RN_BSN09

There are a couple hospitals in my area that have LDRP rooms. My current hospital has separate L&D and PP units, and that seems to usually be the case. It's also pretty rare to see midwives at the hospital... I know of one hospital that does so, and my current hospital is discussing the option of bringing midwives to attract more patients. I'm sure you can find that again if you plan on going to a larger city... although it is uncommon. However, your experience will be a bonus since you are well rounded in them all. If you work in a baby friendly unit like mine, you get to do both PP and nursery. :)

It's funny to me that some of these replies are trying to talk you out of night shift, when your entire question was to know what other night-shifters sleep patterns are. I think you are excited about your new schedule... :)

I hear ya with that one... they think "oh that's great you get 4 days off" but they don't realize you have absolutely no time between shifts to do anything, and your days off you're tired

Well you're no longer considered a "new grad"... so just highlight the experience you have as a school nurse, and tell them your dream job is OB/women's services. If they know you are willing to learn, and have a good work ethic, I'm sure they would be happy to train you! Good luck! Some units want experience of course... but my unit just hired new grads for both mother/baby and also for L&D. So you never know!

hahaha! That's funny

I used to work in telemetry, and I have a bunch of stories from that floor. However, one of the nights I had to float to a different unit (Neuro/GI/Oncology) is a night that will go down in history for me that I will never forget. It was probably the worst/most stressful shift I've ever had. Of course, I don't remember too many details since it's been over 2 years, and I now work in the happy mother/baby department. :) I was given a horrible assignment, probably because I was the floater... (which by the way seems messed up, and I still don't understand why floaters get s*** on). Anyway... I had my max of 6 patients. I had 4 patients with PCA pumps. I had 2 patients with tube feedings. I think 2 patients were total care... and the rest were walkie talkie. I remember it took forever to even get through my 2100 meds... by the time I finished it was 2330 and time to start rounding on my midnight meds. I had to cath one of my quadriplegic patients multiple times... give IV abx to several, in addition to changing out and wasting PCA medications. Towards the end of the shift, they decided to give me an admission... it was an agitated male patient with an NG tube suction who was screaming and wanted to pull out his NG tube... the girlfriend freaked out whenever he freaked out... luckily I got an order for Ativan. A separate night on telemetry that I will also never forget, I had to call 3 CRTs at the same time! One of my CHF patients had a very low BP, and the doctor didn't want to bolus her, just keep rechecking the BP which I didn't have time for since I had 5 other patients. Another patient has a psych history, and she crawling out of bed and into the hallway yelling "diff hospital! diff hospital!" security came to her room and said they received a 911 call from her room... awesome! Then meanwhile, while all of this is going on... another one of my patients tele monitor showed her HR in the 130's to 140's when she was previously in the 80's and 90's. Thank goodness for my coworkers helping me get through that night! I remember one patient I had on 4 point restraints, with mittens because of altered mental status... he had a central line and an NG tube feeding. They had to take away the sitter because we were short on sitters, and the suicide precaution room took priority. So... I had tightened the restraints, made sure everything looked okay, pt was pulled up in the bed, and left the room. Not less than 5 minutes later, I returned to find the NG tube out and dripping onto the sheets... At first I couldn't figure out how it happened... but with further investigation, I realized he had scooted himself down in bed to give the wrist restraints more slack, then he used his knees to take off the mitten, and he could then reach up and pull out the NG tube. The CRT nurse attempted to put the NG back in, but the Xray showed it was inserted into his lung... but at least the Dr. said to leave it out for the rest of the shift. I don't miss those crazy nights!

Wow SaoirseRN!! That sounded like a rough night!!!

Oh and as far as my sleep schedule goes... it varies. Usually in between shifts, I'll go to bed at 9am and wake up at 4:30pm. Before my first shift, I'll take a 3 to 4 hour nap to prepare to stay up all night. After my last shift, if I plan on switching to days I'll usually sleep all day, get up that evening and go back to bed that night for 3 or 4 hours, and then stay awake the whole next day. Another option is to stay awake after work, which is pretty hard, and then go to bed early that night. Some people I work with take a 3 or 4 hour nap after their last shift, then make themselves get up so they will go to bed that night... I find that option difficult because I usually won't wake up once I fall asleep (maybe that will change when I have kids!)

