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Hello! I've been at the bedside in various specialties for 8 years now. I'm a bit burnt out from it and would like a break. There are several ambulatory surgery positions available in my area right now that I think might be a nice change. I shadowed in ambulatory surgery briefly as a new grad and it's a bit foggy now but I do recall liking it. My IV skills are a bit rusty as in my current position we don't do lots of IV starts, though in the past when I've done them more I was a lot better. I don't really like working with children. I love children, I just hate putting them through anything painful. In a previous role I had, I had to administer shots to kids, and I got through it but it sucked. My biggest concern about transitioning would be working with kids, especially starting IVs on them. I would feel absolutely awful if I missed on a child. So much so I'm not sure if I should even consider ambulatory surgery. Did anyone have any similar reservations and how is it going now?

Ok so I work PT (2 12s)/week. I was doing PT bc of my daughter, but now need more hours so would have to go back to 3 12s soon. Busy med-tele unit. Hate the docs, they're awful. Coworkers are ok, not the best, not the worst. I like my manager. Every other weekend, some holidays. I'm always running around and charting my butt off. Pay is about 36/hr. Benefits so-so. Job offer is for an adult day care. I think I'd love it (obviously not for everyone) biggest nursing duty is the UAS assessment . The manager and other nurse seem amazing. It's 7 to 230 m to friday. No weekends/holidays (actually off Xmas Eve, Xmas, tgiving, Black Friday etc) and snow days. As my child gets older manager said she is very flexible on bringing them in if needed here and there. Violent/disruptive attendees are not allowed in the center. Pay was offered at 29/hr, I might be able to negotiate to $30/hr. Benefits for family were astronomical however reasonable for someone single and are on par with hospital benefits. Daughter would switch to husband's benefits. It's been so long since I did m to friday. I'm worried I won't see my daughter as much but I don't see her at all the days I work now. Obviously the pay cut is significant as week, though I think I could swing it financially.

Just wondering how everyone handles the ciwa scale. On my floor it's typically ordered q2 if the Pt has a history of drinking. However with the last couple of patients I believe the patients lied (or at least exaggerated) symptoms to get meds. I think this then led to them becoming actually worse off... Hallucinating, violent etc. Soon after when Ativan was eventually cut back or stopped they became better off. I typically go through the questions, but just as with pain, if they tell me they have severe nausea headaches pins and needles etc I enter what they state... Which leads to a dose of medication. I've also seen nurses who, if the Pt "looks OK" to them enter 0. I don't want to falsify documentation but it almost seems like sometimes they would be better off without the Ativan. So what do you do if you think the patient is lying?

When I was doing IV meds I rarely pushed anything for the full amount of time recommended unless it was a cardiac med or chemotherapy. Narcotics I would push over at the very least a minute, but slower in more critically ill patients. As far as lines go I always back primed the saline into the old antibiotic bag, then hung the new antibiotic. If there was a severe incompatibility (chemo, TPN, etc) I started a separate bag with its own clean line. Rarely we would have an MD order that it is OK to hang TPN with something else.

I wanted to be a wildlife rehabilitator. However, they don't make any money. So here I am. Still something I'd like to volunteer doing in the future.

Thats crazy. I've never had a urologist come in and tell me my bag was going in too fast. I usually open it up enough where its fast but I can still see it dripping, rather than pouring out, in the chamber. I think an average bag for me will last about 70 - 90 minutes. Not good for the pt. if they start clotting. Anyway you can discuss with a urologist and maybe get the policy changed?

Haven't had this happen to me personally, but know lots of other nurses who it did happen to, usually by a difficult patient/family. Don't know why they liked me, but I really wish they would have "fired" me, ha. I just think some people don't have a clue... I'd be thankful I didn't have someone like that.

I often jokingly get a "what are you 15?" thing from many patients. Many patients don't say anything. I don't really think much of it, I explain things, am honest when I am unsure of something and make sure to find the answer, and am compassionate. I've had some skepticism due to my age, I'm sure, but as far as I know I haven't had anyone unhappy with my care.

About 4.0. The patient had severe cancer mets spread throughout the GI tract. We transfused a ton and they would get to around 6.0 for less than 24 hours. They eventually went to comfort care and died, but was quite alert for a while.

