aussiemom

My patient, just the other day, called me over to her chair during her dialysis treatment. She complained of having "terrible gas". The 'bowel sounds" were loud and audible without a stethoscope. I went through the usual litany of questions regarding her recent diet, bowel habits, etc. The sounds just kept coming, and I became more concerned. I was about to make a referral to her GI doc when she lifted her blanket and showed me the squeaky dog toy that was making the offending "gas" sounds...She got probably 3-4 nurses, as well as my nurse manager with her prank.

I appreciate you taking initiative in clinicals and grabbing interesting opportunities for yourself. This will strengthen your knowledge base and practice. However, I suggest that you not "tell the nurse what to do" while you are on the unit. Maybe I am misunderstanding where you are headed, but as a guest on their unit, you need to be respectful of these working nurses' environment. Keep in mind your chain of command if situations are causing you trouble or you feel you are not getting an adequate experience- go to your CI first, then your dean, and so on. Hang in there, it will get better. As you gain a quiet confidence in your abilities, you will not feel as though you have to "fake it 'til you make it" quite so often. Best of luck on your journey!

Please, when you have an observation day or working day on a specialty unit, please don't act bored with what I am telling you. I have worked hard for the knowledge I have attained and I truly do enjoy sharing it- so please don't act like you know it all or just don't care. I'm sorry dialysis isn't as glamorous as the ER or ICU, but guess what- you can learn something valuable wherever you are. You may have a fluid overloaded patient land in your ER one day...guess what...maybe this experience will help you there. Pay attention. I understand if you are overwhelmed- you should be. But please pay attention. I thank you and your future patients will thank you. The majority of students I have had have been eager and inquisitive, but one young woman really bothered me with her attitude problem- sorry to those who work to get the most they can from each experience.

In my purse: Ipod touch, cell phone, wallet, lip balm, feminine products, ibuprofen In my locker: Binders for various committees, assorted paperwork, stethoscope, bandage scissors, BP cuff In my lunchbag: yogurt, frozen diet meals, granola bars, possibly leftovers, fruit and a drink

My unit offers opportunities to care for chronic as well as acute patients. Caring for the acute patients from the floors, as well as those in the ICU, gives me exposure to med-surg as well as critical care environments. She may be able to float to other floors as well to develop her skills. This is something I have been doing lately, and I think it's been a positive experience since I am a fairly new nurse...and started in dialysis. Our chronic patients are a very ill group of people and are frequently in the hospital. Getting a perspective from another department's point of view may be helpful for her career. Also, consider this: whenever you take a new job as a nurse, that department will orient you and make sure you know what you need to know. I don't think she will be boxed in or limited by her experience as a dialysis nurse. She will gain knowledge of many different disease processes as well as their end results. Basically, I would encourage her to get the biggest bang for her buck and go with a unit that has diverse opportunities- chronic and acute populations.

Get to a store that can fit you properly for your Danskos. I must have tried on 6-8 pairs of the SAME size shoe, and none of them fit the same due to being handmade. If one shoe fit, the other didn't. Find a local place that will let you switch shoes between boxes. For instance, if the right shoe from one box fits, and the left from another fits, see if they will let you take one from each box. Remember, they are the same size, so this should be ok with them. In the end, I'm glad I took my time to find the right fit because my back does not ache, my knees do not ache, and my feet are happy after long shifts. I encourage you to take good care of yourself and make sure your footwear fits properly. The fit of your shoe can impact your entire day. These shoes are designed to be a bit loose, but not falling off, so that you can take proper steps.

Epoetin, Zemplar, Ferrlecit, vancomycin, heparin

I'm a new grad with 7 months experience, and I'm feeling frustrated. Maybe someone could provide me with some insight on this situation. I have a great fit with my unit, for the most part. I get along well with the other nurses, our nephrologists, and other staff. I am enjoying developing relationships with our patients. Since our patients are with us for 3-4 hours at a time, 3 days a week, this is important. I love to learn and just joined the nephrology nursing professional organization in order to learn more. The problem lies here, however- I still feel like I know so little. I am always running to people asking questions about things I think really ought to be simple. Most of the nurses in the department have been there at least 5 years, so most of them are very comfortable. I feel very awkward- granted, not as much as when I started as a fresh newbie, but I'm still in an uncomfortable place. I feel badly if I know they are busy, but we're all busy and we all want the best for our patients- so I will ask. I just hate to be running to other people all the time. I like to have the answers. I want my peers and my patients to respect me. Most important, I want to be a good nurse but right now I feel like I haven't quite grown into my license yet. I put my badge on with the great big RN and still doesn't seem quite real. There's a knowledge base that I'm expected to have. I think it's in there somewhere but in the middle of a crisis, I don't know if I could implement it well. Interestingly, I must project a more composed image than how I feel inside. My charge nurse the other night told me she was reviewing her assignments for the evening, and thought about me. She thought that I would not need anything, that I would be fine. She then told me she remembered that I had only been a nurse for 7 months- and decided to ask if I needed anything. I took her up on the offer to talk, and it was helpful. Sorry for the lengthy ramble. Any thoughts you have would be appreciated. I'm trying to not be discouraged, but I feel like I'm isolated. Thanks for your help!!

