StudentAmie

That was my point exactly. Whether the OP was incorrect on thinking the dressing change should be sterile is irrelevant. The practice witnessed was wrong and unsafe.

I would rather someone incorrectly change my dressing in a sterile fashion than in the manner this poster's preceptor performed the dressing change. My point was that there are many comments here that stated this poster is "nitpicking" her preceptor when the practice she is seeing is wrong. Not "real life nursing", but actual unsafe practice that can cause an infection. No, it didn't need to be sterile. But the preceptor has some issues with her nursing practice and if nurses are advising "go along to get along", well I'm sorry, but I hope no one who thinks that way ever cares for my loved ones.

I admit I haven't read all the comments, but I find it disturbing how many people have dismissed the dressing change as "it's not a sterile procedure". Maybe not, but you absolutely need to wash hands and change gloves between dirty/clean dressing. Ew. I also think the fact that many posters closed rank and said it was this new nurse's attitude vs. poor practice was the real issue at hand speaks volumes about the reason it is said we eat our young.

100% agree with KatePasa. Whether it is safe to administer the medication in question should be the only consideration. On a medsurg unit you are NOT treating addiction, and what purpose does it serve to get into a power struggle with your patient? It makes me very sad how differently mental illness is viewed than physical. You have no place judging any patient or denying PRN medications that have been ordered by a provider because you feel like their addiction is inappropriate or you feel like they are lying to you about pain, etc, etc. If they are opiate dependent, it IS going to take a massive amount of medication to get legitimate pain under control as well. Just curious if anyone has actually spent time exploring the "frequent flier"'s (hate that term) life history or what led up to their addiction. My patients have been very forthcoming with me when I've asked some basic questions and I have heard some sad, horrifying stories. It may help to realize that these patients are people like everyone else, and most folks don't decide to choose a life of addiction because it seems like a fun idea at the time. In my experience, they have had hard, hard lives and end up substance abusers either self-medicating a mental condition or out of desperation. We nurses are viewed as one of the most compassionate professions...it's time to live up to that reputation and be compassionate to EVERYONE, not just those whose lifestyles we approve of.

Liddle...I actually wondered if that was how you intended it after the fact. The sad truth is that the nursing faculty shortage means there is a lot of very expensive but very poor instruction going on out there. YouTube is a great resource, but no one should have to rely on it in lieu of quality education, it should be viewed as a supplement.

Has anyone here recently taken the CPNP exam (through PCNB)? I am in my second year of a primary care PNP program and am trying to find some resources to order that would help me review throughout my studies. I have looked at both of these, which each have question books to puchase separately. Directly through napnap there is another version of the first that is called Core Curriculum rather than Core Review. Any insight on these?? http://www.amazon.com/Pediatric-Nurse-Practitioner-Certification-Review/dp/0763775983/ref=sr_1_1?ie=UTF8&qid=1345334240&sr=8-1&keywords=pediatric+nurse+practitioner+certification+review http://www.amazon.com/Review-Primary-Pediatric-Nurse-Practitioners/dp/0323027571/ref=sr_1_3?ie=UTF8&qid=1345334270&sr=8-3&keywords=pediatric+nurse+practitioner+certification+review

I think the fact that the first things that come to mind as "wise advice" gleaned are negative comments like the ones above speak volumes about how nurses treat one another. Eat the young, indeed.

I agree wholeheartedly with what Jennifer said. I am in my peds class right now with the FNP students and the thought of how little peds coursework they get would make me nervous to be certified to care for those patients with so little experience. I think it's one thing if you are an RN with 10 years of varied experience, but for me personally, having gone basically straight through, I don't think it would be enough training to be expected to handle issues across the lifespan especially all the adult chronic illness stuff. It definitely helps that I have 3 kids of my own, so none of the developmental material has been new to me as well as issues like breastfeeding. Also, peds is a HUGE field. Remember it's age 0-21 so there is plenty to learn. In my clinicals it is a constant challenge to go from seeing a 2 week old, to a 15 year old sports physical, to a 5y WCC, back to a 6 month old. The nutrition, development, and safety advice is different for all the age groups so it's definitely a challenge. There are also plenty of areas to specialize...I am doing a fellowship in a pulmonary clinic next semester where we will see everything from asthma to CF to kids with trachs. I have an adolescent health course in the spring and surprising to me has been how much I enjoy this age group. As far as finding work, I live in a fairly small community and like nursing in general I think it's all about networking. My program only graduates PNPs every 2-3 years and accepts a small cohort (8-10) so they are careful not to saturate the market. I keep track of names of every preceptor I work with and strive to establish excellent relationships while I am there. I don't constantly see PNP job postings, but I put myself out there on a regular basis with the hopes that when my dream job pops up, someone will remember my name! :)

I am so excited...I graduated in May and have been working on a Medical SubAcute unit...but my passion has always been maternity (former doula), and I just landed a DAY job in Mother Baby! I am also in a Peds Nurse Practitioner Program. So I am wondering if you nurses who work with babies have a pediatric stethoscope you would recommend. I am sure I will need one eventually for school. :)

University of New Mexico in Albuquerque, same school I did my BSN. Is the PC/AC portion acute care? The one limiting factor to this program is that it is primary care only. Not a big deal right now since that's what I want to do, but if I ever want to do in-patient care I will have to go back to school, again. :)

Hello! Is there anyone else here pursuing the pediatric route? I am in a bit of a unique situation as I just graduated in May and got my BSN/RN. I actually work on an adult Medical Progressive Care unit as peds jobs are super difficult to attain in my area. Just wondered if there are other peds people out there!

