PS0812

Case Management does not always involve being in a clinical setting. The insurance industry hires case managers. One can either work in claims or in underwriting (evaluating medical records/risk of those applying for insurance; quoting rated ages). How about occupational/industrial nursing? How about working for the state reviewing nursing homes? Oil and gas extraction companies hire nurses (jobs can be scarce). Learn to do Medicare Set Asides and work either for an insurance company or a vendor. Get your certification in Life Care Planning (LCP) - you can either be self-employed or work for a LCP company. There are a multitude of availabilities for nurses outside the clinical setting. Good luck to you!

Heck no, don't feel badly. You're PRN. If you wanted to work full time you would. Nursing administrations love warm bodies. Stick to your guns and offer no excuses!

For every action there is a reaction.....thank you Mr. Newton. Don't burn any bridges. I feel your pain, we've all been there. Try to blend the receptionist and nursing work as the patient load permits. Study for the NCLEX and put your backside in warp drive and get out of there as soon as you can.

I think my most embarrassing moment happened when I was a young nurse in the ER. There was a handsome available resident and I wanted him to ask me out so I thought I'd dazzle him with my knowledge. Had a chest gunshot wound, got a CXR (backed into that order) put the films on the viewfinder (before digital diagnostics) and proceeded to review with him what I saw. I saw a clear right lung, no infiltrates, blah, blah, blah (couldn't keep my mouth shut). He was a gracious gentleman. He lowered his voice so no one could hear and proceeded to tell me that the reason the right lung was clear was because it was not there, it had collapsed when the bullet went through it. To this day I don't dazzle anyone. If I know what I'm talking about I speak my piece. If I don't I stay mute and learn from others. Yes, he's probably telling the same story too!

Used to be able to tell there was a pseudomonas infection (by smell) on a burn patient before the lab confirmed it.

I'd interpret Q2D as every second day, but not being a recognized abbreviation, I'd contact the person that wrote the order to seek clarification. Now you younger nurses are going to think I'm nuts, but 4 years of Latin (which I took in high school) was recommended before entering nursing as prescriptions/orders used Latin abbreviations. I never had a problem with abbreviations, albeit I did with some illegible hand-written orders. If I'm taking the order off a chart and I don't understand the order I call the ordering practitioner for clarification. It lessens my chances of being caught up in litigation.

Giving an IM in the backside.......yes, you aspirate first. Per the Academy of Medical Surgical Nurses' site: "According to the CDC, aspiration is not indicated for IM injections of vaccines and immunizations, nor is it required for subcutaneous injections of immunizations, heparin, and insulin. However, it may be indicated for IM injections of medications such as PCN. The CDC recommends following facility policy in regards to this practice. Perry & Potter (Fundamental of Nursing textbook) describes aspirating when using Z track method of injections; yet for routine injections in the deltoid or vastus lateralis muscles, aspiration is not necessary as the sites do not contain large blood vessels. Most nurses are concerned about the practice of aspiration as they often ask about the appropriate technique and are quite fearful. Because there are no large blood vessels in the recommended sites, aspiration before injection of vaccines (i.e., pulling back on the syringe plunger after needle insertion but before injection) is not necessary. Also, some safety-engineered syringes do not allow for aspiration. Old habits die hard.....I'm an aspirator.

I learned never to use a good pen. I was charting with a gold Cross pen. It was 2 AM and suddenly we had a code (CCU) and had to open a chest. After cleaning up I came back to find my pen MIA. Been using cheap BICs ever since.

Worrying about a job after graduation is normal. The nursing shortage is regional. Expand your sphere and consider jobs outside the acute care hospital. Is relocation possible? Consider long term care or consider public health. How about personal networking - do you know anyone who is already employed somewhere who can put in a good word? Experience in a healthcare-related setting can only improve your story. Would you rather hire the nurse who didn't work in a healthcare-related capacity for the last year because they couldn't get a job in a hospital? Or the nurse who spent the last year learning what it takes to care for patients, one who learned the importance of bedside manner and one who understands patient care? This will give you experience and if your heart is set on acute care, you'll be a better prospect to a potential hospital because you'll have experience.

Love the wandering around comment. I'm a nurse in the USA and that's the only reference I can comment upon. If I had a nickel for every heart/lung sound I listened to, I could have retired early (ICU-CCU-ER nursing). As for males catheterizing females, I say cowboy up! You're a nurse first, then a male. I've catheterized more men than I can remember. If a patient refuses a particular sex then get the one they want. Otherwise be a nurse and do your job.

As a clinical nurse I always thought that I should have my own malpractice insurance. I knew - as I was told - that the hospital covered all their nurses for malpractice. Once I left the clinical setting and started working for an insurance company my opinion changed. I was asked to review a case (at my former hospital) in which it was my opinion the nurse was negligent (short story, she failed to recognize impending signs of increased intracranial pressure). The patient died and the family sued the hospital, the neurosurgeon and the nurse. The hospital under the doctrine of respondeat superior (let the master answer), the neurosurgeon (who had his own insurance) and the nurse who felt she had coverage not only through the hospital but her own malpractice policy were all sued. When you look at a malpractice policy, under the conditions section, there is wording to the effect that "If any other coverage is enforce at the time of the occurrence, this policy is secondary". Both the hospital's policy and the nurse's policy had that statement (as they all do). Well, when the nurse was asked (by the hospital's risk manager) if she had malpractice insurance - which she did, the hospital denied coverage based upon the "If any other coverage is enforce......." clause. So she put the claim under her coverage only to find out she had no coverage for the exact same reason. She had to, at her own expense, hire two attorneys. One to defend her in the malpractice action and one to sue both insurance companies for coverage. After much and costly litigation (at her expense), she eventually won coverage (by court order) under the hospital's insurance policy. The defense attorney for the hospital told me that if I worked for a hospital to never have my own policy as I would find myself in the same boat should I be sued while in the course/scope of my employment. I learned a valuable lesson at someone else's expense. I caution all of you to read and understand all aspects of your personal malpractice policy, should you have one.

Run away from that postpartum unit as fast as you can!! You do not want to work with others who appear to be catty and certainly not with a manager that lets catty nurses sway their opinion. Who wants to work where they're not wanted? I would not push the issue as you have nothing to gain but a potential job where you're not welcomed. Look around for other OB jobs in your area as it sounds like that is where your heart is. Sounds like you've been saved from a nasty unit. All things happen for a reason. Who knows, maybe one day that manager will interview with you for a job?

I worked nights when I was younger and loved it! The schedule at times interfered with some social time but all-in-all it was a wash. I never maintained the same sleep habits and did really well, but I think this is an individual preference. Now that I'm older I no longer work nights and doubt I'd be able to do. I say go for it!!

As long as your bipolar is controlled and you're doing well, you should not have problems. Good luck to you!

Yes, nurses can be brutal to each other. Have you considered taking your skills to something like medical case management for an insurance company? Insurance companies look to nurses to provide guidance on claims involving bodily injury. The job is autonomous and can be highly rewarding. The hours are (usually) Monday - Friday. You could use your skills in this area without all of the cattiness.