All of these posts have great advice... How many shifts will you be working per week? How many days per week do you homeschool your 9 year old? Will your shifts vary each week, or is it a set schedule? Is your spouse home during the day when you need sleep, or do you have family/sitter/daycare as an option? I've been working night shift for the past 3 years. I work three 12 hour shifts. I do not have kids yet, but we are planning on getting pregnant and I will hopefully switch to two 12 hour night shifts per week. I definitely plan on staying with night shift... I love working nights, I like the flow of night shift while I'm at work, and the pay increase. I work with a lot of moms who work nights, and have asked many of them how they do it, because I am planning on having kids myself. As long as you have a way to sleep between shifts, whether your child goes to school or has someone at home to watch them so you can be left alone, you should be fine. Almost every mom that I work with will have at least 1 or 2 days a week that they are on VERY little sleep... usually the day after their last shift that they have to stay awake to watch their kids, or to try and switch to days. I've been told that it's okay to do that some, but definitely not every shift. Like the other posts have said, you NEED sleep... but night shift is great, you can totally make it work, and one day a week with little sleep is totally do-able as long as it's not all the time so your body can get rested and recharged. I think you will find that working 12 hr shifts will give you more family time... your previous shift of 3 to 11 was five days a week and during the best time of day to spend with family! It's sometimes hard to switch back and forth on days off, but overall compared to your previous schedule, you will certainly see your family more. :) Good luck and welcome to night shift!

Those are some interesting dreams blondy2061h! I have had some really weird dreams myself... but usually with nursing dreams it's just IV pumps beeping... I work in mother/baby currently, and recently had a dream I gave birth... without any pain, by myself in bed... not totally nursing related, but maybe has to do with being around babies?? haha

I didn't realize that this thread was old till you mentioned it! ha. Well, I currently work 3 12hr night shifts per week... and I agree, even tho it's only 3 shifts, it feels like your days off are short because you spend so much time "catching" up. The days/nights you work a 12hr shift there is literally no time after the commute, eating, showering, etc to do anything other than sleep in between shifts. I plan on switching to part-time (two 12hr night shifts) per week once we have kids. My husband works 24hr hour shifts, so we'll have to have opposite schedules. The benefit tho will be no day care to pay for. Good luck with your new job OCRN3!

I don't think there is any type of nursing that is a silent place... any, including NICU or med/surg, or women's services, or clinics. Whatever the type of nursing, there will always be communication with family, fellow staff, doctor's etc. Am I right when I say "fewer" family members are allowed in the NICU? I'm sure it varies from hospital to hospital... In mother/baby it may not be critical, but there are a lot of family members... sometimes 15 in a room at one time. I am aware that NICU is not just "baby feeders" for staff... just like some people feel that mother/baby nurses are just "waitresses" serving Tylenol and water. NICU nurses are awesome, and have a tough job... wasn't trying to sound like they didn't do much, just trying to compare different areas of nursing related to her questions.

Well, if you are interested in applying to Austin, TX. The Versant Residency at Seton Family of hospitals states they hire RNs with less than 1 year of full time RN experience (less than 2080 hours) by start date. Accepted: Texas RN license Temporary Texas license Compact RN license Eligibility Requirements There is the website. They have a ton of hospitals all over the Austin area, so that might help for you to find a position somewhere. Good luck! The open house was already on 03/07/2013, but they have a residency every 4 to 6 months if it's too late for this one.

