VURN2010

I was in your shoes about 9 months ago...now I'm just about at one year in Ortho/Surg and it's a world of a difference. Some things I have learned though: 1. take your time in report Another RN on our floor made up a report sheet (optional of course, some ppl just jot notes on worksheets) but it helps me to make sure all boxes are checked...including space for vital signs and possible more frequent I&Os. It's helped me stay organized tremendously. It's organized by system so that also helps to get a picture. There's also a spot for D/C plan, Consults, Tests etc. so you know what to expect. 2. If you don't do walking report, take a minute to pop in and introduce yourself to patients or at least eyeball them. It might also be helpful to let them know you are IN report still and that you'll be back in a bit to assess them (I try to give myself till closer to 745-8) so unless something is urgent I like to SET LIMITS so I don't get a 100 requests to "get washed up" or other items 1- our cnas could help with or 2- that could wait. I find most people are understanding knowing you'll be back soon. 3. take time after report to update things i try to make notes for our rounds (issues that have come up), take note of labs (by 745 ours are usually posted from 0600). It's also nice to note low/high values so you know what to ask about or expect...low Hgb means I'll check for T&S and prep for giving blood at some point--keeping an eye out for K orders for low k...etc. also key, i see what meds i need to give & who needs to go first. i'm a nut about checking bp right before bp meds--so i know that's going to be extra time. I'll also grab my antibiotics and see who's gonna be due for pain meds to save some trips on our big/spaced out floor. I try to organize my patients in order of when they'll be seen. I've eyeballed them and sometimes i'll grab their bedside chart, take note of vitals and note that they were resting or if i assessed pain or if they had any requests. 4. personally i like to make lists & bring my report sheet in to assess the patient. I try to be quick, but assess those systems & make notes of anything else I might need before I leave the room...do my systems assessment, give some meds (usually i'll get a couple pts that'll kinda just have multivitamins, iron etc. that i can just give right away). I'll try to at least document that I saw them. I might doc their assessment if it's long/complicated 5. Try to have uninterrupted med giving and uninterrupted charting. It is SO hard, but I try to delegate as much as possible while in assessment/charting mode. It might also be a good idea to partner with your tech/cna so they know how you roll. I also try to bait them to let them know I'll be more helpful later when the majority of my meds/charting is out of the way. 6. Get started on your I&Os early. I also alert patients that I'm a crazy about I&Os so regardless if anyone else was ok with bathroom privs etc. I wanna know what they drank & peed. It helps to partner. 7. It just takes time. The important thing is to communicate your limits with Charge Nurses, your preceptor and CNA. You aren't magically born with the ability to be the organized/knowledgeable RN...it'll happen for you soon! 8. Keep asking questions and just take your time with important things. I try to ALWAYS pay attention to high alert things--narcs, glucose items, vitals, bp meds etc. Mistakes DO happen (I've had one actual med error and a near miss), but the important thing is to be careful, take your time and learn from your mistakes and others. It helps to ask what mistakes have happened to others (if they are forthcoming) so you can learn what NOT to do (like taking a verbal order for a heparin drip...don't do it.) 9. Ortho is harder than it looks. I'm sure many disciplines could claim this, but it really is. Everything takes a lot longer and people need a lot more help. Most Nurses don't get (however many patients your load is) ours is 5 (flex to 6) NON ambulatory heavy partial-complete care patients. Give yourself credit. If you don't love it after a couple more months and even as your experience grows: maybe it IS time to think about something else. That being said: do you like the health system? Are people in the hospital in general friendly and seem happy in their jobs? Do you experience a lot of conflict RESOLUTION where you are? Do you like the benefits of the job & does it seem to offer reasonable compensation & good opportunities? If you answered YES to many of these questions you might consider switching floors. If you answered NO maybe it's time to talk to people who work elsewhere to see if there's better opportunities elsewhere. No health system is perfect, but there are definitely some that have a lot more positives than negatives--or that might be a better fit for you. Good Luck. I hope I offered at least a little helpful advice from my experiences. It gets better! Promise!

I just started on an Ortho floor and absolutely love it. This would be a great fit for you to just start to feel comfortable with routines, talking w/ docs and if you'd like to see happier outcomes. I would also say that it probably depends where you work. I used to say I'd never do ortho because I worked somewhere where nurses had 7-8 patients and could flex up to 10. To me, especially as a new grad, that is absolutely absurd. I know people do it, but I feel with less patients you have more time to work on getting them well controlled on pain, moving with their CPMs and out of bed and eventually out the door. I'm also at a teaching hospital and as mentioned before we have the same group of interns. It's wonderful. We learn together & address each other as peers. This has made my life a lot easier because I never feel uncomfortable paging/calling/text paging when I need something or want to inform them of smaller changes/preferences or NEED them for a change in status. You do see a variety of co-morbidities and different devices, but its' a great place to start because most patients fit a standard routine. good luck! PM with questions!

I guess I can come out and say that as far as I've heard (from fellow new grads) all Penn Entities (HUP, Presbyterian & Pennsylvania Hospital) start new grads at 27.32. I'm fairly certain I heard this from recruiters at fairs & in published material so I think it's ok to share. I haven't heard anyone really having success "bargaining salaries"--at least not at facilities with established Clinical Ladder Programs that you have to apply/achieve raises based on your experience and contributions (which I believe most Magnet Recognized Hospitals within the city have--at least places such as UPHS, Chop, Jefferson etc.) There would be a notable differential between Union and non-union hospitals. That's something to consider when accepting a job (which is, from what I understand) why Temple would be considerably more than UPHS. Good Luck!

