alwayslearnin

Greetings, I am an older nurse with years of experience. L&D, ER, Med-Surg. I have been away from hospital for 3 years. In reviewing my 20 years nursing experience and where I want to go, I realize L&D was my love and is the best fit for me in this stage of my life. I also realize that although I have done post partum in the past, it is not what I want to do, nor is it the best fit. So here goes my question.... Now that I understand my focus (L&D only) how do I get back to doing L&D when it has been 3 years since working in hospital and 12 years since I did L&D. Is there any way to get back or am I just chasing an unrealistic dream? I have years of great experience to offer (I believe my ER experience enhances my L&D experiences). I just need the opportunity and time to get back into the groove and update. Suggestions/thoughts? Thank you for reading and responding, alwayslearnin

Thank you for reading my post and replying.

I apologize if I was unclear in my post. No, the Psych Provider is the one that orders the med. They are not always in-house so I have to determine when do I need to call the provider to request an emed. Or at least call with the situation. Just wanted other nurses experience/thoughts around making that call? Thank you for addressing my question. alwayslearnin

pixierose, Thank you for replying. Yes, Ideally you take all of the above measures you mentioned in your post before hand. But when you have done those interventions, what finally says, ok, we need to do emeds. Yes, we have to ask the provider for the order, but we are the ones that basically say, "hey, we are at that point (Emed) here is the situation. The providers are not there to see the situation, So I try to make sure I have good reason to take that step

Greetings, I am a ED nurse on travel assignment and having a bad go of it. One large area of concern is pt handoff. The other day I was iin pt room getting pt ready to go to ICU-pt had self dc'd IV etc. While this was going on staff put not one, but two CP's in my rooms with no report, heads up or anything. I went into rooms later and neither was on monitors, gowned or anything.This is not the first time this has happened. The first few times I thought maybe it was me not understanding their system-now I know it is not me and it is bad practice. When I have mentioned it a few times to regular staff and I get this" ya, that happens here" and then usually they follow it up with their horror stories. So if you review the charts-they have a quick reg/triage and then a long lag before being seen by RN (me) I'm tired of looking like the bad guy/poor care because I didn't even know they were there.I did talk with the charge nurse the other day and got a "I'll talk to the medics" I don't think the medics brought the one gal in. It just felt more like a brush off. I dread going to work there. They just care about get the guy in and out-we don't care how much your drowing cause we all are cause we just want to get them in and out. There is no concern about what your pt load is like-just that your rooms are full. they just went to electronic charting so everthing now is evan more chaotic and it is harder toget help as everyone else is needing it also. I can't wait to leave here.I have worked in other ED's. Yes it is get them in, treated, and dispo'd, but not like this. In the meantime, I need to protect myself and my license in this place. Does anyone have suggestions/information on what i can do? I thank you in advance for your replies alwayslearnin

Greetings fellow nurses and travelers, I am still relatively new to traveling-this is my third assignment, second in my field of nursing that I currently work in (ED) The facility I am at now is just-well, scary. I have had multiple instances of bad pt hand=offs-primarily from triage to room or medics to room. For instance, tonight I have pt being admitted to ICU-I am working on him-mult orders, he self-dc'd IV etc and during this time I got not one, but two chest pains place in my rooms with no report-I walk into their rooms-not on monitors, not undressed, nothing. one was young, but had pulmonary artresia and had a valve "blocker" in her heart-so she had potential for problems. I don't know her outcome, but I am tired of this poor care-like I said, this happens regularly-and I am hearing it is a normal occurrance from regular staff-they just act like, yup, that's just the way it is....and follow up with their stories. Pt load is terrible-no consideration for what is happening with your pt's it's all about get em in get em in.....so Talked with charge nurse and got the "Ill talk with them....ummm, ya right. So I'm starting to think about documenting each instance, pt name, CC-problem and take to admin. So, if you have had this, what have you done??? i am tired of looking like I give late/poor care when I am not even notified I have these type of pt. Any thoughts/help would be appreciated.Oh, and yes travel company is getting an education/earful tomarrow-my guess is this won't be the first time they have heard problems with Hospital X. I know current other travelers are having same experience. Anyway, thanks

Greetings Fellow Travellers I am on the my third travel assignment, and I am nervous as heck! I have been on the assignment for a few weeks now-been on the floor x5-so far, ok. Paper charting in the ER. In a few more weeks the facility is going computer (cerner) which seems quite cumbersome and I am freaked out! I am not particularly computer savy-and I literally run all 12 hours now so I am wondering how in the heck I am going to be able to do my pt load and learn this new computer system. Intellectually I know that everyone else will be there too but Im still trying to figure out where everything is much less how to open the computer chart. I know I will get through this-there is no choice, but I just wanted to get it out there.....I'm nervous! Anyone else have to change like this? This assignment was so I could be with my daughter in California-she just had a 28 week baby (2lbs even and holding her own) and this was going to be my "adventure" so, here goes the adventure.......ha.

