Momof2inMO

Hi all. I am in need of some sound advice. I am scheduled to take my OCN exam on Saturday. I am in high anxiety mode right now. Just changed jobs and am orienting and trying to study still. I took the 2 day chemo/biotherapy course and just finished the OCN review. My problem is that I know there is so much stuff I do not know, so much so that I am concerned about not passing. I feel like I need more time to study general classes of chemo/biotherapy and individual agents, usual uses and interventions for side effects etc. I will most likely get some of this experientially in my new position, but will be working 5 days per week, so less study time potentially. I can request a transfer of my test date one time, but wonder if that will reflect poorly on me as I am just starting out in a new place. I really don't want to come in and say I failed though. There is the chance I could pass, but fear of failure is looming large right now. What would you do?

Found this article, as I was researching what one of our contributors had posted. This is about Dr. Dalmou and his discovery of the anti-NMDA encephalitis. Pertinent to me also as a high percentage of sufferers had tumors and it is sometimes considered a paraneoplastic disorder. http://www.aan.com/elibrary/neurologytoday/?event=home.showArticle&id=ovid.com:/bib/ovftdb/00132985-200805150-00012 And some basic info from Wiki, http://en.wikipedia.org/wiki/Anti-NMDA_receptor_encephalitis Whatever it is, glad you are working so hard to figure it out.

No peds ward for me! I'm at least 100 years old. Elves have longevity ya' know. I'm just tired out this year and Prancer got a little too rambunctious and stepped on my foot! Got any elf-size crutches?

Before taking ACLS, I pulled out any and all cardiac related information from nursing school. You should still have yours handy :) I had taken a telemetry elective from a top notch cardiac nursing instructor and the information from that class was very helpful in addition to the ACLS book. You can order the provider manual on-line from The American Heart Association's website. Best wishes to you

Yes, attempting to pull in opposite direction. Bio patches should not be sticky, but they often are not placed with the slit opening in such a way as to make removal easy when the window portion of the dressing is adhered to it and the PICC line (they often come up together making potential movement of the line a real risk right at the insertion point where the disc sits!) I will look for the video though-thanks.

hello, i would like to ask for some help, tips, ideas...whatever you've got. i am an inpatient oncology/med/surg. nurse and have been on my unit for almost 3 years. we recently changed to new dressings on our central lines after they were trialed at another area hospital. they are called sorbaview. every time i have changed one it sticks to both the antimicrobial disc and the picc line to the point where i am concerned about dislodging the line as i try to get the old dressing off. i hate them! i have started bringing in sterile suture removal kits to hold the line while i remove the sticky stuff (also our discs seem to never come off like they should), but i am concerned about pinching the line and trying to maintain sterility. i even bring in multiple pairs of sterile gloves. i dread these dressing changes because they can take up to 30 minutes depending on the state i find things in. do you all have any solutions or tips to offer? we are not a magnet facility so there is no "practice board" that i can go to. i even thought about taking a poll of the whole hospital, but don't want to make waves i can't survive. what kinds of options are out there? thanks all!

sorry that the neurosurgeon did not think ahead and address this for you. you, then, were put in a difficult situation-wake him up, or have the pt suffer. neither is fun or good for either one (or you). i was taught in nursing school, that it is standard care to provide gi prophylaxis in surgical cases and especially if a patient has anything involving the neurological system d/t the stress response and danger of stress ulcers. i have, however, seen this standard routinely ignored and find that i routinely ask when my hospitalists round if they will add something, unless the surgeon rounds first :) here's hoping that this will prod the day shifters to address this for you folks on night shift when you share what happened in report. may your next shift go better.:hug:

Sorry guys and gals. I can't agree and I might get flamed. No, we cannot be perfect. Yes, we can attempt to understand our client/patients' points of view, empathasize etc. We can attempt to teach them about making better choices, but they have the right to choose. Got it. I work with cancer patients. We nurses know better. Smoking is linked to lung cancer, esophageal, oral cancers, stomach cancer, GERD, you name it. I can't condone it in my peers, although I know it is incredibly difficult to quit, but ultimately it is the choice of my peer also. Just please don't bring the smell on my unit, sometimes our folks are prone to nausea/vomiting after being exposed to strong smells.

It took me a long time to get used to the stress of working, adjusting to a new place, learning how to BE a nurse plus deal with adjusting family life too as a new grad. I was working 3-12s though and my 12s were more like 14+, so I'd work, then come home and sleep, do nothing at home for a day, then do it again. I learned quickly that 3-in-a-row is not possible for me on my unit. I am exhausted after 2 shifts. 7 shifts in a row seems way too much for anyone, even if some of them are 8 hours. Are people required to work every other weekend? Communication with your nurse manager is a good thing as long as you don't come off as a "whiner" to him/her (It doesn't sound like you're whining to me.) Perhaps there are other options or he/she may have some tips. I was afraid to talk to my NM at first also, but really find her to be a good mentor and encourager now. Best of luck to you in your journey!

hello all! i have a couple of questions...lots of life variables at the moment, so i am considering lots of angles.. i graduated rn, bsn, 2009 and have been working med/oncology since aug. 2009. 1. does anyone know of icu fellowships in the kc area or across the country that don't require you to be a new grad? (then how to get in?) 2. does anyone know of oncology fellowships that don't require you to be a new grad? 3. what is the best way to prepare for acls is your present employer does not require it? (personal goal). i'd like to get the book anyway. thanks!

Ok, the person is on hospice. Your job is to make the person comfortable and ease suffering, take the best care possible, prevent sores, best quality of life for time left. These are the goals of hospice. I agree w/previous posters about positioning for optimal respiratory expansion. You can also try alternate positioning of the head and neck to keep airway open and relieve work of breathing as much as possible. Elevate extremities as they can often become swollen. If the person is not aware enough to reposition him/herself, you will need to do this frequently as long as it does not create extra stress on the person. We often use roxanol (liquid, sub lingual morphine) if our palliative care patients are having respiratory distress-excess fluid diverts to the body's periphery, decreases work of heart and eases fluid overload in lungs if present. Previous posters have discussed what labored breathing is. Sometimes it is really hard to tell if a dying patient is in distress/labored breathing, in pain etc. Abbey scales are helpful at times, counting respirs, noting how hard the pt is working etc. also helpful. Does your facility have any policies you could utilize? Our unit is a designated palliative care/medical oncology unit and has a "care of the dying patient" policy/protocol that is helpful.

Unfortunately, there is now a new wrinkle added that will keep this attitude in place. Hospitals are reimbursed incrementally by how they are "scored" by their clients/patients. If you score less than 90-100 percentile in key areas, then you get less and less money back from medicare/aid etc. for each drop. If less than 50%, good luck.

Loved the website. I've been in practice almost 18 months and it is so good to be able to review some of these skills again. Thanks!

Another conservative. Have one particular co-worker who keeps talking about right-wing Republicans who "overreact" or some such thing. I keep wanting to look her in the eye and say, "Well, you're looking at one."

I have to agree with you OP. I work oncology/med surg, but we get a lot of palliative care pts also. My co-workers and nurse manager have made me want to stay and not look for work elsewhere. They have supported me and taught me a lot (I am now just one year out, BSN). We help each other out, check on each others' beeping IV pumps, and my nurse manager is never above jumping in to help out. Her favorite quote is "There's no I in TEAMWORK"