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jjjoy LPN

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Content by jjjoy

  1. jjjoy

    Eliminating LPNs - are hospitals doing this?

    I don't know about you all, but it was thumped home to us RN/BSN students over and over again in school that our license was on the line in regard to those working under our supervision and "under your license", especially LVNs who pass meds, do assessments and treatments. What the reality is, I don't really know. I really had no idea the extent of some LVN responsibilities until after I graduated and started working. Before that, I thought they just did only routine stuff like passing stool softeners and changing dressings on long-healing wounds. Or working closely paired with an RN, taking care of the routine tasks so the RN could focus on any changes in status or emergent situations. So I was surprised to find LVNs with full patients loads "under the supervision" of an RN with her own full patient load. And in LTC, to find LVNs almost completely responsible for 30+ patients day-to-day. All that with just a year of formal training? I'm really not clear on the differences in preparation between LVN and RN except of course the LVN course is shorter. It was clear in nursing school when we were covering the functions usually carried out by CNAs. But other than IVs and some assessment & documentation, what more are RNs trained for? What does that extra year or two of instruction cover? (I know in my BSN program, the extra included things like public health and research as well as general ed requirements.) If LVNs don't have the same extensive background of pharmacology, pathophysiology and the like, what are they doing on acute care hospital units providing essentially all nursing care? On the other hand, what extra training is it that RNs have that prepares them for the wider job responsibilities for which they are qualified? Certainly, an RN ought to be able to carry out all LVN (and CNA) functions, yet as I understand it, an RN cannot apply for an LVN position due to different license requirements. Correct me if I'm wrong. Perhaps RNs are just needed so badly that if you've got one, they won't let you work as 'just' an LVN. I'd certainly appreciate any clarification on these issues.
  2. jjjoy

    nurse researcher

    Thanks for your feedback. I want to get into research as soon as possible, but I'm currently unemployed and am afraid it will take too long to find a job I really want. Any suggestions of what kind of work I could pursue meanwhile that might help my future in research? So far, I've put in several applications as a research assistant at a local research-intensive university but it seems there's lots of competition for those positions. I just started considering applying for non-research positions at the university figuring at least it would get my foot in the door. Thanks again for your thoughtful replies!
  3. jjjoy

    nurse researcher

    How much does your clinical nursing experience play into work as a clinical research coordinator? Is it at all possible to get into that without acute care experience as a nurse? I ask because I really enjoyed research in school and would love to work in that but I wasn't so good in clinical. I got by in school, but not through a hospital preceptorship. In contrast, I stood out as a student research assistant and enjoyed work with an outpatient research project. So I'm trying to find a niche for myself. Thanks for any input.
  4. jjjoy

    Nursing education today

    My program included ten 5-week rotations to different areas. Each week, we had two days on the floor Tues and Thur - 7a - 3p with a post conference. We had to go in the previous day to get our assignments, check the charts, make detailed care plans, and make med cards. There were about 8 in each rotation group with one instructor. We could only give meds, change dressings, etc when it was our turn with the instructor.
  5. jjjoy

    getting into PH

    Tempting... but I've got to pass. Still I appreciate the feedback and am trying to find out more about local opportunities. I'm in southern California, the LA area, which is why budget cuts and second languages are such critical issues. Thanks again for your input!
  6. jjjoy

    warm bodies for staffing

    At one facility, a foreign nurse who had already got her US state license was "volunteering" while waiting for her work visa. It looked like the facility was using her license to round out their staffing some days even though she couldn't really do much until she was formally hired. I also suspected that this same facility used new grads still on orientation to meet legal staffing requirements. I'm not at all sure about this impression of mine. Was my imagination working overtime or has anyone else heard of such practice?
  7. jjjoy

    Betadine? Alcohol? (one, the other, or both?)

    Do you actually wait two minutes or more for the betadyne to dry? I haven't much experience with IV starts but when I've witnessed others, they didn't seem to wait that long.
  8. jjjoy

    Cost of medication as an inpatient is SHOCKING!!!

