RNMarykay

JulesA and Libby1987 I think I was just nervous about the line of keeping comfortable/hastening their death and as a newbie RN I have not seen a lot of active dying. When I was a tech I mostly stayed out of the rooms of the actively dying while the nurse did direct care, whereas now I am the one in the room with the pt and their family. I'm trying to speak in hypothetical language rather than specifics of a situation. I just wanted to make sure I had done the right thing.

I am a new nurse and wanted to get feedback. If a patient is a DNR/Comfort measures and actively dying (say from a GI bleed, or disease process that can't be stopped for whatever reason) and becomes restless and agitated and there is prn ativan available, is it unethical to give a small dose even if it may cause resp depression/hasten their demise? Or is it good palliative care to help them relax and keep comfortable? I'm trying to see where the lines are, they seem so blurred at that point. Thanks.

Do something relaxing tonite; get some sleep, drink water and have a good breakfast that won't give you a carb coma. Answer one question at a time and do NOT keep looking at the number you are on. I've heard the average is 120 questions so I didn't even think about getting wired up until I hit that mark. When it cut off before then I was pleasantly surprised. Read slowly and ask yourself what they are asking. Don't overthink or second guess. Use ABC, Maslows hierarchy and Kaplan decision tree when answering. You'll do fine!

In every situation check the hospital Policy/Clinical Standards. Beyond that, KNOW your state Nurse Practice Act to know if it is within your scope. I recently heard of several ER nurses and a manager who were fired bc they were inserting external jugular lines. Their rationale was that if paramedics can do it within the field, they could within the hospital. It was against hospital policy AND state practice act. It's YOUR license on the line.

I am a new RN and am wondering which organizations are generally beneficial to join? I'm also interested in journals that are helpful. I would like to grow as a nurse and also be aware of trends, best practice, etc. With limited funds I want to make good choices on where to focus first. Also interested to hear how many of you carry your personal malpractice insurance? Thanks! mk

Hello, I'm a recent grad and will begin my first RN position soon. I would like opinions on which position to take in light of my experience and goals. I've been working on an adult med/surg floor as a tech for five years so I have some experience behind me, but our hospital is a satellite of the main hospital (about 150 beds). My unit does basic med/surg and a lot of the more complex things (insulin drips, chest tubes) get sent to our PCU or ICU. I can stay at my hospital for a year as a new grad on days and learn time management and basic nursing or I can go to our main hospital, a trauma 2 center, as a float nurse on nights. They offer a relatively good orientation (12-14 weeks) and according to them, plenty of support, but it is on nights, which will be a strain. Ultimately my goal is to end up in the ER or ICU and the experience as a float would be invaluable for skills and meeting people. But I wonder if it is just TOO much, TOO soon? I go back and forth in my mind on the pro and con. Part of me wants to stay where I work -- I know the other nurses, the doctors, the facililty and have good, supportive relationships all the way around. The other part of me wants to jump into the big stuff. What would YOU do as a new nurse?

I agree with loriangel 14. A good friend of mine went into nursing because he had a son who was severely disabled. He always said he wanted to work pediatrics, but when he did his clinicals he was bored out of his mind. He actually LIKES med/surg tele pts because of the variety of diseases and situations that come up in a day. My brother is a great nurse, but works at a slow pace. He learned quickly that he'd better figure out an area to nurse in that would be suited to his personality and ended up in dialysis. He doesn't mind the acuity of the patients, and he likes that he only has two at a time and never has to do any of the admission/discharge paperwork that med/surg nurses do. Me? I'm hoping to go into trauma nursing. Severe blood/guts/codes don't bother me, but dealing with the same patient for more than six hours at a time can make me crazy. It's all about figuring out where your personality fits within the scope of nursing. I think it just takes time.

This is not the practice my hospital system uses. We have several PST's (CNA on steroids) now that have all finished school, passed their boards and are interviewing within our system for RN positions. They remain on the floor as techs, or monitor techs etc until they have secured a position. G

My first job I went to visit each hospital and by chance met the nurse recruiter. I simply asked her how a new CNA would go about entering a hospital. I shared a little of my goals (to become an RN) and she told me that while the hospital in general did not hire new CNA's that the rehab floor did and set up an interview. It was a great way to introduce me to the pace of a hospital, charting, etc without being surrounded by seriously acute patients. We had a lot of strokes, some accidents etc. About six months later I transferred to a step down unit where I could interact with more acute patients. It was great, but they were chronically short staffed and in time I wanted to leave. I targeted a hospital that I really wanted to work at and then applied, and applied, and applied. EIGHT times I applied for a position and finally got a call back. I've been in my new position two years and love it. Great hospital system that encourages education and I'm almost ready to start nursing school. Keep your chin up and keep trying to make connections! Apply, apply, apply! G

