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Ddestiny BSN, RN

ICU, Post-Surg, Oncology, Psych, Family
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Ddestiny has 7 years experience as a BSN, RN and specializes in ICU, Post-Surg, Oncology, Psych, Family.

LPN: May 29, 2012

ADN: December 13, 2014

BSN: December 16, 2016

3 years of Primary Care

2 years in acute Post Surgical/Oncology

2 years in Critical Care

Ddestiny's Latest Activity

  1. Hello, I noticed your reply on nursing shortage is BS. 
    I’m originally from the city you are in.

    Could I ask you a few questions about job market in that area?

     

    thanks 

    Kristen 

    1. Ddestiny

      Ddestiny, BSN, RN

      In Toledo? Sure. I haven't been here long and I've only looked at trauma/critical care listings but I'll help if I can. 🙂

       

  2. Ddestiny

    Nursing shortage is BS

    Shortage or not, is all about location. I just recently moved but before that lived in Kansas. I lived throughout the state at different times and there is a legitimate nursing shortage there. New grads can get into the "hot" specialties (at least ICU and ER....I never really inquired about L/D) right out of school without having to pay dues on night shift. BSNs are not typically required though there are a few magnet hospitals sprinkled here and there. Now I live in the Toledo, OH area and the market is a bit different here. There is definitely a need for more nurses but one should still expect to spend some time on nights, irrespective of experience. I've been a nurse for 7 years with 2 years ICU and I accepted an ICU position on nights. My first night job! lol The unit I'm working on is really hurting for nurses and there are a ton of new grads. One thing I will say, they definitely support their new nurses a lot better than what I saw in Kansas. A FIVE MONTH new grad orientation! But it's also very rare for them to (get the opportunity to) hire experienced nurses. Since everything in the area is so seniority-based and you'd have to start over anywhere you go, I think people tend to stay in one hospital system more. Anyway, my point is that location is key, and it can be hard to really understand a place's job economy until you really delve into it. Picking a location to move and then finding a job might be doing things backwards -- the strategy may need to be to find the job you want, and worrying about location second. It sounds like California is very difficult to break into, and there's enough competition that they don't feel the need to take a risk on someone who is changing specialties. The required strategy to get into your preferred specialty might be to move to a cheaper/less desirable area of the country, pay your dues, then return back once you can secure a position in CA. It's a lot of work, admittedly, but it just depends upon your priorities. There are no wrong answers.
  3. Ddestiny

    Forgot to unclamp the secondary

    Whenever I have a student or I'm precepting a new nurse, I point out one of my favorite pieces of advice to avoid this very common problem: Always make sure that the correct drip chamber is dripping before you move onto the next task. That being said, it still doesn't make me immune from making the same mistake, especially if I'm in a hurry.
  4. Ddestiny

    I hate being a sitter

    I would definitely recommend putting a lot of energy into looking at RN positions. The sooner the better, really, with the upcoming need for maternity leave. Nursing orientations in the hospital are usually anywhere from 4-12 weeks depending upon the unit, so having plenty of time to get through training and establish yourself before being off for a while will be really important -- especially for a new grad, practicing new skills. Don't allow the concern of them not hiring you due to your pregnancy, keep you from getting out there and applying. Everywhere. Aggressively. The sooner you get your foot in the door, the sooner you are making RN money and using your new knowledge. Oh, and you'll never have to worry about "too much sitting down" as a nurse! Good luck with your decision.
  5. Ddestiny

    Is this interview process unprofessional?

    I've been involved in peer interviews in multiple different facilities. Some were more organized than others, as far as guiding what questions could be asked. The last place I worked didn't even offer the general refresher of "these are illegal/inappopriate questions, these are common questions, etc" so it wouldn't have surprised me if someone accidentally came out with one because we are nurses, not HR. But we absolutely want to take those peer interview opportunities to assess the fit of a potential employee. After you work with enough staff where you find yourself asking "how does he/she work here?" from their lack of cultural fit or general knowledge base, you'll grow to appreciate being given the chance to participate. Many employers don't offer it.
  6. Ddestiny