You may find working nightshift is for you. The pace is a little slower, and there are less family and doctors around the unit to add stress. I would avoid working in any type of dr. office or clinics, because you will spend a TON of time on the phone. (I worked at an urgent care clinic for a few months, and was always on the phone, and didn't feel like a nurse anymore). If you want something related to your B.S. in psychology, maybe try oncology... I'm sure patients would need support on an emotional level more than some. Psych nursing however would probably be very stressful, I do know nurses who like it, but I think you have to have a certain type of passion towards psych nursing to enjoy it (who knows, maybe you would like it). Women's services seems to have a lower staff turnover than other units. L&D or mother/baby are happy units, but a lot of times they like people to have experience first. You might try NICU... I've heard they like to get new grads so that they can train them from the beginning before they learn habits somewhere else. NICU might be good with your speech impediment actually, because most of the time you're caring for babies, and they may limit family members coming in... Anyway, just some thoughts, hope it helps!

If it makes you feel any better, I had to apply twice in order to get into a residency program. I found a random clinic to work at as an RN until I could get the residency position. Is there an open house that you can go to?? I didn't have any connections whatsoever, and went to the open house for the residency, passed out my resume, and that's how I got my foot in the door for an interview. Have you been asked to interview? How many different hospitals have you applied to? Are you only applying in Dallas, or would you be open to Austin or other areas of Texas?

I used to work in telemetry, then switched to mother/baby. It's a much happier unit with way less stress! If you're trying to decide between L&D and mother/baby... L&D has fewer more critical patients... mother/baby has much more patients, but they are less critical for sure. So it just depend what you are wanting. If you really like caring for babies, then mother/baby would be the way to go, because you won't get much of that over in L&D. There's a lot of Breastfeeding help as well. Good luck!

I've never heard of aspirating for anything other than IM. When you administer SubQ you are admin into the fatty tissue... no veins or arteries are in subcutaneous tissue like they are in the muscular tissue, so if there is bleeding it's from damaging capillaries...

I agree with nurse carla espinosa... you will definitely have Dr. orders for most of these questions, when in doubt, look at the orders and also the hospital policies. You can also ask your preceptor as well. :) Here's my answers according to what we do at my hospital. Vag delivery without epidural, right away. Vag delivery with epidural, I'll usually get her up a couple hours after she was last cathed in L&D... some take longer for the epidural to wear off than others... take it slow because occasionally they aren't ready to walk to the bathroom and in the past I've had to use a bed pan (altho rare). Usually the problem is they can walk, but are unable to void, in which case you would eventually cath them if they cannot void. For C/S patients our orders say to get out of bed 6 to 12 hours after delivery. I'll usually walk them to the bathroom for peri care to start with. Vag deliveries rarely have a foley over in mother/baby, unless they were unable to void and ended up with a foley that way. The Dr. will usually write the order to discontinue. C/S the orders say to take out foley 12-24 hours post-op. We usually wait closer to 24 hours because if it's taken out too early, they won't be able to void and then it needs to be put back in. Pt is DTV 6 hours after cath removal. I'll have the pt attempt to void every 2 hours. Sometimes they will start to feel distended before the 6 hour mark, and you might need to I&O cath before then. Bladder Scanner is a great tool to measure retained urine if you're not sure, just don't use the bladder scanner on C/S d/t their incision. You can use the peri bottle or a sitz bath to encourage the pt to void... the warm water helps if they have difficulty by the second or third attempt. Our orders say to straight cath x2 if still unable to void and insert foley on 3rd cath if still unable to void. Vag delivery right away. C/S start with ice chips, then clear liquids. There's not really a set "time" but see how the patient handles liquids, whether she has any N/V. Then try crackers, then real food. If your unit is baby friendly they will get baby breast feeding immediately after birth, then every 2-3 hrs even if baby is asleep. Usually first 24 hours they are extra sleepy and tend to feed less. Formula babies feed every 3-4 hours... they have a smaller amount per feeding on day one, and slowly increase the amount on day 2 and 3. (probably in your orders). See above answer. You can technically go about 8 hours without a feeding if baby is unable to latch at the breast... by then you need to check a blood sugar. If ever worried, or baby is jittery, check a blood sugar. Again, see what your orders say. Breast feeding classes are helpful also. Yes. 1 wet and 1 dirty on day one. 2 wet and 2 dirty on day two. 3 wet and 3 dirty on day three. 4 wet and 4 dirty on day four... until day five, then it's 6 to 8 wets per day. We never really worry unless it's been greater than 24 hours with no void, or for no stool. Then we just let the pedi know, and usually they say to do rectal stimulation, and eventually baby will stool, esp if he's already had a stool. Hope that is helpful! Congrats and Good luck!

