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harvestmoon RN

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harvestmoon's Latest Activity

  1. harvestmoon

    Transferring WGU Credits

    WGU is around $4K each term (6 months and you can complete as many classes as you want in each term)
  2. harvestmoon

    Time Management

    I misswrote - they don't change 3 times; they change twice. I get 2-3 NAs though.
  3. harvestmoon

    In Search For The Perfect Nursing Job...

    So I'm a new grad at 60 (graduated last year at the start of Covid) and worked C-19 testing/vaccination clinics until I got a job in an ER (go figure), which I thought was going to be my dream job (very small rural ER and you do everything from UC to inpatient). Loved trauma-1 ER I had volunteered at and thought ER was my jam. I'm 5 months into that job and I'm not sure. I've been working 3 months in a stepdown ICU and I really enjoy the bedside. So dunno. I'm keeping both jobs (ER is a 0.3 and SDICU is 0.75) and we'll see how things play out. I probably only have 10 years in this profession though and I'm only planning on 5.
  4. harvestmoon

    Time Management

    I gave NAs assignments at 2000 and I have no idea where they went. I wonder if they were as overwhelmed as we were. I tried at 0700 but the day NA said the night one should have done what I asked him to do and by that time I was so over everything I just did it myself. EXCELLENT idea about asking an NA to source flushes! The NA assignments change 3 times during my shift and I have a really hard time figuring out who is my NA so I'm going to make that a priority going forward. Also I could have Vocera'd the charge. we're supposed to place Vascular access consults daily for the PICC patients and they order the tPa but neither patient had that ordered so I couldn't. I did place consults for both of them and let day charge know though. Techs do not do any V/S past 2000. I know. I don't know why, but that is the way this unit works. They are supposed to do BG checks but I could not find anyone and, again, I do need to make a priority of learning who is my NA (they change 3 times during my shift). Thanks everyone. I've been on the unit only 3 months so I'm really new to this and not sure what is a staffing issue and what is a "me" issue.
  5. harvestmoon

    Nurses Caring for Nondiabetics After an Insulin Injection

    Pretty much all our patients on TPN get insulin. I had a covid patient on massive steroids getting insulin but she was not diabetic. I've only worked for 3 months but that's what's come up so far. so plan was BG q.4 and cover according to protocol. C-19 patient was pretty anxious (and EtOH abuser) so did emotional support and teaching for her. the others (on tpn) are pretty sick and don't really even care about the insulin.
  6. harvestmoon

    Nurses Caring for Nondiabetics After an Insulin Injection

    Pretty much all our patients on TPN get insulin. I had a covid patient on massive steroids getting insulin but she was not diabetic. I've only worked for 3 months but that's what's come up so far.
  7. harvestmoon

