jorjaRN

Another vote for at least 3 in a row here. I actually do 6 in a row...and I love it that way-sure, I'm exhausted by the end, but having 8 days off in a row, and not having to "flip-flop" is great. Ultimately, however, I think you have to do some experimenting and figure out what works best for you. Some of my co-workers hate doing even 3 in a row-most of them think I'm crazy. If you decide you want to try doing a long stretch, I would recommend starting with three, working your way up to four, and seeing how it goes from there. The key is getting good sleep during the day-I'm home by 8 most mornings, eat some cereal, read a little bit, and usually turn off the light by 9:30, and I sleep until 5:30. It helps to live really close to work. As far as the PP who asked about noise reduction-a fan is your best friend. And turn your phone OFF (or on silent)-not on vibrate. I also have a dark colored blanket hung over my window to keep light out. I never have trouble sleeping-I actually sleep better during the day than I do at night. Hope that helps, and good luck with the beginning of your career in nursing!

Hello Everyone, I'm hoping for some input regarding looking for jobs and how to handle notifying current coworkers/management. A little background: I went to college about 3.5 hours away from my home town, met my boyfriend there, and planned on remaining in that area when I graduated. Unfortunately, after searching for over eight months, I couldn't find any employment in the area. I moved back home, got a job at the hospital here, and have been working here for a year on a telemetry/PCU floor. I actually LOVE my job, my coworkers, and really respect my manager. If this place was 3.5 hours north, I'd be happy to stay there indefinitly. I've been working six twelve hour shifts in a row, so I have eight days off in a row-which I use to drive up to my boyfriend's house (so right now, I'm driving 3.5 hours every week-either there or back). Just FYI-he has a great job and owns a house, so he won't be relocating. Now that I have a year of experience, I'm hoping to find a job in the area I went to college/where my boyfriend currently lives. I'm aware even with experience, it might take a while, and I'm fine with continuing my current routine for as long as it takes-just want to get things rolling now. So my questions are: 1. I had been planning to wait until I had some definite interviews/things were a little further along in the process to let my manager know that I was looking. She's been supportive in the past for employees leaving due to relocation (telling them they should contact her if they ever come back to the area and are looking for a job, etc) as well as employees who accepted positions at local hospitals. I know the prevailing wisdom here is to wait until you have a definite offer to let your boss know, but I feel like I owe it to her to give as much notice as possible. Also, several applications have asked for contact info for my current supervisor, and I'd like her to be aware that she may be getting phone calls/e-mails. So do I tell her now that I've filled out applications, or wait? 2. Several applications have asked for professional/peer references. I've tried to keep in quiet that I'm looking, but several of the co-workers who I'm closer to know that at some point, I would be planning on trying to find a job closer to my boyfriend. Who would be the best people to ask to serve as references? Right now, I'm thinking two of the charge nurses I work with, as well as a girl that I'm close to/was hired with. Sorry this is so long...but felt like the background was relevent. Thanks so much in advance for your input!

I'm pretty much the same as others here. I usually eat something light when I wake up around 5pm, sometimes it's part of a full meal if my family is around and cooking. I never have had a big appetite right after waking up, so I'm usually not too hungry before work. I keep some granola bars, crackers, stuff like that in my locker, in case I get hungry before my "lunch" break. I usually eat between 1am and 2am if I can, simply because that's halfway through the shift. When I get home in the morning, sometimes I eat a bowl of cereal, sometimes I'm too tired to do anything other than crawl into bed.

I agree with PP. You need to write them up, especially if this is something that is happening repeatedly. I know it feel like "tattling", but this is a patient safety issue, and there could be factors influencing this pattern other than the nurse herself that need to be addressed, and there's no way that's going to happen unless you go through the proper channels to report the issues. I know it's hard, but try to remember, you're reporting the incident, not the person.

I feel your pain...it took me months to find a job after graduating in May 2009, and I had to relocate even then. There are many, many threads already started on this site with a lot of great information and tips. I suggest doing a search and using them as a resource. Good luck!