Greetings fellow travelers, I have been speaking with other travelers who use more than one agency so they more opportunities of aquiring jobs. Great, got that concept-but now I am wondering, if you go from one agency to another, how do you keep your insurance going, or do you? I like the idea of working with more than one agency, but need insurance for self and hubby. Thoughts/experiences??? Thank you for your reply alwayslearnin

Thank you so much for taking the time tor read and respond to my question caliotter3, bonesrn and 79Tango. I just felt uncomfortable with the idea of the travel company saying one thing, yet turning around and only offerring the other option. I will go back and get clarification about why they will only let me use the 3000.00 a month stipend option. You guys let me know it is ok to question and in this case, it is probably a good idea. Thanks for "having my back" I guess that's how it works in nursing (at least, that's how it should :) Looking forward to this travel adventure we are all on-hope it is going well for each one of you! alwayslearnin

Greetings fellow travelers, I am new to this life and am just getting started. The other day I was talking to my recruiter who told me on this one job I could make x amount hourly with a 2000.00 a month stipend or X amount hourly with a 3000.0 a month stipened. Then When I told her I wanted the less amount stipend (I don't need fancy housing, I am just staying for a few days to work then will commute home) she said, well we really just want you to do the 3000.00 a month one. So, if they won't let me do the 2000.00 a month one, why do they even state it is an opption. Doesn't make sense to me, but I don't want to come across as paranoid or pushy right off the bat on my first contract. Thoughts???? Thank you so much alwayslearnin

Thanks for replying caliotter3. I want to be a steady worker. The problem is if I worked per diem I would be traveling about 2 hours each way to work and between gas prices and how much that would take out of me, well, ya it makes me think twice. If I could get contracts where I could get housing, then that wouldn't be problem as long as there wasn't a very long wait time between contracts- and that is the thing that makes me nervous is the wait time. I would work back to back contracts-that would be the ideal. I haven't taken an assignment yet, so I don't think I need to do a resignation letter. Actually, it was one of the employees that said if I was having second thoughts, I might not want to do it. Again, I haven't made any contracts yet so..... Again, thank you for the reply. Hope you have a good day! alwayslearnin

Greetings, I signed up with a Seattle-based Agency. I guess I had expectations that I wouldn't have a hard time getting contracts. But in inquiring with the agency I was told that if I wanted to count on a regular, steady income, maybe travel nursing is not for me. When I asked what the average time between contract is, I was told, it varies depending on need. I was also told that they do reviews for benefits at the first of each month and if you go for longer than 4 weeks between contracts and you have been turning down jobs, or don't seem to be trying to get work, they will consider that in determining to continue benefits. They said I could go on Cobra but that is waayyy to expensive. So now I am having second thoughts. So my question is-how has your experience been bieng a traveler in Wash State and getting contracts? Have you lost your benefits R/T length of time between contracts? Fo you go out anticipating long stretches of time between contracts? Any experience or thought to consider would be appreciated! Thank you alwayslearnin

Greetings, I have signed up with a travel agency but am starting to have second thoughts. The people said, "if you are looking for regular work that you can depend on, maybe travel nursing is not for you."Well, I do need to depend upon a pretty regular income. Thye also said they review insurance at the first of every month and if it doesn't appear that you are really trying to get more work between contracts, or are turning down alot, they will consider that and could stop your insurance after 4 weeks. They said I could sign on for cobra, but that is waaaayyyyy too exensive. So now I am starting to have some doubts. I tried to get a sense of how long the average time is between assignments, but all I got was that varies depending on the needs at any given time. So fellow travelers, is this your experience? Is this the information you were told? Do you go out with the risk of going for extended periods between contracts? Thoughts???. I would appreciate any experience or thoughts about this. Thank you. alwayslearnin

Greetings inkedRN, Just wanted to welcome you to Emergency Nursing! It is quite a ride and you will grow alot. I hope it is a good fit for you! I am so glad for Allnurses-it has been a wealth of information and support! Good luck in all your endevours alwayslearnin

