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Has anyone successfully pushed back against hourly rounding against management? I've been through mandatory "sim labs" on hourly rounding that take 20 minutes per nurse to hit management's entire script, managers checking that our whiteboards are updated and the patients are happy during every shift, and frequent reminders about hourly rounding during daily safety huddles. It's too much. Management seems to believe this is the magic fix for our poor HCAHPS scores--I believe the numbers never going to improve so long as we are understaffed, only have semi-private rooms, and really inflexible food service. How have you pushed back?

I went to nursing school in CA, but before I graduated my husband took a job on the East Coast. I've seen it both ways. In the community hospital in the SF Bay Area I trained at it was 4:1 for the tele floor, and only 1 CNA to cover 30+ patients. Where I work in Virginia, it's 5:1 in an Intermediate Care unit, with one tech covering 8-14 patients. It definitely feels unsafe when I'm running high risk drips (Cardizem, Heparin), pushing a lot of IV pain meds, etc....but it is sooo nice being able to rely on the techs for all the lab draws and assistance in turning/cleaning patients.

As a new nurse, working in a step-down unit, can I tell you how relieved I am when the peds nurse from my son's pediatrician's office calls me back? I am so grateful for her wealth of knowledge and willingness to work for less money in an out-patient setting. She's gotten me to come in to the office when I didn't realize he needed it (impetigo) and called in Rx to keep him out of the office for other stuff (conjunctivitis). It certainly helps relieve the worry I occasionally experience as a working mom sending my toddler to daycare.

Thank you all for your posts! I've been orienting the past two weeks; most shifts have been in dedicated classrooms to teach us Epic, ECGs, etc. I was pleasantly surprised to find a dedicated lactation room near the bathrooms at the training center. I'll second the comments made about having a hospital grade pump making a difference. I was an exclusive pumper and rented a Medela Symphony for seven months--I loved that it was so quiet and automatically shut off after 30 min (sometimes I would fall asleep while pumping). I also have a Medela Pump In Style (that's what insurance would cover). Although it was a dual pump like the Symphony, it was much louder and made it harder to forget I was pumping. However, the PISA did make pumping in the car and even on a plane possible. Agreed, pumping bras are awesome! I also learned from a RN/IBCLC that you can rinse your pumping parts, put them in a ziploc bag and store them in the fridge and reuse them a couple of times before washing. That was a HUGE time saver. After all this, I've decided it's time to stop pumping. Baby is 10 months old, I'll be working 12 hour DAYS on a busy step down unit where patients have your phone #, I'll be commuting 45 minutes each way to/from work, and I was only getting 5 ounces a day at best. It just seems like the right time to stop. However, I feel much more empowered to pump at work when we have another baby. I'll take your advice to heart and consider switching to nights and see if 8 hour shifts are available.

I'm a new grad, but took a year and a half off for pregnancy/raising a baby. I'm starting a new job in a step down unit and have been exclusively pumping for the past 8 months (baby is 9.5 months old). My supply magically tanked when I got the job, I went from 24 oz to 10 oz...if I'm lucky. I'm now at the point where I'm OK if I only do 2 pumps a day and I don't resent formula like I once did. But I still feel incredibly sad that I might not make it to my one year goal. I don't feel comfortable asking for time to pump at a new job at a busy unit with high acuity patients (vents, central lines, etc). My commute is far enough that pumping in the car to and from work seems reasonable. Anyone have any experiences with pumping or weaning with a hospital job? Most RNs I know have no idea that the ACA now requires employers (with 50+ employees) to provide a pumping room and adequate time to pump. The nurse managers I interviewed with know I have a baby (and great daycare) but I didn't dare bring up pumping during the interview. Thanks!

Jessica-- Normally I'd say you have the right idea to get the books now! BUT SFSU is actually changing their whole academic program starting with your cohort (example: Med Surg will be in the final two semesters instead of just the second semester). It is very up in the air right now what your books will be as well as how many units you will have your first semester to calculate the total cost of your tuition per semester. Hang tight for now. If it really bugs you that you're not doing anything, start reading Nursing Interventions & Clinical Skills by Perry/Potter. No guarantee that you'll be using that book in the first semester like we did, or that you'll even have Skills Lab during the first semester, but it was always referred to as "the bible." We also used Calculate with Confidence--we were expected to do that book on our own to be prepared for a math test every semester. Don't know if that will change. Other than that--congratulations on getting in and starting your new adventure! I recommend starting a new thread on allnurses.com for your Cohort....

