majestix

8 weeks minimum - but clinical training period can be extended based on readiness to start. I'm in dialysis by the way.

The evidence was in the visible damage to graft material from various causes: bevel up, bevel down, bevel sideways, and applying pressure too soon when withdrawing. The tearing/holes from the bevel down approach were noticeably smaller than those from the bevel up approach. Also, it was mentioned briefly in one of the training videos. I don't remember the exact phrasing, but the description made me feel surprised that we use the bevel up approach instead. Since I only learned of this today, I obviously have not yet looked up the research. Hence the reason I am asking those who are in this field and likely have way more experience and knowledge of this subject to draw upon.

I just started working in dialysis nursing last week, and today we were learning about venipuncture. Our instructor taught us to puncture with bevel up, pinching the butterfly wings between your fingers (in nursing school I heard multiple opinions about how best to hold a butterfly needle, and am not going to go into it here since I have seen no definitive evidence one way or the other about which is better). But after the practice time with the fake vessels and fake arms, we watched several videos, as well as a powerpoint presentation, and in both the powerpoint and one of the videos, there was substantial evidence to suggest that bevel down insertion does less damage to skin, superficial tissue, and - most importantly - the wall of the graft or fistula. When one of my coworkers asked the instructor why we don't learn bevel down instead, the instructor told us that this is just how we do it here. I was disturbed, because all through nursing school, I had the idea of evidence based practice crammed down my throat. You do things in a certain way because the evidence suggests this is the BEST way, not because this is the way it's always been done. But as a new employee (and even worse a new grad RN) I am hesitant to be too vocal in my stance on this unless I have an overwhelming preponderence of evidence to back me up. So I was wondering what the policies and procedures were elsewhere and whether others had found significant evidence one way or the other.

Sorry - I've been away from my comp for a few days so unable to reply. I'm the OP by the way. I did find a job - not necessarily the one I thought I wanted, but a good position which may have long term potential - I'll have to see how I feel about it after a year or so. Someone wondered if my problems with finding a job might be due to lack of hospitals in my area. I live in Seattle - we have PLENTY of hospitals - my alma mater used eight major ones for clinicals that I know of (not even considering the smaller clinical sites like psych inpatient facilities and nursing homes). We also have a BUNCH of nursing schools. I can think of at least five off the top of my head within the city limits (University of Washington, Seattle University, Seattle Pacific University, Seattle Central Community College, North Seattle Community College - sorry to anyone I forgot), not to mention at least another half dozen within 10-15 minutes of Seattle. The combined websites for these hospitals had literally hundreds of jobs posted. But as someone mentioned, most of them only wanted to hire new grads twice a year. I never worked as a tech, so perhaps that may have had an impact on my hireability, but whenever I was informed that I was not being considered, the reason stated was consistently that they were not hiring new grads at that time.

From what I've heard from some of my new coworkers, other parts of the country are not as bad, since their nursing shortages are so severe that they will take any nurse ASAP. I've just found it somewhat absurd that everyone seems to be aware of the nursing shortage, but the system has so many bottlenecks that they are unable to reverse the trend yet. There are so many people out there who are interested in being nurses, but the system makes it difficult for them to enter it at any rate faster than a trickle.

Unless we change the rules so that any patient can choose the gender of their caregivers for any care in which they might feel uncomfortable with one gender or the other, I think we are being unfair and sexist to say that male nurses should not be allowed in OB/GYN. We allow male doctors to do OB/GYN. And we allow female nurses and doctors to do prostate exams, testicular cancer care, etc.

Dansko Clogs (professional line) - great arch support, thick rubber soles to reduce strain of standing on hard floors, water/heat/chemical resistant, lots of colors to match whatever you want/need. Only downside is they're pretty expensive.

My biggest pet peeve in nursing school was professors who knew less about the topic they were supposed to be teaching than the students. I had more than one who borrowed another professor's power point presentation of a topic from some previous term and tried to teach from it without even looking over it first to make sure they actually knew what they were talking about (even looking up at certain slides and saying, "I have no idea what this slide is about so let's just move on"). How were we expected to learn the stuff when the person teaching it was as clueless about it as we were?

3rd born - no ETOH abuse This is a career change for me though that was inspired by talking with a nursing student while I was in labor with my daughter.

This is my rant. You may or may not agree with it, but I felt the need to express it among people who might understand where I am coming from. I graduated from nursing school in August. I had quite a good GPA and was class vice president. I still wound up applying for over 50 jobs (beginning in late July) before getting an offer in November and starting my first job this week (beginning of December). The problem I faced was that the hospitals only wanted to hire new grads for February and July start dates (about 1 to 1.5 months after the December and June graduations). They wanted to train all the new grads together. So, I repeatedly received replies to my applications like "we are not hiring new grads at this time" or "we have no positions available for new grads - please contact us again at a later date" My frustration with this was extreme. I could not afford to wait until February to start working - that's six months after graduating. What was I supposed to do in the mean time? Knit? And yet, we are still in a nursing shortage where I am - there are dozens of RN jobs posted on each hospital's website. They just all insist that you have at least one year experience as an RN before they will even consider you. But how am I supposed to get experience when nobody wanted to hire me because I was a new grad? This system is flawed. If we want to increase the number of nurses in the system we need to eliminate these bottlenecks. This also goes for admission to nursing schools. There were over 400 applicants for 65 spaces in the nursing class I was in. The college simply couldn't support a larger group at once. This is partly because of the fact that tenure track professor positions are only available to people with doctorate degrees, and until very recently, there were very few doctorate degrees available relating to nursing (there were many that were semi-related such as anatomy or public health). Without the job security and pay raise that tenure track professors receive, there has been little motivation for nurses to become professors (most take a significant pay cut to go into teaching), so there are not enough nursing professors to increase class size to meet demand. The new doctorate of nursing practice degree is the best step that nursing has taken as a profession in a long time since it may ease that bottleneck and make entering the profession of nursing smoother and less stressful.

I would be careful though about switching jobs too soon if this is your first job. I've been warned that if you agreed when hired to stick with your current job for a given period that to leave before that just because you don't like the job is like commiting professional suicide. To a potential employer, someone who jumps ship too soon worries them. Do they want to put the money into training you when they aren'y sure you'll stick around long enough to earn back their investment? I just graduated in August as well, and just started my first job this last Monday. I signed a contract saying I would stay put for at least 12 months, or else would pay them back a pro-rated fee for my training costs. If you have other professional references that are appropriate and really strong, then you can probably get away with it, but if you need your current employer as a professional reference and some facilities require at least 3 professional references), leaving so soon may make it difficult to get a good reference from them. Just thought you should hear the flip side of the coin so you can make an informed decision whichever way.