MaroonTX

CVA symptoms can also be subtle.. I had a patient recently who came up to us after getting tpa for an ischemic stroke. When they brought him up he was intubated and sedated so in order to do neuro checks they just had me cut off his sedation every 1-2 hrs as tolerated. Since his blood pressure would sky rocket soon after the drips were turned off I had very limited time (basically just long enough to see some movement and eye opening, but not following commands) Then during one of my checks I noticed a slight decrease in the amount of activity. Since I had only been working in the ICU for ~1 month, I wasn't sure if the change was significant or not, especially since I wasn't able to perform any sort of objective assessment. It just seemed to me that he was moving a little less, so I decided to let the docs know anyway, just to be safe. A stat MRI was ordered and he had indeed had a hemorrhagic stroke as a complication of the tpa. It was definitely a learning experience!

The hospital I work at has an ICU fellowship program for RNs with experience outside of the ICU. I am in the internship and the folks in the fellowship go through the same type of education/orientation period as we do, except their length of time in the preceptorship is 12 weeks instead of 16 weeks. The program includes class at least once a week, rotations through the STICU, MICU, CTICU, and CCU with various preceptors and of course ACLS and other certifications our hospital requires for their ICU RNs (dysrhythmia, epidural, stroke etc.) You should definitely look into hospitals offering similar programs :-)

I am new nurse in the ICU also (~3 months) and what many of us have started to do (since there's quite a few newer/inexperienced nurses on our unit at the moment), is print off a list of Y-site info for our pt's and pass them off during shift change. These lists usually include what drips/meds the pt. is currently on + common emergency/procedural drugs we use. When there's a change made people will update the lists, or if time did not permit during that particular shift they will just mention that there was a change and I will usually try and update the print out at start of shift. It really helps save time (not to mention paper) to hand these off rather than printing out new ones every shift. We don't expect the experienced folks to update them of course, but they have been great about keeping them to pass along and will just mention during report that these meds have been started so you may want to add them to the list. Another thing I started to do is make a master list of all the IV drugs I've encountered (starts off a little tedious, but eventually you won't have to add drugs that often) and just play around with them on the Y-site program on your days off. Definitely not close to being an expert yet, but the repetition is helping things to start and sink in. If I've learned anything in these past couple of months its that being a new nurse is like being in school. Your job is definitely not over when your shift ends, you gotta study and do your homework on your days off, b/c as you mentioned free time is a rare occurrence during your shift (esp. us newbies, who are much slower at getting things done lol)

I did my nursing school capstone in the SICU and LOVED it, but like you I had reservations about being a new grad nurse working in the ICU. Especially when so many say "new nurses should start on the floor". However after speaking with those I had worked closely with (preceptors, other SICU nurses and a couple of my professors) they all said that there is no reason ALL new grads HAVE to have floor experience first. I have been working in the ICU now for about 3 months as a new nurse and I'm LOVING it. I think what area of nursing you start your career in should depend more on your personality and what you find satisfying in a job. ANY new grad is going to have to work their butt off regardless of the unit. I won't speak for others b/c I don't want to upset anyone, but I feel that straight out of school I was pretty useless. 3 months of experience + extra education/guidance, I'm not quite as useless, but I'm still far away from knowing it all, heck I've barely scratched the surface. What's important is that my work environment (the ICU) keeps me driven. Everyone thrives in different environments, you just need to figure out what you're most interested in learning about and the type of environment that keeps you motivated to persevere. As a new grad nurse you're going to have to overcome a whole lot of obstacles. I can't even begin to describe the highs and lows I've experienced in just 3 short months, but when I reflect on my career thus far the positive experiences outweigh the negative ones by a long shot. That being said, I would strongly encourage you to start out in a program designed for new grad nurses (whatever area you decide to work in). On a side note: What is the reason behind "the new graduate needs to put in their time on the floor" theory?? Please know I'm not being rude or sarcastic, I'm just genuinely curious b/c where I went to school this was never encouraged. I just remember some of the veteran nurses (20 + yrs experience folks) saying this all the time while I was in clinicals, but never really got the chance to discuss with them their reasoning??

