jjjoy LPN

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!

My experience was similar lelafin. I can only commiserate. :heartbeat

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. : )

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?

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!

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.

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.

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?

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.

"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.

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!

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!!!

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!

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!!

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...

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.

Best wishes to you as map out a plan! It sounds like you will work something out! You say you've been in MT, maybe also look into other areas in Health Information Management. Working with information can sometimes better allow for working around bad days than working in a hands-on clinical capacity. Much of the opportunity and flexibility in nursing comes from one's experience working as a nurse, as opposed to just having the license. The skills and knowledge required by those opportunities often come from specific work experience, not just nursing school. New grads are often strongly recommended to work a few years full time in an acute care setting to build the skills and experience for which nurses are valued. Nursing school really only introduces you to nursing and gives you the license to *start* practice. Strong assessment skills, clinical judgement, prioritization, working with physicians - these can only be developed with more time and experience and exposure than nursing school alone provides. There are roles for nurses that do not require acute care experience, but just be aware that not having solid acute care work experience does *limit* the scope of flexibility and opportunity for which nursing is known.

In many US universities, one doesn't just "major in"nursing, they enter the "nursing program" which is a very structured series of nursing courses and clinical experiences that each cohort of a very limited number of nursing students moves through together. If you fail a class or clinical, you generally are out of the program altogether immediately and you may have to apply for a spot in the next year's cohort and/or hope for someone to drop from the next year's class so that you can fill their spot. Courses and clinicals generally are at pre-set, non-negotiable times (eg Lecture MWF 8-12, clinical Tues Thur 7a-3p, skills lab MW 2-4) which can make taking other coursework rather difficult just logistically, even if you weren't overwhelmed by the workload. There is lots of required reading and projects that take a lot of time *outside* of class and clinical time as well. At my uni, you'd be pre-nursing the first two years (taking gen ed, pre-req sciences) and then apply for the nursing program for junior year. The nursing program was then two years. If a pre-nursing major didn't get into one of the just 50 yearly spots, they'd either just have to wait a year and apply again or switch to a non-nursing major. Many majors, on the other hand, don't have such strict limits on the admission of students in the major or classes. My uni's BSN program did count many psych courses as elective credit towards the nursing degree - courses such as developmental psych & abnormal psych. So you still may be able to get some extra psych under your belt as a straight BSN student. There are lots of different majors that focus on how the body works. You can major in anatomy, physiology, psychobiology, human biology (or some variation therein) and learn about the body. Nursing school level science courses are not as in depth as the courses for other science majors. Nursing school is about gaining the foundation and qualifications to be able to start working as an RN after graduation. Some say the "real learning" starts then. Just food for thought!

Guilty as charged!

ADPIE is a problem solving process that works very well without the D. This particular format of problem solving works well for nursing. It also works for problem-solving in many other areas as well. Assess, Plan, Implement, Evaluate. To assess is to identify the problem that needs addressing. Heck, I'd argue that the diagnostic process is *part* of the *assessment process* If an initial assessment identifies the problem to be addressed, then go straight to planning. If the initial assessment doesn't provide enough to plan an intervention, then one detours through the diagnostic process as part of the assessment step. Assessment? chest pain Plan? it depends on if the cause of the chest pain can be determined Diagnostic detour: consider possible etiologies and run tests = further assessment Assessment? ECG shows ST-elevations = Diagnosis: myocardial infarction Plan? (continue planning based on assessment) Assessment? chest pain, ST-elevations ND? altered tissue perfusion, cardiac r/t impaired transport of oxygen and interruption of blood flow aeb chest pain, ST-elevations Plan? (plan based upon the ND - which includes all relevant assessment information within the 'diagnosis')

I kinda felt this way. It's not that more information wasn't in the official curriculum, but there was That is, somewhere in the thousands of pages of reading surely was lots of useful information. But a good percentage of that reading wasn't useful (ad nauseum repetition of basic nursing interventions - therapeutic listening, turn-cough-deep-breath, etc). And the rest of it, well, who had time to do more than skim the readings when more intensive reading only made test performance worse (d/t 'overthinking') and so much time needed to be spent on care plans (ad nauseam repition of basic nursing interventions) and other projects? So the nursing school could claim to have 'taught' so much info on all variety of conditions (see it was in the curriculum-week 3, chapters 12-20) wheres what was actually learned could be a whole other story.

Thanks for sharing! (and enjoy your 6 weeks!) Thing is, what is the difference between 'diagnosing' diarrhea and nausea and simply having made the observation of diarrhea and nausea? It sounds to me like the nursing care plan book with it's comprehensive list of possible interventions is what helped, not a 'nursing diagnosis'. With or without 'nursing diagnoses', a nurse or physician or dietician or worried mother can identify chronic diarrhea and nausea as a problem and research possible etiologies, diagnostic tools (such as a dietary holiday), interventions, etc. Page 1 of the US Dept of Health and Human Services - National Digestive Diseases Information Clearinghouse notes celiac disease as a possible cause of diarrhea.http://digestive.niddk.nih.gov/ddiseases/pubs/diarrhea/

msn10- question here... can you specifically identify which ND helped in this case and how it helped lead to an answer? I just reviewed a list of NANDA approved ND and I'm not seeing how NDs would help further the search for an answer.

I appeciate the exchange msn10 and hope I'm not coming across as snarky either. My perception is that most people find NDs to actually HINDER communication between health care providers. If one nurse tells another nurse that this patient has impaired mobility r/t loss of limb & weakness, they'd probably have to follow it up with a translation as well as other relevant info - pt has a right BKA due to diabetes, is weak & needs assistance getting OOB. So I don't see ND assisting with communication there. Does it help students? The concept that nurses need to consider mobility issues is important. But I think students can easily learn that concept without the awkward wording of ND. If a student can't figure out that mobility MIGHT be an issue in a pt with a BKA, then ND aren't going help, are they? And I know I'm not the only who found ND MORE confusing than helpful. In general ND as I was taught them seem circular. The student/nurse recognizes mobility might be an issue for the BKA pt. The student/nurse does an assessment. They see that the pt is weak and unsteady. They determine that the pt should have assistance getting OOB. Where exactly does formally hanging the label of "impaired mobility" add any value? I see that the issue of mobility directs the nurse's assessment - a young pt in for a nose job may not get such an intense mobility assessment from the nurse as an elderly BKA pt. If a patient needs assistance OOB because of BKA and weakness, tagging on the ND "impaired mobility" in no way further clarifies things.

Again, what about the fact that the use of the term 'diagnosis' in ND only further muddies the water? A cancer pt undergoing chemo has thrown up after eating several times. ND: Altered nutrition (or pot'l for). How did we 'reach that conclusion'? If someone is having trouble keeping food down then they aren't taking in as much nutrition as they would otherwise. Brilliant! 1+1 = 2 is not the diagnostic process. Pt had a hip replacement yesterday. ND: Impaired mobility. Is there any possible way someone with a hip replacement yesterday would NOT have impaired mobility? Pt is having loose stool. ND: Diarrhea. Assessment = diagnosis. Yes, there are extenuating concerns r/t to the problems, but it still confuses matters to me to use the label 'diagnosis'. A pt with impaired mobility may also be likely to be a fall risk. How does one determine that? By doing an assessment and pulling upon one's knowledge of the particular mobility impairment, not by using the diagnostic process. A pt with diarrhea may be at risk for fluid volume deficit. How does one determine that? *Any* pt with diarrhea may be at risk for fluid volume deficit. Who is more at risk? An assessment would give valuable in addition to knowledge of the pt's known medical conditions. No use of the diagnostic process there.