    Time Management

    Last night was a *** show and I'm looking for pointers. New grad; licensed for 9 months and 3 months into first real hospital job (step down ICU). I'm also 60 years old (and I wonder if that has anything to do with it). Our unit does V/S q.4, focused q.4, HTT at start of shift (12 hours). NAs do not do any VS other than 2000. I had one patient who had intractable pain - narcs every hour, allergic to everything so had to manage her hives/itching reaction to the narcs with benadryl and other options. she had 3 drains (duodenal, new nonfunctioning jtube, something else and foley). POD2. PSH of several spinal surgeries and her body looked like some congenital stuff (never got a chance to check her history so honestly no clue). she had TPN, lipids, 3 different antibiotics running into a 3-lumen PICC that, by the end of the shift, had only 2 working lumens. thankfully did not have to reposition her. She had an NG and was unable to swallow (not sure of the HX there) so for PO meds I would put them through the NG and turn off suction for an hour and hope they were absorbed. she had BG checks q.4 in addition to pretty much hourly meds/pain meds. Contact precautions and NAs never entered the room except for 2000 V/S. patient 2 had only an ileostomy with crappy lungs. day before I had asked day shift to request CXR and RT/Pulm consult because her lungs sounded super coarse, she had a green sputum and productive cough. intractable pain and meds q.2 hours (oxy and dilaudid) in addition to her other meds. TPN with 3 rate changes during the night. PICC line with 2 good lumens. I think she had abx - don't remember. BG checks q.4 hours. NA did one of the checks. patient 3: New admit from ER for CHF exacerbation, only had her for 8 hours of the shift. non-english speaking but had daughter to translate. She was my easiest once I spent about an hour doing the admit, setup, V/S (only twice as she was there only 8 hours), but then her BP started dumping (high 80s/40s) and I had to spend a good 30-60 minutes focused on that. patient 4: POD2 with wound VAC to RLE, 3 new surgical sites, q.2 hour pulse checks, abx, pain well controlled, little forgetful and confused but stable. this was my 2nd day with him and I had asked day shift the day before for lasix because his LEs were so tight, peeling and discolored I was worried for compartment syndrome (not seriously but dayum they looked awful). he was on heparin and bridging to coumadin so I was chasing his labs and titrating his heparin also. by end of shift we were down to +3 pitting edema (huge improvement from rock hard skin) on surgery leg and +2 in nonsurgical. during the q.2 hour pulse checks (I missed one of them during the night) I had to reposition him and get the surgical leg elevated. patient 5: bariatric POD1 with N/V unable to hold down water, pain, EtOH and drug abuse HX (I found from day shift during report), but really a very stable patient. I was in there more than q.4 hours as I was staggering her meds so she could try to keep some of them down. So, hour one (20-21) I did HTT on 3 patients and got meds up to 2100 passed as I suspected I was going to get another patient and I wanted to be ready if/when that happened. Found out about 15 minutes before tranfer I was getting the ED xfer so I was glad I had planned for another patient. Hour 21-22 passing meds, addressing pain on pax 1 and 2, charting exceptions to HTT, adjusting TPN and replacing all tubing (expired). chlorhexidine baths on the PICC lines. Chart 2 HTTs fully. Check everyone's labs and make sure nothing was crazy. Give insulin like candy. hour 22-23 pretty much dedicated to new admit. hour 23 I got 5th patient. HTT on them and keep running all the meds hours 24-8 I'm bouncing from patient to patient. We had 2 rapids on the unit and everyone was pretty busy. Shift ended at 0730 but day shift as a whole said it seemed like many from night shift were trashed at report. I didn't start charting until 0830 as I was still responding to the uncontrolled pain patients and making TPN changes and trying to give report (we do bedside). There were 6 of us charting from 8-9 and 2 of us from 8-10. So, new grad, I know I'm lousy with time management but I do try to cluster stuff and anticipate *** coming up (I will dump heparin and maintenance fluids in the rooms (after say 0100 or so) so if the alarm goes off and an RN sees it they might hang the new fluid. I keep my tubing labeled and know when it needs to be changed (all TPN, lipids and abx tubing was changed so I make sure I have that *** before I leave the med room). We ran out of 10mL flushes about 5 am so I was chasing my *** on that for the PICC line patients. So, pointers on how I could have structured the night better?
  8. harvestmoon

    Where Do Minneapolis/St Paul Nurses Live?

    I live in south Minneapolis and have biked to work locations from St Paul to brooklyn park to edina and SLP. Minneapolis has great transport options
  9. harvestmoon

    Minneapolis/St Paul VA

    I work at the MSP VA. I would say floor nursing is good but all the clinics (endo, GI, onc, etc.) are kind of little kingdoms and can be incredibly difficult if you don't get along with the NM. I'm floating all around and there are some really good ones and some really not good ones.
  10. harvestmoon

    Transferring WGU Credits

    I got my BSN in December and I'm looking to get a FNP; not that interested in DNP. From what I've found, BSN-FNP has just around 20 more credits compared to MSN-FNP. WGU's BSN-MSN is 36 units so it really doesn;t make sense to me to do WGU. Has anyone else looked into this and does this sound correct?
  11. harvestmoon