Wise move sending a thank you card! I sent one as well following the interview I had with my current department. My manager still mentions the fact that I sent a card, and how much that impressed her. You will stand out as a gracious, thoughtful, and thorough candidate.

I love both my Dickies and Grey's pants- they have drawstring as well as an elastic waist, so you get the best of both worlds Grey's pants run a little long so if you are vertically challenged like myself, consider hemming them (or get taller shoes). Dickies are the perfect length. Grey's tops fit a little close to the body so if you like more room, size up. Otherwise, they aren't tight but do (appropriately) show off your shape.

I'm not sure if I've mentioned epocrates for Ipod before...it's free and you can download it right onto your Ipod touch. I use this in my daily practice as a RN to look up meds my patients take, and it would have been infinitely helpful as a student. Small and portable, you can easily look stuff up on your downtime. I also found another free app called "med calc" for Ipod that I use frequently for work. i'm not sure how helpful it would be for clinicals but it never hurts to have another tool in the toolbox. Be careful with the touch, though, because people may think you are just playing on your phone or texting. On a lower tech note, a small notebook is very helpful for equations, passwords, combinations, and information about your pts. Pair this with a clicky pen (so as not to stain your beautiful school uniform) and you are set to go! Shoes: I have been wearing Sketchers sneaks off and on with Dr. Scholl's clogs. I think the clogs may be on their last legs (after about 8 months of wear) but they've been comfortable. I think they only come in black though, so for regular clinicals you may be out of luck. I wore them to our community health clinical with black scrub bottoms and felt well-dressed. You'll find what works for you. Best of luck on this exciting journey!

I'm a "mom" to my Australian Shepherd puppy

Appearance is part of projecting a professional image, so you're wise to consider what's realistic while still being attractive. I wear a little makeup to work, about the same as I would apply on my casual days off. Light foundation, mascara, a little nude eye shadow, lip gloss/tinted lip balm and occasionally blush are my go-to items. I especially enjoy the tinted lip balm because you can apply it without a mirror, it doesn't feel heavy like lipstick, but gives your face some color- which is big at 4 am. Just take care to not go too crazy with the makeup/fragrance- some women (younger and older alike) do not know "when to say when". You're at work, not a fashion show.

I started in dialysis straight out of school (approx. 6 months ago), and I enjoy my work. Starting as a new grad anywhere is tough, but dialysis is challenging as a specialty. There is a great deal of technical knowledge you will need to acquire about the machines we use. Learning to cannulate fistulas and grafts, as well as assessing their patency, is an ongoing process. "Putting the pieces together" between anatomy and physiology, pharmacology, and pathophysiology is vital. You need to be observant at all times because our patients are very sensitive, and what we are doing with their fluids and electrolytes is no joke when it comes to their cardiac status. On top of your body of nursing knowledge, your "bedside manner" is crucial for working with patients and families. Our patients can have challenging psychosocial needs at times due to the chronic nature of their disease. Your organizational skills and delegation skills will come into play as well on a daily basis. The only constant is change- and we often have to change plans very quickly. I work in a hospital-based dialysis center. In addition to hemo, we have nurses trained in peritoneal dialysis. We also carry out acute treatments in our satellite "acute room" in a nearby wing, and perform acute treatments in the ICU with our portable machines. I hope I've given you a taste of what your work will entail. Give yourself time to learn and remember to be kind to yourself. I like my co-workers and it's a good work environment, but the focus it entails definitely wears you down by the end of the day. Best of luck and welcome!

I am still edgy at 6 months! The good news is that I'm not as utterly terrified as I was when I first started, and either will you. Make your charge nurse earn his or her keep. Utilize them as well as your preceptors, and your other co-workers as well. Run your reasoning by them about different situations. I often find myself "checking in" about various things, just to make sure I'm on the right track. Congratulations and good luck.