Okami_CCRN

You will either be circulating, scrubbing, or doing moderate sedation. Pace will be dependent on the facility you work for; higher acuity / large institution = more cases. procedural areas like CCL and IR will keep you on your toes, you need to anticipate what can go wrong and be prepared to intervene appropriately, especially in CCL. On-call can be a quite a bit in these areas so you may want to ask about what does call typically look like and who consists of the call team.

I have given notice during the 90-day probation period; this period goes both ways, you too can decide this is not a good fit. My only advice is that the grass is not necessarily always greener, but I am sure you know that.

NRSKaren did a fantastic job at highlighting what you can do as a bedside nurse to build yourself up and make your resume pop; remember your resume is a marketing tool! Below are some of the things that I have done to advance my career: -joined the ICU practice council and work on several quality initiatives throughout the years -joined and actively participated as a volunteer with the AACN -attained CCRN certification -volunteered as a subject matter expert for Epic during our Go-Live -joined the system-wide professional development committee It's imperative that you get out there and meet people in other departments, word of mouth travels fast!

I think this really comes down to what are your career and personal goals. I highly recommend making a pros & cons list for each position (be realistic about what is a pro/con). Once you have set up the list sit with your partner and discuss what this looks like moving forward in your relationship. Some things to think about, the current healthcare and overall economic status in the country is unstable at the moment with multiple healthcare systems announcing layoffs and set backs. Do you need health insurance? if so the per-diem position is ruled out. Unfortunately, we have to be practical and realistic in the current job market. I wish you the best and hope it all works out regardless of what you choose.

Good morning, Our bed board is centralized to our hospital and is staffed by 4-5 registered nurses with critical care / emergency experience. As bed requests come through from the emergency department, transfer center, and direct admissions the nurses review the charts and assign them to appropriate units and make the admitting team aware. Each nurse is responsible for 1-2 service lines and works in conjunction with floor charge nurses to discuss bed needs and upcoming discharges for bed planning purposes. The priority is to keep a healthy supply of open critical care beds while decanting the emergency department, which as you can imagine is a delicate balancing act.

As many echoed, I would highly encourage you to take the telemetry position. In cardiac/medical telemetry you will learn invaluable skills such as cardiac rhythm interpretation, time management, delegation, prioritization, and clinical pathways for common disease processes. These skills will easily transfer to the emergency department when you are ready to transition. Do not feel discouraged about not landing the new grad role in your desired specialty, the beauty of nursing is that there is growth both upward and lateral!

The NYC nursing market is incredibly over-saturated at the moment, with multiple healthcare systems either in the midst of lay-offs or hiring freezes. You might have better luck expanding your pool outside of the NYC area and into North NJ or Long Island.

Unfortunately you will find that most nursing courses with clinical hours will not transfer. This is multifactorial in that every school has somewhat of a different curriculum, even if there are small difference. Schools also, do not want to vouch for clinical experience that their professors/clinicians did not observe. During my time in nursing school I met a handful of students who had to start from scratch when they transferred schools, this was the norm in 2010.

The NCSBN is clear about the what constitutes a primary state of residence (PSOR); "PSOR is the state where you hold a current driver's license, voter's card, federal income tax return, military form no. 2058 or W2 form. If a nurse's PSOR is a compact state, that nurse may be eligible for a multistate license. If a nurse cannot declare a compact state as their PSOR, that nurse is not eligible for a compact license. They may apply for a single-state license in any state where they wish to practice". https://www.nursecompact.com/FAQs.page https://nursecompact.com/files/licensebyendorsementv2.pdf

I typically do not let my immediate manager know of any open internal job prospects. In the past, HR has asked me if I prefer they inform my manager of my acceptance of a new position or if I would like to inform them. It is at this time that I opt to inform them as both professional courtesy and prevention of them block/delaying the transfer.

I am sorry you are finding yourself in this situation, unfortunately most nursing programs require that science courses be taken within 5 years. This has been a policy as far back as when I started nursing school in 2010. LPN to RN Bridge programs will offer a diploma/associates in nursing at local community colleges that you can then go for an RN to BSN program at a local 4 year school. I hope that helps a bit, best of luck.

