NCINDASUN

Greetings! I need some advice. A December 2005 grad, I've had 2 jobs since graduating and I need some guidance on how to position this. First, let me explain. I'm 46 and this is my second career. My first job out of nursing school was with an oncology clinic where we saw 50+ people a day for chemo. There was no orientation to speak of and I felt like I was in over my head. After 6 months I felt it was time to find something else. What I didn't know was that my son was about to be diagnosed with a tumor. I took 6 months off to deal with that and went back to work in December. This next job was wonderful. I loved the patients and what I was doing. It was intense and I stuggled but I was determined to be successful. Unfortunately, the (much) younger staff felt I was wrong for the unit and set out to make sure the nurse manager knew it. Essentially, the story line about nurses eating their young also goes for the older ones too. When I was given notice last week (after 6 months) I was told the reason was that I hadn't challenged a superior on an order, one I went over line by line with the person standing at my side. It wasn't a medical error, just when to d/c a PIV. So how do I go about presenting myself without looking like a job hopper? I know, be honest with potential employers but I need to get past that first glance of the resume. I even had trouble writing this because I couldn't begin to share the ridiculous things that have happened without it sounding made up or like sour grapes. Any help would be greatly appreciated.

Ok, I did it. I accepted the position. You are right, I really did want it over the other offers I got, but when I told friends what I was considering they all gasped and said there was no way they could do it. For some reason, it doesn't scare me. I don't start until January 2nd so I'll spend the time brushing up on peds, etc. Hope you all have a wonderful holiday and I hope you'll be willing to offer a shoulder on those really bad days. Thanks so much!

Greetings and Happy Holidays! I'm a 2005 grad and took a job right out of school with an Adult Oncology Outpatient clinic. I absolutely LOVED the job. I was so amazed at their courage and dignity and I felt incredible honored to be allowed to be part of such a personal time in their life. To make a long story short, I left after 5 months because I didn't feel safe administering chemo without significant orientation and specialized education. After a few months off taking care of a family member, I am ready to get back to work. I've been offered a job on a Ped Onc/Hem/Pulmonay ward in a large teaching hospital. I've been very upfront about why I left my last position and they have assured me that I will get the training and support I need. I have excellent patient/family skills and I feel I would do well in this environment, as difficult as it may be when we lose a battle. I take great solice in knowing that I made their lives just a little bit more comfortable, be it physically or emotionally. That being said, can you talk me out of accepting this job? All your comments would be greatly appreciated.

Thanks to all who responded. This has been VERY tough. I think the toughest part is that I felt I had finally found my purpose in life. Sounds dramatic, I know, but after 9-11 I really started to question why I was here, like many my age did. Suddenly the corner office didn't mean a thing. I wasn't even sure about nursing school and questioned my sanity frequently while I was there. But once I started working with these patients, it was a feeling I can't put into words. I found such grace and courage in them. Their faith in a high power even moved me to question why I had strayed so far from my own religion. I felt honored to be with them as they faced their journey and for some of them, their final moments. With them, I believed I would become a better person and grow to have a purposeful life. And now, I don't know what to think. I'm emotionally exhausted. I had a pretty tough childhood and first marriage, and my self esteem has always been pretty shakey. This has just about put me over the edge. I've gone back to seeing a therapist to save my poor husband from having to take the brunt of this (men really do have a hard time with emotions - can't fix it and they become SOOOO frustrated). I'm going to take some time off, take care of some family issues and get my act back together. If you include work & school, it's been nearly 25 years since I've done "nothing". My question to you is this - When I'm ready to climb back on that very big, scary horse, how do I explain that I graduated in December, passed my boards in January, started a job in February, left in May, and took several months off before going back? Failing at my first job doesn't instill confidence in my abilities, needing a break sounds lazy, having a meltdown says "don't touch with a 10 foot pole". Aside from moving and using that as an excuse, any ideas?

