TX_nurse_08

I'm in dire need of a preceptor in the Houston area. My school expects us all to "self-place" and the few GNE placements that were available were given out in advance, leaving no help for emergencies or anyone who simply could not secure a preceptor. We did not even get any information on the process or requirements until November, and what we got was vague. The clinical coordinator has been little help so far, I gave a list of 12 zip codes that are convenient for me and received a list of less than 40 "leads". Many of them I had already contacted and they no longer take students, had only 1 or 2 spots that were reserved well in advance, or have been closed for years. I've posted on multiple social media outlets, I've gone door to door with resumes, I've left messages at many clinics and offices and only had 1 callback (to tell me that they only accept GNE placements). I've messaged HANP and ANA as well. I'm just not well-connected with any primary care providers. Paid services - I'm broke and can't really afford these, but I can borrow some money to do this. I just don't want to get scammed. Has anyone here used a pay-for-precepting site? I've even tried to find out if it's against school policy for me to pay a preceptor directly, it sounds unethical but I'm out of options. The semester started on the 9th and I have to do 120 hours by the end of April. Any advice, tips, resources, recommendations are very much appreciated.

Having graduated from my RN-BSN program at 6 months pregnant and being hired the next month, I can say from experience that you may be able to get a job somewhere. That said, I would absolutely recommend at least taking your NCLEX as soon as possible. Ideally you would be able to get hired and get part of the way through orientation before taking maternity leave. Just because you are not yet eligible for FMLA does not mean you do not get maternity leave. Many places have policies for such circumstances, I know that I was allowed 6 weeks with no problem. It was extended to 8 due to c-section, and I returned to work without too much difficulty. I did nights, and was able to pump only 1 or 2 times per shift, but it was enough to keep supply up. I also had no trouble scheduling my pediatrician appointments since I was technically "off" every day. My husband did great with the baby overnight, we only needed a little help during "shift change", so if you have someone who can stay with baby at night and maybe a little after you get home so you can nap, you won't even need daycare. Personally, had I not started working before I had my baby, I would have had a very hard time with interviewing and orientation with a brand new baby. You need to think about what will work best for you but I would be hesitant to wait too long to get that first job as a new grad.

I think that things are not quite ready yet for the Summer students, the classes still have day, time, and textbook as "TBA". My E-value has not had any items verified yet, nor has my drug screen been entered. I was hoping to register tomorrow to try to get both classes as "in-person" instead of having one online and one in-person. Has anyone had their "nursing admissions hold" removed yet? Please update if any of you are able to register tomorrow...

I reviewed the JC data, they have a pretty extensive list for what qualifies as a VTE prophylaxis. I can't find anywhere that indicates that multiple prophylaxes are required, or that a pharmacological intervention is necessary for all patients. There also seems to be some types of patients who ARE able to be excluded, namely those whose length of stay is less than 2 days but also those at "low risk". Perhaps judging the level of risk is too tedious? It's too bad it's not 3 days, most of my adult appy/chole and medical patients are d/c'd in 3 days or less. Just FYI for anybody else who's interested.... Data Element Name: VTE Prophylaxis Collected For: CMS/The Joint Commission: SCIP-VTE-2, STK-1, VTE-1 Definition: The type of venous thromboembolism (VTE) prophylaxis documented in the medical record. Suggested Data Collection Question: What type of VTE prophylaxis was documented in the medical record? Format: Length: 1 Type: Alphanumeric Occurs: 1-8 Allowable Values: Select all that apply: 1 Low dose unfractionated heparin (LDUH) 2 Low molecular weight heparin (LMWH) 3 Intermittent pneumatic compression devices (IPC) 4 Graduated compression stockings (GCS) 5 Factor Xa Inhibitor 6 Warfarin 7 Venous foot pumps (VFP) 8 Oral Factor Xa Inhibitor

