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.

They do teach it as the "fifth vital sign" in school. But I think that the connotation is similar to the "sixth sense". Of course you only have five senses, of course you only have 4 vital signs, but there is this extra one that we are going to call a vital sign because it is really important to assess. They put it right up there with the other 4 because they don't want you to forget how important it is. Whether you agree that the "6th sense" is important is subjective.

As this is a thread that I supported, I guess I should answer the question "what do you want to see done?" Honestly, I would like to see more money thrown at healthcare overall, but also to ongoing nursing education, loan forgiveness, RN to BSN programs, etc. Take the "cash for clunkers" rebates and throw them at public servants. I'd like the state to quit cutting hospital budgets and freezing New Grad programs. I'd like the "powers that be" to realize that even jobs as foolproof as nursing and teaching are effected by this recession. I'd like recruiters and the rest of the world to quit looking at new grads like we must have done something wrong to wind up without a job after getting our nursing license. Yes, I am personally upset by the fact that when I started studying for this there were 15,000 dollar signing bonuses and now I can't get a job to start paying back my student loans that are due next month. I got into this profession because I wanted what I did to matter everyday. There are a lot easier ways to make a nurses salary, but I can't even get a job as a CNA or a unit secretary because I am overqualified. I have a BA, a BSN, honors to high heaven, and an RN license. Everyone knows that the job they offer will just be a holding pattern for me - and they are right! Yeah, I realize that the world didn't guarantee me anything, but who would have thought that the economy would ever have gotten so bad that a nurse wouldn't be able to find a job? Why do I think that Oprah would care? I don't know if she would personally care, like I said I don't really watch. But I do think that just the sheer volume of nurses that exist in the country would give a ready market for the topic. Maybe only nurses would care, but we are many. That might make her care. Additionally, discussions regarding the economy and healthcare concerns are prevalent now. Why not add an additional view point? And maybe, just maybe, the program would show older nurses, nurses in management, people in hiring positions, and those with experience that it would be okay to take us newbies under their wings, bring on a few interns, hire a few nurses a unit secretaries, or somehow keep us new grads doing something, anything that keeps us learning. Volunteering is fine, but teach us while you use us for free. So whatever, write, don't write. I don't care. I didn't think this would spark that many feelings in the negative. Right now I feel impotent, I feel sad, and I feel angry. I need hope. Enough hope to manage yet another call to a recruiter where they tell me there is nothing for New Grads. Enough hope to manage hearing that all of the 25 job postings currently up are only for people with 2-3+ years experience. Enough hope to keep plugging away even when I realize that I can't even get my old retail job back because they too are downsizing. All people start off their careers shiny and new, and I have always heard that nurses eat their young, but I am an optimist, an activist, and a supporter. I believe that nursing is a great profession. I feel lucky to be a nurse, I don't want to be jaded. But is a new grad without a job even a nurse? According to the rest of the world, apparently not.

I second the Saunders suggestion, used it all through nursing school. In fact, my teachers often pulled questions directly out of that book. Fundamentals was one of the hardest classes for most of my friends because it wasn't directly related to any pathophysiology. It is all the nursing version of "common sense." You have to learn to think like an NCLEX nurse. (NCLEX world is ivory tower nursing, not the real thing). The absolute best suggestion I can make is to practice questions over and over and over again for that course. Do the questions in your book, do the Saunders questions, do the questions in the online portion from your book. I just took the NCLEX and I have to say that the format of the questions was most like the format of the Kaplan study questions. So I would suggest their book as well (though content wise, Kaplan was too general). For nursing school though, I thought that Saunders was the best. The main thing to focus on in fundamentals is the nursing assessment and then the implementation. So for example. How do you know someone is having oxygenation problems (and along with that why are they having them?) They are short of breath, they have a tripod stance, pulse oximetry, lung sounds, etc. And then what are you going to do about it? elevate the head of the bed, Chest PT, oxygen, etc. In this class you are learning the basic problems that nurses deal with, how to look for them, and what to do about them when you see them. If you can keep that in mind when you are studying, you can study any fundamentals topic. Cultural issues, Heart problems, renal problems etc. The only way my friends and I got through school was to study together. Take awesome notes and then make study guides before your exam from your power points, notes and reading. When you get your test map from your teacher about what will be on the exam, handwrite or retype all of those notes into a study guide based on the test map. Anything you think that you don't understand well enough, go to your book to flesh it out. You can break up the portions of the study guide between you and your friends, but make sure that everyone in your group gets a copy. Make as many friends in your classes as you can so that you can trade study guides amongst the various groups. Then take your practice questions. Anything and everything that you can find on the subjects that you are going to be tested on - Saunders, Your book, Kaplan, whatever. Then, the day before the exam get a study group together of around 3-6 people. Use an empty classroom or someplace that has a chalkboard/whiteboard. Throw a topic up on the board and have the group list everything they can about the topic. Also make up questions to ask eachother. IE: "Billy bob in room 304 has rales when you listen to his lung sounds, what might be the problem and what can you do for him?" Make the questions simple but try to format them like questions that might be on your exam. Lastly, in notes, on study guides, and in the review make it funny, make it dirty, whatever. Find ways to remember things : acronyms, limericks, songs, whatever. Relate everything to potty humor if you have to. Anything that you might remember on the test. Good Luck!

