yuzzamatuzz

Whenever I have a kid pull out their gtube we immediately put in a foley so that it doesn't close up (assuming it is not a mickey button in which case I would just replace myself). If surgery can't take them that day then we start feeds through the foley. I've never had any issues with it. Given, my hospital policy clearly spells out all of this.

To me it sounds like this kid might just be having a hard time expressing his discomfort (probably related to constipation, stomach ache, etc). It's hard to know over the internet what your patient really needs. If it is behavioral then I don't think chemical restraints are a good idea, unless he is a harm to himself or others. Keep in mind that chemical restraints won't help to correct his behavior and he will just continue to have this problem. Does he see a therapist at all? An occupational therapist would be able to help him figure out ways to express himself without language. The problem with drugs for agitation is that we don't really know what is causing his agitation. Patients with very severe CP/mental disabilities will sometimes have a prn ativan order. I've rarely given it because it is reserved for situations of very bad agitation. Ativan is not meant to be used as a quick fix and it is much better to decrease agitation in other ways. Maybe you could suggest they see a pediatric palliative care specialist who would be able to answer more of their questions about symptom management.

I usually ask the parents/patient what they usually do. If not I give it with the pump over 30-60 minutes (depending on volume and size of the patient).

That sounds like a disaster. Who do you escalate issues to if there is no house supervisor or charge nurse? I've never heard of swing beds...I don't understand how they can call a patient just "half of a patient". It'd be one thing for them to open up a "long term care" type floor and have different ratios. But to mix those patients with telemetry patients is just unsafe and takes aware from everyone. I usually have 4 patients on my telemetry floor...if I had 7 "swing" patients and one telemetry patient I wouldn't be able to adequately monitor the telemetry patient. Personally I'd quit, you deserve better than that.

I would feel uncomfortable interviewing in my scrubs. I'm sure some interviewers would be okay with it but some might not be, and why risk it? If you are thinking about this now, you will definitely be thinking about it at the interview...I personally wouldn't want that to distract me. I think the safest thing would be to dress up in regular business-like interview clothes and change into scrubs when you get to work. It's a pain but I think it will make your interview much more enjoyable.

First, congrats on graduating! Nursing school is tough and you should be proud of yourself. I caution you though about thinking life after nursing school will be stress free. Being a nurse is also stressful and I certainly wouldn't call it freedom. You don't have to do homework or study for a test. And you have a lot more money than you did in school. You have a different kind of freedom than you had before but you also have a different kind of stress. I remember feeling free for a few months after graduating while I was still being oriented to my unit. And then I came off orientation and my patients became my own. The realization that I was primarily responsible for someones life was humbling at first. You work with the medical team but you are the primary caregiver for a patient. You will be the eyes and ears for hundreds of patients a year. The decisions you will make as a nurse could change someone's life forever. That kind of stress is a stress that people don't experience as students or at desk jobs. You have to experience it to understand. You will get better at dealing with the stress overtime but it will always still be there in some form. I just recommend being cautious in assuming that your life as a nurse will be stress free. You should enjoy the upcoming months, graduating from nursing school is a huge accomplishment. I remember it feeling like a whirlwind of events. Graduating itself was exciting and a little sad. Passing the NCLEX is one of the best feelings in the world. After you get your first nursing job, your life will change a lot. My favorite memory was buying my car... I still treat it like its my baby since it was my first big purchase after getting a job as an RN.

Unfortunately IV infiltrates in babies can happen pretty quickly. A small amount of fluid, say 30 cc, is going to make an infant's hand pretty swollen when it would hardly be even noticeable in adults. Babies also can't vocalize when it is uncomfortable and they may not cry until it gets very bad. Babies also have small fragile veins that blow easily. Combine that with the fact that they move their limbs erratically and will put any foreign objects in their mouths (i.e. the IV board) and you have a recipe for disaster. There are a few things I do to try to prevent infiltrates. When I put in an IV, I wrap the armboard in such a way that I have a small window to view around and above the insertion site. There are some nurses on my floor who will use a ton of tape to stabilize the armboard and it drives me crazy because you can't see above the insertion site at all (I often will re-tape these when I first see the patient). You want to make sure the arm board is on well enough to hold the patients arm in place and also that it isn't too tight. First, a tight arm board can be very uncomfortable. Second, tight arm boards make chubby kids look chubbier. As an above poster said, you definitely want to compare the IV arm to the non-IV arm. IVs in babies often are positioned in odd ways because their limbs are small. Depending on what IVs you use at your hospital, the t-connector can protrude from the patient in ways that make it prone to being knocked out...I usually wrap these parts with gauze to make them less likely to be knocked out. If you are putting in your IVs yourself, I personally have found the AC to be one of the best places in an infant (there are quite a few people who would disagree with me on this though). The AC has big veins and IVs often last longer there. Babies also can't put their AC in their mouth nearly as easily as their hands and feet. I look at my IVs at least every hour. I tell my parents that infiltrates do happen occasionally and to let me know if they think the IV might be getting swollen. You can't beat yourself up over an infiltrated IV. Even if you do everything in your power to prevent it, they will still happen. The best thing you can do is to check the site frequently so that if it does infiltrate, you won't have a bad infiltrate on your hands.

Is it bad after reading this entire thread I poured a glass of wine and immediately turned on an episode of Greys? ...guilty pleasure...

