RFRN

You did the right thing. I'm sure that nurse just wants to avoid anything coming back on her so she didn't want her name associated with not having the patient seen that day. I agree with you, the pt probably should have been seen if the MD had time in their schedule. As an RN in a clinic setting, if I am told anything by another nurse/MA/doc, I chart it so it doesn't come back on me. Who knows if these sores end up infected or something happens and you don't chart that you brought it to someone's attention, it could look like the patient told you and showed you these and you did nothing! Don't listen to them, cover yourself!

I work in an OB/GYN clinic and the thing I love the best is actually getting to know your patients. You see them fairly frequently and can develop a great relationship, which also means you can assess better because you know their history. Also, I love working in such close contact with the MDs. Ours are FANTASTIC! As well as our NPs. They love to teach and are always willing to explain reasoning for their plan of care or show you new things you may have never known about. I honestly can't see myself ever leaving where I am. As far as specific questions, I don't know what they'll ask you but review your basic OB stuff. What you need to be in a clinic is a fast learner - that's what I would mention during my interview. As a nurse, you may be asked to cover a few different areas (triage, floor, in-office procedures) and you need to be able to pick up on things quickly.

We do have 10,000u/ml in our clinic but that's the most concentrated I've seen.

Check with your state board - In Nebraska, our BON states - http://www.dhhs.ne.gov/crl/nursing/Rn-Lpn/advisory.htm It is the opinion of the Nebraska Board of Nursing that it is acceptable practice for registered nurses to insert the various intrauterine pressure devices. Such nurses should have knowledge of anatomy and physiology of the pregnant uterus, and of the potential complications of the various devices. The decision to insert intrauterine pressure devices should be based upon self-assessment of competency, and following an assessment of the client and environment. It is the opinion of the Board that it is acceptable practice for a registered nurse to apply internal fetal scalp electrodes for fetal heart rate monitoring when membranes are not intact. It is not appropriate for a registered nurse to apply internal fetal scalp electrodes when membranes are intact. However, if external methods of monitoring appear non-reassuring, amniotomy by the registered nurse to place a fetal scalp electrode to assess fetal well-being may be indicated in the absence of the physician or certified nurse-midwife. A licensed nurse is accountable to be competent for all nursing care that he/she provides. Competence means the ability of the nurse to apply interpersonal, technical and decision-making skills at the level of knowledge consistent with the prevailing standard for the nursing activity being applied. Accountability also includes acknowledgment of personal limitations in knowledge and skills, and communicating the need for specialized instruction prior to providing any nursing activity. Regardless whether the Board has issued an opinion determining that a specific activity is "within" the nursing scope of practice, a licensed nurse is accountable to be competent for all nursing care that he/she provides. Individual competency varies among nurses; when a nurse does not personally have the competence to perform an activity, such activity is "outside the scope" of practice for that nurse.

You don't have a problem, you're missing what you used to do and that is totally normal! I always say that even if I won the lottery, I'd still do what I'm doing now because I love it and I'd miss seeing people everyday! I know being a stay at home mom is work, but it's a different kind of work that you may not get a lot of recognition for. Maybe you're missing the recognition you used to get from nursing? I can't tell you why you're missing being a nurse - could be a lot of things (extra income, sense of satisfaction, recognition of your work, having co-workers, having work goals, etc) - but I can tell you it's absolutely normal because I would feel the same way. :)

Ok - I have to ask why NOT aspirate? Other than the needle is in the patient for the extra half a second it takes to do this and might cause a little extra discomfort (but in my experience, patients do not notice if you do or don't aspirate). I was taught to aspirate with ANY IM injections.

Funny - we had the same issue come up in our clinic recently. Had to give 1 liter of NS IV and we only had a 3 L bag (not a bottle) that states "for irrigation". Couldn't figure out what was different but I guess the microfiltering makes sense.

This happened to me during my preceptorship in my senior year of nursing... thank god I wasn't standing at the foot of the bed! I watched it fly about 5 feet and land at the foot of the bed... in the carpet (yuck). WHY DO SOME HOSPITALS HAVE CARPET!?!

Feel out all your possible options before you decide to go for it. Agree with other posters - ask them where they usually get stuck, heat packs, gravity, tie that tourniquet tight and give them a stress ball to squeeze. I had one not too long ago where I had to do a 1 hour glucose tolerance test and was having trouble finding a vein. Talk about pressure! Lab gives us an 8 minute window (+/- 4 minutes from exactly one hour from when they finish their glucose) to get the draw. Luckily, got it on the first stick. Would hate for the patient to have to come back and drink that Glucola again. I have to say, I started off doing venipuncture for lab draws prior to IVs and found that a good way to learn.

Agree with previous poster... interventions all are going to be teaching based so teaching the person how to prepare for a disaster - what is an appropriate shelter for a tornado, diff. between watch and warning, getting a weather radio, having extra batteries, and having a plan for their family on where they would meet after a natural disaster. As for rationales, just use common sense. As I learned in nursing school, rationales are hard only if you make them hard. Eg - Purchasing a weather radio (rationale: in case power goes out during a storm, you will still know if you need to take cover). Goals could be having the person be able to recite a plan back to you on what they would do to prepare and what they would do in the event of a tornado warning. Also, goals could be having the patient buy necessary supplies - batteries, radio, first aid kit, etc.

I have to say I used to feel that way but nursing has actually made me a little more outgoing. Since I have to get to know a lot of different people, I have developed some better social skills - there's nothing like helping with a pelvic exam in awkward silence to make you learn how to find ways to make people more comfortable. I now feel like I could talk to anyone, anytime.

Keep trying!! Took me 4 month to land a job after graduating and I had a 4.0 GPA!