If you haven't already decided (or for anyone else who might be interested) I'd recommend Home Properties of Bryn Mawr. It's a nice, large apartment complex with a decent amount of options. You may hear some mixed reviews because there are so many units and the people in the office can honestly be a little ditzy sometimes. We had some issues at first with them misspelling names on the lease, misspelling names in emails etc. but nothing you couldn't resolve. After we signed the lease they were very helpful when we needed them. I appreciated that it was a corporately run complex, because I never felt annoying submitting a request to fix something and no one EVER gave me a hard time about fixing or attending to anything because they had a full-time maintenance staff to do so...whereas I've heard horror stories of other students (honestly mostly in privately owned apartments/houses) with issues getting the most basic needs met--like fixing a leaking roof, getting rid of rats, attending to carbon monoxide leaks--the list goes on. I lived in Home Props my senior year and it was convenient to the school, very well-maintained and professional. It's part of the national (or at least multi-state) Home Properties conglomerate. Had I not decided to live in the city, I definitely would have stayed. The nice thing is that they always have units open. I found they were super responsive to my needs and even the most basic unit was clean and well-maintained. They now also offer upgraded and renovated units--some will include washer/dryer. All units do have high functioning central air/heating systems and hardwood floors. It's also a safe neighborhood with great parking. If you don't want to live in Bryn Mawr, there is also a Home Properties of Devon. However, it was definitely easy being that close to the school (in Bryn Mawr--where you're anything from a 3-8 min commute door to door to the College of Nursing and 20-30 min from most sites in Philadelphia). If you are in Devon, most commutes into Philadelphia for clinicals will be longer and most other students live in Bryn Mawr, so you may be a bit isolated in carpooling for clinicals, in social situations or for study groups etc. If I hadn't lived in Bryn Mawr, I would have lived in Haverford or Ardmore (closer to Philadelphia and therefore clinical sites) but I wouldn't recommend any further out than that. Bryn Mawr is definitely the most popular option. I believe a lot of grad students do live in Home Properties, so that's a plus as well. Another option in Bryn Mawr/Ardmore is the Marks Corporation. A couple friends have lived in some of their buildings and they also find they are responsive to needs/concerns and have new equipment. You may have some luck on your own, but having lived in independently owned apartments and houses in the area, it's a totally mixed bag. Bryn Mawr tends to be either super nice out off Lancaster Ave (where families live) or run down in student housing because it's a prime location for the bars for Villanova Undergrads and landlords definitely take advantage of that. I have seen nice apartments, but I also know a lot of people with unwilling/unresponsive landlords and when you're busy that's the last thing you want to spend your time on. Some also live in South Jersey (one landlord had never even SEEN the house and a realtor had just purchased it for them, some might live closer, some further away. As far as rent goes, I'm fairly certain Home Props and Marks run about the same as other units and are fairly inexpensive (not to give you unrealistic expectations, but our unit was a bit under $1200 for 2 BR 1 Bath...but you can probably get a better deal on a 1 bedroom or pay more for some upgrades.) Other places in Bryn Mawr, friends have paid upwards for $1400-2100/month (houses and apartments) and that seems to be pretty standard. It just depends, too, what kind of conveniences you'd like. I'd recommend Home Properties to be a nice, safe place to live where you don't have to worry about maintenance and pay a reasonable amount for a nice apartment. Good luck!

sometimes it's easy to eliminate dis tractors first--like remembering the smallpox thing, or that influenza/pneumonia are seasonal & usually not for children (though older adults, flu/pneu typically go together & are recommended). It's just been helpful to eliminate those & then try to remember from my own immunization record like would I have had MMR, Hep B etc. at this age? Grouping typically helps me! Good luck!

If it helps at all, maybe review your own Immunization Record? (I know I had to have mine for employment...and just try to remember groups, as the questions I've always had tend to be 2-3 immunizations.) I guess some important things I've noticed are: -smallpox is usually a distractor (as it's not currently recommended) -meningitis for college students -common age group that pops up with most books is the 6 month old -always catch up asap--if they missed something at the last visit, give it now. if they come in a bit before they are scheduled for something, (with no fever) why not give it now? Just my (amateur) observations! Good luck!!

Hey PhillyN, I'm not sure it's saturated, but everyone's budgets are running a little differently (at least that's what I've been told). So, it seems, hospitals will probably have smaller New Grad classes throughout the summer into fall-winter. I would continue applying & trying to get in contact with Nurse Recruiters. This way, they can tell you if that program is worth pursuing or when to try back. If you can't find numbers etc. online, I would simply try to call the hospital main number, either ask for HR or the Nurse Recruiter. Someone will probably be able to transfer you. Is there one specialty or hospital you're focused on? One specialty you aren't (Peds only, adults only)? Best of luck!

Best of luck! Thoughts & Prayers from PA! Can I just ask what made you feel ready? I'm struggling with how much to study/when to ease up!

There are lots! As a new grad, I have NO idea about pay. However, my classmates and I have done clinical rotations at: Pennsylvania Hospital (a little plusher from what I've heard, but a great teaching/learning environment) Hospital University of Pennsylvania (pretty high risk patient population, in terms of social determinants, co-morbidities etc., HUP also runs an free pre-natal clinic so you'll see some great transitions with their pre-natal offerings) Thomas Jefferson University Hospital (city population again, very cool mix, they also have a clinic for mothers with substance abuse problems--again very acute, good learning experience!) Each has its own strengths & unique features & would be a really exciting working environment. I'm SURE there are more in the downtown area-but these are the big names that come to mind. There are also quite a few in the suburbs if you're willing to work a ways out from the city. CHOP also has a special delivery unit for high risk deliveries...they may be hiring too! However, with one year under your belt, it sounds like you'll be in good shape! Best of luck to you!