hakunamatata

I could use some serious help and appreciate any responses. I am a visiting hospice nurse and have a patient at an ALF that has a now Stage III clean pressure ulcer. Multiple issues - no one seems to know the best treatment, and I cannot for the life of me get a dressing to stay on. He is incontinent of B/B. The wound is 2x3cm, showing some white slough but clean. Depth about 1cm. We have been packing with calcium alginate, but my instincts are against this, as there's really no drainage or moist areas. I've tried bordered gauze dressings, cutting Tegaderms, securing with retention tape, nothing is working and I have no idea what I'm doing. I can only get there 3-4x a week at the most, I'm wondering if I should just recommend that he go to skilled? I am the only person that can dress the wound, and he is very non-compliant about turning himself in bed and eating the right diet, and the ALF is not much help, as they're not staffed to take care of things like this. I feel like an awful nurse because I know with these circumstances, he's just likely going to get worse. My other nurse recommended medical grade honey and a duoderm. Still confused on how to get these to stay on. I deeply appreciate any responses!

Hi there - I'm a hospice nurse/case manager and haven't had much bedside experience with pressure ulcers in years, and would love an opinion. I have a patient in ALF who has had issues with incontinence dermatitis on his buttocks/sacrum for awhile, and while assessing today I discovered that he now has the beginnings of a Stage 2 pressure ulcer at the very top of his sacrum. It is about the size of a pencil eraser and is showing a little bit of slough (from what I remember...that's what we call it ...). He is going to have to move to skilled if we don't get it healed in 2-3 weeks and there are numerous reasons I don't want that to happen. My MD gave orders but she seemed a bit unsure of herself, so I just want to double check that this treatment sounds appropriate for the patient's sake: pack with calcium alginate rope and cover with Tegaderm. My other RNCM told me to apply some gauze in between those for it to drain. Three to four times a week. Does this sound good? I know I sound like a nimrod, but I've been doing HIV research and then bartending for years now, and have been a bit removed. Appreciate anyone's input!

Hi all, I've been a nurse for almost 4 years now and started my career at a major Level I trauma/teaching hospital doing acute med-surg, that was back in 2012-2013. I then worked at a free clinic doing mainly clinical trial management and routine primary care for a year, and then worked again at a major hospital on a surgical oncology floor (with a lot of general acute med-surg overflow) for 6 months. That makes a cumulative 1.5 years doing general med-surg nursing - learned a lot, but last time I was in a hospital and using skills was December 2014. I am currently doing home hospice, and while it's definitely great and fitting for my personality, my company is about to close up shop. And I am ready to roam again soon, not get another FT nursing gig in the town I'm in. Looking into travel as the 'gypsy lifestyle' is already my thing, and I've been considering it since before becoming a nurse. I've talked to a few recruiters, some seem to think that they can get me an assignment with this gap, others are iffy. I'm of course more curious from a personal standpoint what I could handle, and if I need to consider staying in town and getting back into a hospital setting (I obviously would rather just go, and there's not a ton of options where I am). I am not concerned about my inter- or intra-personal fears and skills that come with traveling, but am hesitant on the technical skills and giving the best care to these patients right off the bat. Appreciate any thoughts and your time.

I have been an RN for ~3 years now in multiple specialties, and just applied to a PMHNP MSN program. I've always found that I love psych, although I'm not currently working in that. I actually got so exhausted with nursing that I went back to bartending two days a week, and work as an RN at an infusion center 2 days a week. I love both of my jobs right now, have a great life balance...I'm still young so having a lot of fun in my current lifestyle. For economic and lifestyle purposes, the PMHNP route makes sense to me. I've always been fascinated with psych, and of course, the salary and lifestyle will be a huge step up for me if this happened. However, the idea of school and not being 100% sure I want to do this is a bit scary. Anyone regret their decision to do this? I've found that most PMHNPs are incredibly happy with their decision. I'm really a "work to live" person in general, so I've never been set on "finding" my perfect career or anything. More or less something that pulls good income, allows me to have a life, and be OK with going to work each day (I will personally never "love" going to work!). Any feedback is appreciated!

