AC439

Thanks. I just resigned and I turly believe I made the right decision.

Thanks for reply but I really want to hear from Vitas people. Currently there is no EHR, everything is paper. Have I talked to my educator and manager ? You bet - many times! They keep telling me I have been doing a wonderful job. I know the system fails me and I am frustrated everyday. I'm actively thinking about quitting, same reason as you stated - it is absolutely nothing close to what I hoped for ! I started around 8am today, saw my pts with some unscheduled visits. Tons of phone calls, messages, emails. Almost 5pm now and have not charted a thing.

Hi there ! I'm new to hospice and have been with Vitas for only 6-7 weeks. I am sure there are many of you also working for Vitas. It doesn't take long for me to realize the system within Vitas is broken (I used to work in hospitals). Biggest frustration is my pt's med list never get corrected regardless of what I do. My understanding is we are switching back to Enclara but I was also told they will not maintain the med list any more. So then, what do you do to make sure meds corrections are reflected under the pt's profile ? Also, I found myself on lots of phone calls. A call here and a call there. You are only supposed to use 047 group activity for 30 mins but certainly I spent way more than 30 mins. How do you account for those lost time ? Thanks. AC

I have just switched from hospital nursing to hospice nursing for about a month, thinking I would give it a try. Although the OP typed in all caps, I interpret it as a big crying out for help (cause I feel the same now !). When I read the OP's posting, I felt like someone can completely read my mind! I have been off the so call *orientation* and on my own for 2 weeks. But I already feeling burn out. Most of time I feel alone in the field without resources and also not knowing what to do (in the hospice system). Our company still charts on all paper and the med list is a mess. In the past few days, I have doubts if I made a wrong choice. I got burn out in the hospitals and thinking hospice will let me stick to the purest form (or close to) of nursing. But in a new case I'm handling past 2 days, nobody cares except me and the SW. I'm giving some it some thinking over the weekend and then decide if this is the right place for me.

I apologize if this has discussed before but I don't see a thread recently regarding this subject. I wonder if the agency pay rate has dropped in response to the bad economy. I have friends that did agency before and referred me to their favorate agencies. They told me how much they were making. But when I called their recommended agencies, I was quote a much lower rate. I'm wondering if you guys see the agency pay dropped across the board, or it is just me not knowing the hiring manager in person within the agency? Can anybody shed some lights ? (I'm in the central florida area) -AC

Really all your worries are valid. With a year of experience, you should be able to handle that although it can be difficult at the beginning. But if you stick it out, you will feel better and better with the facility as you are more familiar with them. Also, you are making more money than everyone else on the floor so be prepare to be cancelled first when the census drops.

I rarely check allnurses.com anymore but just happen to read this thread by accident. I went through similar career change 3.5 years ago from I.T./Electrical engineering. I went through some layoffs in my previous career. My wife is an RN and, of course, told me what kind of work it is. I did admire people with scrubs and stethroscopes around their neck. I then went through the same path as most of you do - talked to schools only to find out there is a long waiting list. I was lucky enough to get into an LPN school and finished in about a year then went on to finish RN. I jumped rather quickly and now being an ICU and ER nurse. I can only speak for myself and don't mean to discourage anyone -- I am leaving nursing. My wife warned me before I decided to pursue nursing that this is not a professional environment and I did not understand. I thought everyone goes thought school, earn a degree, pass the board and be a caring person to work on the floor. The real environment is far from ideal although I do see some excellent nurses sometimes but not very often. Instead, horizontal violence is what I see most of the time. Hospital policy is another issue (which you should find many threads here about it). In general, nurses do not get much respect from pt or the family (you do once in a while). However, I have to say being a male nurse myself, I have the most respect from doctors and rarely get into conflicts with them. I still remember the cultural shock my first day in nursing school. If you are from an engineering background, you will be shocked by the nursing education - how they put simple common sense into those 2" thick books. Again, I can only speak for myself. Maybe it's just my environment or region. Maybe some other places are better. Now, I don't blindly admire people in scrubs. I only admire and respect those who really care about people. -AC

