pumpkin

I was placed on the alternate list last year, and they sent me a letter to interview......

Thank you all for your replies! I've decided to do the online BLS. There are quite a few training centers offering skills sessions near me. Since I've already expired, I didn't want to have to wait for a course to pop up. I'm going to have put my expiration date in my calendar so this won't happen again!

So I went to make a photocopy of my BLS card today and did a double take when I noticed that I was due to renew back in April. In the past, the nurse educator of my unit would always let us know when we were due. Last year I started working somewhere new; apparently this nurse educator does not keep on top of our certifications. I'm assuming that I need to take the initial course now, but I was hoping I could still take a renewal course. Does anyone know for sure? Thanks!

I'm hoping someone here has some advice they might be able to share with me. I'm planning on applying to school in the fall. Unfortunately, my sciences are now over 10 years old so I decided to do UNE's online organic chemistry class. I've never had much trouble with chemistry before so I thought it would be fine. I was wrong. I am having such a difficult time in this course. I feel like it's too abstract for my brain (I do much better when I'm able to visualize). At the rate I am going, I'll end up with a C in the course. I've been doing well on the labs, but averaging Cs on the quizzes. I only have 4 more weeks to go, and I know the final counts for most of the grade. I feel like a lot of the quiz questions are coming out of left field. I can't find the answers in the book or in his lecture. The prof has been very helpful when I've emailed him after the quizzes, but that's obviously a little too late. I really want to try to pull my grade up on the final. I would be so grateful to anyone who took this course who can give me some tips. Thank you so much.

Thank you all for your replies. Normally, I would never do an entirely online program. But right now I don't seem to have a choice. I come from the ER, but I unfortunately let my ACLS expire. I do not look forward to paying out of pocket for a course that I am going to have to retake in 6 months or so. However, I don't feel that I am lacking in skills - the ICU I'm at is a Level 1 Trauma Center and I have participated in a code almost every week since I've started (and some weeks, more than one code). Thanks again!

I have been in the ICU for almost 4 months now, about to get off orientation. While I am new to ICU, I am not a new nurse. I am having a really difficult time giving report at shift change. If it's the same nurse returning, I'm fine. But if it's someone unfamiliar with the patient, my report seems to be all over the place. I have an especially hard time if the patient has been there for a long time. I have a hard time summarizing what has happened during their hospital stay. I'm also having trouble remembering what happened during the day, especially if it was really busy. I try to write stuff down on a sheet of paper to help me, but if it's really busy I just don't have time. I never used to have problems with report, and I had a lot more patients than two. My educator assures me this is normal, and that as my "ICU mind" develops I'll be able to remember what's important and what't not. But what can I do right now so I don't look like an idiot at shift change? s.

I am in the process of applying to a school right now, and have a question about ACLS certification. I just started in my ICU over the summer, and my nurse educator does not want me to get ACLS until May. She doesn't know that I am planning on going to CRNA school and I don't want to tell her yet. I have been looking for an ACLS course on my own, and I haven't found that many before December 1 (which is application deadline). The only ones I have found are 2 day courses, and I am scheduled to work at least 1 of those 2 days. I have found some online ACLS cert courses, but they are not AHA endorsed. The school website does not specify that it requires AHA endorsed ACLS. Plus, I will have to take ACLS again when my nurse educator wants me to, so I will have an AHA endorsed ACLS before school starts, should I get in (this school doesn't start until fall of next year). Do you think it would be a problem if I take one of these online courses for the time being?

I feel your pain. I worked nights when I gave birth to my son. I thought this would be ideal - we wouldn't have to put him in daycare and I would get to spend time with him during the day. But it was awful. He was a horrible napper, so I would get home after working 12 hour shifts in the ER and he'd nap for 30 minutes at a time. I was miserable, and I felt I couldn't enjoy him as much because I was so sleep deprived. I ended up taking a job in the OR where I work days and rare weekends. My son is now 13 months and even though he is in daycare I feel like I can be a better mother to him with a full night's sleep! I don't feel the OR is my passion, but I don't want to have to go back to nights. It's a tough decision, and I wish you the best of luck.

