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

Diane, Thank you for your reply. Our facility is non-profit so I'm guessing our CEO is just an ass :) I appreciate your response as to how to get pro-active!! I love it and will follow up. Since I've been there we've had two falls ;( and yes, skin breakdown though honestly we are turning, cleaning, putting on the proper ointments and dressings, documenting, etc. It's just unbelievable to me how much work goes into all of this. But your ideas will help me not feel so helpless in all of this. :) g

Hello, I am a nurse tech and recently transferred from one unit in a hospital to a newly opened "sister" facility within our system. It is called an LTAC (long term acute care and NO, it is not a nursing home). It is essentially critical care for long term patients. We have anything from a guy who fell 30 feet and got impaled on the way down and has multiple fractures and an ostomy, suprapubic foley etc. He's medically stable, just needs to recover long term -- to a traumatic brain injury -- to a woman who had triple bypass and is a CABG. Lots of peg tubes, about 50% on vents, etc. We have OT & PT daily. RN to Pt ratio is 5:1 and tech ratio is 12:1 and the nurses do plenty of tech work like bathing, turning, cleaning up poo. EVERYONE is overworked. It is easy to be in a pts room for up to an hour -- once gowned and gloved up we can do vitals, accuchecks, turn, clean someone, change an occupied bed, nurses give meds, etc.....and in the meantime there are 11 other pts wondering why the heck they aren't getting a bath or where their pain meds are.....AND we have a lot of family involvement and frequent overnight stays and interaction with pt families. I have NEVER taken the 2 15 minute breaks a day that my hospital docks my pay. EVER. I force myself to take lunch because if I didn't I would go insane. And at the end of the day it is reflected in our patient surveys which then it comes down on our heads. Our nurse leader is awesome and doing the absolute best with the situation. The "problem" is the CEO. It seems every decision she makes is strictly on the bottom line $$$. She comes to our unit, smiles, asks how we are doing and what she can do to help, yet it seems that she doesn't actually give a damn about how anyone is really doing. The issues of understaffing get said to her again and again. One day one of our RN's answered her honestly, "Get me another aide. That's what would make my day better." And the CEO went off, called a team huddle and claimed that we aren't managing our time well enough. The aforementioned RN that spoke up said, "well, _____, why don't you put your scrubs on and show us how its done. show us how to use our time better." Needless to say, that didn't go over well. We have good nurses & techs who care, who want to give excellent care to pts and who at the end of the day leave feeling that they left short changing someone OR stay 1-2 hours past shift finishing up charting. I had been working towards going back to get my RN but going through this makes me think healthcare isn't for me after all. I am so disheartened by this CEO and the lack of care for employees. Some nurses say that it is like this all over nowadays and that if they were me they wouldn't go down the RN path.....I do love the field of health and would like to make a positive difference in this realm if possible. I am all ears to hear from you all -- is it really like this all over? Thanks, g

I recently had a pt with neuroblastofibroma. Nicest guy in the world. Saddest thing to see. Invaded his lungs and spinal cord.

I agree with those who say dump him, BUT you may not want to do that....so you could go the route of saying "Well, you may not like it now but you won't mind when I'm making 50grand..."LOL (I'd still dump him and surround yourself with people who are supportive of your goals)

Hello, I am curious how everyone managed to pay for life while they went to school. I am a nurse tech at a hospital, a little older than some (43) and want to go to nursing school. BUT at this point I need to pay for housing and my kids as well. I know I could be a good nurse, I'm just struggling with how to get from tech to RN financially. I would likely need to go to a vocational nursing school that costs a bit more because they do the pre-reqs as part of the program. I'm all ears if you'll share how you've done it! g:twocents:

Hello, I am a relatively new nurse tech on a critical care/long term floor. My RN's have up to 4 pts at a time and I have 10 (supposedly not more than that but I 've had 13!). Some of our pts are on vents, most have multiple issues, peg tubes, various wounds and recovering from surgeries, a couple with brain injuries, and maybe one or two walkie-talkies in for shorter visits. So - intense! I am struggling with the feeling like no matter how hard I work - and I do work hard, we all do! - I will never have a day that I don't feel like I short changed someone by the time I leave. It is common to walk into a room and not leave for 30-40 minutes depending on what is happening with cleaning someone up, changing positions, doing vitals/accuchecks for everyone can take up to 90 minutes with all the isolation gowns and whatever else has to happen in a room, etc....But some people don't get a decent bath, enough attention for feeding (hurry up!), whatever... Part of it is chasing down the right gear - we struggle to stay stocked with PPE, trash bags in the cans, linens in the clean linen room even though we are talking to all the right depts about getting those things ordered and in stock. It takes extra time our of every day! Now my nurses don't complain - they are awesome and they realize I've got 10+ pts to their 4 and they know I am working my tail off and am a good tech- but I know they are working just as hard as I am all day and we often work together on a task. Like me they are often charting at the end of the day and staying beyond their 12 hour shift. I have been seriously considering nursing school, but sometimes I wonder if I will ever adjust to this feeling like I just can't get it all done and walk out feeling a little defeated instead of proud of how well I cared for my pts all day. If you have ever felt like this I would love to know how you dealt with it. Thanks a bunch, g:crying2:

Yes, I was afraid when I started too! A couple days after I started a nurse introduced herself and said she would've done it sooner but I looked too afraid! ha ha Just take a deep breath, have a couple of stock questions (where are you from? etc), and pay attention. I ask a lot of questions of other techs, nurses etc...I decided to admit I was a "newbie" in healthcare and just ask away. I've found that instead of thinking I'm stupid I look curious and interested. Good luck!

I definitely think you need to know the steps involved in the clinical exams. Of the 9 people taking the exam only 3 of us passed the clinicals on the first attempt. I've heard you can find some videos online that will walk you through the clinical portions. Good luck!

I work on a rehab floor. We work as a TEAM - there is no "I'm the RN, you are the Tech" attitude here...if someone needs help getting pulled up in the bed, so be it. If they are a total assist - get a gait belt and get help. Our nurse leader also creatively schedules the techs so that we have enough to get it all done in the midst of daytime/dr's/physical therapy etc... We also have our physical therapists work with techs and new nurses on how to effectively "block" a patients knees, lift without hurting their back, etc. When the PT's assess the pt they usually put on the whiteboard in their room what kind of assist they are (min/mod/max) and why (knees buckle, confused). It's helpful to know that some types of stroke patients are more prone to attempting to transfer themselves (I think it is the ones with left sided weakness, it affects their judgement), and put those on a bed alarm or close to the nurses station where we can keep an eye on them. We also park pts in their wheelchairs out in our view point between therapy sessions so they don't try to get out on their own. Hope that helps! g

Where I live the market is saturated with LPN's. Most that go to school for that are just trying to "leapfrog" into an RN program. LPN's get first seats over non-nurses so it works out better for them. Plus, on my floor the nurse leader will hire techs who become LPN's straight onto the floor.