DennRN

I haven't been in Med-Surg long but the managers have already discussed how I should get some more experience and can transfer to the ICU in a few months if I want. Their words were "med-surg will teach you time management, you have the knowledge base, you just need to get some time and experience." I told them honestly I still feel overwhelmed at the moment, and would like to grow in my current position and learn as much as I can on my current floor before considering any moves. Long story short, options will present themselves if you apply yourself.

Some people would subtly hint that CNAs aren't licensed, but that's not me hehe What I meant to say was welcome aboard, we'll be passing through some rough weather ahead but the temperature at our destination is a balmy 85 with sunny skies. Thank you for choosing to fly CNAirlines!

Social Studies is the closest related field to nursing? You sir have officially crossed into the realm of the Grimm's fairy tales. :igtsyt: Beware all ye who venture beyond this point. All travelers crossing this bridge should pay the troll-toll.

The first 3 min of my psych rotation a 300 pound guy started posturing like a gorilla and staring at me. I edged behind the nurses station and he pounced on another male nurse punching him in the face. Next thing I know, the 60 year old female nurse that was sitting at the desk somehow gets the pt in a headlock, and starts talking to him in a calm voice about how it isn't nice to hit people and slowly brings him to the ground without a struggle. I was both impressed and terrified at the same time. Kudos to all psych nurses that know what they are doing!

I grabbed a 3ml syringe last night while rushing to my last med pass. I never got a chance to even look at what I was holding because another nurse saw me with the insulin vial and asked me what mistake I just made. I felt pretty embarrassed too. This is nursing, we make mistakes, some greater than others. I know I wouldn't have administered the dose since I would have never been able to draw it up without a leur lock sq needle, but I took another lesson from what happened to me. From now on, I will not rush when gathering important supplies such as syringes, and will pay close attention and ask if I can help with anyone who rushes in and out of the med room. Thank you for posting this, many people have made the same mistake as us, and some will do so in the future. Your posting this may have prevented some, I just hope the rest are as lucky as we are, and as good at following protocol as you were.

Or was the pt actually receiving plasma to restore blood volume after a coumadin overdose with bleeding, given vit. k which would reverse all coumadin, switched to heparin while inpatient and waiting for vit k. to wear off, made an error ordering the units of heparin and asked someone to correct to 50,000 units of heparin? I'm just spitting out a plausible scenario that could result in the key things you mentioned happened, the reality of the situation is that we can go all day thinking up things that can go with 50,000. My scenario actually makes a lot of sense, as will tons of others. We need more info and so do you. My advice, think of this as a learning experience, and speak up if you have a question. I have never allowed anyone to make me feel stupid for asking a genuine question, and you shouldn't either. Remember you are asking for your pt as well as yourself.

To Imthatguy, Because if nursing is not a science than nurses are doing tasks without the basic principles of why these tasks need doing and what might be the right task to do for one patient, is completely wrong for another patient with the same problem but a different set of co-morbidities. It is the science that guides our practice and why a new nurse knows that a pt with low oxygen saturation needs O2, but because of the way that the body responds to oxygen levels climbing in a COPD pt, we as nurses should not administer high flow oxygen or we risk suppressing respirations. It is science that serves as the reason why a nurse tells a physician they cannot administer this medication to a client because they might respond in this manner, and requests further clarification of an order. Tasks alone, or relying on other sciences to make nursing decisions for us are not sound practice and would result in increase incidence of negative outcomes. It comes down to the whole irrefutable fact that nurses make decisions. Without science to base these decisions upon there will be needless suffering and increased mortality rates for all of our pts. Do you understand that it is science that will help you understand that certain medications can be given late but later doses will have to be re-timed? How about the fact that giving certain medications to a pt can have horrible side effects such as poisoning if given under certain circumstances? I mean come on, something as common as lithium can become toxic if the pt gets dehydrated, the cascade of clotting factors can be altered by coumadin, but vit. k is the direct antidote, but it can also be taken in through diet, and pts have to be warned about foods such as kale when receiving therapy. I could go on for days behind all of the small things I do or say to the pts I have had recently based upon my scientific understanding of what they need.

