tracey2705

Hi, Congrats on your upcoming graduation! I don't have a ton of advice for you but your work as an LPN certainly counts for something. You already have experience with managing a shift and all that entails and handling a patient assignment. That's alot. What you will have to transition from is from a long term care to an acute care perspective. It's different. Also, you will encounter many different types of patients in acute care. Anyway, your LPN experience is a plus. I have no clue how things are in Florida. I think I'd take the exam as soon as I possibly couls, but that's just me. IOW, I have real rationale for that. Good luck!

I would have said, in a helpful way, "It's right over there" and possibly asked the case manager if she was finished with it. That puts the ball back in her court but you've neither jumped to her ridiculous command nor acted unprofessionally. I'd also go off to do something at the same time so it didn't just become a public power struggle; there's no advantage in that (usually). But I'd be clear by my body language and my comments that, while I'm not going to make her look the fool or force a struggle, I in no way will play step and fetch it. You're a professional. Also, I doubt a doctor would go to administration to complain about a nurse who wouldn't get her a chart from 10 steps away. But, I think an MD would speak to admin if that nurse made an issue of it. Just hold your head up and go about your work. You have plenty of important things to do. Let the jerky doctor stuff roll off your back. I had a resident tell me once to write up an incident report on nursing. I refused to do it because a) in now way was the problem clearly a nursing error and b) I'm not a secretary. I told him to write it himself but in a professional and assertive way. As in "I don't agree that this is a nursing issue. If you feel that it is, you can write the incident report." OK I said a few other things too maybe not so controlled but that was the important message. Like I said, remember, you have an important job. Assume the doctor is not trying to take from it even when you know perfectly well he/she is. :chuckle

Like someone said, you can find ERs that take newbies if you look. What I suggest is to choose the hospital that has the ER you'd like to work in first, then get a job on a floor that has medical and surgical patients if possible. You might want to choose an ER that is a designated trauma center rather than one that isn',t or a hospital that has a helicopter. (I never did that but I always thought that very cool being a flight nurse. You'd need a ton of experience first, though.) But if you start on a combined medical and surgical floor you'll get a pretty broad baseline of exposure. It won't be like an ER but you can at least refine your assessment skills. Then maybe after 6 months you can transfer to the ED (if they don't require ICU experience first). Good luck!

Everbody's fears are really bringing back all the stuff that scared me. It's amazing to see how far we've all come, though. Yeesh! I really was clueless in the beginning. This isn't a patient care fear, but I also used to be worried about dealing with some of the docs who were notorius for being difficult. One time one af the older attendings came into the nurse's station with a whole gagle of interns and residents and said, "Who's the nurse taking care of Mrs X?" We all just stood there afraid to answer because it looked like he was going to yell at someone. Then he said, "Well, I just wanted to thank her for taking care of her, etc.." We all breathed such a sigh of relief that all of us, the doctors and the nurses, started laughing. Whew. Tracey

One reason to use macrodrip is if you think there's a chance you might have to push fluids in a hurry, for example if you're hanging an IV on patient who looks a little shocky. Another reason might be to make conversion from mg or units per hour to the drip rate. Not sure how often that would come up though. Another reason might age of the patient; you wouldn't hang macrodrip on a kid.... Do they expect you to evaluate a drug or do they provide a apatient scenario? HTH Tracey

I'm just curious about what you found scary or intimidating when you first started out? I'm preparing some info for new nurses and I want to make sure I address their needs. What procedures were scary for you? Or what kind of situation? I was always worried about making a med error and I had no clue how to get a nonfunctioning NGT to start working again. Chest tubes pulling out worried me. The worst would be pushing potassium instead of NS. We used to get single dose vials of KCl to mix with an IV. They had the same color cap and similar labeling as a vial of normal saline. I would check myself 10 times before flushing an IV. Thanks! Tracey

There are definitely jobs with less stress and better hours. Like working in a doctor's office (pay is much less). But it also depends on what you personally find stressful. I like a fast pace so I'm stressed on a unit where there isn't a lot of hands on care to do. Many people work 12 hour shifts (7 am to 7 pm or 7pm to 7 am), a total of 7 in two weeks for fulltime. There are variations. Also, tho stress levels and work schedules are important considerations, you also should learn more about the nature of nursing and if you're cut out for it. It isn't just a job. Good Luck.

