sashamay

Just wanted to run this by you all.. I'm an inpatient oncology nurse.. So I hurt my thumb (..jammed it against the pyxis of all things) 2 months ago- a couple days of it not improving, i filed workers comp and was told to wear a thumb spica brace. 2 weeks of light duty, and my left wrist starts acting up(tendosynovitis) (I do have a connective tissue disorder so am more prone to these things tho ive been injury free for quite some time)... that earned me another spica brace on the other side and more precautions. 2 months later i finally see the ortho hand specialist- he put a spica cast on my right hand/thumb/wrist/arm and a custom plastic spica splint thing up my forearm with cortisone injection for the left.. He gave me "modified duty" and said I can do whatever I'm allowed to do as long as I'm in my cast and brace.. I did light duty for the last 2 months- limited w my braces but i could write and stuff.. so all the chrge nurse paperwork/audits etc were all mine. Limited pt care but i did some, sometimes more than I should have.. (perhaps thats why they didn't heal..?) Now I'm in this cast and brace for 6 weeks... So This time I had to write a list of things i can do... writing really hurts but with a big foam thing on a pen I can do it.. tho my handwriting is crap w this cast. No patient care (sanitation and liability..)tho I MIGHT be able to help w oral meds..if I use a pen to puncture the blister packs. No IV meds. call lights..If i can write enough, I can do all the audits they keep piling on the charge nurse.. Almost seems pointless. part of the issue is.. i don't know what I can do! this dang cast is way more limiting than the braces were.. and some things I CAN do but they end up hurting me later.. (major things hurt right away, other things take several hours to hit me). They really want me to switch to dayshift and do admin/secretary crap but I'm a true night shifter of 10 years+ and I can't tolerate functioning during the day.. and now with me on light duty (plus we're down one nurse as it is), we are super short staffed.. sorry this lengthy.. its just a frustrating situation and Ive also never had a cast before.. I miss being able to use my hands! i miss patients.. and I feel useless not being able to do my job or help out w a lot things at work.. anyone been in my shoes?

I'm suppose to come up with an "action plan" for not being there late.... part of the issue is a damn useless CNA, insane assignments that you sucks when your coworkers point out how lousy of an assignment you have and offer to help as they can and having to now actually clock in and out for the lunch I oh so rarely actually get to take.... if i dont take it, I get yelled at for both the late hour and the missed lunch- but I could do what every bloody one else does and lie about it.... clock out and then do patient care (which worries me liability wise). I also refuse to just copy and past other people assessments word for word and I actually document on education, care plans, daily care, I/O and ensure all my crazy amt of pain assessments and f/u are done as well... (Which only maybe 1/3 of my coworkers do). I've been an RN 5.5 years and yes, i have struggled with time management off and on but had a pretty good handle on things until this CNA started-My latest issues I can pretty much chalk almost all of them up to days I work with the CNA i can't stand.. and extra crappy assignments... How do I make an action plan for crap I can't control? Itd be nice it wasn't all BS either but to be honest I don't even know how to lip service this one... Help?

Hey, I've been a nurse for 3 1/2 years, doing med/Surg with remote tele and have been on an oncology specific unit for the last 2 1/2 years. What agencies do you recommend for per diem hospital work in the Portland metro area? I have my WA and OR RN license. Hubby is in between jobs and my income isn't cutting it. I did agency work as a CNA for about 5 years total in PDX and Seattle area but that was quite awhile ago and I know the scene has changed a bit (Legacy doesn't use agency at all anymore). Thanks!!

ahhhH!!! I just started at a new big hospital (compared to my awesome little 44 bed unit i moved away from =( and at this new hospital, they use Epic and I was just told today I have to go thru and put stop times for the same reasons, and cuz of something goofy with the I&O's (cuz most of the nurses don't actually CLEAR their pumps.. they just click the little button on the program that guesses how much has gone in based on the start/stop times)... And i have to put start/stop times for the IV pushes too! what the hell?! I have sooo much more little stupid pointless crap to do with this system, its driving me nuts... and ironically, my charting is WAY less thorough and detailed than it was with my old system.. when I could put a freaking nursing note in... grr... so yeah, anyone with stop time tips for meds you don't have set to yell at you when the Abx is done? cuz I personally hang too many damn piggybacks at night... its a computer, make it do the math! Or even give you an "estimated stop time" and a little box i can check to say it was right or i can change it? stupid crap.

