Miriam57RN

I guess CNN didn't want to shatter the (holy) image of House and other "doctor shows" where the (TV) docs give the meds, do all the testing, hold cups of juice for the pt's to sip..... so ridiculously unreal.

Thanks for your replies. I think it must be the McKesson. Unbelievably, one hour after I posted this question I had a medical crisis that landed me the hospital - the one I'll be working in. I saw the hand-held scanner and the computer on wheels. While eating dinner at around 6:35 pm, I noticed a strange glare over my left eye. I covered my right eye and freak - couldn't see out of my left! I took my blood pressure and took a baby aspirin thinking I could be having a TIA as mother did a few years ago - her only symptom was transient unilateral vision loss. She recovered sight in that eye. Though I'm 20 plus years younger at this point than she was when it happened to her. Saturday night in the ER. RN comes in to take blood and start an IV - not too happy as I'm not in his block of rooms - RN who has this room is busy with a lady next room over having an abdominal aortic aneurism. ER doc looks with an opthalmascope - can't really see anything grossly wrong, but since it's an eye and there was a concern of something evolving, they admit me and I get upstairs by 1:30, though (thank God) the cat scan of my brain was negative. Saw the Opthamologist by late Sunday afternoon - he brought in his magnifier scope on wheels. Central retinal occlusion. Retina is white/ ischemic. Permanent loss of sight in my left eye. There is a small 60 - 90 window of time when something can be done to reverse this (tpa, hyperbaric oxygen). Then the question - where did this come from? So now it was Sunday - have to wait till Monday for the testing - Transesophageal echo, MRi of head and neck, doppler ultrasound. I was told they all seemed normal. Additional coag studies drawn this morning - a coagulopathy? Don't know yet. I'm home and will f/u with neurologist next week. I just read a medical article on central retinal artery occlusion and it says "Life expectancy of patients with central RAO (retinal artery occlusion) is 5.5 years. Very depressing as I am 50 years old and my son who is 14 now will barely be turning 20, and my daughter 25.

I applied for and was hired for a weekend position in a nearby hospital and will be starting in late August. The nurse manager who interviewed me named the computer system they use and I later tried googling it to find out what I could about it in advance, but nothing came up so I may be spelling it wrong. I remember her calling it "McKeesus" - does this sound familiar to anyone here? Is it at least fairly user friendly? A few years ago I worked in a hospital that changed computer systems a couple of months after I started working there (had to learn two very user-unfriendly almost-esoteric) glitch-filled systems, so I'm wondering about this one. What have your experiences been with computerized med/note systems? Thanks.

I think you are wise to wait a bit. This is my second summer of camp nursing and I find it to be as independent a practice as you can get compared to most of my other nursing experiences. We have a camp physician, but he's never on-site. My assessment skills determine whether a camper or staff member needs to see him or not, or needs to go to the ER - and whether he can be driven there or we need to call 911. Become well familiar with asthma management - control and rescue meds, triggers, etc. Become familiar with anaphylaxis and epi-pens. Also with strains, sprains and fractures, as well as care of eye injuries and ambulatory care stuff like conjunctivitis (allergic vs. chemical vs. viral vs. bacterial), ear infection vs. otitis externa vs. swimmer's ear), signs of strep throat, bronchitis or sinus infections, impetigo, excema - there is a lot more but these came off the top of my head as I've seen them all over these past two summers (except anaphylaxis). Subscribe to the ACN's (Association of Camp Nurses) quarterly publication, which has a lot of good clinical info for camp nurses. Keep in touch at this site, we'd love to hear about your progress and eventual camp nursing experience - if you should decide to take one next summer.

1. I work per-diem for a pediatric home care agency most of the year, and take time off from that job to work as a camp nurse full-time during the summer. Being around kids/ youth helps keep me 'young at heart'. 2. Worked mostly hospital nursing earlier in my career (1984 graduate), now mostly home health/ community nursing. I might still be working at the hospital I was first employed at, but for an out-of-state move (from NY metro area to PA) when we bought a house and had our first child. I still miss my old stomping grounds, CPMC now NY Presbyterian.

