AJPV

How to share 1 vent with 2 or 4 patients:

Probably the first time white boards in patient rooms have improved patient care ?

The language of your question, “...limiting transgender healthcare for youth,” is loaded with bias. It promotes a false dilemma: either you get in line with the politically acceptable position that supports unnatural hormone treatments and radical elective genital alteration of minors, or you are an evil intolerant bigot who opposes providing healthcare to transgender youth. The most disturbing thing is the unofficial punishing prohibition disallowing the same type of rigorous medical research on the long-term effects of these treatments that is considered an absolute necessity in every other medical specialty. Exogenous hormone therapy outside of transsexual treatment has rightly been scrutinized in many studies because of increased risk of myocardial infarction, stroke, and several cancers. It’s impossible to have an honest risk vs benefit discussion apart from this knowledge. These topics don’t even earn a mention in the articles and discussions I have seen related to gender reassignment. Studying long-term psychological risk of gender reassignment is a career-killer politically, so these topics are similarly exempted from rigorous study. Would we tolerate this kind of carelessness in any other area of pediatric medicine? I don’t think so.

And I thought we had maturity and professionalism problems with a lot of our 21-24 year old new grads!

You should look into whether the accuser violated any laws by making her false accusation. Most governmental bodies that accept complaints/accusations from the public have a lot of regulations and laws requiring that the complaint is made in good faith. If it can be demonstrated that it was a false accusation, the accuser could likely face criminal and civil liability. I believe that defamation could be an issue at the very least.

Pediatricians often only make a little over $200k in some markets. $150k for an RN who is not an APRN is laughable.

The most important thing you can do is work hard, get excellent grades in school, and get a foot in the door in the specialty where you want to end up while you are still early in your nursing program. Get a job as a CNA, tech, intern, etc. All of my classmates who had this experience were quickly hired as nurses. Many of those who didn't took a lot longer to find jobs. All of that aside, you may want to really look into the work environment in Florida. This state has low pay for nurses, among the worst work conditions (high patient loads, lots of for-profit hospitals), and a high rate of malpractice litigation. Just something to be aware of.

The hardest part of the CMC exam is the "steel cage" fight at the end when they throw you in a cage with Ronda Rousey. I'm still sore a month later!

Don't be careless with sterile technique! A central line bloodstream infection can absolutely kill a patient. It might be difficult to trace it to a particular nurse because it takes time to develop, but we are absolutely responsible as nurses. When accessing a port, always keep track of where your fingers are, where the port is, and where the sterile tip of your syringe or IV tubing is. We should view it the same as handling a loaded firearm. The slightest slip up - a momentary brushing of a gloved finger against the port or syringe tip - is all it takes. If your flush slips off the port and touches your glove or bed sheet, throw it away and use a fresh one. If the dressing is peeling off and there's already an air tunnel to the insertion site, don't "reinforce" it by slapping another Tegaderm over the top. Do a full dressing change and swab with chlorhexidine. When a doc is inserting an IJ line on a man with a beard, insist on trimming back the beard with clippers so the dressing doesn't peel halfway off and become contaminated 5 minutes later. Insist on it even if the doc is in a hurry. And probably most importantly, always be thinking ahead to get invasive lines out as soon as possible to minimize infection risk. Don't just leave a central line or Foley because it's more convenient for nursing. If your patient's arms are edematous and it's Friday morning and your IV access team (i.e., PICC nurse) doesn't work weekends, call them and see if they can start a couple ultrasound-guided peripheral IVs so the central line can be discontinued later that day or on the weekend instead of having to leave it in due to lack of planning. Be proactive in asking the docs if you can pull central lines and Foleys - even if it means you will have to work harder to get lab draws and help your patient with toileting. Do what's best for your patient. Nursing schools are sadly deficient in providing adequate practice with these very important clinical skills. It's not your fault, but it does mean you will have to develop the skills on your own.

I passed the CCRN yesterday. I spent the majority of my time studying the AACN online review course and doing the Pass CCRN online question bank. I did watch the Vonfrolio videos about a year ago and made notes. I skimmed over the notes recently but I did not do Vonfrolio's big question book. Parts of Vonfrolio's videos are helpful - mostly because she uses clever memory tricks. She also includes some concepts that the AACN course doesn't that are important. For example, which particular heart rhythm/valvular complications/hemodynamic changes (ie, Swan Ganz numbers) can occur with different locations of MI (inferior vs. septal vs. lateral). The AACN course just tells you how to determine the location of the MI based on which EKG leads show ischemic changes and it leaves it at that. However, the downsides to Vonfrolio's videos are that they are overly brief, they are light on pathophysiology, and that they are dated. They tend to be more of a Cliff-notes study - not a comprehensive review. There are so many things changing in critical care that you really want to use a resource that is more current than from 7 years ago - at least as your primary source. If you want to study not just to pass the test but to really learn, the AACN course is great for that. If you do all the Pass CCRN questions, you will definitely be ready for the test.

Night shift bagging powdered milk in a milk processing plant. Usually about 90 degrees and humid due to the huge machinery. Came home in the morning blowing milk dust out of my nose. The guy running the thing was an alcoholic and routinely stood on the back dock enjoying beverages and smoking (when he wasn't cussing at me). They didn't properly clean the tanks that made up the huge four-story tall contraption which caused one of the large tanks to start on fire. On the following shift I had to crawl into the burnt out tank with no protective gear or mask and pull out all the burned up filters. All that for about $7.50/hour.