A new battery for your laptop--in case you're to far away from a plug during class. Plus, you don't have to kill a tree if your prof posts their power points online. An iPhone--great for recording lectures, looking up lab values on the fly, setting reminders, and keeping track of your schedule.

I had a 2.5 GPA with my first degree, too. Pulling mostly As in my pre-reqs, becoming a CNA, and volunteering over 400 hrs at two different hospitals (and getting great letters of recommendation) made a strong statement that I was now a serious student, and I was admitted into a BSN program. I continued to prove myself by getting a 3.8 my first year of nursing school; hopefully this will help me get into grad school one day. Seek out programs that calculate your GPA based on your last 60 units, not your total college GPA. Associate Degree programs in my area (California) have significantly lower overall GPA requirements, too.

Will you have to work more than one shift per week? How heavy is your load? My nursing school requires us to take classes in a specific pattern--all students are taking the exact same 15 units the first semester. It was on par with taking anatomy, physiology, and microbio all in the same semester. You may want to hold off accepting that job until you're aware just how intense school is going to be.

Here are the "stories" I made up for my med-surg exam: CA is the abbreviation for California. How would you rate the weather in Calif., out of ten? 8.5-10.5. Ca++ 8.5-10.5 There is an inverse relationship between Calcium (Ca) & Phosphorus (P). How to remember it's these two: CaP Na: 136-145. I just think of hypertension and the relationship to salt. 136-145 (systolic) is prehypertension & stage 1 HTN. K+: 3.5-5.0. No easy way to remember this one, but it's the most important electrolyte to know. Potassium is mostly inside the cell, and sodium is mostly outside the cell, which is why the numbers are so different for serum values. Hope this helped!

It had some good ideas, but was a little older. My instructors are able to post all powerpoints and docs online for us. A 3 hour Med Surg lecture can easily have 120 slides-- I'm not about to print that out and put it in a binder. Instead, I bring my laptop to class to take notes. I use my iPhone to record the lectures, then play them back when I'm driving. I also use quizlet.com to make flash cards (you can share them with classmates, too!)Try to embrace technology now...you'll be using it frequently in the hospital.

Don't believe everything you hear from an employee at a very expensive private school...they have other motivation$. I'm in the SFSU program. Degrees outside of nursing are taking a long time to obtain because everything is impacted. Nursing is different. Your spot is reserved for all nursing classes. If you have all of your G.E. done prior to starting nursing school at SFSU, there is absolutely no reason you can't finish in 5 semesters. There is a Segment III Upper division requirement you must do in order to graduate...it's 9 units you must take after you've completed your first 60 units. Most SFSU nursing students opt to take them in the summer time when they don't have nursing classes. It could be fair to call that a "6th" semester, or you can take those courses when you have a lighter load, say level 4 or 5 (4th or 5th semester).

"Commit to the stick" is still stuck in my head. We practiced on oranges, hot dogs, and then finally in check offs did saline into our partner's abdomen. So only one person got to stick you--not bad. A few weeks later we gave each other flu shots at clinical (supervised).Shots aren't that bad compared to a fellow student attempting to start an IV or do a blood draw (final skill we did first semester). When your partner is digging around to find your vein--that hurts!

Yes. Main campus does require white scrubs at clinical. Main campus also requires scrubs during lab time, but allows any color/print. The Canada/Sequoia instructor does not require scrubs during lab. After completing the second semester everyone gets to wear colored or print scrubs.