I usually look stuff up a few times a week on my own at home. If a pt. has something I'm unsure of I look it up at work. I also watch medical shows, attend monthly educational dinners, and ask doctors (if its not crazy) things I am unsure of. Plenty of docs like to educate.

I work in oncology, but with med-surg patients too. It has its ups and downs - the patients can be very complex. Complex chemo, patients who have had reactions to chemo, colostomies, urostomies, PEG feedings, trachs for those with with masses potentially occluding the airway, A LOT of pain management, pain drips, transfusions... You have a lot of very, very sick patients and many times they're pretty young. I've had many patients take a turn for the worst within a shift's time, so you really need to pay attention. I find it very trying at times, the patients can be very needy (with good reason) and you often will see them at their worst. There are a lot of ethical issues, patients with mets every where, still getting chemo that probably won't help and you wonder if its killing them quicker than the cancer would itself. Seeing younger people die (youngest for me was in their 20's, not much older than I am) is absolutely awful. However when you see patients get better for a while, or they're so appreciative of your help its very rewarding. I've also learned a ton, and am constantly learning more. These patients have such a huge variety of things going on.

I'll vote oncology as well. We're also a med-surg floor, so have a variety of patients. But our oncology patients come in often, and many of them are there for a while. The sad thing is seeing them pass away though, as many do. But hey, some of them do get better, at least for a while.

I wear gloves if I'm spiking antibiotics or meds (well, usually, sometimes I forgot) because I've had some leak on me and it freaks me out. I don't typically wear gloves during pushes because who would I be protecting? I always wear gloves while pulling/starting IVs, hanging blood, albumin, platelets, etc, and drawing blood.

This largely depends - DNR doesn't mean do not treat. I may have a pt who is a DNR who is perfectly alert and oriented, mostly independent and in with cellulitis. If I walk into the room and they are unresponsive I'm calling a MET call - maybe they had an MI or stroke and need treatment ASAP. If I have a pt. that is deteriorating over the course of week, and eventually has poor sats, bad vitals/labs but has expressed to me they want everything done short of compressions/being intubated, I'm calling a MET call. If I have a pt that has been poor, family knows they are poor, pt has no plans to ever recover etc. then I would treat whatever symptoms they have, oxygen, lasix, etc. I always try to evaluate which patients want comfort care/hospice, vs treatment but not compressions, etc. I think so many people are hesitant to sign a DNR because they think we will no longer treat them. And unfortunately I've been in many arguments with MD's because they think the patients DNR means they are comfort care, when the pt. has clearly expressed that they want treatment. I may not agree with it, nor the MD, given the patient's condition, but its not really our decision to make.

I always have thought I was very compassionate, and still think I am, but maybe not to the extent prior to nursing. I think its because I've seen young patients die horrible deaths, yet stay in high spirits until the end, and have watched their families in misery throughout the whole ordeal and at the end thank the nurses so much, etc.. Then across the hall is a demanding pt with cellulitis, with a demanding unhappy family who are sue-happy, and have complained to management about x, y, and z, and so management says we have to give extra attention to this patient, etc. And I would never rant near a patient's room (I have seen others and find it completely inappropriate), but I must admit I will to another nurse, usually behind a closed door like the utility room or something. I feel situations like this suck my compassion, but I am still nice to all. I don't believe being mean or vindictive gets you anywhere. I think once I get out of this area of nursing it will help, its too depressing for me and that takes a big toll!

Can't answer about pay. As to the oncology part the most difficult thing for newcomers I think would be the extremely sick patients you may have - many very young (I have had numerous patients die in their 30s, 40s, 50s). And the death. CNAs at my hospital are the ones often cleaning the patient up and wrapping the body after death. I find wrapping the body after death very morbid myself, our wraps look like trash bags. Many of your patients will be very dependent - colostomies, urostomies, difficulty walking (either to weakness or bone mets.), and many times pts can become confused with brain mets. Lots of nausea, vomiting, and diarrhea with chemotherapy. Good luck to you.

