darcicat

I worked at a clinic as an MA through the registry after I got my license because there were no RN jobs for New Grads at the time. The clinic had one nurse for patient education, but the rest of the staff was comprised of MAs. The MAs were fantastic and taught me everything about working at a clinic, something I didn't know squat about. And in actuality, I would have eventually gotten bored with vitals, rooming patients, and giving injections. I think a well trained, compassionate MA can do all those things. The part that was difficult, is that patients had to make an appointment to see the RN for education. Much of the education that occurs between patient & nurse requires a relationship be developed over time. Th MAs all had better relationships with the patients than the nurse did because they saw them at every appointment. I think that MAs have a great place in the office, but I also think that there needs to be more than just one RN in an office. There needs to be someone who floats in and around, who actually provides direct supervision, and who drops in on patients to talk to them about their health. JMHO.

I think that you start the new job as planned. There is no reason in this job market that you should think you are a shoe in for any job. You may not get this new-new job at all. In nursing you are only as effective as how much you love your job, so you do what's right for you without intentionally screwing anyone over. You will be a better nurse for landing your dream job.

Oh, side note. Finding a satisfying and stable career is never a bad move as a mother, especially when you only have to work 3 days a week.

You have to figure that you are not going to have a life whether you are in an ADN program or a BSN program. They are equally time consuming. The difference is the types of classes that you are taking. My thought is, get it all done at once if you really want the BSN. Otherwise, you end up paying for 2 degrees and spend twice as long in school. Online classes are sometimes more time consuming than lecture based classes anyways due to the fact that you actually have to do all your reading and teach the course matter to yourself. Online learning does not necessarily make it easier. One caveat, BSNs are more expensive than ADNs. If you don't really care what degree you have, the ADN is cheaper. PS. I did a BA to BSN program.

Has anyone heard from HRSA regarding loan repayment yet? Theoretically, we should get acceptances via e-mail or post by September 30th. Just wondering if anyone has heard anything yet?

It is a patient safety thing. 1) All of your infusion rates are different - 125 ml/hr for your LR, 200/hr for your loading and 50/hr for your maintenance dose. 2) If you hang your 1000ml mag bag as a piggyback it will be higher on the pole than your primary bag, and that is how you choose what bag is infusing at what time, it works by gravity, even when you have a pump. 3) So, if you did it that way, you would hang your LR lower on the pole and set it as the primary at 125/hr. Then your 1000mls of mag higher and program 100 mls only to infuse at 200/ml an hour. 4)HOWEVER, when your secondary program was over after 100 mls, the secondary would switch off and the primary settings would take over (1000 mls at 125/hr) BUT your mag bag is still higher on the pole! So you would be infusing your mag at 125/hr not 50/hr like you were supposed to. 5) There is no way that you could prevent this from happening in that scenario, because you cannot be at the bedside every minute. You have to pee, take a break, see your other patients, etc. So you never want to set something up like that. Therefore the pharmacy will break it up into two bags. This prevents that from happening. You just have to write a note to yourself to come back in 30 minutes to switch the bags.

I am going to be volunteering for Rock Med this year, just wanted to know if anyone else here had ever done that? What should I expect my responsibility to be as an RN at the shows? How far do the MDs take their practice at the venues - i.e. starting a line to give fluids for a dehydrated patient? Defibrillating a patient having a heart attack? Enacting MONA and ACLS? Or just BLS? Any good stories from previous volunteers? (Obviously mindful of HIPPA.) I really want to hear what I am going to be in for, and what I should brush up on. I'm a Med/Surg nurse, not an ED nurse, so I'd like to know what I need to know. Also, should I look into getting insurance, or does the company cover you when you are volunteering - I know that they are non-profit, so they may not be able to. Thanks for any advice. :)

Thank you all for the advice. With my first student I did check in with her for everything, the relationship seemed very natural. She had 3 patients but only one of them was my patient - however, she was always present, always around, always asking me questions, tagging along behind me. It was easy. She got her charting done on time, so I had PLENTY of time to go over everything with her. She came to me to get meds like 30 minutes before they were due, she already had her accuchecks done for the insulin. I am realizing that she was just a good student, going to make a great nurse. All of these students are in the 4th semester, doing their last clinical on our unit. The students are spread out across 3 floors, so while the instructor is on site, she isn't always present. I asked my clinical coordinator the first time how I was supposed to handle students and just got some brief directions. I've asked my peers, and I've asked the students themselves. The answers all seem to vary. I think I need to actually sit down with my CC and make her tell me exactly what I am expected to do. My thought is that I am going to do my own charting so that I am not waiting to go over their charting at the end of the night. If they get it done in a timely manner, I'll go over it with them. If not, I will just say "you can review mine for the correct assessment." I like the idea of saying "meds are given up to an hour before to 30 minutes after they are due. If they are not done by 15 after I will give them myself." Students like working with me, even these students did, because I am youngish, I'm friendly, and I'm pretty laid back, and I'm great at explaining patho, and I drill them on their interventions. One of them even asked me to precept her (I said no because I feel that I am still too new at this game.) However, I think that I need to be a little more assertive at the beginning with my expectations. I also think that I need to be more assertive throughout the shift... Asking for status updates and what their plan/priorities are every 30 minutes or something. Just to make sure that they are on the right track. I like all of your ideas, thank you.

