Becster

Hi Kimmie. I have not been on allnurses in awhile and didn't see your post. I moved to NH in December and love it. I am not working yet but have a phone interview with DHMC tomorrow and had an interview at a small hospital in the area today. Funny, I am originally from NC! I have not been up to Maine yet so I cannot speak to that state. Vermont and NH have similar topography but the politics vary quite a bit. Vermont appears to be more liberal where I would say that NH is more conservative in the sense of self reliance and personal liberties area. Upstate NY is beautiful but seems to be heavily influenced by the decisions made in the NYC area. If you want to message me I can answer more questions for you. Of course it's been so long since you posted, you might already have moved!

I found that my best interviews were when I went in with the attitude of interviewing the employer rather than them interviewing me. It sounds llke you have some solid skills and are aware of your capabilities. I would ask them questions about staffing ratios, staff turnover, reasons for employees leaving, etc. I think it is very appropriate to say that you left your previous employer because you felt as if you were not able to provide the care that the patients needed due to the nurse/patient ratio and that it was not a good learning environment for a new nurse. I went into my first nursing job with this attitude. I made it very clear that I was building the foundation of my career and that the first job I took would be a very important part of that. I was looking for a place that supported its new grads and had a commitment to continuing education. I think when you go in confident in your ability to learn and use the interview time as an opportunity to ensure that this employer is a good fit for you, it comes across to the employer that you are capable and prepared. This method worked well for me - I was offered every job that I interviewed for and all but one even came back and offered me a day shift position as a new grad even though they originally said that only nights were available. Good luck. You sound like you have plenty of skills. Too many nurses in the hospital get too focused on tasking when the assessment of the patient is the part that really saves lives.

If you're studying for CCRN, I would know all the norms from your PA cath and what the implications are.

I currently worked in a mixed ICU in Washington state. My husband and I are planning on relocating to New Hampshire to be closer to family - but not too close. I am very interest in Dartmouth Hitchcock Medical Center in Lebanon. Would you please give me the inside scoop on working there? I recently read articles about the recent layoffs and attempts to unionize so I am a little nervous about the current hospital climate. The article specifically noted a termination of DHMC's patient transport program and I am curious how that is working out. It appears that DHMC has 3 critical care units. I really love the variety in my current workplace. One day I can recover a post-open heart and the next take care of a septic patient. Is there opportunity to rotate between units? Also, job postings note shift rotation requirements. I'm not a huge fan of night shift. How much of a rotation is required? Finally, I would love to get some feedback on the best areas to live in the Dartmouth area. We would like to purchase some property without going underwater trying to do this. I would like to keep my commute under 30 minutes each way. It's hard to get a good feel for a community via the internet. Anyone have the skinny on Lyme, Orford or Enfield? It looks like Canaan has a flooding issue. Any information would be very much appreciated. Thanks!

Sounds very unsafe. I work in a 21 bed CCU. When we have tele patients that are waiting for transfer (sometimes this can take days) to the floor we sill staff 1:2 with rare exception. 2 or 3 tele patients can be really demanding of your time especially considering that CCU transfers to tele are considered the heavier tele patients. A couple of tele patients can really eat up the time the nurse needs to spend with the critical care patient. Our nursing staff has really stood together and refused to allow management to assign us more than 2 total patients when there is a CCU patient in the mix. Our 1:1 policy is a little gray. Some patients that tend to be 1:1's include unstable balloon pumps, pts' requiring high FiO2 with high PEEPs, innercool pts being rewarmed, recent codes, pts with unstable arrhythmias, intra-arterial TPA with frequent neuro checks, intubated pts coming from the OR who require recovery, and pts requiring frequent gtt titrations. We don't have camera beds. All of our rooms have hard wired monitors so the primary RN is responsible for watching them. We do have monitors at the desk but our unit secretaries are not monitor trained. All of our monitors have alarm parameters and vfib would set off a loud crisis alarm. Hope this helps.