    I should be happy with this new "dream" job

    I think the responses to this post illustrate that there are many different things that one can value or prioritize in their work environment. For example, I am pretty apathetic about working holidays, and I'd much rather work 12 hour shifts because then I only have to get up to an alarm 3x per week. lol Boredom, on the other hand, is a big dealbreaker to me. It's one thing to have intermittent (i.e. census-driven) down time but if I'm not feeling challenged, then that makes your day go by incredibly slow. I've felt fulfillment in nursing positions and now it's a requirement for any future positions.I want to be learning more so that I can improve over time. Some people prefer things to be more comfortable, either because they have a lot of stressful things going on in their life or they're just a more laidback personality. That's okay, too -- lots of different folks, lots of different types of jobs. It sounds like you've learned something important about yourself. It doesn't mean you necessarily need to leave, but it sounds like some soul searching for what you really need to feel content is going to be important. Getting a PRN position like others have said, or adding more things to your life outside of work (how many of us lose our ability to maintain a social life during nursing school and take years to pick it back up again? lol) might be the answer instead. If you decide to leave then finding a position that matches your needs will be important. I never thought I'd see myself in Critical Care but it turns out, that it checks off all of my boxes. Good luck with your decision.
  7. Ddestiny

    Is it worth it?

    Agreed! I enjoy my job. I don't enjoy every moment of every day, but overall I have no major complaints. In my 7 years of nursing, I've worked 3 different areas of nursing (primary care, post surgical/oncology, and now ICU) and I've decided that the ICU is definitely the place for me. I initially went into nursing wanting to be an NP like everyone else, but after I fell into the ICU (long story) I really fell in love with it. I want to stay at the bedside. And I see nurses that are finishing out 30+ year careers at the bedside, that are knowledgeable, compassionate and engaged in their work. I want to do that. I want to keep learning and growing in my role, and be the best that I can be. I like the responsibility that I hold. I like working with very sick people, and guiding their loved ones through what's happening. It's not anything like what I envisioned for my career because I was scared ****less at the idea of critical care when I was in nursing school, but now....here I am! Nursing is not for everyone and that's okay. Of those who would enjoy being a nurse, not everyone area of nursing is going to fit. It's hard to know until you're really there, but shadowing and fulling investing yourself into your clinical experiences is as close as you can really get. Nothing is like when it really falls on your shoulders. I see a lot of posts on here from people that have been a nurse for maybe a year or two, in the same job or similar types of jobs the entire time, and they decide that nursing is not for the them. Maybe that's true.....or maybe that particular job is the actual problem. They'll never know if they're not willing to take a risk and try somewhere else. And that being said, your unit culture definitely makes a difference too. I wouldn't enjoy my job as much if it didn't have a positive culture, where anyone can say "I need some help" and they'll suddenly have more hands than they could ever need. There are so many variables, just like with other career paths.
  8. I'd admit I didn't read all of the responses so far, so maybe this has already been mentioned. When I am being notified by my CN that I am getting a patient, I am also getting the very basics of info about them. At least a diagnosis and including whether or not they're intubated. If the first indication a nurse gets that they are receiving a patient is that a nurse from another area is calling to ask to give them report, then that sounds like a breakdown in communication from the charge nurse to the receiving nurse. Most of my received reports are at the bedside, including from ER (ICU nurse communicates with ER charge about a good time to come get report, ICU nurse goes to ER bedside to get report, ICU nurse and an ER RN/CNA/Transport bring pt up on the ER cot). I have no problem with bedside report. But, I would be unimpressed if someone walked in with a patient for me and I didn't know that they were coming or to expect them (but my questions would go both to the person bringing the patient, and my charge nurse, to figure out where things broke down). In very busy circumstances the charge nurse or another unit RN will take report for incoming patients and then they'll settle the patient until the original receiving RN is able to do another handoff.
  9. Ddestiny

