Maerzie

I have been retired for awhile,(2006), but still, it seems insane that ADN's make more than Diploma RN's, who have had so much more practical experience, if they were hospital trained. ADN's get such a minimum of practical experience in this area (Michigan/Wisconsin). I recall some new ADN's that I was orienting, who didn't know a Foley catheter from an N/G tube, and had actually PASSED their state boards. I remember, after sacrificing, working full time as 3-11 Charge Nurse (Diploma RN)of a 32 bed hospital (E.D.. ICU. CCU, Med-Surg, Medical Records, etc.), while also having the expense and stress of going to college 100 miles away, every weekend, to attain my BSN, I got an enormous 10 cent an hour raise after I got my BSN in 1993. Have nursing incomes really gone up that much?

I've been spit at, and had an elderly male reach for my private areas, but the actual GROSSEST thing I can remember was stopping at Penney's on my way home from work, and realizing I still had poop all over my shoes, from cleaning up after an incontinent patient. That was years ago, when I was breaking back into nursing (after years off to raise kids) by working at a nursing home. I also remember, as Charge nurse at a hospital, I was in our tiny, one person med room, all by myself, and passed gas. Immediately after, the pharmacist stepped off the elevator and brought all the prescribed IV's into that very room, as I got out of there as fast as I could. Of course, he couldn't miss the facts of the matter, but we never mentioned it to each other.

I was fortunate in graduating before all the foolishness occurred. I had my education in a hospital-based Nursing School, and received my nurse diploma, becoming a Registered Professional Nurse AFTER I passed my state boards, which are very high requirements in Wisconsin and California. My nursing school actually staffed the hospital, in those days, and, because of all the varieties of hands on, supervised experience, turned out the very best of nurses. I did, later, go on to get my BSN, where more technical knowledge is learned (and got an enormous 10 cent an hour raise, LOL!), but hands-on, supervised, multi-disciplined practice and learning STILL turns out the best nurses, right out of the gate. My very FIRST job was Charge Nurse, on a 52 bed surgical floor. Nowadays, new nurses don't have the knowledge OR the experience to want to be, or accept, any role of being "in charge". At one position, I frequently had several new RN's, fresh out of school and with their new registration, and one, with her BSN, had never even inserted an N/G tube, NOR a Foley catheter, while another, a graduate of an ADN program, did not know the DIFFERENCE between an N/G tube or a Foley catheter! This ignorance should NEVER be put out onto the market, as an R.N.! That is VERY POOR schooling and a shame to their teachers, that they allow such neglect, causing so much fear and insecurity in a new nurse, who trusted that her school prepared her/him well! Practice and experience, including experience of being in charge of a department, is ESSENTIAL to instill the confidence needed by every single nurse. If a nurse feels ignorant and inexperienced, he/she is much more vulnerable to error, which, in nursing, could cause a fatality! No RN wants to have to go to a superior o learn all these things she SHOULD have gotten competence in, as a student, but, these days, there are THOUSANDS (or more?) of these "nurses" out in the market, making nearly the same salaries as the competent, experienced nurses. There is ZERO excuse for the inferior schooling, allowed to claim certification by the NLN, to exist anywhere. It is not the letters, RN, ADN, or BSN, which make the difference. Certification of nursing programs is being handed out too easily, obviously. It's the quality of the school and the amount of supervised experienced skills included in the program. Far too many include only a token amount of hands-on, supervised experience, not NEARLY enough to put anyone's LIFE into those hands. This is NOT the fault of the graduates. It is the fault of the inferior "pancake schools" that are usually sloppily "certified?", and are in a hurry to turn out huge numbers of graduates, without the essential experience. After all, we DO need the nurses, and there is a LOT of MONEY involved! The more corners that are cut, the more inferior the education of the graduate nurses will be. This is,sadly, symptomatic of the current growing disease in our country: GREED! Money before quality!

I have never heard of separating the needle from the syringe. I usually just assess the site in the upper outer quadrant of the gluteus, spread the skin taut with your thumb and forefinger of your non-dominant hand, eye up your target spot, as you "dart" (holding the syringe securely) the needle of that syringe into your selected spot, aspirate for blood, and if none, inject the medicine at the most comfortable rate suggested in the flyer. The insertion is less painful when it's done instantaneously. Hesitating/going slowly for injection is more painful. Sometimes the medicine itself is painful, so slowly injecting helps a little.

Any small SQ needle is fine, but I've always used a #25 gauge (short) needle.

Very nasty, unhelpful remark from an obviously dangerous nurse, who already "KNOWS EVERYTHING!" I'm ashamed to say she sounds as if she's a Newbie, from Wisconsin, by her moniker. No seasoned nurse, worth her salt, would ever be that snarky!

Far too many administrations have become greedy toward the nursing professional needs. I had my last place of employment try to push me out with set-up, crooked, malpractice-type traps, so they could fire me and not have to pay my retirement pension. NOT ethical at all, but pure greed! I was wary because they had done it to two other RNs before me! One of my directors, years ago, had told a group of us: "If you EVER feel like you're being 'set up' to be fired. document, document, document!!" So, I did! I was doing Home Health, at the time. I kept track of times, days, people present, suspicious circumstances, patient name, etc. When the day came, I was prepared, because I found out my contract allowed that I could file a grievance, in defense of the charges. I had to travel a hundred miles to get to the home base, and the committee, but I had miles on THEIR car to use, which I did. It was all very nerve-wracking and stressful, but I wrote up my notes the night before, and did such a good job in my own defense, they didn't have a leg to stand on. I went back to work, and never got setr up again. To this day, I receive my full pension every month. Always be wary of greedy crooks in any nursing/hospital administration. MANY have no ethics or consciences!