I usually do not response to debate threads but since this thread seems already got nasty, so what I'm gonna to say shouldn't make the matter worse. First, I totally agree with Timothy. When I first heard about "nursing dx" in school, I was laughing. I thought the school was joking but unfortunately this was part of the nursing education. IMHO, the so called nursing theories are nothing but trying to make a big deal out of common sense (or even nothing). They are written in a way that "sounds" professional but when you read it, you've got no real meat from it. In real world, nobody cares about the care plan, nursing notes or admission paper. What important is to carry out the MD's order correctly, know how to read labs and when to call the doc. The docs only care about labs, diagnostics reports and the pt is still breathing. Due to the knowledge gap, many docs don't want to talk to nurses. This is not to say all nurses are incompetent but unfortunately many of us don't meet the MD's expection. If we are at the MD's level, we will be doctors. I have also seen some MDs respect nurses, but seems to be limited to those top of the line nurses that knows how doctors thinks and what they want. Nursing is not a science. That's what I was told by my nursing school director. Most nursing instructors don't know science. I wish my nursing education were science based. I personally think the nursing education is a dianosaur. IMHO, to train better nurses, they should drop the nursing theories and spend more time teaching scientific materials. Teach the nurses to apply basic science/physics/chemistry/maths to their everyday work. I don't think things will change. I believe those people that designed nursing education are trying to spin off from medical and build their own empire. Students are therefore required to follow their "thoughts". Does it work in real world? I'll let you figure out the answer. No, I have not used any nursing theory at work. I only use them on paper (charting) to fulfill institional requirement. I know how to take care of my patients (and MDs), properly.

I also see this issue everyday and I don't think there is a solution to this. I'm in the same boat and from a different career where hardwork pays off and any non-production or non-professional behaviors (such as the bullies and horizontal violence) are strightly prohibited. Before, I consider nursing a profession. But, now, being a nurse and have to face this kind of working environment everyday, I can no longer consider nursing a profession. In fact, I started to see this bully problem from day one I was in nursing school. I listened to a radio program couple of months ago and they talked about bully at work. The mentioned a survey on nurses has identified this true problem at the working environment. The survey says that nurses reported the highest percentage of workplace bullying. I see this as nurses' way out of being stuck in the health care ladder. To make oneself feels better, has to beaten up some weaker folks. Afterall, we can't write orders, Dx (except those so called nursing Dx, which nobody cares), have no autonomy and being supressed. We can't beat up the managers, MDs or administration and we are so insecure so we turn to the weak and beat them up. There are some really good nurses out there willing to mentor and help the newer nurses succeed, but you don't see them often.

I also just came into ER from med/surg. Just finished my 5 weeks orientation. I'm getting comfortable in most areas except fast track, especially one nurse for 6 fast track beds without tech/CNA. Actually, I like ER in a way that the documentation is lesser and MDs works with nurses. You also have a bit more autonomy and being less bounded by policies. Most ER people works together as a team although some are not team players. But I'd never go back to med/surg.

I just left a CHS owned hospital. My new job pays less but money is not everything. CHS tends to pay a little more but they run their staffs level very thin so it can be a bad environment. CHS lies on newspaper that their staff satisfaction level is all time high. But when you are on the floor, most nurses are slammed really bad that you'll hear really bad languages all the time.

Congrats !!! Thanks for sharing the experience !!!:balloons:

Thanks and good luck !!!!! Looking forward to your goodnews !

Hi...I'm planning to take CEN exam and have started using the Lippincott's Q&A in Emergency Nursing book. I'm wondering if anyone has used this book recently and taken the exam. I'd like to know if the questions in the LWW book resembles the level of difficulities in the actual exam. If the LWW book is not enough, what other books should I use? Thanks - AC

Don't be disppointed ! The NCLEX is basically the last torture in the entire nursing education before you're allowed to practice. It is not designed to tell if you are a good nurse nor designed to see how competent you are at work. It is designed to see if you can read their mind (those who set unreal questions). There are some questions that you will never answer right, such as those ask for drugs that we have never heard of. So, you ask, what's the point? Exactly ! When I studied and took the test, I tuned my thoughts to the NCLEX way and used the rationales I read from the study materials. When I'm at work, I have to use a complete different mind set to get things done. You will soon find out that a lot of smart nurses are not textbook bound. You can pass NCLEX !

