NO1_2NV

remember nurse techs, health aids, teachers, etc. cannot, and i will repeat it, cannot do assessments, etc. someone has pointed this out in a previous post. please review your nurse practice act. i would never delegate those tasks to anyone under my license. that said i would like to respond to the following: "bee stings, falls from play equipment, diabetic crises, seizures, tummy aches, menstrual cramps and the like". bee stings can turn into anaphylaxis. if you don't know the "pending" s/sx when full anaphylaxis is realized it could be too late. falls from play equipment need to be assessed extensively. a child who falls could have internal injuries including a closed head injury that if you do not assess appropriately and periodically you could miss something very serious. how many times have you heard "well there isn't a bump"? if there isn't a bump you better be worried. a diabetic crisis is one of the most common medical conditions that 911 are called for by parents and care givers because they do not know what to do. i can't think of the number of times i looked at my diabetic student's lunch trays and questioned the portion size and have had to march back to the kitchen to find out who was serving that day and had to ask how many ounces the spoon they are using was. would someone who wasn't paying such close attention to the details bothered to do that? just a half of unit extra in insulin can drop a child into a diabetic seizure do to blood sugar being too low. sometimes a diabetic crisis is unavoidable but it is the management of the disease that is so important and cannot be taken lightly. seizures are another issue. a minor form of seizures can occur but would you know what to do if a child began to seize and the seizure lasted more than 5 minutes or was followed by cardiac arrest? tummy aches and menstrual cramps also need to be assessed. either of these could actually be an obstructed bowel or even appendicitis both requiring emergency surgery. tube feedings are done by an rn...not assisting personnel. trachs fall out and must be replaced. vent students are very complicated and need an rn. asthma is probably one of the most common however many people fail to recognize the early s/sx of a child who is beginning to have problems. it is through good assessment skills that these problems are caught and the appropriate treatment given that keeps our children healthy and in class. today's student population is not the same as the student population say 30 years ago. today, it is the right of all children to have an education and attend public school so we are seeing more and more children with what we would consider high acuity health issues that would have stayed at home way back when. education has also changed. teachers are so focused on "no child left behind" that they tend to tell children to be quite and sit down and can easily miss the s/sx of a pending health crisis as it is occurring. teachers are also struggling with large class sizes. i tell my medical fragile children that if they are having trouble they are to grab the student next to them and head to the health office not asking permission to leave the classroom. i tell them in front of the teacher and in front of their parents too. i can assure you that if a medically fragile child gets up and starts for the health office a call will go to the office and we go into "all hands on deck" mode and we have procedures and protocols in place to provide quick help. so please, do not assume that lay people can replace and rn or school nurse.

In one district that I worked for this would be considered a medication error. Medication error paperwork must be filled out, signed, and submitted. The teacher who would have been responsible for administering that medication on the trip (not diabetic meds) would have to sign acknowledging the medication error and that they had been retrained on the 5 rights of medication. They often ask why an error and I would explain that one of those 5 rights is the "right time". I would then have to sign that the teacher indeed had been retrained and the paper work is submitted to the nursing supervisor and of course the state department of health. I can assure you this scares many a teacher into assuring they have the medications with them and that they are well trained in administering. You might consider something similar if your state does not have these types of requirements. It assures that the teacher at the minimum would recognize that they are responsible for assuring the safety of every child on the trip.

I call for EVERYTHING! It is becoming more and more difficult in this "there are not accidents" environment to treat and "send them back to class". Often when I call, the parents want to know the name of the child that their child accidently bumped heads with or whom, while playing basketball, threw the basketball at their kid (isn't this how you play basketball?), or why did their child fall from the slide, etc. There are many times phone calls are made by parents to the teacher or the principal demanding information regarding who is at fault and demanding that their child not be allowed to play if we can't supervise children and assure they do not get hurt. I call this the "bubble" mentality. You state that you sent a letter home. We too have them but I do not trust letters. If the child forgets to give the letter to the parent and the parent does not see it and a problem arises this becomes problematic. Call, call, call. I have also learned over time that the more I call the more the parent trust and trust is so vital in this day and age. If a problem ever did arise the parent has some confidence in your ability to assess and treat knowing that you tend to error on the side of caution and always call. I have been guilty of telling the parent I would rather feel stupid because I recommended the child see a doctor than to not suggest it at all and have a problem and the parent come back and say you told me it was something "minor". Remember as nurses (a medical professional) we cannot diagnose. NEVER EVER. The fact that a parent chooses to seek medical attention is always their choice and you should never ever take it personally. Thank you for what you do. NO1_2NV

love the cold issue. i generally smile at the teacher and say "3 days coming, 3 days here, and 3 days going". it is a bit of a way of saying "the child doesn't have a fever, but a little runny nose and it is okay for them to be in school and oh, by the way, they are going to be this way for a week or so." it also helps explain to a child why after gargling with a bit of warm salt water and blowing their nose they are not miraculously cured. anyway, hang in there. when i get into these kinds of moods i generally visit the special ed. class rooms. we have a number of special needs children and i generally visit the room to find out if their needs are being met. while i am there i get many smiles and hugs. when i leave the room i am reminded that the reason i do school nursing is to help children stay in the classroom so that they too can succeed and the special needs kids remind me of this. thank you so much for what you do purple_scrubs and thank you school nurses. hugs, no1_2nv

Have to work through Tuesday also. Everyone enjoy your holiday!

