libbyjeanne

Considering the placement difference between a port and the distal end of a CL, I highly doubt that you can obtain a CVP from a port.

I was thinking about this the other night. At my hospital, we change the propofol tubing q12, but we only change the tubing to 20% lipids q24. I wonder what the rationale is behind that...

Med surg- 5:1 on nights, 4:1 on days. PCU- 3:1 ICU- 2:1

Usually, hospitals in LV only do new grad programs in the summer. They start in May/June. My advice to any new grad is to make yourself more marketable by that time. Have ACLS, BLS, and PALS. Know the director and/or managers names of the unit you are applying to and check up on the status of your application frequently. I know you guys may be thinking that next summer you will be an "old" new grad, but don't let that discourage you. You are just as good as a "new" new grad that will be graduating this December and this May. Has anyone thought of applying to LPN jobs and offering to work as an RN at an LPN wage? That is what one of my coworkers did. She worked as an RN at an LPN wage for six months at a LTC facility until she scored a new grad job on the floor I worked at. Hang in there! Don't give up!

To be honest with you, further certifications (such as ACLS, PALS) will not be a deal breaker in you getting a job. My advice is for you to just wait and take the class for free.

I work with some nurses that use to work at Kalispell Regional. From what I have heard, the pay is poor and they do not treat their employees well. Kalispell is beautiful, though.

As a new grad, I made $28. Now, nearly two years out, I have switched jobs and make a bit more. You can easily make at least $27.

Maybe the school offers a part-time program?

Oh, sorry. I meant that the Sunrise hospitals all do hair analysis, along with urine. The Valley Health System hospitals do not do hair analysis....just urine.

The Sunrise Hospital system (Sunrise, Southern Hills, and Mountain View Hospitals) all do hair analysis. I know the Valley Health system hospitals do not. Not sure about St. Rose hospitals.

Seven patients on a step down floor? As in a ICU step down?!? Run.

Okay, so about using your stethoscope... How long does it take you to use that stethoscope? I am guessing not very long. If you think about it, did you REALLY not have the time to use your steth and listen to your patients? Or were you so stressed that you just put it off? When I was first starting out on my own (like the first 4 months) I would put the simplest things off until I got "caught up". Then I realized that it takes me longer to put things off rather than to just get it done right then and there while I was there in the room with the patient. Just my

You are not stupid. Being a new grad is a scary thing. I have been on a M/S floor since June and I still ask questions every day. It's only your second day of being on your own! Give yourself time. Learn from your mistakes. You will get the hang of it. Also the other new grad with LVN experience...she has had experience that you have never had. She had been able to develop routines you have never gotten the chance to do, and see things that you haven't had the chance to see. Don't compare yourself to others, because everyone is different and everyone learns differently. Stick with it. It was only your second day.

That is ridiculous! I would do the same thing you are doing...putting in my notice and getting the heck out of there!

Just the other night, I had the same question asked to me. We have a new doctor, and a young one at that. Poor thing is having the hardest time working night shift. I have been blessed with being able to sleep anytime of the day or night, just as long as I am tired. The new doc said, "Once I even get a glimpse of sunlight, my body wants to wake up. So I put my mattress in my closet." How big this closet is, I don't know. But black out curtains do exist, and they work wonderfully. Some doctors are brilliant...just not so much with common sense.

When I was a Nurse Apprentice in NV while going to school, we also had ambubags in every room. I will definently ask our educator about that. I also thought that it was odd that we only had one on the whole unit! It's weird that I don't think about these things until I actually need them. Also, although we have suction equipment in every room, we don't set the suction up in all the rooms; only for seizure precautions, r/o CVA/TIA, and aspiration precaution patients. You know, I was thinking the same thing about my patient. Being a 23 y.o. with all these health issues, mainly because of drug abuse. It really does break my heart. but because of the experience he gave me, I know I will be more prepared from here on out. I was fumbling around like a lunatic. Sheesh.