Has anyone ever had trouble with near fainting while working?? I remember this happening to me a couple of times in the past, but today it happened again and it really freaked me out!! It seems to happen in the early morning during day shifts (I've been on nights for so long since the first couple of occurrences that I had totally forgot about it happening to me in the past), but before it happens I'll just be going about my business and I suddenly feel overwhelmingly hot, then sweaty, light headed, then my vision and hearing becomes distorted and at this point I usually have to leave the room and sit down or run cold water over my face. I know it has nothing to do with bad smells or any of the "grosser" aspects of patient care, so I can't really seem to figure out what is causing it. Any help would be appreciated because it's pretty embarrassing when I have to suddenly leave a patients room (especially right now since I am in orientation at a new job, working with another nurse). Not to mention I won't feel quite right for a long time after. THANKS!

Lovely- I tried to send you a PM, but I'm not sure if it went through or not (don't think Ive made enough posts or something??) Anyway let me know if you didn't get it!!

I can say that after orientation I'm more excited than ever to start my nursing career at S&W!! Yes, it was a long week, but wow what an amazing opportunity they give all of us new graduates to fulfill our potential as nurses!

Lovely, I had my interview on a Friday and received the call from HR with the official offer on a Tuesday and they e-mailed me the new hire packet later that day. Apparently the offer I was given the day of my interview was "unofficial" (oops lol).... Anyway I'm sure HR is just swamped right now, but it couldn't hurt to call just to see what's going on. And again CONGRATS

Congrats lovely!! Sorry, I haven't been on here for a while, but that's really exciting and I will see you in June. As far as places go, I didn't look at apartments because of my dogs so I don't really have any advice on those unfortunately...However, it only took me a day to find a place, so hopefully the rest of you won't have too much trouble!! Anyway congrats to everyone and I am sooooooo excited to start and meet all of you :-)

I went to Temple today and found a duplex that I signed a lease on. I didn't check out the apartments because I have dogs and wanted a backyard, but from what I can tell prices are pretty reasonable (I'm paying $779/mo for a 3 bed, 2 full bath duplex with a yard). There are definitely some areas of town that are kind of sketchy, but also really nice areas (i'm lucky bc my boyfriend is from the area so he could tell me immediately what places to avoid based on address). If anyone has any specific questions regarding an area they are interested in, let me know and I would be glad to try my best to help. Another tip one of the realty companies gave me is that right now the selection is a little slim, but starting soon many rental properties will open up bc the interns/residents @ S&W leases will be up and they will be moving on.

What unit?? I got the call for the ICU, and I'm super excited :-)

I believe for the ICU it is room 286 on the second floor. I was told it was in the South Tower, but technically you have to go around some strange way to get there. There is a patient services type desk if you take a left after entering the South Tower and just tell them where you are trying to go and they will give you a map with some directions (as you can tell I got lost and had to do this lol). Again, best of luck :-)

Yes I'm from Texas. Definitely let me know how it goes, we may be coworkers in June :-)

I interviewed for the ICU. Lovely, what they did was initially talk to all of us in a group and basically gave us a brief overview of how the program and the interview will be conducted. Then everyone is separated and given one on one time with each interviewer (director, manager, educator etc). Then after about 10-15 minutes they will swap you off to the next person (just like you are rotating through stations). Try not be nervous and instead show them your enthusiasm for the program. Good luck :-)

