DreamingTree

It's true that some homes are beyond cluttered & dirty. The odd thing is that it rarely bothers me. Don't get me wrong -- I'd love it if all of my patients' homes are clean, safe, & smell good. That's just not reality, so to make it in home health, you have to have a great poker face. People don't want to be judged, and unless it's a safety concern for the patient, I just do my thing without mention of the environment. You honestly learn to block it out. If you like to educate patients, are good at working independently, and can manage unexpected challenges, then you'll love home health. Some days unfold smoothly, while others are chaotic. I've found that I learn so much more about a patient from being in the home. For example, medication errors are so much easier to catch because you can look at the bottles and have them show you how they are taking them. I haven't regretted making the switch to home health.

I agree wholeheartedly with this comment! Your manager has set unrealistic expectations for you. It's great to be a strong advocate for your patient, but you did that by trying to communicate by phone, and by following up with written documentation. In addition, you provided education to the patient on the need for a follow-up MD appt. As much as we care for our patients, we can't be solely responsible for their health. Be thorough in your assessments, document carefully, provide good education, and communicate with all health care providers. At the end of the day, realize you did the best you could do, and let it go. It's the only way to remain sane. :-)

I have a MS in psychology, and then went back to school to become an RN (ADN). In order to hone my nsg skills, I worked in med-surg for awhile (very valuable). My plan was to become a psych NP, but being married w/kids, I'm limited to where I can further my education (& found there aren't a lot of online options). I work as a psych RN in home health and absolutely love it. Although I'm on the road a lot, I learn so much from going into homes. Having education in both nsg & psych enables me to assess the whole person.

Yep - it really does get easier with time. When you are first starting out, every little step of the process is new to you. You have to think your way through each task, which takes time. With practice, many of those steps become automatic until you can do them in your sleep. You also get better at prioritizing, problem-solving, and remembering details (more cognitive space due to many tasks becoming automatic). Trust us...we've been there.

Maybe you need a new system for keeping track of pt info. I use a very detailed "brain" sheet. It has boxes for the following: info I receive in report, kardex info (name, age, code, dr, dx, allergies, IV, diet, ACT), assessment findings, labs/tests, & meds (I put times + any PRNs I give). It's the only way I can keep track of things -- especially when it's busy. Keep in mind that everyone makes mistakes; how you handle it is what makes the difference. Figure out what you can do to rectify the problem & you'll grow as a nurse. Don't beat yourself up -- that rarely works. MERRY CHRISTMAS!!

Everyone is right about you needing to learn how to do these problems & do your own work. However, I'll try to give you a few suggestions because you need help getting started. Pitocin was ordered 2milliunits/min IV. The solution is 9 units in 150 mL NS. What is the pump setting?This type of problem can be very confusing at first glance. Tackle it by doing the following: Pumps are programmed with the hourly rate. The order is for the amount to be given per minute. There are 60 minutes in an hour, so adjust the dose by multiplying by 60. Important rule: whatever you do to one side of the equation, you need to do to the other side. You can't adjust the minutes to hours without also adjusting the dose. The solution is stocked in units, but the order is for milliunits. You need to adjust the order so that they are both in units. Another important rule: keep your measurements consist. Milliunits do not equal units, but can easily be converted. Same for liters versus milliliters, grams versus milligrams, etc. You are now ready to plug your information into an equation. There are two choices:Desired/Have x Quantity -- For this equation, you'll divide the amount ordered by the amount supplied and multiply that number by the volume. Example: MedX is ordered at a rate of 5 units/hr and comes in a bag of 10 units/200 mL: [Order (5 units/hr) divided by Supply (10 units)] x 200 mL --> 0.5 x 200 = 100 mL/hour Ratio -- plug in the units/mL of the order and it will equal the units/mL of the supply. Cross multiply and you will have your answer. Example: 5 units/x mL = 10 units/200 mL --> Crossmultiply (rewrite these as traditional fractions -- I couldn't do that here) --- [5 x 200] 1,000 = 10x --- divide both sides by 10 --- x = 100 mL/hr When I would take a dosage calc test, I used both methods to check my work. The key to using ratios is to always place the same unit of measurement in the same place (numerator or denominator). Think of it this way: 1/2 = 2/4 = 8/16 -- you are just working with real life examples in dosage calc. Give the problems a try, show your work, and I'll try to help you out (if you want...).