If your state allows quick result, you can actually check the result tomorrow. I took my exam on Thursday and I had my quick result today (Sat). You just need to logon to pearsonvue.com and sign on. When your result is ready, you can use a credit card to pay and it show the result. I had lots of priortizing questions and I thought I failed at 96, but I passed. The questions were somewhat easier towards the end too. Good luck !

I passed. I do believe the last question (and the last few questions) has something to do with passing or failing. The last few questions are probably to let the computer to increase the certainty that the test taker is above the passing line or not. In my opinion, the computer will probably sure about the passing or failing, but the last 10 or so questions are to confirm the calculation. For me the last question was easy and I think it is by design. The computer threw me with some difficult questions then saved the easy one for last to make sure I wasn't guessing the difficult ones right with pure luck.

At the very least, it does not test your ability to do a good job in a real working environment.

I took mine today. It started out somewhat easy but then it turned out to be a lot more difficult as the exam went on. I did not have any calculation questions, I have several "put them in the right order" questions and a few "check all apply" questions. I also have many prioritize questions and a few deligation questions. I had a few med questions, about half of the meds I had no clue and never heard of. Overall, the exam was not very easy. When the computer didn't shut off at 75, I got a little panic. I knew I didn't have enough passing margin at that point, mostly due to the prioritizing questions being so tricky. Then I went on to 85 questions and also at the 2 hours mark for break. I opted not to take the break and continue. The computer finally ended the test at 96. I don't know if I passed or not but I believe I passed since I'm pretty sure I answered the last question correctly. Will post result here in 2 days. -AC

Update here from previous posting. I'm now just started in ER and love it ! I will never go back to m/s again. Too many man made problems in m/s and many times they make a big deal out of nothing ! The system won't let me vote again. I wonder if I can unvote and revote cause my area has changed?

I did LPN school first, then work and just finished RN school (now am a GN). I think I have the advantage of having more experience on the floor and pass the first year nursing sooner then a straight RN from a college. At least, it didn't take me long to figure out all the downside of nursing (1 yr LPN school, then got burnt on the floor right away). Now that I have passed the first year in nursing, the worse seems to be over. If you go straight to ASN, typically you will be spending 1 year to 1.5 years for pre-reqs, then on a waiting list to nursing school. You are still on the "dreaming stage". Then ASN school start and you'll graduate in 2 years and work on the floor only to find out you now start to get really burnt. So, after about 3.4 to 4 years in school, you start on the floor and ask yourself: "So, this crap is nursing!?" Well, I may be a little off topic but I spoke from my experience. If you do LPN school first, at least you can get a "nurse" job while you are in ASN school and earn some money and get your feet wet. They usually will hire you after you finished ADN because they already know you. They may also give you a schoolarship (with 100 pages of fine print attached) while you in ADN school if you are already a LPN with them. Not much help here.

Currently in med/surg as an LPN. Hated med/surg but have no choice for now. Will be an RN shortly so I can get out of it.

Many places in the health care industry are setup for failures no matter what you do (including my current employer). I'd stay emotionless with them, believe in yourself and look around for another job. There's got to be a place that you will find yourself comfortable with and may takes a while to find. I have worked in different fields and my eyes are really wide opened by how dysfunctional healthcare managements are. I was recently recommended by a coworker to raise my voice to the CNO about the problems on the floor. But what good will this bring to me? Literally nothing ! Things are presetted and won't change (at least won't changed by me). If I talk against their "presetted" ideas, I'm sure I'll be black listed. And I have seen this happen to a coworker. So, I'd recommend you to look around. When you are ready to quit and they ask why (which is a BS), just make something up and move on. Don't need to get emotional with management. If you do, they'll probably bad mouth you after you have left such as "so and so just left, yeah right, she is bi-polar, blah, blah, blah..." Not much suggestions here but hope this helps.