see, this is pretty much exactly why I'm having a hard time learning EPIC! I just got hired at a new hospital and we use EPIC... and at my old hospital, we used Meditech, and my charting there was rather thorough and detailed, mostly in the form of nursing notes. I'd make one note, and add on to it all shift.. so in that case, my documentation would have provided backup cuz I wouldda put something at least once or twice on my little one or 2 line updates such as "Provided pt with 7-up, per request" but in epic... its ALL charting my exception, and I'm having a hard time cuz i feel like my documentation won't save my ass if something happens!

So I just wanted to exclaim my excitement.. I'm gunna be working on an Oncology/BMT unit! Sometime this year, they will chemo certify me, and next year, they will start the mentoring process to get me BMT certified! The unit has 8 BMT rooms. I've been a Med/Surg nurse for a year at a small hospital so I've gotten to have a lot of experience with a little bit of everything over the last year, which has been great. I actually really like my little hospital (44 bed). But I wanted to come back home (Portland, OR area), as i've been up an hour north of seattle for 3 years now (2 yrs of school and 1 yr of work)... Oncology is what is want to specialize in.. and have for a long time. I worked an Oncology unit as a CNA for a yr and 1/2 and it left a strong impression.. Cant freaking believe it!! =) (and im really glad it panned out, cuz I got sick right before an interview at the same hospital for a cardiac obs position, and had an interview on a general surg/neuro floor that got canceled cuz they hired someone in the meantime lol... not to mention this is totally what i wanna to do so that makes it that much cooler!) They seemed to really like that i was already an Oncology nursing society member so thank you guys for all your suggestions to other people about that, cuz I totally listened! hah

I told a co-worker about a potiental move and to be fair, I did email the boss and let her know of the impending decision.. and suddenly coworkers on the prev shift i hardlly ever see are sayin "So I hear your moving eh?!" And then my boss forget I emailed her....and called me and asked me about it cuz she "heard it" from someone. surprised me how quick it spread. very weird.. not use to that kinda thing, esp about me. Lol

So I have been a nurse on a med/surg/tele floor at a small hospital for a year now.. and I want to move back home (Portland, OR). i SOMEHOW landed an interview at a good hospital, on an oncology floor, which is what i want to specialize in! I worked Oncology as a nursing assistant for a yr and 1/2 and didn't realize how much I liked it until I moved away for school. All through school i tried to get Oncology patients, usually pretty complex cases! (I like a good challenge =) And now even through my little 44 bed hospital, we get the occasional oncology patient. We have a pretty decent outpt oncology unit, and we get the neutropenia's and various other complications. I KNOW i want to specialize in Onc, i can't wait till I can get Oncology Certified and get Chemo certified and all that... Ohhh how i want this job!! I'm so afraifd i'm gunna mess up the interview... i haven't had very many in my life, and my only other RN interview was for my current hospital, and it was... so laid back and unofficial-like it didn't feel like a real interview. (830pm and i was in hospital scrubs cuz i had just gotten off work) so this is like.. all official like! Its the only job i've applied for i've heard back from anyone about.. and ohh how i want it. Its night shift, 12 hr shifts...which is also exactly what i want (I'm a true night owl). Its a big high ranking hospital and they are i guess in the top 6% in terms of oncology programs in the nation... I have a suit (skirt.. drk grey/ subtle pink pinstripes) its slightly too big but i think it'll still work alright. its gunna be 80 degrees that day, which sucks... im opting for the not-as-fancy-but-way-more-comfy shoes... cuz im meeting the guy in the lobby, so i figure there will be some walking involved and i want to keep up! ohhh i hope i get it... i hate wanting it this badly. I have a little exp at this hospital too, I use to work for an agency in portland and I often worked there.. its been about 3 or so yrs since then but i am vaguely familiar with their computer charting system... *crosses fingers* I know i'm cut out to be an Onc RN.. hope this is my in! Any tips/advice about any of it is welcome! I suck at asking them questions...seems like usually they end up answering em all for me before i get a chance!

