mikeicurn

You might be a new grad, but some of these basic skills like straight cathing someone should not be making you nervous. You are going to have to start jumping in and doing them. Transferring to Med/Surg or anywhere else is probably not going to be any easier. Nursing is nursing, every area has their own procedures that are kinda unique to them, but the majority of your job is going to be basic nursing skills. They obviously hired you because they thought you had what it takes to do the job. Now, show them they were right. You can't hide in the charts, your job is patient care. Charting is basically documenting what you did for the patient. So, get in there and do things for the patient, then worry about the charting. Good luck!

Don't get your honey where you make your money.

Good Luck!

You might be able to leave it off your resume, but when you fill out applications they often want all time accounted for, and explainations for any gaps in employment. So you may have to address it then. You have a good reason for leaving, and the fact that you left and went to Florida just supports your reason for leaving. Good luck,

You did good!

I have my own sheet that I use for my patients, as well as a form detailing these notes you are talking about (I have heard them them called fishbones).

1. Do RNs still create care plans anymore? In my area everyone admitted to the hospital or LTC facility has a care plan. 2. Was school beneficial to learning the creation if a care plan if the answer to Question 1 is 'yes'? I think so, in school you learn the process. The "why" instead of just the "how". 3. When a care plan is implemented by the RN on a hospital floor (non-ED), does the MD ever disagree with decisions made by the RN? I have never seen this. 4. Is a care plan becoming outdated in the hospital setting? Is there a certain population, like LTC, that a care plan is more productive? I don't think so. If John Doe comes into the hospital from a LTC with exacerbation of COPD, he will be treated for his COPD, but he also needs to be treated for all the other health problems he had at the LTC facility. If he was a fall risk there, he is gonna be a fall risk in the hospital. 5. With so many lawsuits being thrown around, should the RN even create a care plan anymore and then be prosecuted for causing what the recoving surgery patient says is undue pain because he was made to ambulate or even a differnt example with perhaps more validity? (I see enough RNs/LPNs scared to do what is perhaps "right" for fear of being viewed as "wrong" and then being sued. Let alone poor reflection of the HCAHPS b/c the pt didn't get to sleep in until 10am). In the facilities I have worked in this isn't optional. It is part of doing an admission. The driving force for change in my hospital is not fear of lawsuits, it's fear of not getting full compensation from Medicare/Medicaid. Case management is constantly digging through charts ensuring everything is done correctly so we get full compensation. It is even more important nowadays for these interventions to be done to ensure the length of stays are reduced, core measure patients are treated correctly, and people are not being readmitted for the same diagnosis over and over again. We have to fill out separate paperwork for most of this, but it is really just an extension of the careplan in many cases in my humble opinion. 6. Is the current state of care-planning just to assist student with critical thinking skills? Well, like I said above. Care plans in my school were much more detailed, as a means to make you use the critical thinking process. In the hospital our careplans consist of checkboxes. In school we had to write out the nursing diagnosis, the medical diagnosis it was related to, the subjective and objective data, goals, and outcome criteria. It was a learning tool. If for instance, I get a patient in with dehydration, I don't have to to write out in my care plan that he may have poor turgor, decreased NA+, increased K+, c/o headache, and dry mucus membranes. I am a nurse, I should know that, however as a student I had to show the instructor that I knew it. I also had to detail what was objective, and what was subjective. So part of the exercise was to fill out the careplan, and part of it was to educate me on signs, symptoms, treatments and interventions. I think the careplans in school are a good exercise to tie everything together in a more "real life" manner. I also think they have some value in the hospital/LTC setting. You certainly wouldn't need one in the ER. I wasn't aware if they used them in corrections or not. You taught me something there.

As it's been stated already, it all depends on where you are at, and that particular facilities' policies. I make more hourly at the hospital, but the shift diff at the nursing home meant I actually made more there on the weekends. At my hospital PRN employees make about 20% more than full-time, but at the nursing home the hourly rates are the same, and PRN people get $1 less for shift diff, so the full-timer's actually make a bit more.

Agreed, you also have to be realistic. You may not land your "Dream job" right out of school. I have heard many new grads state they have to have a day shift job, don't want to work weekends, expect to be able to take off for children's birthdays, boyfriend's birthday, grandma's birthday, that concert I just can't miss, because I didn't sleep well last night and I am too tired to work, etc... You might have to take a night shift job to start out, you may not be able to take off at the drop of a hat, you may not get every weekend off, and you may have to take a job on a less desirable floor until an opening comes available on your "dream floor", but you can find work if you look hard enough and have the right attitude.

