NurseRatched67

Used as a 15 minute premedication IVPB in chemo patients. I have never seen it as continuous.....

Make sure you document what you saw and what you did (report it to the RN). You did exactly the right thing, just make sure you cover you butt by documenting the blood on the sheets and that you brought it to the nurses attention.

I think most RN's on here will tell you that the pumps beep TOO MUCH! To clarify your situation...yes the pump will be if you are trying to infuse a piggyback without the clamp on that line open. Let's say you have a mainline (line A) of .9NS infusing and you are going to hang another medication as a piggyback (line B). You can program an infusion pump to run a few different ways. One way is to run both lines (A&B) concurrently, another is to program (B) to run, while (A) is on a delay. When you do it this way, then once your piggyback infuses, your mainline (A) will restart on it's own. The third way is to run line (B) only. If you want to infuse line (B), then you have to make sure the clamp is open on your piggyback or else the machine will beep. It will beep if you run line (B) alone and let the line run dry, and the pump "cassette" backs up with air. The machine will not necessarily stop and beep if there is a large amount of air already past the cassette (i.e. you didn't prime line well enough). The pump will also beep if the line is occluded...that is if it is pinched off or there is air backed up in the cassette. If your pump beeps, then stop all lines...check your settings and restart. Take your time on pumps... I see too many new nurses rushing through pump settings and making simple errors in programming. Breathe and slow down. Don't always trust the pump to do ALL the work for you...make sure your lines are primed, right tubing is used, clamps are properly open or closed and the pump is not malfunctioning before you start your infusion.

Here's a little trick I learned. I have a little solid tin of a perfume called "Karma" by a company called LUSH. I keep it in my pocket and if I have to clean some one up..I take a litte and rub it under my nose (then wash my hands of course!). It smells really nice and clean and takes away at least one factor in the poop-phobia! After a few years you will embrace the poop and learn to do things like melt a bag of hersey's kisses on a bedsheet to help initiate the new RN's and CNA's. LOL!

Hi, I live on the north side of Chicago, just north of the Lakeview area. The two area's you mention are different in their proximity to the downtown area. Lincoln Park will be closer to downtown then Lakeview. Both areas are nice and have good transportation north and to downtown. Northwestern is downtown and would be easy to get too from either area you are interested in. Rush and UIC are a bit more challenging and would take you way more time to get to on public transportation. Both of those hospitals are not exactly in the greatest of neighborhoods as well. You have a few more options then those three hospitals...if you are looking for major hospitals then you have Illinois Masonic and St. Joseph's close by, Evanston Hospital and St. Francis just north and community hospitals like Swedish Covenant, Thorek and Mercy close by as well. If you are an ER nurse who loves the adreneline rush, you also have Cook County and Mt. Sinai hospitals south of the city. (Both of those see alot of action!) All the hospitals here have pretty standard and decent benefits, but the salary ranges are big. UIC's nurses are unionized, with better pay, but they are going through some rough times right now with staffing ratio's. Salaries are varied throughout the city and depending on your years of experience. Big question is "will you have a car?". Northwestern is better off being accessed by train, as you will have to pay to park in a remote lot with a shuttle. Most folks working at NW take public transportation. If you have a car, you can also consider a few more close in suburban hospitals that you may find better different pay levels and shifts. As for Critical Care - Mt. Sinai, Cook County, NW, Illinois Masonic and Evanston are all Level 1 trauma ER's. I'm not really sure about the others in terms of levels. You will probably find more critical care positions at these types of hospitals. If you are a childrens nurse, then Children's Memorial Hospital is in Lincoln Park and is world reknown. Hope this helps...let me know if you need anything else!

I work in outpatient Oncology. We change dressings on PICC lines and draw labs using nothing smaller then a 10cc syringe. We flush with NS 5-6ml, then drawback and waste 5ml-6ml, then switch syringe and draw labs. We put vacutainer device on draw syringe, not on PICC port directly. You want to limit pressure on vital, small lines. We put new extensions on for our patients (because they go home and flush their own lines daily!), flush with NS and heparin. The only time we would not draw from a certain lumen of a PICC is if it is being used for TPN. Our patients usually come in with double lumen Hickman lines so we only draw off the lumen not being used for TPN. Again, that is in an outpatient setting. What is done as an inpatient may be different.

Not going to happen...unless they want the largest population of nurses in the field currently (45 years of age and up with ADN's) to all leave nursing? The ANA has pushed this agenda for years, claiming that a BSN will give more credibility to the nursing industry. I know that obtaining Magnet status in Illinois hospitals does not mean that LPN's get the axe. I will agree that sometimes it means that an LPN get's converted in his/her duties to more of an advanced CNA type. It really depends on the hopsital and their staffing needs. There is no way they will mandate a BSN by 2010, 2/3 of their RN's would leave the field.

