alphabetsoup

If you do not have "ostomy putty" then use stomahesive paste to fill in any crevices. Just use a small amount. Also, use a bridging technique to bring the trac pad over to the patient's side. This will help decrease tension on the trac pad tubing and diminish the chance of the patient dislodging the trac pad tubing.

I would not apply duoderm on open wounds that are around the orifice. Getting those dressings to stay in place will be next to impossible. In cases like this, if the wounds are due to incontinence, manage the cause. The patient needs to be frequently evaluated for incontinence and promptly cleaned. An appropriate barrier cream needs to be applied (I like Calmoseptine) every 8 hrs and with each episode of incontinence. Can the patient have some diaperless time to promote air flow to the skin? Would a toileting schedule help? Are there any indications that there is a superimposed candidiasis (red, satellite lesions) necessitating the use of an antifungal product? And lastly, is there any chance that these are shingles or herpes lesions?

Is the scrotal wound due to Forniers gangrene? Cancer? Pressure ulcer? What is the goal of treatment? Comfort only? Drainage control? Odor control? Is it dry gangrene or wet gangrene?

You need to check with the surgeon for specific wound care orders for a surgical wound. If the surgeon wants it irrigated then it should be irrigated. If the surgeon doesn't want it irrigated then it shouldn't be irrigated. It's that simple. Irrigating and cleansing are not always the same thing, especially if the wound is unexplored (ie you don't know what is at the "end of the tunnel") and has depth. You could introduce bacteria by forcibly instilling saline.

Sounds like you have an ADN/ASN, new grad, looking for entry level position, no prior experience in healthcare. So yeah, it's gonna be tough. My advice is to re-evaluate your resume because it might be lackluster. You might want to have someone coach you on your interview skills. And you might be in the wrong job market.

First, I would look up the potential employer on the web and see what services they offer. Then, look up those services and see what is involved in terms of care. Be honest that you do not have the experience. But DO announce that you would be very eager to learn. The fact that you would have "done some homework" prior to the interview might be impressive to the interviewer.

I think some of the issues of "shortages" and geographical locations have something to do with the worst economic downturn since the Great Depression. Some nurses ended up delaying their retirement. Some nurses re-entered the workforce when their spouses lost their jobs. Some nurses became more reluctant to leave their current employer because of economic uncertainty. It used to be very easy to leave one job quickly for another job. Perhaps not as much now.

In state first and see if your employer will kick in some tuition.

Someone asked a while ago about why I have that perception about entry levels and education. I think I have seen these issues posted on the blog, whether it is a nurse with a certain educational background supervising another nurse with a certain educational background or a nurse working in a position without a certain knowledge base. I have completed the ASN, the BSN, and some grad level work. Yes, there are some differences in all of those levels. Was I a crappy nurse when I had just an ASN? Nope. Would I have been able to do what I do today with only an ASN? Nope. I needed the extra knowledge to do what I do today. Could my employer fill my position with an ASN? Sure. Would my employer get the same results? Maybe not. But it's that mindset of a nurse is a nurse is a nurse. We can all tell ourselves that it is all the same but it isn't.

That was an excellent point! Perhaps you are overthinking the questions (easy to do and even easier when you are a nurse). Are you also second guessing yourself during the exam?

Have you looked at online programs out of state? There are several reputable universities that offer online programs. They are no less rigorous than onsite programs. I have completed online coursework and some of my classmates lived in other states, Guam, etc (one in Galveston!). It takes a lot of dedication and this type of learning is not suited for everyone. If you can make the commitment and stay on top of the required coursework, it is a great option. You do have to arrange for your own clinical rotations though.

Florida.

Yes, always report a problem to the resident's nurse. Do you know for sure that the house supervisor was relaying information to the resident's nurse or to another nurse who just happened to be standing in the hallway? And if that nurse in the hallway was supposed to tell the resident's nurse and forgot, BUT you had knowledge of the situation....well, that might not lead to a great outcome. It becomes a game of "psssst, pass it on". And trust me, that is never a good game to play because rarely does the message come through.

You should point out the error on the schedule to your manager (maybe it was a honest error or maybe the manager was given some erroneous information by another party). If you do not get an appropriate response, then you will need to concede that this job is a wash. But should you need to tender your resignation, let the clinic know exactly why you are leaving the position.

Don't worry about this at all. It's not worth the stress of worrying about it.

You were hired for a 3 10 hr/shift week schedule. Period. There is no swapping around hours unless the manager decides to realign the positions and offer full-times benefits. And if the clinic wanted to do this, they would have considered this prior to hiring anyone to fill the open position. The response that you need to work out the schedule yourselves is asinine at best. Personally, your manager has demonstrated some poor leadership skills. If you are forced to deal with this, my response to the nurse would be that I accepted the position with the explicit understanding that I would be scheduled to work 3 ten hour shifts per week and due to other obligations (like sleep but that's between you and me) I would not be able available to work any more than that.