First of all, no, it's not wrong at all for you to be afraid of those who are dead or dying. Yes, death is a part of every person's life, but it is not something that people normally have to deal with on a regular basis, so it's completely understandable to be intimidated/afraid of being so intimately involved in the process. As far as the details concerning a death go, it largely depends on what setting you are practicing in. For exaple, working in acute care, you may be experiencing more unexpected deaths than in long term care. Where you practice also probably dictates what your role in post-mortum care will be. I think this also varies alot depending on the facility. Where I work (in acute care) the nurse and PCT take care of cleaning up the patient, family is given however much time they want with the body, and then the funeral home comes up with thier stretcher to take the body (if they are a non-autopsy case...if they are, we take them to the morgue after the family has had their time). For me, the most important thing I can tell you is this; the majority of people who have passed away while I was involved in thier care are at the point where thier life has reached an end. This includes many elderly people who have lived full, happy lives, but also younger people who have had horrible accidents which essentially ended thier lives the moment they happened. Many of these individuals have DNR orders, but even those who don't, at least I personally have felt thier lives have reached an end, and that death was the natural outcome. Many times, thankfully, the family has realized that this is the inevitable outcome. As a new nurse, I have been involved in very few code situations-none of which were completely unexpected. Taking care of these bodies is really not much different than taking care of a totally comatomse patient, to be honest. In general, they are not cold or stiff, and you're perfoming the last act of care that you can, and bringing a great deal of comfort to the family.

I appreciate what you're saying, and agreee that people who whine because they can't get a job in L&D or ICU right out of school are ridiculous, but the reality is, many new grads have been unable to find work of ANY kind. Personally, I applied to multiple positions at the VA hospital, and never received a call back for any of them. Camp nursing, prison nursing, clinic nursing all want nurses with experience. Many of these positions require a nurse to be the sole medical professional on site, so it's not a great place for a nurse with no expereince, regardless. The current economic climate has placed many nurses with years of experience either out of a job and looking, or back in the job market after retirement, most places will hire those nurses over a new grad any day. New grads of the past several years are up against a lot of obstacles that the classes of new grads before us did not have to face. My roomate in college graduated one year before me, and she was upset that it took her until the following September to get a job (in NICU, her preferred specialty). The class before her all had jobs lined up, most in specialty areas, before they graduated. That was the reality when we started nursing school-that's why people had the idea that when they graduated they would be able to quickly find a job in a specialty area. I think we've all had a rude awakening. Trust me though, most people who don't have jobs after 15 months of looking ARE looking everywhere possible, they're just not getting called back, much less hired.

Two things come to mind for me; the air at my hospital is so dry, that by the end of 12 hours my lips are chapped, and the inside of my nose is incredibly dried out, and I bet that could cause headaches. Also, I notice when I'm stressed at work I clench my jaw, which could definitely cause a headache if you're doing something like that for 12 hours...or even only 6. Good luck...hope you figure it out!

It's absolutely about location...I spent about six months looking for a job in the mid-atlantic (and I mean, pretty much the entire region...applied everywhere from DC to New York). I finally realized that I wasn't going to find anything, and even though my goal for all of college was to get a job/live in a city right out of school, I moved home to my small town in southwest Virginia and got a job that I really enjoy in a mid sized community hospital. I know relocation is NOT realistic for some, but if it's at all plausible, my advice would be to look in more rural areas, and at community hospitals that may not be quite as saturated with new grad applications. You might be surprised by the oppurtunites if you look 30-45 min. outside a metropolitan area. Good luck, I know it's tough, but hang in there!!

We had the same policy at a hospital where I worked as a PCT while I was in nursing school, at the hospital I work now as an RN, we have the RRT system, but to my knowledge, patients/family aren't able to activate it. I thought the exact same things you are thinking when I realized the fact that patients or family could activate the RRT at my old hospital, and I even asked some of the RNs if it was a huge issue, and surprisingly, no one had any problems with patients using it inappropriately. I think the key was explaining that it is only to be used for life threatening emergencies/changes in condition that they feel are not being adressed, and that it will be taken very seriously if that system is used for something that could have been adressed by the nurses on the floor, or a non emergent situation.

I work on a telemetry/PCU combined floor, and we do staffing together. Usually at night, we have 5 RNs on tele, 2-3 for PCU, no aides, one clerk for both sides. During the day, I think they have 6 RNs on tele, 3 on PCU, 3 aides and a clerk for both sides. Of course, this all depends on the census, but they wouldn't ever leave an RN alone on the floor-if for no other reason because we have too many drips and stuff that need to be double checked/co-signed.

I actually laughed out loud when I read the subject of this thread. Why don't you try getting some finance majors on board, maybe you could get a class action suit going.

I can't be 100% sure, because it's been a while since I had one leave AMA, but I think the paperwork we (attempt to) have them sign says something about "the possibility that insurance will not cover the cost of this hospitalization, or subsequent hospitilizations resulting from refusing care" or something like that. Of course, most of the time they "threaten" to leave, once you set the paper in front of them, they decide the warm bed and free food aren't so bad after all, even if it doesn't come with all you can eat narcs.

