ScrubCap

I wonder if KU has changed their program since you attended? When I searched under their Organizational Leadership degree, it only gave information for a joint degree in Health Services Administration.I am curious Mrs_White25, since you decided to leave KU, have you attended another graduate school? What concentration do you think is the best to pursue middle management? Honestly, I am disappointed by the graduate program options in Kansas. They either don't offer the concentration that interests me, or they are not 100% online and require in-class time. I have been looking at other programs out of state now. Thanks for the input!

We give out a Halo sleep sack with our hospital logo on it, a board book ("baby's 1st book), a travel coffee mug for dad, a lullaby CD, and the mom's get the large insulated hospital water mug (they use this as a patient while they are there). Everything has the hospital logo on it. As the patients are transferred to M/B, their postpartum room is set up with the "gift pack" - sort of displayed on the counter as they enter the room. They also get to take home whatever supplies are in the room (i.e. diapers, wipes, pads, tucks, etc) and the thermometer for the baby.

I appreciate your opinion as I know that you have a lot of experience and are very passionate about this field. I have read a lot of your responses to others and have found them very informative and honest. I do understand your reservations about someone with no LTC experience being in a supervisory role - it doesn't make sense because I don't have a full understanding of the MDS/RAI processes among other things. interestingly enough, my interview went well - they liked my patient care experience from the hospital and said "you can pick up on the other stuff easily enough." Honestly, this is frightening to me. Thank you CapeCodMermaid for your input.

Did you approach your manager and tell her your concerns? What is your staffing ratio? New grads typically get an 8-12 week orientation and it tends to be very structured (i.e. 3-4 couplets WITH your preceptor, ensuring that you have both lady partsl and c/s postpartum patients)...what does your preceptor say to all of this? You mentioned that you were leaving your facility - what part of the country are you in? Please keep us posted....I wish I could give you a proper orientation!

Given your 3 years of med/surg experience, I think you will be fine on just a M/B floor, especially with only 3-4 couplets. The patients are healthy, self-care types - and as far as meds, you'll be passing Colace, PNV, Iron, and pain pills - way less than what you are used to on med/surg. Your biggest obstacle will probably be learning the care of the newborn and all that goes with it (STABLE, NRP certifications, drawing labs and PKUs, circumcisions, etc.). Make sure to ask your director for more time on orientation if you feel you need it - I think you'll do great given your background. Good luck!

Are you currently in the KC area? You might speak to your nurse manager about a RN position for you once you graduate next year. My husband is also a RN and tried for two years to get into Children's Mercy - they have very little turnover and tend to hire their own techs into their RN positions (from what I've been told from people we know that work there). I work for a hospital that has a level II NICU and we do not have any positions open nor do we hire new grads. It's a tough market out there, but I have noticed some hospitals have posted positions specifically for new grads although they are mostly med/surg type of jobs. Best wishes with your last year of nursing school and good luck with the job search.

As an expansion to my OP, I want to share that this particular SNF/ALF has 223 beds, poor ratings, and is also currently recruiting a new DON (offering a sign-on bonus for DON position). They have numerous complaints and have had issues with skin care, breakdown, care plans, medication administration, etc. I would love to be able to make a difference in this facility and ensure that the residents are given the treatment they deserve.

An opportunity has risen for an ADON position at a local LTC facility and I am wondering whether or not I should take a chance and go for it?I have been a RN for 10 years and have various experience in surgery, med/surg, telemetry and women's health. I am currently in the process of obtaining my MSN (management concentration). I occasionally act as a relief charge nurse, but other than that, have no actual management experience. I am extremely detail oriented and tend to gravitate toward projects that others would consider "busy work." While I have no LTC experience, I am a quick learner. My interest in this position is to break into management, although my co-workers think I am crazy for wanting to leave the hospital setting. I am not unhappy in my current job as a staff nurse, I just am getting tired of waiting for a managerial position to open up - they have little turnover at my hospital.Any advice from ADONs/DONs is greatly appreciated!