I do understand that regulations are steadily increasing, and I understand the need for core measures compliance. My issues are with the specifics and the implementation. Am I to understand that the current regulations require all patients 18 years and older to receive daily injections of blood thinners regardless of their ambulatory status? This does not seem appropriate in the least. Also, the measure was rolled out without any prior education (someone in administration must have sent a memo to ER though, because all of a sudden every adult rolled upstairs with the VTE checklist in chart) and the classes which are supposed to inform us about it are not for another week or two. As far as asking about the peak flow meters, our unit is small (less than 10 patient rooms, one of which is a private room) and we have no educator. Our nurse manager does not have an answer for us. Our director does not have an answer for us. I did suggest that they go ahead and have all of the nurses from our unit attend together since we all are going to have fall outs due to the lack of peak flow meters, but was told it will just be me since mine was pulled first and they have not gotten the rest yet. From what I can tell, the personal meeting with administration that I am mandated to attend on my day off will be my only opportunity to have this adressed. We also asked for the form to be translated into Spanish because a large percentage of our patients are Spanish speaking only, this has not been attended to, so we are currently using the translator phone line to read the entire page of information and having them sign and recieve a copy of educational materials that are not even in the language that they understand. This is the kind of thing that is frustrating to me, it seems counterproductive/inadequate/whatever term you'd like to use for "not good enough".

Is anybody else out there frustrated with the "core measures" movement? I understand the idea behind it, but the application has been.....over-administrationed to put it politely. Where I work, we have at least 5 core measures; only 1 of which is supposed to apply to pediatric patients. The pedi unit I work on is also a med overflow depositing area for adults so we now deal with most of these core measures. The issues that I'm having now involve the VTE for adults and the Asthma for pedi. The adult VTE drives me nuts because it's necessitating lovenox, teds/scd for EVERY SINGLE ADULT PATIENT in the hospital! The long checklist has an area where someone could potentially be given reprieve from daily lovenox if they are marked as a bleeding risk. If I was an ambulatory "walkie/talkie" patient, I would refuse the Lovenox and I would be pretty unhappy about being required to wear teds/scd. For the pedi patients, the asthma education was clearly developed around the use of a peak flow meter. This would not create issues except that many of our pedi patients are too young to use one, or do not have one and it is not being ordered. There is a blank in each of the asthma "zones" for peak flow readings that are supposed to help parents and patients assess the status. Well, I can't put a number if there is no meter use but administration disagrees apparently. I have to attend a personal meeting for my core measure fall out on one of these asthma sheets because I did not put numbers on the peak flow spots. Also, just curious - who does asthma education where you work? At my current place of employment the RN is responsible for the core measure education; at my previous place of employment (a fairly large children's hospital) the RT was required to complete the asthma education at discharge.

I am also interested in this hospital, HR says that 11 is an internal code and that all salaries are on a case by case basis, nothing is disclosed until you have entered the interview. Not very helpful for those looking to relocate, although I don't see any chance of their pay rates being lower than where I currently work,LOL.

Thank you, thank you, thank you! My first thought was that I needed to go ahead and call in, but the reaction I got from charge and house got me started doubting my decision. I'm going to start calling Urgent Care places in the morning, and if they are all closed for Memorial Day I will just suck it up and go to an ER. My fiance likely caught it at work Thursday or Friday. I'm thinking that by tomorrow, I should probably be able to get fairly accurate results from a rapid-strep.

Thank you guys! I can't find a policy, and I even called the ER to ask if I could just pop in for a rapid-strep. They said I could come, but I'd have to be triaged and the whole 9 yards. It's a children's hospital and I didn't feel like I should take up space in their ER and I'd probably have the gazillion-dollar co-pay anyways. I felt bad calling in since I had just used up all of my PTO, but I'm still on orientation so I'm not exactly essential staff. I'm going to try to work a make-up shift on Friday if they will let me. I will likely feel like garbage tomorrow and I really, really don't want to give the babies (or my preceptor) strep.

