nannymcpheeRN

Hi Everyone, I'm in my second year PhD in nursing. I will provide my experience so far, which is really an individual perspective. The PhD is an advanced degree that requires perseverance and determination. It's a long haul emotionally and intellectually. However the personal growth you will achieve is phenomenal. There are philosophy, theory, and lots of qualitative, quantitative, measurement classes. My program has a PhD practicum (which is rare). Some programs require your research area be in line with a faculty member. My program does not. In fact, it supports and promotes individual study trajectories based on your passions in advancing nursing science. There is a tremendous amount of reading and writing. Right from the start you will be critiquing research studies and critically reviewing scale development. That's because the PhD is a Research Doctorate. Early publication is encouraged as it hones your scholarly writing skills. Make sure that you spend some time learning to write well and write every day (something creative, then something scholarly). I was concerned about the IQ needed to complete "The proverbial PhD" but it is really about being honest with yourself about your passions for advancing nursing science and knowledge development. Surprisingly, it's quite a creative endeavor. The sky really is the limit to research activities. If you love learning new things (spending at least 20-30 hours devoted to your work per week), and have dogged determination (there's lots of support for this in good programs), then go for it!! I've heard there are only 2-3% of nurses in the nation with a PhD. We need more! You will change in the first semester. It's like taffy pulling sometimes (you struggling to improve yourself and the way you think and structure concepts, questions, etc). But the personal development is yours to keep forever. It's not for the faint of heart, but you don't need to be an Einstein, so to speak. This is my current assessment...likely to change as I progress.

Dear New Grad, Some states do have nurse:patient ratios of 4:1 days; 4-5:1 eves; 6-8 nights. That does not account for the acuity of patient however. Many new RNs struggle to keep up, so working as a team (promoting health work relationships) is key. Also, it is important for you to know your limitations, what you are not sure of, don't know how to handle, and how you prioritize your care. How long do you have a preceptor? Many hospitals are now instituting 6 month nurse residency programs to help with the new nurse transition period. If this situation is not supportive of your as a beginning practitioner, check out some nurse residency programs and work to land one. Having a strategy to succeed is the most important thing in developing your nursing career. I wish you the best in your endeavors, and don't be afraid to speak up and let your preceptor and nurse manager/educators know how you feel. Experienced nurses are a wealth of information and support (if you find the right ones willing to mentor you). All the best, RN with >30 yrs experience NannyMcPheeRN

Kali, Thank you so much for this comprehensive response.

I am interested to survey which clinicians ( other than a RN or LPN) in home health care can accept verbal medication orders? Your responses are valuable. Does anyone know which Federal regulations govern this topic? Thanks Everyone.

A critical care or ER background is an asset in HH. You will feel more at ease with sudden acute situations. HH requires good time management and creativity. Good documentation is essential in HH. I left PACU and now work as a case manager RN for HH. I love working one on one, coordination od community resources, the creativity of applying the care plan, teaching (a lot), and driving the back roads to my next adventure with a new pt. The pace is slower, but HH is never boring!!!! Always good material for a book(as truth is truly stranger than fiction)! Best of luck with your decision.

Hi, Have you checked out nursing-informatics.com ? What a wonderful site. All about the field.

Hi Rachel, I too just started HH in Jan 2012. Our agency is computerized and we have the Visiting Nurses Association of America's website loaded on our home page. We use their guidelines for treatments/procedures. It includes tons of reliable and evidenced based info. Check with your agencies Policy and Procedure manual to cross-reference if you can. Good Luck!

Hi Fellow SJC students, I'm in the distance ed MSN/ED. I live in Massachusetts and I'm planning on doing the summer residency on Sebago this summer 2012. Anyone else going? I'm on my first course: Nursing Informatics. I find the distance learning website very informative. I have emailed my advisor and instructor, and have always received very thoughtful, personal responses. I'm going to check out the facebook group.... All the best, NannyMcPheeRN

Did you have bad experience? I know the grass isn't greener; I,m looking for different surroundings and was wondering if others had made the transition. Thanks for the input.

Hi everyone, I'm interviewing Wednesday for a visiting nurse position with a reputable VNA. I'm a hospital nurse in PACU with experience in clinical teaching, critical care, and surgical/post-op care. I really need a change, as I feeling de-valued in my current position. I working on a MSN in Nursing Ed, and I was hoping to work part-time in HH. Any tips for the interview? Also, any new HH RN's willing to share their transitional experiences? Hope to hear from you. I've enjoyed reading the HH threads. NannyMcPheeRN:redbeathe

Hi nmred, Yes. We had the same recommendation. Here's what our "anes md's" did: We have a pre-printed order form that lists meds with doses based on patients pain levels. We start with the number one analgesic/narcotic, say, Fentanyl up to 200mcg, based on patient's response, then add MS or Dilaudid (if checked off on the pre-printed sheet) if the situation warrants. I see this are a better communication of managing patient pain, based on clearly written guidelines. This saves a lot of unneccessary phone calls for add'l pain med orders. Also, both the RN and MD collobarate to customize the dosing based on indivdual patient factors. Hope this helps. We've used this system now for the past 6 months, and found the we can give narcs, quicker, and pt's pain scores drop quicker, and d/c from the PACU is faster. One caveat. Be careful with OSA patients...they have to stay in our PACU for 3 hours after the last dose of narcotic to monitor for apneic episodes. (we had a sentinel event on the med-surg unit after a OSA patient was d/c'd from PACU after 30 minutes post narcotic. So now, even though we have this pre-printed narcotic pain orders, nursing/medical judgement always rules. JACHO is satisfied, because it is now documented, very clearly, what our approach to pain management is. Isn't that what JACHO is always looking for? A documented approach to trace patient care. Sorry for the long answer, but this was a hot issue in our PACU (large city hospital).

Thanks for replying. Where are you working now? The stance I've taken in PACU is to stand up for myself and others. (I have 27 yrs RN exp). I truly believe that people develop bad habits when dealing with others, and of course if you don't stand up to a bully, they'll keep on abusing. So, I'm speaking up...and I'll go face to face (away from patients please...) and pin the person down. I'm not backing down. PACU is a wonderful place to nurse....and I'm not going to let passive agressive, arrogant, crabby, mean-spirited people ruin my day and that of my co-workers and patients. Life is sooo too short.

Take a deep breath....you've studied hard for your RN...it will all come together. If you have to re-do the exam...get some mentoring before the next test date. Agree with Morte, take a break.....you'll accomplish your goals...just pace yourself. Best of luck!

Our PACU is loaded with nurses who have been working in the same unit for 20, 30 plus years. Some of the personalities are horrendous. Since joing the team a few years back, I have witnessed some real low-blow interactions among them. I intervened the other day when 2 RN's were berating the secretary (all the while, yelling across the room with other staff and patients to witness). I was inflamed and embarassed to call this my PACU team. This is an ongoing problem. Personally, I confront problems and nip them in the bud; most people know I won't stand for poor communication and bullying. Many others either have such a bad habit of complaining and back stabbing, and others don't have the skills to confront the abuse. I wonder if a Code of Professional Conduct could be enforced? All our RN's are represented by a union. What are your thoughts on creating a constuctive atmosphere?

We have the same issues....good rapport between nursing units is sooo important....but let's be realistic...it's tough. Our situation has improved somewhat with the implementation of RN bed managers, available 24/7. They work hard to maintain rapport, walk miles in one shift, and can challenge the nurses if "slow discharge" or sitting on empty beds is discovered. Even though we have bed boards, the computers aren't always accurate.