crystalchen

I totally agree! I am a new grad last year and during my 8 months working in long term care facilities as an NP, there is SO MUCH that they don't teach/never mentioned in NP school. I was a good student, graduated with honor, and several clinical rotation places wanted to hire me after my rotation. Then what, I really don't know much! I guess PA school will provide you more clinical knowledge and medication knowledge, and for NPs, we gotta learn from our experiences. Best luck!

relax dear, it was fullmoon last night

So I guess last night was full-moon.... no wonder why my pts were all crazy:devil: Don't feel bad if you got crazy pts, too

I think your LTC experience will help you a lot in med/surg.

I was told by experienced RNs that you should do a bedside swallow eval, just ask the pt to drink a sip of water first. If they have to troubles, give them pills, because I have seen pts that was ordered swallow eval but result is not available before I am giving meds.... If you ever question a pt's ability to swallow, contact the pharmacy to see if you can crush it, for sure...

In our hospital we have to follow unit policy. In my unit we can only push 7 meds, which is not including dilaudid or phenergan or ativan........ sad.......... Check it with your preceptor, and remember to always ask pharmacy if you have any questions about if you should dilute it before administration, how much you should dilute it with, and how fast you can push :)

I learn that antibiotic is extremely important for the first 24 hours, and it needs to be given after the labs, right? keep them hydrated.

Thank Xing! I will need to look at the curve again, this always confuse me during school and now. I dont remember his pH, I will go to work tomorrow night and find out more about his labs. I found an interesting graph to explain it: here is shows what you just corrected yourself that in acidic body, blood doesn't combine to O2 and release more O2 to the muscles where needed, am I explaining right? so there is not enough O2 in blood and then it becomes more acidic. in his ESRD kidney not working so no base can be released to blood to adjust this imbalance? Here is the graph

All of the nurses on my floor take 30 minutes uninterrupted break, it is safe for our patients. I do believe that I need those 30 minutes to get off the floor and do something else. Of course, charge always ask around who wants to take the first the break and who is the last, depending on the patient load, if the nurse is getting an admission, and just like handing over a shift I think, I always feel absolutely ok to give a minireport to the nurse who will be covering me, I know it is frustrating if something happens during the break, but taking some rests is necessary for better taking care of your patients. I would rather take the break later in my shift, though, because it will make the rest of the day pass faster :)

I learn that knowing your resources and don't be afraid to ask stupid questions. Utilize family members, keep them busy if you can, do your teaching with patients, even one sentence, they don't usually ask questions, but they appreciate your teaching because they think you care. :)

Does charge nurse has patients last night? Did they call to ask if anyone else is ?available to work? I work in emergency - observation and each nurse always just have no more than 5 patients. If someone called sick, charge nurse should either find someone else to work, or charge should take those patients, or management should come in to take patients (we have 2 nurse leaders and 1 crn on the floor). I think it is unsafe and you should talk to management about this. but my friend works on surgical oncology saying they usually have 6-8 pts at night...... maybe it is an unit thing?

I suppose she was having diarrhea? If so I would call the team and put a rectal tube in her, which is both good for her skin and for the staff on the floor.... I had a pt before, similarly, refuse to use a lift because she had a bad experience before. I could imagine this is hard to take care of her, someone who does not appreciate your help at all. I like the quote by the previous post, and in reality, it is so true.

he was admitted for SOB at home, he tried on a cpep mask and was planned to have that machine home this Friday because he always wakes up at night because of SOB and I noticed he had to move from bed to chair and many different positions to sleep during my shift. You answered my question about the lactate and Co2s.... thank you!!! yeah his K was high before yesterday's dialysis but then after that 4 lab draws could not run that K test because hemolyzed... his blood was like... very dark blue color this morning! I didn't know if the spouse has diabetes. He is in the 60s,sponse is a lpn worked in a school clinic for 20 years... Could you explain more on this please?"Lactate reflects that cells are hypoxic and in anaerobic metabolism. Acidotic blood doesn't give away O2 easily". Thanks a lot! ps i am from China, but i was educated and working here in the US :)

I am glad you experience that in nursing school.... I had my first code yesterday and did my first post mortum care... it was a little scary, and also sad... I could not sleep for 4 hours after went home and then kept dreaming about the whole thing..... I think it will be better and better along with more experiences...

I am thinking about pain management because a fracture is a lot of pain....... effective pain management will also stablize the patient for future interventions.

yes, that was CO2 in his Chem7. What's the differences between CO2 in chem 7 and in ABG? I could not remember his other lab values... They were deciding if he should go to dialysis or ICU first and then decided he should go to ICU. He was actually almost on his way to dialysis this morning. They didn't know why his BG dropped so low, he is not a diabetic and they asked me twice if he received any insulin. He also had an episode of low BG yesterday in dialysis so he only went for 2 hours and came back. There was some mental status changes noticed from yesterday to today per wife. Please write more!! Thank you

