emmy27

I have no problem talking to a therapist and have done so of my own volition when struggling with issues in the past. But I would never avail myself if one who was also a coworker. Even if I trusted that nothing would get back to management, it's just too close a working relationship to be comfortable sharing personal vulnerabilities. I want someone entirely separate from the rest of my life for that.

All the members of our leadership team- basically everyone who has a desk job in our department- ends all their department-wide emails with "I appreciate you all!" They *have* to have learned it in some seminar. And it sounds hilariously inappropriate at the end of emails that are just completely neutral or worse, negative. "Please, each remember to complete two chart checks this week. And we need to stop placing unbagged dirty linen in the carts, housekeeping WILL NOT collect it. I appreciate you all!"

The opportunity to purchase a t-shirt if we wanted it lololol.

Literally the only person I've ever seen get angry at someone wanting to watch them waste was later fired for diversion. I can imagine a way that the request could be phrased/toned to get someone's hackles up even though it's the law, but it doesn't sound like you did that, and, well, it is the law. This is *not* normal behavior and I'd keep an eagle eye on her and her record-keeping and definitely not sign anything until you see the actual waste (with her or anybody).

Everywhere I have worked there has been no difference. There is sometimes a small differential for certifications or a BSN, but some places don't even offer that, but rather count those things as points toward a "clinical ladder" program in which you get small extra raises as you climb the ladder (in addition to typical COL/performance raises). The major advantage of a specialty is that it gives you more flexibility in where you work, and usually slightly better working conditions than med-surg. It may also open you up to travel and contract positions in which the pay is higher because the specialty is in demand. But typically no difference in pay for different units within a single employer.

Many nurses work a full-time 36 hour job and a second per diem/PRN job (which can vary in hours from as few as one shift a month to one or more a week). The per diem job usually pays more/hour as it has no benefits. The reason for this is that per diem jobs are very flexible and it's possible to schedule them around your full-time job. It's essentially impossible to work two full time nursing jobs, because no full-time job is going to agree to schedule you around another full time job. You absolutely would run in to scheduling problems. It also makes no sense- most jobs have available overtime, and you would make far more working those hours somewhere where you're paid overtime than working a second job where you're somehow at 72 hours without overtime. You also probably can't and definitely shouldn't take a second job of any kind while you're still a new grad. You have a *lot* to learn in that first year, which will include didactic classes outside your work time and a lengthy orientation- take the time to learn it properly. Any job that would be willing to hire you PRN as a new grad (and there wouldn't be many) is NOT a place you should work. PRN jobs are typically intended for experienced nurses who need minimal orientation to a unit and specialty. New grads typically need and get 3-6 months of orientation before being allowed to practice independently. You can see why good employers would be reluctant to hire people who need months of orientation for a job where they might only work one shift or less a week, right? "Anesthesia nurse" is an advanced practice role that requires completing years more of highly competitive school and an additional licensing process. Travel companies do not hire new grads for the same reasons that new grads aren't hired for PRN jobs- they are looking for experienced people who can hit the ground running in an under-staffed unit.

Wonderwink- I like their "origins" (basic cotton/poly) line as well as their various performance lines. Fit well, have nice pockets with interior dividers, wear well, and are cheap. I have some Cherokee Luxe and another of the fancier Cherokee lines that I can't remember because the branding marks have washed off, that are comfy but haven't worn well for the price- holes, fading, wear at the hems, and dinginess after about a year, while the Wonderwink still look basically new. Cherokee is what we're officially required to wear and is all the hospital scrubs shop sells, but nobody has ever fussed at us for other brands as long as they're royal blue. I don't mind expensive scrubs- they're certainly cheaper than business wear, and they typically last longer too. But of course I'd rather pay less for the same quality if it's possible. I loathe royal blue, but it is what it is and that's what I buy.

You realize that when an ER nurse transports the patient (mandatory for ICU patients in all facilities I've worked and common for all patients, especially on night shifts and weekends), she is also leaving her 3-7+ other, frequently unstable patients for the duration?

