SteelTownRN

You can elect to have anything that you want to have; however, if you expect insurance to pay for anything, there had better be a solidly documented medical indication for a c-section. Patients don't get to pick if they have a c-section unless they are footing the bill AND the OB agrees to do it. -STG

I teach OB clinicals, and strongly believe that birth control teaching should be part of discharge teaching. At the very least, ask if they have any questions about new methods or would like to change methods. Postpartum is the best time to have your tubes tied, as they are easier to find and the surgery can be done on the 1st postpartum morning, and you can keep the epidural catheter in until then (most of the time). Also, some birth control must be initiated early, and we can give the first depo-provera injection before they leave the hospital. Some hormonal birth control optionsshouldn't be used while breastfeeding, and the only way to know what your client is planning is to ask them early enough, while still hospitalized. Planning is the key here. STG

I have to agree that not everyone who applies to nursing should be admitted to the program or has a right to be a nurse. I have been on an admissions committee for years, and can definitely speak from experience on that one. If we admitted everyone who applied, we would have numbers only and no quality of nursing. The resources, such as class, lab and clinical space, as well as available qualified faculty would be tapped out so quickly that your head would spin. The nursing shortage has so many identifiable causes, that pinpointing one of them is hard to do. Admitting everyone who is interested in being a nurse looks good on paper, but in theory, would be a natural disaster. Hope I'm not offending anyone. Just adding some thoughts. STG

Buy what you are most comfortable with. You'll be using it to time seconds measuring respirations and pules, as well as counting drips on an IV bag to calculate flow rates. I prefer a sweep/minute hand, as I don't have to touch the watch to initiate counting the seconds. That keeps one had free and you can just twist your wrist and watch the minute hand move. But, many of my nursing students swear by their digital watches. I've been a nurse fro 15 years, and lvoe the sweep/minute hand features, but that's my choice. Buy what is functional for you. STG

Interesting question about what to do about the dip issue in a classroom. I guess I'd have to look at the tobacco use policy for campus, and if the wording includes oral tobacco dipping, as well as smoking cigarettes as being forbidden in classrooms, then it is clear what to do. I suspect that our policy is clear about that, as I've never seen it in the classroom. However, I'm sure that somewhere it's been done right under my face in the classroom. STG

There is an organization, Association of Camp Nurses, that has a great website. http://www.acn.org You should be able to find lots of information there. STG

I know that I'm not going to say what you'd like me to say, but I'll post anyway. You need advanced degrees to be able to teach. I do agree with the comment earlier that we are not all born teachers. We all have the desire to teach, the passion to pass on what we know and the patience to do so. My master's program gave me more information and clinical experience to be able to become a content expert. Having a clinical masters degree opens the door for you to teach clinicals in your specialty area. My doctoral program taught me many, many lessons that I probably didn't want to learn, but looking back, I'm glad that I did. I learned how to make the most of my time, and work smarter, not harder. I met other students literally from all over the US and the world and learned as much from them during discussions as I did from the teacher. I also took courses that gave me alot of insight into higher education that have proven valuable to me today, including Law and Higher Education, Program Evaluation and Curriculum Development. I had been teaching with a MSN for 5 years before entering the doctoral program, and thought that I knew alot, but I was able to use what I knew and build upon it. Don't be afraid of more education. It opens plenty of doors for you and no one can take it away from you. STG

As a clinical instructor, it is my policy to treat all students equally. That would include that no one leaves the floor except for when we go to postconference during the last 30 minutes of clinicals. We are only in clinicals for 6 hours a day, and our habits have to be left in the car, along with cellphones and cigarrettes and whatever else. I have only had one student challenge me on the no smoke break thing, and he wasn't successful. No one wants to smell a nurse who is covered in smoke or excessive perfume/cologne/aftershave. I just don't buy that a separate lab coat will prevent smoke smells from lingering on a smoker after returning to a floor, as you can easily smell smoke on a smoker after they come back from break. It's all over them, in their hair, and around the other clothes they are wearing. One of the hospitals in town recently passed a ban on smoking ANYWHERE on their grounds, and that would include parking lots, outside the doors, etc... I personally think that it is the best rule that they ever passed. Secondhand smoke is not healthy, and we shouldn't subject staff, visitors, and patients to it. STG