If we really want a fair system that encourages the highest academic standards, the NCLEX should not only report pass/fail, but should also report a numerical score. This is what the USMLE does for medical students. Scores are strongly considered for residency placement. The NCLEX already calculates such a score (called the logit, see Passing Standard | NCSBN), but it is never disclosed. This would allow fair competition between new graduate job applicants and it would create healthy marketplace pressure against underperforming schools (which are often for-profit and have low standards). Prospective nursing students and the public should be able to see the average scores for each nursing school and employers should have access to the scores of applicants.

Keep pursuing the second ICU position and just see what happens. If you need to respond soon to the first offer, you may have to accept before you have an answer from the second hospital. If you are in that situation and then get an offer from the second hospital, you can consider your options. Many new grads face a similar situation. You want to be respectful and notify hospitals as soon as possible when you make a decision, but the bottom line is that you need to pursue what is best for you and your career. I work in an ICU in a teaching hospital and I think it is an outstanding place to develop your skills and grow in your medical knowledge. Some of the medical/surgical content being taught in nursing school today is what was current in the medical and surgical world 20 to 30 years ago. There is no better place to learn about current practice than a teaching hospital where you will be around residents, medical students, and the attendings who will be teaching them during rounds. The ICU is a great place to develop close working relationships across all disciplines.

I'm interested in following this thread. Looking forward to reading the replies.

Fentanyl drip ordered to run at 900 mL/hr on a med-surg unit (dying patient). At a concentration of 5 mcg/mL, that equates to 4,500 mcg/hr. I told the doc I wasn't comfortable euthanizing the patient.

American Journal of Obstetrics & Gynecology (AJOG). I think it will benefit you as a future midwife to have ongoing familiarity with the science-based medicine side of OB to balance out the sources that are solely from a nursing or midwifery perspective, as good as those may be.

curriculum.

I along with most of my classmates started doing the ATI NCLEX review immediately after graduating. It was the review where you are assigned to an online review coach. Honestly, it was a complete waste of time. They give you tons of Power Point slides that have less info than you were required to know in first semester nursing school. They give you far fewer NCLEX practice questions than you really need - probably only 10-15% of the questions recommended by Kaplan before you take boards. The ATI review will take you 3 to 4 times the number of weeks that ATI estimates because you are constantly waiting for your review coach to release more content to you. The quality of the review questions is very poor - content recognition/regurgitation, not application and analysis. Mastering the higher level questions is critical for passing the NCLEX and ATI provides no help with that. I quit ATI after a couple weeks of spending 6-8 hours a day on it and I did the Kaplan in-person course instead. Kaplan was very strong in every area where ATI was weak as detailed above. The Kaplan decision tree is critical for passing and their questions are extremely accurate when compared to the real test. In fact I had a couple questions on the NCLEX that matched Kaplan almost word for word. The trend I noticed with my class is that Kaplan students had a slightly higher pass rate than those that did ATI and among those that passed boards, Kaplan students tended to pass with far fewer questions (most of us with 75 questions) compared to ATI students (often 200+ questions). That tells me that with ATI you are more likely to fail or barely pass than with Kaplan.

I chart all the juicy details. Pt stated, "@!*! *%!" Pt then threw urinal holding approx 700mL of urine. Urinal struck wall approx 12 inches from my head and left urine splatter pattern on wall approx 3 feet in diameter. Pt then verbally compared my physical likeness to several species of livestock. Pt then threw overbed table through window." You get the idea...

Have your buddy "rescue page" you out of the room. Set an appointed time when you want your pager/phone to ring - or you can ask to be paged to the nurse's station over the call button speakers. Works like a charm :-)

TrevyRN - you're right. There are very few indications for hypertonic fluids. It is a standard of treatment for traumatic brain injury to try to keep intracranial pressure from spiking.

The AACN does have an advanced critical care journal, don't they (beyond just the American Journal of Critical Care & Critical Care Nurse)? Maybe the AACN and their journals aren't necessarily for you after you are a CRNA, but then you should be doing something else to keep your practice current. Maybe an anesthesia association or journal, conferences, etc. While I think a lot of the alphabet soup stuff is dumb, I actually do have respect for the medically-oriented certifications like the CCRN. I actually have more respect for those certifications than I do for the worthless paper-writing BSN, or even worse, the MSN based in pseudo-religious mystical "energy field" theories.

In our facility (teaching hospital), the supervising docs started emphasizing to all the residents that they need to ask for the nurse during rounds. If the nurse is available, he or she is to be included in rounds. This has really improved communication. It also raises the standard a little for nursing. Nothing is more frustrating than getting report from an overnight nurse who can't tell me why a patient is NPO, whether the patient has actually gotten out of bed, at least a guesstimate of I&O, etc. I know I'm going to be asked these questions 10 minutes after report when the docs start rounding. If we can't answer those questions, it really downgrades the credibility of nurses to the docs, they rely on us less, and they have less motivation to include us in discussions. I've had good shifts and bad shifts. But I find that when I'm on top of my game, the docs take far more interest in including me. It feels good when I can point out an assessment finding that the doc's hadn't noticed yet - like a patient's off-handed comment that their peripheral vision is blurry, or that I noticed new pedal edema.

I can't stand it when I'm trying to get stubborn poop to come off of a bedpan by spraying it with the toilet sprayer thing and I end up feeling some of the splash on my arm - or even worse, on my face! My coworker was changing the bag on a rectal tube and the connector popped off a bit more suddenly than he anticipated. It splashed a small amount of poo on the side of his face.

pknurse: dude, does the PVT really work? Just kidding