LiliaBSN

This thread has hit on a lot of topics from both sides. I have worked both LTC and ER, and I can say Esme is correct. Those who come to us sent from PCP's and LTC's are sent because even if you do call your doc in the middle of the night, they don't have the resources to treat a patient over the phone. What I can vouch for is that even though we might vent amongst ourselves, we don't treat patients differently based on why they are in the ED. That being said, we have had an instance of a patient being transported to the ED for possible sepsis from pan-resistant psuedamonas, and when we ruled out sepsis, the LTC refuse take him back. Granted, he was on his 10th LTC in two years and had a behavioral contract a mile long, but that is a massive EMTALA violation. There wasn't an accepting physician to assume care so we ended up having to admit this patient for nothing. This is a very rare instance, but ED "dumping" does occur. But other specialties do it too, and thankfully, at least in our facility, it isn't prevalent.

Its been my experience that med surg nurses do pass meds and answer call lights all day. That's med surg and is the nature of the beast. What did you think you'd be doing? Multidisciplinary meetings, developing care plans and education materials? What you discover in nursing is that EVERYTHING is your job (regardless if it actually is or not). It's frustrating, but in the end beneficial to experience the jobs of others. Depending on how many nursing programs are in the area, clinical placements can be ridiculously competitive. I agree with a previous poster: learn what you can, pass NCLEX. Side note: nursing jobs were incredibly scarce when I graduated, and my first job was in a nursing home. An LPN trained me (thanks again, Arriyn!) and I did the exact job she did for eight months before I got my current job. The positive side of being a BSN is that others assume you can do anything.

Yes, there are grey areas. I would NEVER copy off of a never person or write actual answers on my hand. And the whole "is it only cheating if you get caught" question is simply a repetitious statement. You can't compare doing a dressing change differently to cheating because you are comparing apples to oranges. One is obviously wrong while the other is a shortcut. And as far as codes of conducts are concerned, yes, there are grey areas. Is helping another student with something they didn't know cheating? According to the wording of certain codes of conduct, sure. How about sharing notes with someone? Also could be considered cheating. This kind of "I did it the only correct way possible so I am better than everyone else here" attitude is what lends to the concept that nurses eat their young. Nursing school IS NOT about making sure you come out on top of every one else but learning as much as you can so you don't end up killing someone out of negligence or ignorance.

Is there a nurse educator at your facility? During our orientation, we had three days with the nurse educator who showed us everything from how the IV pumps and PCA's worked to the different cath kits we had, how their IV kits looked, and everything else between. If you can find a nurse educator, ask them, because it's their job to make sure the nurses in their facility know this stuff.

I'd say others skip it because you can't necessarily prove that the other nurses didn't do it. Another nurse on our unit was supposed to be bladder scanning and straight cathing a patient q6h if the residual was >200. She charted that she was scanning but it wasn't over 200. I saw this and finally called the doc because it looked like he had less than 240ml of output in 8 hours. No, she wasn't doing it because she "didn't have the time" and the patient was just peeing his attends and she'd make the aids change him. Well since the supplies were in his room, I brought the nurse manager into the room at the end of my shift before she got there and we counted the supplies. When we got there twelve hours later, we counted again and it hadn't changed. Since we had proof, she then got fired for neglecting her patients. Bottom line, your nurse manager isn't going to give a crap unless you can prove that these other nurses didn't assess this patient. Not saying that you aren't right, and that it should always be the first and most important step, but don't go being the squeaky wheel too much, because there are a lot of nurses out there that need jobs and will probably work cheaper than you.

I didn't have a choice, we had to buy it for senior year, which was when we took the HESI (if we didn't get at least an 800 on one out of three tries, we didn't graduate without having to prove we had paid for and were taking a remediation course). I didn't mind the Evolve one that bad, seeing as they are the ones who do the HESI and the online resources are actually pretty good.

I was taught that you can shut it off for a minute or two, draw a waste and then get your sample. But yes, TPN has to be off. As far as the whole dressing change thing, it depends on where the statlock is. If it is underneath the clearsite dressing, then yeah, you have to change it and the bio patch. Because if you don't then you are just putting a nice clean sterile dressing on top of a dirty statlock. It can't hurt to change it, especially since they aren't that expensive.

The level of cheating I guess depends on the program. I am more than willing to admit that a few study buddies and I "team-worked" homework and lab assignments that weren't necessarily supposed to be team assignments. Even writing formulas on desks, hands, etc. isn't necessarily a bad thing, as long as you know how to do the calculation and get to the right answer instead of just copying an answer. During senior year acute care, we had to do an online supplementary course to our classwork. It was 'supposed' to be independent, but a few different groups of people would have one person go through on assessment mode to get the answers and then email it to the rest of the group. So when they went through the course on test mode they got all the right answers. Now I know it was a stupid supplement and it was time consuming, but the school did pay for it, we did get charged for it whether we used it or not, and some of that material was on the test even though it wasn't in class. I felt so uncomfortable with it that I ended up talking to the prof about those that I knew were involved. Because a) it was plain flat out, bald faced cheating on a pretty large scale, and b) if the profs found out that every one in the class knew what was going on and no one reported it, she would have failed us all on the online courses. And I hate to disagree with the author of the original post, but I do think that cheating is cheating yourself. You aren't going to remember something that you never really learned in the first place. Its kind of like the difference between white lies and really bad ones; there are grey areas. And you do learn to take certain 'shortcuts' in nursing that aren't necessarily cheating, because anyone who has ever done clinicals knows that how you get taught to do it isn't necessarily the easiest or best way.

