BellsRNBSN

I am currently in talks with a travel nurse agency and am hoping to start my first travel assignment in late May/early June. My recruiter keeps pushing the housing stipend over taking the company housing. The company housing appeals to me because I won't have to worry about rent and major utilities, as well as renting/buying/lugging around all of my furniture and housewares. I understand that with the housing stipend, I would be taking home almost twice as much money, but the added pay seems like less than what I would be spending on rent and utilities, especially for the area I am looking to work in. My recruiter says most travel nurses take the housing stipend. I want a one bedroom place and no roommates, as I would be working night shift and sleeping odd hours. Can any experienced travel nurses give me some insight on this? Is my recruiter pushing the housing stipend because they save money this way, or is that really the better option to choose?

So, recently I cared for a patient just over 31 weeks gestation with a hx of PTL admitted for PPROM. She was given our standard PPROM antibiotic protocol, steroids for baby's lungs, and magnesium sulfate for 24 hours for neuroprotection for the baby. I cared for her when she started going into labor, just a day or two after her initial magnesium infusion had been completed. Once her cervix started dilating and she was indeed in active labor, the OB ordered magnesium to be started again. I'm a little confused as to why we had to Mag this patient more than once. While some nurses on my unit confirmed that this was standard protocol, others were just as surprised as I was. What is the magnesium policy on your units? If you have a patient in early enough preterm labor, do you mag her during labor (strictly for neuroprotection for baby, when hypertension is NOT an issue), regardless of whether she has already completed a previous magnesium infusion?

I've always wanted to try travel nursing, and now that I'm approaching two years of experience in my field, I'm thinking of applying to some travel agencies. It looks like most agencies require at least two letters of recommendation from direct supervisors. I worry about being able to get these letters because only one or two of my co-workers know that I'm thinking of leaving the hospital I currently work at. I was even told right after getting my current job that the director and managers were worried I would leave soon after my training to work elsewhere. Gossip is a problem on our unit, and I would hate to tell my supervisors that I'm trying to get another job so I can get a letter of rec from them and then possibly end up not getting the job, or deciding to stay, and having to work alongside people who know that I tried to leave. Has anyone else dealt with a similar situation? Any advice?

With our standard order set, there is a checklist that must be completed before the pitocin can be started (MD order in; gestation of at least 39 weeks, or documented reason for induction/augmentation if not; OB with surgical privileges on campus; the last 30 minutes of FHR monitoring must show moderate variability or at least one acceleration, no more than one late decel, no more than two variable decels that dip below 60 bpm from the baseline for 60 seconds or longer, no more than 5 contractions in a 10 minute period for two consecutive 10 minute periods, no more than one contraction lasting longer than 120 seconds in 30 minute period). If that checklist is met, the pitocin may be started at 1-2 and increased by 1-2 every 30 minutes, as long as the FHR requirements I mentioned above are met. The max pitocin dose we may go to is 20, but we can surpass 20 with an MD order.

I'm coming up on one year in LDRP now (so, still a new grad) and an issue that I still haven't found a very effective way to deal with is having patients who have overbearing visitors. To give a few examples: - I was recovering a mom from a C/S whose sister (an LVN in an unrelated field at a different facility) put O2 on my patient while I had my back turned even though my patient's O2 sats were fine (not to mention the obvious fact that this non-employee sister performed a medical intervention on my patient, totally unacceptable) and then proceeded to cuss at my patient's newborn in a sing-song voice, despite my patient's repeated requests for her to stop. Yet my patient still wanted her sister in the room with her. (This was during my training however, and I now do not allow anyone besides the father to accompany mom and baby in C/S recoveries, but my problem was knowing how to deal with this sister.) - FOBs laying a major guilt trip on my patients for wanting/getting an epidural - Mothers of my patients ordering my patients around, speaking in condescending tones, and making them feel bad about the way they are trying to tend to/breastfeed/change their babies - I even once had a FOB step in my way and try to stop me from repositioning and giving O2 to my patient in labor whose baby was having a big decel, despite having explained to both of them what was happening and the rationale for my interventions. I worry about overstepping boundaries in doing something about these family members who mistreat my patients, and I know that some of the reasoning behind these behaviors is cultural. I realize that this will become easier as my confidence increases, but do any of you have tips on how to deal with family members/visitors like this?

Thank you for your responses! If I have a situation like this in the future, I will try IV dextrose first. And ideally, I would love for my laboring patients to eat and drink anything they want, but as a hospital employee, I have agreed to follow hospital policy, which includes certain diet restrictions for moms in labor (especially when my moms have epidurals!).

