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  1. NurseKatie08

    What Program to Pursue? Help!

    I agree with the MSN Nurse Educator track! Education was the whole reason I wanted a MSN--I had no interest in being a NP (and still don't) which is why I took that MSN Ed route. Some nursing programs (mine included) allow you to teach clinical part time with your BSN--you may want to investigate this to get experience while pursuing the MSN program. My program even allows me to teach an online lecture course with my MSN--as long as I am part time!
  2. NurseKatie08

    Precepting for New Nursing Educator? Not here!

    Agreed. I became an educator with seven years of full time nursing experience & a MSN in Education. I had extensive experience precepting senior nursing students and orienting new staff. No one precepted me when I taught my first clinical. I had your standard new employee orientation and was basically on my own with guidance from my mentor. The needs of a new educator are much different and you should more or less have your act together when seeking a clinical instructor role.
  3. NurseKatie08

    Peg Tube Feeding

    I've never seen that happen (at least not that high of residual with gastric feeds being held) so not sure specifically why. I would have asked for an order to hold feeds and to vent the g tube to foley bag to make sure everything was out!
  4. NurseKatie08

    Ambulating post op day zero

    Depends on the surgery, and my floor sees the gamut. Lap chole, appy, or thyroidectomy? Yup, you're getting up on POD #0, because you're probably going home in the morning. Liver transplant? You're possibly/likely still intubated in the SICU until the morning of POD #1 so not until then. Really just depends.
  5. NurseKatie08

    HIPPA violation if the patient isn't in your facility?

    Not a HIPAA violation as the nurse was not providing care to the patient. Just a bad friend.
  6. NurseKatie08

    Non opioid pain options

    Sorry, just seeing this now. Assuming this is in response to me. Unfortunately, not much. Usually low-dose Tylenol (maybe 650mg every 8 hours tops) or low dose Tramadol (something like 25mg every 12 hours). Generally pain meds aren't even ordered PRN for these patients--they are typically 1 time orders as we have to assess on a case by case basis. A lot of heat, repositioning, non-pharmacological stuff is sometimes all we can do. It's really awful.
  7. NurseKatie08

    My role in student nurse clinicals

    I am a clinical instructor part-time (as well as a full time staff nurse). It frustrates me to no end when I see/hear of other instructors that just dump their students on the floor staff. That is not your job! I teach med surg, and my students are each assigned to a patient (or two as they get more proficient) and they are responsible for that patient--they are NOT assigned to a nurse! They take vital signs, help the patient with ADLs/ambulation, do an assessment and any other treatments as I see fit--WITH ME! I happen to teach clinical on the floor I work on as a staff nurse, and my colleagues are very receptive to pulling my students in and showing/teaching them things, but I think this is because of the environment I create--I do NOT expect the staff to teach them anything--that is my job! Often times I do pair a single student up with a nurse for one day in the semester, just so they can observe and learn about prioritization & delegation and what having a full assignment is like, but I make the expectations of that day very clear, and I ASK the nurse ahead of time if they would be willing--I don't just assign the student to them with no warning. I have heard of clinical instructors that have students give meds with the staff nurse's supervision...no no no! I could go on for days!
  8. NurseKatie08

    Non opioid pain options

    I work on a pre & post op liver transplant unit...I agree that pain management in certain situations can be tricky. The trickiest population I see is those in end stage liver disease. ESLD is definitely painful (holy ascites, batman!) but our options for pain management are exceptionally limited. Opioids can potentiate hepatic encephalopathy, they can't have NSAIDs because they are already huge GI bleeding risks as it is, and too much Tylenol is contraindicated (we usually limit to 2g but only use it in some situations). It's really tough.
  9. NurseKatie08

    potentially dangerous postpartum situation

    Not a post partum nurse and have no comments on this particular situation, but just wanted to add something about rapid response. At my hospital, ANYONE can call a rapid, patients and family members included if they feel as though something is wrong with the patient and they want more assistance. There are signs posted to that effect in each patient room. Have I ever seen a patient or family member call one? No, but it is possible in some facilities.
  10. NurseKatie08


    Yikes, on your own two months and already floating? We have a rule that new staff cannot float for 6 months, which is at least a little helpful. Also, all of our med surg floors are specialized to a certain extent. My unit is the only unit to take liver/kidney transplants, and we'd never give a liver or kidney transplant patient or some of our specific hepatobiliary procedures (a Whipple for example) to a float. Similarly if I floated to Onc, I wouldn't get a patient receiving chemo, and if I went to cards, I wouldn't get someone who just had a cardiac cath or something.
  11. NurseKatie08

    CCTN Transplant Nurse Certification Study Advice

    I got into transplant on a whim & loved it from day one. I simply applied to a posting for a transplant focused med/surg unit at my hospital. My unit takes newly licensed nurses as well. I did have four years of experience at the time, but not in transplant. I would learn about the hospitals you are interested in when the time comes and find out which unit(s) are their transplant units and go from there! Make sure you take a good personal inventory though, especially as you are a recipient because sometimes things can hit a bit too close to home. Though also your experience as a recipient gives you unique perspective, just make sure you are emotionally ready to deal with the hard times for your patients.
  12. NurseKatie08

    CCTN Transplant Nurse Certification Study Advice

    I can't offer any advice about the CCTN exam as I haven't taken it myself (thinking about doing it soon though!) Just wanted to reply to second your request for a transplant nurse speciality board--liver/kidney transplant nurse here!
  13. NurseKatie08

    Sliding up bariatric residents

    Would agree with the previous who would have to insist that the staff use proper body mechanics. However, is something like a Hercules Patient repositioning system available to order? It is a sheet/special mattress system that boosts a patient with the push of a button. We use them for our bariatric patients who are unable to get OOB and it definitely saves time and backache! Wonder if it is an option for your resident, especially since they are unable to get OOB. Hercules Patient Repositioner
  14. NurseKatie08

    MD was angry I questioned him.

    OP, great job advocating for your patient! Also, let me just add that Lactulose can also end up causing low K due to losses in the stool. I am a liver transplant nurse and very very familiar with giving Lactulose for hepatic encephalopathy (which I'm imagining this is why this patient was getting it). We honestly don't even measure ammonia levels...mental status is what really tells you if the Lactulose is working. Good job! Considering psych usually requires medical stability, this person definitely was not stable to transfer!
  15. NurseKatie08

    Low Census

    Surprised by how often it seems to happen to some! Cancellations are handled by seniority on holidays at my hospital, and then by a list of when everyone was last cancelled on non-holidays. I was cancelled once right around Christmas time this year, and prior to that it had been three years since I had last been cancelled. For us it seems most likely to happen on or around a holiday, and only being at my hospital 5 years leaves me with little prayer of getting a major holiday cancel. Also, since I work 12 hour nights, we are cancelled for the first four hours, but then depending on staffing may have to come in at 11p. Days is cancelled in 4 hour increments. Didn't mention as well that on non-holidays obviously anyone who picked up OT is cancelled before someone else is for their regular shift.