yinit9278

Can nurses in the community setting choose to hold a medication without obtaining a hold order first? For example if you have an order to administer miralax every day at 3:00pm but the patient has diarrhea. Can the nurse choose to not administer it without obtaining a hold order from the physician due to appropriate nursing judgement, and documenting the hold as such? This may be a silly question but I have found that there seems to be more grey areas in this setting due to difficulty in communicating with the physician directly in a timely manner. Sometimes it can take up to a week to get a response/clarification to the order, which could result in negative outcomes. At the same time, I'm not sure if such a decision is outside of our scope of practice. Any insight or thoughts would be greatly appreciated!

Hi all, I want to apply for my dream job as a public health nurse for a town in my area. I have been employed for several years now in different community settings and my resume/cover skills have gotten rusty. If anyone has any advice/suggestions I would really appreciate it! I am sorry if this is too long . Also my resume fits on one page but I used size 9 font , thoughts if that is taboo/ what should I remove? Cover Letter: Dear, I am writing in response to the Public Health Nurse position for the town of X. I am a bilingual (Russian speaking) BSN educated RN, with four years work experience in various community settings. I am very passionate about health promotion and have extensive experience in primary and secondary disease prevention. Currently I am a Nurse Supervisor and Policy & Procedure Compliance RN at an Adult Day Program in X town. In my roles I have successfully prepared the program for Initial DPH Licensure by ensuring compliance and implementation of all relevant policies and procedures. I created and currently maintain the QAPI program and its committees at the facility. I also developed, coordinate and participate in a multifaceted educational and training program for all new employees at our program. I am highly organized with well regarded administrative and supervisor strengths. Proven leadership and training abilities. I am a reliable and ethical healthcare provider with an ability to facilitate groups and educational seminars, and to collaborate on multidisciplinary teams. I believe that I would be I would welcome the opportunity to interview for this position and discuss how I can fulfill your nursing needs. My resume is attached to this email. Please contact me via phone at [COLOR=#1155cc]XXX-XXX-XXXX [/COLOR]or email to arrange a mutually convenient time and date for us to meet. Warm Regards, yinit9278 BSN, RN Professional Experience Policy Compliance RN & Supervising RN (2/2015-Present) · Supervise a nursing staff of four RN's, three LPN's, one medical assistant and 6 program aide's. · Successfully prepared X ADHC for Initial DPH Licensure by ensuring compliance and implementation of all relevant policies and procedures. · Created and currently maintain the QAPI program and its committees at the facility. · Developed, coordinated and participate in a multifaceted educational and training program for all new employees. · Coordination of internal compliance review and monitoring activities, including periodic reviews of all program departments. · Provide screening for patients upon admission to the program, during monthly assessments and on a prn basis, including developing plan of care and comprehensive assessments upon admission. · Developed and implemented care plans specifically designed to meet the unique needs of each individual client. · Facilitated integration of clients in achieving optimum wellness with the goal of independence in the home as long as safely possible. · Recognizing and reporting on early s/sx's of adverse changes in the patient's conditions, and providing proper treatments/interventions per MD order. · Working together with a multidisciplinary team of healthcare professionals and community support services assessed and provided for physical and psychosocial needs of adult clients with acute disease processes. · Promote positive long term health outcomes through patient education tailored for their specific needs and disease process. BSN RN; X program for girls w/ psychiatric and behavioral difficulties (9/2013- 9/2014) · Developed and implemented care plans specifically designed to meet the unique needs of each client in my caseload. · Keep all caseload medical records up to date, scheduling any necessary appointments and or follow up for each student. · Assessing, planning, implementing and evaluating individual patient care based on bio-psychosocial needs. · Planning and teaching Sexual Education, Medication Education, Health Education and relapse prevention. · Administering medications, assessing for side effects and EPS. Assessing need for PRN medications. · Providing a safe and therapeutic milieu, including identification and intervention to early cues of agitation. BSN RN; VNA Company (7/2013- 11/2013) · Effectively determined risk for re-hospitalization, falls, pressure ulcers and home safety risks as part of the initial assessment and implemented appropriate interventions. · Referred clients to the appropriate discipline for ADL/IADL assistance as needed for personal care. · Compiled and completed documentation/ EMR to Medicare standards, organizational policies/procedures, and government regulations. · Supervised and supported HHA, LPNs in the field. · Served as a patient advocate and recognized for patient satisfaction. · Successfully utilized multi-tasking skills in a fast paced and challenging environment. Graduated: May 2013 X College Boston, Massachusetts CERTIFICATIONS: Bachelor of Science in Nursing RN Licensure, Active expires July, 2018 American Heart Association, BLS for Healthcare Providers (February 2017-February 2019) Fluent in Russian, Native Speaker Demonstrated Skills · Caring Nurse confident in patient care and needs assessment · Exceptional clinical skills including comprehensive assessments, treatment of infections and wound care. · Quick study with an ability to easily grasp and implement new ideas, concepts, and methodologies · Strong communication, interpersonal, analytical, administration, organizational, and problem solving skills · Thrive in both independent and collaborative work environments · Proficient in a variety of computer programs, including SNAP, PeopleSoft, and Microsoft Office Suite

I really appreciate the support, your post makes it easier to face putting on my scrubs tommorrow to go back in there :).