How many of you are responsible for trach's and vents? Been a school nurse for several years and have not had to manage any of these. Changing schools though and it appears there might be a few. Trying to get an idea of how you manage these when you are responsible for 1000 other children? I am assuming one would do your initial assessment each and every morning and then perhaps again during the day but just want to make sure I have a game plan in place before I arrive. Thanks, NO1_2NV

Mimilaroo, You should never accept extra work without pay. Please understand that I truly am thankful for a job and have no problem with putting in extra time when asked but.... if you accept work at a facility without pay and you, God forbid, are stuck with a dirty needle or you are seriously injured during that "non-paid" time, you are not covered by Workers Compensation insurance. Any of these types of injuries could be catastrophic to you and your family. Something to think about.

Welcome to the area. We love you being here. Nursing positions can be difficult to come by here. You actually answered your own question. It is a small town and we have one of the finest nursing programs so...simply put, supply and demand. We actually are one of the only places in the entire country that has more nurses then we have jobs for. I could never understand why the nursing recruiters from other areas were not hammering at the nursing school signing up nurses. And why no nursing job fairs? Anyway, some nurses do travel but that usually requires a few years experience. Others work in Amarillo, Lubbock, Roswell, or Carlsbad. You will find that some will rent a 2 or 3 bedroom apartment and then share with other nurses. This allows you to split your costs and commute. Most hospitals in these areas are quit aware of the situation and many will work with you in regards to the commute issue. Not perfect but for many this seems to work. Once you enter school and get closer to graduation you will be surprised at your opportunities. They may not all be here but you will work something out. Hope this doesn't discourage but encourages you to continue. The world of nursing is so vast and exciting with opportunites abound. Welcome!

I am relocating from eastern NM to the ABQ area this summer and am starting to research my opportunities. I currently work for one of the larger hospital and can always transfer but now that I have several other options available I would like to make a informed choice. I am looking for information regarding salary with 3 years of experience and benefit comparisons as well as learning opportunities. Not to mention culture and environment. Anyone have information on Lovelace? How about the VA? What about Pres? UNM Medical anyone? What about other nursing opportunities...anyone work for BC/BS or know someone who does and might have information. What about any other nursing opportunites? Thanks for the information in advance. No1_2Nv

This agency seems to offer 4 and 8 week assignments. Has anyone worked with them before and if so how was your experience? I have worked in an OR and ER and have just been hired as a school nurse and was looking for employment in the summer. Thanks.

Do you happen to know which agency she is with? I am an OR nurse looking to travel only part of the year. Thanks.

I actually worked at a facility that placed you on 3 months probabtion for calling in sick. I remember working one time with a fever of 103 and a nose that would not quit running. It seemed that everyone coming in for treatment had the same thing so it is pretty safe to say it was a pretty nasty virus. I was thanked over and over by management for coming in. One would think I would have been sent home but instead I was treated to forced overtime. I also seem to remember one of the nurses having emergency surgery. She was written up and placed on probation for missing work. She needed additional surgery but had to wait for her probation to end so that she could have surgery and then again be placed on probation for three months. Because the surgery did not fall under the FMLA she was unable to really do much about it. Her time out would only be a few days. I no longer work at this facility.

I too have just about had enough. I am beyond exhausted. I am changing jobs after just 15 weeks at a major teaching hospital. I had a grand vision of how wonderful it would be to be in a learning environment just starting out. So far I have not had one day off that I did not have to drive to the hospital for mandatory this or mandatory that in addition to work. It was also not disclosed during the interview that I would be required to work 84 hours every 2 weeks and that I would be required to frequently take call which is used to fill in for a habitual lack of nurses. This is more like mandatory overtime with a different name. The nurses on the unit are terribly unhappy and because of it they are back stabbing and not so helpful. We are often required to take on a large patient load without help. I am tired and I am stressed and not enjoying this at all. I have had my hours changed from days to nights, to splits, and any combination in between. Enough already!!!! I am giving notice tomorrow. I will also be looking at another field of study or perhaps something outside of bedside nursing.