Hi Nugget, The first semester is insane! I was in class or at the hospital four days a week...the other half of our cohort opted for six day a week schedule. Typical schedule: Tuesday: 8-11 Pharmacology lecture 12-2 Health assessment lecture Wednesday: 8-11? (maybe 12) Skills lab Thursday: 12-4 (maybe 5?) Skills lab & Health assessment lab followed by a loooong evening at the hospital writing a care plan (I feel like I'm forgetting something on Thursday) Friday: 6:45 AM - 3 pm ish Clinical (at the hospital) You will enter a lottery at during the Canada/Sequoia orientation. Based on your lottery number you can pick your clinical instructor, which will dictate if you have Monday clinicals (and are at the hospital on Sunday doing care plans), or Friday clinicals (my schedule above). Your lab time is also based on when your clinicals are. Keep in mind you won't be starting clinicals until mid semester, your first semester. The sooner you prepare your family for the fact that you won't be around a whole lot and might be a bit of a zombie at times, the better. Some of my classmates have young kids and have proven it can be done, but it is HARD. Thankfully you will have the entire week of Thanksgiving off. There is also a 5 week winter break, so you can truly unwind. It does get better, too. The second semester is just 2 days of classes and one clinical day. Best wishes!

**Note to all: this is about the SFSU Sequoia/Canada program only.** There are some big differences compared to main campus. Hi KLJ, We follow SFSU's academic calendar, so classes start 8/31/12. Academic Calendar - San Francisco State University There were several different orientations. There's a general campus orientation that SFSU will send you information about and encourage you to sign up and pay for. It's not necessary--it's mostly a tour of a campus you will never be at and registering for classes that you won't be able to register for yet. This is followed by the nursing school's orientation at main campus (on a different day). It was on July 28 last year. They have some good info, but it's largely directed at main campus students, so many things they told us didn't apply. You will need to go to this--they'll go into detail about your physical/vaccinations, etc. The Sequoia/Canada orientation was a week later, August 5th. You will get to participate in a lottery to partially pick your schedule. We met some of the instructors, some of the students a year ahead of us, took photos for our IDs, and took a tour of Sequoia hospital. After this date, you will be able to officially register for classes. Fees: Yes, it's $300/unit right now. This could always go up. Because our program is through the College of Extended Learning you won't be paying other fees like "health services" that main campus pays for. The book bundle is waaaaay over priced, about $600. I bought all my books through Amazon for about $250. If you'd like a list of the books we used first semester so you can buy them in advance, just ask. Supplies--Medical Supply kit is only available through the Canada bookstore. It costs $150 plus tax. Can't buy most items on the open market (syringes, catheterization kits, etc.) I waited until the first day of school to purchase this kit and the Canada bookstore had already ran out. There's an additional supply kit available at the bookstore that includes a stethoscope, BP cuff, etc. You may be better off purchasing these items on your own, through allheart.com, amazon, or eBay. The most expensive part is the stethoscope... a good one is at least $100. I got mine for my birthday, so not sure how much it was. We're also required to take and pay for a Kaplan exam every semester. It's about $140 each semester and thankfully isn't due until Octoberish. SFSU use to require ATI and they required payment of $400-$500 upfront, all in the first semester. Glad that's not the case anymore. Like all nursing schools, you will be required to have health insurance, and prove it. That's expensive and they don't give you extra financial aid to cover it. You'll also need a set of white scrubs for clinical. I bought two sets because I didn't want to do laundry every week. :) Most instructors are pretty relaxed about how white your shoes have to be--keep an eye out in the summer time when white sneakers go on sale. How about some good news on costs? Sequoia hospital doesn't charge for parking. Yay! I've heard hospitals in SF charge $30/day. Yikes! Also, parking for Fall & Spring at Canada is only about $70. It's something insane like $5-$6 per day at main campus. As far as moving to the peninsula goes...include San Mateo & Belmont in your search. OK...time for me to get back to studying. Best of luck to you!

California? We have the opposite of a shortage. It's taking many new grads up to a year to find a job. Look elsewhere.

Hi Canada/Sequoia applicants, I'm currently in the Canada/Sequoia program. I remember how nerve racking it was waiting to hear back from SFSU...not just for admission but throughout the summer, too. If you have specific questions you'd like answered, give me a shout.

Thanks, Jessica! I bought all my textbooks (new) through Amazon a few weeks ago, but was starting to worry that I would be missing out on some sort of online components. You've reassured me on not buying the bundle. Where did you buy your supplies (pen light, etc.)? Have all your clinicals been at Sequoia? Thanks!