The thing about nursing is that it is a stressful career choice regardless of setting; the real question is what kind of stress can you handle? For example, I enjoyed critical care and after a while made the switch to inpatient case management; I hated every second of it and always felt anxious. Although some people consider case management "soft" nursing, it may not be true for everyone.

Hey there, Everyone's style of learning & studying is different, I have always found it difficult to sit down and actually study. I got serious 1 week prior to the exam date. I bought and used the AACN Study Guide and a colleague lent me the Laura Gasparis CCRN review DVD's (this was in 2016). I felt adequately prepared and passed on the first try. I think what helped me was that I primarily worked in a mixed MICU/SICU, that was the dumping ICU for whatever the specialty ICU's didn't want. The CCRN exam is very much a generalist exam and that was the type of critical care I practiced.

You will be expected to provide basic nursing care at the direction of the RN/LPN, this may include, but is not limited to bathing, ambulating, obtaining vital signs/labs, performing 1:1/1:2 clinical watch, etc. For your interview you may want to ask about what does a typical patient assignment look like, how often is ancillary staff floated. Neurology / neurosurgery units can be heavy both emotionally and physically. You may encounter patients with devastating neurological injuries. However, I think PCT/CNA experience can prove invaluable to nursing school as long as you are able to separate reality from textbook.

It's great to hear you want to advance your education and career. However, the questions you ask are employer specific. Your best option would be to speak to your union representative regarding education benefits as these are employer and union contract specific.

The patient remains admitted until they physically leave the hospital and under the care of the attending physician, resident team (if applicable), and nurse. At times a patient may not agree with their discharge and choose to appeal. Their discharge order remains active, while the appeal process takes place. Do you stop rendering care? Of course not. However, it is important that if a patient cannot be discharged that same day d/t transportation that the social worker/case manager be looped in as well as making the attending aware that the patient will remain in the hospital.

As NRSKaren mentioned, medications that are compounded by pharmacy will often have a small foil covering the medication inject port for tamper proofing. If there is a foil covering the IV spike port, you must remove it before spiking. As seen in this image, the medication has foil covering the spike port, you should never spike through this, always remove it.

I think flushing a j-tube every 2 hours in the home care setting is difficult as I imagine the patient does not have 24/7 care. I have attached a pretty good article that outlines how to prevent and treat clogged feeding tubes especially j-tubes. Clogged Feeding Tubes: A Clinician's Thorn (2014)

As others mentioned every hospital has different policies and levels of enforcement. With that being said I am not a huge fan of long nails both artificial and natural. They are difficult to maintain clean, multiple articles showing an increase in infection especially in vulnerable patient populations. Also in general, you never know what your'e getting into, gloves break and bodily fluids are everywhere.

This is now a patient safety concern, you must inform your supervisor / manager and let them know you have tried XYZ avenues of communication to no avail.

As NRSKarenRN stated, most indwelling urinary catheters have a sampling port that can be cleansed and connected to a leur-lock syringe or vacutainer device for sterile specimen collection.

Every place is different, you should ask clarifying questions to your recruiter and/or onboarding specialist. In general, some hospitals only consider 1.00 FTE as full time, an employee working 36 hours per week is typically coded as a 0.96 FTE employee, which may be called part time (but full time hours). Also, some hospitals will start all new grads as temporary employees with no benefits until a FT spot opens up and they slide them into it. Again these are questions best answered by your recruiter. Best of luck!

A large chunk of remote case management is done by insurance companies. I briefly worked for one as a remote case manager and did not need CCM, they did encourage staff to obtain but never a requirement. I left for many reasons, one of which was the sedentary nature of the work.

I would always choose the controlled chaos of the ICU over the uncontrolled chaos of the ED. I enjoy the patient care of ICU, and following patients through their critical illness.

It sounds like you are working for an insurance company, typically nurses are utilized in the review process and prior authorization department. In these areas nurses are either reviewing treatment plans for members for quality tracking or auto-approving prior authorizations based on guidelines provided by the insurance. If there is ever a situation, where it is not clear the flow should be to escalate to the medical provider for review and determination. As a nurse you are not the one denying service, that would be outside your scope of practice. You can always review the Texas Nurse Practice Act for further clarification.