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  1. Cinqly

    titrating pressors

    I always titrate in mcg/min or mcg/kg/min. We program our pumps with the concentration (usually 4mg in 250 ml or 8 mg in 250 ml), and set it up so that it can be titrated by mcg. I think this is safer practice because you are sure of how much drug is going in. Some nurses still titrate based on mL, but I find that to be risky since depending on the concentration of the drug the mL can change drastically. Furthermore, it is bad practice to have a policy (official or unofficial) to titrate up or down by "5". Patients can have different sensitivies to a drug, and although when initially starting a drug you may always start levophed at 5 or 10 mcg/min, the titration is usually different for every patient. I've had patients where I wean them by 5 mcg every 15 min, and patients where I had to wean by 0.5 mcg every 2 hours because they were so sensitive to changes. When in doubt, always go with the safest methods. Good luck!
  2. Is the 50/hr just your pay? Meaning are they paying all the extras outside of that rate? Just trying to get a handle on pay etc for future contract negotiations.... :)
  3. Cinqly

    Successful night shift stories...

    I took a job working nights right out of school because it was in the area I wanted (ICU) at the hospital I wanted, with an awesome orientation. I was totally not into it and went into night shift thinking that I was going to transfer to days as soon as the first 6-month probationary period was up. Well, it's going on a a year and I'm still on nights and I LOVE it!!! You get paid more, it is generally more laid back (no administration....plus our night time ast. manager is AWESOME!), only the essential staff is there, and the night crew is simply great. I don't know if it is just where I work or if night crews are generally more laid back, but it really fits with my personality. I work 12 hour shifts (7p-7a), and generally work at least one extra shift per pay period. I like to work them all in a row (M-W or M-Th), I almost ALWAYS have weekends off (our hospital has a dedicated night-weekend staff), and I generally feel like it's a pretty sweet gig. One drawback is that if you switch back to a 'regular' schedule on your days off you feel kinda zombie-like for that first day. But I have learned how to manage my sleep, and don't forget that you can always hang out with your other night shifters!!! Many a time we have gone out after work or planned a night-time get-together that fits our schedule. Just find what works for you! Now, don't get me wrong, it's not all fun and games. There's that time period between 5 and 7 that I like to call the 'Witching Hour' , where the floor nurses go and check on sleeping patients only to find out they are blue in the face and in serious resp/cardiac/etc distress. It can get busy somtimes. Plus you always run the risk of being understaffed and having less staff to back you up when things go bad. The positive aspect of this, though, is that you learn to be creative, resourceful, and think on your feet. I think night shift has taught me all the basic stuff - skills, time management, communication (try calling a MD at 3 am! Your SBAR better be spot on!), but it also teaches you to be thrifty, independent and super resourceful. You have to think twice about what you really need when you would have to call the house supervisor or traipse around the hospital to find it. (I digress......) Anyway, give it a try. I did and loved it. I plan on staying for awhile. You might just love it too!
  4. Cinqly

    Cost of Commute

    I usually fill up the tank every payday (every two weeks) and most of the time the tank is not even empty. Roundtrip to work is 10 miles, 3 times a week. So, 30 miles a week, 120 miles a month roughly calculcates to twelve dollars a month (using my cumulative cost per mile on my car wuich is 0.1 cents- I keep a spreadsheet of every fill-up). Not too bad, but I like to live 15 minutes away from work. A lot of my co-workers live 30 min to an hour away. I don't know how they do it - 12 hour shifts and an hour drive each way. Ay!
  5. My opinion is no because you are already so overwhelmed with school, graduation, NCLEX and trying to find a job in this new economy. You come out with the same qualifications as every other new grad, and a class or certification here and there probably won't make you stand out as much as good interview skills, a good personality and showing a willingness to learn. Focus on that for now. Or focus on trying to get a part-time nursing tech job or CNA job since they may give you an "in" for future employment. Besides, wherever you end up your first employer should pay for all that stuff. Most big hospitals offer those kind of classes for free as part of training and continuing education. Don't waste your time, money or energy now...enjoy your last bit of school while you still have it!
  6. Cinqly

    Wages in middle Tennessee

    Which hospital was that at?
  7. Cinqly

    Who Draws blood from a-lines??