Here's my CPNE experience: Atlanta, GA Overall: It was a hard exam but doable. The CA and the CEs are nice and they want us to pass. I think they are frustrated too when they see something is wrong or about to go wrong but they can't tell us. But if you are smart, you should be able to observe them for clues too. Believe me, by observing their facial expressions or body languages, you can prevent disasters. When you are about to do something (or about to forget to do something), they may be looking at a piece of equipment or an area because this is what they expect to watch you do next. We had 7 students and 7 CEs and separated into two groups. All CEs in my group are very nice and cooperate with us. Making sure you tell the CE what you are doing such as "I AM GOING TO START BY WASHING MY HANDS !" Anything you want the CE to hear, say it out loud. Sometimes, you can exaggerate your talking to the pt a bit just to really tell the CE what you are doing. Use the alcohol hand wash as often as you wanted but surely exaggerate that you look at your hands for no observable soiling. Get your nerves in control and you should be fine. Preparation: I read the EC study guide and made flash cards from the first couple of pages of each section on critical elements. I read it over and over and dictated them back on paper. For those that I missed, I wrote them out again in red ink to remind myself. I didn't use mnemonics because it doesn't work for me and the phases don't click. I believe if I understand why I need to do those CEs, I should be able to carry out what I need to do. I bought the DVD and watch it over and over again and made a mental picture out of it. I didn't use skill bags or any preparation class. I didn't join any ECN chat sections but I read old transcripts (especially those recent ones). The old transcripts are very difficult to read because everyone in the chat room basically screamed out their questions so the instructors were trying to answer multiple questions at the same time. Sometimes, I found the answers contradict each other in different chat sessions. The transcripts helped in some ways but it also cause confusions in other ways so use it with cautions. The critical elements are overwhelming but most of the time only a few applies. You are only to apply those that are CHECKED in the kardex. For ex, I didn't have I&O checked in my first PCS so I didn't need to measure fluid I&O but I had to complete other fluid mgn elements such as checking skin turgor. For labs, I have watched enough IVP in work place and I do IVPB with ICD at work so that wasn't problem for me. In fact, I do gravity drips at work for IVPB on my patients. I like it better is because for one is I can practice, for two there is no pump beeping at me when it is finished. We rarely mix insulin at work but I have done it before so that's fine for me. Wound is the area that I rarely do nor was I taught enough at LPN school so preparation for the wound station was entirely from the DVD. What works for me in lab is to mentally reheorifice everything from the DVD over and over. My total preparation time was about a month. DAY 1: Trip, hotel and hospital: I drove to test site on Friday. It was first started out ok but then it rained after 1200 and Atlanta traffic is terrible. I thought I would arrive the hospital at 1430 but ended up getting there at 1515. Still not bad. There were already two of us there when I arrived (you can tell who they are - EC stuffs, reading notes and holding the NDx handbook etc). If you can afford an extra night of hotel, I recommended getting there a day earlier. I basically sat there and unwind from the driving stress and ate a snack. I used this time to focus and regroup myself rather that scanning my notes at the last minutes. Due to the NASCAR race at the same weekend, I couldn't book any of the hotel they recommended but I ended up in Holiday Inn Airport North. Weekend traffic is no problem and it's only 15 mins to hospital and the room is quiet. Other students complaint about their hotel mostly noise level. So at 1600, the CA arrived and took us down to the room where we signed in, ID checked an got our name badge. The CA read the scripts as exactly in the study guide. We were then oriented into the lab and the setup is the same as the DVD. However, the lab is very small. Then the CEs arrived and they introduced themselves (all) in less than 10 seconds. Then we were called into the stations to start the exam. LABs: First one was IVPB. It was easy, only took me 10 mins. Had my calculation recheck 3 times. The only thing it took me long is to adjust the drip rate because the roller has been on the same tubing for possibly very long so I either shut the whole thing completely off or it runs too fast. So, I move the roller into a different location on the tube and I