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It depends on the degree of genetic defect. Normal hemoglobin is made up of four "subunit" proteins -- two alpha units and two beta units. With sickle cell gene, the beta units are defective and has wrong combination of amino acids that will result in the shape change. People with only sickle cell trait will have plenty normal hemoglobins to carry on normal life. But extreme conditions may bring about SCD. People who have inherited the trait from both parents, on the other hand, will have crises often and may have various complications like stroke, anemia, etc. The trigger for crisis is lack of oxygen; it can be from dehydration or infection, or... That's all I can think of right now... Anyways, when enough hemoglobins undergo shape change, the RBC will sickle. And when there are enough sickle-shaped RBCs, blood vessels will get occluded causing pain and they will also hemolyse easily causing anemia. This is is by no means comprehensive but I hope it helps!

It's totally a parody of the other post. The title is exactly the same except "most" instead of "least." If someone has a fetish of vomit, I highly recommend oncology!

Here's the amazon listing of the study guide: Study Guide for the Core Curriculum for Oncology Nursing: 9780721603599: Medicine & Health Science Books @ Amazon.com You'll also see the Core Curriculum under "related materials." Like I mentioned, however, I'd say study guide is a "must" and core curriculum as "optional." Provided of course, that you'll study from any reputable sources on the topics that you find yourself lacking while solving through the study guide questions.

Hi Drcricket, I took OCN exam last year. I studied from both Core Curriculum by ONS and the study guide (with questions.) Core Curriculum is a nice book to have although I felt some information is outdated. The most helpful preparation in my opinion and several others I've talked to, is do the study guide questions, go through them twice if you can. Good luck!

My opinion is complete opposite. You already have a debt of $45k. You say the program will cost you additional $35k even after getting financial aid. And then you still need living costs. When you are done, you''l be left with $80k plus in debt with no job guarantee. It's impossible to work full time while pursuing ABSN. Not to mention you live in expensive city and already struggling paying your bills. Your dream will still be there after a few years, so will the schools and nursing programs and opportunity. They're not going anywhere. They will still be there after you pull yourself out of the financial mess. I think it's incredible that you have a brother who's offering you a place to stay. That'll will save you so much money already. Go there, work, reduce your debt, build up some emergency savings, bring up your credit score. And then go back to school. You already know what the smart thing to do is. But I understand how hard it is. Best of luck to you.

Whether you pursue nursing or PA depends on which model of care you want to provide -- nursing model or medical model? Don't settle on one or the other because of convenience or cost or prestige. Really think about this one. With that said, if you choose nursing, your background seems quite perfect for a direct-entry Master's program. The student profile of this type of program is very similar to accelerated BSN programs which a few people have already suggested. Look into local universities that offer such programs. The advantage is that even though you will start as a brand new RN, once you obtain enough experience, you will have wider opportunities to climb up onto management or education roles without the need for further schooling. Cost is probably the biggest hurdle. If I remember correctly, I don't think you're eligible for federal aid for a second master's. I could be mistaken.

Problem is, even the perfectly intelligent people will believe the stupidest BS when they are desperate. And hearing stuff like "eating this fruit every day will cure cancer" seems like a certain, immediate answer they crave than a physician's long lecture on cell cycles and chemo regimens and probabilities. They don't understand the language, so how could they trust medical establishments? It is partly our responsibility to be able to speak on their level of comprehension. I've seen some amazing hematologist who can explain things to people who didn't even know there were different blood cells. Then I've met some terrible physicians who barely talk to patients...

This is why I suggest developing a more mature perspective. I have no intention of going tit for tat, so I'll just stop there. OP, none of us meant to make you feel worse about making that one mistake. We all make a mistake, it's true. When it comes to scrubbing the hub, however, there are ways to make it into as natural routine as not forgetting about your pants . It's very unlikely that your patient will suffer serious adverse outcome from that single incident. Nurses do sometimes omit (or shorten) scrubbing in emergencies where every second counts. There are, however, neutropenic patients, for whom you should always always keep aseptic technique when accessing their central lines. I think that about sums up this thread pretty well, minus the petty arguments...

Sorry, I work BMT where patients walk the fine line between recovery and fatal sepsis daily with zero neutrophil count, where nurses absolutely have to be neurotic neat freaks so that our patients do not end up in ICU or even DEAD in the first place,... which is quite a considerable feat given that there tends to be a lot of vomitus and diarrhea around our patient population... Look, Dranger, it's obvious you take a great pride in working critical care. How about grow up a little and recognize that no specialty is superior to another, and that nurses from different specialty will have different focus? Obviously no fool will spend 15 precious seconds scrubbing the hub when pt is coding. But your cavalier attitude is something that could truly kill a patient on our floor.

How funny, I was going to comment how I don't forget to swab just as I never forget to put on my pants before walking out of my house. You beat me to it with the "pants" analogy! Yes, it should be a completely ingrained part of the routine. But sometimes interruptions happen and that's when the "routine" gets broken. If I ever forgot to swab, I was probably interrupted by something and resumed the task in the middle.

Do you know the reason? We are taught to draw from PICCs using vacutainers. I once had a pt who was an RN working in another state request that I draw her labs using a syringe. I wondered if she was just being paranoid or if there really was a safety issue. If vacutainer method really is sub-optimal, why is that? Is the reason serious enough to push for a policy change at my facility?

If you're certain you copied it correctly, then the only explanation is that you've got a crappy book full of typos. For the first question, maybe option D is supposed to be 4/3 tabs instead of 3/4. 1.3 is approximately one and a third (=4/3). For the second question, maybe option A is supposed to be 0.3 instead of 3? Whoever wrote those questions, they really need a proof reader...

