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laflaca BSN, RN

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  1. laflaca

    buying supplies with your own money

    Hi friends - I work in a public school that is nearly 100% low-income kids. Public school funding here is 48th out of the 50 states. There's no money for anything, anywhere...which basically means that in wealthier neighborhoods, parents get a list and purchase $200+ dollars of classroom and office supplies at the beginning of the year, apart from what their individual child needs. In schools like mine, not so much. Our teachers typically spend at least a couple hundred bucks of their own money, or sometimes considerably more, on basic supplies for their classroom (adding insult to injury, since their salaries are low). The budget for the school health office is zero. Our resourceful administrative assistant pirated $200 from her office supply budget so I could get basic supplies from the district warehouse in September. I brought my own manual BP cuff, pulse ox, and thermometer to the office since it's out of the question to pay $300 to replace the battery and re-calibrate our Welch Allyn rolling unit. I regularly find myself picking up cough drops, disinfectant wipes, snacks, etc for school when I'm out doing my own shopping. Do others face this issue? In a seemingly bottomless pit of needs, where do you draw the line? No one's going to die for lack of a cough drop, for sure. But there are some basic things that make my work life easier (like the organizer bags I purchased for storing medications) - sometimes I'd just rather have them than not, and I'm not going to get them any other way.
  2. laflaca

    Possibly relocating to NC

    Duke is a prestigious name, but brace yourself for the salary. New grads there start at maybe $23ish/hour? So presumably somewhat more with 5 years of experience. Hospital salaries in NC are really very low compared to most places, and although cost of living is certainly lower than NY or CA...it's not THAT low. (I make about $36/hour base where I live now, with 5 years of experience. I'm guessing I'd make $27-$28 base at Duke? And the cost of living is only 10% lower in Raleigh-Durham. You definitely feel the difference. Most of my coworkers at Duke had roommates if they weren't married, or they cranked out a lot of OT). I got to see a lot of cool stuff at Duke, but there was noticeably high nurse churn/turnover...the vibe felt a bit like, "We're DUKE, and you're lucky to work here in whatever terms we give you." They did stuff like rotating day/night shifts that are not required in other hospitals, and difs aren't as good. My impression was that a lot of people start at Duke for the name, but after a couple years many leave for WakeMed, UNC or the VA where pay and benefits are better. The trees, mountains and beaches of NC are beautiful and I'm glad I got to spend some time in the state, even though I didn't settle there permanently. Wilmington/beaches and Asheville are great to visit, but I never lived in either area. Good luck
  3. I had a difficult couple days at work. Kids in dangerous home situations, sick kids, not-sick-but-very-loud kids, kids in fights with each other, administrative disagreements.... just some trying moments. On top of this we were short staffed. Normally we have three social workers, and today we only had one. Any social work shortage inevitably spills over to the nurse - I dread their vacation days. Anyway, as the lone social worker and I battened down the hatches and got ready to embrace the suck, she told me something funny. She was dreading work this morning and decided to calibrate her dread more precisely. This is what she came up with: if she were required to urinate on herself in public to get a free pass to avoid this workday, she would do it. However, she did not dread work so much that she'd be willing to defecate in public. All day long when we saw each other, we laughed and said, "are you willing to soil yourself yet?" And everybody left the building vertical, ambulatory and conscious....SO, I guess it wasn't such a bad day after all. Still beats any shift I worked in the hospital. Happy weekend everyone!
  4. laflaca