Dear asdjkl: I can feel your pain and sadness. I am a new nurse, too, and I feel exactly what you are feeling especially about others talking about you even though they don't really know you, judging about you even though they may not have their brain, and laughing at you with knowing how painful it will be to you. From your words I can feel that you are a very strong person, inside in your heart, and you bring this strong heart with you when you do everything. It is completely fine and normal for anyone to cry under this kind of situation, because no matter how strong your heart is, it should not be bearing these unfreindly and harmful weights. You come to work, with your heart, also with your life that you experienced before. I just want to say, it is really ok to cry, and I will really want to give you a big hug if I am by your side right now and I will cry with you. Here are some suggestions: You should talk to management about these issues, they may not be able to do anything regarding to those nurses, but at least you can require shifts so you don't work with them all together. You did mention that there are a few nurses who are helpful and friendly, ask their working schedules and schedule yourself to work with them. I feel that working day shift is better in terms of staff relationships because it is always so busy, nobody gets time to joke around, and management is usually there to help and to monitor. So maybe you can think about working days? I think there is no friendship in working, so don't even expect to make friends in working place, but, know your resources. As mentioned I am a new nurse, too, just worked 7 months, and I know a couple of nurses on the floor who are always open to answer my stupid questions, yeah, stupid just because we don't have experience !! Same as working in a Salon, you never know how to cut this and that kinds of hair until you really cut it, right? and everybody has their own judgement, just like in Salon, too. You think this style is better for the customer, but others may think it is ugly. but the difference is in the Salon when you are done, you are donne, in nursing, you have to pass along the patients and your care. The care you provided are really very important to the patients, and their families, I am sure lots of patients will appreciate your help and your care from their hearts, but they don't usually say it :) remember to document everything you need in terms of care and communications with the providers, you know. You don't want anyone to fill out incident reports on you and find out later that you don't have any documentations on what you did. Also, if you write a note about some very important stuff, make sure you make a copy and save it, because all it matters is your license, and I am sure nobody else cares about it except you. About family, I feel that. My huband doesn't like me talking to him about work at all. One day I told him that I had my first code and my patient didn't make it... he said well you know it is very common in the hospital about it... they don't know about our job, they pressure we have, and the responsibilities we have. So, find someone else who are also in nursing and share your thoughts, like here :) or I mean some friends in life, you know. Ok, I have been writing without a subject... sorry, but I do really want to let you know that we here feel your pain, your tear, and I do sincerely hope you will feel better. You are a great nurse, a great wife, a great mother, and, you are a wonderful human being. Before caring for your patients, give yourself sometime and care for your self, just like you put makeups on everyday, we do want ourselves look pretty, that's nature, no reason, right? Best luck to you my dear!!!

so I had a pt last night, lab called for his morning labs: BG 17, CO2 8, phrosphate 12.... he was A+O X3, has been SOB for 2 days but the team did not do anything, hx of sleep apnea, was gonna get a CPEP to use at home, and he is a dialysis pt. I am wondering what can those labs effect him.... he was transfered to ICU after the doctor came down, and the doctor said he had never seen pts with these lab values still alive....... His vitals are all stable, and he is not in acute distress. They then did an ABG and his lactate is like 16. Thanks in advance!!

Thanks everyone, I think per diem might be the best option here, our hospital requires 16 hrs per month for per diem, and I think I could definitely afford that... I will request this to my manager next week to see if she will approve.

Thank you Softballmama and B, I really appreciated your suggestions. My relationship with management is ok, I should say, they treat me ok for approving my vocations and so on... I think this is the best option for me now. Hope they will allow this request...

Dear Softballmama: Your suggestion is exactly what my friend has just suggsted me! Our hospital requires per diem to work at least 16 hours per month, I think I could definitely handle that. and I could earn some extra money if I have extra time... I really appreciate that you told me your experience during interview, it is very realistic and helpful. I will talk to my manager next week about this, hopefully they can offer me this. Should I say that I need more time for school, I really like this unit right now (although it is very stressful) and I will definitely pick up more shifts if I have time? Thanks a lot!

Ok I asked this question in general discussion forum, but I think I should ask here again because I am in a FNP program now. I graduated last year in June and have been working in ED-observation room in a large teaching hospital for 8 months. The job is very stressful everyday and I work 4 days per week. This summer is going to be the 3rd semester of FNP program and my advisor suggested me take 2 classes which are requested for clinicals starting in Jan. I graduated from an accelerated BSN program (1 yr) which did not provide me a solid foundation for NP study... I don't want to burn out with this job and all the coming classes, so I am thinking if I should quit my job and concentrate on study. But will my resume look bad if I worked only 8 months, no job for 2 yrs and then become an NP? I will definitely look for sth part-time if I have extra time..... Please give me some of your advices and experiences... thank you everyone!:)

I have read all the replies and I feel like I really need to think about this by myself. My parents are very supportive and they can financially support me. My husband is looking for a job right now so there is no income from him right now. I think I could always find something to do if I feel like I have extra time besides school in the future. This job is too stressful without learning much... I do think I need the extra 2-3 days to read books and prepare for NP clinicals... but another question will be... Will my resume look bad if I only worked 8 months as RN and then become an FNP??

Hello dear all: I graduated in June 2009 and have been working full-time in ED - observation for 8 months. I am in FNP school right now part-time and the classes are getting harder and harder. I am thinking about quitting my job so I could concentrate on my study. (Since I graduated from an accelerated BSN program, so I think my 1-yr nursing school didn't prepare me much for surviving the master degree now). For the job right now, I don't feel like I am learning because most of the times I am doing tech work because we are so busy everyday.... I am thinking if I quit my job in a month, study full-time for the summer, and if I could handle all the classes well, I will start looking for another part-time although I know it is hard. What are your advices? Thank you in advance! Crystal

actually I don't have a super high GPA, only 3.5 on my bachelor (which is telecommunications....) and 3.4 on my pre-requisite. I did two volunteer jobs in local hospitals and I am sure one of the recommendation letters is good (because I know that professor very well, he teaches speech and language science). I think my advantages are that I am an international student (came from China ^_^) and I can speak several langauges fluently. I revised my personal statement 5 or 6 times, and I think that is very important, too. They do have an interview, but it is for everyone. so I don't think that will be counted as a very important part. I still need to finish this quarter and send my grade over there, oh by the way I am from Ohio. What are you planning to?