Serlait

Groan.....my goodness....why not take yourselves and AN just a little too seriously...If this poor nervous kid wants to ask a simple question, let her ask. If you don't want to read it....then don't. No need to be snarky and flame someone for deigning to post an NCLEX question in the precious General Discussion. Get a life and some feelings....you don't have to be a nurse to be considerate of others....just a decent human being.

All the staff in our Cardiac Device Clinic are RN-BSN nurses. We do not work for a cardiac device manufacturer and do not work for a hospital. We work with a team of cardiologists/EP doctors. And the actual interrogation can NOT be taught in minutes. Where did you get that idea? The thought that interrogation could be taught in minutes is uninformed and dangerous. Are you aware that when you use a programmer you have control of a patient's heart? There are dependent patients who MUST be paced and the potential exists in the programmer to cause pacing to be at voltages that are less than necessary to capture the heart. I have heard of patients passing out on the floor because an uneducated person attempted to interrogate their device and caused prolonged pauses in therapy causing syncope. Further, each manufacturer's programmer has it's own format and different devices can have different platform appearance within the programmer. All the nurses in our clinic have been trained to use the programmer from each manufacturer. The cardiac device representatives in our area are highly educated....some with PhD's and are nurses, engineers or other professionals who have received extensive education in cardiac device technology. Some are licensed, others are not, all are educated professionals. Believe me, cardiac devices are extremely sophisticated pieces of medical machinery that are FAR beyond the failure to sense and failure to capture that we were all taught in nursing school.

Just about to complete my first year as a Cardiac Device Nurse. I am an RN-BSN with ICU experience. Had to have strong understanding of cardiac rhythms.....rest of training has been on the job. Our clinic interrogates and troubleshoots pacers, ICDs, CRT devices.

WOW! You're doing a lot of sticks for an alternative medicine clinic. Can't help wondering what the heck all your patients are having infused. Especially those coming in weekly. Is the fact that it is an alternative medicine clinic precluding patients receiving PICC lines to avoid such frequent sticks? Don't get me wrong, I think there is definitely a place for alternative medicine, but I'd be more worried about what I'm infusing so frequently than my ability to stick someone.

Gee...I didn't realize that being a nurse released me from assisting another human being when I'm off duty.

Regardless of her credentials, Ms. Hadaway stated on her website, Lynn Hadaway Associates Inc. Lynn Hadaway Associates, Inc.: Studies on Backpriming "Unfortunately, this is an area of clinical practice that has received no attention and no research." (First line of author's response). Until there is evidence based on research, I'll follow my hospital's policies so I have a paycheck to take to the bank.

"Yes the 2004 article still applies as no new studies to prove there is a better way." But the 2004 article was not supported by evidence based research. Again, there has been no research to support either practice. How can one claim "best practices" with a dearth of research to support such a claim. I find it interesting that if someone is unwilling to switch to another practice, especially when there is absolutely no evidence to support the change, they are accused of being unwilling to "change their habits". Very simply, if you want me to change my "habits" then show me the evidence that supports that change. Please don't site an eight year old article that does not include the most recent recommendations of agencies cited in the article. Both the CDC and INS revised their recommendations in 2011. If I were not willing to change my "habits" in the face of research, THEN I would be deserving of your censure, until then or until I have the evidence to argue for a change, I will follow the protocols of my hospital. I can't imagine trying to defend myself if there were some sort of problem or compatibility issue by saying that I based my practice on an article written in 2004 that was not current.