What is your hospital's policy/what do you do when you have a diabetic mom with an epidural who has low blood sugar? Do you push dextrose? Do you disregard the ice chip diet and give juice? The other week I had a gestational diabetic mother in transition with blood sugars in the 60s and experiencing some dizziness. She hadn't eaten solid foods since the night before and I knew she was going to need energy for pushing. The OB was okay with me giving her cranberry juice, which the mom later threw up (lesson learned!), although it did raise her blood sugar to a more acceptable level. My charge nurse recommended that I push dextrose or hang D5LR (I think?) in the future. I'm not sure if my hospital has a specific policy for this, I am still researching. Just wanted your input!

To all of you moms (and dads too!): If you had a wonderful, positive birth experience, what was it that your labor nurse did/contributed that made your experience so great? And on the opposite end, if you had a negative birth experience, what was it that your labor nurse did or didn't do that left a bad taste in your mouth? Just trying to better my practice and give my patients the best labor experience possible

What Ashley said. Most hospitals probably add their own touch to things as well. In our care packages at the hospital I work at, we include a locket in the bereavement package that splits in two - a small one for baby and a larger one for one of the parents. We let the parents take home any blankets, clothing, or hats, that they used to clothe or wrap their baby in. We also offer to take photos of the baby and parents for them, if they so desire. Some parents don't want the photos right away, and will call the hospital several months later asking if they can still have them, and we are happy to oblige. We offer consults with the Chaplain and with Social Services. Not just any OB nurse on our unit is assigned to a miscarriage or fetal demise - only nurses that have experience in dealing with such tragedies and feel that they can handle the emotional load. We also try to keep these patients in rooms that are closer to our Antepartum unit, where they will be less likely to hear the crying babies of other patients. Needless to say, this is a very sad, emotionally draining time, and I'm sure every OB unit across the nation does their best to remain extremely sensitive to the situation and give the family as much time to grieve and as many resources as is necessary.

Yes, OB is very different from med/surg. Obviously, each nursing student's clinical rotation experience differs, depending on the student, the clinical instructor, the clinical site, the nurses on the unit, the patients, etc. etc. In my personal OB clinical experience as a nursing student, we were fairly limited in what we were allowed to do. I passed meds maybe a handful of times (mostly IV antibiotics in labor and PO pain meds in postpartum). I observed lady partsl and C/S deliveries and epidural placements. I bathed a newborn. I inserted a couple foley catheters and started an IV. I did a few assessments on moms and babies, although they were not full assessments, and were a bit limited. I was one of the few in my clinical group who was allowed to check a laboring patient's cervix. Expect to spend a lot of time observing (and staying out of the way). Also expect the possibility of patients turning down having student nurses participate in their care (this tends to happen a lot with the male nursing students). In labor I often had a lot of downtime, waiting for the moms to progress. You'll get some exposure to the OR and Recovery (comparable to PACU) with C/S's. Some parents are very wary of nursing students doing ANYTHING with their newborns or getting anywhere near mom's fundus. Other parents are amazing and will take pleasure in including you in this most intimate of family experiences. Even if OB doesn't interest you, take advantage of the opportunities you will likely have to brush up on your nursing skills such as starting IVs, inserting foley catheters, and hanging IV meds. Remember, your clinical experience is what YOU make it! Good luck!

In cases such as this, I think the best strategy in answering these questions is just to be honest. If you never made a med error in nursing school, tell the interviewer this, and then tell him/her what you would have done if you HAD made an error (or what you will do in the future if you make an error). If you have never questioned your decision to become a nurse, then tell the interviewer that. Also, if a question catches you off guard, take a few seconds to think about it before you start answering - better to wait a few seconds and have a well thought out response than to hastily reply with something that you may regret or feel unsure about later. Rarely have I heard from my fellow new grads that they nailed the job interview(s) they had. It's a nervewracking time, and we are desperately seeking good jobs with a lot riding on getting hired. Some people are better at interviewing than others. Don't waste time ruminating over how poorly you think you might have done in an interview - it's over and done with and continuing to think about it will only add more stress to your life. Plus, you probably did better than you think you did. Keep in mind that with each interview, you will improve and learn how to answer questions better. Best of luck to you in your job hunt and on future interviews!

Also, sometimes the fundus just happens to lie deeper in some women, or there is more fatty tissue in the woman's abdomen, over her uterus, making it harder for the nurse to palpate and massage the fundus. In this case, the nurse will have to push down harder on mom's tummy to find her fundus, which is often uncomfortable and even painful to mom. But like the PP said, this is all in the best interest of the mother to make sure that the fundus is firm and midline, so as to prevent possible serious consequences such as postpartum hemorrhage from progressing by detecting the s/sx early on.

I'll be switching to nights in a month and have been pretty nervous about it - so thank you for this!!

