ManderRN

I work on a busy neurosurgical unit in the southeast where we have 5-6 patients per nurse. I've been there since the beginning of the year. When I first started, everything was confusing, and everything felt foreign. After 7 months, I feel that I am getting the hang of things. Don't get me wrong- I feel like I learn something new every day, but compared to where I was when I started, the difference is night and day. It will take you a while to get into your own habits, and to understand what to expect with each type of patient you care for. Eventually, you will learn that all surgical patients need to be weaned off of their IV meds, they need to poop, they need to walk. You will learn how to recognize complications like hematomas, CSF leaks, and what warrants calling the doctor for. No one expects you to know everything right away, and on my unit, I have never gotten in trouble for asking. I feel like I may have gotten on a few nerves for the multitude of questions I've had throughout these past few months, but at least I know I tried my best to give safe patient care. My biggest piece of advice is: stay organized. Make your schedule at the beginning of the day, and stay on top of it. Check charts often. Write everything down. Never be afraid to call the doctor for concerns you have, because you've got to start to trust your nursing intuition. The majority of the time, things are fine, but trust your gut. The worst feeling is going home after a shift, and feeling like you didn't do enough for a patient. Eventually, your brain will adapt. It just takes time. You will do great! :)

I am graduating in one week with my RN degree, and I'm already getting discouraged about finding a job. I had an interview last week on a cardiac unit that I felt went really well, and I found out today that I didn't get the position. I have another interview on Monday, but it's on a neuro unit, which is an area that I'm not very familiar with. I am praying and keeping my fingers crossed for Monday's interview. The unit where I am doing my practicum now (pediatrics) has a very low census, and sadly is not hiring anytime soon. So I want to pose the question... how many interviews did it take to get the job you have now? And how long did you have to wait? Thanks for the response!

Sometime next week... I will be finding out in the next few days what my schedule will be. Although it will only be short-lived, and I hope I can make a good enough impression to get an interview! And I agree... I have had a harder time with the adult patients, knowing that their conditions most likely weren't going to improve than I did with the little ones in the NICU! I know it won't always be that way... but overall I loved it the most! I think it takes a certain type of person to be able to deal with adults, just like it takes a certain type of person to be able to do peds. We are all made for something, I suppose! :)

Thank you both for the encouragement! It was exactly what I needed. Peds has always been my heart... and I guess I am just getting the last minute jitters! I just found out the other day that the hospital recruiter has sent my info to a local NICU and Peds hospital. If I am getting any interviews, that is where they will be! I am glad to hear you don't lose any skills in either of these areas. And also, that this is a place you can start out and be successful. Shanlee- I actually spent the majority of my peds rotation in the NICU. I thought it would be a difficult experience due to the possibility of bad outcomes for the babies, but it ended up being my most favorite place in the hospital. I loved being able to love on the babies! Good luck to you, and hope it goes well for you!

Hello all! I have many questions. I am graduating in less than 6 weeks, and I have just found out I am doing my practicum in pediatrics! I am excited and scared all at once. I love children, and have wanted to do pediatrics from day one. We were able to put our "first picks" down for practicum locations, and pediatrics was my first pick up until about two months ago. However, since then, after having some time to think about it, I have wondered if it was the best choice to make. I am wondering how you all feel about working in pediatrics. Do you regret limiting your skills to such a focused area of practice? Or do you feel that you are able to use everything you were taught in nursing school without any difficulty? And how do you feel about having to start IV's/draw blood in children? (Does it ever get easy?) And also, do you think a new grad should start on peds? I am hoping to do well enough to get a job interview through my practicum location. And now I guess I'm wondering if pediatrics is a good place to start, or a good place to work towards after getting more experience elsewhere. I do want to work with children in the long run. I want to be the person there to help them. But I am afraid of being inexperienced/incompetent, and hurting them instead. So should I try for this now, or should I work towards it down the road? Thanks in advance!