Start applying NOW. Depending on where you live, it is very hard to find a job right now - especially for new grads. Took me 4 months when I graduated. If you are doing your preceptorship now and like the floor you're on, make sure you let it know to your preceptor that you would like to work on the floor and ask them what you could do to make it happen. Frankly, getting your first job will probably be about networking and knowing someone who can give you a leg up on competition so having a nurse friend who can give you a good recommendation is a great start.

Good idea! We call first names in our clinic but then if two people stand up we just ask which MD they are seeing. I have been told before we can use first name OR last name but not both because that would be a HIPAA violation. To clarify, we can use a last initial when calling the name. Our receptionists are pretty much on the ball and will catch us if we're about to take the wrong person back.

I agree with AZMOMO2, although in my facility we do not take a temperature - just ask if the patient is feeling well. Even though the flu vaccine given as an injection is inactivated, you don't want to run the risk of causing any other issues if the person is already ill. According to the CDC, potential side effects of the inactivated influenza vaccine include fever, cough, aches, headache, itching, and fatigue. From the CDC website (the influenza VIS) - People who are moderately or severely ill should usually wait until they recover before getting flu vaccine. If you are ill, talk to your doctor about whether to reschedule the vaccination. People with a mild illness can usually get the vaccine.

Working in an OBGYN clinic, I cannot see why an employee would opt out for pregnancy and I do not see any of the docs writing notes for this unless they have a true allergy. We strongly encourage all of our pregnant patient to get the flu vaccine. We even hold our first delivery of vaccine for ONLY pregnant patient so if we have a GYN patient come for their annual and want a flu shot, we have to tell them we don't have enough supply yet for the general population, only high risk.

Love this - I recently had an opportunity to start learning urodynamics in our office and definitely was uncomfortable at first but now I am so happy I took this chance because I have learned so much. I am still not 100% comfortable with it, but that just means I'm still learning!

Change is scary but this sounds like a great opportunity. I have only been an RN for about a year and only have worked in a clinic, but LOVE LOVE LOVE my job! True, clinic pays less than hospital but the hours and people make it worth it. I cannot see myself ever getting "burned out" like many hospital RNs complain about. I get to keep up my skills because we do IVs, caths, and other procedures in the office and I have learned a TON more new stuff that I never even knew about during nursing school. You have to do what's right for you in the end, but in my opinion, clinic nursing is my dream job. Don't worry - everything will work out just as it is supposed to. :)

I don't know the answer, but I agree with checking with the State Board of Nursing. I had the same issue when I graduated - I had not worked as a CNA during school due to time issues (even though I had the certification) but thought about doing it after graduating because I was not finding a job and thought some experience as a CNA would help my resume and get my foot in the door. I was told that hospitals will not hire a licensed RN as a CNA because they have policies in place regarding paying someone based on education and if they hired you as a CNA that they'd still have to pay you as an RN. I even had a friend that worked as a CNA and the manager didn't like her because frankly she wasn't a great employee so after she passed NCLEX they basically said she had to quit because they weren't going to hire her as an RN.

Not sure about what dependent/independent means here but if I had to guess I would say dependent? Just because you cannot insert a Foley on your own judgement, need an order. And yes, a verbal order counts - just need to make sure the nurse charted that she took a verbal order. From working in urogyn and inserting many many caths, I know sometimes you can get someone who seems to have a urethral obstruction or stricture and makes cathing difficult. This could be the reason for the tiny clot and minimal bleeding. I highly doubt she caused a urethral rupture with a cath - likely just a small tear in the skin that will heal on it's own.

Ok, first of all I did not object to anything I was asked to do that day. I did it all without complaining but I guess my point in telling my story was that the ER is not a good place for students. The ER I was in was not a highly acute trauma setting - and not busy with about 3-5 patients and 8-10 nurses, and most pts are non acute. I have no problems with cleaning, making beds, etc as long as I get to watch or participate in that patient's care. Basically my experience was getting tossed around from nurse to nurse because no one wanted a student and I felt like it was "What work can we give the student to do to keep her busy and out of my hair?" Believe me, I do not have a "sense of entitlement". I have never refused to do anything asked of me and I go above and beyond for my patients. I just thought I would share a little bit on my experience.

K, got it guys. HIPAA, not HIPPA. Can't figure how to edit my original post.

Working during school wasn't really an option for me since I did an accelerated BSN program in 15 months. I know some people in my class did the occasional weekend shift but for me, school was enough to keep me very busy and I didn't want to worry that my grades might suffer because I couldn't find time to study. For me, all my money came from what I was able to save up and a little extra from student loans. I did end up having to take out a personal student loan (not based on financial need) that has a higher interest rate but it was worth it not to stress about money AND school. Even if you made a lot last year, still do your FAFSA and try for govt loans since they have much lower interest rates. Cut any corners you can - get rid of your cable because you wont be watching TV during nursing school and if you can, move in with a relative or find roommates to split rent with. Cut your cell phone plan down to the bare minimum you need, no going out to eat or to the movies or whatever. Not gonna lie, the next couple years might suck. Just try to be as financially conservative as you can. And definitely if you feel you have time to work, get a job as a CNA (something I didn't do and kicked myself for it when I started job hunting). It'll give you a leg up when you graduate and start interviewing.

This makes sense to me but I just feel there are so many gray areas. Like what if we call with results and the parent answers - can we even say where we are calling from? What would you do if the parent asks why you are calling and why you can't discuss it with them since it's their child? Can't really reveal that it has to do with reproductive health/pregnancy. To my knowledge, our facility does not have a policy on what exactly can be revealed to a parent other than just not violating HIPAA, which can be kinda vague.

I definitely didn't go into nursing for the money, but more because I like helping people, I wanted something in the medical profession, and great job security (or so I hope. Never know with this economy.)