Aeterna

Trust me, you won't need statistics like that in deciding a nursing program. You're overthinking it The CRNE is not purely an academic exam that tests your knowledge of things like pathophysiology, pharmacology, etc. There are a few questions that requre rote memorization in such subjects, but look up a few CRNE practice questions and you'll quickly realize it's more to do with situational responses (i.e. "As a nurse, what would you do if your patient __________") and the like. It's not really things that a teacher will stand up in front of a classroom and teach you about. If you understand the basic principles behind these concepts and can apply them in various ways, then you should do fine. To choose a nursing program, there are many things to think about but CRNE pass rates shouldn't be one of those things.

Tell that to my manager! It's honestly an on-going problem on my unit and a big reason why RNs are leaving in droves.

I can't tell you the amount of times I've had patients expect me to fix their TVs or get them TVs. Once, on a very busy day, a patient was ringing his call bell constantly because he hadn't received his TV yet. I had to tell him that us nurses don't bring the TVs, the TV people do that and they don't usually round on our floor until dinnertime at the earliest. He was very upset about that, kept ranting at me about poor service and "How am I supposed to be entertained around here?" and such...I just threw up my hands in the air and left the room.

I'm almost 100% certain it affects everyone in the union, not just the new hires. I was hired in 2010 and was around for the 2011 increase, and I'm pretty sure my hourly wage was automatically adjusted to the new pay scale.

I'm not entirely sure myself. I'm not interested in certain specialties, which I've already listed. However, I'm pretty open to anything else related to acute care nursing. I was thinking either something surgical or cardiac related, since surgical isn't something I've done a whole lot of and I've always been interested in the cardiovascular realm but haven't really gotten in-depth with it.

Yes, unfortunately for immigrants, a little Canadian experience is often considered better than a lot of foreign experience in the eyes of a lot of employers (including but not limited to hospitals!) Even having Canadian education is an asset. If you're not too picky, I'd take whatever you can just to get a little experience here. Good luck to you, too! I think that will my next steps - look around at smaller hospitals in the surrounding areas. It is not what I was hoping for but I'll take anything closer to my hometown, to be honest. I realized, too, that a lot of positions are in specialty/critical care areas when I was browsing job openings. I'm still not entirely sure what I want to branch into - I just want something a little bit different than what I'm doing now. I know that OR, ER, psych, L&D, and mat-child are not interests of mine at all. The only "specialty" I can claim experience in is oncology but I kind of want a break from it (and there are few positions out there in the field, I find). I'd love to take specialty courses but they are expensive, and if I'm not going to work in an area that will make use of that knowledge/skills, then I'm hesitant to jump into it. Also, there's the adage, "If you don't use it, you lose it!" I've been looking for nearly 3 months now, I think, although I haven't sent any new applications in the last couple of weeks due to other things going on in life. It's not like I'm out of a job and need a new job ASAP to pay the bills. Still, I just want something different and I'm starting to feel burned out where I am now. You are right, though - nursing is a relatively easy profession to move around in. I know people who struggle to find any kind of job. My friend was also in journalism (including an English degree) but never found a job in the field after about a year of looking.

Thanks for the insight! I'm feeling not quite so bad about the complete lack of responses. As much as I was hoping to get a job closer to my hometown (within the GTA), I may have to expand outwards. Right now, I'm a several-hours drive away from Toronto and anything closer would be great. I'm not really feeling any sort of love for agency nursing. A daughter of one of my mom's friends did that and it doesn't sound like my cup of tea. I'm the type of person that takes a while to settle into a new place and get comfortable with the people and the geography, so I prefer to be hired onto a single unit rather than get bounced around several places. I have a friend who has some connections in Toronto and she got an interview just by asking her friend. Must be nice to have those kinds of connections I've got none so I've got to hunt for jobs the traditional way and keep at it!

Morale is incredibly low where I am now. It is frankly scary the amount of nurses who are leaving or are applying to other places. If I added up those two groups, I'd probably list about a third of the total RN staff. It's mostly because of our new manager, who fails to listen to our concerns about the unit. He doesn't understand the meaning of acuity and proper staffing, but he understands perfectly what our budget constraints are. I understand there needs to be a good balance, but when you are willing to sacrifice patient safety and nursing licences just to save money, then it's no good at all. It is especially frustrating because we have multiple management staff on our unit. If they eliminated just one of those roles, they'd cut our unit's deficit by over half.