Reassess yourself after you are fully recuperated and back to normal. Life happenings, like Major surgery, can knock the wind out of anyone!

Whenever any unknown procedure or piece of equipment comes up, ask your D.O.N., or an experienced co-worker, to demonstrate and watch you accomplish same, before the need arises and you are alone. When I first started my practice, even CPR wasn't invented yet, so many new procedures or equipment will arise, if you practice for years. Usually, when something is new to everyone, there will be an Inservice Instruction.

In 40+ years of nursing, I had moved several times, and I never had a problem "fitting in", or, with cliques. You obviously have to know what you're doing, however. I have worked with (taught?) new "supposed RNs", making as much, or, almost as much, money as I was, who had no idea how to insert a Foley catheter, or N/G tube, and/or could not tell one, from the other, and with zero judgment skills. Many of the short term, "RN? courses", don't have anywhere NEAR enough time given to the actual "practice" skills. Much more practical teaching and actual experience needs to be done, in order to qualify for the title, "R.N."! It is unfair to the new nurse, the experienced nurse, the patients, and the administration, that such shamefully inadequate schools are able to charge high tuition, while letting such scared, inadequately prepared "RNs?", out, on their own, whether they can make it through the "written" State Board exams, or not. Please, somebody at the state levels, update your practical teaching time and experience, BEFORE "pretending" these newbies can be called, RNs!

Just got back from Talledega, so haven't been on for a while. I sort of like this comraderie(sp?) NursieMe

Hi Melissa- A Home Health Nurse does almost everything that a hospital nurse does. Sometimes more, because the facilities are only what is or is made available in the home. Primarily, we do the assessments of systems, wounds, I.V. sites, meds, any treatments, blood draws, IV flushes, dressing changes, or wound care the doctor has ordered, and teaching as indicated. It may be how to do the I.V. medication and flushes by himself or a family member, using aseptic technique; how to change the wound/ulcer dressing using correct procedure per MD orders; effects and side effects of unfamiliar or new medications; and any other physiology/dietary teaching relevant to the patient's condition or predispositions in order to prevent complications or recurrence. Safety teaching is an always present need, especially if a person lives alone. Teaching is done according to need, and in some situations homes are filthy, laden with pet hair and/or excrement, cluttered, poorly lighted, etc. , or immaculate palaces. It is your choice in how to do the necessary teaching, taking into consideration exactly what situation and mental capabilities you are dealing with. Sometimes miracles do occur. Writing instructions for the nurse who may come in your absence is also your responsibility. Reporting unusual signs or symptoms, changes in wounds, signs of infection, new pains or uncontrolled pain to the MD is your responsibility, as is making sure there is adequate follow-up so the ball doesn't get dropped with no resolve. Then, of course, since the government stuck their noses in and began a temporary "sample" data collection on each patient to see if home health care is worthwihile, there is also a booklet of extra questions to be answered every 6 weeks and at specified other times, as, after a hospitalization. These documentations proved so well that home healthcare is worthwhile, that the "temporary" "sample" turned into a "required" amount of additional paperwork, which takes much nursing care time AWAY from the patient. It does, of course, provide quite a number of government workers with a guaranteed job. What I am saying is that the government has made the paperwork requirements in home health nursing almost insurmountable. Paperwork to patient care ratio is about 3:1 because of this creation. It is enjoyable work because you meet hundreds of people of every different character and demeanor that you can imagine. You are also quite independent and have a lot of freedom to schedule your own day without a supervisor (who most probably has less experience and education than you do!) breathing down your back. It is an experience unlike any you will ever have in a hospital or other institutional setting because you have an extremely unique opportunity to think and create and resolve and teach! This is a very rewarding field of nursing. If you choose to use any of this in your need, Melissa, go right ahead.

I cover 100-250 mile radius daily, and, like Hoolihan, I plan my labs as my first patients of the day, take them in to the nearest lab, (regardless of the extra mileage), and the go on to my other patients. Except in winter, I always have an icepack in my cooler, and on those days I have forgotten, I have found patients to be more than happy to give me a few ice cubes in a plastic bag or tied up in gloves. Each test requires a certain colored tube, and the volumes required are always printed on the labels of the tubes I use. When in doubt, I always call a lab tech, which is better than screwing it up, causing a repeat draw and irritating everybody concerned.

I have my BSN + Master's credits, but I have refused all recent administrative positions because the position is synonomous with loss of integrity and ethics. I have seen such rotten administrative dictates in the past few years it would make any real nurse vomit! It is unbelievable what they do to people who are nearing milestones, like being vested in the retirement program or qualifying for full pension. Age discrimination is difficult to prove, but I keep excellent records.

wenron- This is more like the times it is taking our nurses also. I suppose a person can do a sloppy job a lot faster, but a good assessment plus all that paperwork takes a LOT of time. Most bosses arrived at their positions BEFORE OASIS days, and don't have a clue how long any of those take. Yes, you have a GOOD boss. Most bosses in this business are paid to make you cringe and do sloppy, hurried work so the company makes more profit under the guise of good nursing care. Instead it should more honestly be called "profitable piece-work", with the words "nursing" and "CARE" eliminated.