Hi, So on tuesday I have an interview for basically my dream job.. noc shift, 12 hr shifts, Oncology unit of a very good hospital back home! (I moved away for nursing school and now that I have a yr of exp, I want to move back..and I very much want to specialize in Oncology). I have the numbers of a few of the Nurses I work with now who are more than willing to provide me a good recommendation/review (charge nurse and two of the people I precepted with when I was still in orientation and have since worked with for the last year on my med/surg/tele unit) but no letters of rec as an RN... I have a few rather good ones from my days of being a CNA which were written as I was leaving those positions for nursing school. But I'm not sure if these are worth bringing or not.. ? Suggestions? Thoughts? (and any side interview tips would be great too heh I'm so nervous cause I want this position so bad!) Thanks! =)

On our sliding scale protocol, if the person gets any coverage at HS, (2100), we have to check the blood sugar again between 0200-0300. Also on that, is if the patient is NPO, then we switch to Q6 blood sugar checks and sliding scale coverage instead of ACHS. (Our orders also say to "notify the MD for blood sugars of 360 or higher x 2"....tho no one has been able to tell me if that is 2 scheduled blood sugar checks, or rechecking it twice in case of machine error..) In the above case, I would have given the insulin, and then rechecked it a bit later to see what happened. If it happened to be a bit too low for comfort, I'd call the MD and mention that he happens to have NS infusing and ask if he wants to change that... (our protocol also says to give the D50 amp if its less than 60, but so far I've caught it before then and told the MD) And as for all the type 1 DM's.. yeah, totally! Listen to the patient! Ideally the nurses can get the docs to write an order regarding insulin per the pts regular routine or some crap, which ive seen a couple times. We have a few docs who write this little math equation to figure out how much insulin to give... BG-130/30 - similar to that, depending on the pt, instead of the usual low/med/high algorithm.

Ive had A LOT of patients that Zofran doesn't seem to do anything at all for... My last shift I had a pt with severely delayed gastric emptying/slow peristalsis who said she had tried everything (and we had given her a lot of different stuff over the few weeks we had her) and the only thing that actually kept the vomiting away was 2mg of IV Ativan every 3 hours. She remained a bit nauseated but was able to keep Boost down periodically.

Weekend for my hospital (and every hospital I've worked for) is Friday and Saturday nights. Our weekend diff is $4/hr, on top of our night shift diff. which is $4.75.

My mom's resting HR is around 140-150 without her meds...she also has random episodes of SVT with no apparent cause. She had tried quite a few different beta blockers (including atenolol and metoprolol) and it wasn't until they put her on propranolol did she have significant results. Her resting is still 90s-100's but she experiences far less SVT episodes and overall her HR is way better controlled. Maybe the pt needs a different beta blocker? Unfortunatly mom now has more respiratory/asthma issues likely r/t the propranolol but least her HR isn't so crazy!

Okay so Im going to graduate on June 7th... and likely then wont be able to take my boards till late June or July, based on what I'm being told. I have started to apply for positions and I was wondering if you guys click the little button on applications that says yes you have graduated or yes you are an RN... I havent been doing so, because well, I'm not yet! When it leaves room for it, and its on my Resume, I always have anticipated graduation such and such date, RN pending July 2010 or something... but yea, I figured I'd ask what those of you who have landed jobs prior to graduating are doing about this little grey area! Thanks!