I've been applying to several hospitals in and around the GTA (think the Golden Horshoe, mostly) and have had no luck - not a single call back. I posted my resume in the Resume Help section and got some feedback, but overall it didn't seem like I had any glaring issues with it. I have 2.5 years of medical/oncology experience and have a wide skill set due to the nature of the unit I work on. I'm wondering: what's the job market like in the area I'm applying to? When I graduated in 2010, the economy had taken a turn for the worse and a lot of hospitals in the GTA had hiring freezes, making it quite competitive. Is it still about the same or is it something on my end that I'm doing wrong or not doing enough of? I'm starting to feel rather inadequate. For the record, I'm an RN and want to stay in an acute care setting. Any insight would be fabulous!

Thanks for the pointers :) As for my BScN, I don't necessarily have to emphasize it. Here in Ontario, nursing diplomas are extinct now, and even before I started nursing school, Ontario hospitals were already placing BScN requirements for entry-level nurses (i.e. if you're already a diploma nurse and have been working, you can still apply for the job; but if you are just starting out, you need your degree). Because I've graduated within the last few years, it's pretty much an automatic thing that I'll have my four-year degree rather than a diploma. And yes, Non-Violent Crisis Intervention and Gentle Persuasive Approach are certifications. In fact, I should probably go for the re-cert courses now that I think about it, but I do have them. And no, I do not plan on moving to the U.S. any time soon. When I first graduated, I considered it but I'd like to stick close to home (which is part of why I want to switch jobs - to be closer to my hometown/family), so removing chest tubes and managing epidurals are within my scope here - even if they aren't wherever I'm applying to, I can at least say I have those skills/competencies, no? Maybe I will bump up my clinical skills over my certifications and maybe come up with a different name for "certifications"?

Throwing my resume up for critique because I can't seem to get any call backs - I've sent perhaps about a dozen job applications over the past couple of months and nothing! As a bit of background, I'm an RN living in Ontario, Canada. I've been applying to other hospitals in a variety of med-surg settings. Obviously, all personal information was removed and the formatting didn't translate too well from Microsoft Word to here so I've edited the formatting/font/sizes a bit to give you the gist of what's emphasized (such as headings/subheadings). Altogether, it fits into a single page. -------------------------------------------------------------------- [h=1][NAME][/h] [Contact information] Objective: To obtain a position as a registered nurse in an acute medical-surgical setting. Work Experience: Registered Nurse, Medical-Oncology unit, [Hospital Name], [City], Ontario, July 2010-present Provided care and appropriate nursing interventions for clients with a wide variety of medical diagnoses, such as cancer, acute and chronic renal failure, complications of diabetes, complex wounds, and more. Health Care Aide, [LTC Facility Name], [City], Ontario, April 2008-August 2008 & April 2009-November 2009 Assisted residents in performing activities of daily living. Certifications: Registered Nurse of good standing with the College of Nurses of Ontario Basic Cardiac Life Support (BCLS) Non-Violent Crisis Intervention Gentle Persuasive Approach Chemotherapy administration Clinical Skills: Administration of blood products (packed red blood cells, platelets, albumin, IVIg) Management and access of venous access devices, including peripheral IVs, PICCs, Hickman catheters, and Port-a-Caths Management and removal of chest tubes Complex wound care Pain management, including patient-controlled analgesia (PCA) and epidurals Total parenteral nutrition (TPN) and NG/PEG tube feeds Administration of oral and parenteral chemotherapy Education: [university], [City], Ontario, class of 2010 Obtained Bachelor's of Nursing Science degree summa cum laude Dean's Honour List, 2006-2007 & 2008-2009 [High School], [City], Ontario, class of 2006 References available upon request.