I agree with the poster above that you need to look at this as a learning experience. I would write down in a journal everything that transpired that day....from your overload of patients, to the lack of CNA assistance to the doctors response. Find a co-worker who you trust or a manager in the same light. Ask for some time with them and go over one to one what happened. Examine what was happening and in what order and if anything could have been changed. Don't be scared of feeling "blamed"...we've all been there and felt that no matter how great the care was we provided, it still wasn't good enough. Have someone to work with to answer you questions. Some times when we are busy, we fail to realize that the floor and other staff members might just be as busy as we are. Don't feel that asking for help in examining that day is an indication that you did anything wrong. We all that hindsight is 20/20, but it's good to purge this from your brain and see if there are some ways that you didn't think about at the time to help you in the future. Talk it out with your manager...you'll feel better.

I'm sorry...the appropriate response from the nurse you asked should have been more along the lines of... "That level is not usually compatible with life"..followed by..."Let's go look at his labs" and see what's going on. Or..."maybe it's an error (seeing as your patient was still alive and fine!!), why don't you look up his labs and make sure that it's not just human error. You don't chide or critize someone who is asking for your help or opinion. You help them. In the end..only kindness matters.

We need to have a more open, constructive dialogue on how this problem can be solved as a whole. RN's that say new grads are cocky? That's a double standard really. We want new grads to come in confident and rarr'in to go if you know what I mean. Most of the time what appears to be "cockiness" is just a defense mechanism that new grads have to help them keep their confidence level up. Established RN's have to step back and look at their experience as a new nurse. I'm sure we have all felt horrible at times, either as the bully or the picked on kid. What's the real problem here? Do we have two groups of RN's that won't admit that they are intimidated by each other? LOL. New grads...what you learn in school is only 1/100th of what you will learn as a nurse on the job. I know that the excitiment and pride of becoming an RN makes you feel like you are going to burst sometimes. You must learn to find a balance between the book world of a student and the chaotic world of a practicing RN. I think we need solutions. Ideas from both sides on how we can make this better. What do we all want? Not just a "be nicer" attitude. We all know there are misconceptions behind all of our attitudes on this subject. What are the real day to day, operational problems for why this is occuring? One suggestion I had for my manager was that all orientees meet with their preceptors and managers for lunch before they even hit the floor. I think watching the interaction of both parties prior to training will provide valuable information on if this is a good fit for both. Should'nt the goal be that BOTH parties have a good experience? That will only help retention of staff and the ability to put this horrible "eat their young" phrase in it's grave once and for all. I would love to hear ideas from both sides on some ways we can make this better...without blame or name calling.:redbeathe I say that we get an idea thread together. I would love to see the information complied be sent to somewhere like nursing spectrum or to the ANA for publishing. Maybe, just maybe...if we work together...we can start making a change...

This may help clear things up for you.. Oncology is oncology. The differentiating factors are if you are looking at "sub specialties" in oncology. For instance...if a patient is diagnosed with an abdominal "mass", then they may be referred to a "surgical oncologist", who may perform surgery and if adjuvant therapy is needed after surgery either follow that patient themselves OR refer them to a "medical oncologist". A medical oncologist is usually a doctor who specializes in treating patients with regimens of chemotherapy. There are many specialites within the medical oncology field. i.e. Heme, Neuro, Breast, GI, Gyne etc. There are also Radiation Oncologists who strictly deal with patients needing radiation, either before, after or in conjuction with surgery and/or chemo. Think of a medical oncologist like you would a specialist, one who you would see in their office for your visits. They would follow your care and order tests, labs and regimens of treatment. Most cancer patients see their doctors at least once a month if not more. Then the next confusing part is where all of this physically takes place. Radiation therapy is done in the Nuclear Medcine or Radiation departments at hospitals and even some outpatient centers. Patients can sometimes have radiation while being an impatient (one who is admitted to a hospital unit/floor) or can sometimes have radiation on an outpatient (they go home after treatment) basis. This is the same for chemotherapy. Some patients will be required to be hospitalized for some treatments depending on their disease and regimen of drugs. Chemotherapy is also given on an "outpatient" basis at cancer care centers all over the USA. These centers are usually affiliated with the hospital that the patients doctor is affliated with, but not always. So in a nutshell...Oncology is oncology, but within the "oncology" tree there are many branches of sub specialities. If you are an RN, you can work on a hospital "floor" which is an inpatient unit. You would typically be caring for oncology patients who need to stay a certain length for whatever reason. They may be there because they are reacting to medications, they are in pain, they are having cancer related problems (ie. bowel obstructions requiring surgery), or they are dying. The inpatient floors may even get patients who have had a reaction during outpatient chemo infusions. Outpatient chemo infusions are done at a center where a patient comes in and is hooked up to their medications for the necessary amount of time and then they go home after. Blood & platelet transfusions, hydration, electrolyte riders and bone marrow transplants or biopsies are also sometimes done on an outpatient basis depending on the situation and patient. It would be good for you to ask which RN's here work inpatient or outpatient. That could probably give you a better idea of what is happening in their world!