I'm just curious to find out how people fell into their area of specialty. How did you know that's what you wanted to do? I have only been a nurse for 3 years. I worked for a year on a Med/Surg floor, which I hated. Then I did a year in the ER. I loved it at first, but near the end my ER became very poorly staffed and I became concerned that something bad was going to happen. I entered an OR nurse training program 9 months ago, because I thought OR nursing seemed interesting and something I might enjoy (and the lack of weekends, holidays, and nights appealed to me). However, I don't really think it's for me. I don't dislike it, but I actually miss patient contact (which I never thought I would) and giving meds, etc. And I'm tired of walking around on eggshells waiting for the surgeons to explode. But I hesitate to switch to another position yet again. Looking at my resume it appears that I only stay at jobs for 1 year then move on;) But I really want to love what I do. Lately, all I do is complain about nursing and how I wish I hadn't gone back to school to do it. And I'm tired of listening to me complain! So, how did you decide what you wanted to do?

I just wanted to ask you PACU nurses your opinion. When I graduated I worked for a year on a Med/Surg floor, then transferred to the ER and worked there for a little over a year. It became very unsafe in my ER with low staffing, and with the birth of my son I wanted to work days, less weekends and holidays so I transferred into an OR nurse training program 9 months ago. I don't necessarily dislike the OR. But I don't see myself there in 5 years. I can't stand the surgeons and I miss patient contact, giving meds, taking vitals, all the basic nursing skills. Before I moved into the OR I had thought about the PACU, but there were no job openings. I'm afraid that if I stay here too long, I'll lose my skills and no PACU would take me. At the same time, I haven't even worked here a year and would like to give them more time. Do you think that since I have worked in the ER, a PACU would consider me even if I worked in the OR for 2 years? Or maybe I should try to pick up a few hours in my ER just so the PACU could see that I was continuing with my critical care skills? I'm not looking to make any sudden job changes, but it's something that's been on my mind lately. Thanks!

Hi, I just need some advice. I have been a nurse for 2 1/2 years. I've worked in Med/Surg, ER, and am now finishing orientation as an OR nurse. I was recently speaking with a travel nurse in my OR and was telling her how I was hoping to pick up per diem hours in the ER (as I want to keep up my nursing skills). She recommended joining her agency, as I would be able to do per diem and get paid much more. I am considering it, however, I'm a little hesitant. I'm a shy person, and agency nurses have always struck me as outgoing. Also, do you get any sort of orientation when you start at a new hospital? I'll ask her more about it on Monday, but I thought I'd start here. Thanks!

Hi all, I recently started in an ER after working on a floor for a year. I really like it in the ER, but I'm having some problem regarding organization. On the floor, I was so used to carrying around a clipboard with all my patients' information on it. I'd have the same patients most of the day, then give a written report to the next nurse. It is not so in the ER. We're constantly moving patients from triage into rooms, from rooms into the hall, and to the floors. I'm having trouble keeping track of who's who, and who's where. There's no time to write down info about the patient, and when I give an oral report to the next nurse, my preceptor has to keep interjecting info about the patients that I've missed. So many patients come in with the same complaint (i.e. chest pain), that I'm mixing them up. When a doctor asks me about a patient, it takes me a few moments to wrack my brain about who they're talking about. My preceptor doesn't seem to understand why I'm having difficulty with this, so it's making me a little concerned that perhaps I don't have the memory capabilities to be an ER nurse. Will this come with time? Thanks.

Thanks for the advice everyone! ~Jaime

After paying my dues on a med-surg floor for a year, I will be moving to the ED in about 6 weeks. I observed there and absolutely loved it. But I know that it's completely different from floor nursing. (I'm used to carrying around my clipboard with all my notes on it, but no one down there had one - yet they all seemed to know what was going on). Any advice would be greatly appreciated. Thanks! ~Jaime