Greetings! I have been looking at online nursing courses for a while now but I have a concern that I needed so info about. I was thinking about getting an online degree from an Institution like university of Phoenix or Liberty University (also online) These are "accelerated" courses. My concern is-what if I get my next degree from one of these places, but later continue on through a "regular" college where the classes are 12 weeks long rather than 4-5 weeks etc. Do you get transferable credits when you go with the on-line class? Or is it different? Any imput would be greatly appreciated! alwayslearnin

Today is the day sister. Start today. Right now. If you had the Chinese -ok then. Get up and take a 20 minute walk. Just 20 minutes. You can do it. Energy begets energy. I was where you were. It comes down to you honey, no one else. I know, I know, "but I alwys start and fail" that's ok, just do it today. Eat today how you should, and if you fail, ok-go back to what you know you need to do. Just start today. YOu don't have to be perfect-just start. What a wonderful day to start a new way of life-just start. Good luck to you and get on it!! alwayslearnin

Greetings, I was hoping that I could get some information/suggestions. I am an Associate Degree prepared RN who has 11 years experience in Med/Surg, Labor and Delivery, and for the past 4 years ER experience. There was a job posting at my facility for Clinical Nurse Educator with the caveat that they would hire someone with less that a MSN or BSN if you would contract and continue your college education. A fellow nurse knew of the position and recommended me. I applied. So, my questions are: what makes a good Clinical Nurse Eductor? What skill set should you have? What kinds of things should I consider in looking at this position? Are there particular personalities that should not go into Nurse Educator role? Any other tips would be greatly appreciated! Thank you for your responces, alwayslearnin

Hilarious and sooooooo true. I use to work infection control and heard all of the above mentioned DA reasons. Thanks for the laugh and for the posting that is going to be copied and put up in our ED in the a.m. alwayslearnin

Hey canoehead, First-I just want to let you know I always value your experiences and thoughts on this board. My other thought was does your ER have a guidelines for triage book (one specific for your facility, not just generic) for you to refer too? I know you have been doing this for a while, but i was just wondering what your reference book would suggest . Sometimes it's in hindsight....sigh Don't let it get you down-learn/remember go-don't forget to look at all the good/right/positive you do throughout your day! alwayslearnin

Woops, Just a clarification. When people lash-out because they are hurt/scared, I and most people I believe, will be compassionate and understanding, as they should be. It is the people (patients and family members )who are downright rude, yelling, cursing,threatening, because they are upset with the wait, they didn't get what they want, they don't want X. Those are the type of people that we need to set up some expectations of behavior and say this will not be tolerated. I have talked with other providers who have worked in other countries that they will not put up with that type of behavior-period! and they don't seem to have much problem with abuse from paitents and their families. Sometimes it is we ourselves who contribute to our own problems by not saying no. respectfully, alwayslearnin

Thank you Dr. Leap and mwboswell!!!!I appreciate the honesty of the article and the following comments on the Physician himself. I am an ER Nurse and I and my ER cohorts have experienced, thought, and felt the same way. I always chuckle inside when I read about people who have never even worked in the ER get on their high horse about out judgementalism. Honey, it is just REALISM. I have worked the floors and other areas and the ER is a unique type of Medicine and place of practice. THere are alot of things -EMTALA for one (good principle behind it-sucks in the actual practice, kinda like HIPPA) that make it very difficult for all providers. Makes ya feel like your hands are tied and there is no way to stop the abuse of the system and the providers. I wish I had the answers-but I do believe that sometimes we got to quit being so "nice" and be a true professional and be honest and call a spade a spade." Let's get honest about your 60 visits to the ER this year " (and the year is only half over) . "We won't treat your chronic pain issues here with narcotics-that is what your PCP is for." You don't have one? I see for the past five years in various dictations that you have said you don't have a pcp-lets look at that. No I won't write you a prescription for that med because you want it. I is not appropriate-here is why and be honest. ( abuse, antibiotic for virus etc). Just a few examples. I understand when people lash out because they are hurt/scared. But we can say-"that is not ok behavior and I will come back and treat you when you can treat me with some basic human dignity like I have been treating you." Again-no great answers, but looking at what we Can do to help with the "Dirty and Used" feeling. My heart goes out to each and every ER Doctor, Nurse, Tech, Aide, Unit coordinator, secretary, housekeeper and every else who is in the trenches trying to give their best. I hope your energy, hope and hearts are refilled ten-fold. God Bless, always learnin