    Advice from experienced nurses please

    I think you're right on schedule with where you "should be" for your level of experience. None of the mistakes you've described are terrible. They don't show any glaring lack of critical thinking. They're just little mistakes that people will make, especially when they're busy, trying to rush, and maybe a bit distracted. No patients were harmed. You're doing better than you realize. I wasn't a new grad when I entered the hospital (3 years primary care) but I still felt like I was drowning. My expectations of myself were not realistic and I beat myself up for every little mistake, no matter how insignificant. I went to my boss crying and she was surprised because she'd been hearing good things about me. I just expected that I should be doing better.... more time efficient, more knowledgeable, etc. Unfortunately the only way to get rid of that feeling of drowning.....is to continue to allow yourself to drown. I had to take deep breaths, remind myself that other people went through this same process and that's how they got to be the people that I looked up to and admired. None of them started out that way. I worked on that floor for 2 years before I moved to the ICU and I became someone that new hires and nursing students looked up to because I made a point of letting them know that it's okay to feel overwhelmed and to make mistakes, as long as you learn from them. Writing everything down helped me a lot. If I have to rely on my own memory by the end of the shift, that information is going to be gone. lol I updated my little nurse brain sheets to have a "things to do this shift" section where I could write down things that needed to be done as I was getting report or along the way, and a "things we did this shift" section so I could give updates in a prompt way during hand-off rather than trying to look back over the shift in my head. Take note of that voice in your head that says you're not good enough. If you pay attention, you might be able to decide whose voice that is. You'll figure out your way, in your own time. Self-flagellation will not make you a better nurse or a happier human being. Be patient and kind with yourself. Remind yourself at frequent intervals, that a lot of people that have been where you are right now and lived to tell about it, all say you're doing a good job.
  10. Ddestiny

    Air in Line

    I'm going to assume that you're needing to re-prime the tubing around the level of the pump, not just the area immediately below the drip chamber. This method will work for both, but if you're just getting a little air below the drip chamber then you can re-prime with a syringe without having to pull the tubing out of the pump -- just pause it. Below is a longer way, to be used if the bubbles are down below the secondary port in the tubing (the port immediately above the pump). You don't need to unhook the line from the patient to do this. 1. Pause the pump. 2. Clamp the roller clamp immediately below the pump (I'm assuming that all Alaris tubing is the same? Maybe not?) 3. Open the door on the pump channel and pull the tubing out of the channel. There will be a blue clamp that will be active/closed when you pull the tubing out and you will need to re-open it. (Make sure Step 2 is done before Step 3 to keep more fluid/med from running into the pt and bringing your air level lower.) 4. Squeeze and fill your drip chamber. 5. Connect the empty syringe to the port on the tubing that is below the part of the tubing that goes into the pump. It is usually right above the roller clamp. 6. Pull back on the plunger of the syringe. You should see fluid/med dripping into the drip chamber. If it is not, you have missed a step somewhere. Just keep pulling back until you get all of the air out. You will end up with some of the med/fluid in your syringe. No big deal. 7. Put the tubing back into the pump chamber, release the roller clamp below the pump, and restart the infusion. If your secondary tubing goes dry, you can back-prime it with the primary fluid by simply making sure that the clamp on the secondary tubing is open, then lowering the secondary medication below the level of the primary fluid. You'll immediately see the tubing start to backprime. This can be done when the fluid is still running, without pausing the pump. Hope this helps!
  11. Ddestiny