Have you ever considered Botox injections for excessive sweating? I know they do them under the arms, and for palm sweating as well.

The "westside" of the city is actually quite rough. However, if you are really talking "western" suburbs of Chicago, that is totally different. Apartments in the city itself, can range from 1000 a month or more on the Northside to 2000+ in the downtown area. (you have to pay for your view of Lake Michigan sometimes!) The Northside has many neighborhoods that are safe, moderately priced for housing (rentals) and close to transportation and hospitals. For example a one bedroom apartment in Lincoln park in a "3 flat type of situation" may cost you 1500+ vs. a multi unit apartment building in that same area for 1000.00 a month. Further north you have areas like Wrigleyville, Lincoln Square, Wicker Park, Andersonville etc. Areas get a little less expensive the futher north in the city you go. You also have the North Shore suburb of Evanston, were Northwestern University's main campus is located as well as two hospitals, Evanston and St. Francis. Evanston has very "divided" neighborhoods. Some are cheap, but a bit rough and others can be as pricey as the best parts of Chicago or even more. There are alot more single family homes in Evanston, but the average price there is about $325,000 (median price range). It really depends on what your lifestyle is like as well. Are you looking for a house vs. renting? Will you have a car? How long would you like your commute to work be? Do you prefer to commute by car or public transportation? Do you think you want to work in a major hospital vs. community hospital, VA hosptial or public aid clinic? For instance, the southside has some major hospitals and lots of opportunity for work. There is public transporation, but certain areas of the southside would probably require you to have a car to get around for your travel besides work related commute. The southside is a bit more "spread out". My suggestion would be making sure you are close to public transportation if you move to the southside. Also make sure you know the "neighborhood". The southside has a reputation of being "racially divided" in most areas. I can say this with confidence as I grew up on the southside. While it's improved in the diversity of neighborhoods somewhat, there are still very divided lines and neighborhoods. There are also a lot of "up and comming" areas in CHicago. My friends bought a place in the "Ukranian Village" area about 4 years ago and it's booming there now. I've lived on the southside, northside and in the south suburbs. There is so much to choose from, it just really depends on what type of lifestyle you are looking for here.

Two doctors and an HMO manager died and lined up at the pearly gates for admission to heaven. St. Peter asked them to identify themselves. One doctor stepped forward and said, "I was a pediatric spine surgeon and helped kids overcome their deformities." St. Peter said, "You can enter." The second doctor said, "I was a psychiatrist. I helped people rehabilitate themselves." St. Peter also invited him in.The third applicant stepped forward and said, "I was an HMO manager. I helped people get cost-effective health care." St. Peter said, "You can come in, too." But as the HMO manager walked by, St. Peter added, "You can stay three days. After that, you can go to Hell."

I think actually asking them to clarify, in front of the whole staff and nursing students, exactly what they meant by their conversation (since you are obviously a student and would need clarification.:icon_roll) would have been an interesting approach as well. I would also praise them for offering to do the jobs of the RN's on the floor, and that you would be happy to let the charge nurse know that they will take care of a few patients. That way the RN's could go to lunch. Thank them alot for their gracious offer to help, and tell them you are impressed as a student to find doctors willing to go out of their way to help nurses get "prioritized". :rotfl::rotfl::rotfl::rotfl:

1. That ALOT of women poop while delivering a baby lady partslly...and have no idea until the wafting smell makes it their way. Followed by complete silence in the delivery room. 2. That Nurses are some of the only people who can use emesis basins (new, clean ones) to eat their lunch or birthday cake out of. 3. Using a new plastic bedpan as a birthday cake mold is really funny. 4. That putting your face anywhere in arms length of a actively laboring patient who does not have an epidural.....is never a good idea. 5. That people's butts are really "pimply". 6. That cancer patients can sometimes have a wicked sense of humor. (pt playing scrabble..."tits and ass" were words on the board. 7. That women who don't wear socks with shoes have feet that stink more then their crotches. (remember this ladies, in the summer, if you are having your pap done!) 8. That being called "dear" or "honey" by the 80 year old man is actual endearing and not sexual. Calling him "troublemaker" in reponse is also endearing. 9. Doctors who are patients are the biggest babies. 10. When starting your first IV, don't wear white pants or scrubs.

