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november17 ASN, RN

Ortho, Case Management, blabla
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november17 has 9 years experience as a ASN, RN and specializes in Ortho, Case Management, blabla.

The way to my heart is through peanut butter cups. I used to precept a lot.

november17's Latest Activity

  1. november17

    Fellow student=back stabbed?

    I was thinking of it in terms of the sheets HR and nursing management uses to score individual applicants these days. Peer interviewing is a buzzword fad. It's just part of the algorithm for hiring and doesn't really carry much weight.
  2. november17

    Fellow student=back stabbed?

    There's a book called the Survival Guide to Working With Humans. It'd be a good little self development project if you're truly interested. Sent from my XT1585 using Tapatalk
  3. november17

    Fellow student=back stabbed?

    That's better. My advice; Act professional. Grow a thick skin. Stop worrying what she thinks. This career is no joke. I really truly mean that constructively. Ever hear the phrase "nurses eat their young"? Her saying that stuff during the interview was just a taste. I would personally let it go. They may have been doing you a favor and you just don't know it. Again, stop worrying what other students think. The ONLY person you should be worrying about what they think of you is your patient. Period.
  4. november17

    Fellow student=back stabbed?

    A) I'm failing to see how her conduct is unprofessional, honestly. B) It sucks you didn't get the job. It sounds like you are blaming her because she was a part of the peer interview part. I doubt her opinion really carried enough weight in the selection process to make or break you. Maybe somebody more qualified with more experience came along? I understand it's probably frustrating, though.
  5. november17

    Evil Nurses

    Personally, I'd start looking for another job ASAP. Sent from my XT1585 using Tapatalk
  6. november17

    Fellow student=back stabbed?

    I think you should act like a professional. Sent from my XT1585 using Tapatalk
  7. november17

