MntnGirl

We have a PsychNP at our hospital, she is not a FNP, she is licensed as a Mental Health Nurse Practitioner. She practices alongside the psychiatrists in the clinic and hospital setting; she has prescriptive authority, and from the experiences I've had when working with her she is very knowledgeable, thorough, and provides her patients with excellent mental health care in the acute setting. There are specific Mental Health Nurse Practitioner Nursing Programs that provide this Masters Nursing Degree. I suppose a FNP could exclusively work in the Mental/Behavorial Health area, I'd hope that these FNP's would have nursing experience in this field. In rural areas of the country FNP's probably have to take on varying roles such as Mental Health providers due to the limited amount of providers in general.

It is not uncommon for employers (especially large organizations) to have computer people working for them whose job is to look through the employees web pages such as Facebook, MySpace, etc. No joke, people are paid to 'surf the web' for employee information. Assume nothing is private and assume that your facility is spying on you via the internet.

This Just In Time Gig is being done to cut costs but I'm very interested to know how much this hospital paid to get this program implemented. Just like the Studor Propaganda, I love that Studor has all these "studies" to pass around but when you look at the fine print all the research has been paid for by, who else, but the Studor Group. Fortunately at my hospital patient acquity is taken into consideration and we're all about customer satisfaction, patients aren't smiling and giving us all our "stars" on our surveys if they have to wait for ANYTHING so we seem to be staffed pretty nicely, all to make our 'customers' smile and tell their buddies to come to our hospital.

Chronic tardiness comes across as "my time is more important than your time", the tardy person needs to start seeing the situation from anothers' perspective (very unlikely though). I've dealt with a chronic tardy person (married into family)for years and it is frustrating and un-excusable. I see it as a very selfish act and I avoid interactions with my tardy acquitance because of the feelings evoked when I'm left waiting. I have a hard time understanding why the "always late" people are late, can't you just get going on your preparation earlier? I don't have an opinion on this person being fired for tardiness (and additional issues) because I don't know how often they were late, how late they were coming onto shift, etc. I just wanted to vent about how I feel regarding chronic tardiness. Thanks for listening.

I suggest the 3 in a row, when shifts start getting spaced out like 1 here then 2 a few days later, it feels like you're always at work. Working 12 hours shifts can be exhausting so for me that 1st day off (when you get off at 7am and then sleep and don't have to return to work) is pretty much a useless day for me, my body and mind are usually burnt - it's my "Recovery" day. So the more days I can have off in a row the better for me. But there are times when I will schedule myself only 2 in a row with a day break before returning for the last shift of the week, and this is usually when our floor is rocking full and or we have patients that are lots of work. Some of my coworkers do 4 in a row to maximize their time off but I only do 4 if forced to because by Day 4 I am exhausted - you certainly know your crew of patients by Day 3 and 4 which is helpful but in general 12 hour shifts are long and draining.

3 days of orientation is barely enough time for you to get familiar with the layout of the floor neverless learning how to manage your time so that you can care for 30 elderly patients. All I can say is "WOW" and Good Luck.

You should get your facilities Policy regarding this and have a paper copy to present to your Nurse Manager. At my workplace we do have low census times - we are not required to use PTO with low census shifts, and we do acquire PTO for low census oncall shifts (cuz we are still 'oncall' - we could be called in at any time). We also acquire about 7 hours of PTO every 2 weeks and I work 12 hours shifts, I save my PTO for my actual vacation, it certainly isn't a vacation waiting around at my house to be called into work. I find that because of my 12 hours shifts, taking 1 shift off of work (be it for sick day, vacation, or oncall low census) requires about 1 month of PTO - it takes awhile to get those hours accummulated to a nice amount. I'm curious to why your nurse manager is 'requiring' your unit to use PTO for low census? Please fill us in on your thoughts. Good luck and I hope this is able to get figured out so that you aren't losing all your PTO and you don't even get to go on vacation.