I reposted this idea in the general nursing forum - giving full credit to you with a link to your original post and a copy of your original post. I really think you have a good idea here. Kudos. Here is the post there: https://allnurses.com/general-nursing-discussion/letter-campaign-oprah-424680.html#post3867274 Darci

So I was reading posts and I think that this a great idea. So, if you agree you should write as well. I don't normally watch Oprah, but I must admit with her ties to Obama she is one powerful lady. All of our nursing literature is addressing this problem, but lets get some press on a national level. You don't have to be a New Grad to tell her why you think so many of us can't find jobs this year. What's your take? Too many nursing schools? Johnson and Johnson ad's "Be a Nurse" bringing too many people into the field? The economy making too many experienced nurses return to work after their spouses were laid off? Stock market caused retirement to tank and no one retired? When do you think it will recover? If you are a New Grad you can just simply tell her your struggles to find a job. Mention allnurses in your post to her so that they know where all of this is coming from. Here is the link to the "Write to Oprah" page: https://www.oprah.com/ord/plugform.jsp?plugId=216 Here is the link to the thread that began this: https://allnurses.com/graduate-nurse-forum/i-finally-did-416430.html And the original Post: I Finally Did It! I Wrote to Oprah! by EmilyLucille523 I did it. I finally wrote to Oprah on her website for show ideas. I think it will take someone like her to shed light on this so-called nursing shortage issue. If as a nurse you were laid off from work or you are a New Grad having a hard time finding work, I recommend that you do the same so that they see that this is a national problem. I also mentioned the whole foreign nursing issue too. Speak your mind! Here's the link: https://www.oprah.com/ord/plugform.jsp?plugId=216 (Use your Microsoft Word to help you keep it under 2000 characters. Thanks for all your support!) If all nurses in the country united we would be a force to be reckoned with.

I just wrote a letter to her too.

Your school probably has access to the nursing journals online. That is the best place to start. Talk to your librarian about how to find peer reviewed nursing journals. Those are generally the only ones that are acceptable for "credible references." Talk to your teacher as well. Even if you use the below suggestions for this project, do this soon, because if you are in a BSN program it is better to learn how to find these articles and get practice sooner rather than later because you are going to be doing a good deal of writing up nursing research. As to the interview idea - that is considered 'qualitative research' which is good if there is not much information on the topic already, but is a lower standard of evidence. (See http://ebp.lib.uic.edu/nursing/?q=node/12 for the standards of evidence) You need to find Randomized Controlled Trials (RCTs) or Systematic Reviews/Meta-Analysis for the information to truly be credible. Use those as search terms when you search. For the shortcut method if this is due tomorrow: Google Scholar - type this in to the google search window and it will bring you to the page or there is usually a hyperlink at the top of google. Go to advanced search and type in your search "Working Parents" or whatever. You can add other things like "Child Development or Breast feeding", whatever aspect you are interested in. The only problem with this is that sometimes you will find that the articles you need are for purchase only - another reason to go to your library. They have free access. But when you find a result that looks good you click it and then look for a link on the page that says "Full PDF". Sometimes only the abstracts (brief summaries) are free. PubMed = generally you can find quality free research here too. Go to the advanced search hyperlink near the search bar and you can select all sorts of options. I would suggest selecting "Links to full Free Text", "English", "Meta-Analysis, Randomized Control Trial, Practice Guideline (another high level of evidence)", and maybe even "review". Good luck with your project.

I'm looking to boost my resume and I was wondering if anyone knew of programs in the Greater Sacramento area that offered certifications/courses for nurses. EKG, Basic Cardiac Monitoring, ACLS, anything else you can suggest that an unemployed new grad could take. I want something that I can put on my resume, but all I seem to be able to find are CE classes. Which I don't think you can put on a resume, right? I did find one place the Continuing Education Consortium http://www.continuingeducationconsortium.org/ otherwise known as the Mercy Learning Center, but I wanted to compare it to anything else that might be out there. If you have any other resume boosting ideas, please fill me in. (I am already setting up a volunteer position). Thanks

Just make sure that they have a preceptorship. If they don't have that give your money to someone else.

It does take awhile to get on the list, the last I heard was somewhere around 2 - 6 weeks. But I was applying for correctional facilities. You stay on the list for a year though, and you don't NEED to have your license to take the exam/self-assessment. So, you could do that now before you graduate, but you won't be able to get a job until you have your active RN. I have to tell you though, the new grad market here is a beast. There is nothing - especially if you are not local. Most places want a preceptorship on the floor you are applying to. Hospitals are getting 400 new grads applying for 8 slots because no one can find a job. With the state, you get a score after your exam/self assessment - usually 75, 85, or 95%. The state can only INTERVIEW the top 3 people on the list with the highest scores. As a new grad with a BSN I was at 85. I believe with an AA if might be 75. So again, tough market there too. If there is anyway that you can stay in Florida for 6 months and work there for your "New Grad" period I would suggest that. Either that or have a new grad job lined up before you move. Start looking now for hospitals that have programs so that you can get your ducks in a row (letters of ref., transcripts, etc.) and then apply for May-August start programs probably Feb/March.