Hi all, RN for over two years and just going back to bedside the the 12-hr shifts, scheduled to "rotate" (we get to pick, and usually works out OK). I am about to be off orientation and trying to decide the best way to schedule myself, and trying to figure out the sleep thing. Working a day schedule is so much more normal, but I am naturally a night person. I hate getting up at 5am-something...no amount of caffeine gets me through day shift, plus, our floor is of course crazy on days. I literally feel narcoleptic when I work most days, I'm falling asleep on the toilet, nodding off while charting. I can't help it. It is often a battle. Most of this is because I get such sleep anxiety about watching my alarm, and it's very difficult for me to fall asleep before midnight, and of course is difficult to function off 4-5 hours of sleep. The answer seems to be work night shift, right? I do love night better, it's chill, and I'm actually alert almost the entire shift. I like everything better about the actual work. Another plus is I'm back in school as a premed (whole other story), so night shift is great because there's typically hours of downtime for me to study. That's a big plus. The pay is another - we get almost a $7 hour night diff. I've got a lot of debt so that extra REALLY makes a big difference to me. Here is my qualm for nights: my sleep gets so ridiculous on my days off and I can't stand it. I do not have any interest in being up later than 4am, or being up at 4am. But my body cannot seem to sleep more than 3-4 hours throughout the night, no matter how much I try. I use way too many diff sleeping pills to try and correct myself to a sleeping schedule, and even do not those work. I've been dealing with insomnia since I was 10, so it's nothing new. Most people say that the morning of their last night off, they just sleep half time (4 hours), and then try to go to bed at a normal time that night (say, 11pm). I try to do this too, and I wake up wide awake after 4 hours of sleep, which I have no interest in. If I get up and try to do things, not only do I feel all depressed and screwed up, there's not much to do at this hour. And without fail, I'll get tired again as the sun comes up and then want to sleep during the day. I've even tried to use Ambien on my first night off in an attempt to sleep from 12am-8am or so, but I still wake up wide awake but feeling drugged at 4am!). My body is def not normal when it comes to sleep, I know this. So, are any of you similar? HELP! I'm trying to take advantage of it but it's just weird. I want to know how to return to somewhat normal on my days off. I've been up since 4am right now and still awake (it's 6:30), so I'm doing laundry and gonna go to yoga at 8am. But it feels like so weird, I just don't feel right! And then I'm guessing I'm going to be tired after this, but I have a dr. appt I scheduled at 1pm to go to, so no middle of day naptime. Arghhhh! Do I just start planning on sleeping in 4 hour shifts? Finally, I'm going to start going to school on T/Tr. I'm thinking once that starts, I'll work a day shift on Wednesday, and then do two nights on the weekend. Does this sound like a good idea or a failure? My classes will likely be 9am-3pm each day.

Hi guys! I have two job offers right now and due to scheduling, it looks like I'm going to take the job on a surgical-oncology floor at a big teaching hospital. I used to work general medicine at another major hospital and found it very stressful. I've heard surgical is still of course busy, but in a different way. What is it like day to day? Are most patients oriented, able to ambulate, continent, etc? On the medicine floor, many patients were not A&O, were incontinent, and I found this stressful (I'd never be an ICU nurse, cheers to them). I am not above helping sick people, however I do like to do a lot of talking (listening) and teaching, educating is one of my favorite aspects of nurses. I'm hoping the surgical floor would be a fresh change for me, as opposed to medicine. Or are they really not that different? I've always wanted to do oncology as well, so I'm hoping that helps to make it more specialized learning. The manager said it's a lot of ENT, gyn, and GI patients. If that helps. I'd love to hear from surgical nurses what they think.

I have two job offers on the table, and having a dilemma. One is a *great* job and is 4 10 hour shifts, M-F, no weekends or holidays (so, one random weekday off each week). The other is still ok, not as great sounding as first, and is 3 12's, and self-scheduling. Weekends once a month. I can't decide which to choose - I know 4 10's and no weekends or holidays sounds super appealing, but not as much to me. I like to travel and get out of town for days at a time, and I still couldn't do this with the 4 10's, because only once in awhile would I have a Monday or Friday off. Still not a long time either. The beauty of the 3 12's is that it is self-scheduling, so I could have tons of days off at a time if I wanted. Weekends off of course are a great thing, but I don't care too much about working holidays. Someone give me your thoughts! Please!