I agree boooo to the negativity. Of course I appreciate when people share their experiences and give input, but it is definitely understandable that in a competitive atmosphere people do not want to be too revealing. I will go ahead and share that my experience interviewing at S&W was amazing. I felt very comfortable and connected to all those I interviewed with, and can honestly say it was the best interview experience I have had so far. The interviews seemed more like a conversation than a nerve wracking test, and I feel that I really got to know about the hospital and they really got to know me. My advice may sound a little generic, but it really made the difference between this interview and previous one I had about a month ago, so here it goes..... 1) Prepare. Google or read the forums on this site about common interview questions. I printed these out and quickly jotted down my thoughts on each. The first time I interviewed at a different hospital I did not do this for fear of sounding too reheorificed. However, I quickly learned that nerves may leave you feeling tongue tied or as if your mind has suddenly gone blank. By collecting your thoughts on these questions ahead of time you can avoid those long awkward pauses after the interviewer asks you a question. Take out the pauses and you seem more prepared + you have more time to let the employers know just how wonderful you are :-) 2) Research the hospital and unit ahead of time. This is pretty self explanatory, but I think it allows you to really get a feel for what the hospital and those who work there are all about. 3) Be prepared to ask questions. What do you need to know about them in order to assess whether this place is the best fit for you. I actually wrote these down ahead of time and brought them with me to the interview. 4) Be yourself!! Yes, I know this sounds a little lame, but I think a major part of an interview is letting the employer get a feel for your personality. Most people probably have the same basic types of answers to the questions you will be asked on an interview (ie. Q: Why do you want to be a nurse A: I enjoy helping people). Think of ways you can incorporate aspects of your personality and past experiences into answering these questions so that your answers are truly personal rather than generic sounding. 5) Get there early!! The hospital is a little confusing and I wandered around for about 15 minutes before someone kindly directed me to where I was supposed to go. Plus getting there early will allow you to sit down, relax and talk to others who are there to interview -- This really helped relieve some of my pre-interview stress. So like I said, not the most original advice, however I made the mistake before of not taking these simple steps and the result was less than desirable. This time around I really prepared, and things went much more smoothly :-) .... Best of luck to everyone who has interviewed or will be interviewing soon -- and don't be discouraged if you (like me) have had any previous bad experiences interviewing -- learn from those experiences, stay confident in your abilities and have faith!!

Heyyy everyone! I was contacted yesterday about setting up an interview for an ICU internship position at S&W! Scheduled it for this Friday and I am sooo excited/nervous !!!

Yes I took the test on Feb. 25th and passed :-)

Just an update- I went to the doctor and found out that my iron level was LOW, couple that with all the weight I lost due to inadequate nutrition and stress (i'm 5'9" and dropped down to 120 lbs) over the past year and surprise surprise this = NO ENERGY... so glad I got it figured out and fixed b/c I managed to get my energy back , pass my NCLEX and have the motivation to work on applying for jobs again. Thank goodness it was nothing major, because I was starting to feel depressed because of these symptoms... Thank you for your support :-)

Yes those were the only 2 things I really used. I would occasionally look at the ATI books as well since we had them for school, but they weren't a huge part of my study process