I have been an RN for 10 years (I have my BSN), and am interested in pursuing my MSN. My main interest is in Leadership/Administration and was wondering if anyone could share their opinions and experiences on graduate programs in Kansas. I have been researching KU, Wichita State University, and Fort Hays State University. Another goal I have is to obtain my MBA, which I realize I will have to obtain separately as none of these school offer a joint degree online. Any information that you can share will be appreciated. Thanks!

i think that myhartsings4u had some wonderful suggestions. in addition to the items you mentioned, i also keep a kelly clamp and dry-erase markers (for updating patient white boards if they have them) for nursing needs. also - i keep a small makeup bag that has deodorant, chapstick, toothpaste and toothbrush, floss and nail clippers. i also keep some fiber one bars in my bag in case i don't get to lunch in a timely manner (never know how your shift will be) and also some crystal light lemonade packets to add to my water mug when i need a little boost. it's also a wonderful idea to keep a spare change of clothes (scrubs, bra, underwear and socks) in your car - just in case! good luck with your new job and welcome to nursing!

As other posters have mentioned, your first step should be to have your resume and cover letter reviewed - probably by your professor.Do you have any teaching hospitals in your area? They are usually more apt to hire new graduates and have specific programs to ease a new grad into orientation. With May fast approaching, you will soon be facing a whole new challenge as you will be back in the competition with all these new nurses. The advantage that you have over them is that you have already passed your boards and can start work immediately - in most states, one cannot work as a graduate nurse anymore and needs their RN license to work - so this is good for you.I applaud your decision to obtain your BSN as this can only strengthen your resume and application. Be sure to select a school soon and apply (even if you start school in September, it will still look better on your resume to have it on your resume that you are attending). And most school deadlines are in May too - so don't procrastinate!While you are waiting to hear from prospective employers and for your BSN program to start, there are a few things you could do to further strengthen your canidacy such as certain certifications that most Family Birthing Centers require such as ACLS, NRP, and STABLE. It is true that the employer will pay for these requirements after you are hired, but it wouldn't hurt to get them out of the way and it makes you more marketable.In the meantime, I would encourage you to apply for every position out there for new graduates: med/surg, postpartum, women's surgery, etc. Are there any positions available in a doctor's office? Look for openings in an OBGYN's office. I really encourage new nurses to try to start out on med/surg if at all possible. It is hard work, but you will learn invaluable skills such as prioritization and time management, not to mention the nursing knowledge you will gain. Spend a year or two on med/surg then pursue openings in OB or Women's Services. Whatever you do, DON'T GIVE UP! The job market is tough, but you will eventually find something. Good luck!

I completed my BSN through an online program and found that it was a nice fit for me as well as my family. My original nursing degree is from a hospital-based diploma program, so I had plenty of clinical experience, and also, I didn't start my BSN until I had already been a nurse for 6 years. With many online programs, however, you don't need to have much experience, just being an RN is the only requirement, although it certainly does help to bring more depth to the classroom discussions. My online program was accelerated, and I took 2 classes every 8 weeks. A traditional classroom course is over a 16-week semester, so this gives you an idea of the time frame. Online classes are typically a lot more work than what you would do if you were going to campus and you definitely have to be self-motivated and organized. The online class is divided into weekly schedules and there are reading assignments and required postings that you will have to do - by that I mean that the instructor will assign anywhere from 1-3 questions every week that require a paragraph response. Some questions deal with reading assignments, others deal with practical experience, or some deal with current events. Also, you are required to make so many responses to your classmates and you are graded on the "depth" of your responses - they are not looking for yes and no responses, or simple "i agree" responses - they want to see that you are contributing and learning something from the discussions. Also, you might have weekly quizzes and tests, or you might be required to write papers. In several of my classes, we did group projects. I was a little unsure how this would work since we were spread all over the country, but it actually was a nice learning experience - we communicated through email and/or phone, elected a group coordinator, divided the assignment, and communicated pretty much on a daily basis. These group projects usually involved some sort of power point presentation that we submitted for the entire class to review. Another component of online classes that you may run across are the journal assignments. Some instructors require you to complete a weekly reflection or they ask you to journal about a specific topic. To take attendence, most classes have an "attendance tab" in which you have to log in on the last day of the week (usually the classes run from Sunday-Saturday) and you have to log in and post what you have learned throughout the week. Most online programs also allow the instructor to see how many times you have logged in, and they will give you specific deadlines for each assignment and posting (i.e. post initial response by 11:00 pm EST Tuesday, etc.). I found that the instructors were always very clear of their course expectations. They provide you with an online syllabus and assignment schedules, and they are readily available to answer questions. When I took my BSN classes, my children were 1 and 3, and I was pregnant with my third. I worked 7 am to 3:30 pm at the time (in surgery) and wouldn't start school work until after they were in bed. My husband was also very supportive and helped a lot with the kids, especially on the weekends, so I could get a bulk of my work done. Online school is very manageable, but you have to be very organized and motivated - it is not for everyone. My husband is also an RN and tried the same online program, but it wasn't a good fit for him; he learns better in the classroom setting. Good luck with your decision to return to school and to complete your BSN!