Agree with all the other posters. I'm from Louisville and I'll tell you that Nashville is amazing. I just started over as a young, single person in Charleston, and I'm happy I decided to move for lifestyle. You sound a lot like me. I also went to a city I didn't love for a prestigious job, hated the city, never felt at home, and lasted a year. BLAH. Oh yes, and I feel the same way about Baltimore as you do. Barf. Be happy outside of work. You will probably be working 3 12's too, correct? So do you want your four days off to spend in a town you like, or a town you don't feel at home in? Also, Hopkins is amazing, but you don't want a job where people buy into names anyways. You will get hired where you want to be in the future because you are intelligent and compassionate. Trust me when I say names from schools or hospitals don't make or break it in nursing. It's a sincere field where people want those who are caring and a good fit...not because they came from a fancy hospital (but you're right, it doesn't hurt). Nashville or bust! And go to the Kentucky Derby one year Seriously though, all the best in your future. You sound like you're going to be great wherever.

Need help folks: have two job offers, and while it sounds crazy, I am likely going to pick based on schedule. Both jobs seem great and do-able to me. Job A: 3 12-hr's, self-scheduling. Job B: 4 10-hr's, M-F, a random weekday off each week. No weekends or holidays. I get that a lot of people would say Job B immediately. But there are no long stretches of days off for travelling, and that's my passion. I'm young, single, and love to get out of town for long weekends, or even stretches of time. It seems like that is impossible with Job B without eventually running out of vacation days. Job A would allow me to take 4-5 days off at a time, a decent amount! The other plus with Job A is I could get a PRN job as well and still not feel like I'm working all the time (I've done this before and loved it). Lastly, Job B seems a lot less stressful than Job A. Job A is returning to floor nursing, but a surgical oncology floor. I'd learn a lot if I want to become an NP one day. Job B is the OR...which has always sounded awesome to me. I think I'd be great with the patients, and the team. Hopefully I'd deal with the docs fine. HELP! I can't DECIDE!!!

Hi there! What a post So the first thing I thought was...huh? So she is a staff member at Floor B? It seems like if it was a decent place, you'd automatically accept a job offer there, since that's your "home". Is there something about it that turns you off? I only act surprised because I feel like you'd just accept it immediately if you were happy there, correct? Anyways, it sounds like you wrote your pros and cons list to me in this post! Also it sounds like you just need someone to reiterate what you already know in different words to help you choose, haha, so here I go though ("going with your heart" is not the advice you're looking for, I assume!): Job A: Seven patients seems like a LOT. Especially for this environment. Sounds like you'll be where you want to be though, and sooner than later. A supportive manager and staff can make all the difference. But seven is a lot. Seems wild. Job B: First thought was that every other weekend is a lot! But you're already here...if you like it and your team, why wouldn't you stay? The pay is higher as well. Of course money is not everything, but we live in a capitalist society and money DOES help make life easier (especially when you're trying to go back to school ). That differential adds up to almost 6,000 per year more (minus what the feds take). That's a big deal! Also, don't let the two new grads that couldn't catch on stop you. You sound incredibly intelligent and mature, and you will likely excel in whatever you do. You're smart to think about your future - what does give you more critical care experience? If you're really, truly serious about being a CRNA, I would advise going to whichever unit will give you more experience with drips and such (not an expert on the pre-reqs) that you need to have. It sounds like you do have a tough decision, like I said, I'm in the same position as far as deciding which job based on which schedule. If it helps you feel better, you sound like a smart gal who is going to make whatever she wants happen for herself. Don't stress too much - that's why you have two positions instead of zero - you're in a not bad spot.