Greetings, Here is just my from my experience. One of the nice things about L&D/MB is you are dealing with healthy young women (for the most part). The atmosphere is pretty positive (although you do have the domestics, no dad involved, immature patients, or very demanding-all heathcare places have their particular pt. population problems). You definetely won't be using all of the Critical Care Knowledge you have. Again, for the most part it's young, healthy women. But when the s*** hits the fan, you'll be in your element. The occassional pulmonary/amniotic emboli, ruptured uterus, etc. You will occassionally have medical emergencies and yes, there you will definetly be an asset. I guess for me it was just a different aspect/focus. I still used my critical thinking/ knowledge when looking at history and potential problems, labs, etc. But it was an opportunity to help these families through the birth process and becoming a new family that I loved. You will never get tired of seeing a baby bieng born. Always wonderful!! There is alot of patient teaching-unfortunetely you usually have a very short time to do it in. Most people go home within 24-48 hours for vag delivery. But if you love patient teaching-this is definetly a place to do that! Not just mom care, but baby care and family. After a while it just gets to be routine for the most part (again, you always have the "surprizes" Nuchal Cord, shoulder dystocia (always good for a few VERY intense moments) decels, fetal demise ( known or just revealed). You might want to consider going into high-risk L&D. Management would definetly look upon your CC experience more positively:yeah:And you would probably feel alot more satisfaction. There you have the mom's with cardiac issues, diabetics with insulin drips, preterm labor, ruptured membranes, HELLP Syndrome .More of a challenge (which is what I like about Critical Care, you have to be dilligent, maticulus, always thinking ahead and prepared to intervene in possible life and death problems at any time.) Typical day depends. Are you doing triage-You are assessing the mother who walks into your unit, gathering infor while checking Prenatal (or not-some mom's don't get prenatal care) reporting to MD findings and then doing whatever needs to be done-admit for labor vrs false labor, r/o rupture of membranes-all kinds of things. Just like doing traige in ER. Or are you doing Labor that day. Get your patient, Take report-review patient hX, labs whatever, go in and pick up where the previous shift nurse left off (is mom in early labor, ready for an epidural, in the tub doing well with breathing and relaxing? Hows baby-Do you need to get them on on FM? Usually we are one to one once a woman is in active labor (facilities will vary) and your follow through to delivery and into post delivery or to the end of shift. You might be very actively involved in the labor process (by the patient's bedside alot helping with breathing, positions, pain management, epidurals,etc, or more just on the sidelines and just making sure mom and babe are medically doing fine. Of course when you get to transition and full dilation/effacement you are constantly at the bedside-now your helping with pushing, setting up the delviery table and room etc. If you are doing mom and babe-you have 4-5 coupletes. You are monitoring mom vital signs, bleeding, first void, pain management. With babe- transitioning to "the outside" again vital signs, head to toe assessments, temp monitoring, feeding, voiding/stooling, immunizations. And a whole lot of education and answering questions. Granted this is normal mom/babe stuff not if there are problems (usually respitory, low blood sugar, poor feeding are the most frequently seen) Any way I have written alot-whew. I hope this give's you one small view into the world of L&D. Whatever you decide-good luck. I hope you get a lot of responces. Go to the L&D unit and talk with the nurses there. You know how we all love to share :chuckle alwayslearnin

MrRacer98, If you are wondering if its a possiblity that you are burned out, you probabley are. Sounds like it. Time off??? How is the rest of your life? Do you have some fun, some challenge, some time with friends? If your whole world is nursing, your in for some deep doo-doo. It is a lot harder to get burned out if you have a life outside of nursing. Counsiling?? Sometimes that can help you sort and get unstuck and help you to find some new directions. It's a tough field we work in, don't forget to give credit where credit is due-look at the positives you do and you bring to each day. Is there someone at work that you can use as a confidant-someone to "share the burden" and support you? That can be helpful too. I understand. Was told I was in stage 4 burnout. I had to do some changes in my life. Now I am greatful-but it was scary at the time. Good luck to you, be gentle with yourself. Keep looking for the light, evan though for the moment you do not see.:heartbeat alwayslearnin

Thanks Maisy, Where is your location? Currently, here in Washington State in our hospital, we are just asking for recent exposure to or visits to Mexico at triage. That's it. Although there are mosre staff on the med/surg floors wearing masks.

Greetings fellow nurses, Just wondering-Since the ER is typically where you will initially see folks with potential/actual cases of Swine flu, have you noticed/instituted new infection control measures i.e. masking everyone at the front door with respiratory symptoms? Just curious where everyone is at in their practices now that we have this "public health emergency" going on. (Swine flu). Thanks for any information. Keep healthy-protect yourself! alwayslearnin