My first job at a hospital was 16 week orientation and I had a 1:1 mentor that whole period - I'm sure it cost the facility a pretty penny to pay my wage and not have me taking my own patients for 4 months. I got my first RN hospital job in January 2010 (graduated Dec. 2009). Along with me there were 4 other New Grad RN's - I don't know the exact dolllar amount but I imagine it was definately "an investment" for the hospital to train us new grads.

One doesn't have to "be psychic" to figure out whom you're referring to. All it takes is for one of your co-workers to read this post to figure out who your referring to. If I worked for this organization and I saw a post titled like this I would read it - anyone that was involved in this specific situation, or heard about it through the grapevine, is going to know the who, what, where, and how's regarding what you're posting here. I think too much information was revealed in the original post, and it's very possible that someone will be able to figure out who the person is that you're referring to and even figure out who posted this question.

Look at the facility you're interested in website; I've also found that your states 'department of labor' website can be a good site to look for available jobs.

On my floor, med/surg, all new nurses hired (experienced RN's) are given at least a month of mentoring with an experienced RN on the floor. Then if the mentor and new hire agree that the new hire RN is ready to be on own ,so be it, but there is always the option to extend orientation. As for new grad RN's, they are hired into a 'new grad program' and are given 18 weeks of mentoring/orientation to floor and classroom time also.

I frequently am giving Lovenox several times on each shift, never held the injection site and am not aware of anyone else that does (coworker). As for bruising, it happens, especially if the patient is on additional thinners; I try to administer the Lovenox into the 'love handle' portion of the abdomen, more lateral than medial, this area has more fatty tissue.

If you're really concerned about getting meds administered within that 1/2 hour window maybe you could administer meds to each of your patients and after administration go back and begin your assessments. This way your introducing yourself right away and getting meds passed and basically starting all over with the patients. Patients (most) seem to like this because they get to see you 2 times within the first hour/hour and half of the start of your shift. I imagine you will be getting bigger patient assignments as your training progresses? With more patients (a typical pt load on my floor is on days 4-5 and nights 5-7) comes more meds and more assessments and more orders, so time management becomes extremely important. What can really throw me through a loop is change of shift admits - I still have a hard time juggling the admit and passing meds, assessing, and managing my patient load. It will take time and experience to develop your own routine, I've been on a surgical floor for 15 months (started as a new grad) and I can say that it took me a good 9 months to recognize that I wasn't as rushed as when I first began, and I was doing more 'looking at the big picture' versus just checking off tasks on my daily checklist. At 15 months experience, I'm comfortable with managing my 5-7 pts at night (minus that dreaded admit right at the start of my shift), I have developed my own routine and have my own brainsheet which is my organizational lifeline during my shifts. Good Luck!!!

I use to be in the same position you are (schedule wise), I recently told my manager that this was not working for me, I only want graveyard shifts and nothing else. Manager was okay with this and I am now 100% graveyard - the flip flopping was hell on my body, physically and emotionally, and by the time I had adjusted on my days off I had to turn around and go right back to work. I find that if you don't speak up and let the powers that make the schedule know what you want you'll continue to be prone to these chaotic schedules. Now on my floor it was no problem for me to say I want 100% nights but there is no way I would be able to do 100% days (never want to work days on my floor anyways), there is a waiting list for RN's to get day shifts. You need to speak up or forever hold your peace!

There are jobs out there for new grads but it does require lots of searching around for these jobs. I think you'll have a better chance of getting a new grad job in the more rural areas of the country, look in smaller communities and in more isolated areas/states. As for sign on bonuses, I started with a hospital as a new grad in January 2010 and there was NO sign on bonus (the year before there was sign on bonuses). I was able to get moving costs reimbursed but this was not profitable for me, it covered my moving expenses and I had not a penny left over. Good luck with your new career.

