Ddestiny

No this is not normal. I did my LPN at a community college in KS in 2011. It was a 9 month program and cost $5,000 for everything, including books and the cost of taking the NCLEX. I didn’t deal with any of that stuff. Obviously Covid wasn’t a factor then but Im not convinced that has real impact on not having enough chairs. The for-profit programs in my area cost a lot more and would seemly do things to weed people out early without giving them a refund. For example one of my classmates had failed out of one of those programs in the first week because she flunked a medication math test so they kicked her out with no refund. The first week! And it was crazy expensive so it took her forever to get out from under the debt to even get into not-for-profit program. We spent one half day on vital signs and CNA tasks because we all had to be CNAs as a prerequisite to get into the program. If I were you I’d see what your options are to get out and find somewhere better. Spending weeks on basic tasks is really scary to me and makes me think the program probably doesn’t have a good NCLEX pass rate. Is it accredited? If not you might have difficulty bridging from LPN to RN if you do continue through with this program. What an unfortunate mess. :/

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.

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. ?

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.

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.

There was no separate program or special process. I don't know if it is different now.

I think a lot of those specific questions would be better fielded by current members of the program, since I graduated so long ago. I found the program less challenging than LPN program. My tests were all online, not proctored. I don't remember if we were allowed any fails. I don't remember ever feeling in danger of failing. Nothing to lose by applying. If you get in, great! If you don't, you're no worse off than you are now. For some perspective, It took my husband several years and literally thousands of dollars between application fees, transcript fees, GRE fees, flights and hotels to get into a PhD program in his highly competitive field. And "competitive" in KS looks very different than on the coasts. Don't let feeling intimidated hold you back from making a move that, after just a year, can seriously change the trajectory of your financial future.

It's kind of hard to keep track of everyone since we only were all in the same place at the beginning of the first semester. Since so many are from out of state, not everyone attended pinning. I only know of two specifically that didn't graduate with us. One may have quit, I just remember that he left early in the first semester. The other I was pretty sure that he was dropped, and he was very lazy at clinicals (i.e. said things like "I'm not going to be an OB nurse so I'm going to sit back and let [all the female classmates] get your experience in". I told him that I had no interest in OB and would probably not use the information much after the NCLEX but that doesn't mean you can just not participate). Hard to know how he was as a student. The program itself is really flexible. I think if you're able to get through your LPN then you can get through this program as well, as long as you're willing to put in the appropriate time. I felt LPN was more difficult just because it was the first time learning the info, whereas RN is mostly going over the same thing plus a few additional pieces. I definitely didn't study as much during my RN, personally. I think if you're having problems then the instructors were open to working with you. I got to a point where I was able to get a month ahead of assignments so that I had a really nice cushion if anything came up. Clinicals were available almost every single day. You might not be able to get your preferred specialty location depending upon your availability vs the days that actually go to there (i.e. there were only a few days to go to dialysis or prison, if I remember correctly) but the hospitals had availability almost everyday. It was incredibly easy to manage. I had gotten accepted into Pratt's LPN to RN bridge before Hutch's and almost went with it, but it was nowhere near as flexible (had to go to clinicals M/W/F for weeks on end.....not many jobs you can work around that unless you're employed through an incredibly flexible nursing home or something. I was working M/T/W/F at an office so there was no way I could miss that much work. With Hutch's program I think I only had to miss a total of 3-4 days of work. In the spring (orientation and skills check-offs was a Monday through Wednesday or Thursday event) and in the fall (mental health clinicals was a 3 day/2 night trip). Hope that helps!

I don't think the Kaplan exam was required when I was going through this. The HESI was required at that point, which was really simple, especially for someone that's already an LPN. When I was applying the program would typically get ~200 applicants for 50-60 slots. But this was also 5 years ago, so I unfortunately don't have much up-to-date information.

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.

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.

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.

It's definitely something I've considered. It's hard to know the real reputation of a hospital when you've not been within 500 miles of their city. I don't like the idea of job hopping or the added stress of multiple periods of orientation, but it might have to come with the territory. One factor that I have on my side is that I don't have to move for almost 4 months so I can hopefully get at least something decent then continue to look if needed. The interview I have coming up sounds pretty great if I would be able to come to days in a reasonable time frame. Unfortunately that's one of those "crystal ball" questions that no one can really answer.