Hey all, I'm hoping you can help me out. Right now I feel absolutely sick about this. My cousin had a baby girl a little over a year ago. My cousin has been diagnosed with major depression and she goes on and off her meds. She's fine when she's on, but right now she's off. She's constantly taking the baby to doctors and having tests done because she thinks there's something wrong with her. This baby has gone through more invasive tests than a lot of my patients. Lisa limits the time my aunt can spend with the baby because she gets jealous when Emily gets excited to see other people. She refuses to feed her food with "empty calories", including milk and cheese. As a result, Emily is very small and developmentally delayed. Now, I am hearing this all secondhand as told to my mom from my aunt. This morning my mom forwarded me this letter from my aunt: "Emily had another one of the episodes (on Friday)which she gets every few months. She woke up vomiting, very weak, almost in a trance. They called ahead and then took her to Boston Children's Hospital where they have been seeing a couple of doctors for her. I guess she does have a metabolic disorder which is why she isn't growing. The treatment for it is a special diet. She gets really sick and weak when her blood sugar levels go too low (like after sleeping all night). And lactic acid builds up in her body. They took a lot of blood and tested it and tested her sugar levels which were very low. They gave her a glucose IV and by late in the day she was much better. Over two weeks ago they had given Lisa a special diet for her to help her grow and Lisa still hasn't given it to her. It's very upsetting to me and I can barely think about it. Lisa gets mad at me if I even say anything about Emily's diet at all. They have to do more testing to find out exactly what metabolic disorder Emily has. But I guess that's why she doesn't have good balance a lot of the time too and why she walked late. They think it is genetic. Now that Emily has been diagnosed with this, Lisa will be even more strict about not letting us see her. She has already told me that she doesn't want her exposed to any germs and she doesn't want us going over there if Emily is tired or anything. They are going back tothe doctor in Boston in two weeks to discuss all the results of the blood work they did on Friday." As a nurse, I know I am compelled to report any instances of abuse. But I'm not sure what this truly is. I haven't seen any of this first hand, and I have strongly encouraged my mother to tell my aunt to call Emily's pediatrician and tell him all of this. Maybe nothing is wrong, but maybe Lisa is doing something to Emily. For all I know, my aunt is exaggerating. My aunt doesn't know that my mom has been telling me all of this, and my mom doesn't want me to do anything because she doesn't want to start a family war. Any advice?

Hey all, I'm hoping you can help me out. Right now I feel absolutely sick about this. My cousin had a baby girl a little over a year ago. My cousin has been diagnosed with major depression and she goes on and off her meds. She's fine when she's on, but right now she's off. She's constantly taking the baby to doctors and having tests done because she thinks there's something wrong with her. This baby has gone through more invasive tests than a lot of my patients. Lisa limits the time my aunt can spend with the baby because she gets jealous when Emily gets excited to see other people. She refuses to feed her food with "empty calories", including milk and cheese. As a result, Emily is very small and developmentally delayed. Now, I am hearing this all secondhand as told to my mom from my aunt. This morning my mom forwarded me this letter from my aunt: "Emily had another one of the episodes (on Friday)which she gets every few months. She woke up vomiting, very weak, almost in a trance. They called ahead and then took her to Boston Children's Hospital where they have been seeing a couple of doctors for her. I guess she does have a metabolic disorder which is why she isn't growing. The treatment for it is a special diet. She gets really sick and weak when her blood sugar levels go too low (like after sleeping all night). And lactic acid builds up in her body. They took a lot of blood and tested it and tested her sugar levels which were very low. They gave her a glucose IV and by late in the day she was much better. Over two weeks ago they had given Lisa a special diet for her to help her grow and Lisa still hasn't given it to her. It's very upsetting to me and I can barely think about it. Lisa gets mad at me if I even say anything about Emily's diet at all. They have to do more testing to find out exactly what metabolic disorder Emily has. But I guess that's why she doesn't have good balance a lot of the time too and why she walked late. They think it is genetic. Now that Emily has been diagnosed with this, Lisa will be even more strict about not letting us see her. She has already told me that she doesn't want her exposed to any germs and she doesn't want us going over there if Emily is tired or anything. They are going back tothe doctor in Boston in two weeks to discuss all the results of the blood work they did on Friday." As a nurse, I know I am compelled to report any instances of abuse. But I'm not sure what this truly is. I haven't seen any of this first hand, and I have strongly encouraged my mother to tell my aunt to call Emily's pediatrician and tell him all of this. Maybe nothing is wrong, but maybe Lisa is doing something to Emily. For all I know, my aunt is exaggerating. My aunt doesn't know that my mom has been telling me all of this, and my mom doesn't want me to do anything because she doesn't want to start a family war. Any advice?

When I first graduated, I applied to the Mass General program and they turned me down as I have no ICU experience. Now that I have 8 months on a med-surg floor, I have looked into transferring into an ICU and have been told I would be hired if I choose to apply. No ICU experience needed as most ICUs have a long orientation. Not sure about MGH, though.