I have been on a med/surg unit for seven months now. I have seen 2 codes and 1 rapid response in the past, but those patients were not mine. I helped out with one of the codes and the adrenaline rush was amazing. I thought to myself, "Oh yeah, I definently want to do ICU or ER work someday." Well, I told myself that before it happened to my own patient. I arrived to work last night and noticed that there was a code happening in one of the rooms near the nursing station. I sat there sipping my coffee watching the nurses and the doctor work frantically trying to coordinate intubating the patient and doing compressions. I thought to myself, "Wow. They look like they are horrified. I am glad that isn't my patient." I got report and was told that one of my patients was a 23 y.o. male that was admitted 4 days ago for polypharmacy drug overdose and resp. failure. He was in the ICU for two days, and last night was the end of his second day on our floor. He was suppose to be discharged the next day (today) to a methadone rehab. He is an ex-heroin user, and a benzo addict. The nurse gave him 1mg of IV Ativan (for withdrawl) at 1800 and she said, "I think the 1 mg was too much for him because after I gave it, he was dozing off as I was talking to him. Oh and he desats to the low 80's if he isnt on O2." she explained that they had been working on pulmonary toileting and a pulmonologist had been in to see him today. Then I got report on my other pt's, 2 of which I was familiar with and had them the previous night. I started off first by seeing my first patient; a fresh post-op that got up to the floor at 1700, and she has a running Epidural. Did my assessment, documented, and moved on to my next patient...the 23 y.o. male with respiratory issues. I walk into the room, he is laying down and snoring very loudly...and slowly. I walk up to him, calling his name and he is not responding. As I approached him, I thought, "Is he...cyanotic?" I reached down and touched him, still calling his name, and he still wasn't responding. I look and see that he pulled off his nasal cannula and had it bundled up in his hand. Then I look up at the continuous pulse ox (that wasn't beeping) and his HR was 174 and his O2 was 62%. I called a rapid response and froze. "Oh ****!"was all I could yell (thank God it was just me and the unconscious pt in the room or I'm sure there would have been consequences for that). I pulled it together enough to run to the supply room, grab a non-rebreather mask, run back to the room and put it on the pt. I was applying pressure to his nail beds, yelling his name, doing everything I could think of at the time, just so my pt would wake up and talk to me. The ICU nurse came in, along with the RTs, and she immediately did a sternal rub and the pt nearly came out of the bed. A response! Success! Now why didn't I think of that? He was transferred to the ICU and as far as I know, is still alive. Since a code JUST HAPPENED, we had no Ambu bag on our floor since they used it. Also, the day shift nurse neglected to set up the continuous pulse ox correctly...it wasnt plugged into the wall and transmitting data to the computer at the nursing station where our unit secretary can see it. Plus the pulse ox was defective and not beeping when sats drop below 88%. Having a mechanical breakdown like that was infuriating. But walking into my patients room to see him cyanotic and barely breathing was the worst feeling ever. Whew! What a night! and it was only 2000. LOL....

Thanks for the advice! I still have a few months to think about it. "go big or go home"

Hello all! I have a question that I am sure you hear all the time. I have been in Med Surg for almost a year now. Soon, I will be moving to a different state and I have been thinking, maybe it is time that I work with more critical patients. I have learned a lot on Med Surg, but I just feel like I want more sick patients and more focused care. With Med Surg I feel like I am taking care of a bunch of patients, documenting on them, and fixing problems when they arise. My coworkers have pointed out to me, that I seem to be enjoying myself when I have problems arise and my patients need more care than they typically need on M/S. I have always dreamed of being an ICU nurse, but I was too chicken to start out there as a new grad. So here is my question, should I do a step-down ICU floor first? Or try to score a training bid in ICU? Any and all opinions are definently welcomed. Thank you very much.

Well, both UNR and CSN are very good programs. Both have good equipment, intructors, and NCLEX pass rates (although I believe UNR is a smidge higher). I went to CSN just because I was in a situation where I was limited to reside in Las Vegas. I would have loved to attend UNR and get my BSN over with. It all comes down to what degree you want. Do you want to get your masters someday? Then maybe you should just go ahead and get your BSN now? Once your in the program, UNR is shorter because they go through the summer. If your fulltime at CSN, the program is two years since fulltime students do not attend school during the summers. Both are very good schools with very good reputations. Good luck!

Do you have any tattoos? My boyfriend was suddenly diagnosed with Hep C last year and the only thing we can come up with is his tattoos that he first got when he was 16. I am sorry your employer is putting you through all that. My boyfriend was a paramedic and they put him through a bunch of crap too. He sought legal advice and now everything is going quite well for him. Good luck to you!

There is nothing wrong with writing a thank you letter to the DON. That is perfectly acceptable. Just handwriting a thank you note in a nice card sounds good to me. I did that after I interviewed for my current job.

Yes, sometimes there are days where I feel a little "overstretched". But with your second question about my multi-tasking skills kicking in when things get really stressful- During those times I not only use my multitasking skills, but mostly my prioritization skills. I am coming up on my 1 year anniversary, and I still have a long way to go before I am a pro at multitasking and prioritization.

Multitasking is the ability to simultaneously execute multiple tasks. Several things influence your ability to multi-task; Mostly it is your experience. More experienced nurses can walk into their patients room and get everything done in one visit while subconsciously thinking what they need to do with their other patient as soon as they are done. Being able to multitask effeciently takes critical thinking skills. Therefore, you will have the mindset to make better clinical judgement.

I use patient all of the time. I have never used the term, "client". I hate it and will never use it.