The CDC issued new guidelines as to the time a primary set should remain in use in 2011, this is the conflicting information in the cited article. Also it is noted in the 2010 Lynn Hadaway Associates Inc. link r.e. backpriming "Unfortunately, this is an area of clinical practice that has received no attention and no research." (First line of author's response). And further down in the authors response to a post "Of course there are no studies to refer to about this practice. I would recommend that your practice council consult with a pharmacist knowledgeable about IV drug compatibility information just to be sure. I just checked some recent compatibility information on Vancomycin and found conflicting compatibility information when given with ampicillin, several of the cephalosporins, nafcillin, piperacillin, ticarcillin and tigecycline. I would recommend that you assess the common combinations prescribed by physicians in your facility and then assess the compatibility of those combinations." Additionally, per the 2011 CDC guidelines, "No recommendation can be made regarding the frequency for replacing intermittently used administration sets.Unresolved issue " (#2 under Replacement of Administration Sets). Hence, the use of backpriming cannot be claimed to be evidence based, therefore, how can it be best practice? I don't see it as not wanting to change habits, but in following the protocols established. It seems to boil down to using the practice that your hospital or agency establishes as best practices. If your agency says a new secondary for each drug and 24 hour use for each secondary and you wanted to argue the issue, what evidence would you present? What research could be presented? At this point, per Lynn Hadaway, "The absence of studies means that we are left to base practices on general principles of infection prevention." (Paragraph 3, author's response). It would be extremely interesting to look at the rates of blood stream infections in hospitals with varying practices to see if there is a greater incidence of infection when multiple secondaries are used vs limited access for secondaries. Perhaps a good research topic?

I can't help wondering if the cost of a secondary set is more or less expensive than the saline used to backprime. Further, the sited article is dated (copyright 2004...which at 8 to 9 years old would this source even be an acceptable source in most evidence based research papers?) and no longer complies with CDC recommendations. It looks as if the Infusion Nurses Standards of Practice were also revised in 2011. See new CDC recommendations here.... CDC - Patient Cleansing - 2011 BSI Guidelines - HICPAC

Interesting. You've been a nurse for just a little more than a year, have zero L&D experience and you're going to be a charge nurse? Wow....THAT doesn't seem safe at all.

I tried New Balance as well when I first started school and working 12's as a PCT. My back would KILL me by the end of the shift. That's when I switched to Dansko's which really helped the back, but just didn't work over the long haul. Honestly, there are so many shoes and feet are so different, you may need to just try a few pairs to see what works best for you. Good luck in finding a comfy shoe AND with school! Congrats on getting into school!

I'm not as tall as you are, but am a little overweight. I tried Dansko's and wore them for a long time, then started having really severe heal pain. I switched to Merrell's Jungle Moc and LOVE them. No more pain. I can walk in the morning after getting out of bed with no pain.

Now that's just sad. You've worked hard for your degree and title. Don't let anyone pay you less than what you're worth. CNA pay....NO WAY!

Congratulations on your acceptance into school! You've got a great start by working part time in a hospital. That's how I got my job. But never forget that school is your priority. I busted my butt during school, graduated with a 4.0 and worked part time (16 hours a week) as a Patient Care Tech on the unit I wanted to work on after graduation. When I was at work I gave it 110%. I did everything I could to provide good patient care and to be supportive of the nurses. The nurses were awesome and allowed me to observe so much of what they did. I was offered a position in February to be filled after I graduated in May. So it's great that you're getting your "foot in the door" now. As unit clerk, you'll learn a LOT about MD orders, procedures, etc. etc. Good for you for being so proactive.

Worked for me and five others.

Caliotter.....I think you're absolutely right. It really is all about application....THAT is what it feels like is being tested.....Can I take what I've learned from school and the seven jillion questions I've answered and apply it. Ya GOTTA know the content.

I used NCSBN, Saunders 4th Edition, (especially the CD that came with it), Lippincott's new Alternative Format book and website, some NCLEX 4000 (not too much, though, cause I started finding errors), and LaCharity Prioritization and Delegation, and the mneumonics for infection control from the Random Fact Throwing thread. Made sure I knew basic drug classes. For me the NCSBN, Lippincott and LaCharity questions had more of a feel for the actual NCLEX. I did read the new Kaplan book, it was somewhat helpful, but not indispensable. The Saunders book has really good "how to pass" section.....loved the info on NOT reading into the questions. Hope this helps.

Thanks be to God, I PASSED NCLEX on Sunday in 75 questions. I was absolutely certain that I'd failed when I walked out of the testing center, but wasn't able to re-register to take it again and called BON today and I have a license. WHOOT!!! I'm an RN!!!! Can't believe it! Thanks to all the wonderful people here at allnurses who posted their stories, both of success and near success. And to everyone who posted random facts and the mnemonics, THANK YOU!! Though I don't post often, I lurk a lot and keep up. If you're waiting to test, be sure you understand the WHY of the rationales. Know your content. That's the most important thing, I think. Also, someone....sorry can't remember who....posted this prayer...and although NCLEX wasn't easy, I was able to remain calm during the exam....so reposting lest it help others. "Oh Great St. Joseph of Cupertino, who while on earth was given the grace of being asked in your examination only the questions you know. Please obtain for me the like favor in these examinations which I am now preparing for. In return, I promise to invoke you and to make you known through Christ, Our Lord. Amen."

