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JBMmom

JBMmom

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  1. JBMmom

    Questions for APRNs

    Not my original question, but I appreciate reading your response, very well put. I know that as a current student, I have some concerns and reservations about my own preparation when I'm done with school. Your point about an on-board period to support training rather than focus on deficiencies is an excellent one. I hope to find a supportive environment when I'm done with my own training so I can practice safely and competently. I don't think anyone's goal is to be a poor provider, they're just working with the opportunities they have available. Thank you for your feedback.
  2. JBMmom

    Share your great day experience

    Have you left a shift feeling like you just hit it out of the park? Is there a particular experience over the course of your career that you really feel made the other days all worth it? There are plenty of bad day stories here, let's share the times when you really made a difference. I'll share mine from a while back. I'm still relatively new in critical care and I came into work one evening and the nurse handing off mentioned to me that I would likely not be handing the patient back 12 hours later. Things were looking pretty grim. Without details (because I have coworkers that I know frequent the boards and I'd like to remain anonymous), I asked a couple questions about medications that were going and the experienced nurse and doctor both downplayed the potential medication effects and basically said the patient wasn't going to make it. Well, the beauty of titratable drips with parameters was that I could use my judgment along with the patient condition, to justify giving my hunch a try. Long story short- 12 hours later I handed a relatively stable patient back to the nurse. One of the consulting physicians rounded quite early that morning and was shocked, and he even complimented me on my care. I walked out of there feeling like a million bucks. Might not ever happen again in my career, but I can say that I saved a life that night. Looking forward to reading about the times you got it just right!
  3. Giving the med from someone else's stock was the problem, not the charting (although that wouldn't really go in a medical record either, because you shouldn't have another patient's identifying information in your patient's charting). Doesn't your facility have a pyxis system of medications that can be pulled before the pharmacy supplies the doses? There should never be a reason to take another patient's medications, and that's the real problem because I think it can be pursued as medicare fraud because the other patient's coverage paid for the dose. Will anything happen? Probably not, but it's a good point to learn the lesson about what to do in your facility in the future so it doesn't happen again.
  4. JBMmom

    Effective use of Nurse Educator position

    As far as turnover, nearly 50% of the unit has turned over in the past 18 months, after many years of stability. I'm a relatively new hire to the unit, coming up on a year. They don't do exit interviews, a couple people said they asked for them but were told there wouldn't be one. We're trying to undertake many changes and address some frustrations. Unfortunately, the overall "education" blanket has been thrown around a bit and managers have really latched onto that as if it's the key. So we're trying to do what we can to bring education to the forefront, but it does not really address some other issues. Unfortunately, even among those that left or are still there and unhappy, it's difficult to pinpoint a specific reason for the dissatisfaction. Most responses are something like- it's different than it used to be. So for those of us that are really invested in making changes that will benefit everyone, there's not a lot to go on. Thanks for all your feedback.
  5. I'm right there with you. I often end up with 3-4 12s in a row and then it takes me at least a day and a half to recover. Yesterday I got home at 8:30am, fell asleep on the couch until 1pm, intended to do some school work but couldn't find the motivation. Puttered around the house cleaning up a bit, then was busy with driving kids for the afternoon. Then last night I fell asleep on the couch about 8pm and never even got up to go to bed, woke up at 2am to go to the bathroom and right back to sleep until 7am. I know some people really like the 12s, after doing it for almost a year, I'm really not a fan. But, it's my only option for another couple years, so I'll muddle through as best as I can. Good luck, you're not alone.
  6. JBMmom

    How can I BE a better preceptor?