I'll keep my fingers crossed for you. I remember those darn dosage calc tests -- very anxiety provoking. The key to doing those problems is to: 1-- keep your units straight 2-- always use your formulas 3-- ALWAYS check your work Good luck!!

This is the type of diagram I always followed, but it's probably the same as in your book: http://medicalcenter.osu.edu/pdfs/PatientEd/Materials/PDFDocs/medicatn/geninfo/intrainj.pdf What gauge & length needle are you using? Maybe that's the problem. How quickly do you insert it? Did you hit a bone? I've given mostly deltoid injections (flu & pneumo vacs), so I could get away with a 23 gauge, 1 inch needle. No complaints with that. I try to make my injections quick & steady (avoid lots of movement when it's in), but not so fast & hard that it freaks the pt out. Hard to explain... Wish I had more suggestions to help you out!!

It looks like it is missing information. Your answer is in mg/mL -- but the information given before that only lists the mL. Does the original problem provide the mg ordered & the mg supplied? If so, then you just plug this information into the following formula: Desired (mg ordered) -------------------- X Volume (mL available) Have (mg available) Here's an example: Desired = 2 mg (lidocaine ordered) ---------------------------------- X 1 mL (volume available) = 0.1 mL Have = 20 mg (lidocain supplied) If this amount has to be diluted to make 10 mL total, then you would take the 0.1 mL lidocaine (from the vial supplied) and add 0.9 mL NSS. You would start with 2 mg/0.1 mL (lidocaine), which is the same ratio of the lidocaine supplied (20 mg/1 mL). Once it's diluted, you have a strength of 2 mg/10 mL. Again, since the original information didn't have mg, I guessed at the values that should have been listed. It was an educated guess, though because lidocaine 2% is available at 20 mg/mL. Hope this makes sense!!

same explanation, but i'll phrase it a bit differently. make a chart: acidosis alkalosis 7.35 ph 7.45 45 co2 35 22 hco3 26 sorry -- the chart won't work on here. i hope you get the idea of how it should look. put all acidotic values on one side, alkalotic on the other. for some reason, the post edits out my spacing. follow these steps: 1. look at ph (using the chart). this is how you determine acidosis versus alkalosis. 2. look at co2 & hco3 (again, chart). which value is out of whack? ----> if your co2 is > 45 and the ph is acidotic, then you have respiratory acidosis. ----> if co2 is ----> if hco3 is ----> if hco3 is > 26 and the ph is alkalotic, then you have metabolic alkalosis. 3. now consider if compensation is taking place. this is a bit trickier to explain, but....here goes: ----> compensated: ph will be away from it's norm (7.40), but within the range (7.35 - 7.45) ----> uncompensated: ph is outside of the range ( 7.45) ----> if ph is on the acidic side, but compensated (w/in range), look at co2 & hco3. choose the value that is out of whack on the acidic side. this will determine if it is resp. acidosis or metabolic acidosis. the other value will be out of whack on the alkalotic side because the body is trying to compensate. hco3 increases to compensate for resp. acidosis. co2 decreases to compensate for metabolic acidosis. make sense? until it becomes second nature, keep making a chart (like i did above), and put checkmarks next to the values that are abnormal. the value matches the ph (hco3 or co2) will give you the final answer. good luck! disclaimer: all info blatantly stolen from a former nsg instructor's lecture. she made it all seem so easy....

Before making your decision, I'd do an old-fashioned "pros/cons" list. The following would be important factors for me to consider: 1. Commute time. I have a 5 min commute now, and little desire to drive 30 - 45 min to the other area hospitals. 2. Nurse -Pt ratio 3. Staff turnover 4. Unit "personality" -- how does everyone get along? Do they help each other? 5. Support staff Those are just a few considerations. A sign-on bonus is a great perk, but if you end up miserable there, the time commitment may seem like a jail sentence.

