ExpatHopeful

It depends on the rules of that country I'm sure - what country? In general I would say no, unless it's a pretty weird country. Every country has different rules about what training and licences a professional needs. For example, just because I'm an RN in the US doesn't mean I can just move to Australia and be an RN there, I'd have to pass their RN test and get licensed. The same goes for MDs, NPs, PAs, etc. In addition, not every country even has a profession equivalent to an NP or PA.

They're such different environments, it really depends on what your personality is and what your long-term career goals are. I've worked as a CNA in two outpatient clinics and in a hospital and enjoyed them all in different ways. Here is sort of how I'd break it down: Clinic: Moderately fast paced since visits tend to be short. Patients are generally in pretty good health. Limited opportunities to develop relationships with patients, since only if they return again and again to the clinic will you get to know them (although this depends on the type of clinic). Generally you'll develop a wide range of skills. Depending on your clinic you may do vitals, blood draws, basic lab tests, assist in outpatient procedures, and a variety of office type work such as restocking, entering things into the computer, etc. The day is very scheduled and it's important to keep people on time for their appointments. Hospital: Very fast paced generally. Patients can be very sick with major wounds and/or multiple chronic illnesses which you may find an exciting challenge or totally disgusting. Many of the patients will be very dependent on you for help. Can be very rewarding to see someone improve and walk out the door a week or two later. More chances to develop relationship with patients since you will often see them for several days in a row (or weeks). Some hospitals really value CNAs and invest a lot in educating you and providing opportunities to learn new skills (EKGs, blood draws, stoma care, etc), in others you will feel like an unappreciated bed-bath giver and the CNA role is very limited. It's important to figure out during your interview or before which type of place it is. Time is unscheduled and it's important to be able to prioritize (4 people may want your help at once - who do you see first?) LTC: I've never worked in one, but off the top of my head I'll say that this probably where you have the greatest chance of developing really long term relationships with patients. Many of them will feel like family to you since you care for them every day for years, of course, if they drive you nuts this can be a problem. I suspect that compared to the clinic and hospital the care is routine in the sense that you may know every morning to help Mrs. Z with her breakfast first thing, then to wash Mr. L then to help Ms. K into her wheelchair, whereas in the hospital every day is pretty crazy and you have to come up with a new plan for your day. I would suspect that there's not a lot of opportunity to learn new skills, because most residents are stable and not requiring lots of tests or interventions. Possibly if you worked at a LTC facility that also had a sub-acute rehab floor this might be different though. Hope this helps. If you want to be a nurse someday I would opt for hospital, either now or in the future, however I personally loved working in clinic because of the diversity of tasks and skills you needed to learn to do the job.

Thanks! It's good to hear that going float has been a good experience for you. This is the option that I'm most leaning towards, it's just that I love my floor so much and am intimidated about being a float. But it's good to think of it as a chance to gain new experiences and skills.

Hey ashley, I don't know if you were offered the position or not, but I work on a colo-rectal floor that also takes elective bariatric patients. About 1/4 of our patients are post-op gastric bypass/gastric band/ or occasionally post-bypass fistulas. In general I find it a good group to work with. As a previous poster said they are generally very well educated in advance of the surgery about what happens when and although they certainly need monitoring, most do well and are able to be discharged as planned. They are very 'routine' patients in the sense that there is a regular protocol that they all follow (ie, NPO until swallow study on the first post-op day, ambulate q6hr, PCA until on clears then switch to crushed percocets, etc). I think a previous poster did a good job of describing the co-morbidities you see and need to manage. You will definitely do a lot of discharge teaching with this group and reinforcement of what they were told pre-op, which I find rewarding. Many of them are just beginning to realize what a major change this is. It's one thing to be told you can only drink or eat 2-3 tablespoons at a time and another thing to automatically take a big swig of water only to vomit (which is why dixie cups are great). We actually see a fair number of 'young' patients, 18-30 year olds, and they especially can be a little slow in coming to terms with the actual surgery. 'Yes, you are going to be sore after surgery, no, you haven't lost any weight yet.' There's a lot of reassurance, but as you said, it's elective and planned so it's great to see them get better quickly and head home. As for lifting, you may find you do less than with ortho patients! In my hospital all the bariatric patients arrive on our floor from recovery in special bariatric beds that turn into a chair. 6 hours post op you just push a button, the bed goes into chair mode, they stand up under their own steam and walk. There's no lifting or rolling involved. We have yet to have a patient fall or collapse, although we do have an emergency hoist of course.