    Isn't the premise that nurses (and other ancillary staff) are like the factory workers while the hospitals and doctors are the owners and engineers? The hospitals (owners) provide the materials and facilities that require lots of financial investment and the doctors (engineers) provide the know-how and determine the best way to meet the owners' goals (here to make money from providing medical services - or at least to be able to cover costs to continue providing such services). The nurses (factory workers) tend to be considered as interchangeable and relatively easy to train. The original idea does seem to make sense in the traditional capitalist system. However, there are real problems with this idea. 1) Nurses and other nursing staff cannot all be lumped together as interchangeable factory workers. Basic tasks can be taught and carried out routinely on stable patients and these workers don't demand high salaries - aides, techs, etc. But we run into trouble trying to determine how to assign tasks to different job roles while still providing quality care and being financially sound - which tasks can be assigned the "factory worker" and which tasks require more extensive education. With sicker patients and busier doctors, nurses need more than basic skills - they regularly need to exercise judgement on unique individual patients as opposed to working with standard equipment. 2) Healthcare is unique. Ethical issues abound as do regulations; providers don't have so much choice over what services to provide and how to provide them. In industry, if a product line isn't turning a profit they can eat their losses and try something else. If industry makes a substandard product, they simply lose out on the profit. If a healthcare facility offers substandard care, people's very lives are affected. Yet, if the facilities cannot recoup expenses, they can't continue to provide service - no matter how great the service. Sicker patients also need a lower patient-nurse ratio yet don't seem to provide a proportional monetary return. What to do? I don't have any easy answers. I don't have any answers, really, but I do want to learn more so that I can where I fit into influencing the future of healthcare.
  9. jjjoy

    non-clinical nursing?

    I'm a (relatively) new grad BSN/RN and am looking for work. The catch is that I don't want to work in a clinical setting. Why not? I've worked at two different inpatient facilities in the last year. I just couldn't handle the pace and patient load (couldn't do competent care AND complete necessary tasks in a timely manner). I was giving it my all and wasn't ready to give up, but in the end my supervisors made the decision for me to leave. Now that I look back at it, even if I'd had more time added to my orientations, I can't imagine ever really feeling comfortable with that pace. I looked into a third place that was much more manageable in terms of patient load and responsibilties (a unique facility), but I'd have been the only RN supervising LVNs and CNAs. I'm not comfortable being the only RN there to deal with emergencies. I could keep trying to find a "good fit" but am afraid of failing again and changing jobs too often. I'm very reluctant to try another clinical job. I really enjoy working people, problem-solving, and learning new things. I like getting things done. I've always been interested in health care and public service. I did very well in school. Public health, epidemiology, and research were some of my favorite courses. I can't say I loved clinicals, but I did fine. However, it's nothing in comparison to having the multitude of responsibilties and distractions flying at you that the average nurse deals with non-stop. People always say nurses have so many options. Our instructors were very insistent that nurses don't have to work bedside. Nonetheless, most non-clinical "nurse" jobs require a strong clinical background. Nurse educator ads require years of related experience. Public health and research are areas that I'm interested in as well, but the job market is tight and I can't afford to be out of work for six months to a year trying to find work in those areas. I don't want to "waste" my education, but I'm tempted to just take any stable job at this point. Any advice?
  10. jjjoy

    From "Nursing to Medicine" is it uncommon?