If I step in something horrifying, I wipe down the soles of my shoes, and I wipe my phone down with alcohol wipes now and then mostly because otherwise touching it to my face seems to increase breakouts, but I agree with above comments that this ritual you're describing is both excessive, unnecessary, and likely to escalate. There is no clinical evidence that special laundry techniques change the microbial load of nursing uniforms, either. Have you talked to your doctor about treatment for your OCD?

Weird how true mortgage companies don't provide mortgages for the love and gift of underwriting, though, and true grocers don't distribute food for the love of... grocing? True nurses *provide good nursing care*, period, and all of them have to eat and live the rest of the time. You don't get bonus sanctimony points and your patients don't get any better for martyring yourself.

I had a PICU preceptorship (that went very well!), one that I fought and begged for (because prior to that semester they didn't place in PICU) that I thought was the first step towards working in PICU. In the end I realized that my idealized concept of PICU was not the same as the reality. I wound up in med-surg as a new grad and ER later, which is a much better fit for my personality. And I realize too that if I had a sudden hankering to work in PICU now that I have several years of critical care experience and good performance reviews under my belt, I could probably make that happen. I haven't, though. My point is, your preceptorship, although it feels like THE BIGGEST THING IN THE WORLD while you're heading in to it, and it IS important, is ultimately just a few weeks out of years of training and career. After your first round of new grand interviews, people probably won't even ask about it/you may eventually wind up deleting it from your resume for reasons of space. It can be a stepping stone to a job, but it isn't necessarily, nor does getting one in a specific unit represent a dramatic step towards that specialty. It's JUST a few weeks. If you're passionate about NICU, you can convey that to interviewers and apply like anybody else, even without a preceptorship in one. And going in to your preceptorship with enthusiasm and an open mind will be the best way to guarantee you have a good outcome and maybe even earn a good recommendation from your preceptor, which ultimately is much more important than where you were placed. A specialty unit can TEACH a new grad their specialty- they don't expect a NICU preceptee to be more than a hair's breadth more competent in independent NICU practice than someone who has never stepped foot in one before. What they'll be most concerned about is your ability to thrive and learn even in a setting that might not be exactly what you hoped and dreamed of. Because even your dream job probably won't be exactly what you hope and dream for.

I was wondering about this, too. What course would you suggest the ER take with a full code patient six hours from death?

One of my (dearly beloved) instructors as a student made the comment, when someone expressed concern over feeling like she wouldn't know everything she needed to be a staff nurse, "You definitely won't. You will know enough to be educable when you begin, and you will learn the rest in your specialty." I actually took some comfort in this, and over the years I've realized how true it is, and how it's not only true of new grads- few if any nurses, even those with years of experience, know enough to thrive in every specialty without additional training and education, even if it's informal and on the job. Nursing school and licensure is there to ensure you have a base of universal knowledge- anatomy, physiology, pharmacology, pathophysiology, and nursing theory, along with a few basic tasks- things that will mean you aren't totally at loose ends when you're handed to a preceptor- you will understand their rationales as they teach you, you will be able to comprehend the whys behind the whats and hows of policies and procedures. Everything else will be- almost must be- picked up as you go. Pay attention, look things up, ask questions, don't be afraid to admit when something is new or confusing to you, and you'll be fine.

Yes, I encountered this with a patient who would have her phone on under the blankets and try to goad staff in to saying something inappropriate. This was just one in an entire galaxy of trying behaviors on her part, and not one that was ever formally addressed. I never said or did anything in her presence that I would have objected to having recorded, but it was still extremely irritating. You never know who is doing this, legal or not in your jurisdiction, and the court of public opinion can try you with the advent of easy videosharing on social media even where it is illegal.

Why would a patient be liable for a HIPAA violation? They are not covered by HIPAA. HIPAA governs how healthcare providers and entities manage health information, not how everyone in the world does.

By and large variations in staff nurse pay are determined by geographic location, experience, and shift, not specialty (although of course working in a higher-demand specialty makes it easier to go where the money is). All the facilities I've worked at have a standardized scale based on years of experience for starting pay for staff RNs regardless of unit. If they want bigger salaries, going back to school for advanced practice or becoming travelers is probably the way to go. Big money in clinical staff nurse positions tends to come, as I'm sure you've experienced, only with a correspondingly huge number of hours.