Are the two cases that start off the day for different surgeons? If not, then when you are closing on your first case, the second OR team could be bringing patient #2 into the other OR so that when the surgeon closes and talks to the family of patient #1, he's ready to go right to work on the next case (given that he had seen them in preop prior - or he could see them in the OR just prior to induction). I am assuming that you have at least two anesthetists present during the day to complete cases? The only other thing I would suggest is to pull all your cases for the next day before you leave - one less thing you have to worry about in the morning. What's the third RN and tech doing? I would think that you could hire a dedicated RN for PACU - this RN could help the outpatient/holding RN with admissions and preparing them for surgery until she gets her first patient in PACU. Other than those minor suggestions, it sounds like you have a good system.

What process do you have in place for picking the cases for the next day? I have worked at a large teaching university/trauma center and also at a small private hospital - like you say, they are completely different environments. At the larger institution, we had OR Techs who had the job of picking the supplies for the next day's cases and they would assist the "turnover team" in getting the room cleaned. The RN would help the scrub tech open the case and together they would make sure that everything was accounted for. This worked out well because when the RN was taking her patient to PACU, on the way back to the OR she would swing by holding and meet the next patient, check the consent and H&P and appropriate labwork and be done - it was the CRNA or Anesthesiolgist who was responsible for bringing the patient to the OR. At the smaller private hospital, we only had 5 ORs, 1 cysto, and 2 endoscopy rooms. At the end of each day when the cases were completed, the staff (both RNs and scrub techs) would pull the cases for the next day - suture and gloves included. We always pulled by the preference cards, which were always up to date. So, the next day as we do our cases, we only have a 10-20 minute turnover because the RN comes back from PACU to help the scrub tech and sterile processing tech with the turnover. CRNAs are responsible for their own circuits and meds. RN helps tech open case and then helps CRNA bring patient to OR. It seems like it is more than one process that is broken in your institution. I would look at it from the path that the patient travels and try to identify all the avenues that could be improved. For instance, do you have a pre-op clinic in place? Establishing a clinic with anesthesia to get their pre-op labs and diagnostic testing completed before arrival is a tremendous time saver. Are there delays in pre-op or in admitting/assessing the patient. How about with equipment that you need for cases - is there one for each OR or is it at least centrally located? Keep us posted on improvements as they happen and best of luck!!!

