calgrrl

We also like caffeine! An assortment of coffee or tea would be just as appreciated as chocolate! Or both....hey!

It would seen out of place for them to ask you specific L&D questions since you've never worked that unit. My recommendation would be to evaluate the type of characteristics that make you a strong candidate for the department, then come up with scenarios from your med/surg experience. Examples: how you react in an emergency, how you demonstrate compassion, how you advocated for your patient, how you resolved conflict with coworkers, etc. Good luck.

Night shift post partum experience here - 4 couplets were the norm. 5 couplets on a really busy night. 3 couplets was a treat! NICU moms would count as 1/2 an assignment, so you could either get easy antepartums or other NICU moms assigned, or even a twins assignment. Breastfeeding help at night was a lot easier to give than during the days, when they're just discharging patients home as fast as they can. If you spent 1 hour working on bf'ing with a dyad, your night is pretty much shot. My new facility is usually 3 couplets, but the mothers or the babies can be very sick so that throws everything off.

During my training one of my preceptors discussed the risks of hemorrhage and the need to have access through which one can transfuse blood if needed. I am not sure it's the official policy, but I have only seen 18 ga used.

I would like to add that you might consider picking up the phone to call nearby hospitals to talk to their manager and/or nurse recruiters. Explain your situation (the differing philosophies part...I would not go into too much detail or bad mouth the hospital) and see what they think. This will give you an idea of where you stand. Additionally, if you talk to the manager they might just want to interview you for open positions.

You're a pre-nursing college student. Don't even worry about which direction at this point! Make school your priority for now. If you need to work, try to find a job in the area of interest. OB/GYN or birth center office, peds office, hospital, etc. Once you're an RN, you can look for NICU and L&D work and THEN decide which area to specialize in. I wouldn't worry about whether it's hard to do both at this point. Is it hard, yes. Could you do it, yes. Do you want to?! How would it work?! Who knows...IMHO, it's too soon to know and it is almost irrelevant. So much can happen between now and then

I am a PP nurse with close to the same amount of experience as you and have just been hired to an L&D position. I was careful during my interviews to be very specific about the type of antenatal patients I cared for and the assistance I provided to L&D. Do you float as a baby nurse or do you actually work as the labor nurse? As you know, there's a clear difference. Have you taken fetal monitoring classes yet? I took beginning and intermediate before getting my position. I have also worked in a birth center with midwives since before I had my PP job, so I have experience taking care of laboring patients, as limited as that may be for a hospital setting. I also called different hospitals and asked how to best qualify for their L&D positions. One suggested I take L&D training from UCSD extension, as they offer an actual course on obstetrics for nurses. Perhaps you can find out if there is anything similar to that in your area. It will make you a strong candidate if it shows you have a true interest instead of just expecting a transfer. As far as medsurg, you know there is a big difference between caring for our patients than caring for medsurg patients. I mean, we have a very specific population whereas medsurg gets a whole spectrum of patients. If you have a strong interest in critical care, I imagine a transfer to medsurg for 3-6 months will garner you the experience you need to make you a strong candidate for ICU. These are very different avenues. Good luck.

I think...there's a lot of work for me to do!! Thanks for the feedback and yes, I will do my best to not include any more medical plan of care in my NURSING care plan. It makes sense how they differ (although it would be a lot easier to fill up a care plan with them included LOL). My interventions need a lot of refining and I see that as I read them over with your questions next to them. I can fix them, though. Off to work on said care plan....thanks for the tips!

Dear Esme12 and GrnTea - if you have time to review my newest care plan, I would really appreciate it! It's titled feedback on nursing care plan - renal under nursing student assistance. I would like to know if I'm on the right track. Thanks in advance!

I would like to ask for feedback on my current diagnosis. I've received very insightful information in my last request. Thank you! I prepared this: Excess Fluid Volume R/T decreased urine output, compromised kidney function secondary to CKD Stage V AEB urine output of 760 mls, BP of 163/77, RR 21, general edema +1, bounding pulses Defining characteristics that she fits: altered electrolytes, anxiety, azotemia (uremia, really), blood pressure changes, decreased H/H, edema, oliguria. However, she doesn't have abnormal lung sounds or JVD. She also had weight loss of 4kg in two days due to dialysis (they took 2500 mls of ultra filtrate the day I worked with her and about the same the day before). Is it okay to use Excess Fluid Volume as my nursing diagnosis for the concept map if I use dialysis as one of the interventions? What she does have: anxiety, social withdrawal (not wanting to talk much to her son), body image issues, deficient knowledge, etc are care plans that I could write, but I wasn't sure about the priority. If not this nursing diagnosis, what would be the priority? I sure hope I'm on the right track, because this has taken me a long time! This is the data from my patient: 74 year old female w/ hx of DM, HTN, CKD IV now V. Blood pressure 163/77 RR 21 HR 78 Temp 98.6 BUN 71-->32 Creat 4.6-->2.9 albumin 2.5 RBC2.92-->3.3 after 2 bags transfused H&H of 9.9/29.5 Ca 7.9, Cl-116-->110 K+ 6-->4.2 CSM: pale, sluggish, bounding pulse +1 nonpitting edema ABGs of 7.3, PaCO2 30, HCO3 15.4 quiet and withdrawn weight loss since admission of 4 kgs (2 days). The arrow -->) above means the first number was before dialysis, & second number was the next morning before her second dialysis treatment. Short term goal patient will demonstrate an acceptable fluid balance as evidenced by: acceptable blood pressure (at least systolic of 130), fluid electrolytes within normal limits, 16-20 respirations per minute, clear lung sounds and demonstrate no edema, dyspnea or orthopneafollowing dialysis. Prepare patient for dialysis Administer antihypertensive medication as directed Monitor ABG levels. Monitor potassium levels Monitor for low calcium levels and Teach patients about nutritional needs after dialysis, specifically regarding protein intake Patient will decrease bounding pulses to within normal limits Monitor intake and output daily Monitor respirations every four hours to evaluate for dyspnea Long Term goal: Client will remain free of effusion, anasarca and improve level of edema by end of hospitalization Turn or have client move at least every 2 hours to prevent skin break down from edema Monitor for decreased edema after dialysis Monitor lung sounds every four hours for evidence of crackles and of effusion Monitor and document blood pressure levels Monitor daily weights to track fluid levels Assess for jugular vein distention (suggesting intravascular volume increase) with HOB elevated to 30-45 degrees twice a day Teach patient importance of participation in fluid management through fluid and sodium restrictions Teach patient to avoid medications that may cause fluid retention, such as over-the-counter nonsteroidal anti-inflammatory agents, certain vasodilators, and steroids. Teach patient for signs and symptoms of fluid overload