Hi! You have a background similar to mine. I went to UMass Boston. Almost all of my prerequisites were done. The only ones I needed to take were Chemistry I&II, A&P I&II, Nutrition, Microbiology, and Human Growth & Development. These were classes that I never took getting my BA, but if you did the school you attend might accept them. Also, I took all of those over the summer in 6 week sessions so they were done quickly. In my opinion, there is no status attached to your nursing school. Now that I'm working as an RN, nobody knows where I went and nobody asks. I have heard that you get basically the same education at a community college, sometimes better as they focus more on clinicals versus class (at least, that's what I've heard). All I know is that I took out a lot of loans to pay for school, and I still didn't feel prepared for the real world. I don't think paying more money to go to a supposedly "better" school will make any difference. It definitely did help, though, having all my nursing clinicals in Boston hospitals. You get a lot of experience and are able to see the working conditions of the hospitals you go to. Plus, you can the floor nurses their opinions. I don't work there, but I had my maternity clinical at Brigham & Women's. While it's not my cup of tea, the nurses there loved it and it was a really nice working environment. As for psych and ED, I'm not sure, but again Brigham & Women's has an excellent reputation for how they treat their nurses. There's always McLean's Hospital in Belmont for psych if you want to work in a psych hospital versus a psych floor in a regular hospital. I had my psych clinical there and it was amazing. About paying for school, you have the option of taking out loans, which I did and am currently paying now. However, if you're willing to do the research I know there are a lot of nursing scholarships out there. You just have to look. Lots of times, nursing students aren't aware of them. I was lazy and unwilling to look around (which I am regretting now). Good luck!

Hi all, I was just wondering if anyone could recommend a good clinical skills book that shows the "proper" way of doing things. I was rushed through my orientation at work, and every once in a while I worry that I'm not doing something the correct way, for example giving an IM, deep suctioning, trach care, flushing tubes, etc. Whenever I have a question about a skill at work I always ask, but usually I'll get 3 different answers. We have very few nurses that have been nurses for more than 2 years, so I get slightly concerned. When I leave my floor for a new job, I don't want the RNs looking at me like I'm nuts because somehow I've managed to give heparin the wrong way for the past year. Thanks!

Thank you all for your advice and support. I do feel better about the situation now. Part of the reason I took his behavior so badly is that my wedding is next week, and I'm already on edge. It takes very little for me to cry nowadays. You've given me some great responses if another MD treats me like this in the future. Luckily, I did document, both on Wed and on Thurs, about all of my unreturned pages to the MDs. Hopefully when I go in tomorrow, something will have been done about it. And I can assure you that every nurse on my floor will know the name of the MD who did this.

I am a new grad of 6 months on a Surgical/Ortho/Trauma floor. When I first started here, I was miserable. I'm very shy and it's hard for me to talk to new people. But in the past 2 months things have gotten so much better - I feel more comfortable, I know most of the interns and attendings, and I'm actually happy. Being a new nurse, I sometimes question what I need to page the intern about, and what I don't. Sometimes I call over things that seem important to me, but apparently aren't to the team. Up until this point the interns have been really nice and humored me, explaining gently when I ask that it was probably something that could have waited. But on Thursday all of that was ruined and now I am angry and upset and I'm not sure what I should do. So I'm just going to rant in a long post here, and hopefully feel better after getting this all out. This past week I was working 7a-7:30p. Near the end of my day on Wednesday, one of my patients was complaining of increasing pain. She had just been started on percocets that morning, and they really weren't helping her. Her daughter was there and for obvious reasons, quite concerned. I told her I'd call the intern on call to see if he could change her pain meds to something else. I started paging him at 6pm and still had received no call back by 7pm. By this time, the daughter was furious, stating this was unacceptable and she wanted something done NOW. So I looked for the person who made the last order, who happened to be the chief resident for that team, and I paged him. Several times. After another half hour, he called back and I explained my patient's pain issue. He said to give her IV Dilaudid and he'd have the intern change her pain meds to po dilaudid. I did so, the patient and daughter were happy, and I went home. Thursday morning I came in and was told by the night nurse that the same patient was doing wonderfully on the po dilaudid. She also told me that another daughter had called that night complaining that nobody gave her mother pain meds on Wednesday (which the night nurse assured her that I did). I went in to see my patient at 8:00 am- and she told me her pain was excrutiating and would not be able to do anything if the pain stayed that way. She wasn't due for more dilaudid for another hour and rather than have the same thing happen again (and have the daughter yell again) I decided to page the on call intern right away. It was the same intern on as Wednesday, and once again he did not call me back. After another hour of paging and no response, I spoke to my resource nurse to ask her advice. I wasn't sure if I should page the chief resident again, or if there was someone else on the team I should page instead. We looked at my patient's orders, and once again the chief had written the last order, so she suggested I call him. So I paged him several times with no call back. After 20 minutes, I happened to see the chief resident walking onto the floor, so I hurried over to him. Our conversation went something like this, all the while me trying to keep up with him as he continued walking away: Me:"Oh I just paged you. I'm sorry, but Mrs. so and so is having more pain issues just like she did yesterday- MD: "This is the first I've heard of this." Me: "well I've been paging the intern for an hour-" MD: "He's in the OR." Me: "Well, he never called me back to tell me that. Anyway, Mrs. so and so-" MD: "There's a third year resident you should have called." Me: "Well, I didn't know that." MD: "Next time call the third year." and he stormed off muttering. At this point I just stood there with my mouth open. Luckily, my nurse manager was walking right around the corner and she grabbed me and pulled me into her office right away as I began to cry hysterically. Apparently, the MD had been swearing at me as he walked away. Whether it was "f you", or "f off" I don't know, but my nurse manager heard him and he didn't abbreviate. She told me she immediately turned to this resident and told him that they needed to talk. He told her he was busy and kept walking. I explained to her the whole issue and what had happened. She assured me that I did nothing wrong and that there was no excuse for his behavior. I'm supposed to be the patient advocate, yadda yadda yadda. While I felt better when she spoke with me, the rest of the day I obviously felt like crap. I kept questioning everything I did. It's hard to stand up for yourself when you're new and you're not convinced that what you did was right. And being shy doesn't help. Anyways, my manager said she'd definitely speak to this resident and his attending. I've been off since that day, and I'm so nervous to go back in on Wednesday. I'm so scared that I'm going to have another patient on that team. And what if my nurse manager doesn't do anything - should I do something? Part of me wants to stand up for myself. He really made me feel like I was worth nothing, a lowly nurse. But part of me just wants to pretend it didn't happen and not cause any tension. I'm just so angry, I wish I could have yelled right back at this guy. Any advice?? ~Jaime

