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jjjoy

jjjoy LPN

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Posts by jjjoy

  1. I've recently noticed A LOT of advertisements in my email from AllNurses sponsors (or whatever they're called). To unsubscribe from the advertisements, I had to unsubscribe from the Nursing Insights email.

    I realize advertising isn't going to go away, but I am disappointed to have to choose between receiving unwanted email advertising and interesting snippets of discussions/articles at AllNurses. Nursing Insight includes some advertisers as well, but at least there's something besides just advertising. I get way too much email as it is and do NOT want advertising-only emails taking up space. It would be nice if a paid subscription allowed one to opt out of extra advertising. Those who can't afford a subscription or choose not to pay for a subscription are paying by accepting the extra email advertising.

  2. You do have one advantage now. You've already taken at least a couple of tests already, and have probably learned a bit about the... unique... style of some nursing test questions. I had to totally re-think my study strategies for nursing school tests. I felt more like I was learning how to take that type of test as opposed to learning all the material we were covering. Hated it, but it got me through the tests. On the bright side, for my own learning style, it was much less work to study "nursing school style" than to study my traditional way (read everything thoroughly, stick with it until I really understand it thoroughly). There was too much to cover to study that way and actually led to poorer performance on tests ("overthinking" the questions/answers).

    Do check out an NCLEX review book. If you're in fundamentals, stay in the fundamentals section of the book. I'll bet you pass!

  3. I don't think you're saying that health care techs function at the level of a trained monkey, are you? If techs are lacking in any needed skills/competencies, then can't they be taught? Can only nursing programs teach patient advocacy? Delegation skills? Infection control practices? Can only nurses perform these skills?

    I know I got very little training in delegation at my school. And one elective through the public health school covered at least as much about infection control as was covered in nursing school. Process improvement? We didn't cover anything that any business major wouldn't have covered and probably a LOT less.

    I'm not saying OR RNs are unnecessary or superfluous, not at all!!! That's someone else's argument. As an RN myself, I just wonder at where nursing stops and starts amonst the many different needs/roles in health care. And I realize that it's fluid and ever-changing. : )

  4. Wow, what a great detailed description of all that OR nurses do! I certainly get that they do a lot!

    My question is which of those activities are *nursing* activities (regardless of whether or not a nurse is doing it) and which are not necessarily *nursing* activities that the nurse is responsible for. For example, the role of scrub nurse. Is prepping and anticipating surgical supplies *nursing*? Or is it a skill/role that nurses learned and performed but still is not necessarily, or uniquely, *nursing*?

    When there wasn't so much demand for certain roles, if you needed someone to fill that role, it would make sense to recruit a nurse to fill the role. The nurse clearly already had some medical background and they could also fill multiple roles. But when the demand for that role increases such that it can support training programs and full-time employees just for that role, then why 'borrow' a nurse for that role anymore? Respiratory techs and surgery techs are examples.

    Thoughts?

  5. To me, this comes back to a key issue.... what *is* nursing? Nurses can *do* many things... from emptying trash cans, to intubating in an emergency. From giving injections, to taking a health history, to identifying medication errors, to assessing hemodyamic status, to teaching safer sex. From circulating, to scrubbing, to 'first assist'.

    But what is it that nurses offer that is actual *nursing care* as opposed to care/service that a nurse happens to be well-positioned/well-qualified to learn and to perform but is not necessarily *nursing care*? What is the *nursing* knowledge/skills that logically would be at the heart of nursing education to make for the safe and competent practice of *nursing*?

    For example, patient education is an important responsibility of many nursing roles but I don't see it as "nursing care" per se. A good dietician will also provide education during their dietary consult. A good physical therapist will also provide education while going through exercises with the patient.

    While not not all nurses provide personal hygiene assistance for someone incapacitated in some manner, such care is generally considered "nursing care", is it not?

    And while some non-nurse personnel do participate in activities such as on-going monitoring, & treatment provision (such as med aides, pt care techs), it, too, is generally considered "nursing care", is it not?

    Activities to prevent deterioration and complications (early ambulation, position changes, bandage changes, etc) generally are considered "nursing care", whether or not a professional nurse is providing the service (eg 'nursing' one's family member).

    I've gone away from the specific issue of RNs in the OR, but I see it all as interrelated. My 2.5 cents!