Not yet, but it is definitely on the "to do" list. It's been a definite goal for this year but if my upcoming interview doesn't prove fruitful then it's definitely going to need to be expedited!

Thank you! I appreciate your positive vibes! And though I haven't looked into it specifically, it does seem like there are a decent number of nursing schools in the area. One of the ICU recruiters I spoke to said that they usually hire via their new nurse residency.....not sure what to think of that, hopefully it means that they have a good base of experienced nurses. But as difficult as it can be to "break into" the market, maybe that means that people are less apt to job hop in comparison to other locations.

I guess what I have is less of a question and more of an observation/pseudo-vent. I'm a nurse in Kansas. I started off as a non-certified home health aide in 2007. Ever since I became a CNA (and later bridged to CMA, LPN, ADN and BSN) I've been able to get every job I've ever applied for -- with the exception of one where the fit was one that neither I nor the employer/interviewer found to be ideal just from the interview. That statement is not to brag, but more to illustrate the market in my state. I've lived in multiple places throughout KS, from the state capital to a town of 13,000 while achieving these jobs. Everywhere needs more nurses. I've heard of places with much tougher job markets, but assumed a lot of those areas were on the coasts and in more desirable cities. Even in those places I'd assumed that I have paid enough dues that I'd probably have a decent shot of securing the job I wanted, if we were to move. Well, now we are moving, and it just amazes me how difficult of a time I'm having. I was really excited to be going to a place with 3 level 1 trauma centers in close proximity as I've wanted to transition to a trauma/surgical ICU anyway. I've looked at other cities over the years with less hospitals and that had many different job options, but I'm just unfortunately not finding it. Literally all positions that are not procedural areas or supervisory are all night shift (which I'm not 100% against on principal, but my own history of attempting night shift exacerbated historical mental health issues and insomnia). And finding an ICU or ICU stepdown option has proven daunting over the last 6 weeks or so that I've been scouring the ads each day (plus reaching out to recruiters). Of the 3 level I hospitals I've seen 2 ICU job openings total, of course both nights. One was early on in my search so I didn't jump on it like I should have, the other I did. I've also looked at other trauma centers in the area but am surprised that they do less intense interventions than my current, non-trauma designated hospital. I might be able to get the jobs I'm applying for, but the specific position I want is apparently not available even with 8 hospitals that service adults in within the city (and multiple others within an hour-long, 1 way commute). So what super-desirable place am I describing, with such a difficult market to break into? San Diego? New York? Nope. Toledo.fricken.Ohio. ? Maybe it sounds silly, but I never anticipated this. I figured things there would be "on par" with Kansas as far as having more older/sick folks than they can care for, especially with so many hospitals in such a small area. Before we lost a lot of content on AllNurses I read all of the threads pertaining to Toledo and they spoke a lot about the pay but nothing about difficulty in actually securing a position in your desired specialty. I have had a couple phone interviews (level 3 trauma centers -- 1 in Toledo, 1 in Michigan) and have secured an upcoming in-person interview with a level 1 for a night ICU position. At a previous time when we almost moved to Knoxville the critical care nurse managers commented how they'd love to have an "experienced ICU nurse" like me work for them...and that was when I had less than a year of critical care experience! I was offered positions in a couple different ICUs while it was still uncertain whether we'd actually move there (and, of course, we didn't). I had a similar reception in St. Louis. Of course, the location that's best for my husband's career is proving difficult for mine. lol On a positive note....for those that are having difficulty getting their start, it really can pay to move to a different area. It's easy to assume that all job markets mirror your local area, but they can really vary. Sooooooo.....anyone got any connections in Toledo? ? ?

That sounds really frustrating. When I started out in nursing I worked in a primary care office that also owned 2 urgent care offices in the same town. Providers could see information between both different systems so if one of our primary care patients had an issue over the weekend, we could be aware of everything. The urgent care office could also see all of the pertinent medical history. It was a really nice system and it makes me wonder if there is something similar in your area?

There may be some hospital options depending upon your area. I was looking into some hospitals in different states as my husband and I were not sure where we would be moving. He was interviewing for PhD programs and I'd come with him to some of the interviews and check out the nearby hospitals. There was a hospital in Saint Louis where they told me they had a "very robust" weekend option program so those that worked a regular full time shift only had a weekend every 2-3 months. This is definitely not the case where I work now and in the city I now know where my husband has accepted his PhD offer, but it does exist. If you don't live around such hospitals or have the ability to move, then you may find yourself pretty limited in options. Good luck with your decision.

