation on my research project for one of my MSN FNP classes. Can I say- I HATE ORAL PRESENTATIONS! Does anyone have any good suggestions for how to get through it? It is a fifteen minute deal....my problem is I just get nervous and HATE having everyone sit there and stare at me while I present!

I agree with the other posts...I had two years of experience in med-surg and then critical care before I began my FNP program. I am now in my third semester and just beginning clinicals. One thing I chose to do is to complete the program part-time while continuing to work full-time and gain additional bedside experience. The workload of classes has not been nearly as difficult, my hospital pays my entire tuition for me to go part-time, and once I graduate I'll have close to five years bedside experience as an RN. I now have three semesters of classes left before graduation. :mortarboard: As I began clinicals with an NP at an urgent care clinic this semester, I realize (and am grateful) that I did not jump right in immediately post-graduation and begin this program. My RN experience definitely gives me a knowledge base to pull from when I get in the exam room with the patient and begin getting a history and assessing.

I definitely agree w/ all of the above. The dayshift nurse explained that she tried to get him to speak w/ the nurse manager, but he was so insistent and would not wait. The clerk spoke to me when I asked and then handed him the phone. I should've just not answered when I checked my caller ID and saw it was the unit. My first mistake. Second, I should've informed him that I was off duty and had reported off to a dayshift nurse who would gladly help him out. I should've just refused to get into it with him. Well, lesson learned, next time I will just screen my calls w/ my caller ID and answering machine!

Well, I finally got so tired of trying to unsuccessfully explain to him that he had not given me an order to move the patient, and if that was his idea of an order than he needs to clarify himself better next time if he expects his orders to be communicated effectively. He got my home number by simply asking the unit clerk to look me up and call me for him. When I answered the phone (1st big mistake!) the clerk said "Here, Dr. so and so wants to speak with you) and hands the phone to him. That's what makes me mad. He can pass the buck if he wants but I am not a doc, I am not on call when I go home, I am off work.

Ok, well, it is truly getting on my nerves how SOME physicians can act like the biggest, immature babies! Yesterday I had a patient who had just been extubated, was on a nasal cannula yet would desat quickly to low 70's with any sort of exertion. Our unit was full; her doc called and wanted to know if I felt she could move to the floor. I informed him of my concerns with her oxygen saturations but that she could probably do fine if she were monitored. Well, he NEVER gave any orders, just said ok and hung the phone up quickly. I felt clear that this was NOT an order. I also spoke to our house administration AND the ER nurse of the patient he was wanting to send us and let them all know I did not receive an order and if they were going to be needing to move this patient to please let me know so I could contact the doc again. Well no one was in a hurry for beds apparently because I never heard another word about it. Until this morning when I get home. The doc is making rounds on the floor and wants to know where HIS patient is at that he moved out. Well of course, she's still in the unit. HE calls me at home, demands to know why did not move her. We discuss for five minutes that he never gave me an order, and that we have just had a miscommunication, patient is fine, no harm done, that I also spoke with house and the ER nurse. He is fuming. Finally, after I suck it up and apologize for our miscommunication, he settles down and we are okay. I just don't believe he is that upset over having to walk from one end of the hall to another. Besides, he was in the ER last night and KNEW his new patient had not been moved to the unit. Never questioned why. I cannot believe he called me at home to address this. :angryfire I feel like he knew why I hadn't moved the patient, he just wanted to vent on me. Any thoughts?

Hey Pike! I too am from that area, maybe you are familiar with Belfry? I did not attend Pikeville College, however, moved away to school. I have been a nurse now for a couple years; I started working post-graduation in Lexington on a post open-heart unit and LOVED IT...hubby and I eventually moved and now I am in a 12-bed CCU and working on my MSN as a nurse practitioner. I have learned SO much since graduation and still do every day. You will find that a big part of your learning begins AFTER graduation. The real fun starts now. Just from my own experience, ask tons of questions, my former nursing preceptor once told me the only dumb question is the one never asked. No nurse knows everything. Learn as much as you can from every experience. I have also found that acting confident and competent around your patients, even though you may be shaking in your boots can help ease the patient and family in any stressful situation. Fake it till you make it, basically, when it comes to acting competent and professional. Make sure you take time off for yourself and relax; our job is a stressful one and you will burn out if you don't enjoy yourself every now and then. And finally, remember why you started this career in the first place. You will have to deal with short-staffing, high acuities, stressful situations, etc...etc...etc....but remember you are there for your patient and everything you do should revolve around that. Message me if you want, I'm sure you'll do fine, Lexington has a lot of great hospitals and programs for new grads, you'll love it. Congrats again!!

Well, I have just finished another semester of my FNP program. I now have one full year under my belt! Since I am just going through part-time b/c of working full-time, I have four semesters left. I will be beginning my first clinical rotation this fall and am already feeling the nerves kick in! I am stressing over finding a preceptor and wondering do I really have what it takes? I have called one NP I know to see if I could get in some clinical hours and am waiting on a return call, but other than that I am not very familiar with how to go about finding a preceptor other than just asking around and calling. That's what stresses me. Anyone else deal with this? Also, I guess just the reality that I am finally moving on to actually learning how to practice nursing in the role of an NP, and moving out of the classroom into the clinical setting has set off some nerves and doubts in my mind. Just wondering if anyone else has dealt with this during the course of their education?