Long waits - inconvenient for the campers/ counselors. They'd all descend at once upon the HC, many groups at a time - this meant even those kids who weren't on meds had to wait. Thing is, this is also when many campers and counselors would bring up their physical c/o's. This naturally increased the wait time. We had a meeting with the Director yesterday and brought up our concerns. I said I was going to administer the meds at the cabins the first couple of nights so I could at least meet these children, assess as needed, and train the unit leaders. I could tell he thought I was going overboard, that he thought it wasn't necessary. 'What's to giving a kid a pill?' Surely he has no appreciation for the implications involved. My sense is that the Dir. and Assoc. Dir. think all we're necessary for is med preparation. Get everyone trained in Wilderness F. A. and off we go. I'm very uneasy about this new plan to say the least, and it showed in my BP. I had the NA's practicing on me and we got 160/96 with repeats. He also moved our bed out of the HC. Now only the two NA's will be there overnight. I do have the prerogative to stay overnight when I feel it is necessary, but will be in another building. I am also - have said I want them locked (except for epi twin pack and benadryl). Yes, some kids will have to be brought to us. Capped oral syringes that will be labeled and poured into med cups when given. I'll have to show them to wash out the med cup with water so the child gets whole dose, etc. The unit leaders will have to return the oral syringes to the HC (hope its not too inconvenient for them!) as we don't have an unlimited supply of these. They'll be labeled so I'll wash and use the same oral syringe for the child each night, as in home care. I feel the same way. I was told that at his old camp, "only 5 - 6 kids came to the HC on a typical day" - he maiy be in for a rude awakening here. Last year we logged in about 50 on a typical day, 60 some days. He has cut back the amount of kids that will be camp at any given time to 160 - 180, down from around 240 per session. But these kids come from the city and many have chronic conditions and are on meds and there are fights and injuries. A lot of pychotropics. Last year we had a girl on growth hormone, getting a nightly injection (Genotropin pen) and another girl was getting nightly v. supp. (Premarin). Of course, and I have a feeling this is going to mean a lot of work on my part in tracking down counselors to bring the children to me - hey maybe they'll find this will not turn out as convenient for them as they think.

This year we have a new Director who has made some changes. Last year me and another RN alternated working 11-day sessions. We were there 24/7 so there was always an RN on the premises. We had one nursing assistant. This year, he hired two nursing assistants. An RN will only be there for 12-hrs/day. (We are alternating 7-day sessions - I work for a 7-day session, she works the next 7-day session). He feels confident because they are nursing students (it turns out that one of them is not even in a nursing program yet but has only done some pre-reqs.) and sent them for Wilderness First Aid Training. What are the implications for our licenses? (me and the other RN). He expects us to train them to know what they will need to know to provide services while we are not there (but on call). I am very, very uncomfortable about this set up. Also, the campers will no longer be coming to the health center for PM meds. We are going to be preparing them and putting them in labeled envelopes in a zip lock bag which the unit leaders will pick up and administer to their campers in their cabins. Thoughts? Advice? M

I apologize if I seemed to be making assumptions about a specific situation. I was mainly generalizing about a child's perspective later on, when that does happen, as I've seen it. Obviously that won't be a problem in the situation you're referring to.

But you need to know something. When the child comes to an age of understanding, they will want to know who their biological father is. If they were lied to, they will feel a sense of betrayal and often become resentful. I've heard of and read about many instances of this. It should be one's birthright to know who both parents responsible for their existence were. Adoptees, for example, especially struggle with this because in most states their original birth certificates were sealed stonewalling them from this information even after they reach adulthood. Children adopted by stepfathers where the b.father is unknown, also. In past decades if a mother was unmarried, the father was automatically left off of the birth certificate...no fault of the mother it was just done because according to the state the father had not "legitimized" the child and therefore didn't legally count. Years later an adoptee would gain access to their information or their birth certificate and would see no name for the father, but continue to search for who he was, even wanting to meet him if possible. The unknown, or lies, become a sure source of anguish.