Thanks for all the advice! I am halfway done and will finish in April. My concern is that quite honestly, I don't feel like my education is preparing me much. Other than clinicals, my coursework has been kind of baloney and since it was a second degree program I never took patho and the pharm course I took sucked. I did have a great A&P couple of courses, but if I am expected to pass without outside help...I think it will be a stretch. Again, thanks so much!

It sounds like everything you did was incredibly appropriate, and well within the scope of NURSING...so why it's even being brought up that doulas are so terrible sounds like just a somewhat toxic work environment. I can see in an environment like that where that animosity would get fueled. However it got started...at this point, the nurses are pushy and rude with the doulas, the doulas are pushing back against interventions because they don't trust the nurses, and where does that leave mom? caught in a sucky power struggle when she just wants to have a baby. In my area, as a doula I have had great experiences with nurses. One of our hospitals has a doula program which I worked for, so that facilitated a much greater partnership. But I do remember at one birth, the CNM was over the top happy with me because I didn't discourage a mom from accepting Pitocin during a long 2nd stage labor. It was a completely reasonable intervention, and I don't ever really encourage or discourage anything more than informed consent on my clients. I do think some doulas out there have a very different interpretation of their role, however, and I can see how that would build animosity in the hospital environment. I have stood by and watched things unfold in ways I have found unfortunate, and supported women making decisions exactly the opposite of what I would do...but I just don't think it's my job to force them to think like me.

Given all of that-the best thing that we do is give good patient care-the other stuff doesn't matter. In fact, I found that patients that got poor care often complained about the extra things we did too!! There is no substitute but parents feel special when there are also little perks! Oh, wow is that ever brilliant. It's unfortunate that "out there" hospitals are competing for birthing business on stuff that is completely dumb and has nothing to do with evidence based, safe, compassionate care, isn't it? Our 3 local hospitals have gone at it over the years with the wood floors (all the better for puking on??), flat screen tvs, tempeurpedic beds, you name it. I have worked as a doula in all 3, and the one that is thought of as low rent actually has the best providers and nurses in town. The fancy pants one is a csection factory but no one wants to hear that because it looks so nice on the outside. Especially because like someone said, the labor rooms are beautiful and ginormous, and then the postpartum ones, where folks are actually going to try to get some rest are teeny tiny and uncomfortable. However...since I know it's important and the reality is these perks sell, I will tell you the things I have seen that I think are great and work. The tempeurpedic beds at the one hospital I mentioned...they are in the postpartum suites where I had my last baby and they are COMFY. Like seriously awesome. I think they were ungodly expensive though. But compared to a regular hospital bed? My goodness. I still think it's kind of crummy that our patients who are in for far longer for less joyful reasons are given such crap beds, but I digress. The snack packs. At around 3pm dietary would bring snacks to the postpartum rooms. I was so starving from birth, breastfeeding, etc, that I wanted to kiss that lady. It was those tuna snack packs, some peanut M&Ms and a soda. Not the healthiest, but seriously, I still remember how great those M&Ms tasted! We had the massage, and I bet you could do this on the cheap if you are letting the masseuses distribute their cards for future private business. I am realizing all of these things are postpartum stuff. I do think including dad is just all the little things nurses can do. Also, I know this isn't under our control, but a lot of the midwives here encourage dad to help catch the baby if he's interested. Those are some very, very special births.:redbeathe

babyktchr, we were sort of advised to put clinical rotations on our resumes, especially if our actual patient contact experience is limited. Our groups are also given lots of choices for which rotations to do so I can see how it would be relavent, I just finished a rotation on a Med. SAC unit so if I were hoping to work in the MICU, it would probably be good for them to see I have worked in their exact stepdown unit. Anyway, I am early, early in the process as I am still only halfway done with school, but I too have doula, "earthy birthy" experience and I've just been putting it out there. I spoke with HR about an internship while I am in school at the women's hospital here and she said that because of that experience she definitely wanted to sit down with me. Who knows what will actually come of it but I had the same fears as you and it was nice to see it responded to positively. This hospital is about the "crunchiest" in town and I live in a fairly progressive birthing area so maybe it's different other places...but I also feel like as much as you may want/need a job, it's important to be up front about your feelings on the topic. If it's a hospital with a 70% csection rate and a place where people wanting a more holistic experience mocked, you may as well find that out up front because you won't be any happier working there than they would be having you! Good luck in your search! It's gnarly trying to find OB work as a new grad and I applaud your efforts!