I will be graduating in May 2008, with my MSN as a Family Nurse Practitioner. I have already been an RN for two years; am now working in the CCU at our local hospital. I currently have a total of 18,000 combined undergrad and graduate student loan amounts. My estimate and goal is to keep that amount less than 30,000 for me to finish entirely with my MSN/FNP. I am only going to grad school part-time because my hospital pays entirely for six credit hours of tuition with no strings attached. I take out a student loan for the year, the smallest I can afford, then turn in my reimbursement check directly to my loan company once the hospital reimburses my classes. I am also enrolled in a loan repayment program for nurses in my state that pays 20% yearly on the principle, as well as all of the interest. So my actual total I have/will owe in student loans is hard to calculate. I feel the amount is worth the cost because of the many options I'll have as an advanced practice nurse; and with all the repayment options available for nurses, it is very doable. Nursing is such a great field because of the high demand for nurses and the many options you have as an RN, getting a decent paycheck should not be a problem. :)

Ok, well, I've been orienting in CCU for six weeks now; I have three more weeks to go and then I'm off on my own! It has been the best orientation I have ever received as a nurse; I've been out of nursing school since 2004 and will have gotten a full nine weeks of orientation. Is is normal for someone new to the CCU to be a little nervous about going on my own? Although I do have nursing experience and am not a new grad, I still feel at times as though I don't know a thing. I know technically I will have help available through other nurses at all times; but I guess I still have a case of the jitters, those what-if this happens thoughts. I just want to be the best nurse I can be in this unit. On another note, I just purchased a resource book from kathywhite.com, which is AWESOME. Has anyone else used it? It is specific for critical care, and divided up by systems, giving info on assessment, interventions, procedures, drip mixtures and concentrations, and you can even purchase additional inserts for things such as trauma and IABP. Wonderful! And well-worth the money IMO, it is sort of pricey.

Well, I have been in CCU for about a month now, and I LOVE IT! My manager has been wonderful in working around my grad school schedule, and placed me with a great preceptor who is close to my age and loves to orient new CCU nurses. I have been rotated to cath lab for pulling sheaths, respiratory for extra vent management experience, dialysis, and was sent to surgery to watch an open heart. I also have a critical care educator who coordinates all those rotations, and stops in at least once a week to make sure I am satisfied with how my orientation is going. She serves as sort of like a liason between me and my manager, to evaluate my progress and make sure we are both satisfied with how things are going. I definitely have about four more weeks on orientation, which will make a total of about nine weeks orienting, which is great IMHO considering I am not a new grad. I LOVE being able to have more in-depth knowledge about what is going on with my patient, more autonomy, the ability to work more closely with patients and families, and just the challenge in general of learning more and improving my assessment and other nursing skills. It has been a wonderful transition for which I am so thankful I took the plunge and decided to do despite my fears. I wouldn't change a thing........

I had used the Littman Lightweight for many years, from my first semester of nursing school till now. I finally broke down and bought a Littman Master Cardiology from Allheart.com. I am in grad school for my FNP and wanted something more advanced. Although I won't need it presently in the CCU (hopefully), it has an adapter to attach in order to better listen to pediatric patients. I chose it over the Cardiology III simply b/c of ergonomics; I liked the stainless steel outside and the feel of it better. I think it's simply a preference.

I am in Western Kentucky area now, but worked three years in Lexington at Central Baptist and LOVED it! Starting pay was around 19 base rate, with a $4 differential on weekends, around $2.50 for nights. So you could pull 25 on weekend nights, but that was with NO RN experience starting pay. You'd start out higher. It was a great hospital, I worked cardiac with wonderful management. Good luck!

Ok, so the hospital where I work has developed a new policy to help offset the high census during winter. We now have an overflow unit, and the unit I currently work on has to take call on the schedule to help cover this new unit. We had no choice; the nurses MUST be on call and come in if needed in addition to their regularly scheduled 3-12 hour shifts per week. Supposedly all the other units were taking call as well to cover the overflow, but for some reason ours is the only one which reguarly calls its nurses in extra for staffing. We are being paid extra, but sometimes we're called in to take only ONE patient. Although the decreased workload of having one patient is nice, I don't want to work more than my agreed-upon hired hours of 3-12 shifts weekly. Is this common practice in other hospitals? Would this be considered mandatory overtime? What do you think our rights as nurses are in this situation? When I was hired I agreed to work 3 shifts a week, guaranteed, but not more.

Wow! What an awesome post! Thank you for those encouraging words. I will definitely keep those in mind as I start in CCU in two weeks! Thank you!

Thanks for your encouragement. I start in about three weeks. I am really looking forward to it; not quite as nervous now, just anticipation I guess. Good luck to you as well!

Thanks for the reminder. Sometimes it helps ease the anxiety of a new transition by remembering that. I am very excited and looking forward to this new challenge! It will be an adjustment but I am up to the task and can't wait to expand on my nursing skills and knowledge.

Well I totally understand not wanting to sacrifice family time. I am the same way, that's why I was hesitant to make the switch to CCU. But I interviewed and found it will not require any more time away from home than my typical work schedule; 3-12 hour shifts a week. I am looking forward to the challenge; I think it will add a nice kick to my grad school learning, being able to work with new patients, procedures, and meds. Plus it will definitely look nice on my resume as a FNP. Good luck!

I know exactly how you feel. This past August my husband and I moved about 2.5 hours from where we lived; bought our first house! :balloons: I ALSO started my first semester of grad school (FNP program-part-time). We both ALSO began new jobs-I really wanted critical care at the time but nothing was open. Then I met some friends in my NP classes who work CCU; and recently the full-time position opened. Plus my classes have just began, have grad research and advanced pharm. One blessing, though, is that I don't officially move to CCU for another five weeks, have to finish out my schedule. I completely understand the craziness of trying to do everything you're doing. But hang in there; its busy but I really think its worth it. You & your husband will fall into a pattern as things go along, and everything will fall into place. I was nervous about taking on a mortgage too; but I am also working full-time. Could you work PRN to get a higher pay, and maybe get benefits elsewhere? What about benefits through your husband's job? Its a huge step and a scary one to do school and buy a home, plus work, but it is totally worth it! :)