nedlloyd

i think that depends how you define "better". i'm going to provide the same level of care for all my patients. even if someone is mean or rude to me its not like im going to hold off on giving them pain meds or whatever they may need. but i probably do spend less time/talk less with those patients.. i know there are people truly in pain/suffering that can be short and thats ok. but then there are those patients who just seem to have a bad attitude that you dont want to be around! an example that comes to mind, my third night in a row with this particular patient. i go in to the room and give him his pain meds as soon as i get out of report at 1930 b/c i knew he would be due/wanting them. he had visitors and while i'm in giving his IV dilaudid he is telling his visitors this hospital sucks, the nurses suck (no offense) they dont give me my pain meds. i'm leaving here tomorrow and going to a different hospital where i will get better care. meanwhile all his visitors are glaring at me. so then as im walking out of the room the pt says to me sarcastically "i guess i wont see you until the morning". really had to bite my tongue on that one! maybe you forgot the last 2 nights where i was in here every 2 hours for your dilaudid?? there was more but anyways... no, a pt that gets on my nerves like that, im not going to stick around and chit-chat. on the flip side, i had this patient who was just the nicest lady. i was having a crazy night but she wanted to talk and show me pics her grandkids made for her. so i took the 10 mins to stay and talk with her. i know she appreciated it and it made me feel good i could do that for her. so is that better care? i know if i was a patient i'd like it if my nurse could spend a few extra minutes just talking with me. i know its a lot to ask for given the nature of our jobs. but i think the same is true for any line of work, you make my job easier and i'll be more inclined to help you:)

i think its hard to say.. i used to come on this website a lot while i was prepping for the nclex and i would complain to my husband that i would never find a job b/c so many on here couldnt find work. he would always get mad and tell me not to stress b/c it was only the people who couldnt find work that would come on here and vent. I gradded in june 2009. i was 7 mo's pregnant at the time. didnt work at all, didnt take the nclex until september 2010, got my bls cert in mid october and then started applying. i applied to 4 positions and had 2 interviews. from the time i applied until my interviews was about 2 weeks, and then another 2 weeks until i got an offer (i took the first offer i got even though i would have preferred the other job). so for me it was not an issue at all. but there are a lot of girls on my floor who took 3, even 6+ months to get their job. i really wish i didnt know about this website until after i was already working. coming on here reading all the "i cant find a job" rantings stressed me out! PS just wanted to say your post didnt offend me, you sounded just like my husband did:lol2:

for me it would depend on the shift length/number of days worked to see if it was worthwhile or not. currently my commute is about an hour +/- 15 mins depending on traffic. i work 1900-0730. i'm up around 1645-1700, out the door by 1730 and i get home around 0830. its fine for one or 2 days, but after 3 days in a row the drive home can be hell. i declined a job offer on my dream unit b/c of this. it would have been about the same commute but working only 8 hour shifts. even though it was 40 hrs vs my current 36 the extra 2 days of commuting just wasn't worth it.

i get 3 half hour breaks on a 12 hour(or should i say thats what I'm SUPPOSED to get lol). first meal is breakfast-y, usually a banana, yogurt, maybe some cereal (i put it in a tupperware container and keep a little thing of milk in the staff fridge). lunch is leftovers or i make myself a sandwich. i'll also have a salad or some cut up veggies (salad dressing also in the fridge). third break depends.. hard boiled eggs and tomato slices i sprinkle with salt and pepper. more fruit. apples, cottage cheese with strawberries (when they're in season), maybe a granola bar or some nuts. sometimes i'll take a couple pieces of bread and throw some peanut butter or honey on there. I'll prob think of more to add later but those tend to be my staples. i try my best to include a protein source with every meal

personally i dont understand why YOU would be outraged. yes be sad for your friend, but as others have said, it's not just that single question that broke her. Nursing school is full of tricky questions. i remember when i was in everyone would argue about the "multiple multiple" choice questions and how they were unfair. guess what, we kept getting them. It is not the instructors job to make things easy for you. for what its worth, i had a couple instructors in school that i had been warned were really strict/mean. They ended up being my favorites! I learned WAY more from them than I did from some of the 'easier' ones. If you can do well with them, it will give you a huge confidence boost. and if you cant, just suck it up and get by...

advanced cardiac life support & pediatric advanced life support. Yes it will probably help if you only plan to apply online. Your certs vs new grad without certs would probably move you towards the top of the pile. But nothing will help so much as getting your face out there! start networking while you are still in school, hand deliver your resume to nurse managers and be sure to follow up! I was recently on the job hunt. I applied online for 4 positions, all i got back was an email from HR saying my application would be forwarded to the hiring managers. so i went and spoke with a few nurse managers. within a week i had calls to come in for 2 interviews (for jobs i hadnt even applied to online, all they had was my resume) and offered both positions.