I just found out yesterday that I'm not going to be asked to stay at what I considered to be my dream job. I graduated in December (2nd career) after somewhat of a struggle, passed my boards in January and started orientation the first part of February at an Oncology clinic. I LOVED everything about the place - patients, staff, schedule, everything. I could handle the tough emotional situation. What I couldn't do is memorize all the different regimens, drug side effects, etc. There were two of us that started at the same time - there's a 20 year age difference. This old brain just isn't as nimble as it once was, and she just could ramble off the facts like nobody's business. They told me that I had people skills that outweighed anyone there, including the old-timers, but my technical skills weren't good enough for their needs. They were very nice, offered to let me work out the next two weeks and promised to give me great references. What am I feeling now? - depressed, humiliated, guilty, the list goes on and on. I feel like I should have spent every night studying instead of tending to my family. I ignored them for so long during school, I thought I was finally past that. The more I began to feel pressured about it not clicking at work, the less sleep I was getting, the worse my memory became....downward spiral. I don't know how I can ever even apply for another job - I feel like such a failure. Has anyone else had to get back on the horse after being thrown so hard?

I did it! Just got my results and you can add RN to my name. It took 25 years but I did it. Came out of the test feeling numb after 82 questions. Wasn't until I heard someone else in my class failed with 88 that I began to panic. It was a very long weekend, but now it's time to celebrate. Too bad dear husband is away on business. Start my dream job on Monday. Can't wait to get back to work and not worry about studying. Don't know what I'll do with my free time - oh yeah, I can get back to being a mom and a wife! Thanks to everyone who gave such encouragement, either directly or through other threads. For those still waiting to take the exam, remember to just take it one question at a time, celebrate the ones you nail, and most importantly - BREATHE. Good Luck!

lgbentle, You must have been taking the same test I took today! I felt like all I was doing was prioritizing and some of the answers offered...it was like which is the least worst of some really bad answers. I shut off somewhere between 82 and 86 - was totally shocked when it happened. It's a strange feeling afterwards - kinda like a cross between "what the heck just happened?" and being comfortably numb. I'm figuring I either passed or REALLY sucked. The majority of the people in my class are averaging between 75 and 100 questions and passing, so I'm keeping my fingers crossed. I'm so jealous, though. I'll have to wait until late next week. NC - 25th in education, 49th in NCLEX reporting time (thanks California)

I know I am beating a dead horse :deadhorse but that's part of the trouble I'm having here. What if the question read "Anthrax patient, no signs of distress, infiltrated IV" Just because the symptoms are gone doesn't mean that the meds should be stopped/changed. If it comes down to knowing the details of all the drugs, not just the side effects/adverse reactions, I'm scr@wed. One day and counting....Heavy sigh....

See what I mean? So many ways of looking at the questions. I appreciate Suzanne's reminder of the collaborative effort. The way D is written, there is no mention of stopping the infiltration. We were taught to never assume anything and that the answers had everything you needed in them. Two days and counting. Heavy sigh.....

I'm still plugging away at practicing questions. Some of them drive me crazy! For example: A client who has clear lung sounds and unlabored breathing is receiving aminophylline IV. Which of the following would be the MOST appropriate nursing action if the client's IV infiltrates? A) Apply warm soaks to the infiltration site, start an new IV, and continue IV medications. Didn't seem like a good plan B) Wait two hours, reassess the client, and restart the IV if the client has wheezing or labored breathing. That's a no. Can't just stop and not tell Dr. C) Restart the IV and contine the previous medication schedule. Sounded good to me as long as you use a different site D) Call the physician and recommend that the IV medication be changed to PO. My first thought: If the Dr. wanted IV, why would I challenge that? Turns out D is the answer, BUT: Davis says IV aminophylline should be avoided but if extravasation occurs, give local injection of 1% procaine and application of heat may relieve pain and promote vasodilation. So by this intervention A is also true. How the heck am I supposed to work through a question like this? I can't win!

Thanks everyone (and anyone else who wishes to comment). I went out last night and bought the Saunders and will spend the next couple of days reviewing it and doing more questions. I'm praying that my critical thinking skills will hold up. I scored 95% on the NLN compaired to a sad 78% on the HESI. I think the big difference was the knowledge that the HESI was part of my graduation requirements and I panicked. On an interesting note - my 17 year-old was reviewing some of the questions with me and I was amazed at her ability to think through the questions and pick the right answer on many of them. Even with just an anatomy and a sports medicine course, she was able to critical think through them. She used some innate Kaplan-esque ability that she must have gotten from her father :chuckle Wish me luck, pray for me, and let me know if you think of anything else I should be doing. Thursday seems to be coming at lightspeed.