Hey everyone, I took my test on the 25th (75 questions in about 1 1/2 hours) and found out I passed! Since I really appreciated the advice people posted after taking the test, I thought I would pay it forward! Every test is different, so of course none of this is set in stone, but this is all based on my personal experience with NCLEX! Since we aren't supposed to post test content I thought I would focus mainly on what resources I used, how I used them, and areas that were prominent on my test. Saunders- Used this as my basic overview of facts source. Many people have covered the strengths of this book, so instead of mirroring their praises I will describe where I feel it is lacking. While it contains lots of information, I sometimes struggled with actually learning from it. However, this may just be due to personal learning style (I like to focus more on how a disease process works and derive S/S from there, along with HOW the interventions serve to alleviate or reverse these processes -- Memorizing lists of S/S and interventions is just not something I'm particularly good with) During my test I encountered a few questions where not knowing the answer really irked me because they were some of the few pure fact regurgitation type questions that don't really require any critical thinking (usually the give-me questions). After I left the testing center I got into my car and immediately opened up Saunders to look up the answers to these questions and was disappointed that the book failed to contain the information. This could have just been a case of bad luck, but it leads me to recommend having more than one source of information (one book can make up for another's shortcomings). Another recommendation I have is while Saunders does a good job of providing you with a list of interventions and client education (good for SATA), it rarely goes deeper into which one is best (bad for priority)-- I would occasionally refer to your text books or school notes and star which would be a priority and add more detail to client education points. If time is an issue, then stick with Saunders because overall it contains plenty of useful information that will more than likely allow you to pass!. LaCharity - WOW am I ever glad that I read this forum and decided to purchase this book at the last minute (well like a week before my exam date) -- As many have mentioned before prioritization and delegation are pretty important and this book does a stellar job IMO in helping you learn how to work through these questions. I didn't manage to get through the entire thing, but what I did manage to get through helped tremendously! Delegation: My approach to using this book was finding what I like to call patterns & constants. I started off by labeling separate sheets of paper with each role (nurse assistant, RN, LVN/LPN, physician, NP etc). Initially, as I went through the questions I would assign each answer choices to their appropriate role by writing it on their role paper. Since this would be way too time consuming to do for the entire book, I then read over what I had written and started noticing certain keywords that seemed to pop up over and over again when a certain task belonged to a certain role (I posted some of these earlier on this discussion board). I proceeded to continue answering questions based on these list of keywords I made and found that I was doing much better on the questions! From there, instead of every adding single answer choice from every question, I would just add instances when these keywords failed to help me come up with the right answer (the exceptions to my "rules"). I also added a can/can't column on the role papers. In these I would fill in tasks certain roles (primarily LVN/LPN and nursing assistants) could or couldn't do (ie. a nursing assistant CAN take out a foley but CAN'T insert one). Yes, this process was initially time consuming, but in the end I was flying through questions with much greater accuracy. Prioritization: Had a little more difficulty finding a methodical approach to these questions. The test and this book rarely give you a blatantly obvious answer choice. Multi-patient questions will never present you with one critical patient on the verge of death and 3 stable patients. It is mostly discerning which "stable" patient is least stable and which critical patient is most critical. ABC and Maslow are difficult to apply in these instances, so don't solely rely on these concepts to get you through this. Don't just answer the questions, look up the answers and move on. Read the rationalization and make note of things you overlooked. Focus on trying to truly understand why the correct answer is right and why the others are wrong and what clues are given in the question. Case Studies: Extremely helpful with single person prioritization! When reading the scenarios I would write down what I believed were the most relevant facts (the abnormalities). Then after looking at these I would think about the pathophysiology of the condition (what's causing this to happen) -- this helps me differentiate between which abnormalities are likely turn deadly most quickly (does the patients condition or health history suggest they lack certain compensatory mechanisms? -- if so that abnormality may be much more urgent than usual), which ones are typical of the condition and therefore less relevant (ie. hypercapnia in a patient with COPD is normal). It is also good to distinguish which abnormalities are always an emergency (although, as I stated earlier I found in NCLEX that they rarely give you something this obvious -- you're usually competing with at least 2 major emergency and need to derive the relevant facts presented in the scenario to discern which one is the bigger emergency). My biggest difficulty was not so much which abnormality to attend to first, but when you are focusing on treating one aspect of the condition and given a list of interventions. I think this is b/c what we see during our clinical experiences rarely reflects these NCLEX situations. Real life: you usually will be implementing more than one intervention at once. NCLEX world: everything is done in 1-2-3 type steps. Luckily, my test didn't really focus so much on these type of prioritization questions and interventions for a single condition were more in the form of SATA -- but obviously every test is different. [*]Other Tips Based on My Test: Learn the signs of symptoms of common complications/emergency conditions (ie. pulmonary embolism, pleural effusion, anaphylaxis, pneumothorax, aspiration, atelectasis, DVT, thyroid storm, cholinergic crisis, infection, peritonitis, AMI, stroke, spinal shock, autonomic dysreflexia, severe electrolyte imbalances, infiltration, transfusion reaction -- just to name a few) -- Know who's at risk -- Know what to do to prevent -- Know how to intervene if such complications appear to be arising. This will also help on multi-patient prioritization questions! Electrolyte and Acid/Base Imbalances: S/S, risk factors for (basic drugs, common conditions etc.), interventions, which foods to eat or avoid, and which medications to take or avoid -- I studied this the day before my test and am REALLY glad I did!! SATA (I had tons of these!)- Transmission precautions, delegation (much like LaCharity), question physician orders and interventions Did I mention learn interventions??? I don't know why but these are the questions that stumped me the most -- Many answers look right and sometimes things seemed strangely worded leaving me second guessing the validity of the answer Client education -- sometimes pretty straight forward, other times another case of all right answers but which one is best? Pharmacology (4-6 ?s)-- I tend to be strong in this area, but I felt like I was given more NOT obvious drugs than the common stuff -- My perception can also be off as I tend to have a better memory for questions I did not know, and quickly forget questions I instantly knew the answer to. Know indications, contraindications and side effects. When should you question a prescription? -- Other than that I don't really have any direction to give regarding which classes are most important as mine were kind of all over the place. I totally neglected to study or review pedi/OB/psych material, and can't say that it was at all detrimental -- take this as you will Only had 1 diagnostic procedure question -- didn't know the answer as I had never heard of it before Everyone mentions the importance of delegation, prioritization and transmission precautions -- They weren't lying. I would say Prioritization > Delegation > Transmission ... My test wasn't particularly transmission heavy, but these things are simple to memorize and will guarantee you some easy right answers! Had 1 audio question, 1 hot spot, 1 ECG (which I actually studied a lot, and somehow had no clue what what that thing was showing),couple of pictures, 1 calculation and tons of SATA as I've already mentioned. Other than that no other alternative format questions that I can remember. Okay, think that is enough NCLEX talk from me! Hopefully I can help someone out (if they can make it through all of my rambling). Just remember to relax, don't over-analyze the questions and start second guessing yourself -- You probably know more than you think-- If your subconscious mind is telling you an answer looks right or wrong but you're not sure why -- Go with it! -- Your brain is probably telling you you've seen this before even if you can't exactly remember all of the details. Study hard, and stick to methods that helped you get through nursing school because they worked for a reason. After the test, many people don't feel like they did well, but try and STAY POSITIVE! I felt terrible after taking that test, but decided rather than focusing on it I would go out and do all of those things I had been missing out on while studying. Besides, if I did end up failing I wouldn't want to have missed out on the opportunity to relax a little before starting the studying process all over again. Anyway best of luck to everyone :-)