I interviewed for an RN position on an army post and was told that the fastest the hiring process could possibly go once the official offer was made would be three months, and that it might take as long as eight if the background check was complicated or the person in charge of my background check was slow/new/overloaded/whatever.

Honestly anyone who has the long-term organizational skills, patience, and financial resources to gather 30K, travel halfway around the world while heavily pregnant, raise a bilingual child who can obtain admission to American university, and otherwise start planning their immigration 2-3 decades in advance is probably by definition a strong future asset of a citizen.

You can say yes to working extra 99 times and then that hundredth time you say no, *people will still talk about it*. It's not fair so just ignore it. Set your limits. Meet the terms of your contract, work extra shifts when the schedule and the pay is beneficial to you and feel no guilt about not working when it doesn't. I promise you that this, and every employer you will ever have as a healthcare worker, would slash your position without a second thought if they thought it would benefit their bottom line- they're not doing you any favors, and you owe them none. Always remember that, and conduct yourself accordingly.

We have staggered shifts at my current ED and there are still a lot of patients going up between 1700 and 1900- and it's not because that's how the staff RNs like it (nobody likes to play phone tag, get chewed out by the floor, or get a brand new patient from the lobby right before their relief arrives) but because that's when the BEDS are assigned. I truly believe the key determining factors are hospitalist scheduling and culture, along with a determination from senior management to get beds cleaned and assigned in a timely manner and hold all units to a high standard of calling and receiving report in a timely fashion (one hospital had a 30-minutes-from-assignment-to-arrival-in-room rule with a detailed incident report due from all participants in the process any time it wasn't achieved and hey look, suddenly patients were making it to the floor on time). The ED is continuing to be slammed (hall beds and extra patients, anyone?) regardless of whether we hold a patient or not. Our motivation to keep a patient with a bunch of admit orders past when they can reasonably go to the floor is very low.

The "catch" is that CRNA school is highly competitive and demanding. You need several years of critical care experience as an RN (something that is not guaranteed to a new grad- some are able to start their careers in ICU but many are not) and excellent grades to get in, and then it is (reportedly) a challenging and demanding program. It's not a bad goal to have but it is a lengthy career path with multiple potential roadblocks along the way. I don't know that I'd consider it "shaky" as a goal but I would consider what you plan to do/how happy you foresee being for the years that stand between you and even potentially starting CRNA school, and what it would mean for your plan and life satistfaction if you are not able to obtain admission to or successfully complete a CRNA program. I agree with the prior advice to keep your CRNA goals relatively quiet early in your career- it will make a more favorable impression on the people you need to impress to obtain the training and ultimately recommendations you will need if you appear to view being an RN as more than just a stepping stone to another career. It will benefit your practice if you can actually achieve this perspective, too. How difficult it is to obtain a specialty is highly variable, dependent on location, grades, and sometimes personal ability to network and market yourself. If you live in an area with a high demand for nurses, new grads may be accepted to ED and ICU- in others it may be challenging for new grads to obtain hospital work of any kind. If you make a great impression on ED or ICU staff in your clinical rotations or work in an ED or ICU as a tech or secretary during school, that can also lead to better employment odds. Conversely, making a bad impression can permanently trash your odds- more than one worryingly overconfident clinical student/preceptee was pre-emptively vetoed to the manager by floor staff in one ED I worked in. Make sure all the people you meet as a student think of you as someone they'd want as a coworker. But again, this only matters if the hospital you're seeking employment in is willing to hire new grads to critical care areas at all. Also, be aware that while ED does involve critical care, some CRNA programs want ICU experience specifically- ED experience is too varied in what it includes for them to consider it reliable critical care experience. With few exceptions, licensure by endorsement in any state is available to a graduate of an accredited program who has passed the NCLEX and been licensed that way in any other state. It can be a somewhat expensive and time-consuming process to get a new license by endorsement, depending on the states you are moving between, and CA is reputedly one of the lengthier states to obtain a license in due to some problems with their process at the board, but there is not any advantage to going to school in CA in this regard that I am aware of, nor do employers look more favorably on licenses originating from one state than another (other than in the sense that you generally must have a valid license in the state where you will be employed). Hope some of that helps.