Hmmmm...are you calling me "old school" Focker??:chuckle I am definitely not one to say "do this because that's the way we've always done it"! But I do know what you mean. I agree that anesthesia is different and MS skills are much less important there. I have worked both areas (ICU and MS) and still think it's better to get your feet wet in an area where you're less likely to hurt someone and where you can acquire basic skills at a slower pace. I do not think it HAS to be that way, it's just the way I did it. For one thing, I lacked the procedural skills I needed in an ICU. Like starting IVs or getting an NGT to function properly. Or putting one in for that matter. I just think it's alot to learn right off the bat. By the time I went to ICU, a few years after graduating, (it isn't necessary at all to stay in MS that long) I felt ready and was very confident in my assessment and procedural skills. I could concentrate alot more on the physiology you're expected to know and the pathophysiology you have to recognize. Plus the meds. Anyway, JMO.

I find long term care very depressing, too. I can't work there. Like others said, don't give up but set your sights on a different area. Although I worked on medical floors at first, eventually I stayed on surgical units or at least a combination of surgical and medical patients. I like the fast pace of a surgical unit. As for not hearing her lung sounds. It does take practice. Also, she's probably not taking very deep breaths. Get some more practice on people you know--friends or family. Then you'll be familiar what lung sounds are supposed to sound like and you'll more readily realize what you're hearing in the patients.

Don't be afraid to go. Or be afraid but still go. You will gaining skills and insight into physiology and pathophysiology that you won't get in MS. You'll also loilely have a more colleagial relationship with physicians, which is an improvement over how it works on the floor (sorry to say). But do recognize a few things first: 1. The staff doesn't always welcome newbies they way they should. It may be awhile before you're accepted. Don't let that bother you. It isn't personal. 2. Think about which ICU you want to work in--they all have their personalities, at least where I worked they did. 4. Try to learn something about the nurse coordinator. When I worked in SICU we had a nurse coordinator who thrived on chaos. She was very knowledgable and a fun person but after she left we realized it didn't have to be as nuts as it was. Her replacement was much more organized. 3. Be careful about burnout. It can happen anywhere of course, but the high stress of an ICU is tough. 4. Ask a million questions--there's alot to learn. I'm sure there are other things that I can't think of right now. But I do recommend going. It is exciting and you will be getting experience that is sometimes a prerequisite for other nursing jobs, such post anesthesia care.

Hello, Wooh, I agree that it is a very different skill set! My suggestion to start in MS was not because ICU nursing is somehow just more detailed MS nursing. I think a new nurse will have an awful lot to assimilate in his/her first 6 months of practice and beginning nursing with a patient on say 4 drips, ventilated, with an NG tube, an A-line, a PA catheter, and a very complex diagnosis will be that much harder. Also, tho management of 8 patients is very different than management of 1 or 2, you certainly will be employing skills that are first practiced and learned in MS. In other words, the patient care skills, assessment skills, etc, that the MS nurse will learn in the first 6 months will not be wasted. A lot depends on the orientation, too. A long orientation, say 3 months at least, with ample time to practice basic skills and experience with the least sick patients would help the new nurse hone her basic skills and prepare her for managing very challenging, complex patients. I've worked both med-surg and ICU, and step down for that matter. I've also worked in staff orientation and preceptoring. Many new nurses really struggle in the beginning just getting their priorities straight. JMO Tracey

I don't know about ER, but I think you should get 6 months to a year of general nursing in before moving to ICU. The first 6 months for a new grad can be very stressful in many ways, let alone the stress of an ICU. Also, though I'm not saying you will make a mistake and I'm not saying making a mistake on general med-surg patients si no big deal, but in an ICU you are responsible for many potent IV vasoactive drugs. I think I'd rather get my feet wet a bit before taking on an ICU. Good Luck!