It depends on the facility's policies and the patient himself/the family. I did not know that some facilities require bed alarms. In my unit, there are no bed alarms at all! Literally, they do not even exist. However, it seems like bed alarms are not mandatory in OP's workplace, so let's assume that. Any patient, if they are competent, can accept or refuse any treatment or intervention. If the patient is not competent, then their POA can accept or refuse any treatment or intervention. If this man, the patient, was alert and oriented, did he refuse the alarm? What was his opinion of it? If he was not competent, however, why did the family/POA not want the alarm? If I were the admitting nurse, I'd ask the patient/family why they did not want the alarm. I'd explain the risks of not having the alarm on, as well as the rationale for using it in the first place. However, if they insist on refusing the alarm, then I'd document something along the lines of, "Patient/family refusing alarm. Nurse explained rationale of alarm and risks of not having alarm on. Patient/family continues to refuse despite education, therefore alarm left off." That way, if they ever take you to court, you have your documentation to back up the fact that you provided the necessary education to help the patient/family make an informed decision, but despite your advice, they continued to refuse the alarm. I'd also document what other precautions were put into place to prevent falls from happening, such as routine checks, side rails, etc. Bed alarms, after all, are not the only precautions you can put into place - like I said, my hospital unit has no bed alarms at all!

My unit is crazy - it's high acuity, very fast-paced, constantly underfunded (seemingly compared to other similar floors), and chaotic. It's difficult to recruit new staff to our floor because it has a bad reputation for being crazy busy. However, a common thing you hear amongst the staff is, "I stay here because of the people I work with." Basically, the only reason why we're not all leaving in droves is because of our co-workers! Basically, we all realize we work in an extremely stressful environment, but even so, we do our best to laugh and have fun. Last Christmas, we had some down time - a lot of patients go on day passes, leaving most of us nurses with some free time. So, a few of us went out onto the patio and made snowmen - the snow was perfect for it! The patients and families who could see us through the windows loved it, and of course we had a lot of fun, too. Or, there was the one night shift where one of the nurses brought in a whoopy cushion from home. We played around with it in our nursing station, but when that got old, we started pranking the other two medical floors! The nurses on the receiving end of those telephone calls had a blast, too. And yes, there are some nurses who are lazy and sit around while their colleagues drown, but for the most part, there are plenty of nurses who will do everything they can to help. We also have some amazing charge nurses, who do a better job of looking out for their staff and patients than the management does. Our current manager is trying to cut down on paying out overtime, so one of the charge nurses got in trouble with him for calling in a nurse for overtime to cover a sick call. Her response was basically along the lines of: "The floor is heavy. The nurses are drowning. It's not safe for the patients. So, I don't care if I get in trouble if it means no one is drowning in work."

To err is human! We all make mistakes at some point in our careers. Any nurse who says she/he has never made a mistake is either lying or isn't aware of it! We all miss something or another. We are expected to juggle multiple things at once, so it's almost inevitable that, one day, we will miss one thing. Once, I missed an order for a stat magnesium bolus! I hadn't realized the doctor had come in at around 6pm (less than 2 hours before the end of my shift!) and wrote that order; and, at the same time, I was dealing with a new admission who needed a stat blood transfusion, and then who developed a fever shortly into the transfusion, while at the same time, transferring one of my other patients to palliative care! And, no, I was not fired for it. Someone called me the next day to make me aware of the missed order. I explained what had happened during that time frame, apologized profusely, felt bad for a little while, but got over it. Live and learn!

"Mosby's Manual of Diagnostic and Laboratory Tests" by Pagana and Pagana. I have the 3rd edition. I'm not sure if there are others or what they're like.

I know a lot of my nurse co-workers don't like students. From what I gather, it's a control thing - nurses have so little control in a typical hospital environment (everything is dictated by patient wants/needs, management, and doctors!) that having a nursing student gives them even less control while still having the responsibility for the patients the student is looking after. Personally, though, I love students. I remember very clearly being a student and feeling lost and no one would help me piece together why we do this or that, or why the lab values are the way they are, or why we do dressings for this wound like this but this wound is dressed like that. Or, no one showed me the little tricks that help changing bed linens easier, or the tricks of time management to make your work flow better. So, I try to pass on that information to students, to show them the little details that no one really thinks of telling them to make their jobs easier or to help them piece together the bigger picture of the patient's situation. Of course, a student who is always around, asks questions, and is attentive is more likely to get my attention and my help. There was one student who practically disappeared the entire time she was on the floor - in fact, I answered her patient's call bell most of the time! I can't teach a student that I can't find. However, I've pulled students aside for all sorts of things - trach care, chest tube dressings, IV starts, stoma care, and more! I almost always have something interesting in my assignment for them to see/do, and if not, there may be a colleague of mine who does!