Our L&D suites are huge and have armoires with flat screen televisions and dvd players - dads love this - until they are transferred to the mother/baby side of the unit and we don't have the bells and whistles. We are in the process of purchasing couches that flip into a twin bed - they are very comfortable but very expensive, but the dads that are lucky enough to get the rooms with the couches have really positive feedback, not to mention that they appreciate a comfortable bed instead of a flimsy cot or "dad chair." We also give welcome packets to the new parents - it includes a stainless steel travel coffee mug for dad (with the hospital logo), a lullabye cd, and a Halo sleep sack. At my previous place of employment, they offered new moms and dads a "celebration dinner." They were able to choose from a variety of entrees, sides, and desserts, and it was delivered on a special table-cloth covered cart with a bouquet of flowers. Yes it was still hospital food, but it happened to be very good, and it made the parents feel special. They also mailed cards to the new family after they were discharged - they were signed by the staff and had sweet little messages in them and also the saying "thank you for choosing _____ hospital."

What a busy year you have had! I have worked in med/surg and surgery for a long time, then last winter took a night shift position on a mother/baby and gyn unit. This is the first time I have ever worked night shift and I absolutely love it! I was afraid I was going to be bored, but there are nights when I wonder why the patients don't sleep. Granted, it has NEVER been as busy as I ever was on med/surg - it does feel like a vacation. We never have more than 4 patients (combination of couplets/gyns), and all of our gyns go home the next day after surgery. The patients are almost always 100% self care and we mainly administer colace, prenatal vitamins, iron, pain medications, and tDap vaccines. I find my job relaxing and rewarding. I get to do a lot of teaching, assist with breastfeeding, and best of all, hold new babies - who wouldn't love to do that? I would totally recommend a mother/baby unit - totally different atmosphere than anywhere else in the hospital. Very quiet and rewarding. Night shift has also given me ample time to work on my master's. We recently had three float/agency nurses join our unit full time because they wanted stability, a guaranteed schedule, full paychecks, and benefits. Best of luck to you if you decide to pursue this area of nursing. And good luck as you complete your BSN!

Thanks for giving us an update on the patient and you are more than welcome for the advice. It always seems like you get these types of patients when you already have a full load, are short-staffed, etc. As your experience grows, so will your intuition and you will become more attuned to when something isn't right with a patient. Early reporting to a doctor is always important, and even more so: DOCUMENTATION that you reported it to the doctor. I have had doctors blow me off for reporting various changes with patients that they told me were not a concern - it's almost an arrogance and they treat me like I'm stupid, and then later down the road the patients did develop complications but there was my documentation that hours before, I had reported it and the doctor did nothing at that time. Again, good luck in your future practice!

I have been a nurse for over eight years - my first position as a new grad was on a 50 bed GI med/surg unit, very high acuity. My advice for new nurses is to always give your surgical the highest priority - meaning that I watch over them like a hawk. Make sure that you know your facility's policy on routine post-op care. In most places, once you recieve a patient from PACU, you do initial vital signs and a head-to-toe assessment, then vital signs every hour X 4 then every 4 hours. I also do an assessment every four hours and monitor the dressing site, drains, edema, etc. As for monitoring the I&O, I do that every 2 hours - because, like you stated, normal output is supposed to be 30 mL per hour. So if after 2 hours you noticed that you didn't have adequate output, you should first check your foley catheter (sometimes moving it around, "milking" it makes a difference); sometimes you have to deflate the balloon (without removing the catheter), push it in a little further, then reinflate the balloon with the correct amount. If the urine didn't start to come out after that, I would next do what your supervisor suggested (irrigate - although sometimes you need an order to do that) and bladder scanning. After all the interventions, I would call the surgeon to report the output and color. And when you call the doctor, make sure that you have the total output from the previous shift too - get all your ducks in a row and anticipate any questions he might ask. I am surprised that during the surgery they did not put in a three way catheter, especially since they had inserted and removed ureteral catheters (which will always make the urine bloody and might result in the need for continuous irrigation). But at any rate, just keep in mind how important urine output is - and measure it every 2 hours. Even if the orders state "q shift" it's just good practice to monitor it closely every 2 (I was taught in a very "old school" diploma hospital-based program), especially since it sounds like your patient had very extensive surgery. Also, don't rely on your aid/tech to report inadequate urine output to you - they may not recognize the change, or simply may not be paying attention, and quite frankly, it is the RN's responsibility to be monitoring this anyway. Like Robinroo62 stated, I think that this event will stick with you for a long time and that you will learn a lot from the experience. By the way, did you have a chance to visit this patient? How is she doing? Don't let this discourage you from your nursing practice, use it as a learning tool and know that it will make you a stronger nurse. Good luck!