Lil late but figured I'd chime in... I've been a CNA since 2004, and did homecare for a year privately before I got hired on with my first agency. I was thrown into a nursing home and i literally had no idea what i was doing or what needed to be done as I hadn't been in a nursing home since my cna training over a year before.. then i was put in a hospital, a small one, dayshift, 12 hr shift... fastward about 2 years. I very quickly learned that i could refuse shifts, (i only do nights and occationally evenings), refuse types of facilities (all nursing homes are a no-go for me.. ive worked maybe 5 shifts in em, ever.. and i suck at them lol) and strongly prefer hospitals and psych units (and ONE assisted living place that rocked heh) Didn't take me long at all to decide what i liked and what I didn't. There is one hospital id only work at if i was desparate for money cuz i always got a bad vibe from that place.. but it usually wasnt a big deal. If your willin to help them out every so often for a "oh crap, a shift just came up! help!" shift... and u sorta set the rules and work enough for them, then they'll help you out too. Id pick up on things fast... try to figure it out on my own and if i couldnt figure it out, i'd ask someone and theyd usually show me with no problems. I also watched people intently, and listened..to see how the nurses talked to the psych patients to redirect them and calm them down etc.. As i got the hang of the smaller hospitals, and got to know all the staff on nights and requested back... then i was put on the floor of the affiliated larger hospitals, where usually the nurses were eternally greatful to see me as there were 30 patients to a floor, and i was the only CNA on nights. i learned how to chart electronically on the fly because at the time, the hospitals didn't have any formal comp training for agency cna's (now they do!) (ha! once i worked a unit i was very familiar with for a 16hr shift cuz of a snow storm and lack of people able to make in to work at 11pm - and the hospital had just launched a bran new charting program the day before... after asking nurses how to put in my vitals and I&O's, and after charting all 16 hrs on my 30 patients over and over, i got the hang of it real quick!). Usually im pre-booked with the hospital, but dont know what unit until either a phone call confirming im for sure working 2 hrs before the shift, OR i show up to the hosp and find the staffing office and they tell me where to go.. then i show up, and if its a new unit And if its a floor-shift instead of sitter one, then I always ask what is their routine for things on that shift, like when/who does vitals, daily weights, i&o's and any other quirks. Then i ask for a brief tour of the unit...so i know linen, dirty utility, med room, supplies etc... and then off I go. =) and write down my nurses names on my census sheet, so i know who to ask for when i have an abnormal blood pressure or whatever.. Ask questions when i need to, but try to figure out stuff so im not annoying. OH! And i keep sticky notes in my pocket to pass on stuff to nurses, and to jot down important things about the unit...like their routines, any special tricks unique to that hosp or floor, and things Like the code to get in the break room for future use, so i wont have to ask again =) keep it all close by so when i go there again in 6 months, i still have it handy =) I'm just about done with Nursing school now..and by July will be ending my career as an Agency CNA. (i did end up working at one hosp part time to supplement my income for a yr and 1/2). Since March 05' when I was 20, I have worked at 13+ hospitals, 6 psych units including a lock down group home for schizophrenics (which was pretty interesting and they kept offering me a job tho the pay was lower, and I like the variety of agency too much), 1 assisted living facility, etc... Even once I got sent to a tiny 12 bed hospital at a local beach (2 1/2 hrs away). They paid my gas and my hotel.. i did an evening shift, went to bed, then did a 12 hr day shift (special circumstances for me, usually i didn't do days but it sounded fun hah which it was!). As a side note...I've learned *SO* much in the last 5 years its amazing... and everything has helped me get through nursing school! My evals always talk about how i can enter a new hospital/unit and figure things out, that I'm very indepdent but ask for help when its appropriate, very comfortable in a hospital, and i get along well with all of the staff, that i dont let it show when im overwhelmed hah "nerves of steal or a very good poker face" my prof told me last wk heh I was kickin myself before that i hadn't gotten into school sooner... but now i wouldn't trade it for anything. I also really wanna do travel nursing when ive been a nurse long enough. =) can't wait! I also think it'll be REALLY weird to work only at one hospital for a year... cuz even when i worked at one hosp, on one unit... even tho the overtime wouldda been waayy more, I picked agency shifts instead cuz I'd get bored or burnt out goin to the same place all the time hha). Anyway..enough blabbing! =) Sorry hah