BornHealer

First let me comment on the way you signed your thread (I:redbeathe a nurse) because this might be the most importent part of what you said --- You can expect that your love will be tested more than once. I will share my own experience with you, because ultimately that's all anyone can do. I was 33 years old when I entered my Nursing Program ---I was 19 years old when I married my husband and we now had two children (Ages 8 & 10). I had no college education when I started, so that meant I would be carrying a full and heavy load for three semesters. My days started at 5:00 AM and I did not return home until 6:30PM (That was necesary to get all my nursing classes, all my clinical rotations and college classes completed in the time frame alloted) When I returned home -- I would eat the dinner my husband prepared, have a brief converstion to catch up on how everyone elses day had gone, and I would then go into our bedroom --- Close the door --- Study -- Complete Homework assignments and work on the various Term Papers that were always due. Then at 11:30 PM my husband would come up and we would retire for the night. The year was 1981, so there was no internet and all term papers were typed on a used typewriter. Weekends were spent at the library doing various assigned research ssignments and then returning home to spend the remainder of time studying. Doesn't sound like much fun --- Does it ??? It wasn't --- But it had to be done that way. 1) Courses had to be taken in the order assigned 2) Financially I could not afford to spend two years completing what was assigned to be completed in 12 months 3) I couldn't afford to fail and retake any courses a second time --Or barely pass with a "C" average --- Statistics show that students with only a "C" average rarely pass the State Board Exams --- So, then what would be the use of going through the program if you can't get licensed. I'm not telling you this to discourage you -- but to prepare you. Your experience might not be this extreme, but you might have times that will be rough on your relationship and knowing that ahead of time can help you get through it. The way my husband and I got through it was to sit down and discuss it -- planning ahead before I even begun the program. The majority of running the household (including the children) was going to fall upon him --- So he had to be ready to pick up a lot of the chores that I had always done and also realize that I would not be available for socializing very often. He did this and that's the only way I was able to complete the program. It's a commitment unlike many other college programs. Nursing is not a 9:00 > 5:00 job ---And part of the nursing program is to teach the students thatHTML][/html.[]

In response to RN's getting jobs as LPN's ---- It depends greatly on which state you're practicing in --- In the state of Pennsylvania (where I was licensed as an LPN --- then 4 1/2 years later I was licensed as an RN) the law is quite clear --- An RN can only practice as an LPN if she/he has a current license in that state to practice as an LPN --- It's not a matter of the RN being educated enough to function as an LPN --- You must hold a license as an LPN to practice as an LPN --- And a RN can only practice as an RN if she/he holds a current license in the state to practice as an RN. Another interesting point ---- I'm an RN that worked in a Level I trauma center --- I was certified as a CEN (Certified Emergency Nurse) --- I was certified in Critical Care Nursing, Certified in Advanced Trauma Nursing, Ceritified in Advanced Cardiac Life Support, Certified in Pediatric Advanced Life Support --- I worked as a Critical Care Transport Nurse --- Here's the interesting part --- I could not work as a Paramedic in the "911 Emergency Response System" unless I took a six month Paramedic Course and became cerified as a Paramedic --- So, as you can see --- it's not a matter of having the knowlege to function and perform the duties of the position --- It's a matter of what license and state certifications you currently have --- You can debate endlessly about how many years experience you have and that you have the ability to function at a higher level but as far as the state is concerned --- you can not legaly practice at a higher level unless you are licenced to do so --- as for LPN's who perform at levels that are more advanced than that of other LPN's ---- I remember that one of my instructors told me to always ask myself --- Is it that the institution is "Using" LPN's to function at their highest level? Or are they "Abusing" LPN's to function at a higher level than they're legally allowed to? --- You have to protect yourself --- Always --- Your patients need you --- and you become useless to them if you lose your license because you're practicing above your scope of nursing practice.