I've also never worked ICU, but I work telemetry/PCU in a medium sized community hospital. I've never worked as an RN anywhere else, so I can't really offer a comparison, but overall, I've had a great experience at the hospital where I work. I actually thought I was going to hate it when I started there, as I only had experience in clinicals and working as a PCT in larger teaching hospital. I thought the physicians were going to be difficult to work with, and practices were going to be out of date. I wasn't completely wrong about that, but for the most part, our hospitalists are great to work with, and although there are some things I find a little "backwards" there have been so many great things as well. The people I work with are great, and it really does feel like a family, since it's so small, you get to know the people on your unit, as well as elsewhere quickly, and everyone has been so friendly and welcoming (granted, it is the south, too :) Also, especially at night, we have very little that we delegate. We don't have an IV therapy team, we do our own EKGs and lab draws, just to name a few. I don't know if it's true in every larger hospital, but where I worked as a PCT, there was support staff who usually did most of that. There also obviously aren't any residents, so RNs assist physicians with alot of procedures, and I've gotten the oppurtunity to learn alot from our physicians who enjoy teaching. As far as ICU, I know my hospital doesn't keep the most critical of patients, so that would be one thing to consider, but we do only have one ICU, so I'm guessing you would see a wider variety of conditions than in a specialized ICU. Also, I'm guessing there would be even more oppurtunity in the ICU for procedures and such that might be taken care of by support staff in a larger ICU. Anyway, to make a long story long, I'm really glad that I was "forced" to take the job I have now, because it's been great, and I think community hospitals are definitely worth considering. Good luck with your decision!

If the patient had a PCA, then they had to be pretty alert and oriented, because PCAs aren't prescribed for people who aren't aware enough to use them properly. In my opinion, in this particular situation, the nurse did the right thing by staying with the patient and offering some amount of comfort and worrying about going up the chain or command (which definitely should happen) later. It doesn't sound like this doc was going to wait around for the nurse to be there to do the procedure, and probably would have kept going even IF concerns had been voiced at the bedside. The last thing this patient needed at this point was a nurse and doctor arguing, or getting physically confrontational while the doc (most likely) proceded to do said procedure anyway. I also agree that patient's can usually be thier own best advocates, and the best thing we can do is educate them about how to advocate for themselves. After all, we can't refuse treatment for our patients or request a new doctor for them, they CAN do that for themselves though, and we need to make sure they know that. This post actually made me think of a very similar situation when I first started working. A doc did a debridement, or something similar (wasn't my patient) at the bedside. Apparently, this doc was "old school" and notorious for this type of thing, and nursing staff had been complaining for years about him, to no avail. Someone mentioned to this particulat patient, after this incident, that they needed to make it known how unhappy they were with his care. The patinet refused to see him again, went to the hospitals customer service department, etc. I'm not sure what the outcome was, exactly, but I know there were ramnifications for the doc. In today's customer service obsessed healthcare industry, the patients have far more pull then we do in a lot of situations.

I think med-surg is a great place to start. I worried that I would feel overwhelmed, based on how I felt in clinicals, and I was right. However, you're going to feel overwhelmed no matter where you start. If you have a good preceptor, and adequate orientation, you will develop a good routine that works for you. I work cardiac/PCU and I learn something new every day, and think I'm developing great skills and a good foundation of knowledge to build on. I agree that unfortunately, right now, you kind of need to take what you can get or you might not have any options. Good luck!

I worked two jobs while I was in school, one as a nanny after school three days a week, and for the last two years, as a PCT on a telemetry floor. I think the experience at the hospital was as valuable as anything I learned in class preparing me for clinicals, and my first nursing job. The other job, while not healthcare related was great for helping me learn time management. \ It's definitely possible, and I would go as far as to say that it gives you an advantage. Good luck!!

There are tons of great threads on here about strategies for adjusting your body and routine to work for night shift. I got a lot of great advice from them, and I LOVE nights. I would definitely give yourself and your body some time to get adjusted, but some people are just not cut out for nights. Most units that I've worked on have a list of staff that work nights that are interested in switching to days. I don't see any harm in putting your name down on a list like that if there is one, if you're sure that you are going to want to switch to days. It will probably take a while, and the sooner you get on the list, the sooner you will be able to switch.

Unfortunately, this kind of thing happens all the time. It's not realistic to place every patient that could possibly have some drug resistent bug on isolation until it is ruled out. There wouldn't be any patients not on isolation. I used to work in a facilty that placed patients in isolation on admission if they had any positive results on the records of previous hospitalizations until they were ruled out, but the place I work now doesn't do that. I took care of a patient not too long ago that had a recurring abcess that had been positive for MRSA previously. There was a culture ordered, and he wasn't on isolation until the results came back. Of course they were positive. I had been treating the room like an isolation room as much as possible even before that, because I figured it would, but it's about the money, and isolation supplies cost a lot of it. Honestly, I figure I've probably been exposed to MRSA and who knows what else multiple times by this point, and I try not to stress about it. Like others have said, there are people in the community coughing all over the place with who knows what kind of germs. I try to think on the bright side and figure I'm developing a killer immune system