Grand total for my four year BSN was $68,000, which doesn't count the $20,000 or so that were grants and scholarships. Admittedly, I went through an exceptional program that has a very good track record in the area, so USUALLY nurses didn't have a hard time finding jobs. As of now, I'm working LTC for barely over $20 an hour, soon to get a new position making almost $30. I won't lie, just thinking about it makes me sweat and more than a little nervous, but if you keep at it, eventually you will pay it down. Depending on where you work, you could qualify for what's called the LEAP (leveraging educational assistance program) that forgives up to 65% of stafford loans if you work in an 'under served' area of nursing, which means rural areas, nursing homes, etc. Where I live is fairly rural, so I just have to hold on for another 18 months.

First, the good: I have worked with Apollo students (both RN and LPN) at my workplace during their clinicals, and all I have to say is WOW. The work ethic is amazing, they will do anything to help, and don't just spend time hovering around the nurse watching. They roll up their sleeves and get to work. The instructors (at least the ones I have work with) are amazing, and really push things like pharmacology to the students. Now, the bad: $19000 for an ADN is really extreme, especially since the magnet organizations (St. Luke's and soon to be St. Al's) are really only hiring new grads with a BSN, as this is part of the magnet process. ADN's who already work at these facilities will be grand-fathered in, but getting a job as an ADN at a manget as a new grad, is in a word, impossible. I tend to be a little biased on the bases of an ADN. Yes, they are nurses and nurses are needed. Just not right here and right now. If you have the time and qualify for the financial aid, try a BSN program. It gives time for the job market for nurses to make a bit of a comeback and gives you options later in life if you get tired of nursing; you at least have a bachelors degree. Also, BSN's start out at higher pay and generally have a more in depth education. Don't misunderstand, I am in now way bashing ADN's or LPN's or anything else. I work some really AWESOME nurses who are both ADN's and LPN's, but right now, there just isn't a market for those nursing licenses right now. So, a little alumni plug. NNU is an AMAZING nursing school. Yes, it is also horrendously expensive, but if you stay in an underserved/rural area, you still get 65% of your staffords written off. The program is run by nurses of the highest quality, the classes are smaller, and getting into the program is easy. Have the pre-req's done? Have a 3.0 GPA? There you go. You're into the program. Plus, they just got an awesome new building that is super high tech. Try them out, but if you decide that a cheaper program is for you, great. Just make sure that the decision you make in the long term is a viable one.

Federal regulations require anyone at any time to report any abuse, either observed or suspected. Chances are you aren't going to catch someone sexually, emotionally or verbally abusing a resident, but you REPORT IT EVEN IF YOU AREN'T SURE!! Resident abuse is a very serious situation that is NOT to be taken lightly. If you know, suspect, or have seen abuse, it doesn't matter if you work nursing, maintenance or dietary, you have a legal obligation to report it. An investigation is done, and if necessary, people are fired or placed on a probation. This nurse didn't do the wrong thing at all. I understand feeling guilty about the jobs of others and yes, this kind of thing has the tendency of being seen as "trouble-making" by DON's who don't want to do their jobs. But, this nurse CANNOT get fired under federal whistle-blowing protections. If she looses her job, she can sue big time.

At our facility, which is a LTC unit in a rehab/alf facility, we have what can only be considered a ridiculous amount of paperwork, mostly redundant. We have books for everything from Alert Charting to Communication, you name it. Recently, we got a new care manager who is intent on straightening us out, which I see is a very good thing. I've only worked there for four months, but it only took a few days to see that the previous leadership was stagnant at best. So what I'm asking for are ideas. Mainly, we want to eliminate all our extra books and come up with one system. One nurse suggested a Kardex-type system, but seeing as someone would have to be constantly changing it and rewriting it, this isn't such a good idea. We have faxed orders that come in that have to be put somewhere until they get written on the order sheets and placed in the hard chart, a communication book that no one ever reads and just randomly gets initialed, and lab slips that are falling through the cracks because everyone seems to put them in different places. What kinds of systems get used at other facilities that are effective? Computer charting would be ideal, and while we have been promised it within the next ten years (really, no joke) I don't see this as an option we can count on. Thanks for your ideas!!

It's tough because you don't have that preceptor to follow around any more. And that whole "You're the nurse now, you do it" is a rough thing to get over. Don't be afraid to ask CNA's, DON's and unit coordinators for help. If you can get hired as a new grad (hahahahahahahahahahaha) there will be people there to support you.

The cost of living really isn't bad here, you can make it pretty good on 40K (and I mean like have a mortgage and everything). I wouldn't move here for the BSU nursing program tho. Seriously. Not bashing you guys, but I have seen the BSU RN students in action, and not only do they have NO idea what to do, they are pretty snobbish because they are "Broncos", and they have a reputation with the area facilities for being as such. I worked with a SENIOR BSU nursing student who didn't know the difference between a PICC and a Hickman; it was ridiculous. And when they chart using "ur" and "lol" (I have seen this) it really give the program a bad name. Now they MSN program is totally different, and I have seen some great people come out of that. Their BSN is funny because you go two years with straight nursing and get the RN, but then have to go another two to get the BSN. Most just stop after the first round because now they have the RN and don't see the need for the bachelors (and how the heck are you supposed to work full time as an RN and finish up with a bachelors???).

I'm lucky, I got a position only a month after passing NCLEX. My one piece of advice is this: DO NOT BE TO GOOD TO LOOK AT LTC. Even if they only have a PRN position open, you will still be working. I oriented with a new grad who would be working PRN and so far she works 40 hour weeks. Just keep in mind you won't get that dream job as a new grad and you have to start somewhere.