HospiceRN08

I have applied for admission to the FNP program for fall admission, but I have a major concern about whether Chamberlain really assists students in arranging their clinical/practicum sites. I have opted out of other online programs because I do not like the idea of having to arrange for my own preceptor and clinical sites. I specifically asked the enrollment advisor and he said that Chamberlain has approved clinical sites in each state and a nursing practicum advisor will arrange the clinical site and preceptor for me, but that sounded almost too good to be true. He couldn't give more details so I didn't quite believe him. Can anyone who has been through the program explain to me how that works? Details please. I am just worried that I will have a hard time finding a clinical site and finding a preceptor who is willing to commit for several months.

Question for the travel nurses out there. I'm finally at that point where I think I have enough nursing experience under my belt to start branching out as a traveler/agency nurse. I have med-surg and critical care experience, but my specialty is palliative care. I'd like to branch out and try my hand at other specialties, but I wonder is it wise to step into an unfamiliar specialty as a traveler? One the one hand, I know that as a traveler, you don't get much orientation/training. The expectation is that you hit the ground running, so I figure it wouldn't be smart to step into an unfamiliar specialty as a traveler. On the other hand, I figure I have the basics down and I'm a quick learner, so go for it. Nursing is nursing right... or wrong. What do you guys think?

Compared to other cities (I'm not familiar with rural areas or small towns), nurses is Las Vegas are more likely to be ADN nurses and it does not effect your hirability as a new grad. Now later on down the line if you're considering management or moving away from the bedside, then sure a BSN is a plus. Even so, you'd be surprised how many managers here don't even have BSNs. Also, you must realize where you are. This is Vegas, not NYC or LA or Chicago. Thre aren't any world-renowned medical centers here (LOL). The ADN programs here are strong because in Vegas a BSN is not the standard for new nurses, so if an ADN is more convenient for you right now, then I wouldn't worry about it. Frankly, I often find myself downplaying the fact that I have a BSN. I've talked to some managers and administrators who have told me flat out "I prefer CSN grads to NSC or UNLV." I certainly encourage getting the BSN. I did, but my focus has always been on being a knowledgeable competent nurse. That will open more doors for you than any degree. P.S. Physicians don't know or care where you went to nursing school anymore than you know or care where they went to medical school.

Sounds like the poor husband is in denial which we all understand, but that doesn't mean he should be allowed to make decisions to the detriment of the patient. Some people just need to be hit over the head with a brick. It's the only way to get your point across. Explaining it nicely just doesn't work for some people. So you've pointed out the ascites and edema to the husband, explained the pathophysiology, and he still doesn't get it. Ask him how he feels about watching his wife drown to death in her own secretions. And yes I've actually used the phrase "drowning to death" for a family who just didn't seem to get it. It finally clicked for them and after the patient passed (peacefully) they were so appreciative. I won't even say what I think of this medical director, but I will say that this makes me :redbeathe the docs I work with even more.

Wow, I can't imagine having to order everything like that. Especially on an inpatient unit. The whole purpose of the inpatient unit is to be able to deal with those acute issues, but if you have to sit around waiting for Roxanol to be delivered then the patient might as well be at home in pain waiting for it to be delivered.

Not so long ago I was a Vegas new-grad desperate for a job, so I thought maybe this might help a couple of you. Try some of the local hospices in town (Nathan Adelson, Solari, Odyssey, etc) as they tend to be more new-grad friendly than the hospitals. For a new-grad in this economy, applying online is really not enough. You've got to pick up the phone and call human resources. Speak to someone and specifically ask what they've got and if you can interview with a nurse manager. Sometimes they will tell you over the phone that they don't have anything available, but it's worth a try to ask if you can set up a meeting/interview with the manager anyway. You'd be surprised, sometimes if the manager likes you they might suddenly decide to try you for a position they hadn't considered you for. Use your senior-year externship to sell yourself as far as experience goes, but try not to come across as a know-it-all. Emphasize that you understand that you have a lot to learn and try to show how much respect you have for the expertise of more experienced nurses. Seasoned nurses eat that stuff right up, LOL. And remember, attitude, attitude, attitude counts for more than you realize. Even if hospice is that last thing you want to do, pretend to be really excited the learning opportunity. Don't let on that it's a last resort because you're desperate. LOL. (For me it's my chosen specialty, but I understand hospice is not for everyone). Be serious and professional, but enthusiastic at the same time. Hope this helps!

I work for a larger hospice and our inpatient unit handiling of medications is just as ancient. We have full-time pharmacists but when they are not here we charge nurses have access to the pharmacy and only one signature is required to remove medications (including narcs) from the pharmacy. Two nurses signatures are required for wastes of one-time use vials. Our stock narcs (so we're not constantly taking meds out of the pharmacy) are in locked medication carts and every nurse on the floor has access to them (part of shift change is handing off your set of narc cabinet keys to the oncoming nurse). Part of shift change is counting the entire narc cabinet with one of the oncoming nurses. Talk about a pain in the butt. It becomes problematic because we have a lot of multi-use vials of IV/subcut drugs like Nembutal where it's only possible to guestimate the actual amount left in the vial and no one knows the count is off until someone goes to draw up a certain amount of medication and realizes that there's not as much medication in the vial as the count sheet says. Then we have the oral liquid medications like Roxanol, Oxyfast, Methadone where the count can often be off not necessarily because of anyone's dishonesty, but because of small spills or sometimes what looks like 100cc to one nurse may look like 95cc to the pharmacist. Then somtimes you have a pt in severe pain and you might rush to pull out a vial of Dilaudid without signing it out, figuring that you'll come back and sign it out later (pt care, not paperwork is always my priority) but then you forget and somebody freaks out about a missing vial of Dilaudid. Fortunately, the nurses have a good relationship with the pharmacists, so we generally can ask one of them to come sign off on an adjustment of medication amounts and such.