As others have said, no harm done. It could have been a lot worse. Don't take it personal, although your coworker may have not been the most gracious about it, she taught you something. Take the lesson and move on. When you have the opportunity to help a new grad along and teach them the same thing, remember this and do it in a different manner.

Careplans are a little different in school than in the workplace. The ones you do in school are more detailed, because you need to learn what you are doing before you start filling out the "short form" versions. They are usually meant as more of a teaching method so you learn how to use labs, medications and medical diagnoses to apply nursing diagnoses. So, of course they take longer to fill out. You will learn in school that there are doctor's diagnoses (such as sepsis, cancer, anemia, etc...), and nursing diagnoses. The careplan is filled out by the nurse who is admitting the patient, and every nurse who assumes care afterwords reviews, and if necessary, revises the care plan. This is meant to insure consistant care is given by all nurses. For example, if I admit an elderly patient who has orthostatic hypotension (their blood pressure drops with they stand up), they would be in danger of falling. A nursing diagnosis might be "risk of injury due to falls related to hypotension". So, then I would apply the necessary interventions to try to prevent the injury. Such as "bed alarm in place", "call button within reach", etc... This would all be called out in the care plan. So when you took over care of the patient you would review the careplan, and initial it. This stays in the patient's chart. There is an organization called NANDA North American Nursing Diagnosis Association. They put out a list of standard nursing diagnoses. This is the standard my school used and I would imagine a lot of other schools use as well. Good luck in school, I hope this helps.

I only wear Crocs (the real Crocs not the cheap knockoffs). They are the most comfortable shoes I have found.

I am not sure what part of the country you are in, but in my area $7.50 would be pretty typical for a nurse aid pay. My advice would be, that you may want to research the field a little more before you proceed into nursing school. Since the pay for aids is pretty close to what it is here, I am guessing the LPN pay will probably also be in the same neighborhood. If so, you still probably won't be making $18.00/hr even when you graduate. Also, around here, most new nurses start out on night shift as the day shifts are filled with people with more time. In my unit there are people who have been here for 7 and 8 years that are still on nights. Good luck.

I only worked Med/surg for a short time, and have spent most of my time in the hospital in ICU. That having been said, I don't mind working med/surg. The things you are hearing about being short staffed, high pt to staff ratio, administration expecting too much from you, no time for breaks, etc ... are not exclusive to med/surg. I heard the same things when I worked LTC and also in the ICU. You have good nights and bad nights. I know people in our hospital that love working med/surg. You just have to find your individual niche. I used to run around like a chicken with my head cut off trying to do everything at once. We had one nurse in my ICU that had been there for 35 years (she just retired a few months ago). She never ran around, looked flustered, or got her blood pressure up. I started watching her, and she just prioritized and did one thing at a time, until the work was done. I started trying to do the same thing, and low and behold my work got done more efficiently, I didn't miss stuff anymore, and I was so much less stressed.

Also, if you are that shy, you may want consider a career other than healthcare. You will have to deal with new people EVERY single time you work. You may want to consider a career in engineering or computer sciences or something along those lines where you do not have to work with as many different people on a daily basis. Good luck!

Be persistant. If you go somewhere and they tell you they are not hiring, then go back again in a few weeks. Then again after that. Luck is usually being in the right place at the right time. If someone quits, then that person who has been pestering the DON, manager, etc... should be the first one that pops up in their mind. Be flexible. Tell them you will work any shift, any time, just get in the door. I have found a lot of my co-classmates who are not working have unrealistic ideas about schedules. When I bump into them and they ask if my hospital is hiring I hear a lot of "I can't work nights, or weekends, or holidays". Or "I can't come in on short notice because I don't have a sitter". That makes it hard for anyone to find a job. Good luck!

This seems to have turned into a Canada v/s USA thread concerning healthcare. Here is a link from the AARP with 5 myths that are addressed. I found it interesting in comparison to all the horror stories people spread. I have never lived outside the USA, but I have travelled extensively and have learned quite a bit about other healthcare system models. All in all I think the main difference between our system and "socialized" medicine, is an exphasis on preventative medicine. Other countries spend more money on prevention, and people are expected to attempt to mitigate their healthcare costs. Here, people expect to run to the ER for every little runny nose, headache, stomach ache, etc... When I was training in the ER I was shocked at the trivial things people came to the ER for. I am often told this is because people don't have insurance, so they can't go to a doctor's office, so they come to the ER instead. But I see many of these people do have coverage. They will go to a doctor and get a prescription for a antibiotic. If they are still experiencing some minor discomfort 2 days later they will go to the ER wanting a pill to alleviate their discomfort. Or if their child wakes up at 2 am with a runny nose they will bring them into the ER. With a single payer system I believe people will have to adjust their thinking and be more proactive instead of reactive with their health.

