jbee

My first clinical was in a nursing home and for the first week we were paired with another student with a "complete care" patient. With the help of the clinical instructor, we did vitals, turns, feeds, etc. The clinical instructor helped us every bit of the way- although we had done these things in a lab setting, it's very different with real live patients! My first hospital clinical was on a medical floor. The first day the clinical instructor showed us around the unit and assigned us to an RN who acted as a preceptor for the day- just to get the feel of the unit and to see how a day runs from beginning to end. For the rest of the first week we were all assigned really 'easy' patients so that we could get used to the floor, learn where to find items, observe things like VAC dressings, etc. Once again, the clinical instructor (and the nurses!) helped and/or supervised us whenever necessary... nothing to worry about! Also, prior to getting started on the floors, a lot of clinical instructors like to meet with their students as a group and discuss what you're going to see and general expectations- I always found that this calmed my nerves, hopefully it helps you, too. As the previous posters have said, try not to be nervous! I know it's easier said than done (I swear, I didn't sleep a wink the night before ANY clinical I ever had), but clinical instructors are there to help and guide you. They are NOT going to let you get in over your head... ask them, your assigned RN/LPN, or even another student if you have any questions or need any help. Have fun and good luck!

Have you tried agency nursing? You could pick up shifts in the hospital PRN/when available while keeping your peds home health job... although you would only be able to pick up shifts here and there, it would help you to get some hospital experience as an RN. Good luck!

I'm a Canadian RN who is currently working/travelling overseas. I'm hoping to move back to Canada in autumn 2011... however, I'm aware that the job prospects in Canada have not been the greatest for a while now. I was hoping to move to Halifax but have heard from multiple people that they are not currently recruiting externally.... plus, with talk about a strike in 1.5 weeks combined with the current cap on the province's healthcare budget I have my doubts that I'll be able to find a job. I'm starting to look into the possibility of moving to another province and am wondering: 1) where do fellow allnurses.com Canadians work? 2) what is the job situation in your city/town?

I've recently taken a new job and for the first time ever I've run into the dreaded workplace bully. I was very lucky as a new grad: for two years I worked on a floor with very supportive and knowledgeable nurses. They were ALWAYS open to questions and offered patience and guidance when needed. They were amazing mentors and I never felt threatened by any of them. The other night I went into work and, unfortunately, this bully was assigned to be my preceptor for the night. She was HORRIBLE- she yelled at me for making a bed "wrong" and threw the sheets onto the floor, criticized my EVERY move, and rolled her eyes when I asked questions. She even double checked me when I took blood pressures! I left work feeling completely belittled, ready to cry, and inches from quitting nursing (well, at least quitting this job...). After sitting on it for a few hours, I realized that she was the one in the wrong, not I (how can you make a bed wrong?!? Better yet, why would you yell at someone in front of her co-workers and patients for it?). Here are my questions for you: 1) How should I have dealt with the situation? It was a night shift, and she was the charge nurse for the night. I don't think that she would have responded well had I said anything back to her. However, I realize that accepting bullying/humiliation isn't right either. One of my new co-workers, my regular preceptor, told me that this has been an ongoing issue and that I should report it to the manager right away. However, I also don't want to be a "tattle tale" in a new workplace, either. 2) How should I deal with her in the future? I will not be preceptored by her anymore. However, I do have to work with her in a (hopefully) positive environment. I noticed today that my other co-workers just try to avoid her/stay out of her line of fire/do everything "her way." I don't know if it's fair, however, for me to have to tippy toe around her- there is, after all, more than one way to make a bed . Any advice/stories will be appreciated. Thank you!

I just started a new job in which there's team nursing and bedside charting. I've been working in this hospital for three weeks, and so far there's been quite the learning curve! Re: team nursing... The "team" is two RNs paired with one CNA for twelve patients. So far I find it VERY disorganized... there are just too many cooks in the kitchen! I never know when anything was done last (ie. dressing changes, routine vital signs) and things get done twice in a row. For example, today I took a BP on a patient, left the room for a quick moment, and came back to my partner taking the patient's BP as well. It never hurts to double check a BP, of course, but what would happen had one of the nurses forgotten to sign off a med that was passed? A lot of the nurses that I work with prefer that we split the patients and check in with one another throughout the day... I must say, I prefer this method of team nursing, as well. Sometimes we divide the tasks up as a team... for example, one RN will grab the vitals for all of the patients while the other grabs the meds. So far, I've learned that team nursing requires a great amount of communication, patience, and organization. It seems to work well when the team gets along well with one another, but when you have one person with a bad attitude/work ethic the day seems to drag. As a previous poster mentioned, some days it does seem as though one nurse picks up a lot of slack. As for bedside charting, I hate it! It's IMPOSSIBLE to chart in 4 bed wards- your attention is pulled in too many directions. It can also be difficult to dip into a room to chart and listen for call bells at the same time. Unfortunately, we have paper bedside charting, which must be a huge infection control issue. I also wonder if it could be seen as a privacy issue: there's nothing preventing patient in bed #1 from reading bed #2's notes.

Thank you for your help (and for the extra practice question).

Hello- I've recently accepted a new job in a new hospital. In order to give medications, I have to complete a medication quiz. I'm having trouble with a question similar to this: How many milligrams of Adrenaline are there in 2 mls of 1:1000 solution? I've been working it out like this: 1 part adrenaline=1000 parts solution 1g/1000 mls 1000mg per 1000 ml solution 1 mg/ml x 2 mls = 2 mg Am I on the right track? I've been using the following website for guidance, but could certainly use more help/guidance to wrap my head around these! http://www.nda.ox.ac.uk/wfsa/html/u13/u1306_01.htm Thanks!