I wasn't aware booking off was just a Canadian term.. I dont know of any research on the subject, nor have I ever done it. However, at the hospital I used to work at, one of the nursing sups was not very well liked. she would belittle nurses, yell at them, talk behind their backs etc. When staffing would try to replace sick calls some of the casuals would ask who the sup was and would refuse to come in if she was working. eventually they moved her to nights and finally forced her to resign. then she came to my department (4 of our best nurses quit within a few months).

I received my notice to renew RN license in the mail a few weeks ago with a note at the top stating that, starting on your renewal date in 2011, you have 3 years to complete 531 practice hours and 45 hours of continuing competency. I do think this is a good idea. I was actually surprised when I moved to WA that there were no continuing ed requirements. The practice hours shoudn't be a problem for most, but I am wondering about the continuing ed... I assume things like ACLS (ACLS recert maybe?) would all qualify for education, but even that only goes so far. My hospital does have the odd inservice but I rarely attend since I work night shift (they usually have them in the middle of the afternoon) and my commute to work is 1 hour each way and I'm not about to drive 2 hours to work on my day off when I don't get paid. I looked on the DOH website and some of their suggestions include nursing research/having your work published (no thanks) as well as "independent study". I'm sure it will end up being less of a hassle than I am currently anticipating. Even though I still have 3 years starting in Jan, I would like to get a jump on things now.. I am a terrible procrastinator and I know that if I at least start thinking about this soon, I will be better off for it. So what plans do the allnurses of WA have for continuing competency:)

i think everyone should start out in med/surg! get familiar with nursing skills, meds, everything really.. I think it helps to build up some confidence, even though the first few months will be undoubtedly stressful. A good med/surg job will help you to "learn the ropes" and make you so much better prepared for wherever you might choose to go after. it really bugs me when new grads say I would never work med/surg:mad: I can understand not wanting to work LTC because you will not have as much opportunity to practice the new skills you just paid good $$ to learn. but med/surg? You will experience all types of patients there, you will learn and do so much! it seems more and more new grads these days dont want to spend any time in med/surg. I know some do just fine as a new nurse working a specialty, but the fact is, many do not and I can't help but think how their nursing career could be so much more positive if they started out with a more humble and realistic outlook. my personal preference:D med/surg, ER (where I am now) and I always thought ICU somewhere down the road, but I just don't know if I'll ever be ready to leave the ER, certainly not anytime soon

I think the incentives to go into nursing are largely personal, at least for me. I wanted to be a nurse since I was very young, it's truly my passion, I derive personal satisfaction from it (usually) and if I wasn't working as a nurse I have NO IDEA what I would do instead. I would say the pay in most places is "comfortable". Certainly by no means would I call it generous... The potential is there to make the big bucks but that comes with sacrifice. Sure, if I was still single and had no kids I would pick up overtime, maybe work a second job somewhere. But my family comes first now. I don't think you're making a bad move. You don't sound all that motivated about nursing to be honest. Nursing school is hard work and the initial payoff once you graduate may not be much better, job market for new grads is tough right now, ****** hours (if you are lucky enough to get a job), the stress of adjusting to life as a new nurse can be difficult. How do you feel about your clinicals? Did you think they were going well or did it catch you off guard when your instructor approached you? And maybe most importantly, do you enjoy clinical? personally, if i was working a 70k stress free federal job, unless i truly hated my life, i probably would not leave unless i knew i was leaving to pursue a true passion best of luck in whatever you decide

i think that would be a fantastic opportunity! i always wanted to do something like that. i had the opportunity to go to Ghana a few years ago, but was pregnant at the time and my husband was deployed so i chose not to go. i don't regret my decision but i still feel like i missed out big time. I think it would definitely give you a leg up on other new grads. You will be developing your critical thinking, be expected to make independent decisions/utilize your nursing judgement and care for a large number of patients with limited resources. Best of luck:)

at my hospital we always work the same shifts unless we're called in to cover a shift. It's nice not having to constantly switch back and forth from days to nights. our shifts are 06-1830, 1800-0630, 09-1730, 11-2330, 1700-0330 and 1700-0130. the previous ER I worked in only used to have 07-19 or 19-07 shifts, you would work 2 days then 2 nights. they ended up adding positions for 09-21 and 11-23 so there was better continuing coverage but the majority of nurses still worked the day/night rotations.