Um no, your understanding of the scientific process is flawed Tippy. I agree with most of your post, however you forgot the part about how evidence based practice uses data to further refine hypotheses and control for variables. In the scientific method, when an unexpected or imperfect result is observed, it warrants further study and refinement of hypotheses. Just because an experiment does not produce a perfect or expected result does not mean that the experiment was not scientific, only that there are one or more factors unaccounted for.

"I don't think nursing is because the theories and the applications don't seem scientific in nature." Hmmmn name one field of science that hasn't had questionable theories? When it comes to energy levels, therapeutic touch, and all those other theories, you clearly missed the explicit or implied, "feel free to disregard" clause. But let's follow your line of reasoning with physics, something you believe is a pure science. It has a branch called quantum mechanics with non-observable theories such as string theory, membrane theory, multiple dimensions... Do these ideas make physics less scientific? Okay, let's forget about quantum physics for a second, and consider something observable. When a leaf falls we say it is due to gravity, but where does gravity come from? Here is a wacky idea, mass creates distortions in space-time that allows radiation from an unobservable plane of existence to bleed through and exert an attractive force on objects relative to their mass. CRAZY huh??? Sounds like your definition of the "crutch of evidence based practice" in that it is using "conclusions of research studies to go about solving some issue". Lets follow your thought process which I will call the associative-absurdist theory of negation to disprove physics as a science. Objects fall to earth -> something is acting on these objects -> objects with greater mass exert greater gravitational force -> physics relies upon gravity in part to theorize how the universe works and was formed into its present state -> idea I can't conceptualize or choose not to agree with -> physics is not a science. Seriously, if you have a problem with a particular theory, that's fine, but that doesn't mean a field is not based upon sound scientific research. Nursing achieves its status as a science based upon the natural sciences, (those based upon empirical data). It draws upon the other sciences as a foundation. Observations are made and interventions (experiments) are conducted. This results in empirical data that can be analyzed, and used to create new hypotheses. This is evidence based research, also known as the scientific method. Stop trying to rationalize, (irrationalize), why you feel the way you do about nursing, you are making generalizations that are based on illogical reasoning that goes against the very principles of science. Phenomena are observed, a hypothesis is formed, experiments are conducted to test these hypotheses, theories are formed based upon repeated observations. these theories remain valid until disproved with empirical data. To circumvent this process and follow your feelings that nursing is not a science because you dislike a few theories is beyond ironic. Where is your empirical data that any of these ideas are not valid? The funny thing is if you do have any proof of your claim, you will just be adding to the body of knowledge we call the SCIENCE of nursing. You just can't win can you?

It depends upon dosage and if the pt is opiate naive. I would address the Rights of Medication, if you need clarification, go straight to the source and ask for clarification from the prescribing physician, to do otherwise is like waiting to see if you get hit by a car to judge if it's safe to cross the street. The order is probably for IV on purpose so that you can use your nursing judgement, but better safe than sorry if you have concerns. Personally I have never encountered an IV dosage of an opiate that made me question if I needed to administer it over 30 minutes, and if I did, that would mean I would have to pace out my rounding/charting to allow me to check on my pt every few minutes until peak efficacy, which would start at 30 minutes and last for an 1.5-2 hours after the 30 min IVPB ends for dilaudid for instance. Then comes the problem of clearance time for the opiate, with the tail end of, say, q2 dilaudid still circulating when the next dose is administered. Since IV dilaudid peaks can last 2 hours when pushed, subtract 30 min from that and you can see that the next dose will be available to the pt before the client has metabolized half of the first dose. Check the peak times, you need to be in the room when the normal stated peak is and tack on the 30 min delay for the infusion to run. Then address the problem of what if my pt wants another dose within the clearance time. The medication is there to relieve pain! If it is infusing slowly, it takes longer to bring the pain down, meanwhile the pain is not under control and will need a higher dose to be effective. Lastly IV opiates have a short half-life, and are fast acting. Personally I feel safer pushing it because I know I'm in the room observing the pt when it starts to kick in and will return while it's fresh on my mind. Narcan won't do anything if I have left the room and forgotten about them. In short I would say if the prescribing physician says use your judgement, do what you are comfortable with and get a baseline RR. Peek in every once in a while to see if there is a significant change, and factor in some extra time if you are using IVPB.

