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Med-Surg, Transplant
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RNJill has 4 years experience and specializes in Med-Surg, Transplant.

RNJill's Latest Activity

  1. RNJill

    If I had a million (or more) dollars...

    I actually have an inheritance now that is already well invested...not enough that I could just quit work and be fine but enough that if it remains untouched my financial advisor said I could probably retire at 50. Which is a long ways away, but still pretty cool to think about :-) Soooo, with another 1 million, which we'll assume is not going to be taxed to death, I'd probably set aside about a third to half to invest, and just use the rest to take some time off work and realllly figure out what I want to do. My job is not as terrible as it was (a different story that was recorded in a different thread)but I am not wholeheartedly loving the NP thing. So a little money would probably give me some financial room to do something way different. Oh, and I'd loooove a grand piano too. I miss my music.
  2. RNJill

    Odd interactions

    Oh my gosh...sooo many. Several years as an RN and now a short time as an NP has given me a wealth of odd encounters. And yes, I would agree with the previous poster who said that "odd" is the norm with patient interactions. LOL. 1) I had a patient once who was obviously withdrawing from a number of substances and ended up on my unit because of unaddressed complex medical conditions too (at this moment, cannot remember exactly what). She became increasingly agitated throughout the day, refusing a lot of treatments, pacing around her room, getting angry with her sitter...the usual song and dance. Of course during this lovely day I had an orientee with me who was understandably quite intimidated by this crazy lady. So finally, it's near the end of the shift and this patient has tried to light the toilet paper in her bathroom on fire with a cigarette lighter and I called the hospital police. The police tried to take a calm, hands off approach and the next thing you know the patient had slipped off her gown, tossed aside the cigarette lighter, and was parading around the halls of our small unit totally naked Had an interesting conversation with the MDs that hey, this patient is actively leaving, naked, and apparently doesn't have the necessary psych hold papers in order to prevent this. Of course like every other patient on our half-circle shaped unit seemed to be looking into the hall as this spectacle occurred. 2) Just recently, a patient told me with a COMPLETELY straight face that "I have diabetes but I'm not a diabetic." What? I didn't even ask anything further because it was just too bizarre. 3) Speaking of diabetes, I also have a patient that has fairly poorly controlled diabetes and inexplicably continues to eat a pint of ice cream every night...and complain about weight gain in earnest. Seriously. The entire story is confirmed by her husband at appointments. 4) A random patient's visitor (as in, not my patient that day and I certainly did not know the visitor) called out to me as I was walking down the unit where I used to work as a nurse. A middle aged, fairly normal looking guy. Said he just wanted to tell me that I "had the perfect nose for a girl." Ummm...thanks?? 5) When I was a charge nurse, I at times was summoned to patients' rooms to basically hear their complaints. I was talking to a patient who was providing a litany of complaints...she hadn't been helped right away when she came from PACU, her IV had beeped all night, this was the worst hospital, etc. I was patiently listening when dietary arrived. Patient exclaimed that she was hungry, starts shoveling in food. Tell her I'll come back to let her finish. Return and she's like, "Oh, I think I was just hungry. I'm good now."
  3. RNJill

    Nurses- medical provider needs your opinion!

    The biggest thing that I can echo that has already been mentioned is taking the time to do protocol orders! When I was a nurse prior to being an NP, the hospital I worked at FINALLY underwent a research-based project to place more protocol order sets for patients-especially post op ones. While this is kind of a minor example, we suddenly had a lot more patients with more comprehensive PRN orders for Zofran, JP drain amounts, etc and it cuts down on at least some of the calls. Also, along those same lines, if a patient with baseline crazy vitals (sorry, that didn't sound very professional! Ha) is admitted, it is very helpful especially for newer nurses who may not be as used to a patient waaay outside parameters to have very personalized orders. Ie, notify for SBP over 180 and/or symptoms including headache. Additionally, if it's a teaching hospital with a lot of resident coverage or just a place where a provider has the ability to do this, it's nice when the provider very quickly touches base with the RN about the patients in the evening or early in nightshift. You never know what will come up later, but I think often the nurse could predict that pain might be an issue, the patient seemed better/worse, etc.
  4. RNJill

    Should I take a job in Nursing home

    Unless you are on the verge of homelessness or something similar, I would NOT take a position with only a week's orientation if you're completely inexperienced. Yes, that is a nice salary especially if you live in lower cost areas. However, even for the most confident new grad with some sort of healthcare experience that is like 1/8th to 1/12th of the orientation length you should/would receive in the proper setting. And as someone else mentioned, as an RN in an LTC setting you'd probably be in a supervisory role. Save yourself the trouble of being destroyed by stress or burnout after a month or two if at all possible wait for a more suitable offer. They probably have high turnover anyway if they're only offering a week of orientation.
  5. RNJill

