buransic

I'm a career changer, new nurse, starting month 5 of med-surg nursing. Working through lunch on a 12+ hour shift, catching up charting at the end of the shift, turning more than a few things over to the next shift with a bit of embarrassment, and waking up in the middle of the night thinking about work, are all things familiar to me as well. Here are a couple of items I hope will add, or reinforce, the insight related to this thread: 1) I feel this is the most important thing for new nurses; look around. Are the nurses with more than a year of experience consistently dealing with the same issues as you are now? I look at the crew on my floor, I see the experienced nurses managing 6 patients with effort, but also with grace and sure handedness. They also go home on time. I feel a new nurse can get there if they keep their head in the game, remind themselves why they're there (I want to do meaningful work), and keep studying and learning from others. The odds are with you, those nurses all had a first year as well; they made it through. 2) Having a good working environment. I don't have to deal with the "nurses eat their young" mentality. I have an excellent director and management team that has assembled good teams of nurses. If this is not the case for you, then try to figure out where it exists either in your hospital (as near as I can tell, every manager/floor is different culture-wise) or in another one. 3) On a personal level, as told to me by a senior nurse, an emotional support network or an effective (meaning restorative and constructive) coping strategy is vital for a new nurse. Figure out what's worked in the past when you've had personal challenges, or try some new things such as counseling if the old strategies don't work out. Thanks to the post-ers for insight. Good luck to all.

Although I'm new to nursing, I'm not new to business. TJC has an important role to play in the standardization of care. However, the point that they're nibbling around the edges on important issues such as nurse-to-patient ratios, and since nursing is the key to patient safety, thus the TJC is less than adequately addressing patient safety warrants further investigation. I'll guess that the reason TJC won't take on N:P ratio is because it's a deal breaker for hospital compliance. Lately, all the hospital company annual reports show adverse impact of payroll costs (read nursing) on profitability. For TJC to take this on is just too big a deal and they wouldn't have resource for anything else. Whether that's reasonable or not; well, it's hard to tell. If the probability of success for mandating N:P ratios is low, then the outcome is the same whether they take it on or not.

Clearly the job market is tough. But remember, right now, you can only take one job at a time, so there only has to be one available - yours. Competent, hard working, polite, punctual, cheerful, cooperative people are always viewed as assets. Managers and directors find ways to hire them even in a tough economy (this is true for almost all disciplines). My impression of job hunting kind of matches the post-bubble economy - don't overlook the fundamentals. 1) Treat it like a full-time job (minimum 40hr/wk) and use your network (instructors, clinical instructors, nurse managers on the floor where you had clinicals, anyone that works in a hospital, classmates and so on and so on). 2) Keep your resume sharp, rework it, get help even if you don't think you need it. 3) Use a cover letter; these days it seems to set you apart a bit. 4) Hit the pavement (job fairs, look for nurse managers and give them your resume); it's far too easy to overlook a new grad putting in an on-line application. 5) Get reference letters from you instructors (tip: learn how to write a reference letter, ask them if they want you to write it, send via email, then offer to pick them up after they edit and sign them). Carry these letters to your interviews (a slightly non-traditional twist, but it may set you apart).

I can see where the simplicity of the following statements might lead to the perception I'm being glib. This is not the case. In no particular order, except the last is the most important. Disclaimer, this is based on my previous experience as a student nurse in the U.S. 1) Prepare as best you can. That is, read ahead in your skills book; take your lab work seriously. If you can, spend time learning about the medical interventions associated with your floor. 2) Maintain perspective. A lot of other folks with various combinations of intellect and ability - some similar to yours - have successfully negotiated this path ahead of you. 3) Have faith in your training. There's a reason the curriculum is well established - it works. 4) Cooperate and graduate; work with your classmates in a collaborative manner - watch out for each other. 5) Above all, look, listen and learn. You'll be able to catch on a lot just by paying attention to what is going on around you. Good luck!