Well, I take my NCLEX Thursday and I'm beginning to panic. Others in my class have taken it and have had everything from 75 to 265 questions. They also said that some of the questions came from left field and they had no clue as to what it was asking. For all of you who have taken it, what would you suggest I focus on for the next 4 days? I took the Kaplan review and have been doing nothing but questions and reading rationales in Mosby and glancing at Frye's 3000. I think I've finally narrowed down how to take tests but now I'm worried that I'm focusing just on how to narrow it down to 2. But some of the questions seem so simple I begin to think that the actual questions are going to be so-o-o-o-much harder and ... :chair: I'm really starting to get nervous. I've accepted a position that I REALLY wanted and now I'm freaking out about how to tell them if I don't pass. In addition to telling me to calm down (my husband has tried - maybe I'll believe it when I hear it from you) what should I do for the next couple of days. Thanks! (PS - I have a history of test anxiety)

Greetings! I took a NCLEX prep class last week and there was one area that we were given conflicting information on. It was about questions with orders for multiple meds. One time the instructor told us that if there were 2 meds you either gave both or held both. Another time she said hold one if contraindicated. For example: The physician orders furosemide (Lasix) and spironolactone (Aldactone). Prior to administering Lasix and Aldactone, the nurse determines that the patient's potassium level is 3.2. The nurse should..... I know there is no true decision tree to taking the NCLEX, but does anyone have any thoughts on this?

Went to school with Dusty Rhodes and Kandy Cane. Have a nephew named Desi Linus - older brother (4 yo) was allowed to pick out the name. Inadvertantly did it to my own daughter in some fashion. We had agreed on using our middle names as the baby's middle, depending on the sex. When she was born, none of the first names we were considering suited her. She just wasn't an Ariel or Brianna. As it got nearer to the time for discharge, the nurses were pressuring me for a name for the birth certificate. I remembered the name of one of the women in my prenatal class was Haley. When I looked it up it meant full of vitality and was perfect. Merrily we signed all the paperwork and it wasn't until days later that I realized what I had done. You see my middle name is Raine, making her Haley Raine. I guess it's better than Sleety Snow. The worst has to be the poor kid in high school whose name was Terry Dick. First day of freshman English a new graduate teacher read off the role and called him Harry. The teacher probably wished the floor would open up and swallow him whole. The following week, the kid had legally adopted his mother's maiden name. Talk about your high school nightmares!

I'm a new grad and have been interviewing for a position with a private oncology practice. My responsibilities will run the gamut from assessing to educating to eventually administering chemo (after OCN). Around here the hospitals all have a set starting rate for new grads - about $18.50. What would be considered "fair" in private practice? Thanks!

CrunchRN, I guess my post was somewhat misleading. Eventually I will be doing chemo - after I complete my OCN. I understand that I'm looking at a VERY steep learning curve, but the nurse manager and staff I would be working with are top notch. They don't typically take new grads, but they are willing to take a chance on the right person. The nurse manager is very hands on, loves to teach, and the practice works with each nurse to assist them as they work toward their OCN. There are 2 nurses that have gone on, with the support of the practice, to get their Nurse Practitioners license. Because of my current stage in life, I need the 8-5 schedule that a hospital can't offer. Oncology and eventually Hospice is where I want to focus my attention, so this seems like the perfect way to get my feet wet, as ling as I go into it with my eyes open. Your thoughts?

I'm a new grad and have been interviewing for a position with a private oncology practice. My responsibilities will run the gamut from assessing to educating to administering chemo. Around here the hospitals all have a set starting rate for new grads - about $18.50. What would be considered "fair" in private practice? Thanks!

Hi. I am a soon to be graduate (Friday) and I'd really like your thoughts on what a new grad should do if she thinks Hospice is her calling. I can't imagine that they want new grads, so where does one start? Which is the more important experience? MedSurg? Oncology? Psych? My clinical rotations gave me several opportunities to provide pallative care and I just found something so special about being with the patient through those last days. I felt honored to be part of it. How do I begin honing my skills to make me ready for this type of work. (By the way, I ain't no spring chicken myself) Thank you.