    VA hiring process 2020

    If you're on the fast-track system, weeks. If you're not fast-tracked, then forever and a day...
  12. harvestmoon

    permanent VA job after temporary

    I am in the process of credentialing (new grad RN) for a 13-month RN outpatient (I believe) job at the VA hospital in MN. I think I'm going to be working in their respiratory unit but I really don't know. The job title seems to be "care manager"?? At any rate, it is benefit eligible, 13-months (per HR). The person I initially interviewed with seemed to think it would be possible to transfer to a permanent position once the temporary one ended. Has anyone done that and/or have any advice? This will be my first new grad job and I would really prefer to work in the hospital (I'm a NA at a non-VA hospital now) but have no problem working temporary for the VA for 1) RN experience, and 2) increased possibility of getting permanent hire. I would view the temporary job pretty much like a job interview and make contacts anywhere I could.
  13. harvestmoon

    VA vs dialysis

    I'm starting to realize I might be too old to eventually work in the ER but I do enjoy the little of hospital nursing I've been exposed to as an NA (Med Surg). I currently have two offers after months of not even a call back. One is a temporary, 13 month position, with the VA in their acute respiratoy (likely rule out COVID) clinic. It is M-F and the compensation is astounding. The other would be dialysis with Fresenius - outpatient. I've read the dialysis forum and it seems like it really depends on the clinic as to how the culture (10 vs 12 vs 16-hour days) but Fresenius seems to have better safety and management than what I see online with Da Vita. I worry about treating dialysis patients as somewhat assembly line/factory like setting (get them on, run them, get them off, clean, get the next one on, wash, rinse, repeat) but it might be a little more varied? Not sure. Dialysis can't begin to compare with the VA compensation but I'm really in it for the experience, not the $ (I mean, to a point). My concern with both is my ability to be a marketable candidate for hospital work after a year at either job - I would like to eventually work ER or ICU (maybe) or Cardiac.
  14. harvestmoon

    NA vs RN job offers

    So, I"m an old new grad (will be 60 this year) and am contemplating 2 job offers. I have ADN (attending WGU for BSN-expected May next year or earlier). I need to insure a 20, 18, and 24yo in addition to myself and my husband, possibly the 26yo but I think he has dropped off by now (and he lives in another country anyway). PreCOVID this was not a saturated area. Lots of RNs were furloughed in March but weeks to a month ago elective surgeries began up again and people are getting called back. I have heard through the grapevine that there are hundreds of applications for RN jobs now in this area. Job A: is as an NA about 7-10 miles from home (depending on which bike route I take), pay is mid 16s with shift differential on top of that, short stay med-surg and float, previous employer (so I know all the bennies), health insurance for the whole family (current providers), D/N rotating, 0.6. RNs are unionized and can't remember about NAs. Job B: is 82 miles away (one way) brand new medsurg unit, D/E (no nights), 0.5 but first 10-12 weeks are fulltime for orientation, health insurance providers may not cover the area we live in, pay is $35, RNs are not unionized. Parking is reported by HR and NM to be a real pain. Winter is a concern. They have offered $5-10K for relocation but I'm not sure I would do that. I'm actually leaning towards the NA job due to health insurance, ease of commute (Winter is no joke) and hope to wait out job openings closer. But in this climate (so many furloughs), and due to my age, I'm worried if I don't take an acute care opening I may not get the chance again.
  15. today was supposed to be our last day of Spring break. we now have school completely suspended (not just online but no school whatsoever) for 2 weeks. I know all our hospitals where we had been having clinicals have shutdown to both medical and nursing students. we have no idea what is going to happen. we were on track to graduate mid May.
  16. I honestly would either be checking them out (cute or not) and that's about it. I used to be a line cook so I'm very familiar with men in Danskos but honestly they look nothing like "female" shoes to me, but whatevs.