You might confirm exactly what kind of feeding tube it is and where in the GI tract it is....as someone mentioned in an earlier post, Ecotrin is coated so that it doesn't dissolve until it gets to the intestine. If the distal end of the tube is in the jejunum, as many are, it really wouldn't matter. Just my

Soffy, don't be so hard on yourself. You've been at it 5 whole weeks, did you really think that you would be an expert by now? The first year is the hardest. I am a very confident person, but I found myself praying every morning for the first 6 months that I would be safe and competent. It's scary to feel such responsibility for another's life and one would question anyone's integrity just coming out of school and not feeling a bit overwhelmed. There is a lot to learn and most of it is not taught in nursing school. I've been at this for 2 years now and I love being a nurse. My feet hurt at the end of the day and my job is stressful, but I couldn't imagine doing anything else. There are little gifts that we get all of the time. Mine last night was keeping my patient comfortable and staying with him so that he wouldn't be alone during his expected passing. A few days ago, it was catching a new arrythmia early and being able to intervene before it had further consequences. Not too long before that, it was knowing that the little old lady that had fallen in her garage and laid dehydrated, alone, and in excrement for 3 days was now clean, dry, safe, and felt the love that we as nurses had to give her. You went into nursing for a reason, Soffy. Regroup and find that reason and make it work for you . Everything else will fall into place. You are not supposed to intuitively know what to do right now. You are not supposed to be fast and exude confidence yet. All of this will come with time. You are exactly where you are supposed to be and are fortunate to be working on a unit where people are understanding of this and are being supportive. Once you have started seeing things more than once or twice, you will find things much easier. Cut yourself some slack!

I think that there is a big difference between different pronounciations d/t regional differences and people just plain making a new word up. O2 stats is a good example of someone just not getting what they are trying to say. Sats is short for saturations not for statistics. I am a transplant from the South but have spent long enough away to not have a recognizable accent. There are a number of words that I say the way that I learned them and get teased because apparently the people in the NW speak more proper English. I would like to remind all of the folks in Washington state that since Des Moines is a French word, it is pronounced Da Moine, not Des Moines or Da Moines, as many people here pronouce it. But yet, I am the Southern hillbilly that gets laughed at when I say "ornery" rather than "ahnry". I'd never met an "ahnry" person until I left NC. My biggest pet peeve is when people who have never seen a mountain chain east of the Rockies call it the Appalashuns. I have hiked all through them and the folks living up there all called them the Appalachian Mountains just as they are spelled. Makes the hair stand up on the back of my neck when I hear it. So if in England, it is pronounced orientated, then roll with it. It is nice to keep a bit of home with you rather than constantly having to conform because locals have not traveled enough to realize that there may be other ways to say things. I for one refuse to quit saying "dagummit" and "I reckon" or complain about my coworkers "lollygagging". And although many of the people that I run into believe that they live in Warshington, I refuse to change my tongue. On a side note, it's/its, they're/their/there, your/you're are not regional....major pet peeve.

That's great that you are so considerate of pharmacy. You should speak with your manager about getting an IV drug book for your med room. I have seen nurses draw some med from the line and test it with a dose for the IVP for precipitate, but there are some drugs that do not cause an precipitate but rather act as an antagonist or increase the effects of the other so I don't think that this is a very safe way to be sure that you are delivering drugs appropriately. We have the same access that our pharmacists do to Micromedex where we can check compatability. We also have 2 updated IV med books in our pharmacy as well as a poster of frequently used meds. Most units have access to the internet where there are a number of reliable sources. But, if your unit is unwilling to shell out the money to provide safe patient care, then the only choice that you have is to call the pharmacist. Maybe their manager will get tired of the interruptions and force the powers-that-be to spend $50 on a good IV drug book. On a side note, I am a bit of fanatic about checking compatability and am surpised at how many things that I see piggy-backed that have either questionable compatability or a not compatable. Sad.