    Fat nurses

    I was 5'9" 240 when I graduated nursing school. One year I decided to start taking my weight seriously. I started paying some attention to what I was eating and worked some light exercise into my week. I managed to lose 65 lbs in about a year (from 240 to 175). I've yo-yoed a bit, going up to 195 and then back to 180, but for the most part I've kept it off. No one is going to judge you based on your weight. The extra weight does make it harder to keep on your feet, though.
  8. The term "actively dying" has always struck me as amusing, because in the end, we're all going to die. So in a sense, no matter how healthy, we're all actively dying. Of course, when we say it at work, we mean that the patient is probably going to die within the next 1-12 hours. In other words, your patient will probably be dying on your shift. I use the 1-12 hour timeline very loosely, because humans and our will to live can be amazing. Accurately predicting when somebody will die can be very difficult, and is extremely individual, no matter what the circumstances. I've seen people taken off ventilators where it was predicted that they would have no chance of breathing on their own. Surprisingly, they get off the ventilator and they started breathing on their own, living for weeks. I'll relate a story about a person who had a hemorrhagic stroke and was given a slim chance of meaningful recovery. After their family had traveled for hundreds of miles to say goodbye, the ventilator was turned off. The person lived for several weeks afterward. They were unconscious the entire time and the situation was really sad. Sometimes, although I've never seen it personally, I'm sure that people are even able to make a full recovery against the odds. Medicine and nursing are sciences and art forms. However, the outcomes are not predictable like in a math equation. The course of events in the hospital can be unpredictable. However, we can influence the outcomes in a positive way by applying our knowledge and abilities. At one time in my career, I was a new nurse with very limited experiences. I was learning as I went. Coming into work one evening, about three months after passing NCLEX and being able to practice on my own, I was assigned a patient who was active in the death process. The patient was exhibiting the classic signs of impending death. To me, a person who is dying literally looks like a fish out of the water. Once you see that type of breathing its easy to identify. You know all those death scenes you see in movies? Nice easy breathing and then their eyes closed and they pass away? Death doesn't tend to happen like that. Ever caught a fish before? Ever see them gasp for breath as they suffocate on dry land? It's basically the same thing for people. It is hard to watch. And that breathing pattern goes on and on and on. Fortunately, by the time people get to that point, they're usually unconscious. My patient's breathing pattern was basically like the fish out of water, and she had the death rattle. The death rattle is a sound they make when they are breathing. It is hard to describe, but death rattle is definitely a good term for the sound. The death rattle occurs as the lungs fill with fluid. Its sort of like drowning in your own body fluids as your heart fails. Again, in my experience, 99% of people are unconscious through this process. It still sounds awful. My patient had cancer, sadly. Breast cancer that went undiagnosed until it spread through her whole body. I won't go into details. However, I will say that when I came onto duty that night she was my patient, treatment options had run out, and she was "actively dying." The patient had about 10 family members present. They were aware of the fact that she probably wouldn't make it through the night. The patient had been sick for years, had a recent downturn during the last weeks, and had slipped into a coma several days previous. At some point prior to that night, while still able to make decisions, she made it clear that she wanted to go peacefully. Accepting the inevitable, she didn't want any heroic measures taken to keep her alive. Her family had gathered there that night because they loved her, knew the end would be soon, and wanted to spend a little bit more time with her before she went. I started off my shift by giving her a shot of morphine to ease her breathing a little bit. She was unconscious, but she looked really uncomfortable. I also focused on her family. I broke the hospital rules and squeezed a few extra chairs into the room so they could all be comfortable. I wanted them to be able to chit chat in earshot of the patient. I was taught that when someone is dying, the sense of hearing is the last thing to go. The random facts you remember from school during situations like this are interesting. Although the patient was unconscious, unresponsive, and lying there with her eyes closed, I knew she could still hear her family around her. Ever hear stories about people in comas, and they wake up and remember all kinds of stuff that people were talking about around them? I explained to the family how comforting it probably was to her to hear their voices. Then I made sure to help lubricate their conversation with a big jug of ice water, a carafe of coffee I had finagled from the kitchen, and a mountain of cups. It wasn't a customer service move. I did this more for the patient than for the family. I knew she could hear them. I wanted her to be able to hear them. To use her one last sense to unconsciously know that her loved ones were there with her. I made sure the patient was as comfortable as I could get her. I noticed the tiny dose of morphine was starting to make her breathing appear a little easier. I put extra pillows under her pressure points, put a cool pillow under her head, and demonstrated to the family how to moisten her mouth the glycerin swabs which I had left sitting at the bedside. Then I left the room, to the next patient. Even though there were no vital signs to obtain or medications to administer, I peeked into the room from time to time. The atmosphere was the kind that only close brothers and sisters that hadn't seen each other in a long time can create. There were peals of laughter echoing down the halls from that room from time to time. I made sure to tell the family that they weren't being too loud despite their concerns. A few hours later one of the family members came out and approached me at the nurse station. A young woman that appeared around my age. I think it was one of the patient's granddaughters. She said, "Can you come to check? I think she stopped breathing." Great. I had other patients to think about right at that moment. I was sitting there waiting on a physician to call me back about some minor issue some other patient was having. What was I supposed to pick? The dead that has no needs? Or the living? I decided that the living could wait a little while longer for their 3 am the decongestant request, this was about respect. I walked into the room with my stethoscope. I noticed the 10 family members were staring at me. They were looking at me because they didn't want to focus on their mother/aunt/grandmother. Anything else to look at besides my patient, their family member, who was lying there peacefully. Like the family member said, the patient was not breathing. I tried to stand up tall and look really official. I smoothed my scrub top out, made sure my badge was facing the right way, and put my stethoscope to her chest. I listened. I heard nothing...no heartbeat. I moved the stethoscope a little on her chest. Nothing. 5 seconds...family staring at me...10 seconds... I thought back to my schooling. I tried to remember what I was supposed to do. I had a lecture to help get me ready for this. I drew a blank. My badge swung out and twisted around, facing the wrong way. 15 seconds...I pretended to listen while I tried to remember...20 seconds... Finally, after a minute of listening for a heartbeat and hearing nothing, I withdrew my stethoscope. I looked at the family, I looked at her daughter, their eyes were on me. I didn't know what to say. What came out of my lips was, "I'm so sorry..." It wasn't my brain speaking, though, it was my heart. They knew what I meant by my apology. They hugged one another, softly crying, tears falling. I quietly excused myself from the room and paged the patient's physician. While I waited for the physician to call me, and ever since, I've tried to think of better ways to say than what I did. I'm no superhero, I can't bring people back from the dead. I can't cure terminal cancer, and neither could the patient's physician. All I could do was be there. While the patient's daughter was leaving, after spending an hour saying goodbye to her mother, she gave me the biggest hug I've ever received from a more or less perfect stranger. Through tears, she thanked me for the care I gave to her dying mother that night. A few weeks later, I found a thank you card taped to my locker from that same woman. Years later, the lessons I learned that night have stuck with me. One of the important ones to remember is that, as a nurse, sometimes your heart can explain and do things better than your brain can.
  9. november17


    The NAON website would be the place to start if you're looking for study materials.
  10. november17

    How did you land your first RN job?

    I got my first job on a Friday, the same day I took my last nursing school exam, and started orientation on Monday. Fortunately the area I graduated in had a need for RNs at the time. Me and three of my classmates all hired into the same unit - the same reason I took the job actually - because I figured at least I'd know somebody. I had several other job offers, had been interviewing at different places throughout the week, and interviewed on several different units in the same hospital on that same day. Nurse managers right now are being hamstrung by budget cuts. It costs a lot to hire and orient a new RN and the majority of hospitals are experiencing the "we need help but cant hire anybody" phenomenon. I know for a fact my hospital won't hire new RNs pre-licensure because there were too many that they were training as GNs and they were jumping ship within the first year. I'd probably really stress what a great investment they'd be making in you establishing your career there - nurse managers at a lot of hospitals have staff retention in their performance evaluations. You might also be wise to invest in one of those "how to answer interview questions" books and read it carefully. They'll ask certain questions, give you a score based on your answer, and then compare your numbers to other people they've interviewed as part of the selection process. Customer service behaviors are HUGE right now because medicaid is reimbursing based on patient satisfaction scores. I'd probably start thinking outside the box too if I were in your shoes. You may need to open your mind to other clinical settings or target other job markets if you are able to relocate.
  11. november17

    YouTube Nurses and Nursing Students. My Top 10 List.