Lovesunsets, I was a LPN for 4 1/2 years before I became an RN. Licensing is done by the State , so there can be slight variations in duties permitted - depending on which State you practice in. Nurses (LPN or RN) are to be guided by the "Nurse Practice Act". It was drilled into me by my instructors "READ IT AND KNOW IT' LPN"s always "RECORD & REPORT" - Meaning that a LPN Reports to either a RN or MD or DO. A RN can work Independently within the scope of her/his Nursing Practice - A LPN can not --- Even in LTC a LPN is still reporting to a RN or a Physician - Even if it's by phone. The defensiveness of LPN's --Other professionals and the general public's ignorance of how in depth many LPN Programs really are --- Mine required a year of College and was so through that my Nursing Courses in my College RN program were a breeze. We even used the exact same Med/Surg Textbook. The only difference was LPN Program did not get into Community Health Nursing and the Peds was not as in depth -- Either Way -- You have to pass State Boards to get either license so you gotta know your stuff. The pay difference is significant as is the respect you get, but then you don't need others to define who you are. Best of Luck to You.

LilgirlRN, I definitely have empathy for you. I too worked in a busy intercity ER/Level1Trauma Center. It's a tough situation and nothing will ever change unless the Staff and the Administrators work together. This is what ultimately had to be done at our ER. Nurses had to start thinking like Administrators and Administrators had to start thinking like Nurses in order to bring the whole situation into view. For example: Administration biggest concern was the Budget (How they could get the most done for the least cost) Then they were not too happy when they started getting cited for violations from JCAOH, OSHA, etc. (Hey, crunch the numbers -- "X" amount of nurses can't be in two or even three places at the same time) Critical Care patients must have an RN with them when going to CT Scan or other transports -- So, who's caring for the patients left in the ER, while his/her nurse is away on a transport? Also, it was noted that the number of staff injuries (slip & fall, back injuries, etc.) rose significantly, after nursing staff had been reduced. OK We made our point-- it's better to have more nurses in the ER -- The fact remains -- There's only so much money to go around. We all expect a pay check at the end of the week. The number of patients coming to the ER is constantly rising, as are the nunber of those without insurance. Something has to change. These are a few of the positive changes we made. We started a "Fast Track System". All the non-urgent adult patients (U.R.I.,U.T.I.,Suturing,Sprains,Closed Fx.,etc.) were immediately assigned "Fast Track". It was covered by an RN & Physician away from the main ER. It was quiet and many times pts were seen within minutes & then D/c'd. Children were seen in Peds Clinic -- Both opened 8AM to 8PM. This did help greatly with improving our ability to care for our pts, while trying to get by with a shrinking budget. That's not to say that everything is perfect now. It's a work in progress and more innovative ideas will have to be tried. Good Luck.

OMG Your response has made my day. I've been so busy lately that I haven't taken the time to logon and read some of these posts. That has definitely been My Loss! Your response made me laugh so hard and that is therapeutic. I worked as an ER Nurse for the majority of my career (Can't work anymore due to an injury) But your response reminded me once again how very much I miss it. Nurses who work ER could also go on all night with their "Tales of strange happenings" These experiences make you see the world in an entirely different light, "Ya either Love it ---- Or Ya Hate it" And I loved it! Thanks Again.

Dear Backhill360, Reading your thread brought me back many years to when I first started my nursing education --- 1981 to be exact. I was 33 years old --- married since I was 19 years old --- and in the process of raising two children (in other words -- I wasn't a kid anymore) However, the clinical instructors were so rough on all the students there were many days I felt like I was still in elementary school and I was being scolded by my mother. Also, like you, I never responded well to being yelled at. There were a lot of students that failed "clinical" that first semester because they were not able to function under that increased pressure. Although at the time I couldn't see the reason why the instructors were so rough on the students --- it became apparent when I started to work as an RN. The instructors are trying to prepare students to be able think and act quickly in a crisis and also to be able to do this in the midst of chaos, which many times is the case. Nurses don't work in a vacumn --- there are many things going on at the same time (phones are ringing, Monitors are alarming, IV Pumps are beeping, patients and family members are yelling, physicians are becoming impatient, other staff members are calling for help ---- and many times this is all happening before you've even finished taking report at the beginning of your shift). You are well past your first semester ---- so, you've obviously shown your instructors that you have the commitment and the skills to carry you through to the successful completion of your Nursing Education. All the different personalities and teaching styles of your instructors are all part of your education. Use these experiences to your benefit and realize that none of it is a personal attack against you. I wish you much happiness and success in your career --- in a way I kind of envy you --- just starting out ---- 1981 was 28 years ago. I Love Nursing today just as much as I did back then and that is my hope for you.