I have always wondered about this...if you work OT and are not on the clock so to speak but you are injured on the job while working OT off the clock then I believe you are not able to claim this as an "on the job injury". Gosh, just a simple needle stick could be catastrophic and none of it would be covered. Does anyone have any information on this? Something certainly to think about.

I am a new grad considering a position at UMC in Lubbock. I am trying to do some comparison shopping before I interview. Is anyone working there and if so how do you like it? What area are you working and do you know what the pay is for a new grad including bonuses, benefits, etc.? I have looked at their web site but have failed to see anything regarding any of these things. UMC is over a 100 mile commute for me so I am trying to decide whether to work in Lubbock or go out to the Los Angeles area while my family stays here. It is a commute either way but I am trying to decide which opportunity is better for both my family and me. You can PM me if you like. Thanks

Thanks for the info Veggiegarden. I will check that out. :wink2:

I live in New Mexico and graduate in December and was considering Austin. Do you know if any of the hospitals offer new grad OR postions? If I understand the area correctly they have several nursing school located near by which means they may have so many "new nurses" that finding a position could be tough. Any information regarding the hospitals and working conditions would be greatly appreciated. Thanks.

What really chaps my hide about these schools is that the federal government validates their existance by providing federal loan money for their students. Then on top of this the government, through various social programs, also recommends them as job training programs for folks who have either struggled through high school or who have run out of social benefits. Think of the sheer number of people attending these programs who, after graduating, can't find a job and are now hanging by an even bigger rope then the one they had around their necks before they even started. That to me is just plain wrong on so many levels. We should be encouraging people to attend public institutions and giving job training at the local community colleges. If you want to be an MA great!! Here at the local community college we not only have an MA program but we also have an LPN and an RN program if you should decide you want to further your education. Just my vent.

At my nursing school: A = 90 -100% B = 80 -89% C = 77 - 79% Anything lower then a 77% does not pass.

NPR's (National Public Radio) Morning Addition program on July 25, 2006 did a story on just this very subject. It was very interesting: "Book Costs Shock College Students, Families" http://www.npr.org/templates/story/story.php?storyId=5580358 The cost of my books each semester have often exceeded the cost of my tuition and fees!

It has been said many times on these boards that nursing is a whole world of opportunity. As someone who will be graduating soon I am begining to look at various opportunities. Perhaps some of the experienced nurses or even travel nurses would like to share where they think some of the best places to train, work, and live are. Thanks.

Oh my gosh! I see my self is several of these postings. I am an RN student who will finish in Dec. but I am a new LPN who just started LTC/skilled. I hate my job. I can't sleep at night. I reevaluate every med pass, treatment, etc. that I have done throughout the day. I am responsible for 30 patients. Some patients have as many as 15 different medications that need to be passed and many of these are cardiac meds coupled with narcs by which you need to assess prior to admin and then of course follow up. I have very little or no support and it scares me to death. I have stated to the DON that I am a bit overwhelmed and her reply was that it takes most people 6 months before they are comfortable and the other seasoned nurses tell me that I am doing fine and that I will get the hang of it. I don't think so. I have only been at this job for 2 months and to this day I have never gotten out of this place in 13 hours. I even break into a cold sweat and begin to have stomach problems just thinking about my next shift. I have an interview today as an OR Tech for the summer working into an OR nurse position after I graduate in Dec. The pay is less but it seems to be an excellent training opportunity allowing me to grow as my nursing skills grow not to mention I am very interested in surgery. I am the nerd who likes how things work and go together. I just hope I am making the right move and I will feel some relief.

Thanks for the tips!!! I thought about brewing some fresh espresso and taking it in a thermos and then serving it over ice. I happen to like iced coffees. What about Red Bull? Never had it but I think it too is suppose to have tons of caffeine. The tip on diet is excellent! I know that when I eat protein and cut back on the carbs ( I am a huge carb eater) I seem to feel like I have more energy. I will give this one a try tonight. I am glad to hear that the activities do slow a bit. It will give me a chance to stop and reflect over all of the things I am learning about and to prepare for the early morning hours. Again, thanks for all the wonderful tips and well wishes. K

I am nervous and excited all at the same time. I do have a quick question though...how do you stay awake all night? I am not on a set schedule so this weekend it is nights and next weekend days. Eventually I go to all nights but I am more concerned with these first couple of nights. Do most LTC facilities hop all night or do they settle down during the morning hours? Any advice would be greatly appreciated. Thanks, K

I am currently an ADN nursing student who will graduate in December of this year. I am interested in the field of Nursing Informatics and need a little light shed upon this area. Nursing is a second career for me. I have been in the software industry for over 17 years as a web site designer and programmer, GUI concept designer, and documentation manager. With this type of background will contact hour certifications equal the same as credit hour certifications in an employers eyes? I don't have a master's or a PhD and it will be sometime before I can achieve either of these. Any and all information is more then appreciated. Thanks. K