    New nurse and I had a breakdown at work

    Wow, that sounds like the perfect compromise! So glad it's worked out so well for you. =)
  12. There have been some great tips above. Here are a few I'd like to add: 1. Learn when to ask questions and when your talking will just distract the nurse. If the nurse is reading progress notes, in the middle of a procedure where you can tell that he/she is concentrating hard, or -- heaven forbid -- is trying to fix an actively decompensating patient, bookmark your questions mentally and come back to them later. Watch what's happening (or being read) in the moment. It doesn't mean we're trying to be rude, we just need to give our full attention to our patient or the task in that moment. 2. One of my big pet peeves....don't attempt to give a patient a bunch of medications without telling them what they are and why they're taking them. New nurses and students get so focused on the action of scanning and popping pills that they stop thinking about the great responsibility they have in their hands and all of the ways you can change the trajectory of someone's hospital stay (or at least their day) if you give them the wrong meds. I have no desire to "call someone out" in front of a patient, but if you don't know this information then I'm going to inform the patient for you. It's not to be mean, it's because he/she needs to know. If you feel uncomfortable about me doing that, then make sure you research the meds in advance, write them down if needed, and explain them. I find that naming off each med as I scan them and stating their medication action for each med as I scan them is easier than trying to hand someone a big med cup full of pills and trying to recite them by memory. Also it allows you to have a conversation, and if the patient says "oh, I used to take that but I don't anymore" or refuses a medication for whatever reason then you can easily set it to the side in that moment and not have to go get another tab so you can identify it from the 80 pills in the cup and fish it out. 3. I love to teach. If you show enthusiasm and an interest in learning then I'll take you under my wing for the 12 hour shift, self-narrate so you can know the critical thinking behind my decisions and I'll see if any of my colleagues have any interesting procedures we can get you in on. If you act aloof and disinterested then I'm not going to go out of my way for you. I don't tend to see too many of the latter example but they really do drive me nuts. lol Even if you have no interest in my particular specialty there is always something to learn. And, spoiler alert, I had no interest in my current specialty (critical care) when I was in school, either -- but now I love it! 4. Be graceful if we're grumpy in the morning. I always feel bad on those occasions at 0650 when I'm told I have a student and I'm still half asleep. It doesn't happen often but if I didn't sleep well or if it's the 3rd or 4th shift in a row.... I try to make a little joke about needing more time with my caffeine before I'm fully myself. lol Don't take it personally. And the same goes even if your nurse really is just a grump all day, it's probably not about you unless you're one of those know-it-alls mentioned by someone above. 5. If the unit is on fire and everyone is running around like a headless chicken....jump in there and help. Really even if it's just busy-ish or if you're not actively engaged in something at that time, answer some call lights. If you're not sure how to help with a patient's request then report it back to their nurse. Hospitals usually have a white board with the nurse's name and phone number on it. You'll win major brownie points, even if all you end up doing is calling him/her to say "Room 304 is requesting their pain medication" or to ask if the patient can have the requested snack. It's one less call light for us to run off to get.
  13. Ddestiny

    New nurse and I had a breakdown at work

    I would be very hesitant about this...even in healthcare, where we take care of all kinds, there is still a stigma about mental illness amongst doctors and nurses. Having a documented problem doesn't "cover your ass," it puts a target on it. I've seen this with several friends and family members, in healthcare and non-healthcare fields. You can be fired for not being able to fulfill your job duties, even if it is secondary to a medical problem, mental or physical. And to collect unemployment one must work at a facility for an extended period of time....I think 6-ish months? OP, it sounds like your manager is really trying to work with you. What I'd recommend is to look online at the job postings for your hospital and see what other options there are for days. As others have said, it's not giving up. It's setting yourself up for success. Night shift is not okay for so many people. I know I couldn't handle it even when I worked a boring ol' factory job over a decade ago, so I don't dare attempt it now that errors could mean more than messed up embroidery on a shirt. If you're going to commit to staying in your current job, it means committing to a solid plan that will allow you to get the rest you need. The first year of being a nurse is incredibly stressful, even without working in such a specialized and acute field. Many people don't fully understand that -- they assume that a lot of the stress is over after they pass the NCLEX and maybe that misunderstanding bleeds over to their families that assume the new nurse can take up more of the slack at home. You have to give yourself time. If it means getting a babysitter, being over-protective of your sleep time, having your husband pull more weight for a while, not offering to help with various celebrations/holidays/events/whatever... it's all for the purpose of setting you and your family up for a better future. Make a list of things that would be helpful if they were no longer on your plate. Find a way to get rid of them, delegate them, hire someone else to help or change the schedule on which they're done for as many as possible. You'll be able to slowly add more of these back to your "list" over time....but expect you'll need help for at least a few months AFTER getting off of orientation. Also, a trick I learned from a classmate in nursing school....to avoid some of the Mom guilt and let her young children have her attention in a manageable way, she'd get a little timer and set it for 20 minutes. During this time she was alone with the child in their room and they could do or talk about anything he/she wanted. They'd color, read books, whatever....the point was that they had 100% of Mom's attention and they loved it. She did this with each child and she reported it was really helpful. Perhaps doing something like this can help your daughter have attention in a predictable way that might help discourage the acting out to receive the attention? Good luck with your decision.
  14. Ddestiny