Does it help you to know that you're not the only one with such thoughts? I am a new grad, about to start my first nursing job, and I have definitely had the thoughts that you described, and I KNOW they will be on my mind during my first few weeks out on the floor. I believe it is VERY normal to be a bit frightened about becoming a professional nurse when you're fresh out of nursing school. I have had MANY nurses tell me and have seen from many threads on AN that the *real* nursing training begins when you get your first job. In the meantime, congratulate yourself for getting this far in nursing school and remain focused on your studies. Take one day at a time and try not to worry excessively about what lies ahead. And you can use your fears to make you extra careful, humble, and willing to learn when you do get your first RN job. You're not alone! And it will get better! :hug:

I would love to sell you my Dove apparel scrubs! I'm not sure if you would want the tops, considering I had to sew my university patch onto the sleeve of each top, but I have 2 white tops (1 unisex, 1 fitted female), 1 white lab coat, and 2 forest green bottoms. PM me if you're interested.

In my nursing school class, we had both the type A, constantly freaked out, anxiety-ridden students, as well as the laidback, "will study hard, but not getting an A won't be the end of the world" students. And as long as we all studied enough to learn and retain the information, BOTH groups got good grades and BOTH groups are now RNs. You just need to find which studying style works best for you. I honestly think that being able to stay calm and collected will serve you well in nursing. You will be able to handle a code or other emergency without freaking out, and the grief that is often given to RNs (by patients, patient family members/friends, other healthcare workers, etc.) will roll easily off your shoulders and not impede your work. You will also probably be more able and likely to not take work home with you, which is important! Every nurse has different strengths and weaknesses and just needs to find his or her niche.

About halfway through nursing school, a classmate of mine fainted while observing a routine procedure. The unit made a scene about it at the time, but it only happened once, and she is now a happy, practicing RN. It can happen to the best of us, and it doesn't necessarily mean that you have a phobia or even that it will happen again! Try not to dwell on it, if possible, as this may make things worse and moving on more difficult. Best of luck to you!

I don't think prep classes are necessary, but the Kaplan Q-bank was DEFINITELY helpful for me! Yes it's expensive, but so is having to take the NCLEX again, if you fail the first time! What I liked the most was how Kaplan's format and the way you answer questions and the different types of questions they offer were just like how the NCLEX was, so I felt well prepared.

I think how long you study before taking the NCLEX depends on how good of a test taker you are. Test taking usually isn't a problem for me, so right after I graduated from nursing school, I took 1 week off, then studied (along with some study buddies) every day for 3 weeks, took the NCLEX, and passed. Everyone has their own speed and style. Some of my classmates studied for three months or longer and then proceeded to pass the NCLEX after their first attempt. IMHO, you shouldn't wait TOO long to take the NCLEX after you graduate, because you do start forgetting material you learned in class. And do NOT overdo the studying - take adequate breaks when needed; I truly believe that it is possible to study too much. Also, the day before you take NCLEX, just RELAX and clear your brain so that the information you will need to recall the next day will come through easily! Good luck!

I believe a lot of situations like this may just have to do with the clinical instructor having a bad day. I had somewhat of a similar experience. I only had 3 shifts left during one of my clinical rotations, and my clinical instructor who had only been giving me rave reviews the entire semester, all of a sudden was extremely concerned about my competence and telling me she was thinking she would have to add more clinical shifts to my schedule to make sure I could pass. I had already been having a bad, crazy busy day, and this just pushed me over the edge and crushed my entire spirit for the rest of that clinical rotation. It was a shock to me that all of a sudden she doubted my nursing capability when she had given me such praise every time before. Even the nurses on the unit who had overhead my instructor's concerns told me that her criticism was unwarranted and outrageous. However, I did what a lot of other posters on here suggested - I did everything I could to prove her wrong. I was lucky in that she gave me specific areas that she wanted to see me improve upon in my last 2 shifts, so I busted my butt to do my best, especially in those areas. She came to visit and evaluate me again on my last shift, and she recognized the extra effort I had put in and told me I would pass without having to work extra shifts. I was even eventually formally recognized by my nursing school faculty for excellent work in my clinicals! So use the criticism as motivation to work harder and, though I know it can be hard, don't let it get you down! She is only ONE person, and YOU need to remind yourself of your true worth and potential! Good luck, and keep your chin up!