  6. Different stresses... personally, I do better knowing a few things really well than a little about a lot, so between the two in an acute care setting on the general floors, I'd think RT would suit me better. Of course, nurses work in many different settings with different responsibilities so one can't generalize about *all* RN positions. Still, *many* RN positions do cover a wide bredth of areas - all physiologic systems, family & psych issues, coordinating with different departments (pharmacy, diagnostics)... and more! To me, it's stressful not being able to really dig into anything and constantly hop from putting out one fire to another.

  7. in the event that surgical technician jobs or paramedics became less available or jobs were cut, then it would be the nurse that steps in and fills the void. That reciprocal cannot be said for the other two jobs mentioned above.

    Thanks for your response. I think you make some good points!

    Still, isn't the above issue more of a legal technicality than an issue of qualification and competency? Advance practice nurses have fought for the right to prescribe drugs without physician supervision instead of going with the status quo which said that prescribing was not the scope of practice of nurses.

  8. I do have to wonder how many of the repondents here actually work in LTC. And the ones who do, I have to ask how realistic it is for a newbie to actually check on each and every treatment, as the newbie is probably already waaaayyy behind because they are also having to check on everything else that a more established nurse at the facility may not have to... such as checking ID bands, looking up meds, etc. Would the supervisor approve overtime for the newbie to finish everything up properly until they have a realistic chance to get up to speed before they are established enough in the facility and their own experience to develop those elusive "time management" skills?

  9. As for waiting until things "get hairy" before bringing an RN into the room, things can go bad very quickly and in multiple rooms at once.

    I don't think it's overkill to say it's important to have an experienced acute care nurse in the OR. Just having an RN license in no way reflects a person's ability to respond to such "hairy" situations. Nursing school doesn't really teach those things and even many experienced nurses have never really had to take charge of that type of emergency. That is what nurses learn on-the-job, not in school.

    Ideally, the OR nurse brings those emergency skills to the OR. Is a nurse who doesn't have that kind of relevant experience and skills and has to learn that along with all of the OR specific responsibilities to the OR still better than an experienced surg tech or paramedic who receives rigorous training in all of the responsibilities of OR non-physician staff (eg positioning, assisting with emergency medications, etc)? It's an honest question of mine as someone who has completed nursing school and does hold an RN license.

  10. "Look up the hospital policy" "Clarify the orders with the physician" "Know every med you give, what it's for, appropriate dosage, etc - if you don't, look it up!" ... absolutely! Except that when you're a newbie so much of what one comes across is either completely new, just recently learned (& not yet really retained), or perhaps vaguely remembered from some far off previous experience... If the newbie truly took the time to check the primary source - as opposed to asking a more experienced colleague (nurse, physician) and trusting their call - they'd probably get counseled on "poor time management".... SIGH.... forget "learning curve"... it's a "learning cliff"... if you make it 6 months without falling off the cliff (getting terminated for one reason or another), then you've probably learned what you need to succeed.

  11. My experience with a nursing home was that there wasn't really a "HR" department at the facility such as that found in a large hospital. There was some central office somewhere else that dealt with benefits and the like, but the staff in the nursing home adminstrative office (all 2 of them) really didn't really say much at all and seemed to discourage questions. Orientation was just me, not a whole group of new hires to different departments. If some of those safety videos aren't boring enough in a group, try staying awake watching them alone in a closet-size room!

    You definitely should be getting paid for orientation. It's not unusual for nursing homes to have VERY short orientation periods, even for the inexperienced... like 3 days. If you can get more, take them!

  12. Ugh, exercises like this bug the heck out of me! Without real world experience as a nurse on the floor, how in the heck are students supposed to have anything to contribute a presentation about managing one's time as a nurse on the floor? It's like asking a first-time skier after they've run the learner slopes (not even the green circle runs) once or twice to give a presentation on how to ski!

    Half of what "time management" is in the real world can only come through experience, not just good "management": such as being able to do a focused assessment while at the same time as starting an IV, all in under a minute. Sigh!

    Guess I'm in a ranty mood today...

    To be helpful... I'd suggest keeping it simple... with suggestions of things like gathering all supplies ahead of time before heading into the pt room, seeing what else may be done during any particular trip to a pt room (going to hang an IV? maybe can do dressing change during same trip), assess patient as part of other activities (eg. when bathing, do skin checks)... all of which I tend to think "duh"... if one needs that spelled out to manage their time, can we trust them with sharp objects and toxic substances?

    Oops... ranting again!!!