At the risk of stirring the pot even further, this news came out just in time for this discussion: Poll: Religion Trumps Belief in Big Bang Theory for Most Americans - NBC News

I know what you mean. But I really hope you try different specialty before denouncing floor nursing altogether. I started as an LVN working tele floor and SNF. At some point I swore I've had it enough and decided to leave nursing. Years later... I am an RN working on a hem/onc floor and absolutely in love with this floor nursing job. I like having the knowledge to understand the complex medical condition my patients have and their progress. It gives me a great satisfaction knowing that my nursing role -- observing patients, quick action when their condition changes, my support -- is crucial in their positive outcome and successful treatment. What I do now is far far from a low-level service job, a pill-pusher, glorified maid... which I know too well from my previous jobs...

I can never find the right words in confrontational situations. I'm saving this script so I can use it when I get belligerent patients. Thank you SoldierNurse!

Actually, I do re-check BP myself, sometimes manually even, before holding routine BP meds or giving PRN BP meds. It's not that I don't trust UAPs, but I just want to make sure the original number wasn't a machine error or positional. As for glucose checks, I never worked in facilities where UAPs were able to do them for us. So I envy you if you have enjoyed the convenience, even if short-lived.

I don't have any advice to help you... It does sound like a very difficult decision to make. But I just wanted to comment on your feelings about not being a "real nurse." To me, it seems like you're the one who's doing the real nursing. I know that acute care hospital nursing is the standard of what nursing is considered to be. But most of us just end up spending the entire shift busily following MD orders and meeting patients' demands. A large chunk of nursing is (should be) health promotion and patient education, which we rarely have time for in a hospital. Read on famous nurse figures in the early days. They did exactly what you do: going around the community, inspecting homes, educating families, so on.

Ditto that you shouldn't leave meds at the bedside. Most often, the admin time printed on MAR is an arbitrary protocol per pharmacy. A physician just orders, "Amlodipine 5mg PO once daily." They don't specify an exact time. Pharmacy will generate the admin time for all "once daily" meds at 0900, all "once at bedtime" at 2200, etc. There's no problem to change the admin time for the above amplodipine order to 1030. I do that all the time if pt wants it. If it's a repetitive thing, I'll talk to pharmacy and have it changed so that I don't have to manually change it every time. Likewise, if a pt wants to take their HS meds at 2000 and go to sleep early, that's not a problem either. The only time the exact timing matters is for antibiotics, which should be given exactly as pharmacy determines, meds that are given several times a day, and meds that should be specifically given with meals or between meals. Look through each med for that patient. If any of them must be given at exactly prescribed times, explain to the patient why. For anything that's just "daily," let patient take it when she wants.

Maybe it depends on the setting. In ED where patients are often frustrated and tired of waiting, they might tend to misuse the system? It hasn't been an issue on our hem/onc floor at all. After we started the new call system, there was just one patient who kept pressing "pain" button for everything, and it was because she wanted her RN to do everything she needed. Also, we're pretty good about responding to "toilet" calls because we know if we make them wait, they'll get out of bed by themselves and trigger the bed alarm, which annoys the patient, which then leads to decreased compliance, blah blah... If the CNA is too busy and does not respond after two minutes or so, it will then ring RN's phone. If the RN does not respond either, our unit clerk will try to grab whoever that's available to help. So the system works out pretty well.

It's not unreasonable for reimbursing entities to require certain services to be performed and documented to justify the payment. The real problem is the staffing -- the de facto "normal" ratio of 25-30 patients in a SNF that is accepted and somehow managed. Ideally, nurses would be really monitoring the daily rehab activities and noting progress, and doing all the necessary assessments. But the ratio is forcing nurses to barely manage med-pass alone and end up fabricating everything else. I wish I knew what it will take for the SNF industry to realize the potential of what it could be if they would staff appropriately and allow nurses do what we're actually trained to do.

If all calls come to RN's phone regardless, that's ignoring the full potential of those dedicated buttons. Why not have the call directly go to CNA if pt is calling for water or bathroom? It sounds like a lot of time wasted just delegating. My phone would be ringing every minute if we did that on our floor. I already have love/hate relationship with the phone as it is...

This simply does not happen with our system. Whoever answers the call light at the central phone at the station will page the appropriate nurse or aide on their cell phone. No more "it's not my patient" nonsense.

Thanks to the OP, I looked up the yelp reviews for the prominent hospitals including mine. These are the "best" hospitals in the area. Sadly, 99% of the negative reviews are complaints about billing department... People love the doctors, love facility, impressed with nursing care, and then... the bills come, and confusion and frustration ensue.

Nursing is a good, stable, well-paying job that also provides me with continuous challenges to keep motivated. I started as LVN and I was just looking for a fast track vocation. I felt burnt out and went back to school to study other things but eventually came back to nursing. Now with greater knowledge base and working in an exciting specialty, I am so glad I stuck with nursing.

After only 6 weeks, I would say this anxiety is very normal. Also, good news is that you'll find night shift a lot less hectic. From what I've seen, new grads who struggled with day shift did a lot better once they switched to nights. If unfamiliar procedures are making you anxious, focus your energy into reviewing those rather than fretting about them. Look up your policy and procedures on things like heparin drips and blood administration. Don't be afraid to open up supplies and practice -- things like central line dressing kit or a new wound dressing material. When they're familiar in your hands, you won't be fumbling in front of your patients, and you build confidence. When you start getting behind on med pass, don't panic -- that's when errors happen. You're not going to get fired from giving meds late (unless it's a critical STAT med). So keep calm and do all your checks. When patients make requests when you're already busy, prioritize what needs to be done first and try to cluster your tasks, so that you're not running back and forth to the same patient's room. Most importantly, know that you'll only get better and better with time!