was able to control the flow rate. Took me 3 mins to adjust the flow rate. Passed!!! One of us failed this one because she forgot to lower the primary bag and was adjusting the drip on the pri bag instead of the piggy bag. Nerve control is everything ! Second one was IVP: I calculated the amount to be drawn and the ¼, ½, ¾, check point and wrote it below the calculation. Drawn up the flush and set them aside with exaggeration. Then I draw up the med. I had a bubble that I couldn't get rid of so I told the CE I'm going to discard it and start all over drawing the med. I succeeded the second time with no bubbles. When I draw the flush and the med, I pay attention only to touch the parts of the syringes that I am supposed to or I will contaminate it. Put gloves, checked IV site, ID pt, etc and start connecting the flush, aspirated and push the flush, then med, then final flush. When I pushed the med, I made sure no more than the calculated amount will push faster then the time marker. My push for the med was right on time at the one minute marker (I don't recommend you do the same, slower will not fail you but faster will). Passed !!! Third one was Insulin SC. This one was also easy. I just had to make sure I do it slow and not over drawn anything. I was very careful to draw up the meds and making sure I didn't touch the part of the syringes that I'm not supposed to. I showed the CE all the amount of air and insulin drawn. Then ID pt, put gloves on, alcohol whipped and injected. Passed !!! I think one of us failed this lab because she forgot to put gloves on during injection. Last one is wound. I did everything the same way as the DVD. After I finished, the CE asked to speak to the CA. So I was stunned ! The CA checked and said that I had done it correctly and I passed !!! This CE didn't do my PCS. Another student also told me this CE picked on her packing too. I think the problem with this is the dummy is actually much smaller than the pic shown in the study guide and you could easily over pack and touching the surrounding skin which can cause a fail. FLOOR orientation and first assignment: My first CE took me to the peds floor and gave me a very brief orientation. Basically, there is not a whole lot you need to know about the floor because the CE will get things for you. My first assignment was a 16 years old F with a I&D procedure. My AOC was VS with pain ass, Fluid, ambulate, neuro, abdominal ass, med (IVPB), wound wet to dry dressing change (yeah, right, again). So, I looked at the chart, wrote down orders (especially wound care), base line VS, labs, previous shifts nurses notes and went back to hotel and did my care plan. DAY 2: PCS1 : AOC as noted above. My NDx were acute pain and impaired tissue integrity. Passed the planning phase and started working. (At that time, they changed my meds, the RN had to give the med that I was supposed to give and I had to hang another IVPB at a different time.) I went in, introduced myself and instructor, ID pt, checked IV fluid, site, documented then I was about to start my VS. For IV, the RN started her IVPB and it ran at 100/hr instead of the 200/hr as in the MAR so it will push my IVPB time behind. The CE knew it. Another thing is when I first checked the IVF, it was running the RN's IVPB. So I document the base solution of that med and also stated it was running IVPB over NS at that time to cover myself. For VS, the machine was broken so we had to find another one. Got this done and moved on to neuro, an easy one. When you do neuro, making sure you check strength bilaterally at the same time. One of use failed neuro by doing it one side at a time. If you do one side at a time, you have no way to compare for equal strength. Then I moved on to abd assessment. She has an abdominal dressing but I was still able to do all 4 quards. Then I went outside, do some charting, returned to room for IVPB. The ICD has a different port for PB so it is not needed to lower the pri bag. Connected the bag, set rate, rechecked IV site, ID patient again and start pump. Signed my name on hospital MAR. Then I saved my least favorite part for last - wound. After my CE talked with the RN, she added irrigation to the kardex. The MD's order specified irrigated with H2O2 and wet to dry dressing. But somehow the RN translated to irrigate the wound with ½ NS and ½ H2O2. When I looked at the bottles both full strengths. I looked at the CE and she said she can't teach me. But I managed to mixed 20ml of NS with 20ml of H2O2 and that final solution is therefore ½ NS and ½ H2O2. Got all my stuffs setup and irrigated the wound using a syringe. The CE helped me to pour NS onto 4x4 since I was already on sterile glove (nice). I then packed the wound with the gauze using q-tips. Placed abd pad on top, taped and signed. Cleaned up and said so long to pt and went