I know this is past the deadline, but they seem to go more by test scores (SAT, ACT), than anything. I've known people who have really good grades not be able to get in because they couldn't score high enough on the ACT. It sounds like you've got everything else covered since you're taking the Chemistry. Good luck to you! It's a great program.... but very intense!!!

Thanks!

Hello all- I have just completed my first week of clinicals in mental health nursing, and could use some advice. My pt. has schizo affective disorder of the bipolar type, and is experiencing auditory hallucinations advising him to commit suicide. During his depressive phase, he also experiences suicidal thoughts, although he was in his manic phase during our meetings. I am obviously doing risk for suicide for him, but I am having a little trouble finding the correct "related to" in this situation. To say "risk for suicide related to schizoaffective disorder of the bipolar type" doesn't seem to explain it enough, or give it enough detail. But to say "risk for suicide related to suicidal auditory hallucinations" seems to be putting the "as evidenced by" (which i don't need in a risk-for diagnosis) into the "related to" field. Am I over thinking this? Thanks for your suggestions.

Maybe it's just me, but my class has been on the oncology unit for our last 2 clinical days, and I have ended up with a very sick patient each time. In general, we are required of each patient to ask certain questions (like what kind of support do you have at home, where do you work, what is your education, who are your support persons, etc), and perhaps do therapeutic communication assignment in the event that an appropriate topic arises to discuss with the patient. These "extra" things that we need to accomplish to pass our homework, which are in addition to vitals, physical assessments, meds, etc. seem to put an extra burden on patients who are very ill. I hate to ask a patient any of these seemingly non-essential questions when they are moaning out in pain, and when they c/o pain of "20" on a scale of 1-10! I know that sometimes you might be able to wait for a more opportune time to accomplish these extra "nursing school" tasks, but sometimes an opportune time does not come up. My pts. have had extremely progressive cancer, and I feel like by trying to complete my required school work and ask them questions for my assignment, I am not giving the best care to the patient during their time of hardship, because I am only burdening them with questions I am certain they don't want to answer. For example, my pt. today was in terrible pain as soon as I came in to care for him. I only had the chance to do his vitals before he began yelling at me to leave him alone because he was in pain, and he wanted rest. It just seems unfair to pts. who are in such a state to have to deal with students. Maybe I just had a bad couple of clinical days, but I have to wonder if it's just me, or does anyone else feel this way?

This happened to me a few weeks ago. It was our first and only day in the OR. I didn't eat breakfast as advised, and after about an hour of watching a laparoscopic cholecystectomy (when the burning smell came) I started to lose it. I was fine up until that point. I could feel my legs getting weak and I felt nauseated, so I voluntarily left the room. I had to brace myself on the arm rail in the hallway until a passing nurse saw me, and rushed me into the breakroom and forced orange juice down my throat. By that point I was losing feeling in my arms and hands, and the room was spinning. I never passed out completely, but I know that it was close. Then I had the fun embarassment of all my classmates coming in to make fun of my pale/white self! If there's ever a next time, I'll make sure I eat breakfast first!

I found out today that 13 people didn't make it past our first nursing class out of 50. This is only the first class for us, and I anticipate there will be many more to come in the future classes. The average grade on our final exam today was an 82. I am thanking God that I made it, but I know i have a long road ahead of me, and I will miss the people that didn't make it through to next semester. Good luck to you all!!!

Thanks guys for the insight.... my instructor liked my care plan, so all is well. :) I ended up going with decreased cardiac output and ineffective breathing pattern. Thanks again.