I wish I could move but it's not an option. My fiance has a stable and steady job and in this economy that is just not something you give up, and we recently purchased a condo together . But thanks for taking time out of your day to reply! Just knowing someone out there cares enough to do so makes me feel a little bit better :)

Hi All, I'm a new grad with a BSN in massachusetts that would ultimately kill to find a job in a hospital setting! However, I couldn't get a job anywhere except in a sub acute rehab facility. I am feeling very overwhelmed and discouraged, and seeking some support! I am still training but the patient ratio of 14:1 seems extremely overwhelming, they are still on paper med orders, so no emar :-(. All of the meds are written on paper and I have to search for all patient meds in my med cart, narcotics included! I am terrified of making a med error and feel extremely pressured to move at a faster pace, but have no idea how I can possibly give out meds to so many patients any faster and still practice safe nursing. The seasoned nursing staff seems overwhelmed, and dont have time to evaluate for preventative care. So its feels like they are always solving problems with patients if/when they happen instead of assessing for and pro-actively preventing them in the first place. This is not the type of nursing care that I was trained to provide and I leave every day feeling extremely guilty! I am struggling to see how I can manage my time effectively with meds and also complete every patients treatments. I came home today practically in tears, I cannot imagine doing this on my own three weeks from now! I cannot seem to find the light at the end of this horribly long tunnel... What makes this worse is that other nurses have expressed that hospitals don't view this job as actual work experience, though I cannot imagine how that is possible! This place takes multi-tasking to a whole new level! Do you guys think I am wasting my time here? Any advice on what I should do to eventually open up pathways that would lead me into a hospital?!? Any and all advice will be greatly appreciated!

Hi All, I'm a new grad with a BSN in massachusetts that would ultimately kill to find a job in a hospital setting! However, I couldn't get a job anywhere except in a sub acute rehab facility. I am feeling very overwhelmed and discouraged, and seeking some support! I am still training but the patient ratio of 14:1 seems extremely overwhelming, they are still on paper med orders, so no emar :-(. All of the meds are written on paper and I have to search for all patient meds in my med cart, narcotics included! I am terrified of making a med error and feel extremely pressured to move at a faster pace, but have no idea how I can possibly give out meds to so many patients any faster and still practice safe nursing. The seasoned nursing staff seems overwhelmed, and dont have time to evaluate for preventative care. So its feels like they are always solving problems with patients if/when they happen instead of assessing for and pro-actively preventing them in the first place. This is not the type of nursing care that I was trained to provide and I leave every day feeling extremely guilty! I am struggling to see how I can manage my time effectively with meds and also complete every patients treatments. I came home today practically in tears, I cannot imagine doing this on my own three weeks from now! I cannot seem to find the light at the end of this horribly long tunnel... What makes this worse is that other nurses have expressed that hospitals don't view this job as actual work experience, though I cannot imagine how that is possible! This place takes multi-tasking to a whole new level! Do you guys think I am wasting my time here? Any advice on what I should do to eventually open up pathways that would lead me into a hospital?!? Any and all advice will be greatly appreciated!

After graduating from the hell that was nursing school I firmly believed that I knew all I could know for the Nclex. I just felt like if in four years I didnt know enough to pass then it was futile to attempt cramming more information for a couple extra weeks. I spent the next few weeks after graduation relaxing, spending time with friends and reading books that I never had time to while in school. The night before the Nclex I took several practice tests using Prep-U just to calm my nerves. I took the exam on July 2nd and when I came out I felt awful, there were questions on diseases I never even heard of, and the wording was often confusing. However I knew thats how the test is supposed to make you feel. I got 110 questions, and was just glad to have it over with. I met a friend for drinks to calm ny nerves and did the Pearson Vue Trick together at the bar, after a substantial dose of liquid courage haha. I got the good pop up and the next day my license number was posted on my state nursing board! Anyways just wanted to share, this may not be a good idea for everyone but if you were the type that would test poorer when they overstudied heed my advice. If you are in a good nursing program and truly earned your diploma you should be ready and able to pass the Nclex, I am living proof!

Hi guys I could really use some help, these lab value interpretations are driving me crazy!!! So I had a patient last week that I'm doing a soap write up on. He had sustained burns from an unknown caustic substance on a large portion of his face and head and in several areas on his upper right side. He has undergone several ftsg procedures. I am trying to interpret his lab values and am running into a bit of a snag here. His WBC is high overall with high neutrophils, but he has low lymphocytes and monocytes any idea for why that is? I know that high neutrophils are indicative of bacterial infection and that lymphocytes and monocytes are elevated if there is a viral infection, but what I don't get is why they are abnormally low lymph (7%) mono (2%)? Also his RBC count is low @ 2.5 as is his HGB (7.7) and HCT (23) while his platelets are high (456). I know that the rbc, hgb & hct indicate that he has anemia, but why would the platelets be high? Anybody have any suggestions for these discrepancies? Thanks!!!!!! Any help will be very appreciated

I'm a first year nursing student at Simmons college, and I personally, am a very emotional person. The realization that at some point or another I'm going to have to either witness death, or to tell someone that they are dying is terrifying to say the least. When as a professional in a health care field is it ok to cry? There was an interesting article in the NYtimes online http://www.nytimes.com/2008/04/22/health/views/22essa.html?ref=views but, I feel like it skirted around the issue, and just stated various opinions. I personally think that showing that I care, be it though tears, or laughter does not matter as long as my pt will understand that I care about them. On the other hand how do you know if ur pt will be ok with you crying, or if they'd rather you were strong?? This just seems so difficult to even think about, my mind is reeling!! :uhoh21: