09NewGrad

I moved from one state to the next and have two active licenses currently. I NEVER plan to move back to the previous state no matter what happens, so should I just save some money and let it lapse or does that look bad if I let the license expire from my old state? Also, I am new to the requirement of CEUs to maintain licensure as I didn't have to in my previous state. Are there any good places online that you guys use to get your CEUs? I've seen various sites that advertise them but how do you know if the credits are actually acceptable or accredited? For example, if I take a quiz online and after I pass it says I got one credit, do I simply need to print that page and keep it for my records and proof in case I get audited? I assume they wouldn't want each page sent in when the time comes to renew. Thanks for your help.

Yeah.. I'm not sure what a typical flush is every shift which is why I asked. The nurse I was working with who had done frequent feedings read the order as a 30cc h20 flush every hour, so that's how we set it. Later on I second guessed myself (as usual) and was freaking out thinking that might be too much h2o during the feeding.

Yeah the pump has a water bag - it's one of those kangaroo pumps that alternates the water with the feeding. Anyhoo.. with the order given the pump was set to flush 30cc/hr water.

I took care of my first patient the other night with a peg tube. He was admitted from a longterm care facility and the order was put into his med reconciliation the same way the order was written at his facility. The doctor chose to continue the tube feeding with the order written the same way his facility had it. It was written like this: Jevity 1.2 @ 75cc/hr at all times with 30cc free h2o. How fast would you run the flush with an order written like this?

Thanks for the replies guys, but back to my actual question - What COULD happen if some of the precipitates DID go through his IV line into his circulation?

Nope, as I said above, I was just using the pump with NS infusing as a flush...

Hey guys, today I had a patient with several IV push meds all due to be given at the same time (lasix, protonix, thiamine). He had NS running at the same time and I pushed the meds through the port closest to the patient, using the NS running as a flush - BIG mistake, lesson learned, won't happen again. Protonix and lasix went through just fine, but once I started pushing thiamine, white thick precipitates formed. I immediately stopped the infusion, threw the tubing away, and used a NS flush before I finished the thiamine push. I felt HORRIBLE about this and left the hospital thinking - "What if some of the precipitate got through before I saw it and he codes tonight from a clot"? Even though I didn't see any of the precipitate make it through to him. Could this actually cause a clot, or is it more likely to have a med reaction? What COULD happen if some of the precipitates DID go through his IV line into his circulation? He had a peripheral line going into his AC, not a central line.

Hey guys I just wanted to give you an update. I did manage to get an interview with the job I am seeking next week. Does this mean they already called my references or can they still call after the interview?

Thanks for everyone who decided to post and give advice to me. I decided to put down both references and be honest (supervisor and house supervisor). I will try and let you know if I get an interview.

Hey guys I really need some advice. I'm applying for a new job right now and I'm wondering what I should put in the (Supervisor) box on the application. I left my former position due to having a poor supervisor, and actually more than half the staff on the floor have left in the last year due to this as well. She is a very vindictive person and I'm afraid if I put her down she will give a bad reference even though I left on proper terms. She's the type of person that acts like if you are no longer on her ship you are the enemy. The house supervisor was awesome and said I could gladly use him as a reference. Though he was not technically my supervisor. What should I do??

Thanks for the replies everyone. She felt fine while she was having the temperature, she was just resting quietly in bed. I actually just read up on the policy at my facility and plan to do so on other topics as well. Here's to hoping it wasn't a reaction she was having. I sometimes worry in the back of my mind that I'll receive a phone call in a week or two after I've taken care of someone asking why I did something, stating a patient has died or something of that nature.

True, and I did report the 101.2 to the physician, however this was after the transfusion. The physician also said he wasn't alarmed because temps post op are frequent.

Background... still a new nurse, 1 year experience on surgical unit and still learning every day. Situation... I was taking care of a total hip arthroplasty patient who had only been out of surgery for around 12 hours, and her hemoglobin was Could this have potentially been a transfusion reaction? At the time I kept telling myself this is autologous blood and these patients commonly develop temperatures the night of the surgery. However when i was giving report the nurse told me she had seen a patient develop a reaction to autologous blood in the past. I always love ending my shift with something in the back of my mind before I go to sleep . As I replay the night in my mind, if I could redo the situation I would stop the transfusion, call the dr. just to be safe and see if he wanted me to continue the transfusion.

When I was in school I always thought that two consecutive 12-hour shifts was the most I ever wanted to do because I always felt so worn out doing 12 hour shifts doing my preceptorship my senior year. At my current job that I started in October, they have me doing three 12-hour shifts in a row, I get one night off in between, then I do three more 12-hour shifts in a row, I get a week off, and then I repeat the process all over again. I am getting worn out, burned out, and the week off isn't worth the LONG week of work. It doesn't feel safe and I get so extremely exhausted, especially on the 6th 12 hour shift. I finally talked to my manager about it and she said she would see what she can do about my schedule, but nothing has happened yet.

Thanks guys, I feel alot better after reading your posts. However, I still am upset about this situation as I'm not one of the night nurses who just sits on their butt and doesn't ever check on their patients. I'm constantly seeing how they're doing, monitoring pain control, and seeing if there's anything i can do to help. I know some nurses who go in the patients rooms as little as possible, and this has probably never happened to them. Oh well, I'll use this as another situation to make me better.

I had no idea the patient had an infiltrated vein. When I had last checked the IV, it was fine, and like I said the patient never complained about any issue with his IV. If I'd known it was bad, I would have taken care of the issue long before the vein blew up.

Hey guys, I'm a new grad and have been off orientation for almost two months and work the night shift (7-7) on a surgical unit. Everything has been going just fine, except the other night when I came into work my preceptor (who I had handed a patient off to the previous night) told me to make sure I pay attention to my patient's IV's because apparently his vein/arm was blown up because of an infiltrated vein. I apologized and told her I was surprised it had happened because the gentleman hadn't complained about the issue. Also, he had been sleeping all night and I didn't think to check his IV again right before patient handoff. She said no big deal, smiled, and shrugged off the issue as if i needn't worry about it. Today my nurse manager pulled me into her office and showed me that she had written up an incident report on the issue. She told me not to worry about it, that it wouldn't get sent to HR, it would just go in my file, and that basically it was just to protect us in case of a lawsuit. She told me to always make sure I do my morning rounds (which I do) and make sure I watch things like this closer, because patient lawsuits are on the rise. She said not to worry about it and that i'm one of her best nurses, but I was not happy that my former preceptor (whom I thought we were good friends) felt the need to go to the manager and have her look at the man's arm. I feel that it made me look incompetent at my job, which I make patient safety my #1 priority. This is why I'm so bothered by this situation. I never would have gone to the manager had I found her leave a patient with an infiltrated IV. I debated texting her why she felt the need to talk to the manager, but for now I'm leaving it alone. Also, are incident reports a big deal, as in effecting a future employment opportunity or going on my personal record? I'm trying to use this situation as a learning opportunity to make me a better nurse, but it's really discouraging that I have an incident report this soon in my career. Please offer any insights.

I'm so thankful for all of your posts and insights on my situation. I didn't mean to write a small novel, but the words just kept coming! It really means alot to me, and it has given me a whole different perspective on my situation. I'm confident that everyone's advice will help me to approach my next day of work in a more positive light.

