letitbe_lindsay

I tried to explain this to my husband--God bless him, he's not medical. He wasn't understanding why I was having such a hard time with it because it sounded like "easy money" because the family would allow you to watch TV, etc. while working. I was like screw that--if something happens, I could lose my license and we could get sued for our livelihood over this. NOT WORTH THE RISK.

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Thank you everyone for your advice! My nursey senses were tingling that this just didn't feel safe to me. I brought up all my concerns with my nursing supervisor, unfortunately the family is not willing to budge on most things. They are willing to have an order written for the auditory vent alarms to be turned on, but the 485 still says breath sounds/neuro checks q 4 hours as well as vent checks q 2. The family still does not want the nurse in there to check on those things though. So I told my agency thanks but no thanks! Since I worked my shift in the home one other nurse has been oriented to nights--and from what I understand she told them the same thing. I think it will be an ongoing concern for night shift coverage but you know what? I'm not willing to risk my license over it. The agency is trying to find me a new client now. And it's really slim pickings. So I'm back to the drawing board in terms of finding work. I'm glad I stood my ground but I'm unbelievably frustrated right now.

Hello, I am fairly new to Private Duty nursing. I just began working with a patient who has muscular dystrophy and is on a vent. She is on a continuous pulse oximeter, which alarms and if she needs something during night shift she can flick off the finger probe to get the nurse's attention. However, she is not always able to manage this movement. My problem is, the patient gets "really freaked out" according to her mother if the nurse is in the room with her at night. So the patient sleeps in her bed and I, the nurse responsible for her airway, am supposed to be in the living room. The patient also wakes up at the drop of a hat and does not like people checking on her too much. I was told to go check every hour by looking in the doorway at the pulse ox monitor. It's dark in the room so you can't see the patient and the floor creaks so she doesn't want you walking in there. Also the vent has an auto dim so you can't see that either. The patient has an order for all alarms to be turned off on the vent. So, my only way of knowing her status is the pulse ox and a baby monitor I have. This arrangement apparently works well for the family, but having little ventilator experience, this kind of freaks me out. How would you manage this situation? I want to provide good care consistent with the patient and family's wishes but I feel like most of the tools of assessment have been stripped from me. I certainly don't want to be neglectful. The family fired the last nurse for going in and checking the vent every 2 hours (which is my agency protocol).

Hi everyone! I just started my first job as a PHN with my county health department and I LOVE it! I consider myself a very organized person and all throughout nursing school I was very good at making my own "paper brain" tools to organize my nursing cares for my hospital patients for the day. But now that I have a wonderful, nice desk job I have no idea how to organize! I'm looking for any tips or advice from experienced PHNs on how you organize your office... -How do you group your resources and pamphlets? -Where do you put important "assessment" tools? -What information do you keep posted on your walls for easy access? -How do you you organize your charts? -Do you color code or number anything? I just feel lost. I was given a pretty large office with a bookshelf, ample desk space, a few drawers, and a lockable filing cabinet for charts. I also have a few "magazine" rack things and two "inbox/outbox" trays. Of course right now most of these things are empty but I know they will start filling up soon and I want to have a good framework before that happens. THANKS!

I just got my first nursing job at the county health department. I talked a lot about my previous volunteer experience, but I think the reason they offered me the job was because I really do love public health and that came across pretty clearly. Also--the fact that my county health department hasn't hired a brand new grad in "years and years and years" maybe had something to do with it--like maybe there are more people to precept me? My boss told me today that she thinks new grads make up for a lack of experience with a profound ability to pick new things up quickly. So I'm not sure that having experience matters that much if you are open-minded and enthusiastic.

I'm a new grad but I just got a job as a PHN with my county health department. The interview questions they asked were mostly about my understanding of the differences between acute care nursing and community health nursing. I just talked about how the biggest things were education about health promotion and prevention of illness. From what I gather in the first two weeks...this is an awesome job. I've done a few home visits and I'm working on learning immunization schedules for the vaccination clinics my county provides. Other nurses in my department have varying responsibilities...some are Child Health Care Consultants, some are Lactation Consultants, others work on grants. Still others are carseat techs, some specialize in fall prevention for seniors and some focus on literacy in children. After I learn the "basics" of my job (charting, assessment, vaccinations, home visits, etc.) I get to sort of pick a specialty. It seems like there is a lot of freedom and autonomy...plus the hours are awesome and I have LOADED benefits. Even though I'm new, I'm really glad I decided to start in this area of nursing.