Esme12 Thank you for the detailed response. I really did do my assessment first and wasn't trying to make my patient fit by force into any NANDA - the links you provided helped to clarify how to put things together tho and your questions helped me identify more things to include. I appreciate it!

I'm a relatively new student and dealing with writing the nursing dx. I thought we only use the official NANDAs it just doesn't make sense to me how to set it up! I have my fundamentals NANDA list, Gulanick, Ackley and online mosby that I'm trying to use for reference. For example, my current patient is a 78 yr old female s/p cervical laminectomy and spinal fusion. A few of the problems I can help her with are: --postop recovery making sure she is ok since she is -pain -infection, bleeding risk -nutrition The bottom three are more simple, but my priority concern is the Neuro. I look at the NANDAs and I just don't SEE how to use a NANDA for this patient that applies. I've read a lot of threads, but I'm still unclear. The NANDA I see that have to do with surgical care are: delayed surgical recovery and my patient is not delayed... Deficient knowledge r/t postop? I'm assessing her neuro, it's not so much that she lacks knowledge. When I use the online care plan constructor with "surgery, postop care" I get: Activity intolerance anxiety nausea imbalanced nutrition ineffective tissue perfusion acute pain delayed surgical recovery urinary retention risk for bleeding risk for infection My patient doesn't fit the defining characteristics (unless mentioned above, but I don't think they are my priority) Thanks in advance for any tips...I'm sure I can get this, just need some guidance!

Dear AnxiousRNtobe I have to disagree with RN Liz. While she may have made a decision that makes her feel better, you aren't talking about switching from alternative practices to nursing...you're talking about PA vs. NP! If you haven’t done this already, I would go make an appointment with the administrators of your program. They wouldn’t have accepted you if they doubted you could graduate to be a successful PA. Perhaps they can give you some pointers/advice, etc. to get you through this rough patch. You are half-way in, which means this is where the rubber meets the road. Keep showing up to class to do your best. Put your heart into the program and study like mad! You CAN do it, don’t quit! Let me make a few other points: -Are you depressed? There’s no shame in this – if you’re feeling down, perhaps you need to see a doctor to help you get your emotions in order. Don’t make any decisions in the midst of emotional turmoil! Medical help can be short term, even just to help you get some decent sleep. When you're feeling better, THEN you can make life-changing decisions. if you quit, you’ll have to go through the WHOLE interview/acceptance process again. YUCK. Will you have to take pre-reqs again, because your old ones expired? YUCK. PAs have more clinical freedom than nurses. While you are under a physician’s license, you can do procedures and tasks that a nurse can’t and won’t ever be able to do. Yes, advance practice nurses can, but you are very far away from that level of nursing and only 1.5 years away from doing that as a PA $$$$$$MONEY$$$$$$$$$ You will get paid so much more as a PA! Why would you even consider going back to nursing?! Goodness, if I were physically present with you right now, I’d pinch you so you’d wake up! As a PA, you'll come out with a Master's degree, so even if you leave clinical practice, you will have a better footing...please, please please reevaluate before you leave your program. All the negative things you find in the PA program you will find in an RN program. Negativity is a disease that spreads and we have to fight it daily. My vote is for you to pick up your boot-straps, get the help you need and put your heart/soul into your program. And then get off the boards to study, which is what I’m about to do! Good luck!

I was also accepted! Yay! I'm looking forward to a little down-time now before we get slammed with classes! I searched for the group on FB and didn't find it - perhaps leaving the group open until the entire cohort gets in will make it easier to find online? I did find the summer cohort group, which was a lot easier to find on the public forum - does anyone know why I'm not finding it? Looking forward to meeting everyone!

Hi there! I am applying to nursing programs this summer and I'm also faced with the issues of tuition cost. I will likely go to a private school if I get in, but simply because it is an accelerated program for my BSN. The 2yr community college program actually has a higher NCLEX passing rate and is much, much cheaper, but I figure that if I apply myself I can pass the test and start working a lot sooner. However, I don't have even an 1/8 of the tuition debt as you do and will have help paying my costs. I might make different decisions if I owed so much as 130K is no laughing matter and you will be paying that off for a long long time. A decision to go to a less expensive school may be a big consideration. A doctor friend of mine told me that he went to a decent state school, but that HIS partner, a top-of-the-line Mayo Clinic MD, with crazy credentials is now working at a major HMO in a rural community just like my friend. So, the end result can be the same with a fancy degree or a just-as-worthy-but-less-expensive one. For you, consider getting on the phone and calling local employers. Find out if they would prefer to hire Emory students vs. Frontier. Find out what starting salaries are and what they look for in a potential employee. You may find out that it will or will not make a difference and that can help guide your decision. Good luck with your decision.