I think most New Grad Nurses find the 1st year a 'challenging' experience, everything is new. Have you talked about the 'Benner's Stages of Clinical Competence' in your nursing classes? The transition from student nurse to professional nurse is a journey that has predictable stages, Stage 1 Novice, Stage 2 Advanced Beginner, Stage 3 Competent, Stage 4 Proficient, Stage 5 Expert. I just hit my year mark from graduation and I started on a Med/Surg floor about 3 weeks after graduating, I had 14 weeks of 1:1 training with a mentor and I am very grateful for that experience. I can honestly say that I can very clearly see my movement through the Stages and I do think that at my year mark I am comfortably at the Competent Stage - I am a whole different nurse today than from when I started. Yes, it is true that my patients are sick, I can not compare them from the patients from the past but I have heard stories from the older nurses where patients used to come to the hospital and spend a couple of days for things such as physicals and colonoscopys. The patients that are hospitilized after surgery are the ones who had pretty intense procedures such as craniotomies and hip replacements (and typically these patients have chronic health conditions and are older in age which can add extra stress and complications to the patients recovery course). I am glad that I have learned how to manage these intense patients from Day 1 of my careeer versus the older nurses whom have had to learn how to manage these intense patients after working with the less intense patients from the past who necessarily didn't have medical problems but were admitted for the yearly physicals. Hospital nursing is a hard profession (it's not just taking a temperature and hanging an IV bag), the patients who are hospitalized are very sick, but the more experience we have in our fields of nursing allows us to become more competent and more prepared to care for the patients that we work with.

Sorry about your dilemma, you'll need to look at your states' rules regarding RN's working in the CNA role, some states do not allow RN's to work below their license. I think you should take any RN position you can get, I don't think working in a nursing home will 'ruin' your chances of getting other RN jobs in the future - any experience is good experience. Are you able to move for your job? This will increase your chances of getting a New Grad RN position. Overall, this is a tough time for New Grads to get jobs, to train a New Grad RN is a huge cost for a facility and at this time there are many experienced RN's to fill the positions, which is the cheaper route for the facility than investing in the New Grad training. I was able to find a New Grad RN position in a hospital in January of 2010 (graduated in December 2009) but I did have to move 1,000miles from my home. If you can move try looking in more rural areas where the need for RN's is higher than in urban areas. A few suggestions on where to look for jobs online include IHS (Indian Health Services), Public Health Commissioned Corps, USAJOBS.gov, your states (and other states if you can move) Department of Labor sites, your local Public Health Department, or your State Health Department. Also, make sure that you have an awesome resume that highlights all the good things about you; you need to let employers that you are the best person for the job. Good luck with your journey, you will find a job one day, it may not be tomorrow or next week but it will happen.

I deal with this on my unit (Med/Surg unit) and there are several Charge Nurses who, when I see are working, I know who's gonna get the "easy" patients and downsize. And yes, this is the day shift that these issues are coming about. So I work the night shift and like a previous poster stated, it's a whole different ballgame on nights. None of the clicky,favoritism situations. We all try to work together and when admits arrive we all try to tag team the patient to get them settled as quickly as possible. I love it, and I will never ever ever work days on this unit because of the clicks and favorites and overall chaotic stressful and often very risky situations that come about on days. I also have to deal with the manager that if you talk to and express any concerns involving other co-workers who goes right to the co-workers and tells them who said what about them, I truly believe that my manager likes to stir up drama and trouble between the co-workers. So I keep my mouth shut and am just waiting for the day that I can transfer (got a couple months before I'm eligible). I want to transfer because Med/Surg is not my ideal type of nursing but I can honestly say that my co-workers due play a small role in why I want out of the unit.

I started on a Med/Surg floor in January 2010 and took ACLS in November 2010 - I passed it right away, you'll do just fine as long as you pay attention in the classes. It helps to take a look at the booklet and review some of the meds before the 1st class. Good Luck.