    My BSN program required non-major science courses - eg one term of "Intro to Organic Chem" vs a whole year of "O.Chem for science majors." Same for microbio, physics, and A&P. These courses were not for those majoring in chem or bio or premed. So if one were to apply for med school or a masters in a "hard science" they'd have to go back and take the more indepth version of the courses they took for nursing school. You can do it, just be aware they are different than the classes you took for nursing school. A BSN is not a stepping stone to med school in the way that a BS in Biology is. Academically, that is. Certainly, however, the clinical experience and knowledge of how things get done in the hospital would be a big bonus in medical school. Good luck!
  11. jjjoy

    Advice please: New grad very scred

    I don't have any answers, but I can relate to your feelings. There's a difference between not wanting to go to work and DREADING it. Some folks get a rush from the acute care environment and demands. Some don't love it, but it's tolerable. Some would find sitting in an office something that drives them crazy and would rather do just about anything else. We've all got our own quirks. We each have to find what works best for ourselves. It's especially difficult when it seems like no one else understands how you feel. So let me tell you my experience. The floor is just too hectic and distracting for me. A nice, quiet office sounds really nice after experiencing the true nature of floor nursing. I'm looking at alternatives myself. My advice is not to give up yet. It's been just two weeks so far. Try not to look too far ahead. Don't worry about how you need to be to be a "real nurse." Just look at what YOU can accomplish each day. It's a real lesson in discovering your limits and acknowledging them. If your preceptor is pushing you to do something and you don't feel comfortable with it, practice standing your ground with dignity and tact. "I'm not comfortable with that" repeated a few times may not get you praise, but should ensure that you aren't too overwhelmed. And don't be afraid of overusing those important words "I need your help." You're going to feel a lot of pressure to be able to handle a lot of things, and you just need to focus on YOU and what you CAN handle. Not what you or anyone else thinks a new grad "should" be able to handle. If your progression ends up being too slow and cautious and you are threatened with dismissal, that's better than being let go because you made too many mistakes by taking on more than you could handle. I do recommend scheduling an appointment with your manager and preceptor and see if they have any advice for you. It's scary, but again, if it's already that terrible, might as well find out as much as you can about your performance. You might also want to inquire about changing preceptors. Sometimes that can make a big difference - not that the first one is bad, just perhaps not a good fit in terms of your learning style and personality. Finally, ask about coming in a few hours on an off day (no pay) in order to observe with no distractions of your own responsibilities. Give it another a week or two and see how you feel. You may feel more confident that floor nursing isn't for you. Or you may feel like you're getting it and it's not so bad after all. Just be sure to do more than gripe about it! Good luck!
  12. jjjoy

    emergent situations?

    Thanks for the feedback. I guess I'm trying to find a way to be a "desk nurse" without first going the clinical route. In school, I excelled at critical thinking but not in clinical performance. Clearly, my performance was satisfactory and I graduated, but I don't want to go back into the clinical setting. I really can't stand the hectic, chaotic nature of floor nursing these days. Some folks thrive on it. I run for cover. I honestly didn't realize how much I disliked it because I so enjoy patient interaction and learning about health and science - and as a student nurse you don't have to deal with everything a working nurse does. I still want to use my knowledge of health conditions and nursing care. I've considered pursuing graduate work in a related field, but would like to get some work experience and earn some money before heading back to school. Just exploring my options.
  13. jjjoy

    emergent situations?

    I understand that there are many different job descriptions for OHNs. However, is it common for an OHN to have to deal with emergent situations? Life-threatening accidents? Heart attacks? I think I'd be well suited to OHN but don't want to have to be the EMT for critical emergencies. I have very little clinical experience outside of nursing school. Is that a big drawback? How difficult is it to get that first job in OHN? Thanks!
  14. jjjoy

    non-clinical nursing?

