Sunshine139

Our program is very close to yours. We do 40-60 total joints/week and have a 27 bed unit with an overflow unit. The goal is to do up to 100 total joints every week. (We will need more beds obviously.) We are working hard on getting certified by JCAHO. In fact, they are at our hospital this week! For anticoagulation, our total knees have lovenox bid and the total hips have lovenox daily. Some providers also still use coumadin which the medical md will manage. Our pt also have P.T. BID and then nursing walks them on the pm shift. They also must learn the stairs, car transfer, and do coumadin/lovenox teaching with pharmacy before they are discharged. We also have orthopedic routine care protocols we have implemented so RNs can write orders based on needs. For example, for severe post-op pain we give a one-time dose of Toradol (for qualifying pts), for indigestion we order maalox (if no renal impairment), we discontinue the PCA on POD 2, there is a whole long list the ortho docs have approved that we can write per protocol using our nursing judgment. (For example, I wouldn't order Toradol for a steriod-induced asthma patient since it is contraindicated) This really helps for the night shifts. We also do blood reinfusion if ordered for up to 6 hours post-op. Our patients must also attend a pre-op total joint class. We also do have some patient with perineural infusions (continuous fem nerve blocks) but we discontinue those on POD 2 d/t the knees tending to buckle with the infusions. Almost all of our patients have Spinal Anesthesia unless refused by the patient. We also have a surgeon who does Total Hip using an anterior approach and they don't have to be on Total hip precautions. They have had great results with this and there has been less blood loss and less pain. These patients also do much better with therapy. I wish more of the orthopods would learn this approach!

I am also working on getting my ONC and take the exam next month. My manager just got certified. She said the BEST way to study is to do the practice questions from the NAON cd on the website. She said the questions on the actual exam are set up the same way. She felt that a lot of it was "common sense" knowledge. Good luck! :anpom:

The best advice I can give on organization sheets is to see what nurses on your floor are doing. I have worked at two different ortho floors and have a completely different organization skills for each one. It just really depends on what your demands are. All I know if that for myself, I like to have all my important info on my patients on one sheet so I don't have to flip through a bunch of sheets, especially if a Doctor asks me a quick question about a patient. I put what meds are due when, who needs dressing changes, who has a foley or needs one taken out, I leave a spot for new doctor orders, a place for their activity level, diet, doctor, and if they are a total knee how high their CPM is. I also leave a spot for drains, input/output, and vitals. It is sometimes better to have a seperate sheet made for when you have a new surgical because their is more info that is usually needed on those. For example, you usually need to know what anesthesia they had, their estimated blood loss, what meds they got in the OR/ Recovery room, what pain medication they can have, their history, if they have a medical consult, significant things that happened during surgery. Things like that. Nursing Worksheets is a website you can look to see how a worksheet is made up. I actually took one I found online and edited it to be specific to ortho. Hope I was some help. Good Luck!

There are hiring new grads at Halifax in Daytona Beach.. I'm a new grad and just got hired there.. I don't know if Daytona is too far away bt I also struggled getting a job as a new grad. (I passed my boards in August) I am actually orginally from Minnesota and didn't get hired there and I got in quick at Halifax. Good luck to you and your search! Trust me, I know how frustrating it is to be sitting there with a nursing license and a nursing shortage and not getting hired!

I completely know what you are going through... I had the same problem finding a job! I graduated in December and between surgery and other obstacles I didn't pass my NCLEX until August... I applied all over Minnesota (mostly in the Minneapolis/St. Paul area) but they all required that you were enrolled in their new graduate programs in order to get hired by their hospitals. I missed the deadline for the September rotations so I would have had to wait till Jan. Which is over a year since I've been graduated :uhoh21:... but I was willing to wait till then because it is better than no job. I changed my mind about staying in Minnesota because it was taking so long to hear back that I moved to FL. I just recieved a job offer at Halifax health in Daytona Beach. I have found out from friends I've met around here that it took them months to get a job... so you really just have to hang in there! I know it is soooo completely frustrating to wait!! When it comes to home health, I was told during my rotations they hesistate on hiring new grads because you have to be so independent in home health. At the hospitals, it is easier to ask questions and have nursing right there to help you out, but in home health you are out on your own in most cases. Some places need nurses so badely that they are willing to take the chance though. You should also have someone you trust look at your resume/cover letter. I thought my first resume was great because I used resume sites and had one of my professors look at it. However, when I wasn't getting called back or denied positions I had one of my friends who hires people look at it. He actually ended up tearing it apart so it was really not as good as a thought. It was hard to hear, but better in the long run because it helped me get a job. Just hang in there, I know things will work out!

I went to school at a University in the Midwest and one of my best friends from the nursing program applied to many of the hospitals in LA. She recieved many call backs and interviews by phone right away. She was even offered a position at the UCLA hospital in their ER as a new grad. She got plenty of calls back from hospitals even after she accepted her position so they are looking for new grads out there. :)

I am in the same boat as you are! I passed my boards in August and have applied at over 10 hospitals in Minneapolis, MN and have not heard back from a single hospital yet. Some of my applications have been pending over a month. I know at most of the hospitals you have to get into their new grad programs in order to get hired so that's what I applied for. I'm just afraid it's the worst time of year to apply and that I won't get hired anywhere until Jan. It is just really frustrating to be sitting here with a RN license unable to work as a nurse!