Hi cooger - I know where Morristown is - you're not too far from the city. Have you considered looking at hospitals in Manhattan?

This could happen...and may have happened already. I went on an interview last year which went great... but for some very mysterious reason... she didn't call me back as she said she would... and would not take my call when I called her back after waiting a week. Years ago I sought an in-hospital transfer. My nursing care coordinator's recommendation to the other unit was that I stay within her unit. So sabatoge is a possibility... but I currently work for a pediatric homecare agency and the DON is the only RN in the office... others are non-nursing personnel. The nurses are out in the field.

I have an interview appointment next week for a PCU (progressive care unit) position at a large children's hospital. I am to bring two letters of recommendation with me. In my experience, all prospective employers in the past have mailed these out directly to the people we give as references. I have two references in mind including my current DON. Is it wise to use your current DON when you know she doesn't want you to leave? Also, should they address the letter to the hospital I'll be interviewing at? Any info or advice about going about getting these letters would be appreciated as this is new for me.

I aspired toward L&D during nursing school and did an independent study which included some clinical work in L&D. When I applied at a large urban medical center, I didn't apply for L&D... however I did tell all who interviewed me that it was my goal. In this hospital, GYN, Peds, NBN, NICU, and L&D were all part of a service (for Woman and Children) separate from other areas of the hospital... so they put me in GYN which had medical (especially GYN oncology and PID cases) and GYN surgical patients. I worked there less than a year then transferred to a peds unit, where I worked for a year and a half. Meanwhile, I got to know the L&D nurse manager and was given a transfer there. This L&D hired new grads also, but I was the one who always took on the high-risk patients which included diabetics, asthmatics, hypertensive patients, sickle cell, etc. It was a tertiary level center. I stayed on that unit for close to 5 years. So one idea is to get your foot in the door through one of these other units, while making your goals known. After a while when I wanted to vary my experience, I worked on a med-surg unit and also in ICU, and other types of nursing later on. While I was working L&D, I applied for and was accepted into a CNM program, but shortly after my husband and I were expecting a child so I put it on the back burner. Years later, I no longer have an interest in becoming a CNM but have other goals now. But I know that L&D/ midwifery fever.. believe me. I think a lot of it got out of my system when I had a wonderful home birth... one of the pinnacles of my life in fact... and it was a VBAC.

Well I cared for said client again today (my Saturday case) and yes, my concern was valid. She was not getting any of her neb meds with the neb "T" (I think this is also called a U-adapter) placed where it was - in the expiratory circuit. It turns out it was the mother who had done a circuit change and put it in the wrong part of the circuit. The same night I posted here, the respiratory supply company called her back after I spoke to them, and told her to reposition it into the inspiratory circuit, confirming my message that the baby was not getting her treatments the way it was, so the problem was addressed that night though I didn't know until going back there today, and even though they all seemed to minimize my concern. What a difference in the baby - no coughing spells, shortness or breath w/ anxiety, desats, and hardly needed any suctioning today. So thanks again for well-timed advice - which was to call back the respiratory supply/ equipment company in the hopes of getting it dealt with that night. I had contacted them earlier while in the client's home and wanted to reposition it earlier but the mother didn't want this. One of the problems in home care is that you are in the client-family's domain.

I got ahold of the equipment company and waited for a call back. Meanwhile I also spoke to my home care director as I wasn't getting a prompt call back. She called the client family and spoke to the mother. (Wish she would have waited for me to hear from the vent supply company). The mother (who happens to be an RN) said "we've always had it this way" and claimed it wasn't a problem. The director told me they recently got in adaptors and would send one to her, but wasn't going to "shove it down their throat" (if the family doesn't want to change it). Then I heard back from the RN at the equipment company who does this case... including the weekly circuit changes. (Not an RT as often is the case). She was angry with me and said she'd call the mother. Didn't offer any clinical advice. Apparently this is how they've been setting it up, and all I did was cause a disturbance in bringing this up. I still think the baby needs her nebs. I'm upset.