What you might want to do is investigate what a CBC diff includes and then investigate what each type of cell does. From there, you can logically determine what a high or low value indicates. At a very basic level, you certainly want to know white blood cell count, hemoglobin, platelet count, and possibly hematocrit, so start with those. Then you may want to look at the types of white blood cells there are, because each of them has a specific function. What the patient is going through will also change the perspective of the CBC diff. For example, a patient's white blood cell count is high - does the patient have an infection or have malignant disease (i.e. leukemia)? If the patient has had surgery recently, then it could very well be an infection. I have an excellent text book that I've kept from school that goes over all diagnostic tests, what they mean, how it can affect the patients, and what it means for nurses. It's an awesome reference book to have!

I find myself asking that question, too! I'm honestly not sure. I've only been a nurse for about 2 years now, and going into work stresses me out so much! I mean, there is the occasional good shift where I'm not running around like crazy and manage to make all three of my breaks, but for the most part, most shifts end with me being totally drained. I do like many aspects of my job - being able to talk with my patients, saving lives, the shift work (I'm not ready for a Mon-Fri job!), my awesome co-workers, and the pay isn't half bad either - but I dislike many aspects of my job, too - the stress, the physical exhaustion, the emotional exhaustion, the injuries, the people who are never happy no matter what you do, getting yelled at by people, the constant addition of duties, the paper work... But, from what I hear from people in other careers, the pastures elsewhere may not be greener. Really, I have only ever worked part-time jobs as a student before I went into nursing, but nursing isn't my most hated job so far (that goes to working at an amusement park, making fast food - awful hours, awful working conditions, mean managers, unbearable heat while standing next to giant boiling oil vats or large grills, a few idiot customers). Still, bed nursing is far from an ideal job and I don't foresee sticking around for a very long time. I'll probably stay within nursing itself, but perhaps doing other nursing things, like research or education (once I can motivate myself enough to get my Master's).

I agree so much! Many teachers never both to explain why formulas are the way they are, which would lead to an understanding of what you're looking for, what info you need, and how to go about solving it. As a result, so many people get caught up in memorizing formulas, but as soon as they come across a problem that is just slightly different, they have no idea what to do and panic. However, if they had the understanding, you can apply the concepts over any med dosage problem. Another issue is that there is almost always more than one way of going about a mathematical problem, so the methods vary between teachers (and nurses). As a result, people get inconsistent lessons and get confused. Again, just having an understanding of the problem rather than getting caught up in formulas is the key, because then you can see the logic behind anyone's methods!