Greetings! I need help with a careplan for a patient in ICU that has NO chance of survival. This patient has Lymphoma, Hydrocephalus, coccidiomeningitis, severe malnourishment, a ventriculostomy, permanently on a vent, and a Glasgow Coma of 5. Basically, he's just waiting to die. We are required in our clinical rotations to come up with 4 Nursing Diagnosis and the focus on 2, giving interventions and outcomes. I've selected "Risk of lung, brain, kidney and heart tissue perfusion r/t decreased hemoglobin secondary to malnutrition" as one since inadequate perfusion leads to ischemia and death of these vital organs. In reality, there is no chance of positive outcomes. The only one would be to let this poor man die in peace. I've tried to work with "Patient's BP, Heart Rate, and ABGs will remain within acceptable parameters" and "Patient will exhibit no further deterioration of systems" but how do I set a time frame for these? Any and all help would be greatly appreciated.

I am a 4th semester Watts student (female) but I have 3 males in my class. We originally had 5, but 1 left because of illness, the other dropped out because of personal problems. There are now 29 in our class. I LOVE having the guys in class. They add a totally different perspective. My class is very diverse. The youngest member will be 21 next month and I believe the oldest is 57 (and a male to boot). Close to 1/2 of us are 35+ and this is a second career for us (I'm a former HR manager, the guy that sits next to me is a retired chemical engineer). About 50% are married, and we have racial and sexual orientation diversity too. Yes, Watts is VERY traditional. It can be very tough - I cried every night the first few days of 1st semester thinking I could never handle it. But I have. The majority of the staff is excellent (even the sole male :rotfl: ) and very supportive. The best thing about Watts is that you start your clinical experience right out of the gate. By the time I graduate I will have spent time in Geriatrics, Med-Surg, Pediatrics, L&D, Psych, ICU, ED, Burns, Rehab and Oncology. Like your friend said - "the nurses that came out of Watts had so much more skill and they were very sought-after." It's nice to have Duke & UNC recruiters come to you before you've even finished, never mind taken the NCLEX. BTW, the men don't wear the caps (no fair) and you don't wear a uniform to all your rotations. I think I wore it for one clinical rotation last semester. For me, the decision to go to Watts was simple - I got great clinical training, a great foundation, and I was able to do it in just two years & graduate before my kids started college. Let me know if you have any other questions. I'd be happy to put you in touch with one of them-there male nursing types.

Thanks for the tips. I managed to get one to shower in exactly the way you suggested - "I'll let you go outside to smoke IF you take a shower." Another one took the good cop, bad cop approach. One of the nurses ticked her off by telling her to take a shower, but then the "nice" one asked and she did it just to spite the first nurse! My friends think I'm absolutely crazy (poor choice of words, I know) to work in psych, but I love it. So far, every day offers something new and I love trying to find a way to be creative to get them to do what I need them to do, but yet help them retain their dignity. Kinda like having kids all over again, except I can't use "Because I said so!" Hope you don't mind if I pick your brain every so often. It's nice to have someone on the outside to turn to.

I've finally started laying the foundation for my career in psych, even if it is as a CNA II for the summer (one more semester = RN!). One thing I need help with is - How Do I Get These People To Bathe? I'm telling you, the stench from some of them is unbelievable! I'm open to suggestions. I can't wear Vicks under my nose all summer long :chuckle Thanks

No she didn't... While in 2nd semester I had the dubious honor of being the first one in my class to have a patient die while we were in clinicals. Bad scene - I called the code just as the daughter was entering the room. Had to literally tackle her to get her out of the way of the crash cart. Too long a code, too many family members grieving for way too long. Body was good and stiff when I had to do decedant care and take her to the morgue (what an education THAT day was). Instructor never even checked to see how I was holding up. When it was time to go, I asked the instructor what I should do about my care plan homework for the night. She told me I still needed to do one, so make believe the woman had lived!

Thanks for replying. I agree it seems silly to learn things we don't need to know, but that seems to happen a lot! Maybe they're just trying to weed us out by frustrating us to the point that we quit

Hi! Does anyone know what the difference is between Permissive and Mandatory Licensure? I'm currently a nursing student and this topic came up in my text book. Their definition makes no sense to me - Permissive licensure allows for those meeting certain standards voluntarily to be licensed, whereas mandatory licensure requires that all individuals who wish to practice in the field be licensed to practice Can anyone give me some real world examples of this? My 43 year-old brain just doesn't get it. Thanks!