    I think a good relationship requires ground rules and then work on both sides. Let your RN or NI know that sometimes you'll be thinking through things as you do them, and you're open to questions, but by stopping too much throughout the process you sometimes find it more difficult to follow through as you would like. I've been on the orientation side in the recent past, and I think the last thing any new person wants is to feel they're a burden to their preceptor. And in order to be successful on a unit, there's some level of self starting expected. But you don't know what you don't know, so as a preceptor I would try to hit the highlights of things that you think are the big picture issues and everything else will fill in with time and effort. Good luck, sounds like you're the preceptor people are lucky to get!
  7. I am starting the clinical portion of the AGACNP program at Maryville University. I have friends that are already practicing FNPs and they were happy with the program. I find the quality of the courses to be subpar compared with what I would expect for preparing me to be a practitioner. Specifically the pathophysiology and pharmacology courses seemed quite inadequate. I've supplemented the school resources- basically books and your own reading, with lots of additional online lectures, programs, and review question banks that I can find. Will it be enough? I'm not sure. Basically there is NO teaching of any sort. Teachers post short exam reviews that range from reading some answers to review questions, to just outlining the topics that will be on the tests. If you just want to pass tests, there are resources that spell out almost all the test material, so getting an A is not much of a challenge. But does that mean anything for future practice? Probably not. I've heard that the pass rate for the practitioner exams is good, so I guess there's a level of competence achieved by those that graduate. I'm happier with the quality of the Health Assessment course, and that could be related the professor, who I find is the first professor that seems to put in a reasonable amount of effort as a professor to help students learn. But again, she's not really lecturing us or presenting material herself. I already had a MSN, so I am only taking the post-master's course work. I think there are WAY too many group projects (and I wonder how some of my classmates can function as RNs, much less future practitioners), and I've read complaints about many papers in the MSN portion. But my MSN program also had many papers, I think that's par for the course. Basically, I don't highly recommend it, but I think the quality of on-line education these days has really lowered the standards overall. If my life were set up for it, I would be much happier with a brick and mortar institution education, but I've got really good preceptors lined up for my clinical experiences, so I'm going to do my best with what I've got. Good luck.
  8. JBMmom

    Effective use of Nurse Educator position

    Thank you for your thoughts. We are trying to cover a variety of formats in order to accommodate the different learning styles and needs of nurses at many different experience levels. You've given me good feedback on starting points and evaluation plans. I appreciate your time.
  9. JBMmom

    Effective use of Nurse Educator position

    I agree the last thing we want is to create more work, or busywork, for nurses that are already plenty busy. We were thinking a quick survey monkey through e-mail- less than five minutes for those that want to reply. Knowing that most will not reply, but at least everyone should have a chance to give their input.
  10. JBMmom

    Effective use of Nurse Educator position

    If we could meet, I would totally buy you lunch for your efforts in this response, thank you!! We're really starting from scratch trying to improve the overall performance, morale and retention in our unit that has seen massive turnover in the past year. At a recent meeting, many people cited "education" as a key need for the unit, but there were no specific needs or wants identified- so trying to figure out what will meet the goals of the people in the unit is a challenge. I will take your post points back to my co-chair and this is a GREAT start for us. Again, I appreciate your response and time!
  11. I'm on a committee looking at the most effective use of certain resources within our hospital that support nursing. Specifically I'm looking to develop some ideal aspects of a nurse educator position and would love to hear feedback from anyone based on successful (or not) use of this role. Some of the suggestions I've got so far: Develop a needs assessment and platform for nurses in the unit to take on an annual basis. Attend interdisciplinary rounds at least once a week to hear some of the issues that might come up related to education. Post a calendar at least monthly with anticipated hours on the unit- be sure that 4 (2?) hour increment minimum is scheduled to allow nurses to time to accommodate workflow. Have to have some hours that cover at least a little of all three shifts (not on the same day). Develop - slide decks by e-mail? poster boards in the huddle space? alternative education formats? Educator trivia game night jeopardy style? I'm thinking Audreysmagic might have some excellent ideas about what doesn't work- based on the recent lonely educator ballad. We really don't want to waste anyone's time, nurses on the unit say they want more education, but are we setting ourselves up to have one frustrated educator and a bunch of avoidant nurses? Thanks for any suggestions?
  12. JBMmom

    Lose vs. Loose

    While I might like to know quickly what my patient's oxygen saturation percentage is, I'm often reported a patient's oxygen stat by coworkers. Also, while not every patient has a fever, all patients have a temperature, even if they're dead, so please don't ask me if the patient has a temperature. Phew, nice to get those off my chest and not sound mean....
  13. JBMmom

    Can a registered nurse work as a medical assistant

    A one year gap is not that long. Have you looked at clinics and long term care facilities? It sounds like with your background you would be a great addition to RN staff in those facilities. I also think you will probably not be considered for MA jobs because employers will assume that you will quickly move on to something more related to your licensure. Good luck!
  14. JBMmom

    heparin drips and lab draws

    If nursing is drawing off a central line we just pause the line, flush, draw off a discard tube and then draw the sample. When lab comes in they usually just have us pause the drip if they have to draw on the same side as the IV. Otherwise it keeps running.
  15. You sound more enthusiastic about the UM position, and money isn't everything. That sounds like it's about the only pro for the supervisor position, since you'll have even more flexibility with the UM position once you're able to work from home. Good luck with your decision!
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