I don't expect you all to diagnose him for me... any tips would be helpful. If he were a close relative of yours, what would you do or what advise would you give him as a nurse or family member? Thanks MunoRN for reminding me of the Hgb A1C! I'll have to ask if he had that lab test.

Yes, you can technically start of with any area of nursing and be just fine. If you work on a med/surg floor of some-sort it will help with your skills, time management, and prioritization... like you said you've heard this before, but it does help you become a better nurse and looks good on a resume. I would suggest applying to a bunch of different areas. It was difficult to find a job right out of nursing school, because most places wanted experience, and hiring new grads cost them money to train you. You will increase your chances by applying to many places. If you really don't want med/surg than it would be fine to start in ICU or ED... both of those places use a lot of nursing skills and critical thinking and will be valuable. Good luck!

If you washed your hands immediately afterwards, and then went to the ED they should update you. I'm sure you will be fine. I had a needle stick with a dirty needle... the patient didn't have anything thank goodness! The ED Dr. saw how small my stick was, and said it's more likely to transfer something the larger the wound is. Even if the pt I stuck were positive for HIV, the odds were still unlikely d/t how small the stick was.

Go with what your hospital policy says... that is what will cover you. The nursing schools that attend my work say not to aspirate anymore, and I too was taught to always aspirate with IM. We are no longer aspirating when giving Hep B to infants, but our policy currently says to aspirate for adults, so that is what we are doing until they decide to change the policy.

Hello fellow nurses~ My dad recently told me his Doctor told him he has diabetes at his physical. I asked him what his fasting BS was, and he doesn't remember, but plans to get copies of all his labs. Anyway, the Dr. prescribed metformin. He's supposed to go to an educator in the next week to get a glucometer and diet advice, etc. I've had many patients with diabetes on telemetry... but all of them have other chronic problems, and weren't "newly diagnosed". My dad is very healthy, he is 66 years old, never been hospitalized other than a nose surgery and broken ribs. He's not overweight, very physically active other than when he has gout flare ups. Never had high blood pressure, except this one visit (they did not check manually) and then prescribed Lotensin. His LDL was a little elevated, and HDL a little low... so he prescribed Lipitor. All other labs he said were fine, including liver enzymes and creatinine. He could fix his diet a little, by eating less salt and smaller frequent meals. He tends to eat a big breakfast, have a few beers, and then a large dinner... a habit he grew up with working on a farm. I just find it somewhat odd the Dr. prescribed metformin already after one fasting sugar... I would think he would want to find out more blood sugars, and see what his sugars are doing first. Same with the BP medication... but maybe the doc is being cautious d/t my dad's age? I understand why he prescribed the Lipitor, but feel like he jumped to Rx the other 2 meds. Anyway, sorry for the long post, just concerned for my dad. Should he get a second opinion? I told him to start monitoring his BS as soon as he gets his glucometer, and to check his BP at least weekly. What do ya'll think??

thank you debsgreys! Hopefully I will like it... I guess I won't know until I try!

On my unit we have a Transition Nurse. She attends the deliveries, and does the initial bath and medications (vitamin K, and erythromycin eye ointment). Then the baby goes with mom over to mother/baby if all is well, or NICU if there's any issues. The mother/baby nurse cares for both mom and baby. We also have a Well Baby Nursery that is separate from the transition nursery. The nurse or assistant in this nursery is not assigned any patients, but just helps the mother/baby nurses out with assessments if they are busy... monitors phototherapy babies (but again not "assigned" as their patient), and helps with circumcisions. Most of the time the babies stay in room with mom.