This may not be true for every PA program but the ones I've looked at require intensive curriculums that have very little room for anything other than the PA program, for instance one program I'm looked at is 28months long, no summer break, and the program does not allow the students to work during the 28months. NP programs (again, not all) seem to allow more room for flexibility, the program I'm looking at for a FNP has a 2year or 4 year option, and many of the people I know that have attended NP programs have been able to work while in the programs. I myself am looking at NP and PA programs and have been contemplating which route I'd like to take and being able to work while in a Masters' program is a huge factor in which way I go. I also like the autonomy NP's have (dependant on which state one practices); and because I have my BSN I won't need to take any pre-req courses to attend a NP program whereas I would need to take around 3 pre-req courses for a PA program I'm interested in. Lastly, the pre-req's for the PA program have a 10 year limit on them (if taken over 10 years ago the pre-reqs need to be taken again), so if one has been a nurse for over 10 years they would need to take all of the pre-req's over again. (again, this is just for the NP and PA programs I have looked at and there is much variety between requirements for NP and PA programs). Good luck with whatever route you take.

I have never worked in a LTC facility, I started as a new grad RN on a Med/Surg floor about 1 year ago and yes, there is stress and it can be hectic, but my experience is not one bit relatable to the one you've had. I work graveyard shifts (LOVE this shift) and I find that I can get everything done and have ample time to take breaks and such. Typical patient load is 6-7 patients and we have aides which helps out a lot. Honestly, I have no desire to work in a LTC facility. What I like about working in the hospital is the turnover of patients, when I have a bad day or 2 I tell myself that when I come back next week we'll have new patients. I guess in a LTC that is not the case, these places are the end of the line (in most cases) for the patients (until they end up back in the hospital). The place you work for does not sound safe or supportive - lifting a pt by yourself is very dangerous for yourself and the pt, being verbally abused should not be acceptable, and the lack of basic necessities such as hand soap, are all reasons why you should look into starting your nursing career in a different environment. Not all LTC are like this, you just happened to end up at a bad one.

Burping and or emptying colostomy bags - I have to wear a mask otherwise I'm gagging at the bedside. Sorry folks, it's just how it is.

Am I surprised? Not one bit. Welcome to the many times sketchy world of nursing.

I started on a Surgical floor about a year ago and am still there - overwhelming at first but the more time I put in the more comfortable I get. Pain, pain, and more pain you will deal with most every patient.I found this to be my most difficult aspect of my job, many patient's expect to have no post-op pain (it seems that the alot of the younger patients have this attitude of "no pain" whereas many of my older patients are more tolerant of pain). Ambulation is very important with all your patients and can be more difficult than expected due to ortho surgeries, age of patients, quick deteroration due to laying around in bed, patient motivation - getting a patient to walk to bed, bathroom, to the door, many times requires more than 1 person assist and can take alot longer than expected, try to plan this into your schedule. Surgical floors are much different than a medical floor - I find the patients on surgical floor require more time due to pain issues, ambulation time, and endless post-op complications not covered here. We also get to deal with medical issues that the patient has (COPD, diabetes, Crohns - you name it) ALONG with their surgical procedure. If you live in an area that gets cold/icy in the winter be prepared for increase of patients' due to falls which can lead to broken bones/hips - especially in the elderly population. We also get all Trauma patients (if they don't go to ICU) due to potential (if they haven't already had) surgery. We get all kinds of surgical patients and depending on the surgery and doctor there are certain things we need to look for with our patients - for instance our gynelogical patients must have their I&O closely watched in the initial post-op period, we have to keep every 2 hour tracking of I&O and call the doctor's right away if parameters aren't met. Try to keep "cheat sheets" on doctors so you know what they are looking for with their patients. We keep VERY busy on our surgical floor, invest in a good pair of shoes, be prepared to have numerous doctors' on for one patient, and study up on dealing with post-operative pain. Good luck and try to keep in the back of your head that with time and experience your competence will increase (I don't think it gets easier but competence and comfortableness do increase).

At my hospital the newer nurses are scheduled every other holiday and the more senior nurses are on every 3rd holiday. If holiday falls on your scheduled weekend you do not have to work the day of the holiday but you are scheduled for the rest of the weekend (only get the official holiday date off). Most times we can do some swapping so that people that work the holiday will take over the whole weekend. Bummer that you have to work your weekends that happen to have a holiday also even if it is not your scheduled holiday, that doesn't make much sense to me - you must have many extra hands scheduled on this holiday (all the scheduled holiday workers and all the regular weekend workers).