I feel your pain! Believe me, the ladies get it too! I remember when I first told my parents that I wanted to go into nursing, my dad continued to pester me for at least a year about why I wouldn't "just go all the way" and become a doctor, as if working as an RN is on the stepping ladder up to becoming an MD. And when I tell people that I'll eventually get at least a master's degree in Nursing, they ask me what the point is and why I don't just go to medical school instead. I think it's that most people just don't understand that nursing is its own separate profession. I'm surprised that you have been given grief from healthcare professionals - what I've observed is just the people who don't work in healthcare who seem to think that becoming an MD is the crowning achievement in healthcare and what all healthcare workers should aspire to be. I also blame the media for projecting a distorted view of nurses and what we actually do. It's getting better, but still needs a lot of work. In the end, all we can do is be the best nurses we can, and a shining example of our profession, and maybe help educate those who are misinformed. I feel the same as you - nursing is in my blood and what I was meant to do. I won't let the naysayers get me down!

I was actually in my 3rd year of undergraduate studies when I decided that I wanted to go into nursing. I researched accelerated BSN programs while finishing up my bachelor's degree. After graduating in 2008, I spent the next 2 years taking the rest of the pre-requisites that I needed for nursing school (the community colleges in SoCal are REALLY backed up when it comes to nursing pre-reqs and almost impossible to get into). I was then lucky enough to get accepted into a 12 month ABSN program, just graduated this summer, got my RN license this fall, and am starting my first job as an RN in January! Though it took me a few years longer than if I had just gone for a traditional 4 year BSN program right after graduating from high school, I wouldn't change a thing. Nurse recruiters have asked me about this, and I tell them that I'm glad I got my bachelor's degree in another field before pursuing nursing because it gave me time to mature and grow up and to know for sure that I wanted to go into nursing, and they always seem to like that answer. Thus, with what I have experienced, I highly recommend that you finish school and get your bachelor's degree in Biochemistry, and then pursue an ABSN program. California has some great ABSN programs, and when you are eventually applying for jobs as an RN, it will look really impressive that you have an additional bachelor's degree in another field, and recruiters will like that you're a little bit older and more mature than the traditional BSN program applicants. (Not knocking traditional BSN programs at all - I was just really happy with my ABSN experience!) I hope my telling you of my experiences is helpful in some way. Nursing school in general and especially accelerated BSN programs are extremely difficult, but if nursing is really what you want, it will be SO worth it! Good luck to you!

WOW, just got a call back from Harbor UCLA (took long enough?). My first choice was med/surg. This is the first time I have been contacted by them. I have already accepted a job offer to work at a hospital in OC, so I turned down the interview, but I want to let you hopefuls know that UCLA is still making calls! Good luck!

I have a tip for trying to fit exercise into your schedule. I am SURE you are not the only one in your class gaining weight, so recruit a group of your fellow student nurses and find fun things to do, like hiking or playing sports (basketball, tennis, volleyball) before class or during breaks. Your school campus likely has a running track, tennis courts, basketball courts, or something of that ilk. Playing with a group of people makes exercise more fun and therefore makes you more likely to do it and thus, remain active and help keep that excess weight off. I went through an ABSN program, so we were aaaaaaaaaaalways inundated with schoolwork, projects, and tests. But there was a steady group of us who always made time to play sports or hike before class or during our lunch break. Worth a shot, right? Good luck!

Though they are limited and hard to come by, there ARE available new grad positions at OC hospitals. I graduated in August and students from my class and from the class after ours are getting hired at Mission, Saddleback, UCI, Anaheim Regional, CHOC, etc. Some of them were even hired before graduating and passing the NCLEX. However, most of us had to put in a couple months time of applying to any and every new grad program and position we knew of before we even got interviews. I know the OP posted a year ago, but I don't see any problem in starting to look for jobs before graduating, as long as you don't let it consume you or distract you from your schoolwork. I say this because, as I mentioned above, some students DO get hired before graduation, even in OC. My recommendations are: - Study hard and get good grades in nursing school (GPA DOES matter; if you have a high GPA, include it on your resume) - Take on leadership opportunities in school, if you get the chance (Again, looks good on the resume) - After you graduate from nursing school, find something worthwhile and constructive to do with your time in addition to applying for jobs, such as volunteering at a hospital or clinic (The most common question I was asked by nursing recruiters was what have I been doing since graduation) - Get as many certifications as you can (ACLS, NRP, PALS, etc.), especially the ones that are relevant to the field you want to get into - MAKE CONNECTIONS with the nurses you work with during your clinical rotations and with your clinical instructors (The reason that I got the interview that led to me getting a job was because my clinical instructor notified me about a job opening before it was posted online. I had made a good impression on her during nursing school and stayed in touch with her after graduation.) - Get as many letters of recommendation as you can from your nursing school professors and clinical instructors. Do this SOON after graduation, before they begin to forget who you are and what you have to offer! Not only are letters of rec often required for new grad residency apps, but you should also include them in your portfolio for any position you end up applying for. - Lastly, and most importantly, NEVER give up! It may take several months before you get a job, but keep applying, stay focused, and persevere. Good luck, fellow new grads!