What's worked for me is: regular largish dinner before I go to work around 6pm, around 1am have a greek yogurt and some fruit (either a banana or something else) and a cup of coffee, then at home at 9am I basically have a second dinner and sleep all day. I also keep a bag of trail mix handy for the rare night I'm still hungry. A yogurt and a piece of fruit is very easy to pack, no prep at all, and the combination of protein and fiber works for me. I personally think carbs and sugar at night are just not satisfying or healthy. On my days off I'm not a big breakfast person, so a regular breakfast for me is pretty much just yogurt, fruit and coffee, so you could call my 1am snack 'breakfast'. I had actually lost 2 pounds over 5 months on the night shift (although I exercise on my days off) prior to getting pregnant. Of course, now that I'm pregnant I've had to add a PB&J to my midnight snack routine. FYI the lastest research I've read says that coffee in small amounts isn't a diuretic either. It's only when you get up to 4+ cups a day that you're losing water instead of gaining it.

i would really appreciate any advice or input people could give me on my situation. i've been working on a med-surg floor for 9 months now in my first rn position. i work nights and love my job, my co-workers, and the shift. i'm also 4 months pregnant and due in january. i recently told my boss and discussed my options with her and while i don't have to make any decisions now i'm thinking a lot about my post-birth work options. basically my choices are a) quit entirely and stay at home b) after maternity leave, transition to a per diem float position in the same hospital and work anywhere from once a month to twice a week, either days or nights c) come back full time nights on my floor after my 3-4 month maternity leave. luckily, money is not an issue for us, my concerns are balancing my family/work life and keeping up my investment in my nursing career. option a would be fabulous from a baby and family perspective, but i worry that one year full time in nursing wouldn't be enough to reenter the workforce a few years down the road. b might be the best compromise, but it would be hard to work with different co-workers on new floors all the time. c would be great career wise, but we'd have to do some form of child care, my husband (who works 60+ hours a week) would have to pick up a lot of slack and i worry i would miss out on my new baby's life and we'd hardly ever get to spend time together as a family. anyone have experiences to share or advice? i posted this in general nursing discussion but only got one response.

The best books to turn to are the ones from nursing school, so I hope you kept your med-surg text book and your health assessment textbook. They'll be helpful if you want to read up on various diseases/tests at home after the fact or in preparation for a new clinical area. On the job your best friends are wikipedia for very basic info (as in: what's an ERCP again?), medscape for drug information, and whatever resources your hospital has (policy and procedure documents, length of stay guidelines, patient education handouts, pharmacy, etc) For me, the most important organization tool was a shift task list that I developed for my own use based on one a colleague had. It's a single double sided sheet with 3 columns on each side, one for each patient, and has basic info (name, room number, procedure/condition, diet, fluid order, allergies, md pager number), about 10 check boxes with spaces next to them so I can write in tasks for the shift as they come up, a labs section, a checklist of documentation that needs to be completed for each patient, and a space at the bottom to write things to hand over to the next shift. You can tailor it to the things that you most need reminding of or information that you most need at hand, but for me this sheet was a game changer. Before, I was shuffling madly through sheets of paper trying to find the piece of info that I needed, or forgetting to do tasks.

congratulations on the new job! if they didn't think you were smart enough they wouldn't have hired you. as a nurse 9 months into my first job, here's my advice about making the most of your orientation (i copied it from another thread i responded to). like with any new job, come prepared and on time, take notes, dress professionally, be friendly, ask your new co-workers about themselves and about the job, be upbeat and know what's expected of you when. jobs and orientations vary, so don't assume that your experience will be bad. i was mentally prepared for a rough first year but had a great student to rn transition. my classroom orientation made me aware of hospital policies, hospital structure and who to call for help and answers when i needed it down the road. my unit orientation was great, i had a wonderful preceptor who really understood my learning style (let me try to figure it out on my own and be here when i come running with questions and need you to check my work) and my co-workers were very welcoming and helpful also. expectations were slowly increased during my unit orientation and by the time it was done i felt ready to take on a full patient load. 9 months in i can say that i have felt competent at my job for several months. i know i'm still learning all the time and progressing as a nurse, but i can more than hold up my own patient load. i know not everyone has as a great an orientation, but it happens. don't be afraid to ask questions ever, your patient's care is the ultimate concern, not your pride. know where to find policies on everything and read the policy before you go running to nurse x to find out what they do. it's helpful to know how different experienced rns go about things, but ultimately it's the policy that you should go by and that you'll be held to by your manager. it also looks better if you've at least tried to find out the answer on your own first. on a personal note, leave work behind you when you leave. keep up with your friends, talk to your nursing school friends, get exercise and try to eat well. you'll eventually find time to pee/eat/drink again, but try not to give yourself a uti in those first weeks on the floor. good luck!