    I guess I've just gotta keep looking. The assisted living I checked out locally had one RN for about 80 residents with a couple of LVNs to pass medications. I checked out a ventilator weaning unit on the advice of another nurse who figured the patients were pretty stable, but the manager there discouraged new grads from applying. There are so many different facilities and arrangements out there. I guess I've just got to check them out one by one. My preceptor did share just one assignment with me. It's just if I were doing something, she'd usually start doing something else. If I were passing meds, she'd disappear to help other nurses, take care of incidentals, etc. At that point, I did need to be working more independently; I just needed her to be more readily available. I got the feeling that my needing to ask so many questions was a problem in and of itself. That while I was new and questions were good, I wasn't following the usual progression of a successful new grad. In the hospital, my biggest weakness was assessments. Until I've seen a definitive symptom first hand, I'm not sure if I will know it when I see it. So for any slightly abnormal symptom - abdomen a little distended, complaint of some nausea, headache, I'd be checking with the nurse. Is that normal in these cases? What would abnormal be? Was it noted by the previous shift? Is this something I need to point out to the next shift? In LTC, I just couldn't get all of the medication passed out in the time period. Not even close! And of course, there were lots of other things that needed to be done as well. I couldn't figure out how anyone else did it. I tried and was terribly behind. I wanted to see how they managed to do it all. I'd ask to just watch, but they'd push me to do it myself. "You don't learn by watching. You learn by doing!" Except I couldn't seem to get it all done. I never had such trouble just getting by in a job before. I pick up on the systems very quickly and know all that I'm SUPPOSED to do. I just can't seem to do it all fast enough and keep it all straight without sitting down and making a neat list. Very frustrating.
  15. jjjoy

    non-clinical nursing?

    I worked on busy med/surg floor. And at busy LTC facility. Are there any environments in acute or sub-acute that aren't crazy busy? Where you can go home on time on a good day? It's not that I care about getting off right on time, it's just if the experienced nurses aren't getting everything done on time, I sure as heck won't!
  16. jjjoy

    non-clinical nursing?

    "Could it be that you have troubles with organization, goal-setting, or planning?" It could very well be. But how to work on it? I need time to organize and plan, and there's just not that much time available when working. I'd come in early to try to get some extra time preparing and planning. Of course, oftentimes the assignment changes so you can't plan ahead. It seemed like there was never time to do everything. If I checked for new orders, I didn't get the meds passed on time. If I passed the meds on time, the new orders weren't taken off in a timely manner. I wrote lists, made check off forms to try to make sure I didn't miss anything, tried to plan ahead, but there's always something new, something else that needs to be done now - a new admit, a request for pain meds, someone vomiting, a high temp, doctor on the phone, etc. Planning and organzing can only get you so far. Goal-setting. Do you mean in terms of what to accomplish each day during orientation? Giving all meds for a certain number of pts? Try to get certain procedures on the checklist done? Do all assessments and charting? Whatever I'm working on, generally the orienting RN is busy doing everything else and must be found to ask questions to and so everything I do takes that much longer. And the orienting nurse gets annoyed at the frequent interruptions from me, but if I just plow along, "saving up" my questions (like for an hour, not a whole shift), I'd end up with several things being quite behind schedule because "going back" and doing things takes even more time. If the preceptor tells me to go it on my own for awhile and comes back to find me far behind schedule, she wonders at how I could "let" everything get so backed up. Again, there's no time during the shift to sit down and discuss what you did when and why and how else you could've handled it. By the end of 12 hours, I'd be kind of fuzzy on the details of my day. I could sit down, review my notes, recall certain choices... but I need some quiet and calm to gather my thoughts like that. None of that til at least 30 minutes after the shift is over. I am a thinker. An analyzer. And much of nursing is action. Of course, there's reason for that action, but there's often not the time to fully process the whole line of reasoning. You need to get from A to C quickly without spending time pondering B and it's relationship to A and C. Thanks for your thoughtful responses! I'm still working through why I had such a hard time and what do now. Like looking at those 3-D "hidden" pictures - sometimes you just can't see something even though you're looking hard.
  17. jjjoy

    non-clinical nursing?