I know there are many threads on the subject of resume writing as a new graduate nurse, but I am having difficulty finding consistency in the information that's out there (on this site and others) and was wondering what the most current acceptable practices are. I hope I am not over-analyzing these things, but I keep reading about how critical a resume is in landing a job and want to give myself the best shot possible of being employed! Here are some specific questions: 1) Resume templates: Is it okay to use these? I've seen on some site that you absolutely should not use these, while others say it is important to make your resume stand out visually in addition to pure content. Yes, I realize you want your resume to look professional and don't want to go crazy with a bunch of color and horizontal and vertical lines but is okay to use these things sparingly (like using these types of headings: http://office.microsoft.com/en-us/templates/results.aspx?qu=professional+resume+streamlined&origin=CT010144894#ai:TC030001984|) 2) Clinical experience: I've seen not to use this because it's fairly consistent among BSN programs, then some say to include brief overview of relevant experiences (ie. if you are applying for a position in the ICU you could list Hospital Name, Location, SICU, 120 hours), while others say they list it all or send a comprehensive list separately. 3) Work experience: As a new grad I have absolutely NO paid hospital experience. Some sites I've read say NOT to list any unrelated work experience, while others say it is acceptable for a new grad to list all previous work experience --within past 10-15 years-- (including those not directly related to nursing, patient care, hospital environment etc.) and in the description include duties that could translate well into nursing (ie. if you worked a customer service type job you can list that and in the description describe certain duties that highlight things like teamwork, interpersonal/communication skills, organizational skills, attending to client needs etc.) 4) "References available upon request": I've read that including this on a resume is dated as it is basically expected that you are ready to provide references at the job interview or later in the hiring process. However, some sites I've looked at still include this phrase. Is it now commonly accepted to omit this phrase and have a separate list of references on hand? Should you bring this list to the job interview? 5) Printed Resumes: If I submitted my application and resume electronically, is it necessary to bring a printed copy of my resume to the interview? I did this once and the interviewer looked at me like I was weird for doing this as he pulled out his own printed copy of the one I submitted electronically. Also, if I do bring it, does it need to follow the normal printed resume rules? (high quality paper, not stapled etc.) 6) Cover Letters: Many of the online applications allow you to attach a resume, but I'm finding more and more that it only allows you to upload one document. Does this mean they don't want a cover letter? I am often torn between omitting the cover letter all together or writing one and submitting it as the first page of my resume so it is all one document. So many resume tip sites emphasize the importance of a cover letter which is why I am confused by what these types of applications are expecting. 7) Objective statement: Another resume area where I am finding tons of variance in the do's and don'ts. Some sites I've read say it is irrelevant to include as it is obvious that your objective is to get the job. The ones that encourage it's use all vary in what this statement should include as follows: A) RN position in (insert particular unit) -- Discourage any further elaboration on the subject B) Seeking a position in (insert unit) where I can utilize (insert skills) to (insert how these will enhance or benefit the current employer/hospital/patient) C) A (insert adjectives describing self-- motivated, hardworking etc) RN/Graduate nurse -- the rest follows same basic structure of example B My problem with all the variance in the objective statement is NOT that there are different choices, but the fact that one website will claim that the alternate formats are WRONG or BAD. As you can tell I am thoroughly lost and stressed about the entire process . My school did not teach us about or offer any assistance in resume writing so I've had very little to go on while starting this process, and I apologize in advance if any of this is very basic, common knowledge. I'm just getting frustrated b/c everything I read somehow manages to confuse me more and end up changing things back and forth several times. Any help and input would truly be appreciated!