Like with any new job, come prepared and on time, take notes, dress professionally, be friendly, ask your new co-workers about themselves and about the job, be upbeat and know what's expected of you when. Jobs and orientations vary, so don't assume that your experience will be bad. I was mentally prepared for a rough first year but had a great student to RN transition. My classroom orientation made me aware of hospital policies, hospital structure and who to call for help and answers when I needed it down the road. My unit orientation was great, I had a wonderful preceptor who really understood my learning style (let me try to figure it out on my own and be here when I come running with questions and need you to check my work) and my co-workers were very welcoming and helpful also. Expectations were slowly increased during my unit orientation and by the time it was done I felt ready to take on a full patient load. 9 months in I can say that I have felt competent at my job for several months. I know I'm still learning all the time and progressing as a nurse, but I can more than hold up my own patient load. I know not everyone has as a great an orientation, but it happens. Don't be afraid to ask questions ever, your patient's care is the ultimate concern, not your pride. Know where to find policies on everything and read the policy before you go running to Nurse X to find out what they do. It's helpful to know how different experienced RNs go about things, but ultimately it's the policy that you should go by and that you'll be held to by your manager. It also looks better if you've at least tried to find out the answer on your own first. On a personal note, leave work behind you when you leave. Keep up with your friends, talk to your nursing school friends, get exercise and try to eat well. You'll eventually find time to pee/eat/drink again, but try not to give yourself a UTI in those first weeks on the floor. Good luck!

Things I bought myself: Good shoes (love Birkenstock Londons) Support socks Stethoscope (the one I used in nursing school) Black pens (buy by the box and leave in my locker) Red pens (I use them to circle meds that are due next on my med sheets) White board pen (we have boards in patient rooms) Cheap pocket flashlight Sweater (for nights) Watch Task list (I modified a co-workers, double sided sheet has space for basic info and to-do checkboxes for 6 patients) 3 Ring binder with lots of pockets (organizing handover sheets/order sheets/ and other work papers) Things I just carry constantly: 2x2 gauzes (for removing PIVs, random bleeds) Red caps (for medlocking patients) 3ml saline syringes (ditto) Alcohol pads Chlorhexidine pads Luer-lock adaptors for IV pushes (don't forget these as much anymore, but used to forget them all the time so needed them) Tape (taping down IV lines, dressings) Carpuject syringe holder

I would really appreciate any advice or input people could give me on my situation. I've been working on a med-surg floor for 9 months now in my first RN position. I work nights and love my job, my co-workers, and the shift. I'm also 4 months pregnant and due in January. I recently told my boss and discussed my options with her and while I don't have to make any decisions now I'm thinking a lot about my post-birth work options. Basically my choices are A) quit entirely and stay at home B) after maternity leave, transition to a per diem float position in the same hospital and work anywhere from once a month to twice a week, either days or nights C) come back full time nights on my floor after my 3-4 month maternity leave. Luckily, money is not an issue for us, my concerns are balancing my family/work life and keeping up my investment in my nursing career. Option A would be fabulous from a baby and family perspective, but I worry that one year full time in nursing wouldn't be enough to reenter the workforce a few years down the road. B might be the best compromise, but it would be hard to work with different co-workers on new floors all the time. C would be great career wise, but we'd have to do some form of child care, my husband (who works 60+ hours a week) would have to pick up a lot of slack and I worry I would miss out on my new baby's life and we'd hardly ever get to spend time together as a family. Anyone have experiences to share or advice?

Thanks for the thoughtful reply Alsgal. I do know on a logical level that I should wait another month or two to give myself that extra 'just in case' buffer. And that is pretty much the same advice that my mother gave me. It's just hard to rein in our desire for a family. We've waited so many years for the timing to be right, to have finished school, developed our careers, and gotten our finances in order. Somehow this last month or so of waiting is the hardest because we are so close to taking our family/relationship to that next level. But I do deeply appreciate what you're saying, and what you went through sounds awful and is a real reminder that things can and do go wrong with best case scenarios. Since my intellect usually wins out over my heart I'll probably follow your advice and make myself wait a little longer, but it won't be easy!

Well, I'm confused. And the more I look at the HR pages of other employers the more it looks as if the opposite is true. That as long as you've been employed for 12 months by the date your FMLA leave begins you qualify, regardless of when you submitted your request. Obviously. I'd be pretty stupid though if I didn't plan for the possibility that I might become pregnant the first month of trying because there are plenty of women who do.

I eat a substantial dinner at 5:30pm before my shift, at 2:00am I take my break and have a greek yogurt, a coffee, and a small snack (slice of breakfast bread, fruit, some trail mix, etc), then I eat my second solid meal when I get home before I sleep. I know they say you shouldn't eat before you sleep, but oh well. If I eat a full meal during my shift I get too sleepy to work. I exercise on my days off. I don't feel any more or less hungry than when I was on days. Maybe you're not eating enough before your shift starts? Are you eating enough protein and complex carbs? These will help you feel fuller. I'm obsessed with greek yogurt - it really gives me energy and keeps me from feeling hungry.

One of my co-workers interviewed for the job while pregnant, told the manager about it, and the manager arranged for her to start after she delivered, months later. Pretty awesome I thought. Apparently not all managers are averse to hiring pregnant women.