Here are some of the things that I've done in class and clinical to foster critical thinking/NCLEX success: 1. 5 multiple choice questions at the end of a lecture. Review them with the students. Talk about how to reason through each question. 2. Advocate buying an NCLEX review book during the first semester of clinicals and using it throughout clinicals, not just at the end of the program. 3. Test review for the entire class is immediate. Students can silently look at a copy of the test taped down to a table in the back of the room, as they finish they can go back and look. Immediate test review helps them to learn from their mistakes. I require students who fail exams to do a 1:1 review with me in my office within a week of the exam. Not as punishment, but to pinpoint their weaknesses before the next exam. 4. After AM report, I ask each student individually to rank the patients in priority order (ie who needs them the most according to what they heard in report). I also ask them to list nursing diagnoses for each patient that they heard about in report. 5. My clinical group has a "drug of the day" discussion in post conference once a week. I tell them the name of an OB drug, and they have to look it up during their shift and memorize whatever they can about the drug. In postconference, they each must tell a fact about the drug, but not repeat what another student said. Hope some of these ideas work for others! STG

I was an expert witness in a case a few years back in which the result from a foley insertion was a lady partsl-rectal fistula, and the preteen girl was "voiding" liquid stool. Also, the patient had a latex allergy, and her perineum was extremely swollen and irritated. From that case, I've implemented a few things into my own practice, including checking for a latex allergy before every foley insertion. Not something that I was taught, but certainly worth checking. STG

Some schools are requiring CNA certification in order to enter the clinical courses. That saves alot of time in Fundamentals, as the beds/baths/vital signs skills have been taught, and the curriculum can bild upon CNA learning. However, some schools don't require CNA certification. If your school doesn't, you will probably learn those same skills from your nursing professors during your first clinical course. AFter completing that first course, most hospitals will hire you as a nurse assistant. I was a nurse assistant in a major medical center during nursing school, and was hired after the first clinical course. I learned alot from the job, but never felt like I came close to knowing everything. The unit that I was on was so specialized that it didn't apply to much of my coursework. What I did walk away with was some socialization with professional nurses. During nurisng school, I'd recommend getting a job that pays the most for the least amount of time put in. Because being in nursing school is just like having a full time job, and schedling time to work is easy, but some students tell me that they have a hard time scheduling enough time to study. Just my two cents. Good luck. STG

You need to determine what your career goals are and then the type of program will determine itself from your parameters. CNA certification is nice, but you don't need it if you wait to get a nurse assistant job after completing your first clinical in the RN or LPN program, as the nurse assistant essentials are covered in the first clinical course. I teach nursing at the BSN level, and don't think it is necessary to have an LPN prior to starting the program. Any kind of healthcare experience is nice and it does serve to enhance your overall understanding of the healthcare picture. Some people start out as CNA's while working through the LPN program, and stop there. Or continue on working as an LPN while going through an RN program. Whatever your circumstances are will determine what is best for you. Just for the record, the LPN curriculum and RN curriculum does not "build upon the other". They are not mutually exclusive, and contains some overlap, yet there are many topics that are mandated by state boards and accrediting bodies that must be included in RN programs. It does not mean that one program is "better" than the other, it just means that there are differences. Be a smart educational consumer. Check out that website taht someone else mentioned discovernursing.com It presents a very unbiased view of educational opportunities. STG

We have a rooming in policy that is very flexible. The purpose is to assure bonding between the child and both parents, and to make sure that they are taking care of their child. (I've actually see some parents ignore the fact that their child was hungry, wet/soiled, or just needing to be held for TLC. Of course, social work takes care of that by assessing the situation and removing the child, if necessary.) However, there are instances where the child must be sent to the nursery: If the mom is on heavy pain med postpartally (PCA, or other sedating med), Magnesium Sulfate, post-op c-section and mom is the only caretaker in the room, late night/early morning delivery and mom needs some uninterrupted sleep time. You get the picture. I'm all for rooming in if it fits the situation and the aprents want it. However, I'm also for giving the parents what they want during postpartum. As one of my friends was being chastised for not wanting to bond on the delivery talble said: :"I have 18 years to bond. You can take her for awhile and let me get some rest." I say do what the parents want. They are the customers. STG

I wonder if the policy for observation has any roots in the current staffing levels, as it would take 1:1 staff to keep the baby in the room, but less staff to have a baby in the nursery with all of the other newborns under observation. Just a thought on the rationale. If you really would like to have the observation done in the delivery room, you might want to consider writing a "birth plan". this document is created by the parents, and then discussed with the OB to be sure that what you both want can indeed be done. Then, parents and OB sign it and it is placed on the mom's chart during labor. The birth plan can specify who is in the room for labor and who can stay for the delivery, wishes for pain control, and anything special that is desired. One little word about birth plans that I've noticed from experience....those couples that take the time to write a birth plan usually end up having a c-section and the birth plan becomes a useless document, as the patient really doesn't ahve control over what happens in a c-section. STG

Procardia (Nifidipine) is used to promote smooth muscle (uterine) relaxation to prevent preterm labor contractions. Although the FDA-approved use is for blood pressure. It works quite well. Not trying to be a tease, but I've been called much worse!