    Once in a while I do a youtube search for nursing school clinical groups that are doing roleplaying as patient/nurse. The naiveness never fails to amuse me. I don't mean that in a mean spirited way, its just fun to hear the innocent textbook conversations they have. It can be a little grounding for me sometimes.
  12. I don't know about it being the best but I wouldn't trade mine for anything else.
  13. november17

    Need help for CNA training in Ortho

    Contact NAON ---> orthonurse.org
  14. november17

    Does becoming a CNA help you if you want to become an RN?

    I was an aide for several years before and during nursing school. Being a CNA is practicing the art of basic nursing care. That is taught in nursing school, sure, but it isn't practiced very much during clinical. People that work as a CNA on the other hand, may have had years of practice with basic patient care while working before they ever even set foot in a clinical setting. It helps immensely during school since you won't need to spend very much time mastering basic nursing skills - personally it made my first semester a breeze. It would help you understand that healthcare isn't some glamorous job like they show on TV, where everyone is hanging around the nurse station saying witty one-liners or there's some kind of drama happening. Also, becoming a CNA would be the first step to assuming your identity as an RN. I know when I started working as a CNA I was really proud of it. Like, I provide healthcare, this is what I do. Now many years later I can look back on my resume and I'm proud to say that except for a short gap when I tried to switch fields and be an electrician, nursing care is what I've always done in one form or another. I remember I had a classmate drop out of RN clinicals after a month and a half when she was exposed to the reality of nursing care. She didn't like it. She decided to be a respiratory therapist instead. But if she had been a CNA she would have had an idea of what she was getting herself into. In that sense, being a CNA is a good way to test the waters and see if nursing is a good fit for you. I remember being 19, in a CNA program, and setting foot for the first time in a clinical setting. I walked in and said hi to the patient I was assigned to, he mumbled something and pointed at his butt, I looked under the covers and there was poop EVERYWHERE. That was my first lesson in assisting someone that was dependent on me for their care. Its never really got any better but at least I knew what to expect after that. I also got to work in several different areas as a CNA- something that I'd never get to do as an RN without extensive orientation. It helped me figure out which area was a right fit for me and I was able to pick a job I liked right after graduating - some RNs graduate, take a job, hate it, then switch areas within the first 6 months and then bounce around until they find one they like. Does it help your time management? Yes. It helps you learn how your day should be structured into manageable parts to get the tasks done that need to be done. Show me a new nurse that skips breaks or stays 3 hours after their shift charting and I'll show you a nurse that probably never worked as a CNA. Being a CNA taught me how to get done the things that needed to be done in a certain timeframe (generally revolving around when it was time to eat). Does it help you learn the tricks and techniques you need to provide care? Yes. I'll use an example, putting a plastic bag over someone's foot while getting their TED hose on makes the process as easy as putting on any pair of socks. They didn't teach that in school, I learned that on the job as a CNA. I make sure every single one of my patients gets a bath everyday, even if I have to do it myself...something I learned as a CNA. Some of my RN coworkers don't even pay attention to whether their patients get bathed or not. If there's an RN reading this, when is the last time you asked your patient the last time they got bathed? When is the last time you made sure your patients belongings were in reach when you left the room so the patient wouldn't hit the call light 50 million times for this or that? When is the last time you got up and rounded on all your patients to make sure their needs are met before you went on break so you don't get interrupted? There's many many other examples I could cite that I simply learned or got in the habit of during my experience as a CNA. I don't know any nurses that think they are above CNA work, however I do know a lot of CNAs that think RNs are lazy or purposely avoid answering call lights etc etc. I think there is a huge misperception and blurring by CNAs over what exactly the RNs role is in the clinical setting - I know I used to carry that same misperception. However, having been a CNA before being an RN, I can see both sides of the coin and I understand where they're coming from.
  15. I loved peds...I remember showing one of my little patients how to a straw and wadded up paper to blow spit balls at a trashcan on the other side of the room - to encourage them to do deep breathing exercises..heh..
  16. If you mean numerically dominating, then yes. I've really had no experiences with it being gender biased at all as far as instruction or practice - unless the coin operated tampon dispenser in the breakroom counts. I never felt left out during conversation, study groups, or during instruction because I'm a guy I mean, a textbook is a textbook. If you're forming your opinion off things you read on this forum, I'd like to just tell you to take it with a grain of salt. I remember a classmate making a comment one time about me not being able to work labor and delivery because I'm male, but that was an extremely ignorant thing for her to say.