Sorry for not exactly answering your question. But here's another way of looking at care plan resources. I found care plan books were pretty much the same from one to another. I used the highly portable and easily reviewed Nurses' Pocket Guide (Doenges, et. al.), then used the Merck Manual on-line (free and very informative) to substantiate interventions. This ensured they mapped well to the medical and pharmacotherapeutic interventions. It will require extra time to make a nursing care plan, but you'll learn more. Also, as has been advised by others, try to make sure you do your care plan in some electronic form (e.g. Word). You'll be surprised at how many times you'll use and reuse parts or all of a previous care plan.

Our school selects 42 applicants twice a year. My class started 41 & 1; female to male. The class behind me is 36 & 6.

I think Batman24 hit the nail on the head. Batman24's description is part of the process commonly used in Crucial Conversations. You can open the dialogue with a contrasting statement, something like, "This is not a personal attack on you and I'm not trying to make you uncomfortable. Your body odor is noticeable and I'm concerned that if I notice it that others do and that it may have an adverse effect on your work with others." As long as the conversation can be sustained, you have a chance at educating the student, and correcting a problem. Good luck!

This is a nice job of enumerating and illuminating the characteristics of a good nursing instructor. Having had many teachers, managers, and leaders over many years, I'm inclined to think these attributes are those often found in leaders. Perhaps leadership, the ability to motivate people to achieve more than they would without leadership, is the hallmark of good nursing instruction. One implication is that an instructor must consider the group's opinions and desires as part of the continuous improvement cycle. However, the instructor, as leader, must also ensure the bar is set high enough to ensure the standards of performance are attained, then exceeded.

I'm of the nutrition-variety-taste-convenience school of thought. I've finally reached the sandwich burnout threshold. What I've found works best for me is to pick one day every other week to prepare lunches. I'll bake a pan of seasoned chicken breast or pork chops in a foil covered pan (keeps 'em moist). Then I'll cook up two or three different kinds of veggies in the microwave or on the pan. Let everything cool for 1/2 hour and put in those quasi-disposable freezer containers and put in the freezer until ready for use by reheating in microwave. It's really easy to make 6-10 lunches this way. After a couple of months you have variety in selection at low cost.

Re: Top 10 Most Expensive Cities in the World. I'm thinking it might be more coincidence. Switzerland has a federal program for basic coverage and people have to buy supplemental insurance for coverage for chronic or catastrophic conditions. In 2006 they spent 11.5% of GDP on health care. The US was number one at 15.3%. Japan? Twenty-first at 8.1%. Canada was 8th at 10.0%. Hmmm...the country with the highest, by 35% over the 2nd highest, spend as a percentage of GDP is us (US). That's also an interesting coincidence. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5813a5.htm

With the current role and identity issues associated with patient recognition of advanced practice nurses, I'm inclined to think llg's points are well founded. Also, given that primary care providers (and all those lobbying to be providers) are beginning to use similar processes, I'm also inclined to think fewer specialties may be in order. The specialties for advanced care and anesthesiology should probably be the only two going forward. The care provided by CNMs would roll up under advanced care in a similar fashion where an obstetrician is a physician and still referred to as doctor. Simplifying the provider landscape would benefit the patient and practitioner alike.

Single payer is not going to happen anytime soon. Looking at UHC from a mandated coverage standpoint, it'll put more money into the system. The folks that can afford insurance, but won't buy it, will put in some money. Of course, the bulk of the money will be the federal gov't, er, taxpayer dollars for the public fund option. This won't hurt the insurance companies one darn bit. In fact, it'll work like the Florida's Citizen's Property Insurance system where private insurers cherry-pick the low risk properties (in our case patients) and dump the high-cost/high-risk patients into the public pool. So, this is actually a good thing for insurers, they're just horse trading right now. The public plan will wind up paying for a lot of services, but, there will ultimately be some rationing in the form of approved vs. unapproved procedures, tests, and a so on. So, if you want to be on the public plan, but want premium care, you'll probably have to get supplemental insurance or pay out of pocket. The result will be lower demand for services. Oh, and the medicare covered patients that everyone thinks are uninsured, it'll be business as usual. The overall result for nurses and doctors will look a lot like the current situation where a lot of elective stuff is postponed or cancelled because of the higher financial commitment that will fall to the patient. Thus, a shrinkage of demand might ease the staffing crisis, but it will also drive down salaries. Lastly, the Mass. example shows us that when uninsured people get insurance, that demand for routine services goes up. Perhaps a time will come where some of the work expended on acute care goes toward prevention. That would be a sea change.