You'll get plenty of responses in favor of one choice over the other. I can tell you that I reluctantly followed the side that whispered medsurg in my ear. My days have plenty of challenge, and I can't say that I have much time to make tea. Whatever you experienced during your clinical rotations while in school tends to be different than reality. I was one of the top students in my class -- a great test taker, very good at pathophys, and never a problem in the clinical sites. The real world challenges me every shift, and I'm just starting to remember that I have two years worth of knowledge in my brain. So, what will you learn if you go the medsurg route? Time management, prioritization, and refinement of basic nursing skills. Many may tell you that you can pick these skills up in ICU, and some will tell you that they tried going there first and felt overwhelmed. Ultimately, you'll have to decide for yourself. My advice would be old-fashioned: make a pros & cons list. Consider all aspects of your life. Tally the columns, and go with the winner. Just make sure you take reality into consideration, and don't discount the learning involved in medsurg. I haven't regretted my choice. :-)

Is "focus charting" when you only comment on the abnormals? If so, then I usually include mental status & pain in my comments. I'll write something like: "Alert, oriented, resting in bed. Reports no pain." Plus, I throw in a line that relates to the diagnosis -- if pneumonia: "Lung sounds clear; intermittent, productive cough."

This may be a stupid question, but if he didn't want the pt to have dilaudid, then why didn't write the necessary orders? Are you supposed to be a mindreader?

I would have irrigated the same way you did: quickly flush with NSS, then quickly withdraw same amount. The one time I had an irrigation order for a drainage tube, the dr actually wrote out the w/draw instructions -- w/emphasis on the "quick" part. Easiest solution is to call the dr for clarification.

Glad you liked them, but don't be fooled. My husband says that I'm not as organized as I seem on the surface. :wink2: Here's a link to my brain: http://drop.io/ShiftOrgSheet There are two versions listed, but the newer one came out wrong with the upload to that site (instead of two per sheet, it only has one). The newer one has a box for labs/tests & a few other changes. If you like it, the site lets you download the file, and you can fix it. Good luck.

Your feelings are normal. What you need to do is tackle them one at a time. Worried about your assessment skills? That would be a good place to start. Do you have an assessment routine? For example, I like to start out by asking a couple questions (usually, pain & sleep) & scanning the room for all of the hook-ups (O2?, IV?, Foley?, etc.). Next, I get all of my listening out of the way. Heart, lungs (anterior & posterior), abdomen. Then I do my palpating -- abdomen, feet (pedal pulse, cap refill, check for edema, & ask about numbness/tingling). This routine usually takes care of everything, but I make adjusts for the pt's dx. If you aren't sure about what you are hearing, google heart sounds & lung sounds. There are some good resources out there for learning abnormals. Of course, it still takes time & experience to figure it all out. Plus, make sure you have a good stethoscope -- it makes a HUGE difference. Critical thinking is another skill that comes with time & experience. As you are assessing your pt, make note of all of the abnormals. Take some time to think about the pt's admitting dx, hx, labs, & other tests. Why are they experiencing the abnormal assessment findings you noted, and what interventions can you use? This is where you get to put together all of the puzzle pieces -- practical skills, classroom knowledge. It's not easy, and it takes time, but you will get it. We were all in your shoes at one point, and it does get better. Good luck!

Nope -- trust your instincts. It's your license, so don't agree to anything that you don't feel you can safely do.