    You should know better

    I definitely could cut down on sweets. Not overweight but I loooove chocolate, basically any homemade baked good, and ICE CREAM. And yes, over the previous long weekend I did visit a new-to-me but very popular bakery in my city and enjoy a large red velvet cupcake...after diagnosing multiple patients with type 2 diabetes at work Sometimes, especially after my long and busy work weeks, I'll spend Saturday doing absolutely.nothing. As in, wake up, eat breakfast, Netflix, play around online, random snack, nap...you get the picture. Those days, it's a miracle if I even do a load of laundry. And you're asked, pooh, did you do anything fun yesterday? And it's like, yeah, I Netflixed and introverted. My coffee consumption is creeping up as the years go by. After some dental work/implants followed by whitening, I was told NO COFFEE but I don't even care how poorly I'm following that rule.
  6. RNJill

    Advice needed to stay afloat!

    I think one thing to realize that will hopefully be at least somewhat comforting-although not a magical fix-is that 3 months is just the beginning of a career. It is entirely natural to feel out of your depth at this point and feel like there is so much unknown in your day that can lead to feelings of anxiety and chaos. You're also in that no man's land of being definitely off orientation but so far from being an experienced nurse. So first, give it a little time. Carefully assess the entire picture to see if *anything* has improved. Are there skills that have become easier? A patient that you have really connected with? A crazy day that you have managed to stay calm in the midst of? A work buddy that you have made? I say all of this having ebarked on a new career phase a few months ago and feeling a lot of what you did-hating so much of my work and regretting my job change sooooo deeply. Now, however, things are kind of better. My skills and abilities have improved, my place in the work setting has been better defined, and the list goes on. Things are definitely not perfect and they will probably never be. I still get angry and or frustrated sometimes, but at least now when I do leave I'll be in a much more rational place to determine the next step. However, in the meantime for you there's nothing wrong with casually looking at other jobs, at least you'll know what's out there! In the meantime try to take care of yourself in any healthy way possible, and just know that sometime soon, a little more experience (painful though it may be) may alleviate some of these awful feelings. Good luck.
  7. I used to get report a lot from ER, and in response to the last thread, yes I could read a lot about them in the EMR and had no problem doing that. Really, I had NO problem not hearing about every single operation they'd had since 1968 and not hearing normal lab values read off to me. I guess what it boiled down to for was an honest and current update. This meant.... 1) Brief reason for admit (the sheets we got often barely even said this because notes hadn't been written) 2) And honest set of vitals if things have changed drastically since the last set...e.g., if the BP has only been controlled for short periods after IV push meds 3) Outstanding meds/labs to give/do. And no, I wouldn't be snarky if some stuff hadn't been done. It is just helpful for planning. 4) Abnormals on head to toe; major/contributory medical history. 5) That they have a working IV. Not worried about every detail...just that it works and is hopefully not like a 24g...but if that's all anyone could get, not a problem. 6) Anything truly bizarre going on...patient is really confused, angry, etc. ....and really, I think if they're coming from ER that is a solid start.
  8. It is definitely possible as I worked with at least a handful of people who'd moved from dialysis/LTC/clinics to my inpatient unit. Funny thing is, I feel like on the impatient side there were always those people who were desperate to go to outpatient settings after a year or two í ½í¸„
  9. Depends on what you mean by that. On one hand, coming off as quiet and reserved can actually be an asset. I'm an introvert and those adjectives can fit me until I know someone, but they have never really been a disadvantage. I think in nursing they can translate to a quiet confidence that makes people feel well cared for. Also, people are tired/stressed/in pain/overstimulated so being a super bubbly classic extrovert is not inherently beneficial. Simply put, if you're stressed about being an introvert vs extrovert, please don't worry. However, if by "poor social skills" you are taking about not making eye contact EVER, not being able to do a quick handshake or introduction to the patient's family members, being rude or over-the-top unhelpful to coworkers, or just having no ability to empathize with patients or be gracious in difficult situations....it's going to be incredibly hard. A lot of nursing...heck, for me, even a lot of being a nurse practitioner...is connecting on some level with patients and then coworkers. If this is really difficult for you and steps aren't/can't be taken to correct that, nursing will probably be extremely frustrating for you.
  10. RNJill

    Take this job and shove it!

    I also feel like another issue, regardless of simply *whether* or not change occurrs, is if it occurs in a way that changes things before a long period of time has passed. My former workplace where I was an RN started to have some serious retention issues related to both staffing and heightened complexity of patients on the unit. It took six to 8 months where like 60% of staff resigned for measurable, real efforts to fix the problem began. By then, the unit's reputation for massive turnover and being "the crazy place" to work had gotten so ingrained that the cycle continued. Of course so many new nurses/preceptors needed/changes burn out the remaining few even more... So yeah, that was kind of a ramble, but basically to say that seeing the results of a change is an entirely different thing than "will they make a change"
  11. RNJill

    Self Reflection: What could you do better?