It's pretty amazing that people think tv shows are similar to reality. My friend is in med school and has not started any rotations yet. A few months ago she told me that she heard Scrubs is pretty close to reality . I corrected her, but she still did not believe me. I figure she will find out the truth soon enough, some things are not worth arguing. I don't agree with how nurses are portrayed in these shows, but many of them are good drama. I do enjoy watching Scrubs, House, and Grey's anatomy for what they are...tv shows. I enjoy the drama in them and laugh at the inaccuracies. Just the other day I was watching greys and they showed an intern deliver a baby who came out with an APGAR score that I estimated somewhere between 0-2. The intern had no assistance because no other doctors were available at the time. She was freaking out and asked what she should do. One of the nurses (who looked to be about middle aged and probably experienced) replied "You're the doctor, you tell us what to do"...meanwhile the baby is gray, floppy, and not breathing. I got a good laugh out of it. I must say that I am relieved this kind of situation does not happen in real life.

1) Use gauze. You can't avoid blood coming out of a large vein, it is a vein after all. I usually put the gauze over the site as I am pulling out the IV and apply pressure as soon as it is out to stop the bleeding. 2) Correct me if I am misunderstanding this part of the question. There is no needle left in an IV that is actively being use in a patient. The needle is retracted after the IV is placed and a small plastic tube is left in the vein. This tube will not cause a needle stick injury as it is a flexible piece of plastic. You don't need to put a glove over it to throw it out.

I love being a nurse. When I became I nurse I was expecting the difficult families. What I wasn't expecting was management that wants our inner city hospital to be a hotel yet they don't give us the staffing or supplies or resources to come even close to that. I never expected to have to run around looking for ambu bags, suction equipment, or IV poles. I did not expect to have management breathing down our throats about press-ganey scores but then they don't do their part by having the proper equipment or staffing. Most of the negative posts I see are about inadequate resources/staffing. I love being a nurse which is why I continue to do what I do, and I imagine that is the same for most people. It is the good moments that outweigh the bad and make me come back for more. There's just a lot I would change.

I agree that ideally we wouldn't wake sleeping babies, but I disagree that it is very possible to work around the baby's schedule. I work with mostly patients who are less than 1 year old. I have 5 patients on most nights and the nursing assistants usually have around 12-15 patients each. Because I work with mostly babies, vital signs also includes a diaper change and sometimes a daily weight. We also always have some parents who do not stay overnight so there are babies who need to be fed. It would be impossible for the nursing assistants on my floor to accommodate 10-15 infants and their sleeping/eating schedules. Also, babies can look great one minute and go down hill really quickly the next. For this reason, vital signs are very important. Some parents will refuse a set of vitals or a blood pressure in the middle of the night. However, depending on how stable the child is, we may not allow them to refuse. Usually parents understand the importance of vital signs and will agree to middle-of-the-night vitals when explained the rationale.

I was evacuated from my apartment and still made it to work Monday night. I planned ahead and made sure I had a place to stay in an area that wouldn't be evacuated. I packed two bags: one with clothes/toiletries, the other with food. I went to work early and left late. For the most part everyone found a way to get to work

The fact of the matter is that you asked a question and people are answering it truthfully, it is just not what you want to hear. I work in NYC at a hospital. The job market in NY is saturated with new grads and experienced nurses. There are people coming out of school who are willing to go into ANY area and still cannot get a job. A nurse recruiter at a major hospital in NYC told me that she gets 500+ EXPERIENCED applications for every position they post. Go check out the NY nurses thread. There are people who have been applying to 100+ positions for over a year. As for RNs working in doctors offices, no one said that it does not happen. Usually there may be one RN in a doctors office and they oversee all the medical assistants. That kind of job usually requires experience though that you don't have. For example, say a patient comes into your office in significant respiratory distress... and you are the only RN. Do you know what to do? Would you be able to oversee a group of medical assistants while you manage that situation? Would you be able to triage patients at this point in your life? Most new grads would not be able to handle that kind of situation on their own. Go onto a job website and look up doctors office jobs for RNs. There are very few, and the ones that are there mostly require experience. And if they don't require experience you can bet there are 100+ new grads applying to it. No one wants to work weekends and abnormal hours, but it is part of the job. It's one thing to TRY and HOPE to get a job in a doctors office. It is another to EXPECT to get a M-F 9-5 job as a new grad. Not only did you state you "absolutely cannot work 12 hour shifts, holidays, or weekends", you also stated that you would prefer dermatology or cosmetic surgery although you'd be OPEN to other areas. People are being "rude" to you because you are coming across as entitled when you clearly don't understand that the job market for nurses is AWFUL right now. People are trying to tell you that if you have such high expectations you may be unemployed for years. You are also discrediting the posts that tell you the reality of the situation...that yes, some of these jobs exist but you will not likely be able to get one of these jobs. As a nurse with one year of experience, I just experienced the NY job market. I can tell you that your most "helpful" posts are the ones that are trying to reframe your thinking and keep you more open-minded. I suggest you explore further on the NY threads, the new grad threads, and search job websites. The days of choosing what specialty you work in as a new grad have been over for years.

I feel saying "I am in medicine" is very misleading and uncomfortable. It is just as easy to say "I am a nurse". I get what you are saying about drips and hemodynamic monitoring, but you could really say that about any specialty. There are going to be things on every floor that require specialized knowledge and skills. That is more considered nursing assessment and judgement. Practicing medicine is something that is reserved for doctors. Be proud of being a nurse.