I think KalipsoRed hit the nail on the head. It's hard to prioritize when everything seems important. But, with experience (& mistakes), you do learn to sort through it all. I would: a) take report from ER nurse, b) let the family know that I'll be there in a minute, c) go talk to dr. Just my way of thinking... Don't discount the value of mistakes. We are only human, & we are new to the job -- mistakes will happen. What I do is figure out how I can adjust my routine to prevent the same mistake from happening again. Here are a few adjustments I made that have helped: 1. On my brain sheet, I have a column on the left side where I list all med times & FSBS. As I pass meds, I cross of the times. 2. I also have a spot to cross of when I've completed my am & pm charting, care plans, and chart checks. 3. As I check the kardexes in the morning, I list labs & tests that will be done (another spot on my brain sheet). This helps me to prepare for when the pt will leave the unit, and to cue me to watch for results. 4. Before I walk in the room, I jot down VS. While in the room, I make note of output (esp. w/foleys). Each has a spot on my brain sheet. These were just a few examples, but the common theme is the brain sheet. I would be lost without mine, and there's no way I could use the one page sheet that many others use. My sheet has space for only 2 pts -- because I like to have room to write, & stay organized. I only jot down the abnormals & anything that I want to keep track of -- less writing means more time. Also, on my days off I think about the pts I had & look things up. This helps me to learn for the next time someone has such & such dx. I don't beat myself up for what I should have done -- I just think about what I can do better next time. Again, we're only human & we're still learning. Finally, I don't fret about asking questions. If I don't know how to do something, I ask. If I'm concerned about my pt's status, I talk it over w/someone. The key is to decide how you think it should be handled & then bounce it off of a more experienced nurse. This gives you a chance to practice critical thinking. Remember, it's a tough job, so give yourself time to adjust. Don't worry about what others think of you, and don't beat yourself up over mistakes. Every experience is an opportunity to learn. Good luck!

jelet -- i remember when i was your age -- it was hard to figure out what career to choose. my screw up year was in college, and it had an impact on what graduate school i went to for my first career choice. low & behold, here i am, 20 years later, starting a new career as a nurse. i used to teach at a community college. if you want some advice, send me a pm, and i'd be happy to share my experience with you. a community college may be a good place for you to start because you aren't 100% sure about your career choice & grades. but, talk this over with your guidance counselor -- someone who is used to dealing wtih these issues. i agree with those who suggested that you either become a nurse aide or an emt. both careers will give you valuable experience and some money to get started. our community college provides training for both. your hs guidance counselor should be able to hook you up with the right people in your area. shadowing an rn is also a good option, and i would think that your guidance counselor can help you with that, too. i actually had two hs students shadow me at work during the day. our hospital gave them the opportunity to shadow in different departments. so -- you probably noticed the common theme in my response -- talk to your guidance counselor. he or she is in the best position to give you advice. on a side note, i found it a bit sad that many jumped on this kid rather than nicely correcting his misperceptions. we were all clueless at one point or another -- have some patience & compassion. of course we know how difficult the job is. don't be so thin-skinned as to take offense to those who haven't experienced it themselves.

It all depends on where you live. There are ALWAYS open positions in this part of the country. Maybe if you give a location, someone from around there can offer good advice.

Yep -- there are RN (ADN) to MSN programs, but only for those who already have a BS/A degree in another field. Here's one program: http://www.drexel.com/online-degrees/nursing-degrees/rn-msn-bridge/index.aspx ...but, there are many others out there. In fact, many of these type programs have online options.

Hhmmm....good questions! I don't know what the wait is like in Chicago, so I would probably just call around and ask. For me, it was well worth going the ADN route. Even though I needed to take a few bio courses and wait a semester while I applied, it still only took 3 years. Call different schools in your area, and try to set up a time to discuss their programs. They can guide you through the process. When you have a BS in another area, you can enter an RN to MSN bridging program. Programs I looked at required three bridging courses, & then I would have been able to enter the MSN program. As for tuition reimbursement, every facility has their policy on what is required. Where I work, tuition would have been reimbursed if I had signed on full-time & made an 18 month commitment. Again, call hospitals in your area and ask what they require. If you want good experience now, you might want to consider working as an aide. You will learn far more this way than volunteering. It will probably help you to get tuition reimbursement, too. Just a thought....

Yep -- I agree with Kat & have a similar background. Get your ADN, work for awhile ($ & experience), then apply to an RN - MSN program. There are many bridging programs for RN's with a BS in another field.

I did -- on another topic. Then I read the topic about people recognizing posters here, and decided I probably shouldn't have revealed where I work. :wink2: Ah well...I'm honest, and haven't written anything negative.