    Giving insulin late patient request

    If I understand correctly, it sounds like the patient was requesting the insulin be given in conjunction with her meals, which she was eating a couple hours late. Not everyone is an early eater. I'd just make sure that I'm checking the blood sugar right before she ate (at 10am, not 8am) then giving the insulin with her meal or immediately after. At my facility our endocrinology staff don't have any problems with patients eating late (and thus getting their insulin late). They get concerned when insulin is being given over an hour after the BG was checked (and really they'd prefer it to be a much smaller timeframe but some people get both sliding scale and carb ratio -- necessitating that one waits until after the meal is complete -- and pretty much everyone gives them both at the same time). It's also important to make sure that there are several hours in between each administration of humalog, so if breakfast is late then lunch needs to be late too. If I'm misunderstanding and she's eating at 0800 and not wanting insulin for another couple of hours then that'd be an education issue.
  15. Ddestiny

    Lvn to ADN Bridge online?

    I went to an LPN/EMT to RN bridge program that had all of its classwork online, at Hutchinson Community College. You do have to go to campus in Hutchinson, KS for orientation and the first couple of semesters have all of their clinicals in that general area. The third/last semester you can get things set up to do 1/2 of your clinicals in your area. We had people flying in from all over the place -- Mississippi, Alabama, Florida, New Jersey to name a few. Most came in for a week at a time -- they'd do 3 clinicals, take one day off, then do 3 clinicals again and go home (no more than 3 12-hr clinicals in a row per the program). If I remember correctly there were 7 clinical days 1st semester and 6 over the summer, and ~15-ish the last semester. And I loved the dynamic between the LPNs and the EMTs, which have such different education backgrounds. The program is a legit brick-and-mortar and costs ~$5,000 for the whole thing which helps offset costs of travel. Here's a link to an old thread about the school where I put more specifics of the program. I think there are other threads about it as well if you do some searching. https://allnurses.com/lpn-rn-nursing/accepted-857212.html
  16. Ddestiny

    I am taking Taekwondo!

    I used to practice traditional TKD and went to several all-day tournaments. All of the ones affiliated with my dojang always used the same medical volunteer He was an old, retired doctor (at least in his 70s). I don't think anything ever really came up but it certainly can, especially if your tournaments have many adolescents or adults competing. Kids are all pretty much just kicking the air and rarely seemed to come within a foot of actually striking each other. lol Even the higher ranking kids tend to look more "cute" than "aggressive". During preparation for a tournament I had my nose broken. Luckily it was a straight-on shot so it wasn't severely displaced to the side. TKD folks come from all walks of life and I had no medical training at the time, but I quickly figured out that the advice to tilt my head back was not advice to be heeded when I got a mouth full of blood. But really in the 5-6 years of pretty consistent practice I only saw a handful of injuries and they were all pretty overt and easily diagnosed (broken nose, thumb laceration when someone was trying to break boards but accidentally kicked the thumb of someone holding the boards causing a laceration from the board's corner, my fiance fractured his ribs twice without any complication). They also tended to occur in regular class when we weren't wearing pads. The injuries are usually pretty straight forward ortho-ish kind of things, I can't imagine you'd get too many abdominal or thoracic injuries with all of the bulky pads they make you wear. Shin guards, arm guards, "vest" pads, mouth guard, helmet, and men are supposed to/encouraged to wear cups. If someone gets a decent strike to the head that might be a bit more of a grey area, but punches to the face are not allowed and usually by the time you know how to kick to the height of someone's head you hopefully know how to control it too. (Of course freak accidents happen). Strikes to the back, throat or below the belt are not allowed. Your only targets are the abdomen and flanks (punch or kick), and head (kick). Ultimately these places should require liability waivers to be signed because everyone is practicing and competing at their own risk. Encourage appropriate treatment and call EMS if there's some freak accident. Brushing up on first aid neuro stuff would be appropriate if it's not your wheelhouse. If you enjoy watching the various activities then you'll have a great time, otherwise it can be pretty boring since they tend to go all day. Have fun!
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