Don't overlook proper amounts of calcium in your diet as well. One thing you haven't mentioned is if your back is also bothering you, or if it's just your feet and legs. A friend of mine who stocks shevles at Home Depot always wears a flexible, cloth back brace to help his back. It takes pressure off his lower back and helps his legs at the same time.

Read this... Good article on fever and neutropenia... http://www.cancer.org/downloads/CRI/NCCN_Fever_2002.pdf

Since Chicago is a large city, there is ALOT of opportunity for RN's. There are too many hospitals to list and usually Chicago is divided into what is known as the "southside", "northside" and "westside". Eastside would mean you were working in Lake Michigan! hahahaha Chicago has great public transportation to and from most areas of the city, but depending on where you want to live..it could still mean a long commute. For instance...Northwestern Memorial Hospital is a huge, very prestigious teaching hospital located in the downtown area of the city. They offer good benefits and can actually help you find housing to work there. However, the cost of living in that area is high and NWMH is a bit lower in salary ranges for RN's then some of the other hospitals. Bigger isn't always better. You have Northwestern, Illinois Masonic (Advocate Health), St. Joseph's (Resurrection Healthcare) being the larger hospitals in the city but North of downtown. You have Rush University, Christ Hospital, Mount Sinai, Stroger, Mercy, Unv. of Chicago, UIC being bigger hospitals further South and West of the downtown area. Then you have a HUGE amount of major hospitals in the suburbs that surround Chicago. Evanston Hospital, St. Francis and Loyola, are just three that come to mind in suburbs north of the city limits but still very close to public transportation. If you really want more info, let me know. I can give you some ideas of neighborhoods, housing costs and hospitals in those areas.

Graduated from Truman over 14 years ago! Great program producing some very clinically competent nurses. I do appreciate the fact that even though some of the faculty has changed, alot of the same teachers are still there from when I went. I think Mrs. Pat Murphy, Mrs. Domerand, Mrs. Lux and Mrs. Corbett are all still there. If you are in Truman's nursing program and get a chance to pick who you will have as a teacher, try and get Mrs. Zimmerman (don't know if she is there or not?). I happen to know her and she has alot of ER clinical experience and will really get you immersed into clinicals. She likes students willing to try anything in clinical, so jump right in!

I'm in Chicago... What type of RN jobs are you all looking for and in what area of the Illinois? We all may be able to help if we know of positions open in our respective facilities.

If you really want Dansko's, go to a local store and try on pairs until you find your size. Then go on ebay and search Dansko and buy them there. I've gotten a few pairs of brand new Dankso's for 1/2 price.

Hang in there Nursing Students and New Nurses!!!! It will get easier over time. I'm an RN with 14 years experience in high risk L&D, OB/GYNE and Oncology. Your tear filled, frustrated, exhausted drive homes will change to tearful, frustrated and exhausted drive homes!! LOL. Sometimes those drives can be the worst part of your day. On your way in you anticipate the worst (it's a human response) and on the way home you are either crying from frustration & exhaustion, or in some cases pure sadness or emotional discontent. After 14 years I still get anxious to a certain degree on those drives in. If I know RN's will be out on vacation or census will be high, it's easy to let my mind wonder what the heck I'm going to get slammed with! I still cry on the drives home sometimes. The frustration of being new and feeling like I don't know enough is gone, replaced by frustrations with pretty much everything else. I cry for the Oncology patient, whom I've treated for years who is now not responding to treatment and is going to die...soon, I cry for the other RN's who are going thru the same situation, I cry for the doctors, most of whom are brilliant and wonderful and just as frustrated when there is absolutely nothing else they can do to help a patient, I cry for the families of patients, whom I've grown close to and who put their trust in me to care for their loved ones. I cry at the thought of "what if that was me or my loved ones", what would I do?, I cry at sad songs on the radio on the drive home too. All of this crying makes me realize a few things. 1. I'm human and have empathy for all people. 2. I need to invest in stock in the Kleenex company 3. I have great tear ducts 4. I love what I do 5. I love the people I work with and for 6. I know it's not a perfect world 7. I feel better after a good cry 8. I wouldn't change a thing about my drive home! If you are really having anxiety driving to and from work, invest in some good comedy cd's or affirmation cd's. Better yet, learn a second language by cd in your car. If all else fails, cry and let it out...you are not alone!