The problem is, the patients in the lobby stubbornly refuse to stop deteriorating for two- wait, I just re-read that- SIX hours a day. It would be great if hospitalist shifts could be staggered in a way that moved discharges earlier in the day and reduced the number of bed assignments made at 1830 (a chronic problem in every hospital I've worked in). But holding the patients in the ED and subjecting them to an additional change of care there (we're changing shift in the ED at 1900, too) does not improve safety for that patient- it only reduces it for the one who hasn't been seen at all yet. I've been on both sides of the equation and I heartily agree that getting OR sending a patient at shift change is not ideal (nothing sucks more than finally dispatching a patient to the floor at 1850 and then having night shift look at you like you're lazy for not having the patient that just landed in your clean bed two minutes ago primped and pressed already). But holding them in the ED does not solve anything- it just delays care for another patient. I will say that as both a floor and an ED nurse I've seen PLENTY of delaying tactics regarding taking (and occasionally calling, but less often, as ED is subject to being assigned additional patients if things get bad enough, so there is less motivation to delay) report after 1700 in the hopes that the new admission would fall on the next shift, and that only makes things worse for everyone. If the floor nurse is truly busy when report is called, there needs to be a backup plan in place for the charge or another team member to take report, and if the admission requirements are so onerous that they make it impossible to safely accept a patient, there needs to be either a floating admission nurse or a policy allowing the receiving RN to delay complete admission paperwork till the following shift for admits received after 0600 or 1800 (both solutions I've seen work effectively on real units). Holding patients longer in the ED is never the answer, because there are other people who are literally receiving *no* care at all until that bed is freed. If you think a decompensating septic patient arriving on the floor with a line, a detailed H&P, and an admitting doc on call is frustrating, imagine what it's like to pull one from the lobby and realize they're septic as hell and have been slowly worsening for hours, missing a golden window of potential intervention, because there was literally nowhere to put them. That happens.

It *might* hurt a little but as an adult there's a decent chance your hymen has been torn already by just living, or that it has a large enough opening for a tampon naturally anyway. I'd definitely try them- a tampon plus a pad will buy you several more hours and reduce your chance of leakage. I've also heard really great things about the Thinx panties someone mentioned above- some of the styles supposedly hold up to two tampons worth, which probably wouldn't be enough alone for you if you're changing your pad hourly, but which could be excellent backup to a tampon or a pad. I honestly don't recommend Divacup if you're a virgin/haven't used tampons yet. It's got a pretty steep learning curve and although I was not a virgin when I tried it I found inserting and removing it extremely uncomfortable, and emptying it a very messy process that I could never have safely executed in a public bathroom while wearing all white. Instead cups, which are a very different style and easier to insert and remove (they're like a broad flat ring with a soft plastic bottom that you fold in half and insert the long way) might work for you, though, and they're disposable so you can just toss if and insert a new one if you need to change it while out and about. A period tracking app if you don't already use one is a good idea to help you be aware when you're needing to start wearing/carrying pads just in case. It's easy to lose track of time in nursing school! I recommend the Fertility Friend app, which has more robust functionality than most of them and is helpful to have a lot of cycle data in if you are ever interested later in becoming or avoiding pregnancy. I had to wear white scrubs in nursing school and it was such a pain, sorry you have to deal with it.

If med/surg is at 9:1 ratios I can only imagine what the ER is like. This sounds like a nightmare place to work, OP. Staffing is bad in most of healthcare these days but this is truly, exceptionally awful. Find a new job, any new job kind of awful. I honestly think even if you quit to work in a non-nursing job you could explain it adequately in future interviews by saying "we were regularly given 9 med-surg patients." With modern acuities that is just unfathomable, and any manager you'd care to work for knows it.

Had one on a med-surg unit. Because of the design of the unit, it only registered the person at one nurses' station, as well as the noise of visitors arriving. Visitors, of course, ignored it, and people started to hate that work station. It was eventually gotten rid of. I can think of so many sources of ambient noise that could be addressed before worrying about staff voices (which are, in my experience, rarely as loud as equipment or visitors).