nightyngale

We are taught to think critically as RNs, right? I was in a meeting yesterday regarding pain management on our orthopedic unit. We've been internally audited and found to be praciticing out of our scope of practice...such as pre-medicating a pt with a knee replacement prior to their therapy session when orders say to medicate for 4-6/10 or 7-10/10. If we are pre-medicating when the patient has no pain, then we are making a medical judgement and not a nursing judgement...even though we KNOW that the patient will be in excruciating pain during PT if we don't medicate. (The auditor was clear in saying we shouldn't change our practice, just that docs need to include an order for premedicating in their preprinted order sets.) ANYWHO - a question that was raised was if a patient is complaining of severe (9/10) pain, which calls for two Norcos, but the nurse assesses the patient and sees that they are utterly snowed from too much pain medication or anesthesia, have a low respiratory rate etc, and gives less than ordered. The auditor stated that if we don't give the prescribed pain medication (2 tabs) then we are undermedicating and making a medical judgement. WHAT?!?!? I thought that was critically thinking! If we did as "ordered" then we'd be calling a Rapid Response team, the doc, pushing narcan, etc... I was shocked! Do anyone know of any literature that supports the auditor's claim? This is the same idea as not giving Lisinopril if the pt's SBP is less than 120 or 100...the RN knows not to give it even if there's an order for it. That's why we take pharmacology in nursing school! Sorry if this is confusing...I'd love to know your thoughts!

I work on a very busy strictly ortho unit. For all of our surgeries, it depends on the doc. We have a couple of docs who order the incisions to be OTA starting POD2. But for most of the docs, they do the first dressing change on POD2, then we do it daily and prn. TKAs consist of gauze 4x4s, then kerlix wrapped around the knee and paper tape. Hips are generally 4x4s and maybe an abd with paper tape. Backs and cervicals are 4x4s and maybe an adhesive abd with paper tape. I work nights so we generally don't do the dressing changes, but they are very simple and none of them are need to be "sterile." We do clean the adhesive sites with alcohol swabs, then the immediate margins and staples with betadine swabs. Hope this helps!

I'm a new grad of 2 months and got my job by attending a senior nursing student open house. I went on a unit tour and made a point to connect with the nurse manager of one of the units. I e-mailed this manager every other month until I passed boards. (About 8 months) When it came time to find a job, I was hired by this same nurse manager over other applicants. My suggestion would be to attend any and all open houses you can find at the hospitals. Contact local nursing programs and see when they are having job fairs. Get your name and resume out there. Volunteer if you need to. Find local community outreach programs to volunteer with. Things like fundraising walks/runs, civic center education drives, health awareness, etc... These all look great on a resume. Good luck!

I was surprised to learn how competitve and petty instructors and students are. Some people are super nit-picky and others could care less. I love the instructors who say, "You know what, you'll NEVER do this as a nurse (ie. care plans), so once I know that you know how to do it, you don't have to do anymore." Or those who say, "nurses don't do pre-clinical the night before they go to work (thank goodness!), so, I don't want you to get used to that. I'll assign you your patients in the morning...":yeah:

I'd have to agree that LA is NOT a pedestrian friendly city. It's impossible to go anywhere without a car...you'd be very, very limited. And the bus system is trying...and not very successful. San Diego is absolutely gorgeous, but again, I don't think it's that pedestrian friendly. If you were content to live your whole life within 10 city blocks, maybe. I personally love to travel to the beach, the mountains, and such. I wouldn't be able to without some really nice friends or my car. Good luck!

Ah yes, chewing gum. I personally love to chew mint gum because I think it is a favor to my patients. After downing a quick cup of coffee or a cheese stick, I can get nasty breath. A breath mint or a quick brush just doesn't cut it. I've talked with some nurses who have the worst breath I've ever smelled. And when we bend over patients while auscultating or adjusting linens, many patients have no choice but to smell it. I think a small piece of gum, discretely chewed, is more professional than awful halitosis. What do the rest of you think?

I LOVE Costco!!! :-) I buy pretty much everything there... I'm known for bringing Lean Ole burritos - I love those things. They come in Chicken or Steak, and are full of rice and beans. Very yummy and cheap. I also bring snack cups of fruit (I finally gave in to the pre-packaged stuff), baby-bel cheese, and some kind of carb, like triscuits, wheat thins, baked chips, or something like that. I down coffee and a bagel on the way to the hospital and drink 1 can of soda while there. I grab a drink of water whenever I can throughout the day. Not exactly the healthiest thing on the planet, but better than the congealed food in the warmers in the caf.

Ugh, I can relate. I'm a super light sleeper. As much as I hate moving, it would stink to move and then have to move again. But since you don't like where you are, you could always move to the new place and immediately put your name on the waiting list so that if a quieter unit opens up in the same complex, you can move to it. Then you won't have to hire another moving truck since you'd only be moving within the same complex. And if the corner unit turns out to be ok, then you can always take your name off the wait list. Who knows, maybe the corner unit is the quietest! Sometimes they double pane windows and use extra insulation in the walls of outer units because it's noisier...so inside the unit tends to be quieter because of all the extra precautions. This happened with one place I lived! Good luck!

I graduated in '05 with a BA with subsidized Stafford Loans. I begin an Entry-Level Masters program in 2 weeks. I applied for the graduate Stafford loan and got a bunch of aid - both subsidized and unsubsized. It's more than I need so I'm only taking the subsidized loans as I don't want to pay interest through school. There are other nursing scholarships out there to help too, but you have to be willing to hunt them down and write the essays for them. Good luck!

Aspiring in Cali. I grew up in the RP, speak Tagalog but am not a Filipino. My parents still live and work there. I too have a BA and wanted to go back to school for nursing. I thought about going back to the RP and living with my parents while going to school at UP, St. Ignatius, Ateneo, etc... I didn't look into it TOO seriously but decided after a bit that it wasn't the route I wanted to take. First of all, they are going to give preference to Filipinos. Secondly, while food, clothing and such may be cheap, rent is not. You could always use public transportation but that can be hard to figure out. Also, there are a BUNCH of hoops to jump through before you can even think about sitting for the NCLEX. My suggestion: looking into out-of-state programs here. CSU Fresno offered a new Entry-Level Masters program that was for people who already held BAs. It was part of a state-funded expansion to train more nurse leaders. CSULA, CSUFullerton, and several other CSUs were given the funding. However, CSU Fresno had to shut it down because they didn't have enough applicants! There are openings out there, just in less desirable areas. Better to move a few hundred miles away where you can keep your car and not have to learn another language. You might want to check out-of-state programs such as NV or KS. I don't know what the situation is like in those states but with a smaller population, maybe it'd be easier to get into a program there. That's my two cents. :-) Good luck!

I just found out last week that I have been accepted into a brand new Entry-Level Master's program (EL-MSN). It's at a state school so the fees are very reasonable. The first 18 months focus only on RN licensure and prep for the NCLEX - including lectures, skills and clinicals. Once I take the NCLEX after 18 months of intense study, I can then opt to start working and continue on to my MSN part-time or keep going to school full-time and finishing up my MSN in 18 months. These programs are perfect for people who already hold a BA/BS. My undergrad is in music...go figure!