>> I am finishing A&PI online now with an A. It can definitely be done, and it worked better for me to do it online, but there are a couple qualifiers. First, I had a study buddy who was also taking it online. We communicated and studied together regularly. Second, my school has a great health science tutoring department that held weekly workshops to go over the material I was covering online. (the workshop mirrored the subject matter of the week for online AND in class students). If I was stuck on a the material I went to the workshop that week or made appt with tutor. Third, I am motivated, disciplined and proactive so I found other resources (you tube rocks) and generally dug until I was satisfied I knew the material. I loved doing it online, but am NOT taking A&PII online. I think the physiology is so much more understandable when a teacher teaches it. My study buddy is taking the same class so our groove of studying will continue. :)

I am starting A&PI this semester as well and like you, a bit nervous. I went to a workshop last week intended to give tips for success. I knew it would be tough, but wow, I cam away a little nervous. But as my husband reminded me tonite, I generally begin semesters wtih some trepidation until I jump in and get a plan of action. Cheers! Gillian

I work on a tele/med surg floor and we have the capability to monitor every room. For awhile we had about six dedicated pt rooms with cameras for those extra confused ones and/or Baker Acts. But it got crazy when we would have to juggle people room to room to get the right ones on a camera. Now we have them in every room, but rarely turn them on unless someone is confused and a fall risk. Occasionally we watch something odd -- and actually caught a male boyfriend/"caregiver" stuffing his beloved with benzos. No wonder the woman had been in that state for a year. It led to a court intervention. HOWEVER, everyone is informed that they CAN be monitored and have the right to refuse. Given how we use it pt families are happy to have extra monitoring. As a unit secretary the camera option comes in handy when looking for a nurse to see if he/she is tied up as well as being able to see if staff is already with someone whose bed alarm is going off. I admit, it is a little creepy, and I would put a gown or glove over the camera if I were the pt. but it serves a purpose with careful use.

Hello, My husband has a career opportunity in the Nashville area. We have been in Florida where I began working as a CNA, then nurse tech/Patient Support Tech, and then got training as a telemetry tech. I've been taking prerequisites for a nursing program associated with our hospital system to get my RN/ADN. Within a year I will be in our nursing program which will take 18 months straight through. My question is if anyone knows of a hospital system with a similar program in the Nashville area? I would really hate to give up a good opportunity in front of me here to get locked out of my plans to become an RN in TN. If anyone knows of the different hospitals and what educational opportunities there are I would greatly appreciate it. Thank you! G

Thanks everyone, I appreciate the thoughts and good wishes. MCYICURN - The situation is peculiar in terms of what the actual patient wants to do. Sadly, either from the ICP or the surgery to put in the shunt or biopsy his short term memory has a severe deficit. For example, we were able to get him out to his teenage son's last football game of the season two days ago, but when I asked him about it this morning he does not remember that he went to the game. He doesn't remember from day to day that he has a brain tumor at all or completely understand what is happening though he seems to understand he is not well. So his wishes in this situation are somewhat unclear, but his wife thought that they should have a full understanding of the options before proceeding with what she believes he would want based on their 18 years together thus far. I appreciate everyone's help and insight. I have the feeling this will be quite a road to travel. Gillian

I have been working as a Patient Support Tech for two years and am in nursing school. This last week a friend of ours was diagnosed with glioblastoma bilaterally at the thalamus, already a high grade/stage. They know this is deadly. However, they are consulting with a Neuro-Oncologist this week to discuss the only treatment available that they know of -- radiation and chemo. She asked me to come to the appt since I at least have some more understanding of the language and topics involved in this meeting. My question is - what would YOU ask a Neuro-Oncologist about potential treatments? This is at a research center so my personal concern is that they would encourage some treatments in hopes of making an advance in this terrible disease, but at the cost of whatever little time they have left. My friend is a straight-shooter type of gal - she wants to know the real deal. Doesn't want false hope or hope of extending his life if the quality will be horrendous anyway. She doesn't want an extra week b/c of treatment -- She needs to know what the side effects are and what type of extension they are hoping for by doing it. I would love to hear your opinions of what to ask and how you would weigh the benefits/drawbacks of treatment or no treatment. Thanks, gillian