jottRN

I am 1 1/2 years out of school. I worked my first year in a med-surg float pool, but as of July, have been in SICU. I can definitely identify with having been extremely nervous before work for the first few months, and even after that if I knew I'd be floating to certain floors where acuity tended to be higher. Then, when I moved to the ICU, I might as well have been a new grad all over again. I'm actually just beginning to feel confident enough going into SICU at night without the nervousness that the OP speaks of. And it still hits me when I know we have CABG's on the schedule that day. Let me tell you though--it is like lifting weights. I use this example because it is a hobby of mine. You could say the same about running or anything else. Progressive overload. At first, benching 120 lbs was tough for me. But as more weight is added, the body adapts to lift more. I feel like the brain does the same thing. The more we learn and the more experiences we have, the more comfortable we feel. Sometimes, the worst experiences are the best because when you make it through a terrible shift, you realize... "Wow, I survived," and then the average nights suddenly seem a little bit easier. In the SICU, we had a bad 3 or 4 weeks where it seemed like every night, the worst was happening. Deaths, codes, etc. As a med surg nurse, I had only dealt with a rapid response once the entire year. I definitely wasn't ready for this. I was getting terrified to go to work. I questioned whether I could truly cut it in the ICU. But finally, things slowed down and the average nights were no longer scary at all. And the average situation that I would have found stressful before now seemed manageable next to that horrible month. So when you have the bad nights, just realize they teach you, and while you can't help but be stressed,make sure you learn from them and let them be confidence builders. And go where you want to work. This "You must work med surg for a year or so before going anywhere else" is a load of crap. I did it and still felt I was no more experienced jumping to the SICU than a few of my colleagues who were new grads. Disclaimer: Just make sure whatever you do, you get a decent orientation and have a good support system among other nurses.

Looking at thelittledoe's post--if you can indeed get a BSN in the same amount of time, I'd go for it.

It depends on several factors. First of all, as others have said, it depends on where you're located. I'm in northwest Arkansas. I graduated with my ADN from the local community college and I have gotten both jobs I've applied for--and while my community college's ADN program is well respected locally, my first job out of school was out of state (in Texas) where my CC had no reputation. Assuming you're in a region where nurses are actually in demand, I think it is more important how you present/market yourself. In my area, the community college actually has a better reputation than the University. That said, some hospitals are looking at things such as magnet status which requires a certain percentage of BSNs I believe. The hospitals around here could care less as far as I can tell. The same was the case in Tyler, TX. Seems to be an equal mix of ADNs and BSNs. I'm getting my BSN through a 1-yr online program and like the fact that I'm able to work while I'm getting it.

You should be able to take the NCLEX anywhere so long as you get the authorization to test from your state BON. But, per my understanding, you must be a resident of the state in which you seek licensure. For example, even though I planned to move to Texas, I still had to get the Arkansas license first since I was not yet a resident of Texas when I applied for my authorization to test and all of that. If you could move to Louisiana first, you could get authorization to test from there and take the NCLEX anywhere (I THINK anyway). But if you plan to get your license prior to moving, you'll have to seek endorsement from Texas to LA.

I really get my fill of this crap. We had a nurse in our SICU recently receive a write up for failing a core measure. A patient was ordered to have a foley out a certain date after surgery. That day, the patient went down hill and was basically a hypotensive trainwreck all day. In the chaos, the nurse didn't think to get an order to keep the foley in. Fail. Write up. Wouldn't it be nice if we could just take care of people? I realize it the whole system is flawed, not a single hospital. It is a business afterall and that is why we get paid. But, it still irritates me when supervisors come down on nurses for stupid stuff like that.

I didn't take the time to read other responses, so forgive me if I'm repeating information. I've a little experience with state hopping. I was initially licensed in Arkansas and immediately moved to Texas after nursing school. I was not eligible to work on my Arkansas "G.N." in Texas, so I had to wait until I passed the NCLEX and was licensed. THEN, since Texas and Arkansas are both compact states, I was able to work on my Arkansas license for 30 days before I was required to get a Texas license. The problem is, Louisiana is not a compact state, so I think you'd have to be fully licensed there before practicing. The whole process is expensive and a pain in the butt. But, at least there is only one NCLEX to take. Endorsement from one state to another is generally just a matter of some paperwork and waiting.

I wouldn't include the skills performed in clinicals unless anything stands out. For example, if you were given some award in nursing school for your clinical performance, you might include it. However, anything you've done in the past that might be relevant, throw it on there regardless of how long ago it was. From what I've read, it is best to keep your resume to one page, though. If it is only half a page, it might be okay to add some clinical experiences in to "fluff" it up. If your more relevant experience takes up most of the page, I'd leave the less relevant experiences off. I'm no expert on resumes, but I've gotten both jobs I've tried for.

I had one instructor who seemed to pick on the paperwork of the few guys we had in our class--and at one point made a statement to the effect of men are no good at paperwork. Considering that my writing and charting had received good feedback from all other instructors, I felt that she was a little bias. Other than that, I can't say that I've been treated unfairly in school nor in the workplace. In fact, I've been told on multiple occasions that it is nice having male nurses around because we tend to have a more calm demeanor and don't contribute as much to unit drama. These statements were from female nurses by the way, so I hope ladies don't think I'm trying to accuse them of being dramatic and emotional or anything like that.

I've also been taught both ways by different preceptors. I haven't checked to see if my facility has a policy on it, but I prefer to prime with blood for the same reason you gave. If you're documenting vitals on the transfusion of normal saline and then leaving just when the blood reaches the patient--the whole first 15 minute observation is kind of pointless.