The wonderful (but also awful) thing about math is that there is often more than one way to look at a problem and solve it. Your way worked and is logical, but I prefer to think of things Esme's way. Choose whichever one works best for you and stick with it. With Esme's way, always find how many mg are in just one mL. For example, Your given dose is 320mg/5mL. What you're looking for is (x)mg/1mL. Algebraically, it'll look like this: 320/5 = x/1 Of course, dividing anything by 1 means it's just a whole number (i.e. 5/1 = 5; the value is unchanged), therefore we can ignore the 1. As a result, your calculation will look like this: 320/5 = x So, divide 320 by 5... 64 = x Now we know that there are 64mg in each mL. Then, think of it like this: there are 64mg in each mL. You are giving 15 mL, 64mg multiplied by the 15 mL you are giving = 64 * 15 = 960. If you're curious, though, the mathematical way of doing it is like this: The order is to give 15 mL. There are 64mg/mL. The question is looking for how many mg in 15 mL, or (x)mg/15mL. (x)mg/15mL = 64mg/mL To make it easier to "see" the math, let's take away the mg and mL... x/15 = 64 Isolate (x). Because (x) is being divided by 15, to cancel it out, we do the opposite (in this case, multiply) by the same number, and as always, what we do to one side, we do to the other. As a result, multiply both sides by 15. x= 64*15 x = 960 Therefore, there are 960mg in 15 mL. This looks very long and difficult, but only because I'm outlining each and every step of the process. Once you get practice, you can skip a lot of the little thoughts I have here, and go straight to whatever you need to do mathematically. For me, I already know I can go ahead with 320/5, then multiply by 15 without having to think of any of the other things. Let's do another example with completely random numbers and a completely different problem, but with the same algebraic concept. Say you get an oral solution from pharmacy labeled 530mg/5mL. The order says to give 371mg. So, how many mL do we need? Therefore, the value we are looking for is (x)mL. As before, we find out how many mg are in each mL, or 1mL, therefore, we are looking for (x)mg/mL. (x)mg/mL = 530mg/5mL --> x = 530/5 x = 106 Therefore, there are 106mg/mL We need to give 371mg, but how many mL does it take to get that? This can be represented as 371mg/(y)mL, where we solve for (y). We know that 106mg/mL. As before, I'm going to leave out the mg and mL to make the numbers clearer. 371/y = 106 Isolate (y). To do this, we get rid of the fraction, so we multiply both sides by (y) 371 = 106 * y Further isolate (y), so divide both sides by 106. 371/106 = y 3.5 = y Therefore, you need 3.5mL.

I agree and disagree with the OP. On the one hand, I can certain empathize with a lot of people, and sometimes overbearing or demanding patients/families have a legitimate reason for being that way, even if the way they are expressing their feelings is not the best. For example, just recently, I cared for a man whose wife was seen as very negative, rude, and overbearing. At first, she seemed like this to me, too, but I have a lot of patience and don't often let these things get to me. Then I had to go in and do my patient's weekly PICC dressing. The wife stayed through it and we got talking. I learned that the patient was initially admitted to hospital many months ago, got better and was sent to a rehab unit, and then regressed and got sick again, landing him back in the hospital. His wife was very frustrated and just wanted her husband to get better. I could see then why she was so nit-picky about everything - she just didn't want anything more to go wrong so her husband could get better and return home with her. After that talk, she stopped being rude and negative, and we worked together rather than butting heads over every little thing. HOWEVER. That does not excuse people from being aggressive, overly demanding, offensive, or manipulative. Someone can yell at me all they want about their broken TV but it is not within my skill set nor is it my priority to get it fixed. Yes, I will call the person who sets up the TVs to let them know the TV is broken, but no, I will not go out of my way to entertain the patient when I have other, more important, matters to deal with. Most patients are understanding of the fact that I had other patients to attend to and must split my time accordingly, but there are others who think I'm their personal servant or something rather than a nurse caring for 4 or 5 people. I mean, I literally had a patient with perfectly functioning arms who called because she wanted her purse moved from one side of the bed to the other. Just...no. Also, I have no issue telling people that we're short-staffed or that I need to take my break. When I am out of the room, a patient doesn't see where I am or what I'm doing - for all they know, I could be working with other patients or I could be having my lunch. They don't necessarily know that. So, if I'm running myself into the ground and haven't eaten or drank anything by the afternoon, I do all the urgent things I need to do and tell my patients, "I haven't had a single break yet today. I'm going to eat quickly and when I come back, I will take care of x, y, and z." (The x, y, and z are usually little things, like an extra glass of water or something - things that can wait 15-20 minutes!) Most people are usually all right with that.