  13. Sure would be nice if more instructors could/would explain things so thoroughly... we had "critical thinking" pushed down our throats. Then they'd give a never-break rule of nursing such as "NO AIR IN THE LINE. EVER. IT CAN KILL" We'd see nurses we're supposed to be learning from not getting every last little bubble out and wonder at their competency, maybe even put them on the defensive when explaining "my instructor said 'no air ever'". I've heard the rationalization that it's better to be safe than sorry, so to just tell students "never"... but that is the direct opposite of critical thinking, is it not? Ugh. Another justification is that there just isn't time to go into the details of why in general no air is best but a teeny bit of air usually poses no problem. But what is nursing school for if not to teach to that depth?

    I'm venting because I see this question again and again... and had it myself. If instructors can't trust students to tell the difference in risk between 0.01 ml of air and 10.00 ml of air - and instead continue to teach "ANY AIR IN LINE = LIFE THREATENING EVENT"... then it would seem that they don't have very high expectations of the students' critical thinking potential.

    Rant over!

  14. I'd say to not ask "can I get into and through nursing school"? You probably can. The question is "do I want to be a nurse"?

    Not always an easy question to answer since nurses function in many different roles, from OR scrub nurse to outpatient NP. Still, the core of professional nursing is inpatient, bedside, acute care nursing. If Plan A of becoming a CRNA or sole-proprietor of a primary care clinic in a rural area doesn't work out or takes longer than expected, the "fallback" of nursing is bedside care. There are many other situations an RN may work in (school nurse, clinic nurse, legal consultant) but they are either hard-to-come-by-opportunities and/or require years of prior acute care nursing experience.

    If you want to be a nurse - go to nursing school.

    If you're interested in the medical field in general, with your background, you could probably qualify for any of number of medically-related non-patient care jobs. (In this job market, though, I could see how it might be easier to get into an accelerated BSN program than just to get a job.) Use the web to check out job descriptions at local health care facilities, medical device companies, pharmaceutical companies, etc.

    If you definitely want to be in the medical field in a *patient care* capacity but aren't sure in what role, though, I'd suggest trying to get an entry-level job just to get in there on a day-to-day basis before investing money and time in a full-blown professional program. CNAs & EMTs have fairly short certification programs and often have more direct patient contact than some nurses. Unit secretaries get a good view of how the various professionals & departments work (or don't work) together. Again, I know today's job market it tough. Just know that these days an RN license doesn't guarantee a job either, especially for newbies with little real-world experience.

    Best wishes in your journey!!

  15. To go on a tangent... why in the heck isn't it standard to teach such standard notation in nursing school? I'm sure some do, though even then, I imagine those students who were explicitly instructed on such things just had the good luck of being with an especially good clinical instructor. Goodness knows, the lectures at my school were all about rushing through textbook content with no time for questions or elaboration or even to really have any of it sink in! I'm not sure what the point was except that when half the class got an obscure question wrong on a test, the instructors could say "you should've got that, it was covered in lecture!"

    To become familiar with an everyday notation *and* what it means... why cover that in school when you'll learn it on-the-job? Why bother with school at all? *Everything* theoretically could be learned on-the-job, couldn't it? Ugh!

    Vent over, back to the topic at hand...

  16. One more thing... Do you have thoughts on how a person might become more competent?

    That seems to be a catch in nursing? Since nursing is slim on the residency/internship thing, how does one gain skills? Get a job doing the very thing you want to become competent in! If you and your patients are more or less intact after your first 3-6 months, then you are well on your way to being a competent nurse.

    Nursing seems to involve a lot of "sink or swim". I say "sink or swim" and not OTJ training, because to me, the term on-the-job-training implies structured supervision, not the "here-ya-go-call-me-if-you-really-get-stuck-but-you-shouldn't-have-to-because-this-is-the-job-you-were-hired-to-do-and-I-dont'-have-time-to-do-my-own-job-much-less-yours" pattern that seems to occur in certain areas of nursing.

    I imagine that in the past, nursing students were thrown into more "sink or swim" situations, especially where students essentially functioned as part of the nursing staff. Anyone who graduated, then, had already been through this trial-by-fire. With today's liability concerns, though, students may not be given the opportunity to "sink or swim" (aren't allowed to do much of anything clinically) and so the "sink or swim" part of clinical nurse "training" occurs after one has earned their license and has landed a job with full legal responsibility for the nursing care.

    Similarly, NP education was built upon the assumption of solid real-world clinical experience. Those in NP programs had already been through the "sink or swim" aspect of nurse learning, either as students or as new grad staff nurses. Direct entry programs, then, delay the "sink or swim" aspect of clinical nurse "training" until after the inexperienced student has their RN and NP licenses in their pocket.