The answer is simple but not easy. The ones that are good do everything regardless of what shift they work. The ones that are trouble will try and duck out of the"little things" because they either lack the knowledge of what it means to a client's care, or don't care. Simply cleaning a client could mean the difference between infection, skin breakdown, sepsis, even death if you want to go to extremes. The CNAs I trust and respect are the ones that do everything within their responsibilities as the situation requires regardless of what the clock says or if the sun is anti/post meridian. Btw I am a rn that does everything my client needs as time permits before I choose to delegate a task out to a cna. I got certified as a cna while in nursing school and recognize how important you and your peers are to each of our patients.

Wow, this thread is starting to scare me... Nursing IS a science, let me elaborate with just one real life example from last week. A pt presents with an abdominal aortic aneurism, as new grad I rely on my understanding of biology, pathophysiology, chemistry, and pharmacology to know what is happening to my patient, what could happen to the patient, what lab values to watch (what they are indicative of), the medicines he needs/which ones to question, and what symptoms to watch out for (what these symptoms mean for my client), what diagnostic tests he needs (how to interpret the results and apply them to the plan of care), and prioritize his care versus my other patients. THESE ARE ALL THINGS THAT ARE NOT ONLY WITHIN THE SCOPE OF NURSING, BUT ALSO PART OF THE RESPONSIBILITIES THAT CANNOT BE DELIGATED TO ANYONE BELOW A NURSE. If you are not practicing the SCIENCE of nursing, you are a liability plain and simple. Going back to the original question, med-surg is difficult if you cannot tie together the sciences of pharm, patho, physiology, chem, and various others and apply them to the multiple diagnoses your average pt gets wheeled in with. If you don't think nursing is a science, I don't think you are nurse material, at least not the kind I want anywhere near me or mine. If you are wondering, he was one of the most stable pts I had last week.

Thank you for posting OP, This is certainly a topic that impacts us all. Personally I got a great education for 30k worth of loans. Payments are ~$430 Unconsolidated, and I'm rounding up to $500 a month to pay down the higher balance early. Proper money management and budgeting is something that needs to be learned. I was lucky to have a gym teacher devote a few days to teaching us the basics in 7th grade in a way that really stuck with me. Anyway, investing in yourself is USUALLY a smart move, just be mindful of credit pitfalls. I always look at it as a game of mitigating losses. Things like consolidaring loans are smart if you can't pay them down individually, but the down side is the lower payment and longer term means you pay WAY more. I know this is obvious to most of us, but I'm constantly shocked by how many people I know that can't plan beyond I need this bright shiny thing right now. Back to the OP, I want to say congrats on graduating and landing a job, hang in there and make the sacrifices you need to in order to pay off your highest interest/balance debts as soon as you can.

Yes, after a while it became easy. I just transitioned to listening for moment while the second hand of my watch moves to a position I'll be able to remember. While I'm doing this I listen to the speed/tempo like it's music. The first few times I did this I imagined a metronome swinging back and forth and only counted the swings to the right. Do this a few times with an automatic bp cuff on and you will see you will be within a beat or two. After a few more times you should be able to count out out an abnormal hr with no issue. Mainly it will come down to listening and letting go of your self doubt.

:igtsyt: Please refrain from feeding the troll.

Had this same problem for a while, if you can't kick the habit just count them like you are doing and divide by two once you have counted the full minute.

I just wanted to point out that it is your duty as a pt advocate to bring this up and have it corrected, how horrible would you feel if the VRE made it to another pt? We all know that we care for sickly pts with open wounds, just coming off antibiotics (ripe for superinfection), and suppressed/strained immune systems. If you are not comfortable trying to teach your NM the massive risk she is taking, and the financial implications of just one nosocomial infection, I would start climbing the chain of command until the problem is resolved. The powers that be would rather not have a lawsuit or have to provide free care over something as easily preventable as a breakdown in PPE access.