I believe that once you've reached a certain age and/or stage in a chronic/terminal illness, then you should be a DNR. However, that is my personal belief. It was actually how I was raised. I remember being just a little kid and my paternal grandmother told me, "Granny's going to die soon." She said it in such a matter-of-fact way and, me just being a little kid, I thought she meant she was going to die the next day! It took me a bit of time to realize she just meant, being in her late 70's (my estimate), statistically she wasn't going to be around for much longer (actually, she lived to the age of 94, lol). But, that memory has stuck with me ever since. I spent the majority of my life knowing my grandparents could die any day. They were never in denial of their mortality - in fact, they were completely ready for their own deaths. My dad even explained to me that my grandparents had bought their gravestones and their space in the cemetery years and years ago and pre-paid for their cremation so far in advance that they received a partial refund for it (because the price difference from when they paid for it to when they died had changed so much!). This idea that death was inevitable was reinforced by the death of my maternal grandfather when I was about 10-years-old (I never knew him, but still, I knew what death was). I also had a classmate accidentally drown and another of brain cancer when I was 12. When I was in nursing school, my uncle was diagnosed with stage 4 colon cancer at the age of 70. The prognosis was very poor. He refused all treatment and just wanted comfort measures. His idea was that there was no point going through the difficult treatments only to extend his life a little longer, and for what? He was retired, his children were all grown and self-supportive, and he really did not want to live long enough to be admitted into a nursing home, anyway. He made all the necessary arrangements in preparation for his death, and died 3 months later. The last time I saw him, he was perfectly content with how things were going (besides the pain, of course) and was still joking around with everyone. Now I work in medical/oncology with a small palliative section. I see all sorts - people who are ready for death, and others who want to hold on for as long as possible. That goes for both patients and their families. I also see some miraculous recoveries of people we never thought would make it. On the other hand, we see people go through so much suffering just because they were given false hope. For the most part, I've gotten accustomed to seeing dying people and don't get too affected by it. Occasionally, though, there is a patient that comes along and I get close to, and when the time inevitably comes when they must pass on, I do get emotional (not in front of the families, though) I'm lucky that I work with some good doctors that know how to control symptoms, and if not, I can offer up a few suggestions of my own because I've seen so much. What's most frustrating to me is when families make a person "palliative" but then want certain invasive things done. For example, the family is concerned if a patient isn't eating or drinking enough so then they want an IV put in. They don't understand that, once a person is dying and at a certain point in that process, they don't require the same amount of food/water as usual. Or, in the event of a Code Blue, they want us to do chest compressions but not to intubate.

Sounds like a homework question o_O;

I'd love to take the ACLS course but my friend took it upon being hired in ICU, but it still cost her somewhere around $200 to take it. I think she stomped her feet a little and got reimbursed eventually - after all, she was taking it as a requirement for her new job - but I have no real interest in critical care and so wouldn't apply for such a job. I'd be paying $200 just to have a certification I don't need for a job where I won't necessarily use it just so I can have it on my resume >_>

Generally, we try not to have two types of prn narcotics ordered so we don't accidentally "double up" on them and overly sedate our patients. If two different types of narcotics are ordered, our general practice is to get the older one D/C'd and/or clarify with the MD. For example, a patient's pain is being managed by prn Dilaudid. The doctor comes along and orders prn morphine. I'd contact the doctor and ask which ones he/she wants the patient to be on. There are rare occasions where the doctor wants a patient to be on two types of narcotics (i.e. Percocet and morphine), but in these instances the doctor sometimes writes instructions (i.e. "Give Percocet for moderate pain and morphine if pain is severe"). If the doctor doesn't leave us instructions, we go with the least potent first and if that doesn't work, we move on to the stronger one, and once we start giving one, we don't really bounce back and forth between the two. For example, the patient is in pain so we give Percocet. It's not very effective, so the next time we can give them analgesia, we'll give the Dilaudid. If it's effective, we keep going with the Dilaudid. If that's not effective, then I'd call the doctor for another order. We wouldn't give Percocet, then the next time give Dilaudid, and then the next time give Percocet. Regarding the timing of administration of different prn narcs, as allthesmallthings noted, it's important to know when a medication will take effect and for about how long. Where I work, we never give narcs intravenously. However, we give a lot of SQ and PO narcs. SQ meds take effect faster but last for shorter amounts of time. PO meds take longer to take effect but last longer than SQ. It also depends on the individual patient. For one patient, 2 mg of PO Dilaudid will be enough for half the day, but for another, 4 mg of PO Dilaudid will only last maybe two hours. Also be aware that different meds are metabolized in the body differently. I've had renal failure patients get overly sedated from narcs/benzos because their bodies can't clear the drugs fast enough from their bodies.