AmyLiz

The hospital where I work has the OR staffed 24/7, but even so, everyone (except the "outpatient/ambulatory" staff take call (the hospital has a Level I Trauma Center). We're assigned call, but most people who want extra can get it from the people who try to give it away. It works out pretty well for the most part. People who don't want call will post it on one of our staff bulletin boards & if you want it, you can pick it up.

Here in southwestern Ohio there are several hospitals that have OR training programs. A couple in Cincinnati & a couple in Dayton that I know of are really good. I am in an internship right now & have been really happy with it.

We use pre-printed sheets for counting our instruments. We use another pre-printed sheet for counting sponges & blades/needles. It works quite well for us.

This is straight off of our hospital's website for their requirements for nurses who want to apply for flight nurse positions: Education - BSN required or actively pursuing. Licensed to practice professional nursing in the State of Ohio. Certifications required: Basic Life Support Advanced Cardiac Life Support Basic Trauma Life Support Advanced Trauma Life Support (audit)** Licensed EMT-P in the State of Ohio** Pediatric Advanced Life Support **Must be completed within one year of employment Physical requirements - must meet visual, auditory, and weight specifications. Must pass a physical exam utilizing department criteria. Experience - has a minimum of three years recent active experience in an Emergency Department or other Intensive Critical Care areas. Pre-hospital/transport experience recommended.

I graduated from nursing school this past November. I started an OR internship at a local hospital last month. It's important that the hospital you work at has a good training program. If you interview for a position in the OR, be sure to ask about their training program/internship/whatever they might call it. Ask how long it lasts, if they use the AORN training guidelines, etc. I've learned so much already after only being there for a bit over a month...there's a ton of information & you might feel like you're back in nursing school, but the big difference is that if it's something you're really interested in & enjoy, it's not so bad! I really love it & don't regret jumping straight into the OR. I knew in school that floor nursing wasn't for me! I was good at it, but I really hated it! Now though, I love my job & I can't imagine being anywhere else.

Heck, I didn't study much either. Didn't have any motivation to study until one of my friends failed it. That lit the fire under my butt to study a bit! :) I really only studied for about a week...a few hours a day (ok, maybe 1-2 hours a day...if that). The day before I went over EVERYTHING I could think of just to keep it fresh in my brain.

Depends on the hospital. A classmate of mine is now working as a new grad in an ER without any prior experience (other than observing once in nursing school). A few of my former classmates are getting into ICU, NICU, CICU through internship programs at a few of the local hospital. These internships combine classroom teaching (above what you would get in nursing school) and floor time with a preceptor. So far, everyone is really liking that approach because it eases you in & gives you confidence better than just throwing you in without formalized training.

I work for a large clinic (24 chairs, total of around 150 patients). We have several buttonholes that are just fantastic...really easy to pop those needles in. Others...well, we had to give up on because they would just NEVER establish the tunnel! Then you get the odd pt who gets a nice established buttonhole & then something weird happens & the AVF shifts or something & you can't find the tunnel anymore (which happened to one of my patients a few weeks ago...the arterial buttonhole is still there & great, but the venous is no where to be found, so I have to re-establish that one. ) Sometimes I wish we hadn't started the whole buttonhole thing...there are several patients that I had never had trouble sticking with regular sharp needles, but now that they're buttonholed, I can't get the darn needle in the AVF...due to the angle or whatever that the establishing cannulator used. Other times, it's great. Kind of a hit or miss thing.

You can start looking at the job boards now. Maybe start sending those resumes out in February or so. I graduated at the end of November & some folks started sending them out in late September, early October with some good results. Others waited until November & got jobs easily too, so it just depends.

Not sure if this is possible for you, but in our clinic we have a few pts who have issues with clotting who cannot be on heparin (and some who have clotting issues even with heparin!), so we put them on a saline drip at 200cc/hr per plum pump hooked up to the dialysis tubing.

Don't know much about MSJ, but I have heard that Xavier's got a great nursing program. It's kind of pricey to go there, but it's a great school.

I'd say it would be good experience. I work as a dialysis tech currently while going to nursing school (graduating this fall...yeah!). You may want to look around...sometimes there are PCT positions that just work you on the weekends, so you can have the week to devote to school. Miami Valley Hospital has these positions, but they go quick, from what I hear.

It depends on your unit. I work at a 24 chair chronic outpatient unit as a tech (graduating from nursing school this fall) & it can be quite stressful. A couple friends of mine work at a different outpatient unit & say it's really laid back usually...it just depends on the unit & the acuity of the patients.

We are required to pass a dosage calculation test consisting of 10 questions every term of the quarter. We have to get 100% on the test each time or we fail the class and are out of the program. I don't see how that's unfair though...I mean, when you have to deal with calculating drug dosages for pts, I would want my nurse to know 100% what they're doing. :) Our program also has an attendance policy...we're not supposed to miss a class or a clinical, but if we are sick or whatnot & absolutely cannot make it, usually we're given a chance to make it up, but really...it's discouraged to miss.