Re: NURS 610 - Basic Med Dosage Calculations at College of San Mateo Good question! Last year I was able to sign up and take the class, despite not being a CSM nursing student. The instructor was more than happy to have students from other programs in her class. The summer time nursing classes are meant for preparation and have been open to anyone. I don't see a reason for this to change, despite budget difficulties. That said, CSM has finally computerized their pre-reqs. It doesn't hurt to try to register for the class. If it won't let you, I would email the instructor or just show up on the first day and bring $6-7 cash for a copy of the syllabus.

They have a minimum cut off, i.e. everyone who has certain score in the four core pre-requisite classes (English, A&P, Microbio) is entered into the lottery. Don't worry--it's a pretty low cut off--much lower than the criteria for most BSN programs. Just try to avoid repeating these four classes or getting a "W" because you will be dinged. Obviously As and Bs are the way to go for these classes. If you want to calculate your own score, this formula was developed by the California's Community College Chancellor's office. Google it...all community colleges in CA with nursing programs are using it. Ohlone will explain it in much greater detail at the orientation that is mandatory in order to apply. After you attend the orientation in the Fall (check their website around November), you will be instructed to take Ohlone's own reading assessment test. It's simple and you shouldn't have any problems if you are a native speaker. If you pass the accuplacer test, you will then meet with a counselor who will calculate your GPA and score in front of you. Only after all that, can someone submit an application in early April. The TEAS is not given until after you are accepted. Ohlone does have a few extra hoops to jump through in order to apply, but I think it keeps the applicant pool down and increases your odds of getting in. Compare Ohlone's pool of 236 to CCSF, which had 742 re-applicants and 611 new applicants this year! Take a look at this page for Ohlone's specific requirements: http://www.ohlone.edu/instr/nursing/rnadmissionprocedure.html#minreqmts

LOL, I already have two of them. And I love Lehne's book! It was light years ahead of the Pharm book I had for an online class. Thanks again!

I'm in a similar situation, and volunteering really paid off. I too, live in the San Francisco Bay Area and am all too familiar with how competitive it is for a spot in nursing school, let alone a new grad position. While I was in a CNA training program, I started volunteering at a local community hospital (that happens to sponsor a BSN nursing program) and a large teaching hospital. I had already finished all my nursing pre-reqs and the fact that I was a trained CNA gave me some really plum volunteering positions in units I never would have been exposed to otherwise (Cardiac Cath Lab, pre-surgical unit, etc). Do not feel bad about telling the volunteer coordinator you want to work with nurses, instead of sitting at the hospital's front desk. Over the course of a year, I became friends with some amazing nurses and the experience was invaluable. They happily wrote letters of recommendation for me to get in to the aforementioned BSN program--and I got in. They also were OK with being listed as professional references when it came time to find a job as a CNA. Be forewarned--the agencies I applied to for CNA work did not consider my volunteer experiences as "on the job experience" despite how many hundreds of gurneys I cleaned and how many patients I discharged (giving me a lot of experience with wheel chairs). Take the plunge and contact the hospital's volunteer coordinator. With TB testing, flu shot, and orientation requirements, it will probably take at least a month before you will get the opportunity to volunteer.

The med dosage class was cheap...I think it's 1 unit and College of San Mateo is currently $26/unit. There is a small booklet (syllabus) for the class that is about $6-7. If you take the section offered on the weekend, you won't have to pay for parking, either. If you take anything, take this class!!!! It's only two days long and I learned so much and feel so much more confident about my math skills. The pathophysiology class at UCLA extension (online) was over $500, and the text was around $100. The class was not worth the cost...you would be better off buying an older copy of a patho book and looking at it on your own. Pharmacology was through Barstow Community College (online). It was 3 units in 8 weeks. It was around $80 in tuition and the texts, naturally, cost more than that. In any case, all three of these classes are cheaper than what we will be paying at SFSU--$300/unit. Does that answer your questions?

Sorry I've been MIA...for some reason I stopped getting email alerts for this posting. Candice: The SFSU/Sequoia counselor emailed me specifics on titers/TB tests, etc. I'll forward it on to you. NorCal: Would you mind telling us the titles/authors of your books from the first year? I realize they might change for our cohort...but I already have a few texts and I'm hoping they will coincide. Thank you so much for taking time out of your busy schedule to "talk" to us!!!!