  17. Seems a rather optimistic view to me. There are still so many hurdles to systems talking to each other much less getting accurate data into the system to begin with... then there's the problem of so much data available that one may waste time sorting through it all... finally add in information security concerns...

    Barring significant social/environmental obstacles, I imagine eventually our individual health data/history *will* much more accessible... but it may be a VERY bumpy road.

    I'm imaging the beginnings of the motor car and roads growing from dirt lanes to interstate highways, from harnessing electricity to the implementation of large power grids, from a few novel transatlantic flights to 24/7 airline hubs dotting the globe... I just don't yet see a standardized infrastructure needed to realize the author's vision of readily available and transferrable med recs in the US.

  18. The day/night thing seems like a distractor from the root of the problem - poor support/low resources.

    The eye-rolling attitude described is not uncommon in nursing, unfortunately. And it *really* grates on me - evidence perhaps that my skin isn't thick enough for many nursing jobs?

    As another noted, nurses with this attitude would likely huff and eye-roll no matter what... if they were taking report from night shift for day shift, they'd huff and eye-roll. If everything was completely done upon reporting for their shift, these are probably the types who'd then huff about that person making everyone else look bad by having everything done.

    Still annoying, though...

  19. This is why we need physician order entry. Then everyone would be able to read the orders and the mds will not be constantly called to clarify the obscure and hard to read. Of course when they tried to do this at my hospital the mds refused stating that they did not go to med school to be a secretary. They were not hearing anything about patient safety or efficiency.

    Yeah, physician order entry hasn't gone over really well where I'm at either. The physicians get to experience the tedium of sorting through whatever med info system is in place. If the system were well-designed, I'd be all for it, but it's not. At least maybe the hospital will listen to the physician complaints about the system, though, and try to make some changes... I can hope, can't I?

  20. Ok, to get some direct care experience in a healthcare related field... look in your area for companies that provide group homes and such for developmentally disabled people. Jobs like "residential support staff" or "habilitative support staff" do not require any licensing so you can work there while getting experience like foley care, ADL assistance, PEG tube care and feedings, etc.

    That's a great idea and worth pursuing. I can imagine, though, it could be difficult to land such a job if one has already finished nursing school. Employers may not trust that the applicant would be willing to stick around very long, imagining that the nurse would leave just as soon as a better offer came along... and with an RN license, just about any job offer would probably beat support staff in terms of pay (as opposed to hiring someone with fewer potential alternate job possibilities). Sometimes, 'overqualified' can make it difficult.

    I suppose one might 'forget' to include the nursing degree and license on one's application. I know I'd be uncomfortable with that.

    Regardless, it can't hurt to look for such opportunities and give it a shot! Any inquiry could lead to an unforeseen opportunity. Keep on keeping on!

  21. Also, the lecture and lab schedules for the bio classes may not fit together with the nursing school schedule of lectures/labs/clinicals. Nursing school courses/clinicals often fill much of the day and are not at all flexible.

    And if you have all that free time, I'm sure you can find some other meaningful activities... look into getting a nursing assistant or unit secretary job, take an EMT course, add to and diversify the volunteer work...

  22. 1. it IS a Magnet requirement to show an increasing percentage of BSN's over time. It's a lot easier -- and a WHOLE lot less painful to increase your BSN percentage by only hiring BSN's than it is to force your existing ADN's to go back to school or face getting fired.

    2. A lot of nursing leaders have secretly (or not so secretly) wanted to support the BSN as the required entry level for years -- The Magnet push gives them an easier way to achieve what they have been wanting to achieve all along.

    3. A recruiter may say "We have to do it for Magnet..." because it ends the discussion. "We have to do it for Magnet" is a conversation stopper that saves them a lot of time.

    Your explanations make a lot sense. Thanks! : )

  23. I'd call it "test-taking strategies" or "prep for nursing exams" as opposed to "good thinking."

    In my experience, "good thinking" (or real critical thinking) sometimes seemed to make it *more* difficult to choose the "best" answer. Nursing test questions can be worded oddly, so easily misinterpretted, especially if you "over-think" it. And even worse, in my opinion, there are those questions where NONE of the answers is really accurate and you're supposed to choose the "best" from the selection of not-quite-right choices... as if that's totally objective.

    So having any kind of prep for these test questions before going into the first test will probably be a good thing. : )

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