Sorry for the long post, but I really need some advice on my situation here.. I'm a new graduate and I've been on orientation on a surgical floor since for 5 weeks. I was hired for the night shift but they decided to have me on orientation on the day shift for the first 5 weeks because that's where I'd get lots of practice. I was a little worried from the get go when I first met my preceptor. I could tell from my first day that she is a moody type of person. She also would rarely even talk to me, so I would always have to initiate any type of discussion. She would just do her charting and go about her day without even talking to me, so I had to ask questions constantly. It was bad enough that CNAs sitting next to us ended up showing me how to do charting. She didn't introduce me to any of the other nurses, and when she talked to them acted as if I wasn't even there. Not the best way to make a new employee feel welcome who doesn't know anyone on the floor. Things got a little better after the first day once I was given the responsibility of doing meds, assessments, and charting. The only reason it got better was because I had less time around her and more time with patients. Around 2-3 weeks into my orientation I noticed she started to get more annoyed with my many questions, however keep in mind this is my first job since graduating nursing school so obviously I have lots of questions. By week 4 she was having me do all the meds, assessments, and charting, and she wouldn't help me with any of it even if I got behind. For example, one day I had to get fitted for an N95 mask and I was gone for around an hour being fitted. I was assuming she would help me out while I was gone and do some charting so we could stay on track. Come to find out she hadn't done anything, and was surprised and not happy when I told her I thought she would help since I was off the floor for an hour. Right after I told her this, she got on my case and she asked why I hadn't done the vaccination protocol that we do for new admits. I told her she had never shown me how to do that, and she said in an annoyed voice, "Fine, I'll just do it myself." She then got upset at me for being behind on giving a pt his coumadin. Obviously at this point I'm behind, after having to do 2 sets of charting on 5 patients! This was about the time that she started acting really weird when I ask her questions. She would just stand there for a while and look at me funny while I ask questions. This led me to feel nervous everytime I ask her a question as it seemed she would scrutinize my every thought. I started simply asking other nurses questions I wasn't sure about, as they would just answer the question kindly and not make me feel stupid like my preceptor. Yesterday was the last day with my preceptor and the end of the 5th week of orientation, and it was my worst day of all. I had a bunch of patients with total knee surgeries which required dressing changes, and they needed to be put in CPM machines. And of course I had that one patient who had tons of IV antibiotics, morphine pushes, and phenergan that required me to be in her room constantly. I had everything done, except for 3 dressing changes and the patients hadn't been put in CPM machines. I was told the CNAs always put the patients in their CPMs so I didn't worry about that. Around 2 PM my preceptor comes to find me in one of my pt's rooms and says that the Dr. is ****** at us, and has asked her around 3 times why the dressing changes haven't been done yet and why they aren't in their CPMs. She asks me what has been taking me so long to get everything done and when I tell her about the demanding patient, she just says, "You need to get a routine down so you can get stuff done." So I say alright, get my dressing supplies and get to the first dressing change as fast as I can. I then had to go out to the nursing station to ask her whether or not I should take out his hemovac and I see her complaining to the charge nurse (I'm sure about me). Eventually I get them all done and the day is over. My preceptor finally comes and sees if my charting is all in and says she is heading out. Apparently she didn't want to give me any feedback even though this was our last day together! I am so tired, upset, and confused at this point but I still asked her to give me feedback on how I'm doing. She proceeds to tell me that I'm not getting stuff done quick enough, and at this point i should be progressing ahead of where I'm at currently. My heart sinks.. Keep in mind she's telling me this near another nurse so I ask if we can go into a private room! We get into the room and she says, "How do I say this without hurting your feelings? It seems like things just aren't clicking with you, I don't understand your thinking process. You don't understand lots of things that should be common sense to a new nurse. I can tell you didn't get much practice with nursing skills during your clinicals, how many days were you in the hospital before now?" She then goes onto say that I need to learn how to prioritize things, and she says that I am too slow and methodical about how I do things and I need to get a better routine down. At this point I don't even know what to say, and I tell her, "You know, to be honest with you, for the last 2 weeks it seems like you don't like me at all. Whenever I ask a question you just stand there and look at me funny. I'm not exactly sure what happened but it's pretty obvious. It has caused me to not even want to ask you any questions at all." She seemed really surprised that I called her out on this and she apologized. She then went on to say that the night nurse I'll be orienting with is very anal about how she does things so specifically and she doesn't think our personalities will mesh. I am 90% positive she has told the rest of the nurses and CNAs that I'm a complete idiot who doesn't know what the hell I'm doing. They were very nice to me, but the last couple weeks none of them will really talk to me anymore. My preceptor is very catty and I've heard her calling other night nurses stupid around me. She speaks her mind and if she doesn't like someone she makes it known to everyone. She has also worked this unit over 5 years and is respected and buddy/buddy with most other nurses. She treats everyone great minus the one person she is working with 12 hours per day, me. She even told me that the clinical nurse educator asked how my orienting was going, and she told her that it's not going so great because I'm slow at picking things up. My educator is best friends with the nurse manager on my unit, so no doubt she also thinks I'm an idiot. This was one of the things she said was common sense and I shouldn't have been confused about. One of my patients at the start of my shift was getting a bag of D5 1/2 w/ 20meq K and to be honest I'd never had a patient get that before so I assumed that the K bag was a one time dose and when her IV antibiotics were due, I was supposed to give them with a NS bag, and not just spike a new D5 1/2 K bag. I didn't think you could give K with antibiotics. So I went and asked my preceptor, she misunderstood my question and said to just keep giving it with D5 1/2 but she didn't say anything about the potassium, so I went ahead and gave the antibiotics with regular D5 1/2 without potassium. She was not happy about this mistake and told me it was common sense and I should have already known what to do. I left work not knowing what the hell I should do. I want so much to quit this job because I know she has spread it around that i'm slow and suck at this job. I've seen her talking to other nurses in corners after I ask her a question and she just looks at me funny. My reputation is tarnished on this unit and I've only been here 5 weeks. I drove home humiliated, ashamed, angry, sad, and confused. I can honestly say that when my wife asked how my day was, I started to cry. I have never cried in front of her before but I'm just so torn up about this. I feel like I went into the wrong field. I should have known as I disliked most of my clinical rotations during school. When I think about quitting and doing something else, I feel a sense of freedom. However, getting my BSN was such a chore that I don't want this one person to ruin this for me. If you're still reading, please, offer any support or opinions.