    It may not be rocket science, but it IS nursing responsibility. You are responsible for the patient and those taking care of that patient. Training or not, A-lines, central lines and all other manner of invasive monitoring require more than just simple technical skills. Our hospital allows RN's to do it, period. I will continue to monitor my own. If anyone else does something, well, I document. p.s. Forgive me for re-iterating the previous posters... :-)
  8. Cinqly

    University of South Alabama MSN program

    This thread has been helpful! I'm also starting Spring 2010, although I'm having second thoughts. I'm only taking one class, but it is research and I just DREAD research! I disliked research and statistics in undergrad, and although I made A's it was very tedious. Oh well! Good luck to everyone that is starting!
  9. Cinqly

    Staying late to complete your work

    It's important to remember that even if you do stay late, that it is YOUR license on the line. Yes, you have to take care of your patients. Yes you have to chart. No, you didn't have enough time to chart it all during your shift. But you have to document care that you gave and the required paperwork, or it looks like you didn't do it/were not there. In order to document that care you have to be on the clock. I would NEVER chart on a patient off the clock. How would that look in court? First and foremost you have to protect your licencse and your ability to practice nursing. You can't help patients without that! If management is giving you a hard time I would look at the reasons why. Am I late after every shift? Do I chronically forget to chart certain items? Is it the schedule of events on the units? Is it patient assignments/acuity/nurse-patient ratios? Is there a lack of teamwork on the unit? Am I delegating correctly the the UAP? At the beginning of each shift I look at each patient, develop a plan for the day, and try to stay on top of things as much as possible. I try to chart ASAP, because you never know what might come. I also try to chart in the room (unless it's isolation, and even then I'll sometimes move the computer up and chart standing) - that way if I 'forget' something I am right there with the patient to ask or look. With discharges/admits/transfers/etc if I can't chart right away I keep VERY detailed notes (who I called, when, what happened, new orders, etc) so that I can chart quickly, as well as pass on unfinished orders to the next shift. Teamwork is essential, and although there are a few bad eggs on my unit for the most part people have the attitude of "nursing is a 24/7/365 job; if you can't finish it all in one shift there is always someone coming after you". Oh, and remember that if you work a 36 hour work week you have 4 hours each week to play with. (They take out 30 minutes for lunch if we work 6 or more hours). Managers usually only start to care when you go into OT. Some other things to think about: -Are you delegating tasks appropriately to your UAP or trying to do it all yourself? If you delegate, do the UAP actually do what they are supposed to? -Create your own, personalized brain. Make lots of copies and put them in your bag. Use a different color paper for each patient. I can't tell you how much this helped my organiztion and time management. It saves time because you are not writing from scratch on blank computer paper every am, and it tells me what is important for me to remember each shift. -Don't be afraid to ask for help. -Ask your manager if they can hire/staff a "discharge nurse" that only works on discharge papers in the afternoon. -Remember to breathe. :-)
  10. Cinqly

    Hand sanitizer destorying my hands

    I use this every night before bed!! They also have a sugar scrub that works well to exfoliate too!
  11. Cinqly

    GN's paid more than experienced staff is this typical!

    Employee of the Month at our hospital is a scam. At the end of the month a "favorite" is picked and someone goes around and has people sign slips. And of course night/weekend folks are not in the cool kids club...it sucks. And it is the same with new grads. Next years new grads will come in at the same rate as me after (more like if) I get a yearly raise. And they don't give across-the-board cost-of-living increases...
  12. Cinqly

    Phantom saline in the ICU

    Fluid cart. Charge book. Patient sticker.
  13. I think that as long as you are not buying into a patient's delusion or hallucinations, call them what makes them feel comfortable. Even if she isn't a doctor, how would you prove such? Just another patient. As long as she isn't out at the desk trying to write orders... I had a patient once with a significant other that preferred to be called "baby daddy". He was so proud of his newly-found status as a father that he wanted to be called that. I drew the line at calling the mom of the baby "baby momma" though...
  14. Cinqly

    Memphis Hospitals Starting Pay

    Yes. Call HR and go onto website and apply! Good luck!
  15. Cinqly

    ANP to ACNP?

    Not to get too far off subject, but are you talking about the "Adult/Gerontological Acute Care Nurse Practitioner (GNP/APNP) Curriculum" at U of South AL? Does this allow you to actually take both the ANP and ACNP certification exams? And finally, is the ANP (or GNP? in this case) a more primary care role, and would having this dual certification make you more marketable in both acute and primary care settings? OR would you primarily be looking at hospitalist-NP type roles? Thanks! :spin: