IngyRN

So after many years outside of bedside, I have returned and its been 7 LONG months. Its not any easier. I feel more anxious and self doubt than ever. It's quite humbling to have new grads teach me..& I have been a nurse for 10yrs. I feel like such an idiot. I am under contract for x amt of hrs vs 1 year whatever occurs first. However, as much as I want to work overtime to complete the hours prior to the year it makes me super anxious..........any advice on reducing my anxiety?

Is there some kind of formula to determine or estimate how many units required to meet a certain level. for example how many units of prbc will bring up h/h 1 gram. how many units of ffp will lower inr by how many numbers?

When I was in NS-my favorite rotation was L&D. Sometimes I would even stay hours after my clinical was over to stay with the pt ( of course w/the permission of the pt, instructor and RN). Unfortunately, following the advise of my nursing advisor I went into med/surg instead of a job I was offered in post-partum. Now years into my career I am so unhappy. I wonder is it med/surg or nursing. I dont want to give up my career in nursing without attempting L&D. But how can I get into L&D-nobody will even give me a chance.

I never have pt w/PCA. Can somebody please explain settings/terms. IE lockout, basal, etc. thanks so much

Have you contacted your RD (dietician)? They usually have these resources.

I worked as an insurance nurse in the past. Most insurance companies require bedside experience (usually 2-3 yrs). However, it is best to got to their website. Let me know if you have other questions.

This may be a stupid question but I am assuming MONA is for Morphine, O2, Nitro, ASA. Are these the top 4 prioroities or should these be done in this order?

How important is it for the patient w/CP to get ASA stat if pt is on heparin gtt. The patient was nauseous and could only tolerate taking 2 baby asa instead of 2 ( as per protocol)??

I would not say anything until your plans are definite. You don't want to burn bridges. However, be prepared, although your NM may seem nice, she may not like the idea of training and hiring you for only 6months.

I know the usual needle length for IM is 1-1 1/2 inch needle. I was taught in NS to hold skin taut ( ?sp), inject at 90 degree angle, withrdraw to assure no blood return, if no blood return>inject medication. 2 questions> what if you inject and the needle is long enough that part of it is still outside the skin-obviously it is deep in the muscle, but can it be too deep or too close to bone??? When injecting into deltoid, specifically flu vaccine, I see that some actually pinch the skin instead of holding taut-is this a new technique? Thanks

Thanks for the replies. The pt was actually just on Novolog ( apparently I was sleepy when I started the thread-sorry). The patient initially had very high BS despite being on a high dose algorithm (250 to 370's), so they added the prandial dose. After this, the BS were improved ranging 140's to low 200's. I realize Novolog is fast acting- I was afraid he would bottom out with 8 units. For my own knowledge, how do I know when it;s too much insulin and should question the order-are there any resources you can offer. I feel pretty clueless about it all.

For all you diabetes pro;s I had a pt with a fasting BS 123. He was on 6u prandial humalog , along w/novolog algorithym which indicated an additonal 2u of novolog. Novolog is new to me ( I just returned to bedside after 7years) , it seems like 8units is alot for bs 123. However, my preceptor insisted this was the norm and ok to give as long as pt was eating. Could someone enlighten me??

I too worked for an insurance company as a DCP. Although the insurance DCP has the final say re: authorizing rehab LOC and payment, the first line of communication with the patient is the hospital DCP. They are the ones who meet w/pt, discuss dc options based on par facilities, location and appropriate setting. The patients always have a choice where they want to be referred to based on the above. Many times they ask for the hospital DCP for their opinions and make their decsion based on that.

just a thought. is your survey taking account demographics. i only ask because the pay scale varies so differently depending on area of the country. should this be one of your questions?? i am in oh. 1. how long (years) have you been a nurse? 10 years 2. what is your annual gross income? 60-70k 3. have a bsn. 4. how long have you worked for your present employer (seniority)? 1 month 5. on average how many hours do you work weekly? 36 6. do you work during the week, over the weekend, both? both (every 3rd) 7. what is your gender?female

Why is it that PIV's clot off when a running IV completes infusion and is left connected. Like when an IV abx (Vanco in particular) completely infuses but the line is not detached and line line flushed immediately??