HAHA! I worked in medical records in a facility that used Meditech prior to becoming an RN. The chart was printed after D/C and was more cumbersome to read than you would ever believe. It prints every question you are asked even if you don't answer that section. We had to pay some company to store our records within 2 years of going live after 15 years of barely using our own offsite storage because the charts became so large. The only satisfaction that I got from it was that the attorneys would have so much garbage to wade through! We went live with a McKesson product in March. Admissions are a bear but are fairly quick on readmissions because all of the info is right there instead of waiting for medical records to find the chart. Charting does take longer but I wouldn't go back to paper. I wish someone would take the best from all of the programs and make a more universal product. It must be a nightmare to travel these days. My main complaint about McKesson is that it obviously had more input from IT than nursing. There are so many things listed that are inappropriate. We have to chart tremors under psychosocial and edema under skin! I can't chart that my patient is oliguric or anuric without making an annotated note and the docs have a really hard time reading our assessments (which of course means that they need a ton of hand holding!). As far as the questions about go-live...all staff had 3 - four hour sessions of training. Superusers had 16 hours of training. Biggest issue was that the people training us were either non-clinical people or had never used the system. Staffing was improved for a few days and we had superusers on every unit who did not take pts (unless we were short-staffed) for about 3 weeks. We rolled out everything at once, but I do wish that they had done charting first and then meds at a later date. It's nice to have one thing stay the same for awhile. Good luck to whoever is going-live soon. It's a rough transition, but good God, they don't even teach cursive in school anymore. Computers are the way of doing business for all professionals now, including us.

I believe that what is actually being described is total care nursing rather than primary care. I currently work for a facility that does total care and although I believe in the model, it is not working for us right now. We have no aides on our unit. We take 24 patients with each RN or LPN responsible for 3-4 patients on dayshift and the charge taking no pts. I find that 3 is generally quite managable, but on a 7 a - 7p shift, with 4 pts I generally am scrambling to get a break by 1:30 and feel lucky to squeeze in a 15 min. break later in the shift. We recently went to computerized charting which seems to take up more time. We do have transport services, so thankfully I am not pushing my own pt to radiology or to the lobby at d/c. Housekeeping tends to be marginal. If my pt is in isolation, as many on our unit are, I can count on the room not being cleaned every day. I empty garbage in all of my rooms at least once or twice a day. We also have a huge storage issue on the ward as dialysis takes up a ton of space so I often am running to the other end of the unit just to get a 2x2. I do like that I get a full picture of the pt. Unfortunately, sometimes I don't get to see that picture until late because I am constantly playing catch up. I agree with an earlier poster that if the work is being divided b/t 2 RNs you might as well do all care for each of your 5 pts and have the CNA assist with all 10 as far as baths, toileting, etc.

Henry Ford did not make the honor roll, but it was one of 170 that made the cut. I work at Providence St. Peter's which is also on the list.

I feel your pain. Things happen. What matters is that you were able to remedy the situation and that you had that much empathy for his discomfort. It's tough to be everything. We have no aides where I work. I am constantly stressing because a patient desperately needs morning care but I still don't have assessments done or need to pass meds. I generally keep my cool pretty well, but once broke down because 3 of my 4 patients all were incontinent of stool at once. Sometimes it's just too much to keep up with. Keep your chin up, you can't be perfect all the time.

Dear God. How petty have things become. Sometimes I think that I was treated more like a professional before I went back and got my nursing degree! "Susie did this, Johnny did that." I don't give a Sam Hill what anyone else does as long as it doesn't get in the way for me to provide care to my patients. If my coworkers have extra time and check their email or call their family, who cares? Most of them are more than willing to help out as long as asked. I started carrying my cell in my pocket so that I could screen when to best answer calls from my son who calls to check in after school. We carry spectra link phones at work that are tied into our call lights. When it says "outside call" on the caller ID, I don't know if that is a pt family member checking in, a doctor calling from the office, or my son calling to tell me that he's going to the mall. When my cell buzzes in my pocket, I know that it's personal and I don't have to answer it while in a patient room. I can return the call if necessary when I get done. Being a nurse doesn't mean that you have to give up being a parent. I disagree with the post of the nursing student that her babysitter should only call if there is copious blood. I worked a number of jobs before I was an RN and none of them ever expected me to dissallow personal call from my family. It is more profitable for us to be martyrs. Maybe it's time that we start standing up for ourselves. I give up federally mandated breaks every day because it seems there are no other choices. This is where I draw the line in the sand. Can't tell I had a bad day at work, huh?

It kills me when the many nurses I work with give patients a smoking sensationpacket rather than the ordered smoking cessation packet.