It's completely normal that you are feeling this way, and eventually you will find your niche. When I first graduated (8 years ago), I took a position on a 50-bed GI Med/Surg floor that NO new grads ever went to. The nurses were notoriously hateful and it was fast-paced and stressful. Everyone thought that I was crazy. And yes, there were times when it was overwhelming and I went home crying and I was stressed, but it was the foundation for my career and what I learned there has been invaluable. In today's economy, new grad positions are hard to come by. My husband is graduating next month from nursing school too and is feeling the pressure of trying to find a position as well. Don't worry though about not knowing exactly what you want to do in nursing - that's the beauty of our profession - it's so dynamic and if you don't like an area, you can move on to the next. I worked in Med/Surg for many years, and then one day an opportunity is surgery came along - and I found my passion! I still enjoy acute care nursing though and continue to PRN for the floor to keep my skills up. Whatever position you accept as your first nursing job, be positive about it and remember that every day is a learning experience. Spend time getting to know the older nurses on the unit and soak in everything they share with you. Congratulations on your upcoming graduation and good luck!

Thank you for your response! I am intrigued by this opportunity because I have always felt as though I am made for management; like you it seems like a natural progression. My only fear is that they will not think I am qualified enough and too young (I'm 30). But, I have a lot of good managerial qualities and am very optimistic - the worst they can say is "no" and it will simply be another learning experience. Afterall, everyone has to start somewhere. You sound like the type of manager that I am striving to be - I love being involved with staff and am a hands-on type of person - I never hesitate to help out my co-workers and would continue to do the same for my staff if I get this position. I have a vision of empowering my staff and creating a really cohesive unit. Thanks so much for all the advice! Good luck in your new position.

I recently learned of an opportunity for a nurse manager position of a med/surg unit in a small rural hospital. I have 9 years experience combined in med/surg and surgery yet have never held a management position. I am really interested in this job and need some advice from those of you in managerial positions. When in your career did you apply for your first management position? What was the interview experience like? What kinds of questions should I prepared to ask if I am offered an interview? The position requirements do not say anything about needing management experience, only that I need to have at least 2-5 years experience in med/surg nursing. Any advice is greatly appreciated.

Have you made up your mind yet as to where you are going to live? I suggest Paola, Ottawa, or Louisburg. Paola has a quaint little town square, Ottawa has more ammenities, and Louisburg is probably the smallest and most rural, but only 17 miles from Overland Park and a plethora of hospitals to choose from. I like Louisburg because of the Cider Mill, and it's the smallest, and because it's in Miami County, it will be cheaper than Johnson County (which is where all of the work is). Where are you moving from? Good luck in your search!

A lot of small or rural hospitals don't allow VBACS not because they cannot handle an emergency, but because their OR is not staffed in-house 24 hours a day. They may leave at 3:30 and then the call team covers until 7 am. If a VBAC were permitted, the entire OR crew would have to remain in-house until after the woman delivered...we all know how administration feels about paying for unproductive time. Not saying this is the situation in this particular case, just a possibility. From a personal standpoint of having undergone two lady partsl deliveries and one c-section for a breech presentation, I can sympathize with the feelings of disappointment, anger, and loss of control when the birth does not turn out the way one has expected. I was even more disappointed when my fellow nursing co-workers said "well, it's your own fault you had to have the c-section - just get over it already." My fault that my baby turned back into a breech presentation? How about shock as I labored away and after my water broke and my OBGYN was checking me, he kept reaching and reaching until I thought I was going to come off of the bed...I knew immediately that he was going to say "c-section" and I just sat there and cried and then asked for a "do-over."