Don't be discouraged, it'll only set you back. Give it your best shot, if you have to wait, well, that's just one setback. Also, be sure to look around at employers. Some employers have enrollment preference (e.g. you work as a pt care tech, and when you're finished w/ pre-reqs, you enroll under an employer preference). Also, look at private for-profit schools. Yes, it's incredibly expensive, but if you're young (say under 55) you can probably make it pay off. Hang in there.

Doing a quick cost-of-living adjustment from L.A. to Florida takes $80K to $47K; call it $26/hr straight time. In FLA, the good (not necessarily the best, just the good) bartenders can make what a starting RN makes, just not as reliably. In information technologies, IT pros, many of whom are only high school grads with a few years of experience can make $55K easily. It can quickly go over $85K (that's over $150K in Cali-dollars) if they're any good and willing to travel during the week. It gets higher quickly with experience and certification. This doesn't even account for the sales people and sales engineers that can make a whole lot more right off the bat. Again, many IT people have only professional certifications after high school; many have come out of the military. A lot of folks think nursing pays exceptionally well. It's okay, but not exceptional. I'm thinking the folks getting into nursing for the "great pay" are going to be disappointed. There's more money to be made more easily. So if you're just in it for the money, think about what you really value - the money or the work. It reminds me of engineering in the 80's and 90's. A lot of students enrolled in engineering school and then changed their major to business when they figured out engineering "wasn't their thing" or that starting salary wasn't their highest priority after all.

I'm in my mid-40's, changing from a technology based career, and one year away from completing my BSN. Here are my observations to this point: 1. Is it too late for me to have a meaningful career in nursing? I'm not qualified to comment on on the nursing aspect, but I can tell you it's never too late to make your work meaningful as long as you know what meaningful work is. Guy Kawasaki, one of the original Mac development team members, has a take on meaningful work: 1) Improves quality of life, or 2) Rights a historical wrong, or 3) Keeps a good thing from going away. I can tell you that even as a student nurse, my work is meaningful because I've been able to cover 2 of the 3 in the list. I expect my future work will continue to do so. 2. Is age discrimination widespread? I don't know about discrimination, but there's a lot of criticism of the younger generation out there. Mostly undeserved and much based on less than adequate communication. The whole thing about being quick on the uptake at a younger age? Anecdotally, I can tell you when it comes to memorizing huge amounts of material (think pharmacotherapeutics) the youngsters have a decided advantage. When it comes to integrating knowledge in a meaningful way - let's say the more frames of reference you have, the more likely you are to be able to do this. The important thing to know is, "How you learn things". Once you have a handle on this, then you can make the necessary adjustments. 3. Is employment for new, older graduate more difficult? Dunno, I'll let you know in about a year. But I can tell you that your clinicals are a great place to apply your experience in trying to understand all aspects of nursing including managerial, process approach to management, and interpersonal communication. Your previous experience, and in some instances deference to your age, will allow you to educate your peers, instructors, and nurse preceptors as well as learn from them. The result will be to grow your network so when time comes to go to work, you'll have info to work with. Treat clinicals as an opportunity to learn the craft and consider it a try-out and I'll bet it will help in your job search. 4. Is there a site with information as to best employers for older/new nurses? I'm interested in this myself; thanks for asking. 5. Is it worthwhile/cost effective to pursue studying from:ADN,BSC to Masters or PHD, level in nursing at my age- newly 50? I harken back to what a friend told me when I complained that I'd be over 30 before I attained my first degree. He said, "You can be over 30 with or without your degree. Take your pick." I intend to go on. I would recommend getting into a BSN program to start if at all possible. You'll find it'll take about the same amount of time if you already have a bachelors degree in something else. That said, do not apply to only one program. It's very competitive to get a seat in a school. Keep all of your options open ADN, BSN, public, private and so on. 6. Is there statistic out there, about successes in nursing as a second career at age 50 plus? Neat question; I'll be watching for the responses. I can also tell you, every day I go to class or clinicals, I feel like I'm doing what I'm supposed to be doing. Good luck to you and I hope you attain your goals.