Worked for me, too. Took NCLEX on Sunday, the 13th, and got the good pop up when I got home (although I was sure I had failed!). Called BON today and I have a license. Yes it does work!

Prayers headed your way. I test on Sunday. Look forward to hearing from you!

The Community Colleges in my area are very difficult to get into. Several of the LPN's that I work with have found that they must retake pre-reqs that are weighing down their GPA's. It's not a case of taking just anyone. It doesn't help that they also cut enrollment because new grads were having such a hard time getting jobs. To the OP, consider private school. It may be easier to get into.

From the "For what it's worth department".....I checked on the NCSBN Learning Extension website that I'm using to study for NCLEX and per this site "Management of Pancreatitis: pain relief-meperidine (Demerol: causes less smooth muscle spasms; Morphine can also be used-longer half life). " When it comes to answering....who knows....hopefully interventions for pain will be the choice instead of a specific med. Under Nursing Interventions for pancreatitis manage pain is number 1. It does get confusing sometimes. I even had had a question on a Kaplan test about the steps of cleaning around a central line with acetone and alcohol....When I asked the IV Therapist at work she said that was OLD and no one used that anymore...and no wonder!

Ewww....tight scrubs....I don't know your SIL, but just the folks who I know who wear them should be forced to look at the rear view.....it's SOOO not a good look.

Dear Friend, I understand so totally what you are saying. I also felt that way at the beginning of my last semester. (I also maintained a 4.0 through school.) I just felt like I couldn't do it anymore. But what was helpful was that I opened my ears to listen closely to my classmates and the feeling was almost universal. We were ALL just pushed to the edge and SOO burned out. Knowing that I was not alone in experiencing this feeling was very helpful. The last semester is just a challenge, emotionally and academically. You're just plain tired and worn out. This is especially true if you're in a program that requires year round attendance. It feels like it will never end. But it will, the light at the end of the tunnel won't look like the headlight of the oncoming train....It will be the light of the nursing lamp....shining for YOU! As far as the 4.0....for my final semester I had to really examine myself and see where this drive was coming from. I was fortunate to have a classmate that was also struggling with this issue and we were able to talk about it. My classmate and I share a similar belief system, and we were able to encourage each other to understand that our value as a person is NOT reflected by our GPA. Dear one, do not allow your GPA to define you. You are an infinitely precious person, with a kind heart and love for your fellow creatures. THAT is what makes you special...NOT a 4.0 GPA. That 4.0 is so very transitory and means so little in the long run....Yes, I did graduate with my 4.0 intact, but it was close. Once I accepted that being a nurse was FAR more important than being a perfect nursing student, I was able to relax and get through the semester. It was hard...and there were days when my family had to assure me that I could do it...days with lots of tears.....but hold on if you can, and go for it. Allow yourself to breathe a little this semester. Even if it means no 4.0....it's ok...you'll be a NURSE. THAT is the precious piece....you'll BE A NURSE!!! Hang in there....it's hard, I know....but you can do it. Put your books aside for today....or even for a few hours and let your mind relax. Trust me. Once you're refreshed a little, the NS info will be easier to take in. Let us know how you're doing. I'll be praying for you.

CMonkey....I applaud you for your creativity, but I'd suggest a trial run before wearing your sleeves to clinical. Make sure the tops of your sleeves doesn't "ride down" while you're working. (Maybe wear them around the house while cleaning or while doing some other vigorous activity) Nothing would be worse (or more embarrassing) than having your sleeves come down while you're assisting with a procedure....especially with your clinical instructor watching. And YIKES, I hate to imagine if they wiggled down during a poo change/clean up. I understand exactly what you mean about hot and cold. I decided to wear a lab coat and just shed it when I got too warm. (Just had to remember where I left it usually!!) Let me know how you fare....very interesting idea!