I'm still on orientation as a new nurse and on the surgical unit we frequently do dressing changes. When I was in nursing school and we did sterile dressing changes, we used an entire kit that was sterile. My preceptor has been having me take off the old dressing with clean gloves which I'm used to, and then she has me put on sterile gloves to apply the xeroform and regular 4x8's not from a sterile kit. Is this unusual for a sterile drsg change? I thought the gauze and xeroform all needed to be from a sterile kit, not just the gloves?

Hey guys, im a new nurse here and these questions will seem hilariously simple to many of you, but I'd just like them to be clarified please. I'm just trying to be as safe and competent as I can be, thanks! 1. Say for example my pt's 1000 cc bag of NS is empty and I just need to hang a new bag. Do you spike the new bag, unhook from the pt and re-prime the tubing to get rid of any air, or just spike the bag, set the rate, and start the infusion without removing from the pt? I've seen some nurses do it both ways which has led to my confusion. 2. The pumps at the hospital where I work have the option of doing the backpriming of secondary tubing for you, as opposed to manually doing it yourself. How far up into the chamber do you backprime with the NS before starting the secondary med? 3. If the pump wasn't there to hook my secondary tubing into, would I hook the secondary tubing into the closest port to the patient? 4. If NS is currently infusing and I push an IV med, I don't need to flush before/after correct?

Really... No blood test or anything? At the end of my application it says.. "I understand that any offer of employment is contingent upon satisfactory results of a medical examination, a criminal background check, an OIG exclusion check, and a drug test."

Hey guys, I just got offered and accepted my first RN position as a floor nurse on a surgical unit! I'm a healthy 24 year old male but whenever I go for a physical my pulse and BP get pretty high whenever I'm in an office setting. It's been this way since I was a kid, not sure why. Probably due to the fact that I worry about EVERYTHING. Could this keep me from getting hired on the unit?

I just graduated this month and I'm not sure if I should apply for jobs before I take the nclex, because I'm afraid I'll get hired and potentially fail the nclex. Then what happens? Do they just wait and wait until you pass or give the job to someone else? I'm trying to have a good attitude about the nclex, but I'm also being realistic. Should I wait to apply until I've for sure passed? I would feel so embarrassed if I had a job and they knew I kept failing state boards.

Hi there SDA. When you are applying to pay for the NCLEX, it asks which state board of nursing you want to apply for. So to answer your question, you would just need to select the state you plan to move to and work in, and also go to that state's board of nursing website and fill out an application for licensure.