that definitely sounds like a scam. dont send them any money!

might not be a bad idea. I was talking to a dental assistant one time waiting for my dentist to come in and she was telling me how she planned to go back to school for a hygienist position and she would be making 35/hour, which is quite a bit more than most RNs in my area, plus M-F work and no weekends/holidays. I know it's not for me though... even though us nurses deal with "gross" things all day, the thought of poking around in someones mouth all day gets to me:uhoh3:

we get paid for 1 hr of overtime. I guess I haven't worked enough time change nights because I can't recall it affecting my charting. If there was to be a discrepancy in time I would prob explain in the nursing notes "daylight savings time observed" or whatever. In terms of meds, we always followed the schedule ordered by the Dr, so if it was q6h and last dose was at 2400, the next dose would come 6 hrs later at 0500 and times in the MAR would be adjusted.

You might want to look into working at Madigan (the hospital on post). As a military spouse you would be given preference. They also have nurses working in the clinics at Madigan and McChord AFB. Providence St Peter in Olympia has some openings right now. They are also a magnet hospital so having your BSN will be a plus if you apply there. Will you for sure be living in Tacoma? Tacoma has several hospitals.. Tacoma General, Allenmore & Mary Bridge Childrens, all part of the MultiCare health system. Then there is the Franciscan Health System. They have St Joseph Medical Center in Tacoma and St Clare hospital in Lakewood. St Josephs is big, they are also a level 2 trauma center. A lot of military families live in Puyallup which has Good Samaritan hospital (part of MultiCare). They are expanding right now, I think the new patient care tower opens sometime in the Spring? so I imagine as the time gets closer they will be looking to hire. Be sure to mention to recruiters/in your cover letter etc about your military situation. I know at Franciscan Health up until last year they were hiring new grads from out of state. But it burned them, new grads would get hired into residencies, work for a year or so and then move back to where they came from. So now they are more cautious about out of state hires and don't even want to look at you if you don't already have a WA state license. Personally I would look into Madigan as a first choice if I were you. A lot of the nursing programs around here will graduate in December so there will be stiff competition among the civilian hospitals and the market for nurses around here isn't great. Hope that helps. PM me if you want more info, my husband is also at Ft Lewis. Best of luck:)

that does sound like a pretty normal reaction for just starting out. however, if you find you just cannot handle it then nursing may not be the place for you. Yes you are likely to see more of it in LTC but you can't "escape" it. I work in ER and while a full bed bath doesn't take place, it's not uncommon for me to clean up incontinent patients. You just get used to it after awhile. When I started nursing school I had never even changed a diaper! So it was weird for me too at first but you adjust. and while there are nursing assistants who can do these tasks, a good nurse does not rely on them to do the jobs she does not want to. Sometimes an NA is not available. We are a healthcare TEAM, if the NA's are not around you bet I'll go clean up after someone or help an NA clean up if I'm not doing anything at the moment. I worked as a nursing assistant in LTC all through my nursing program and I cannot tell you the difference it makes to have an RN who helps you vs one who sits at the desk all night. I developed a great deal of respect for those RNs who were willing to help us with the "dirty work"

I am interested to know how well people feel their clinicals prepared them for working as an RN. Obviously there is a huge learning curve going from student to practicing nurse. Back when I started you were expected to hit the floor running, manage a team of about 10 patients (RN + LPN team). We were promised in our interviews at least one month of orientation time but were lucky to get that. sick calls would go unreplaced and instead of orientation you were suddenly on your own. the area i live in has several BSN and ADN programs and my hospital has hired quite a few new grads. I know times are tough out there for new grads and perhaps some have been out of the loop for awhile. however, i see many of them struggling, having difficulty managing care for 3 patients after having worked for a few months. now i am NOT trying to be judgmental. we are/were all new grads once, the learning curve is HUGE in your first year. I am simply looking for some perspective if you wouldn't mind sharing... what type of program did you grad from, how many clinical hours, how many patients were you caring for in your final practicum, etc. :)

Is this your first experience working in the ED? It's certainly not a new thing. Many times I have seen patients come in for Rx refills. Some people don't have a GP and use the ED for everything. or they stop on their way home from work because it's more "convenient". One time I was triaging a lady and she told me she would have gone to her family doc but he was on vacation and one of his office partners was filling in while he was away, but she didn't want to see him because she didn't know him... apparently an ED physician (who she also didn't know) is okay though. I will never understand that logic:uhoh3: We had a frequent flyer where I used to work. I truly believe the only reason she came in was because she had a crush on one of the Dr's. She would always present with a vague complaint, usually back pain, and would even ask in triage "is dr. xxx on tonight" and don't forget the "I'm #1" mentality. What might seem minor to us could be a big deal to our patients. I hate to say it, but get used to it. I don't see things changing anytime soon. I probably sound a bit jaded... It can be frustrating seeing patients who you don't think belong there.