    8 years and diagnosed with PTSD

    Come to public health or school nursing (or a clinic, or an outpatient procedure setting, or many other places outside of the hospital)! Come see some regular people who aren't circling the drain. Today I did health education about iron deficiency anemia, I went over a gluten-free diet for a kid with celiac disease, I helped a coworker with her carb counting for insulin coverage, I went over contraceptive options with a student, and I worked on referring a kid to a program to help her get new glasses. Emergencies can happen anywhere, but the world outside the hospital is different. You've done your time in the trenches. I's OK to take a job that doesn't push you to your maximum capacity 100% of the time. Really! And normal-people hours....just sleep and a regular schedule, alone....can change your whole perspective. 100% worth the pay cut, if you ask me.
  5. We have a student like this...a lot of borderline traits. She'll present with a dramatic complaint (kicked out of the house! pregnant! doesn't have shoes!) and tell varying versions to multiple staff members, who run around trying to help her at cross-purposes to each other; eventually the story turns out to be verifiably false, or mostly so. I like a lot of things about this kid, actually. But as a team we have agreed that she has a "point person" (her social worker) to whom she is referred for any concerns. The social worker will get help from other staff if needed. Kids with these traits have a hard time understanding boundaries. They tend to idealize or demonize people, and will sometimes work really hard to play us against each other. Presenting a united, kind, and consistent front usually curbs unhelpful behaviors and helps them feel secure. You've gotta keep at it though, and it's difficult.
  6. I was also a new grad at 44! And, I also thought I was going to lose my mind. Did you have a different career before? I did - two, actually - and in both careers I finished school pretty much competent as an entry-level practitioner. Unfortunately in nursing that's not the case (WHY is that not the case? Post for another day). Don't compare your new-nurse self to your newbie experience in other jobs. The worst part is the first 2-4 months off orientation. I wanted to stay on orientation forever! Being on your own at the beginning is godawful. I had anxiety attacks too. I woke up from dreams about forgetting to do stuff. For the first time in my life I sometimes stayed awake freaked out for the entire night, and then had to go back to work with no sleep. I was a little nauseated all the time. I'd never had problems like that before, and I was in a very high-stress career previously. It does slowly start getting better. The getting better surprises you - suddenly you realize you had one day that wasn't completely horrible, or that someone asked you a question and you knew the answer, or that you didn't have to ask for help with any IV's this week. Then it sucks again, then it gets a little better - rinse and repeat until the whole thing is more or less manageable. A big part of your learning is pattern recognition ("OK, this person looks setpic, doc is going to order x y and z, so I need to get a, b and c ready"). It's not rocket science, but you have to live it in order to know it. It's why you feel dumb now, you just don't have access to what your experienced coworkers can see. You will see it too, even though you feel like the most useless idiot in the world right now. In terms of coping - as ridiculous as this sounds, I started meditating. I hate that woo-woo stuff, but I was desperate enough to try it, and surprisingly it helped. I hid in the parking lot before work and used a meditation app for a few minutes, and when I had a chance I'd sneak out during my break to do it again. I felt like a nut job, but it was better than crying in a closet :) Ultimately the hospital was not for me. I went on to public health and now am a school nurse. I like being out in the real world, more of a free-range animal. But believe me, I was a complete lunatic....if I got through that year, so can you.
  7. laflaca

    Eager to leave hospital nursing

    OK, I'm behind you all the way EXCEPT the part about maybe taking a break in between...because you're in an awkward spot right now. 6 months of nursing experience is "too old" to get another new grad position, but still short of the 1 year mark when you're generally considered truly NOT a new grad. It's a bad idea to make yourself unemployed between those two points - you will almost certainly have a rough time getting hired elsewhere. If you can get a job offer elsewhere while you're at this hospital, by all means make the transition, trucking to the 1-year mark of nursing experience in your new job and cruising past. But I'd do everything possible to avoid a gap in employment before you hit the 1 year mark. If it's any comfort, it really is true that things get better, even if acute care isn't your true love. You're at the worst part of it (when you no longer have a preceptor, but you're expected to be fully functional, but you still don't 100% know what you're doing). It's not going to get worse than it is now, I promise you. It will slowly get less bad the longer you stay there. You get better at managing, and even if you don't like the environment it becomes less overwhelming. I sucked it up until I had another job offer I felt good about, and THEN quit. [full story is: 8 months in an ED, moved to another state and tried med-surg for 4 months, hated that even more, THEN public health. I had new jobs before I quit the old ones. Not exactly an ideal career path at the time, but four years later it has worked out well]. I'm sure you can do it!
  8. laflaca

    Eager to leave hospital nursing

    You won't regret quitting if you find a job that doesn't suck out your joy....so the real question is, can you find such a job? Only one way to find out! Research public health jobs in your area - the pay, the available roles, and the requirements (sometimes you need a PHN cert). The situation in PH varies a LOT by state and even by county/region. See if you can identify some possibilities, apply, and see if you get any interest. Might not get anywhere until you have a year or two of nursing experience. But then again, you might. A lot of PH jobs are government, and their application process is slow, so you might as well have a look because the job won't happen tomorrow anyway. If you need to do some volunteer stuff, or take a class, or something else to beef up your resume - doing that stuff might be easier than you think, and it might give you hope for a better future while you're slogging through hospital shifts. I hated night shifts, I felt the same way you do about hospital nursing generally. I've found public health staff to be delightful (think: slightly nerdy do-gooders). I got along with people on my hospital unit just fine, but when I started at my PH job I immediately thought, "My people! I found them!" And if your first PH manager turns out to be a nutjob, or it's not quite the right fit, or you're bored, or you want better pay...you'll at least be sleeping like a normal person & more able to think straight while you regroup at some point in the future. Eyes on the prize RhodyBSN, you can do it! (I started as a new grad in an ED and left after 8 months for a job in public health - that was four years ago. For the record, no regrets)
  9. laflaca

    Charge Nurse in 6 months?