1. New York 2. One 3. Hospital - oncology/med-surg 4. $24.80 (Days) 5. Nights gets about $4 more, evenings $3ish, weekends is cents.... don't even notice 6. Nope I live in upstate NY which I don't find to be too expensive. I rent a very small 2br house for $650/month. Gas is about 3.75 right now.

Due to insurance reasons and being in a smaller area this is quite common for people at my place of work. We've had doctors, nurses, ancillary staff we know on our floor. Thankfully I've never experienced that. I agree I'd be quite mortified. However, many of the nurses and doctors I know that have been through it are able to make jokes. I feel like some doctors even forget, if you see 25 butts a day, you'll probably forget about most of them. I must admit this is why I chose not to have a colonoscopy. A doctor I see often enough would have done it.... and hecks to the no (though I really don't think it was needed anyway). Also, I have some people I wouldn't let touch me with a 10 foot pole, though those people are every where and it may be of benefit to know who they are. I certainly feel for your situation - best of luck to you.

I reread it, and would have given it. Though I wouldn't necessarily give the PRN 20 minutes after the routine, I try not to completely snow anybody. But yes, I consider PRNs and routines separate orders. Maybe ask for an MD clarification so the pt receives more consistent pain management. If her pain is always a 7, maybe she needs some adjunct therapy.

I had a small debate once with the older nurses on the floor. I was newly out of school and taught that many IM injections don't, in fact, need to be aspirated. They looked up the policy in the nursing guide we use, and low and behold, it did not say that you have to for all. I mostly give IM injections for vaccines, so I'm not sure about ALL medications. A quick google search revealed this: " The results were not surprising; there was no research evidence to support the use of aspiration in giving I.M. or subcutaneous injections. The researchers recommended the following for consideration: Aspiration is not indicated for subcutaneous injections of immunizations, heparin, and insulin Aspiration is not indicated for I.M. injections of vaccines and immunizations Aspiration may be indicated for I.M. injections of medications such as penicillin Until a standard can be established, injection techniques must be individualized to the patient to prevent incorrect needle placement (Crawford & Johnson, 2012). " (Source)

The information they provided is all relative. If 500 people applied and only 7 were hired thats not a ton of openings. My flood alone hired like 10 new nurses in one summer, and we're relatively small. Also orientation for a new nurse is expensive. While doing hospital orientation, floor orientation you're getting paid a salary, but don't count as staff - you're just learning. Thats a very large cost. I wouldn't take it so lightly. I'm not sure if they could send it to a collection agency if you chose not to pay, but you def. need to do some research. I signed a contract for a 10k sign on bonus for a 3 year commitment. I don't plan on staying all 3 years and plan on paying back what I owe. I signed the papers. I committed. Maybe you can transfer some place else within the organization.

I was not at my hospital prior to magnet but honestly don't care for the status. For one, I think we miss out on many potentially good employees because they will not hire those with two year degrees. A lot more paper work is added. It seems to me as if the nurses who have been there for a while don't care for the changes. To be honest I think magnet is kinda a load of crap and doesn't mean a ton...

Thanks everyone for their input; its very helpful. :) I think with less stress and better eating it may work out well for me. I feel tired a lot right now, so I can't see that getting worse, only maybe better. And maybe I will be able to see my boyfriend more, by the time I get home from work now, take a shower, cook dinner, walk my dog, its already 8 or 9 pm so we hardly see each other (we don't live together). If on night shift I'll be up an hour before he even gets back from work. Also, because of the pay increase I'll be able to work 4 days instead of 5, which would be nice..

The anchor sleep thing is very helpful - thank you!

I was hoping to just give it a whirl first for a very short time to see if it would be a good fit. I just remembered that in school (Jr. high and HS) every time in the summer, I would go to sleep later, later, and later, and eventually I would be awake at night and sleeping during the day. I wish I knew how I felt otherwise to know if it worked for me. It just frightens me about the associated health risks. I always hear people saying how much better they feel on days vs nights but never vice versa, which concerns me. Eventually I'd like to get away from bedside nursing and do maybe public health or more teaching based stuff, which would be day shift things but I think even 9 - 5 or 8 - 4 would be a ton better than 7 - 3 and thought maybe nightshift would be better for me for the time being.