OK, here's the short version: fiance didn't feel well this morning, went to urgent care and tested positive for strep and got abx. I felt fine until this evening when I noticed I have a dry scratchy feeling in my throat, my tonsils are enlarged and gunky, and the back of my throat is red and streaky. All the urgent care places are now closed and my ER co-pay is $150. I work in a NICU and am scheduled to work tomorrow. I called the unit and they said they didn't think I could call in since I don't have any PTO, but I called the house supervisor and she said I just wouldn't get paid. Neither of them acted like it was a big deal, am I over-reacting by calling in? I really think I've got strep and I don't think wearing a mask all day will cut it in NICU. I was planning to go to urgent care (if any are open on Memorial Day) in the AM and get some abx. I couldn't take my fiance's even if I wanted to, I'm allergic to PCN. Anybody have any thoughts on what I should do?

I have worked as a psych nurse (on a children's unit) since becoming an RN nearly 2 years ago and have recently decided to transition to pediatric nursing. Has anyone on this forum come from psych to pediatric? I'm very excited about the change, but also not quite sure what to expect and would love to hear from any of you who have made similar career changes. Any advice or helpful tips would be greatly appreciated!

They are supposed to give us at least 2 hours notice (i.e. - call us at 5 am if we are scheduled to work 7a-7p) of cancellation. If they inform us that we are cancelled when we arrive at work, we're allowed to stay and work for 2 hours to make a trivial amount of money for our inconvenience. I have no guaranteed hours, I'm a regular full-time employee. They don't stop any benefits because of the decreased hours, and they rotate whose "turn" it is to be cancelled! The thing that irritates me most is that we have so many agency and travel nurses that have recently (as in 2-3 weeks ago) been taken on and THEY get all of their hours since they're under contract! Oh well, what can ya do? Besides try really hard not to be jealous of these nurses being paid near double what I'm paid, working a guaranteed 40 hours per week, and living free in furnished apartments or hotels with room service. I do love room service.... :chuckle

I need some advice here..... I work in a private psychiatric facility. Our census is very low now, so some of the units are being "combined" to save money (like adults with CD and children with extended care children), resulting in fewer RN shifts. I work 3 12-hour shifts as I am a "weekend" nurse, and had my shift "cancelled" last Friday. 36 hours works fine for me, but 24 just isn't enough to take care of things. Anyways, I am looking into getting a second job. It would not be permanent, as I'm told the census will pick up before Spring Break. It would not be full time or on weekends, since I will hopefully be working the majority of my regular shifts. I can't decide if I should look for a position with a nursing home, floor nursing, or just go do something totally unrelated to nursing. I have worked at a jewelry store before and LOVED that. I know that a "mall" job would pay about 1/3 of what a nursing job would, but the near zero stress + no risk to my license + employee discounts might = better. Anyone have any advice???

IMHO - If you feel drawn to psych nursing, give it a try. I was afraid that it would be too scary or too sad, sometimes it certainly can be some of those things. I work on a child psych unit, ages 4-12. Some of the things these kids have done or have had done to them are horrifying, but the chance to make a difference for them is worth it. Sure, they scream cursewords at you and kick/bite/hit and slam doors sometimes. The times when they say "thanks", ask for PO meds before escalating to the point of needing an IM, or use their new coping skills for the first time all but cancel that out. Yes, it can be very difficult, but it can be very rewarding as well. I've learned the importance of patience and being even-tempered among many skills I will be able to use when I have children of my own. Plus, last weekend I was informed by one of my patients that I was "the best nurse in the galaxy". If you have a tendency to be more interested in talking to your patients than hooking up their IV and watching their monitors, if you are a "good listener", then you might really enjoy working in psych.

I thought that $13.50 seemed low as well, so I did some asking around at work today. I was told that the bigger hospitals here start GNs and new grads anywhere between $18 and $22. In Houston, my classmates are being started at $22 to $25, shift differentials for the weekends or 3-11/11-7 are ranging from $1.50 to $3. I think that some of the smaller places here in Corpus are willing to offer comparable pay to help reduce the need for significantly more expensive travel/agency nurses.