It's funny that we're talking about the 6 PVCs in a row, because there has been some discussion on my floor recently about whether it's 3 in a row or 5 in a row that contitutes a run of V-tach. Not to highjack the thread, but what is everyone's opionion on that? On my floor, we have monitors at the nurse's station, and on each hallway, which are the same as the ones the monitor techs are watching, so we can go and look at whatever rythym the tech is calling about. They also give report to each other at shift change, passing along what each patients' "normals" have been, and what the nurses have been concerned/wanted to know about. I usually check with my monitor tech to make sure that our parameters match up at the beginning of the shift. Out procedure for any abnormalities is that the monitor tech calls the desk, and lets the charge nurse know if there has been a significant event or change. Usually the charge nurse goes to check the patient, or lets the patients' nurse know if it's not an overly concerning change (such as bradying down from the 70s to the 50s). If it is an event such as a run of PVCs/V-tach, a pause, conversion to a-fib, etc, They print a strip of the event and send it to the nurses station. We then look it over, measure it, and decide if the doctor needs to be notified. All of these strips, as well as the daily "sample" strips of the patients' normal rythym are kept in the patient's chart, so comparisons can be made.

Just don't start with asking about your benefits or how soon you can take time off :)

When I worked in nursing school, I was a SNE (student nurse extern). To put it simply, you're daily routine, and scope of practice is that of a PCT. You're mostly helping patients with ADLs and assisting the nurse within the boundaries of your scope. Daily routine involves toileting, turning, bed baths, linen changes, feeding, vital signs, blood sugar checks, and a hundred other little things :) You should be trained in exactly what is expected of you before you start. Where I worked, everyone also made an effort to involve me/explain when they were doing things like trach care, suctioning, NG tube insertion, foley insertion, etc, as well as any "cool" procedures the docs did bedside, which was the difference between a SNE and a PCT. Congrats on the position, you learn LOTS of great stuff with a position like this that will prove invaluable for you in school, and as a nurse.

Although I agree that six weeks probably isn't enough, it's what I got as a new grad. I did start on med-surg (and I know it's the same for other floors at my hospital), so I'm not sure if that's the norm for specialty areas. Many hospitals have new grad orientation programs, which are different than regular orientation in that they last longer, and are more focused on transitioning from school to real world. In the past, this was the primary way new grads got to start in specialty areas. Unfortunately, a lot of hospitals have either been cutting way back on the number of people they accept to these programs or cut them completely in response to the economy in the past several years. I was fortunate, and got a great orientation with the six weeks that I had, and was assured that I could have extended my orinentation if I felt it was necessary. I still ask LOTS of questions of those around, and am lucky enough to work with a great team who never mind helping me out. The advice I would offer is; if you do end up in a specialty area (which is pretty difficult, though not impossible) out of school that isn't associated with a new-grad program, ask when you are interviewed about their policy for extending orientation if necessary. Any place worth working for won't force you to be on your own before you feel ready. A little anxiety is normal, feeling totally unprepared and overwhelmed is not. Good Luck!

First, sounds like what you said to the visitors was perfect to me. In the facility where I work, the visitors are informed that they need to wear all of the proper PPE in order to enter an isolation room, for thier protection, as well as that of any other patients they might encounter while they are in the hospital (hallways, cafeteria, etc). We have restricted access for young children under these circumstances, especially within the last year with H1N1 (when children under 18 who weren't patients weren't allowed in the hospital at all). If it become a recurrent issue with visitors repeatedly refusing to comply, security has been involved. 99% of the time, it's not an issue, and once given an explanation such as the one you gave, visitors are cooperative with PPE. Secondly, if the patient was alert and oriented, he absolutely should have been informed of the possibility of a complication such as c. diff. I can see where it would get overlooked if it was just something they were ruling out, especially since it seems like anyone who has diarrhea gets checked. However, wasn't he wondering why all the staff were wearing a gown and gloves to come into his room? Unless there was some reason he wasn't informed, he should have been filled in about his condition.

If you can afford to take the pay cut, I would absolutely recommend the hospital job. With the current market for new grads, your best chance of getting a good job right out of school is to have clinical based experience outside of your school clinical hours. Also, the experience you gain working in a hospital will prove inavaluable to you as you work your way through nursing school. You will have a leg up on your peers who lack experience in the hospital setting as you will be familiar and comfortable on a nursing unit. If it is an option, you could look into going part-time at your current job, and working a day or two a week at the hospital. If the program offering you this job is geared towards students, they are generally very understanding of a variable schedule. Best of luck to you!