Go talk to the nurse manager in your ER. She may be able to give you a heads up on any upcoming nursing residencies. Ask if she would want you to have your ACLS prior to working there. Some hospitals require it, others I have seen will train you once you are already working in your residency. As you go along there are other ER specific courses like the TNCC (Trauma Nursing Core Course), but I don't know of any nurses who took it to start in ER, usually it is taken later. You may be able to find a course in your area for cardiac rhythm interpretation as a precursor to ACLS (if that is something you did not cover in your Nursing school). If you can't find one in your area I'm sure you can find one online. I would suggest you buy Dr Dale Dubin's book "Rapid Interpretation of EKGs" it is excellent! Good luck:)

where i work the process is for patients to register first at the main desk. the staff at the front desk write the time and reason for visit in the computer (3-4 word description) along with basic info such as name/age etc. the form is printed out and dropped through a slot into the triage room next door. nurse triages and patients are brought into the ED right after, whether into a bed or the 'fast track' waiting area. triage done in order of priority obviously, except in cases where presenting complaints are similar, and then the patient who arrived first is seen first. if someone comes in with an emergency the process is skipped, pt brought straight into ED and paperwork done later. waiting times are hard to say obviously. if the lobby is getting really crowded and there is a tech available we send them out to take vitals.

i think it would be a good idea for you to include the protocols of your ED, for example chest pain protocol where i worked you give 02, chewable ASA, get a line in and then give nitro etc. once you've been doing it awhile it just comes to you, but for some of the students it seems to help to see it written down. then if there is any down time (ya right) they can review it. also anaphylaxis and stroke protocols and do a demonstration on how to operate the monitors! when i first started out i knew how to read them but i couldn't work some of the controls. so a monitor would be beeping and i couldn't figure out how to adjust the parameters... and also add epi to your list of meds. what items would you expect to find in a crash cart? hands on activities such as stocking the (already stocked) crash cart, check to make sure all supplies are there, ask students to explain their uses.

what is y'alls opinion on taking the ACLS before you apply for a job? I moved to the US from Canada and only just got my RN license for the US. I have not worked since graduating in 2009. I am ready to begin my job hunt and I keep reading on here how new grads are having trouble finding a job. There is an upcoming ACLS course being offered in my area that I am on the fence about taking. I have worked in the ER as well as done a clinical rotation there and taken a basic cardiac monitoring course through the hospital I worked at. I know I am a little rusty with some of the cardiac pharmacology/ECG tracings. One the one hand, I think it might make me more marketable for potential employers. (I am not looking to start in ER, would like to get a med/surg job for awhile first). On the other hand, several people have told me how employers love to hire Canadian nurses so I shouldn't have much trouble finding a job... not so sure about that. but if that is the case, I don't want to spend the $300 if a hospital is willing to hire me, and possibly pay for me to take it sometime in the future. What do you think I should do?

I hope this question is okay to ask, I am looking for rationale. Assume you are a nurse manger on a specialty unit and you have orders to admit a patient and start treatment. All staff nurses currently have patients who require 1:1 care. What is priority action by the nurse manager? The options I am struggling with are for the nurse manager to accept the patient under her care, have a nurse float from another unit or delay initiating orders (non-emergency treatment) until a staff RN can assume the care. I would think the nurse manager should accept the patient into her care, would that be correct? I cannot see delaying the orders, even though not an emergency I would not want to delay the orders. A nurse from another unit wouldn't be a good choice because it is a specialty unit and the nurse probably wouldn't have the knowledge/skills to take care of this patient. So does the nurse manager take the patient? I know you shouldn't go by what happens in the real world (where I have seen a manager do everything possible in order to not assume direct patient care). Am I missing something? Should the manager leave herself open, what happens if there is an emergency on the floor and she is busy providing 1:1 care? It asks for priority action, which I would think is to carry out the orders. Please help me out, thanks:)