WOW, thanks for the great answers, everyone! I've never done anything ortho-related, I've never even had a clinical on an ortho floor, so I really didn't know what ortho was all about (all I knew was what I've heard from fellow nurses: HEAVY HEAVY HEAVY). How often does an ortho patient need to be sent to IMCU/ICU? In my current position I send approx. 2/month... would this be the same on an ortho unit? I suspect that preoperatively ortho patients tend to be healthier than the clientele I currently work with- I'm guessing that this would decrease any IMCU/ICU admissions post-op.

Thanks for the reply. "Leave better than when they come in"- that would be a good change. What's the average hospitalization period for an ortho patient?

I'm an RN with 1.5 years of experience who is planning to move within the next month. I have a job interview for an Ortho position next week- however, I know absolutely NOTHING about orthopedics. Can anyone tell me a bit about this population? What kinds of injuries/surgeries are common to see? Thanks!

That I'm fed up with unsafe staffing ratios. I understand that it's sometimes impossible to find a replacement for a sick call... however, when you don't even try because it costs too much $$$ it's unfair to both the staff and the patients. Being understaffed every shift causes more sick time and greater staff turnover. When half of your staff calls in sick for a shift you need to either call somebody in or close some beds.

I use the DivaCup- you can wear it for up to twelve hours, so it's perfect for shift work. I've been using it for six years and have never had an issue with leaks. Like others have suggested, I also keep an extra pair of scrubs in my locker... just in case.

1. What is your age? 23 2. How long have you been a nurse? 11 months 3. Did you work as a CNA before becoming a nurse? yes 4. If yes to #3, how long did you work as a CNA before becoming a nurse? 3 years 5. If no to #3, do you wish that you had? 6. Regardless of whether you worked as a CNA prior to becoming a nurse, do you believe working as a CNA prior to nursing better prepares you to be a nurse? Feel free to elaborate on your response. Yes, I do think that working as a CNA prior to being a nurse helps prepare you to be a nurse. Being a CNA helped me to learn time management, how to approach patients, how to physically care for patients (ie. washing up, cleaning up incontinent patients, feeding, helping with ambulating). I also found that working as a CNA helped me to know how to use certain equipment- for example, I'm one of the only nurses on my floor who is confident in using a lift.

1. What type of education program did you complete? BSN, ASN, Second degree, etc. BScN- This was my first degree. 2. When did you graduate and how long have you been working? I graduated in late May 2009 and I have been working since June 1st 2009. 3. Current position and goals for the future. grad school, specialty? I currently work as a staff nurse in general surgery at a large teaching hospital. I hope to continue in surgery for a few years and eventually transfer to MSICU. 4. Tell me a little about your orientation. How long was it? Was it structured? Did you feel like you were just thrown in? My orientation was eight weeks long. The first week consisted of classroom learning. I also had the opportunity to see some common procedures performed. Unfortunately, about three weeks into my orientation, my preceptor ended up leaving due to illness. After that, I was orientated by 6-7 different RNs- it was VERY confusing. Each preceptor had a different teaching technique and a different way of doing things- although it was good to see how other RNs organize their day, problem solve, etc. I found it very stressful. Also, because I was being bounced around so much, I found that my orientation wasn't very structured- everything felt different every day. In the end, I didn't end up feeling like I was just "thrown in." By the time I was done orientation I felt ready to be on my own. 5. What were the biggest challenges you faced in orientation? when you got on the unit alone? As previously mentioned, one of my biggest challenges during orientation was having so many preceptors- I felt like I was constantly being told that I was doing something wrong as I was constantly being told, "OH, so-and-so taught you that, but this is how it *should* be done." Throughout orientation I also had a hard time with time management. When I started working alone, I found the following things challenging: time management, being assertive (ie. with doctors, more experienced RNs), and delegating tasks. 6. Biggest suprises? I work in a teaching hospital- we constantly have new residents coming in. Whenever I call to get an order for a drug, a lot of them will say, "okay, what do people normally order?" I never knew how to answer! I was also surprised at how supportive my fellow nurses were- I expected that the more experienced ones would "eat their young" but the majority of them have been very willing to answer my questions and pass on advice. I'm still shocked at how much paperwork we have to do- I feel like I'm constantly writing. 7. Did your educational training adequately prepare for the "real world"? No way! I wasn't prepared for how busy I would be, the stress I would face, the long shifts, night shifts, etc. 8. Something you wish you had been told while you were in school? That I would encounter so many rude patients! And that I would make mistake after mistake after mistake. And that some days you'll end up crying in the staff room- and that's okay too! 9. Were more experienced nurses helpful and receptive to your questions? what about the doctors? It completely depended on the person. Some doctors and nurses were receptive to questions, while others were not. I ended up figuring out who was the most receptive to questions and went straight to them if I had any concerns. 10. Any advice for new grads? Take it one day at a time, don't sweat the small stuff (ie. if one of your patients doesn't get washed up until suppertime, that's FINE- some days you have bigger fish to fry!), don't worry about making mistakes (everyone does! including meds!), and don't be afraid of asking questions. If you wind up in a job you hate, start to look elsewhere. Don't be afraid of doctors- they're human, too!

I work on a surgery floor, and we don't have a policy that states whether or not family members can stay overnight- management leaves it up to our discretion. We do have a few private rooms, but the majority of our rooms are wards. It isn't unusual for us to allow family members to stay overnight with a patient- especially if the patient is confused, palliative, anxious, young, or if he/she doesn't speak English. If we know that a patient tends to have a family member to stay overnight (especially if they're palliative or don't speak English) we try our best to get them into a private room. If not, they're generally free to sleep in a chair/the family room if they're quiet and respectful. In your case, where the family member was being neither quiet nor respectful, I would have done just as the other posters suggested: I would have asked him/her to leave, and if that failed I would have contacted security.