I have been an RN for 2 years now, just relocated to SC and I luckily have three offers that are all very different. My experience includes acute medicine (at a major teaching hospital), psychiatry at a few different places, home health, and clinical research. I have three offers now and all seem to have major pros and cons, and I'm completely stuck. I'd love some experienced nurses opinions if they can offer. I did med-surg right out of school on the craziest floor of the hospital and I was not a huge fan. We had super sick people (tons of rapid responses and codes) so it was really hard in all ways, hated working nights- however, I loved the camaraderie and working 3 12 hour shifts and the flexibility (I love to travel so being able to make my own schedule with 4 days off was amazing... I did a lot). I also loved psych, I felt like generally it was an easy job with low stress levels (not always, but personally I'd just rather handle a psychotic person better than one coding). Jobs I've been offered: Surgical-oncology floor at a major teaching hospital (schedule is 3 12's) Psychiatric charge nurse at independent mental health facility (schedule is 3 12's) Ambulatory outpatient OR in major teaching hospital (schedule is 8 hrs M-F) I am new to this city and would love a job where I could possibly even make a social circle, but it's of course not my biggest priority. As far as schedule, I was never a fan of working 5 days in a row, and up early everyday. I really like 3 12's and the flexibility, and I don't really mind working weekends or holidays (I'm weird, sometimes I like it). Another benefit to this schedule is I would likely pick up a PRN job and try to make extra cash. I used to do this my first year of nursing and it was not bad at all, as I'd still have a couple of days off a week if I picked up a shift or two. At a M-F job, I likely wouldn't get a PRN job, it's too much. I would love to learn oncology and the hospital environment sounds the best for me socially. But, if I hated med-surg, I'm not sure if it's the best idea I go back to this. I've heard surgical floors can be just as hectic, and I don't want to get two weeks in and just want to leave. However, I'm a more mature nurse now and have great time management, so I think I may handle it better. The psych job sounds great for the hours, and I love psych, but I personally feel like it can get redundant. I also don't feel like I could transfer laterally or upward from there...I'd just do it until I wanted to do something else. The ambulatory OR sounds amazing as far as work environment. I like the fast pace, but I do like the more repetitive tasks and knowing what I'm getting into each day (I know all days can be totally different, but to me it doesn't seem like the same type of surprises as floor nursing). However, working M-F and five days in a row and up early just doesn't sound appealing...yes, I'm strange. I know this is also hard to break into without prior experience so I feel like I need to jump on the opportunity. I'm very torn - I'm sorry for the long post. If anyone works in these specialties, especially ambulatory surgery or surgical oncology floors, I'd love to hear how your days go and what you think. THANKS so much!

Hi all, needing some advice from those who know their stuff. I am an RN, have been for about 2 years. Did 1 year in acute care in a hospital, hated it; then got my dream job in clinical research. I run pharmaceutical trials in a small office in San Francisco and see about 2-4 patients a day; I do physicals, blood draws, and generally talk to them about their health and symptoms/medications. It is perfect for me because I have always loved medicine, I do love being a nurse, but I don't do well in hospitals (I'm a wimp, I'm aware). Anyways - my doc and I end up doing a lot of primary care simply because part of our job requires it, and then many of our patients are uninsured so we sort of take care of them as we can. I absolutely love the primary care part of my job, and I've come to find out I'm quite good at it (like I said, I can relate to medicine more than my nursing skills). Thus, I'm considering the possibility of going back to school for Adult/Gero Nurse Practitioner. I do not want to work for my particular boss forever, so I'd either continue to work in clinical research or go back to school. I've still got a ton of debt from two undergrad degrees, so finances are my most concerning point, but then the career in general. Research does not have a lot of cons for me so I don't want to end up having mass regrets. I am however confident that I'd be a great practitioner and would be very happy with the work. Any opinions or advice in general would be very helpful. Especially when it comes to how to work and manage school, and what people's advice is there. Thanks so much

Ha! That's what my gut is telling me. Your response is super helpful :)

Missouri isn't awful. I have been a nurse for 9 months and working two separate jobs, a full-time and PRN position. Not in my ideal location, but made a crapload of money, and now my experience has me relocating to where I want to be.

My referral e-mail wasn't, unfortunately. Boo. It seemed to good to be true! Very happy for all that got positions though - how exciting and congrats! :)