    Medical assistants are much more common in doctors offices. If they need an RN it's usually because they do outpatient procedures and, they often want a nurse with hospital experience who has dealt with codes, can start IVs in any vein and has a second sense in patient assessment. I will keep my eyes open but have seen VERY few job listings for RNs in doctors offices. I did look into school nursing and occupational health nursing while still in school. At that time, I didn't feel like a nurse and in those jobs you are "the nurse." After a few months of working as a nurse full-time, even just on orientation, I do feel more like a nurse. While I had a hard time handling the pace and distractions, I'm much more comfortable with my skills and more confident in my knowledge than I was just after graduation. So maybe it's a good time to look into those areas again. But how much are these kinds of nurses expected to know about dealing with emergent situations? Is the occ hlth nurse expected to recognize if a worker complaining of chest pain is having a heart attack? Is the school nurse expected to recognize if a child is going into insulin shock? I have the textbook symptoms down, but I've never witnessed these events before. For me to be successful in a clinical setting, it would have to be pretty low stress - that is possible to get everything done in the given time period. Of course, there are good days and bad days, but in many places the expectations seem next to impossible to meet even on good days. And, again, I don't want to be the only RN on shift. I'm not confident I'd recognize a pt "going bad" soon enough and quickly take necessary actions.
  18. jjjoy

    How much orientation do new grads need?

    I was a new grad who didn't cut it on a busy surgical floor. I knew I needed to do better but couldn't put a finger on what I could do to improve. I could tell the other nurses weren't satisfied with my progress but vague advice like "prioritize" and "take initiative" didn't help. It came across that I could do it if I just tried harder. I'd go in early to prepare. I'd stay late to review. I'd make lists of things to look up at home. I could accept that maybe this wasn't for me, but I couldn't accept that the other nurses thought I wasn't trying hard enough. All I needed to walk away with my dignity was an experienced nurse to validate my efforts and my strengths. Be specific and work with the nurse to figure out where she's hung up. I'd get these evals that were a mystery to me. "Lacks initiative." "Doesn't manage time well." I was doing more and more each day. I carefully evaluated each situation to determine what to do. I was busy every minute I was there - I wasn't reading magazines in the break room or anything like that. I had to translate the feedback for my situation. I wasn't comfortable performing a new procedure after witnessing it once. I needed to watch it several times before feeling confident enough to jump up and volunteer to do it. That's what the "lacks initiative" was about. Not as useful as pointing out that to work on that floor I'd need to be more comfortable about jumping in to do new procedures. I also was very careful in my assessments and in preparing for procedures, mentally reviewing the steps. But I'd end up without enough time to finish other tasks. That was the "doesn't manage time well." I wasn't comfortable speeding up but the job demanded it. Alright, I can accept that. Finally, if you think someone just is not cut out for the job, frame it in a way that says "maybe you'd be better at something else" and "we need you to be able to function at this level and you're just not there" as opposed to "you should've been able to do this by now."
  19. jjjoy

    How much should nurses be paid?

    I agree with those folks who wouldn't be up in arms over pay if the conditions were better. Nursing is a rewarding field and if you can do a good job and can make decent living, just fine. Too many nurses, however, are stretched too thinly. No matter how great the pay, if the working conditions are poor (stressful and dangerous), good people will leave the profession. There is a definite inconsistency in terms of education, pay, and job responsibilities. More education does not necessarily demand a higher salary, so I don't see requiring bachelors' degrees and masters degrees as being a means of increasing salaries. Plumbers and mechanics can charge a lot per hour because their skills are in demand, not because they need 4-8 years of college education. The average college professor (vs a hotshot big league professor) with as many years of education as an MD doesn't command nearly as much as an MD. You either need the education to perform the job or you don't need it. If nurses need 4 years of education or more, that's fine. I just hate to see the argument that if all RNs needed bachelor's degrees they'd be paid more. LVNs at inpatient facilities have incredible responsibility for patients yet have a pretty short training period. Do they deserve relatively low pay since it's a pretty low entry gate or do they deserve relatively high pay since there's so much responsibility? It is true that nurses with extra skills and information from experience ought to be paid more. But then their job description is exactly the same as the new grad so how much more money is reasonable? It seems like the whole system would have to have to be rebuilt from the ground up with education and job descriptions more clearly defined and pay that reflects the demand for and competency of those skills.