What has been the hardest thing for you to adjust to in your role as a new nurse vs. what you thought as a nursing student? A few things. 1. The physical and mental exhaustion at the beginning of your career in nursing. The toll on your legs, back and feet will surprise you, not to metion the varicose veins if your not careful. Mental exhaustion comes from always feeling like you are in over your head for the first 6 months at least. This is normal. Confidence will come with experience and that takes time. 2.) Time managment- nursing schools give you book smarts, but not a realistic idea of how to actually be a nurse from 7a-3p, 3-11 or 11-7a. Experienced RN's would love nothing more to sit down and actually spend more time with our patients and asking them all of those "open ended questions" we are taught in school. The unfortunate reality is that I usually don't have alot of time to sit and ask a patient "How does that make you feel?". You have to learn to manage multiple patients with sometimes great time needs, computers and charts that are confusing at best, medication needs, phone calls, family questions, covering other patients for lunches & breaks, dealing with MD's, residents, CNA's questions and concerns etc. 3) The dreaded "jaded" feeling. Every student comes out of school full of pep and ideas and thinks "I'm going to be the best nurse I can be and change the world if it's wrong!". I applaud that attitude, however it must be tempered with a bit more reality. For instance, if I don't like the way something is done on the floor at my hospital, then I must go through no less then 9 different people/departments to get heard. You will run into more politics and protocol then you can ever imagine. Be prepared to make change, but know it's going to take alot more then just a good idea...it will take persistance. Was there indeed a "shock" moment where you thought "this isn't what I thought it would be"? And Why. Sure, we all have had at least one. Mine was when I was a new nurse and working on an L&D floor. No matter how much you've been told that L&D won't always have "good" outcomes with patients, you never really never know until you experience the death of a pregnant patient or baby. There is nothing harder then seeing a newborn die and realizing that no matter how much you know, how much you do, how much doctors know and can do...some things in life are just downright unfair,cruel and out of your control. How difficult has the adjustment been for you? I've been a nurse for over 14 years, so my responses are based on how I felt my first year out. The adjustment was difficult for the first 6 months. After that it became familiar and more comfortable. There are big personalities everywhere to deal with, that was the hardest road to navigate. I kept my mouth shut pretty tight for the first few months. I gave everything and everyone a fair shot and always had a timetable in my head to leave just in case I figured this was not for me. I didn't leave and worked there for 3 years before I became interested in a different field. Do you think nursing school did enough to prepare you for the role transition you were faced with in the very beginning of your new career? Sorry to say this to all educators, but no. I'm not sure if the problem lies squarely with them alone though. For example: Probably 8 out of 10 nursing students will go into first time jobs that require a certain skill set. One skill being IV starting. This was something that we were not taught, nor allowed to do during any of our clinicals. During my schooling we spent one whole semester learning how to make beds and how to talk to patients. I think most students can learn how to make a bed and give a bed bath in a few days, rather then a semester. Also, having assignements like sitting with a patient for an hour or two is so far from reality that I feel like teachers are "setting" students up for the shock of real nursing. Clincals should be focused on improving the day to day skill set needed for new nurses to feel more confident. Talking to a patient is great, but I feel schools are missing the boat on assessment skills. It's important that I know about a patients anxiety level, but in reality I have to be even more worried that they are not allergic to the medication ordered, or if their blood type is correct during a transfusion. Today's real world needs nurese who are organized, skillful and confident. Give the nursing students correct instruction and experience on skills they will be using everyday and you will give them confidence. Nothing more exciting then a new grad on the floor who comes in with an "I CAN DO THIS" attitude. That comes from confidence.

Indy, I feel your pain about the Birkie's. I love the styles and the arch is good, but my heel absolutly kills me after about 3 hours in them. It makes my heel feel like it's walking on cement after a while. I tend then to "grip" with my toes way too much to compensate for the discomfort and then my shin(s) start to hurt. I lurve my Dansko's and I agree about the lateral roll. If your lateral roll is that bad than the Dansko rep I talked with actually recommended that you see someone about orthopedic insoles. Lateral rolling is common to most people, but if it's wearing out the 1 1/2 inch sole on a Dansko quickly and making ankles turn then it might be time to see someone. I've noticed that over the years as a nurse, my feet have gotten bigger, flatter and the arches are slowly falling. I own five pair of Dansko's. I rotate my shoes everyday so that they all get even wear. I'm going on 5 years with the same 5 pairs and it has helped the lateral wear on the shoe. I saw a Dansko rep in a shoe store the other day and they were very helpful. I'm wondering if all of us with the lateral problem write to Dansko and/or Sanita, if they might look into a solution? www.dansko.com www.sanitaclogs.com