This month I have had to add a new process to my nursing - working with students on the unit. I am wondering if anyone has any advice on the best way to do this? My first time with a student was lovely, she was on top of things, her charting was great, and though I assessed our patients myself and checked in on them, all I really had to do was co-sign her charting, pull out her meds, and find cool stuff for her to do with my other patients. It was fun and I loved it. Tonight however, I had two students who each had 2 of my patients. They were both super different personalities. I ended up staying a half an hour over waiting for the first to finish her charting so I could review it. Her patients seemed to be happy with with her, but her assessments were a little off, so I modified them. Overall, she got all the patient care priorities done though. Generally speaking, I would have gone through her assessments with her to teach her and had her modify them herself, but it go so late I just felt like I had to fix everything myself so I didn't have too much overtime. I sort of felt like I didn't do right by her education though because we just didn't have time to review everything together. I sorta feel like this was my fault, and maybe I should have directed her more earlier? Specifically found times for her to sit down and chart? Taken over her meds if she was falling behind on the charting piece? I'm not sure here. My other student had been an LVN, and acted like he knew everything. But when it came down to it he had missed meds, he didn't know all the forms to chart, he was significantly late with his blood sugars and all his evening meds, and every time I told him to do something he'd be somewhere else. Eventually, I just went through and caught him up by doing it all myself. I had to repeat things a hundred times, I even made him a list of things he needed to chart and he lost it, it was frustrating to say the least. PLUS he's already taking shortcuts that I don't even take. And some of them were patient safety related - like he wanted to pull out everyone's meds from the omnicell at once. Maybe I am too "by the book", but I do meds one patient at a time. It is hospital policy, and a JCHAO standard. I think that when you are just beginning, that is how you SHOULD be doing it. And he says to me "well, I think you are the only one who does it that way." ARG. First of all, for my own sanity and my own liability, should I just chart everything myself and not wait to cosign at the end of the night if I feel like the students are falling behind? We have computer charting, so it would be easy to do my own documentation, but I don't think that is really how it is supposed to work. I know that if I do things for them, they won't learn, but what do I do if they are seriously missing the priorities? I mean, patient safety comes first, right? So do I just give the meds and tell them I gave them? Do I prioritize for them and say, okay this is what we are doing right now? And with my guy who is totally slacking, is it my place to tell him this isn't cutting it? Or do I talk to his teacher after the shift is over? I'm at the tail end of my first year of nursing, so I know the "right way" the "ivory tower" way, and for the most part I adhere. What do I do if a student is too far away from the ideal too soon? I know that I am a good teacher when it comes to tasks and patho, and all of that, and I am good at getting them to critically think, but I just don't know how to time manage them, how to make sure that every thing gets done on time, correctly, and without us all having to stay an hour over the shift. Any advice?

So here is my advice, keep reading your rationales. Keep asking questions and figuring out why you got wrong what you got wrong. You will see similar questions in the future. All the way up through the NCLEX. Fundamentals is hard because you are learning to think again, learning to think like a nurse, but really it is common sense. Because of that - ALWAYS STICK WITH YOUR FIRST ANSWER. That holds true for the NCLEX too. More often than not your gut is right. However, you do need to think through the questions. I tried to write how I thought about the answers and decided. The main thing is that you think about each answer choice and how it applies to the question. Does it seem relevant? There are of course obvious wrong choices (You'd never get fired for forgetting to document ONCE) cross those out immediately so that they don't distract you. Then think about what the words mean in the answers/questions. What does Negligent Care entail? Well you neglected your patient's needs. You did something bad and you should have known better. Ok, maybe this could be right. But was there damage to the patient? This is a legal term, and usually you need to have damage to the patient for it to be a valid claim. No, the question doesn't say that the patient was harmed. So, this one doesn't work 100%. Maybe only 50%. For C...well the patient almost never sees their chart, so they have no idea what you write or don't write, so that can be crossed off too. At that point if you understand how insurance billing works and that documenting means that you get paid, D is 100% the right answer. You would only know that if you read about it/discussed it.

43 - Appropriate reimbursement for services being denied. Remember this mantra "if it's not documented, it hasn't been done." So the only way that the insurance will reimburse the claim (pay for your time, the catheter, etc.) is if the nurse writes down that she did it. So if s/he forgets to write it down (in other words s/he forgets to "claim" that s/he did the procedure), the insurance company has no way to know that it was done, and therefore no reason to pay for it.

14. D - The only time that you will see which people are on is to make sure the knowledge and skills of the staff fits the specific needs of the patients. None of the others seem relevant. A is a trick, you wouldn't need to know WHICH nurses/aides are on to distribute the work evenly. That should be done no matter who is on.

I don't like question 8, but unlicensed persons cannot assess or teach. Those belong to RNs alone. So documenting the nursing process...no. That belongs to the nurse. Can't give any type of medication at all...so C is out. A routine physical exam requires assessment so D is out. So that leaves B - take vitals every 15 min after a blood transfusion. Well yeah, they can do that, but you had better be in the room checking on them still and assessing for reactions. But NCLEX world, they can do the task. So B.

Im a little hesitant to answer hahaha what if I get them wrong too!?!? Here goes: For #1 I would have put B - draw lines through the space because you never go back and "fix" a chart. Both nurses made mistakes in this situation. The nurse who forgot to document AND the nurse who left blank space. You usually see that question framed from the point of view of the nurse who finds that the one before her didn't finish charting. The right answer is for the new nurse to continue charting right below and not leave any space. The nurse who forgot can come back the next time and finish the charting after where the others have written. You have to remember that the chart is legal document and leaving any space gives room for it to be altered. That being said A is wrong because you are altering the chart, C is wrong because that still leaves space for it to be altered, and D is wrong because you never say a mistake was made in the chart, that happens on an incident report. You say "X drug ordered, Y drug given, patients HR is 75 etc etc..." So in this case saying you fouled up, made a mistake, or forgot and drawing arrows is inappropriate too. B is the only one that gets rid of the empty space, is neat clean and orderly, and doesn't change the legal record.

You can bounce back from anything as long as you don't make it a habit and you apologize.