Thank you all for your kind words and suggestions. Basically how it went down was like this: My preceptor was with me everytime I gave report, sort of as a standby in case I missed anything, but I was running the show. I was always surprised that she never stepped in, but chalked it up to one of those "learning experience" things and went on my way. Yesterday was my last day of my clinical practicum. My preceptor asked me, "Did that nurse intimidate you?" And I answered honestly, "Yes, she did." I was expecting to get another, "You'll have to grow thicker skin" lecture, but what my preceptor said caught me by surprise. She said she admired me for the way I dealt with the situation professionally, and that if it were her, she would have said something rude back and it would have been a mess. And that is why she didn't step in. Because I was handling the situation exactly how I should handle it, without being nasty right back. Anyway, that gave me the warm fuzzies.

I gave this woman report again today, and she attempted her previous pattern of rude interruptions and swearing. I gave her this stare. Didn't say a darn thing, just looked at her, raised my eyebrows a bit, and stopped talking for a minute. Knowing this lady, I was half afraid she would start calling me names or something. Let's just say the stare worked. She took the rest of report without interrupting and asked only appropriate questions about the patient...she still didn't seem too pleased to be there, but at least she wasn't being actively disruptive!

Not technically nursing experience, but I'll give you a story to illustrate what other people have been saying about post-partum. I was a tech in the float pool at a hospital for two years. Generally, being a tech in the float pool means you get to go to the busiest, most understaffed, most undesirable units to work on and are generally given the most difficult or time-intensive patients. Every night I worked, I would have 16-18 patients and I would not sit down. One night I had the good fortune of being floated to the post-partum unit. I had 6 patients only (amazing!), and essentially all they needed were vitals and water refills. I remember this time fondly as it reminded me of that one episode in Grey's Anatomy where Christina goes to the dermatology floor and discovers residents who get raspberry water and hand massages at work. I'm not saying it's not work--every nursing job is work. But I had at least two RNs tell me that night, "this is where us old nurses go to die."

Thanks guys! EricJRN, I think what you said is probably the thing that has put me the most at ease. You are right. Probably nothing I would say to this lady would make her any easier to work with...and yeah, it does help me to vent a little. I've just been getting so frustrated and feeling like other nurses don't understand....maybe the key is to try to humor her a little. Gotta do what I gotta do.

I am currently doing my clinical practicum on a very busy ICU unit. I feel like I'm doing very well given that there is SO MUCH to know and SO LITTLE room for error. My preceptor has given me lots of positive feedback about things I do well and I ask every what I need to improve on (as well as working with other nurses), and I find that this has helped me learn a great deal. HOWEVER. Every night I give report to the oncoming nurse. My preceptor has named my report-giving skills and communication with the team as one of my strengths. However, this one particular nurse is just plain ******* to me when I'm trying to give her information. She walks up to me and says "I hate getting report from student nurses," then proceeds to interrupt me and correct me in a very rude fashion the whole time I'm giving report. Obviously, being ridiculed like this makes me flustered and less articulate, which probably confirms her beliefs that I am an idiot. I have given report to this woman numerous times. Last time, I asked her if I needed to organize my report differently to suit her system (as she would now be taking the patient for 12 hours). She looked at me from like I was from outer space, sighed heavily, and told me "just ******* get on with it." I don't know what to do. As a student, I don't feel like I have the weight to throw around to ask her to stop treating me so poorly. At the same time, my preceptor, who does have the weight, won't intervene and tells me "that's just how she is." How do you deal with this sort of TERRIBLE workplace behavior?

I will be a new grad in December of 2010. Quite a few grad schools require letters of recommendation from previous employers, preferably nursing ones. I have lots of other people that will write me letters, I'm just wondering how it will look if I leave out my only real nursing experience.

Hi all, I'm applying for grad school for the Fall of 2011. Right now I'm trying to gather up letters of recommendations--the problem is, I only have one work experience in a hospital. I was a PCT for a year during nursing school. I worked about 20 hours/week and I was in the resource pool. It was certainly one of my most valuable experiences, however, I'm not sure who to ask for a letter of recommendation. I worked nights; my supervisor worked days. We never had much face time. Unit managers never took the time to get to know me unless I worked more than one consecutive shift on their floor (which didn't happen often). Despite my efforts to be friendly, and genuine, and to make my name and face known, I still get the distinct feeling that no one really remembers who I am. I have hopes that my old supervisor can write me a letter, albeit, probably not a very personal one. Do I still ask for one?

Hi ya'll! I'm applying for UCSF 2011 MSN program ACHIN specialty. I know that the MEPN programs are VERY competitive--does anyone know how the MSN programs compare? How many of you are applying? What have you done to prepare yourself? Have you heard anything about it? Hopefully we can get some good discussions going and learn a lot from each other here =D