    I need to internally chill out at work. Outwardly, I'm usually calm and work well under pressure, but inwardly I'm stewing, heart rate of like 300, etc etc. The thing is, once the craziness is over (even if it's a whole crazy DAY) I truly realize how unhelpful and draining this pressure is! I also need to work on patience...again, an internal thing mostly but a lot of my thought dialogue about certain patients and work situations is not gracious. I may be new and kind of overwhelmed, and I may not display all of these feelings but I still need to work on it.
  12. The other conditions/issues listed seem irrelevant to the vanc dose issue...obesity, multiple comorbidities, tons of meds, etc. They definitely seem like things that shouldn't affect the rate of vanc too considerably for the patient. Vanc is typically one of "those" meds/antibiotics for the chronically ill/multiple comorbidities/MRSA + patients only, so seeing it along with a laundry list of meds shouldn't be surprising. A large dose (still would kind of like to know the mg amount) on a newly admitted patient would not be surprising esp in the case of a new or worsening infection. IDK if you have a pharmacist available or even micromedex/Epocrates, but your workplace should have at least one of those resources available to you be it online or in person. That way you can objectively verify doses and interactions with other meds. I would be concerned about deciding to hold IV meds, esp abx, or change dosing rates dramatically based on the opinions of others/yourself...it seems like a good way to be questioned in the future about why an unwise decision was made (NOT an attack, just thinking back to my RN days and giving zillions of meds).
  13. RNJill

    full time np still wanting to do RN work?

    Enjoy your 8-9 hour days...I would not recommend trying to orient/work as an RN on the weekends. Yes, it is nice to have RN experience (I had a respectable amount before becoming an NP) but I would say that now that you are an NP you should focus on that role and avoid getting burnt out. Obviously if you're enjoying the NP role right off the bat then you are doing something right...in terms of your own personality/work ethic/job environment/skills/etc and I would be hesitant to make your schedule much tougher by adding in essentially another job.
  14. RNJill

    Some people are too smart for nursing

    Ehhh, do what YOU want and tune out the peanut gallery :) I can tell you that people will ALWAYS have comments (even about the stupidest things at the most ridiculous times!) and really, that it all the more reason why YOU should make the decisions for yourself. We don't always love what seems sensible to other people and careers take unexpected paths that no one from the outside can judge. As long as you have really investigated whatever career path you want to take...be it nursing or something else...you should feel secure no matter others say. Don't feel like you have to give people a long-winded explanation either! Even when I was in NP school I had patients ask when I was going to be an MD. I reached the point where I merely told them, kindly but calmly...."never." It was amazing how quickly and painlessly that ended the discussion. Good luck!
  15. RNJill

    First NP Job With Little Autonomy

    Thanks Jules A. I'm a pretty intuitive person and I feel that you are probably right. Even though I'm kind of freaking out that I've basically uprooted my life only to realize that this position is not right AT ALL I appreciate the truth. On a only-half-joking note, if anyone is looking for a NP and willing to treat me like one- primary care, geriatrics, transplant, adult - I am SO interested
  16. RNJill

    First NP Job With Little Autonomy

    Thanks all for the suggestions; I appreciate it. Thankfully the other midlevel is largely on the same page as me re: autonomy. I think the biggest thing that needs to be determined between her, me and the MDs (yes, I'm in a transplant setting, and yes I realize this may be a little identifying but honestly don't think it's the end of the world) is what LEVEL of autonomy we can all agree on. I'm hoping that as I get close to my formal eval in a couple of months that this can possibly be discussed amongst ALL of us. The other midlevel just told me this week that she is NOT a billable provider (which actually doesn't make sense), so I think part of my "homework" needs to be figuring out what other NPs across the institution do before our group meeting. I honestly have a feeling that they are NOT all this hemmed in. Hopefully we can maybe even get some support from the administrators/financial people/other directors in the group in support of billing authority. Just have to tread carefully so I don't burn bridges. I also intend to continue to solicit feedback re: my performance, areas of improvement, what I can do to further my level of independence, etc. One MD has worked with MDs before and is very comfortable with them and I honestly have a lot more freedom with her; the others will definitely be more resistant and I have to tread carefully. I have a feeling I'll probably end up leaving sooner rather than later (nothing too crazy, but at the year mark) because of the combination of staffing + autonomy. I also think the autonomy thing can't be fully addressed until the staffing is improved, which I understand but I think the commitment to fixing that will become apparent over the next few months. And honestly, if it's not fixed well it will make my decision pretty easy. Thanks again all!

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