back to charting. My CE gave me 5 mins for extension and I used up all the time. It was mostly due to the changes and the additional irrigation that made it hard. Also, the wound area is my weakest link. I was back to my room waiting and the CE came back to me after a while and said I passed !!! PCS2: I was back to the waiting room and it was about only 20 mins I was called by my 2nd CE for another PCS. The pt was an older lady S/P TAH with morphine PCA. NDx were acute pain and ineffective air way clearance. AOC were fluid with I&O, VS, ambulate OOB to chair, neuro and resp management with deep breath and coughing, IS x10. Everything with this pt went well except I couldn't get her pain level on the scale. Everytime I asked, she always said pain varies even when I ask her to tell me her pain level at that moment. So I had to chart by observing pt's behavior. Her deep breathing is shallow and cough is weak and refused IS. The patient needs to be reinforced about using PCA pump and so she pushed the button a few times. In the middle, the MD came in and check pt and told her she will be going home. I think this helped the pt. The MD raised the bed and forgot to lower it back when he left so I promptly lowered it after the MD left and voiced it to the CE to show my consciousness of safety.At the end, she drank the entire cup of water I started at the beginning and I assisted her to the bathroom and I promptly claimed these are I&O and OOB to chair. So, when she was back to the bed and sitting at the bedside after pee, she started to talk and gave me lots of words for encouragement. I then claimed this in documentation as the care plan is effective per patient's behavior at the end of PCS. After documenting everything (including those that patient refused and CDM invoked), handed the paper to the CE and was told I passed after she checked it. So, I went back to the hotel happily knowing I had one more to go. I was able to watch some TV and had a better sleep. Also, the time change gave me an extra hour of rest. DAY 3: PCS3: I started out with a patient and got my care plan all ready and passed the planning phase then the pt was taken to EGD and the CE stopped the process and gave me another pt so I had to start all over. This original assignment included IVP protonix 40mg mixed with 10ml NS and 1ml NS flush before and after. This pt is an older lady with gastroenteritis. AOC were, I&O, BR with BRP, SRx2, VS with SaO2 and pain, abd assessment, comfort mgn, Muskeletal - A ROM. No meds. Got my planning phase complete with NDx of Altered comfort and acute pain. Did the first 20 mins stuffs and started assess pain level and the pt said 10 of 10. Of course, I told the CE I'd go tell the RN immediately and so I did. The RN said every time this pt will say pain of 15 and the pain med was given about 1.5 hours before PCS started and it's Q6h. So, I went back and related this information to pt. I continue to access VS, the teaching stethoscope is of low quality and I had hard times hearing BP so I did it twice and slow and got through. Then the abd assessment. She really didn't have much bowel sound at both lower quad but normal at upper. I took much longer time to listen to lower and the CE just dropped her ear pieces and let me listen by myself. After that, I did voice to the CE that the lower quads are hypo. Then I moved on to A ROM. After a few "one-more, two-more", the pt C/O of pain in shoulders so I invoke CDM and abort the AROM. Then I moved on to comfort and offered face waching, oral hyg, back rub and reposition and all were refused. Finally, I gave her some water to drink and told the CE how much was it. Also, she has a diaper so it takes care of the output. I thank the pt and left the room for my documentation. Since there were many areas refused by pt so I had to documented in a different way and put all this down and stated the goal not met and documented all the actions, things offered and the pt's refusal. I rechecked my paper 3 times for all documentation and put adult diaper in the output box and it took care of the business and I passed !!! Back to the waiting room, the CA came and congratulated me. She did chatted with me a little bit and asked what will be my next step. Hope this helps. I may be adding if I can remember things later. But that's all for now. -AC :balloons:

Thanks guys !!! I passed !!!! In fact, I have my laptop during my stay in the hotel and noted this thread but I wanted to hold on until I passed everything before I post. It was a very stressful exam but I managed to get my nerves in control. This was my first CPNE and I passed all of them the first try. The CA and CEs are very nice. They don't work against students and want us to pass. I'll be posting my experience in a few days (after I catch up with rest, I'm still travelling). - AC:smiley_aa