Thanks everyone, It sounds as if thicker skin is just something that will come with time. In the meantime, it makes me feel better to realize I'm not the only one dealing with this. I'll try to hang in there. Thanks!

Hi all, I am a new grad of 4 months working on a busy Ortho/Trauma floor. It has gotten to be an almost daily occurence that I come home crying because a patient/family has decided to take out their frustration on me. When I was in school, I always had the idealized dream that I would get out and help people, and they would be appreciative. At least once in a while, I would get a "thank you". That has yet to happen. The patients/families who I've had problems with are patients who all the nurses have problems with - so I know it's not me. However, this doesn't help me from taking criticism personally. I hate just gritting my teeth and standing there while someone chews me out because it took me 20 minutes to bring in an extra pillow. Sometimes I can understand where they're are coming from - it's a teaching hospital and it can be frustrating trying to deal with the many different interns. But most of the time, these patients are just generally rude, or crazy, people to begin with. If the floor wasn't so busy, I would be able to talk to my colleagues to find out how they're able to deal with these patients. But we rarely get to eat lunch as it is. Can anyone give me some advice on how to handle them? How can I not take this so personally? Is there some mental trick I can play in my mind so I'm not thinking "I don't get paid enough for you to yell at me, you crazy old bastard"? Any advice at all would be greatly appreciated.

I feel your pain. I took my test yesterday. I only had 75 questions, but that didn't make me feel any better. When it shut off, I thought "wait, give me more questions! I can still prove myself." It was the hardest test I have ever taken. Normally, I'm able to narrow the answers down to 2; some of these I couldn't even do that. I had a ton of therapeutic communication and prioritizing questions. I hate those. I've been checking the pearson website every hour to see if my results are in. It's driving me nuts. I wish I had picked up time at work, just to get my mind off of it. Happystudent - we were required at my school to take a review course as well. It was an excellent course, and they recommended waiting 4-6 weeks after taking it to take the NCLEX. They gave us a lot of hints about how to remember the difference between certain diseases, or how to remember signs and symptoms of a disease. Unfortunately, I wasn't asked any of that on my test!

I understand that being an exempt employee leaves the issues such as overtime compensation and comp time up to the hospital and their management's adherence to their own policies. However, since this hospital is in Boston where there are other world renowned hospitals (also facing nursing shortages) literally across the street from this one, I'm assuming (for the moment), that this particular hospital does adhere to its policies. My question is more about what types of policies (regarding comp time, overtime, etc) other hospitals that follow salary practices have. And while this is an exempt position, they pay with hourly based rates meaning that I would get a differential; for example, if I take a day/night rotating position I will get the night differential regardless of whether I work day or night. Also, they don't have mandatory overtime here. I'm more interested in learning about the pitfalls/benefits of being a salaried nurse. They have an excellent new grad training program, and the floor is exactly what I want to work in. I wouldn't mind getting a little less pay, since I would have no problem quitting and getting another job immediately at another hospital. I just want to make sure I understand everything clearly. I'll definitely contact the nurse manager about my questions, since the HR person doesn't seem to know much about it.