Here's some antimicrobial drug info: Ototoxic * Aminoglycosides (gentamicin) * Vancomycin Nephrotoxic: * Penicillin * Gentamicin (aminoglycosides) * Amphotericin B * Acyclovir Hepatotoxic: * Tetracycline * TMP-SMZ (esp. pregnant, breastfeeding or less that 2 months old) * INH * Rifampin * Pyrazinamide * Ketoconazole Decrease effectiveness of Oral Contraceptives: * Penicillin * Tetracycline * Rifampin Caution or **Contraindicated w/ Impaired Renal Function 1) TMP-SMZ: ** Contra. if creatinine clearance 2) Gentamicin 3) Vancomycin 4) Penicillin 5) Cephalosporins 6) Imipenem 7) ** Tetracycline (except doxycycline & minocycline) 8) Nitrofurantoin ** Creatinine clearance 9) Acyclovir (esp. if also dehydrated) 10) Metronidazole 11) **Amphotericin B Caution or **Contraindicated w/ Impaired Hepatic Function 1) **Erythromycin, clindamycin, clarithromycin, azithromycin 2) **INH 3) Rifampin (avoid giving to alcoholics)

The only thing I think that might mean is that your school uses ATI as its exit exam, and must pass in order to graduate. So if you fail and have to retake it they may not send your information as soon, delaying your ATT.

I posted this a couple of days ago but i'll repost it here just in case: It's basically a list of keywords that will lead you in the right direction on delegation questions (NOTE: These aren't 100% accurate ALL of the time, but combining these loose "rules" with some critical thinking has really improved my delegation results) Nursing AssistantADLs/NoninvasiveAssistRemind/Reinforce: usually reminds pt. TO do something rather than HOW to do it (skills previously taught by other health care professional or precaution measures)*** ** Usually in regards to ADLs (hygiene, nutrition, ambulating, skin care), turning, repositioning, cough deep breathe ROM **Special positioning-- requires initial education by RN -- assistant will assist not teachI/O , VS, WeightThey can detach suction and remove a foley but not connect or insertGather (equipment)LVN/LPNAuscultate/ListenCheck(s)Reinforce/remindAdminister (PO,SubQ,IM -- NO high alert meds, plasma, blood products-- these and IV are done by RN)ObserveCollect (data, specimens)MonitorSet up (basic equipment)Review/Teach-- Usually standard practices (hand washing/hygiene) or med administration (ie. eye drops) -- RN mostly teaches/educated and LPNs ReinforceRoutine/StandardWound care/Suction/Urinary Cath/Blood glucose readings** Don't assign LVN/LPN to do a task an nurse assistant can complete** RNAssessPlanEvaluateConsultTeach/EducateEncourageDevelopReviewUpdateCounselSuggestInitial/Comprehensive/Baseline (assessments)Frequent/Ongoing assessments (unstable pts)PhysicianInformed ConsentMedical diagnosisPrescriptionsOrder proceduresAvoid These Assignments for New/Float/LVN/LPN/TravelingNew onset/sudden/acuteNew admissionTransferNewly diagnosedDischargeRequire education/teaching (beyond basic skills -- tend to be complex and specific to patients on that particular unit)Unstable (ie. High risk of sudden respiratory failure, or requires frequent assessments and changes in therapy(like electrolyte imbalances)GiveChronicRoutine meds/proceduresStableALL HEALTHCARE WORKERS Responsible for knowing about and implementing standard precautions + airborne/droplet/contact --> therefore all can teach about it or prepare a room for it

Just wanted to add that a nursing assistant can disconnect NG suction and remove a foley but not connect/insert