Penguin67: Thank You so much for your post --- It was an eye opener to say the least. I've been there myself on some occasions -But not nearly to the extent that you were (the staff knows you're a RN, so, they start letting you --help out a little - and before you know it - they're actually depending on you - And expecting you to perform much of the Bedside Nursing Care) Not only is this unfair to a family member -- But -- it's potentially an unsafe practice that sets the stage for a potential Disaster just waiting to happen. Your post pointed that out - inaccurate I/O Charting - Fluid Retention -Wheezing - all leading up to CHF and exaserbation of your mom's condition, which could have been prevented if all the shifts had been doing their own assessments and charting. Again, Thanks for the view from the other side. That being said, I agree with most of you, who do not support nurses being used by family members, who expect the nurses to provide refreshments for visiting relatives. No Way !!!

I Absolutly Loved It. I've worked ER since 1983 and have seen a lot of changes since then --- But one change has not been for the better ---- We simply do not laugh at ourselves as much as we used to. It's good to be reminded about that sometimes. I was lucky enough to be able to watch his entire routine on "You Tube" and was ROTFLMAO. It felt sooooo good to laugh that hard.:yeah:

and AZMOMO2---- you sound like a wonderful CNA to work with (a great attitude and excellent insight into why all of us have chosen patient care as our careers). I've held positions as a Home Health Aid, an LPN and then a RN --- so I know the challenges at every level of patient care. I've worked with CNAs that don't even earn the space they take up in the chair they're sitting in and others who deserve the highest of recognition (which I made sure I gave to the Nursing Supervisor, before leaving the hospital the next morning) That situation involved me being sent by a Nursing Agency to fill a staff RN position for one shift (11:00PM till 7:30AM) at an oncology hospital, where I had never worked before. It was explained to me that it would be myself, an experienced Staff RN and (3) CNAs caring for very ill cancer patients on IV meds on a med/surg wing (??18-20 pts.) This was totally out of my expertise ---- I work ER/trauma, but they were desperate -- so I agreed to take the shift. I arrived at the hospital ---only to find out that the experienced staff RN I was to work with called out sick. I said, "Oh. no no no I'm not doing this ---I've never worked here before --- I don't even know where the bathroom is"---to which they replied, "You'll be fine - the three CNAs have worked here for years and they'll help you" -- I can feel myself panicking -- thinking "But CNAs can't give meds --they can't do sterile dsg chgs and I'm picturing losing my Nsg License"---Anyway, there was something about the pathetic look on the Supervisor's face as she said, "But who will take care of these sick pts. if you leave?" ---So, I accepted the shift -- I met the CNAs. who did assured me that they would help me. These (3) CNAs were the best I have ever worked with --they knew their jobs, did their jobs, and didn't need to be told what to do. The patients received excellent care and I felt the full satisfaction of working as a team. I apologize for being so long winded here, but this experience was so uplifting for me, I thought it was worth sharing with you. I can remember working with Rn's, when I was a LPN, who just sat at the desk smoking cigarettes (smoking was permitted then -- even though I am highly allergic to cigarette smoke and spent the whole shift coughing, eyes watering, blowing my nose --- to which the Nsg Super. responded, "I can't tell them not to smoke") Amazing --- Isn't it??? Memories like that I keep on a Rolodex in my head --- I use it as reference of what not to do and I try not to make the same mistakes ----Nobody should be sitting idle while other staff members are running themselves ragged trying to care for patients. Patients are the ones who benefit from good team work and that's why we're all here -- Aren't we???? M.A.E. :redbeathe

Oh -- reading your post brought me back many moons ago, when I started ER nursing. I agree 100% with "greenjanell". You're psyching yourself out. I started ER right out of school ---Green as a Granny Smith Apple. The ER was a Level I Trauma Center - So anything less than an 18G wasn't even considered an IV access and many times the trauma surgerns wanted 14G and 16G. (for valid reasons - but I was new -- to everything!!) What I started realizing is that when no one else was around -- My skills improved dramatically. It wasn't that I couldn't do it. I lacked confidence. Every mistake made in front of a co-worker was amplified 100 times worse in my mind. Skills take a long time to perfect and ER's are fast paced -- many times you're working under great stress. Starting IV's takes practice. My advice is keep working with the 18G and don't automatically go for the 20G because you feel more comfortable. You will eventually be comfortable with the 18G and when the situation presents itself, when only a large bore access is appropriate -- you'll be able to get it in --just like a pro. Take care, Murse 7. Remember, we nurses are sometimes our own worse enemy. G00d Luck.