Thanks! I will ask our biomed engineer. Our facility is an older one, so perhaps that is the problem.

Yep, we can use calculators. I agree with shock-me-sane though, really...you don't necessarily need them, since it's not too terribly difficult, but it makes it go much faster!

This quarter we lost a lot. Still have 4 quarters left in the program, so I can't give you final numbers, but... There were 80 students to begin this quarter...8 class sections with 10 per class. In my class, which just ended last week, only 5 out of 10 passed. Thank God I was one of them!

Anyone out there using Braun machines? Our facility has 24 chairs & lately we've been having a run of Reverse Ultrafiltration warnings on the machines. We've been trying to find some sort of pattern to it...for awhile we thought perhaps we had a faulty lot of dialyzers since most of the ones that were alarming were using F200A's, but lately, we've noticed that it's not just the F200A's...now we're getting some on the F8's. There's no rhyme or reason...not the same machines that are alarming. We've been keeping track & can't find anything. Everyone (including our biomed engineer) is stymied. Any ideas? Anyone else out there having similar issues? AmyLiz, OCDT, CHT

We've had one pt code in the 2.5 years I've been at my clinic. It's rare. If a pt starts to look or feel funny, we usually dc their tx and send them off to the hospital before anything really happens. AmyLiz, OCDT, CHT

NatKat pretty much nailed it. Wrong dialysate, although it's a problem, isn't hard to fix. It's pre-mixed (at most clinics), so the only thing you could bone up would be if you picked up the wrong jug. At our clinic, someone goes behind you and re-checks everything (our policy is within 1/2 hour of the start of the pt's tx), so mistakes are quickly rectified usually. Our clinic has 24 chairs, but it's split up into 3 sections of 8 chairs. Usually there is at least 3 people working each section, a combo of techs and nurses. Not too bad if you look at it that way...plus we have a charge nurse that is helping out in each section as needed during turnovers, etc. Dialysis isn't a bad gig. Sure there is higher chance of exposure, but as long as you take precautions, it's not bad. I always wear gloves...if a pt's sit starts to bleed like heck & I'm ungloved, I usually grab a chuck & press it onto their site & wait for someone to come gloved with some gauze. Our clinic has a rolling sharps container in each section, so when you go to take out someone's needles, you can take them out & immediately put them into the sharps container. We wear impermeable lab coats, so that's not an issue, and we have sheilds or masks, goggles or visors that we wear incase of splatter or squirts. You may want to see if you could perhaps job shadow a dialysis nurse. That would give you a better idea of HD nursing is for you. AmyLiz, OCDT, CHT

I am a dialysis tech. My job is similar to what the dialysis nurses do, but it's limited in certain aspects (like giving meds, doing care plans, assessments, etc). Basically, I prep the pt for treatment...get his/her vitals, weight, etc...ask if they're having any SOB, chest pain, Nausea/vomiting/diarrhea...check for edema...confirm their ID (for their reused dialyzer). Then I initiate the treatment...skin prep, insertion of needles (our unit has lidocaine that I can administer to a pt if they request it) or catheter prep...hooking up to the machine & starting the treatment. As a tech, I am only permitted to administer heparin (into the machine...it doses it throughout the tx), lidocaine, O2, and normal saline. The nurses administer other meds (such as epogen, venofer, etc). Throughout the treatment, I write down their vitals qh or prn, watch for s/s of hypotension/hypertension, etc. After the tx is over, I recirc the pts blood back to them with normal saline & dc the tx (pull needles, etc. It's interesting and really gives you good experience. I had no medical experience when I got this job & it helped me out with nursing school a lot. (I've only got about a year or so left in nursing school) AmyLiz, OCDT, CHT

pass/fail at my school too. We get a midterm evaluation from our instructor as well as a final evaluation.

BP goes up after blood return simply because of the increase in fluid volume. As for squeezing the bag...I don't do it...I use the machine, since it's easier to monitor exactly how much saline you're infusing.

I've heard anywhere from 4-6-9 months. I imagine that yours should be done by the time you need them. Our school has them done electronically...they're ready in 2-4 days. So I guess if your prints aren't done by a couple weeks before the exam, you could do them again electronically. They have information on the Ohio Board of Nursing website, under the licensure section.

I personally have not been to a pt's funeral, but several of my co-workers have gone in the past. I can't say that I would or wouldn't go...it would depend on the pt and when the funeral is (a lot of times the funeral is on a day I work). The closest thing I've done is that I went to the viewing of the grandparent of one of my pts. The pt was young (late 20's) and his grandfather had taken him to dialysis every day for 10+ years and sat with him the whole time. The viewing was on a Saturday & (I along with a couple of co-workers) went after work to pay our respects.