    Yes! Run, don't walk. Are you maybe working in a for-profit hospital? In general I would steer clear of those (there are a bunch in TX too)...not saying that good ones don't exist, but hospitals are already difficult enough for nurses and risky enough for patients without adding the profit motive - it's an incentive for administration to squeeze labor costs in the hopes of making shareholders happy (and often earn themselves a bonus, at your expense).
  10. laflaca

    Blended ACLS skill session

    Same for me...I normally prefer online learning but I thought the ACLS program was awkwardly designed, and I wished I'd just sucked it up to attend the in-person class. Lots of futzing around trying to figure out which menu "oxygen" was under, etc, while the patient died! The hands-on was a basic CPR demo, naming rhythms I think, and then a megacode.
  11. laflaca

    Do you miss bedside nursing?

    I went from ED to public health, back to ED last year and now to school nursing....never never never back to a hospital. I saw lots of cool stuff then, and I get paid less now, but when I think back on it....just the simple things, the typical nurse complaints, like not getting to eat or use the bathroom. (If you read a newspaper article about migrant workers who had to work 13-hour shifts and often didn't get to use the bathroom you'd think, "Jeez, that is terrible, how can these places abuse people like that?"....yet most nurses are casual about accepting the same treatment themselves). The endless efforts to speed up the assembly line, the constant demands to take another patient or discharge people faster, the feeling that you're not ever providing great care, just moving bodies in and out the door - no thanks. Any job can get on your nerves sometimes. But now I sleep well, I have more patience for people, I have time and energy to work out, I'm not so anxious or irritable, I drink less, I get outside more. It's worth the pay cut.
  12. laflaca

    Meals, snacks, night shift habits?

    I like this list a lot! I ate in a similar way....I thought of it as my "kindergarten diet." I'm normally a great eater, but sitting down to a full hot meal in a gross breakroom at 01:00, nope. I had success with finger foods or at least simple foods that don't require re-heating, that don't require an appetite, that are easy to get down, with a decent combination of protein and fiber. My go-to list: hard-boiled egg with a bit of soy sauce rolled-up slices of plain deli turkey with mustard orange sections or diced-up melon bananas, celery or apple slices with almond or peanut butter grapes baby carrots or sugar snap peas with yogurt dip an ounce of nuts string cheese Triscuits and hummus granola or protein bar for emergencies - they often have a lot of sugar and fat Trying to avoid carbonated or sugary drinks, but also not liking to drink plain water, I usually brewed up unsweetened herbal iced tea at home. I like the Tazo brand's "passion" tea.
  13. laflaca

    Assessing the student on drugs

    I am new as a high school nurse. Our district has a standard form used for impairment evals - basically vitals, pupils, orientation, nystagmus, stand-and-turn and Romberg, and some questions....but I seriously question the value of these assessments. Or at least I'm frustrated by them, because typically what the principal or teacher wants is "proof." Our form is basically an adapted police field assessment, which was intended to screen for impairment and legally support a decision to detain the person and require they provide evidence - a breathalyzer or blood test. But since in a school we don't do laboratory tests to confirm or rule out substance use, and since we're not building a court case, what's the point? Some of the kids referred to me are surely high as kites (on marijuana or occasionally something else), but if they're regular smokers who aren't dumb enough to do it in front of witnesses in the parking lot and breeze in reeking of weed, there is not any definitive exam to "prove" it. Even if they smell like pot, I'll note that but it doesn't prove anything. If a kid has pinpoint pupils and respirations of 4/minute, or if they're agitated and hallucinating, I'm calling 911 regardless of whether it's from drugs or something else. If the kid is upright, walkie-talkie and doing math problems, denying any use, denying any physical complaint, they're probably going back to class; staff can still call parents if they're aware of some concern. I'm basically just figuring out if they're safe and stable; I don't have secret drug-detection powers! Personally I fill out the form, noting my observations, I'll document whether the kid admits to any use, and I'll provide education to the kid about risks - but I tell the teacher or principal every time AND document on the form, "Substance use cannot be confirmed or ruled out without laboratory testing, which is not available in this setting."
  14. laflaca

    Qualities for a nurse in public health

    +1 for this....different jurisdictions have very different roles (and funding) for PHN's. In my area there are tribal PHN's who do extensive hands-on clinical work in home and clinic settings (wound and diabetes management), there are PHN's in small counties who do a bit of everything (case management, vaccinations, disease control, STI testing), and there are PHNs who have strictly office-based jobs planning or evaluating programs.
  15. laflaca

    Most satisfying nurse job

    Public health! Prevention is way more satisfying (to me) than acute care, the hours and working conditions are more humane, and your coworkers are mostly nerdy do-gooders, my favorites :) Of course the pay is often less, but to me it's worth being able to eat, sleep, and enjoy other humans instead of rushing around like a maniac.