Cervidil, Cytotec, Procardia (special off-label use in OB), Brethine (Terbutaline), Calcium Gluconate LMS

I've been teaching for over 10 years now at the university level. Started with a "fresh" masters and the love of teaching led me to obtain a doctorate. My pay is certainly competitive with hospital positions, and when you consider that I basically work days, no nights or evening, no weekends, summers or holidays (unless I choose to grade papers at home, which can be done in the office if desired). then I think my schedule is pretty good. As for the comment about teaching having little stress (or something close to that, I can't see the presious post for an exact wording), well.... let me assure you that is certainly not the case. Every job has unique stressors and teaching nursing is no exception. Assigning grades fairly and equitably can make you pull your hair out. Counseling students who are borderline or who have failed will make you feel as though you failed them , even though they did it to themselves. Writing a fair test is nothing short of a major feat. Then add in the red tape and bureaucracy that lives on university campuses, and the fun begins! As with any nursing position, you need to find one that makes maximal use of your strengths and less use of your weaknesses and that you truly love to do. Teaching is that for me, but others may want to pursue other career options.

Do you guys have any idea how much Zofran costs, even WITH insurance? I was surprised. I picked up my dad's rx with Blue Cross coverage, and his co-pay for a bottle of 30 pills was $200. Right now, there is not a generic equivalent, so the company can charge what they would like. STG

For something to be a HIPPA violation, there must be a divulgence of confidential information. Clearly, when people voluntarily give out information voluntarily for a specific purpose, there was not a divulgence of anything confidential. Your manager is jumping to some pretty bad conclusions here. STG

I have yet to meet an MD at work that I'd even consider dating, let alone marrying. If they aren't nice to work with, you know they'd be a pill at home as a spouse. I prefer to date someone who is not in the healthcare profession. STG

One of my students asked this in class today "What is it going to take to get nursing to be more respected as a profession?" I responded that we have come a long way in the last 40-50 years, and we still ahve a long way to go. My personal thought is that we need to be more unified as a profession and not be so divided on the issues. (Have you seen how much power the AMA has when they band together?) Also, I think that we tend to confuse the public with so many entry level nursing positions and degrees. We would be more understood by the consumers if we could agree on an entry level degree, but there again lies another huge problem that I'm not going to touch on this forum. Just two cents worth... STG

CDC has been recommending a two-step TB skin test since 1994. The reason is that a false negative could be obtained on the first run, but stats show that a second test should be run to confirm the first test to be sure. Check out the CDC's website to double check, if you'd like. I thought the same thing when our admissions policy changed when we got a new Dean. I thought she was crazy until I went to the CDC site and confirmed that information. STG

C is the answer, at least from my practice and MD orders that routinely read "add X amount of KCL to IV bag after pt voids". Shame on me for not knowing a rationale off the top of my head, but c is the answer. STG (going to look up the rationale now...)

I sit on an undergrad admissions committee. Applications are up (There were over 130 applications for 60 positions for Spring 04). Typically, what admissions committees have to do is look at the entire pool of applicants and select the ones who have the best potential for success in the program. No small job, and we do agonize over all decisions and try to do the fairest thing for all involved. I wish you luck with your application! STG

When I worked the units full time, most of us worked 7on/7 off. You just worked the holidays that you were scheduled, like it or not. Christmas and Thanksgiving fell on opposite weeks, so no one was over taxed with holidays. You could alwsya swap, if you wanted. As a single person with no children, I have to admit that I would certianly resent being scheduled to work just to allow people with families to be off. Are there really people out there in the world that think that single people sit around knitting on holidays without anything else to do? Marriage and family should not always be given preference over single lives. Someone earlier said it well.....single people are other people's kids, too. I hope that there can be a fair way to determine who works holidays and rotate it fairly among the staff. Sorry, but seniority does mean a bit when it comes to holiday schedules. I think as nurses, we need to take a closer look at what we got into when we entered the nursing profession. It is not a 5 day a week job, with 40 hours max. STG