That's terrible. As part of the healthcare team, we are supposed to also "check and balance" each other. That requires asking questions (and being willing to accept someone questioning you). Egos just get in the way.

I think you're getting some great advice, so I just want to add one small point. It's rare that I have heard a doctor say "don't call me" and rarer that it's been something stated negatively (i.e. I have no problem with a provider reassuring the newer nurse that, no, you don't need to call me at 0500 every morning when the labs result with the critically low WBC count, for the patient whose admitting diagnosis is febrile neutropenia). When these 2 things do happen, I take it as an order...and write it as a verbal/telephone order. If I think that my not calling him/her about X might cause a problem, then I make sure that they understand that I'm taking this as an order that will be documented as such. "So your order is not to call you about X. Are there any parameters you'd like me to include with that?" That tends to get someone's attention. And if not then I keep going with "well, I anticipate ___ might happen, would you like me to call you then?". Obviously this is not for every little issue, but if you feel like there might be a potentially dangerous issue developing then I see it as an important part of advocating for your patient. Worst case scenario? If your patient is deteriorating, then one benefit of calling a Rapid Response is that it gets the attention of multiple other people that may (or may not) agree with you. It's sad, but when I worked the floor I did see nurses that had to go "over their doctor's head" with a rapid response to get taken seriously (and their patient taken care of). Well, so much for keeping this short.... ?

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.

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!

The program I did my RN to BSN was do-able in 2 fulltime semesters. It is Fort Hays State University in Fort Hays, KS. It's a brick and mortar school that has their RN to BSN program online. One very attractive feature for them is that your tuition for the program is the same whether in state or out of state, and it's very inexpensive. If you had all of your pre-reqs Gen Eds done through your ADN, it was only required to take 30 hours. I only had to take 1 additional class -- Chemistry. I didn't push to do it in 2 semesters but if it had been a priority for me to do so, it definitely could have been done. Someone was showing me a fully online RN to BSN program that can be done in 2 semesters as well, and it saves money to do so because they charge a set rate per semester, whether you're taking 1 hour or 20. I think it was GCU? I don't remember, it was one of the well-known online ones. I remember that it would cost ~$7,500 for the program if it was done in 2 semesters.

The curriculums are the same, just on a different timeline. People straight out of high school tend to gravitate to the BSN programs, especially if they have any kind of financial help, while those that are non-traditional students (*hand raise*) tend to bridge more so that we can start working faster. Granted there are certainly other variables such as what type of programs are in your area, competitiveness, etc. Some LPN or ADN programs have different/more prereqs than others but you'll end up taking all of them at the BSN level anyway. It is very easy to find programs where you can bridge RN to BSN that are fully online, making it much easier to work and go to school fulltime than if you are attempting to work FT while taking traditional classes and clinicals FT as well. The classes in the RN to BSN bridge program aren't ones that I would consider to be helpful on the NCLEX because they're mostly administrative, research, ethics, etc so I don't feel like there's a disadvantage to taking the NCLEX after the ADN vs the BSN. The only other differences are just facility and faculty specific. Do be aware that there are some highly competitive/saturated locations where it's difficult to be employed with an ADN, that would be another thing to consider in your decision making.

I'd reach out to the community colleges in your area to ask about how competitive you'd be there, and/or what would need to change to make you at least minimally competitive. If you don't get the answers you want, and this is something you really want to pursue, then I'd recommend moving to somewhere that has less competitive programs. I'm out here in Kansas and we have lots of options. We also have lots of job opportunities if you wanted to stay afterwards. I've moved around a bit in the state, anywhere from medium-sized (for Kansas) college towns, tiny rural communities and even our state capital and have yet to find a place where there are not multiple (if not copious) jobs available, of every flavor and variety. My initial GPA prior to deciding on nursing school was abysmal. A few years later I went the CNA/CMA-LPN-ADN-BSN round and never had problems with my previous GPA because my more recent pre-reqs were all As (though I had at least 1-2 Cs in pre-req classes from the first time around in school, that I didn't retake) and my nursing school grades were all As and Bs. I echo what others said above about not putting your eggs into the "accelerated BSN" basket. They're going to be intense and presumably more difficult to get into unless you find a super-expensive/sketchy for-profit program. Good luck in your decision.