Hmmmm. In my experience most facilities give employees a "leeway"time- usually 6 minutes to clock in either before or after their scheduled time. You did not mention the nature of your tardiness so we can only guess. Were you a half hour late? An hour? 20 minutes? Was this once per week? Per pay period? Sorry sweetie but you own some of this. We unfortunately do not work in a profession that allows us to stroll in, from time to time, a bit late. But I am not going to bust your chops because I know that you already feel badly about the entire experience. The best thing to do is to admit you made some mistakes and move on. You can not play the victim because playing the victim will not get you a new job. First, polish up that resume. Second, think long and hard about the work environment and what your needs are. If you need a flexible job where running just a few minutes late isn't going to make or break you then consider a job that will allow for that. If you need a calmer work environment then consider a job that might allow for a slower pace. If you need a job that maybe isn't so people-oriented then consider it. We are blessed to have so many opportunities in our profession: IT Nursing, bedside nursing, home care, clinic/out-patient care, specialized care, etc. When you decide what you need to do, then it is enough to chalk up the last job as maybe not being a good "fit". Good luck!

A BSN pays off in terms of opportunity. Does your employer offer any tuition assistance benefits? That was how I had my undergraduate paid for me and I graduated debt free. My obligation to the employer was not that big after graduation (and who was I kidding, I wasn't immediately going elsewhere after graduation anyway).

Ah, the disgruntled frequent flyer. Stay polite and keep a smile on your face. Before you leave the room, ask the patient if there is anything else that he needs. Document abusive behaviors toward staff but keep it professional and matter of fact. If you have a patient relations department then notify them. Also keep your supervisor informed of the issues. Sometimes situations can be defused before they get out of hand. In some of the bad cases, a patient may be requested to sign a behavioral contract for his care. With that being said, is this patient unable to care for himself (is he a quad or para or otherwise has no ability for any self care)? My experience has been that when somebody has zero control over their body, sometimes they grab on to the only control that they do actually have. That control might be to get on the call-light every 10 seconds or to have the staff constantly running in to do the most insignificant of tasks. But it is all the control that the patient has so they will exercise that control. They need that control. And being in the hospital, they might be seeing more attention than they usually get at their group home.

The bonus to having a BSN is that more doors are open. If you are content to have what you have in terms of your career with an ADN, then an ADN is just fine. If you end up wanting different opportunities, then you might want to consider earning a BSN. It just depends on your goals. You may discover that, after you have a few years under your belt, you actually want to do something else within nursing that requires a BSN or holding a BSN puts you higher on the list for consideration. Just depends on what you want.

You will be dealing with more than just the day to day business of providing good care. You will now have staff issues/conflicts, family complaints, and other anticipated problems. If the plumbing is backing up in room 207 you will be the first to hear about it. If someone feels shafted on their assignment you will be the first to hear about it. My best advice is to always keep your cool, always listen, be assertive versus confrontational, and be well versed in policies and procedures. Offer a helping hand but do not be a doormat. Always have a plan B in the back of your mind (you will be pulling up these plans frequently). There are some nice leadrship and management courses out there. Honestly, 9/10th of your job is effective leading and that can be hard to do. Best of luck!

Some of this sounds like the same routine from my old days romping in LTC. Except for the higher acuity. Very true though, hospitals are under pressure to discharge patients and those patients enter rehab/LTC in not the best of health. Other than supplies/organization (you can be the solution in those cases) and staffing (not within your control), would you ever stay? At least 2 of those issues are easily correctable.

I like my specialty. I could do without the politics within the organization. And some additional staff need to be hired pronto as my workload is crushing me. But I like my specialty.

Good example that some nurses do have more earning potential than others with that $82K. Is that with shift diff, weekends, holidays? Also, some travel and agency can earn more. And someone pointed out location is also a factor. Other factors are employers (for profit vs not for profit) and what they are willing to pay. My own personal experience has been that I earned the most in compensation and benefits working for a large not for profit organization.

First and foremost, averages are the dumbest way to calculate anything. Seriously- you want a median wage, not an average. Second, you have to factor in annual raises in those industries. And were bonuses or incentives also factored into those "average" salaries? Why is that so important? Because your typical bedside nurse is not earning a bonus and raises tend to be in cents vs dollars. My dear sweet spouse, who holds an advanced degree and has many years in his chosen profession, outearns me. If I were to get his typical raise, I would be doing my happiest dance.