I got my ACLS certification after I graduated. My clinical instructor offered it for the cost of the text book, so it cost me around $25. I won't say it got me my job in a small ICU, but it did look good on my resume. Even with this deal, only 10 or so of my classmates took advantage of the offer. The attitude seemed to be "if the hospital wants me to have it, they will pay for me to take it". I think it put me a bit ahead of other applicants. Not only was it one less thing my manager had to deal with, but it showed some initiative on my part. But, I wouldn't recommend spending money on it if I didn't have the money to spare. Ultimately whether or not having ACLS will help you get a job completely depends on who you are sitting across from. What will impress one manager, won't mean a thing to another. In my unit my old manager (who hired me) achieved her BSN later on in life. She worked as a bedside nurse for many years, and was very "hands on". She was impressed more with practical experience than formal education. She recently left and my new manager is a MSN who has primarily worked in management roles with little "bedside" experience. She focuses much more on formal education. She is currently trying to fill two open positions. What she is looking for in applicants is no doubt very different than my old manager. So there is no universal answer to "what will help me get hired". You just have to do all you can to plump up your resume, and sow, sow, sow, and hope you soon get to reap. Good luck!

You did good.

I have been in ICU for just over a year. I feel confident I know what I am doing probably something like 90% of the time. There is always that uncertainty when doing something unfamiliar. Hang in there, it gets better. You just keep learning new things everyday, and it will get easier and easier. It helps if you are in a good unit with a lot of support. I work in a small ICU (6 beds) and we have a pretty tight knit team who supports each other. That makes a huge difference.

I would have to guess as a new hire, and especially as a new grad you will most likely be working nights. Most places have people on nights who have been there for sometime waiting for a dayshift position to open up. I can't see them hiring you off the street into a dayshift position. I would talk to the DON and find out what shift I was going to be on if you can't work nights. The DON should also be able to tell you what the pay will be. If they are setting up an orientation, then they must have made you a job offer, and you must have accepted it. That would have been the time to work all that out.

There is a school near me that churns out people with BA's in social work. My sister-in-law fell for their sales pitch. When she was graduating she was telling everyone she couldn't afford to work for less than $16.00 per hour to make it worthwhile. That was several years ago, and she is working a grocery checkout. There are people all over this area with those social worker degrees working minimum wage jobs. It's a shame that they con people into getting those degrees.

I posted this in another thread, I am reposting it here because most of it applies here also. You have to take in advice from all sources, then make your own decisions. I worked as an LPN at a LTC facility while in RN school. I went to work in a small ICU after I graduated as an RN. My manager picked out my resume because she used to work at the same LTC facility that I did. She felt that LTC experience is very beneficial for ICU nurses. Time management is important in both environments. And the majority of our patients are elderly people from nursing homes, or from home, but in the same age group. While you are treating the reason they are in ICU (resp distress, cardiac issues, etc...), you still have to deal with more routine issues such as crushing their meds, incontinence, fall risks, dementia, sundowners, family, etc... Who better to handle these issues than those with LTC experience. Most of the ICU nurses I work started out in LTC. I have heard that nonsense about hospitals not hiring you with LTC experience. You have to understand hospitals don't hire you. Managers hire you, or at least tell HR who to hire. Every single manager has their own ideas about who they want to hire. You cannot make generalized statements like your friend is making. How could he know what any particular manager is looking for. Put yourself in the manager's position. You have a hard working hustler who took a LTC position out of school, worked at it for a while to learn the craft of nursing, then wanted to move into a hospital environment to try something new. On the other hand you have new grad who has been unemployed since graduating, because they say they don't want to settle for a LTC job. Who are you going to hire. One last thing. When interviewing, keep in mind that the manager across from you has very likely worked LTC at some point in their life, and you may want to be cautious about what you say about LTC. You might unknowingly offend them, and lose you chance at job. Wherever you work at, make the most out of it, and learn as much as you can. That good attitude will take you wherever you want to go.

"You learned central line care in school" is not good enough. Your facility needs to have policies, procedures, and protocols in place. This is both for the protection of the patients and the nursing staff." Right, and my hospital has all those. We get them in our communication book and in CBI's. My point was don't you think getting these policies online would be sufficient? Do you really need demos and skill check offs?