I had a pt. who was admitted over two weeks ago for the following: chest pain, abdominal pain, and an extremely high BP. After he was admitted, it was found he had suffered an M.I. Pt. also has diabetes, which had been previously untreated. While in the hospital, pt. developed pneumonia, a UTI, was found to have gallstones, and got C. Diff. Pt. also had restraints due to falling 2X during stay. While I was caring for him, his BP was 120/80 in the morning, but fell to 93/45 in the afternoon w/out any BP meds. His pulse was consistently around 50 bpm, but in the weeks prior it had ranged from 60-80 bpm. And most importantly, his respirations were at 26/minute in the morning, and by the afternoon had risen to 38/minute. I don't know why he was having a drop in vital signs- I reported each reading to the nurse on duty and to my clinical instructor, and right as we were leaving, the physician came to do an evaluation on him. I never found out the reason for the abnormalities. He complained of no pain, and from what I read in his charts, his pneumonia was resolving. I am trying to think of a good nursing diagnoses to write my care plan on, and with all that was going on with him (and me being a first semester nursing student), I'm drawing a blank. I already have risk for impaired skin integrity and risk for falls (those are a given in his situation), but I'm not sure if I should attempt Ineffective Breathing Pattern because of his respiration rates or Decreased Cardiac Output because of his respiration rate/heart rate/and BP and recent MI. Any help would be appreciated, and if I'm heading in the wrong direction, please let me know! Also, there's not a nursing diagnoses that could be used related to C. Diff., is there? Thanks so much!

We had 3 chances to pass a med math test at 100%, and if you didn't do it by the 3rd try, you were out of the program. I made it (only by the grace of God) on the first try. 2 out of our class didn't make the third time. I *believe* we will have a test each semester like this. The questions were not that hard, but it was just having to get that 100% passing grade. I understand WHY though- they want us to understand that we can't make any errors in real life. But I know it's hard for some people when they may have forgotten to round, or they might have put a trailing zero in, and they're out of the program. I feel a little better today. BMXmom, you're right, if you want it bad enough, you can do it! I do want it bad- and I know if I can make it through this semester, I can make it through the rest! :) Good luck to all of you out there!!!

you're having clinicals (and performing nursing tasks) in your dreams.....

I'm a first semester, first year RN student. We lost some students today in our class. It was a very rough day. They were not able to meet the requirements for medication calculations. It was just a wake up call that this is hard to do! Just barely getting by is not enough! Here we are, over halfway through the semester, and I'm hoping that no one else (namely myself) gets the boot! It just feels overwhelming at times. With our most recent test, I studied for hours and hours, and there were still things on our test that I didn't know. I know I wasn't the only one having trouble, because we got our test results back today, and half the class looked like they were close to tears with their results! Is anybody else feeling this way? I guess the important thing is to keep things in perspective and not let the stress get to you, and just do what you're supposed to do, and double check EVERYTHING, write EVERYTHING down, and listen to EVERYTHING. Also, pray really, really hard!!! How are other people faring, or how did they fare in their first semester? Does it get any easier? Thanks for listening. :)

Thank you for your help! :)

Hello, I am a first year nursing student and I need 3 ideas for care plans from my client from clinicals this past week. My client was diagnosed with pneumonia, and already has COPD. She also has a history of lung cancer. Client has had frequent bouts of pneumonia already this year. However, her vital signs were mostly WNL when I assisted caring for her. Her respirations were at 20, and O2 sats were at 100 with 4 L of 02. She did have high blood pressure, with the first reading at 164/87, and the second at 185/101. She was alert and oriented, eating and drinking well, and walking with assistance. She had little risk for skin breakdown as she was moving frequently, and she had a PRN adapter, but was no longer on the IV. She was coughing frequently, and productively. She was on medication for pain, with a pain level of 7, so I already have: Risk for falls related to presence of acute illness and use of narcotics for pain. Pain related to pneumonia as evidenced by pt. states pain is at a level 7 on a scale of 1-10. What should I do for her third diagnoses? I am thinking ineffective airway clearance, or impaired gas exchange, but at the time that I cared for her, I collected no data to suggest (besides the productive cough) that these two things were still happening. I appreciate any advice anyone has to give! Thanks in advance.