decembergrad2011

I think newer nurses don't understand that once you've worked with a patient population for awhile, it really can be much easier to look it up yourself. It also prevents you from relying on someone else's information about orders and discovering later that they were wrong. I definitely listen to report, but I may not write every little thing down. I'm not sorry that I am a dual certified in my field and have been there nearly a decade. I give and prefer to receive report by exception - I don't need to be told they're a full code, lungs are clear, on room air. EMV = 15. I assume they are unless told otherwise. I don't really need report on things like medical history, physical assessment, etc, either because I will read the H&P and do my own assessment. I do like to know little idiosyncrasies that don't translate well over EHR. You won't likely find a doctor writing a note about the patient preferring their big pills cut in half or wanting applesauce instead of pudding to swallow them, but knowing that before you head into the room with pills makes it smoother.

Accessing portacaths!! I love pulling back and getting great blood return.

That makes me so sad. Poor thing ate a donut that was essentially trash.

I breastfed my daughter until 2.5 but stopped pumping at 1 year. Most women who do extended breastfeeding and work tend to give up the pumping sessions.

On a 12 hour shift, I would pump 4x for the first 9 months. At 9 months, I dropped to 3x, then at 10 2x, then the last month was spent only pumping once halfway through my shift. I plan to do this again. People had problems with it because it was impossible for anyone to take a break some days unless they literally said, "I'm taking a break, bye" and went away. I was protected by law and my baby was a priority, too, so I made sure to take my breaks even if my day dictated that they were brief. However, I didn't take any other breaks where I was unavailable, including my lunch breaks. I would often let my food grow cold as I attended to something, or would eat while charting. I did start allowing myself uninterrupted breaks again when I dropped pumping sessions, but I think that minimized people thinking I was getting extra breaks. Now, I try to be an advocate for pumping nurses and offer to watch their patients while they pump. I am thankful to those who did the same for me.

We're scared, too. Many of us never believed our country would fall so far. I am currently trying to convince my husband to draw some lines in the sand for what we will stand for before we leave the country. We are hoping so much that Mueller can do something through this investigation to restore justice and order, as I am still not convinced that Trump was the will of the people.

You cannot be scientifically minded and say, "meh, big deal" about this recent revelation. However, I also believe wholeheartedly if you read this news and say, "meh, big deal" you are part of the problem anyway.

Gifts are always appreciated. I haven't received them from licensed nurses, but from almost all my nursing students. But one of my favorite students I've ever precepted is the only one so far that did not actually get me anything and I didn't think about it negatively. They usually would get me Starbucks gift cards, a nice handwritten note, and maybe a trinket like bath bomb or candy. Things that were inexpensive and practical and sweet. The meaning behind it was awesome, and my favorite part is ALWAYS the cards. :)

Sorry if I'm stating the obvious, but is there a policy to follow at your institution? For example, I work in progressive care with telemetry patients and our charting requirements are different than those of the acute care floors, but also the ICUs. I would look for this policy and follow it for your basic guideline for your daily shift charting. When there is a decline, a change, or even if I contact the doctor and it's not obvious that any action had been done (i.e. sys blood pressure is getting close to 180 but doctor just wants to recheck in an hour and continue monitoring for now, so there is no new order in place) I make sure to chart my action because I want to make it clear that I was aware and took action. Sometimes this is lengthy or requires going back and documenting every time I notified a doctor to establish that I was appropriate in following up, but that usually is for extreme circumstances.

I already said it was the first day and to let it go. I also explained why I did not think placing with a CNA preceptor was an acceptable practice for an ongoing RN clinical experience because that was a topic of debate within the thread.

I am talking about the nurses that I personally work with on my floor that I have seen go through graduate school. I work with them and see the things that they miss and the gaps in their critical thinking. They are where I would expect 2-3 year experience RN's to be at, and I am not saying I was any further along at that point in my career. However, you do not even know what you do not know until around two years, and that's if you stay within the same specialty. They will be fine with experience like most people, but I do not think that 2-3 years of experience total working as a nurse in healthcare is enough to draw upon for the practitioner role. I'm in a 5 year part-time DNP program because my family needs me to continue working FT. A full-time student can complete the program in 3 years total from a BSN. I'm okay with it taking 5 years because it gives me the opportunity to continue learning and the time for a really good research project.

I think that you need experience to be an advanced practice nurse in any capacity. I entered my DNP program with 4 years of inpatient med-surg oncology experience, and will finish the program with 9 years total as a nurse (planned to stay on the same floor). However, I work with many co-workers who will be graduating with an advanced degree with barely 3 years of experience total before going out there. Most of them started their degree program with less than a year of experience, sometimes just the summer between graduating with their BSN in the spring and starting grad school the following fall. They are not ready, in my opinion, to be independent practitioners at that point, but it is not their fault that programs will accept new graduate BSN students into the next semester's course. Some of them are definitely pushed by their universities to aspire to an advanced degree, if not necessarily to become a nurse practitioner.

I would have been annoyed about being paired with a CNA as well. When I was going through CNA clinicals, I expected to be paired with a CNA and see that role in its entirety. However, the RN role is much broader and requires a different skill set that includes the skill set of a CNA. I can understand their desire to allow the students to shadow CNA's in early clinical settings for the purpose of learning basic hygiene, bed changing, and mobility (and a whole lot more) if they do not require them to go through a CNA licensure prior to starting their clinicals. However, that should not be the norm for a med-surg clinical in any respectable nursing program. If there are not enough nurses to go around, the clinical instructor should facilitate learning by taking a small group of students themselves, splitting them into teams, assigning multiple students to one patient for parts of the day...there are just so many more creative ways to allow students to get an idea of the RN experience rather than being another body performing hygiene tasks. Yes, these tasks are important. Yes, the CNA role is important. But that does not change the fact that placing a student nurse with a CNA is not allowing them to see the delegation, prioritization, and coordination that a registered nurse performs in the hospital setting on a daily basis. While yes, you may have to be your own CNA for patients due to short staffing, you still are responsible for the duties performed by the RN. One clinical - I would let it go. But I would not allow myself to be placed with a CNA the next clinical without speaking up, especially if they are not rotating the nurses around. We had anonymous evaluations every semester - if you do, I would also make sure to note that this occurred in your evaluation and how you felt honestly. Schools do make changes, including clinical site changes, based on evaluations if multiple people speak up.

Watching the abbreviated video made me sad. Watching the full version made me angry. There is no justification. Although, we knew we had a cancer growing with the police force if we were listening to people of color who were seeing it and providing us evidence of it happening in their communities. The only positive out of this situation is awareness of the corruption and brutality that is silently accepted by police and steps to prove it is not okay. Legally, she was expected to stand there without protest while he moved her body. In fact, she was supposed to comply with his "arrest" and then let the law figure it out later. That infuriates me even if I don't have a solution. HE SHOULD NEVER HAVE TOUCHED HER! The fact that he was not placed on administrative leave until after the public leak is ridiculous. He needs to be held accountable by being let go. Let him have his early retirement, whatever, if this is the first and only incident and chalk it up to PTSD. But if he has a pattern of being involved in "situations" like this, then the appropriate departments need to take measures to ensure justice where he was involved and negatively influenced others with unlawful actions. I also believe he is a sociopath, but that is a gut feeling based on only 20 minutes of footage and a few hours of internet perusal.

If they need it for chemo when I go to start a peripheral IV, I attempt to stick it in the forearm, avoiding wrist and AC. I'm not real keen on giving chemo through a peripheral IV because *many, many* times I've not been able to get blood return after the initial placement, and other times I've been able to get it at the start of chemo but not at the end.