I wanted to clarify that their NCLEX pass rates are compareable to other schools, what is hidden is the number of people who fail out becuse the quality of instruction is poor but the school exams are standardized to the NCLEX. In short, going to ITT tech is a gamble on an unknown variable. Are you willing to take a $40,000+ bet with money you may not have on if you will get a good education? The stakes are too high for my tastes

They are not dropping out, think of for profit technical schools as a conveyor belt mass producing a product. There is often less pressure to produce a high quality product that has to be painstakingly hand assembled, than mass producing high quantities of inferior items. Do not mistake me in my analogy, I'm not saying in any way that ITT Tech grads are inferior, in many ways they are superior is their study habits. What I am saying is that there is pressure to get as many students through the admissions process, (more than is reasonable), less emphasis on individual attention, and less focus on trying to teach to the highest standard of instruction. Basically a cookie cutter mentality, if you dont fit in the form, you get the "privilege" to shell out an extra semesters worth of tuition and start over. People fail out because nursing school is very hard to begin with when you have great grades and impecable study habits. That is why most nursing schools have such rigid entry requirements. Now lower the entry requirements, increase admissions, decrease individual attention, and what do you get? A whole bunch of people that are made to believe they are "stupid" or "can't hack it" when under other circumstances they would probably be successful. The catch lies in the fact that the courses they passed are highly unlikely to transfer to anywhere else, thus locking them into ITT tech. When you have a captive audience there is little pressure to improve. Its like prison food, you can grumble all you want but when meal time comes, what options do you have? I have heard that there is a big deal with federal student aid and technical schools, they are accepting money from a government that would like to see taxable income from graduates only to have a school take the money and spit out a student that has thousands of dollars in debts and no degree. Why would the state and federal government want to continue to provide interest payments on loans, or grants to schools that don't produce as many graduates per admissions as other schools? Finally, I don't want to try and "convince" anyone to accept my point of view. THINK FOR YOURSELF. Search for information, look at reviews, look at government and school statistics, then think to yourself is there something wrong with this picture? What information is out there and what information looks like it's being hidden? If a school is of high quality, they want you to know it, thus they will publish the graduation rate, they want you to know how sought after their services are, and what the value you are getting for your money is in terms of an education. Conversely, a bad school will see pressure to hide these stats, who would choose to go to a school that cant teach 50% of their students. Back to the original point: There is a national standard the NCLEX RN, it is beyond the schools control to hide the information on who takes this test and the pass rate. So, each class has to be of a certain standard sufficent to get people to pass this final test, if the instruction is poor but the standard is the same you will end up with high rates of attrition. If you manage to graduate under these conditions, you would have done even better at another school in my opinion. In closing, a license is a license, anyone with one is able to provide care, who cares if you got it from ITT or somewhere else? There are some places that do distinguish, for the most part it won't hurt you, nor should it. I just believe there is injustice being done to the people who will never get a fair shake at reaching that point. Instead they get tore-enroll, pay back mountains of debt with a no-diploma, entry level job, or find something else to do.

Recruiter Bob, The nursing job market is saturated, where did you find 5 job offers for her, I'm skeptical because I have friends at the top 10% of their class from prestigous univerisities telling me that they are desperate and going to settle for nursing home jobs. BSN graduates with great gpas, references, resumes, lists of volunteer and extra curricular activities, and they don't get a single call back. To anyone reading this please be aware that getting a nursing job will be an exhausting process and you will be competing with people like my friends who are still on the lookout to trade up. As to the original post, I know ITT grads, students, and drop-outs. 50% of them failed 1st semester, no problem though since they have rolling admissions... WRONG! A 50% rate of attrition is horrible, and since you can't transfer your credits to another school from ITT you are locked into their expensive program. The program is basically sink or swim with independant learning from text books being the make or break factor. Personally this sounds like predatory practices to me. Any reputable institution will release its statistics on enrollment, and rates of graduation. ITT tech may have a comparable NCLEX pass rate but this is deceptive since it is possible that 90% of applicants who were enrolled in 1st semester never make it to this point. From the people that I know, I have heard that people dissappear from the program so fast you never even get to know everyones names. This is a big deal considering the tens of thousands spent on tuition yield credits only useful at ITT tech. So they are opting to not "throw good money after bad" All this to compete in an over saturated job market with graduates of established and respected universities. Bob did have a good point at the end, weigh all the facts, try doing some independant research on ITT tech it isn't flattering what you will find, and it's the things that you should be able to find that are missing that are the most worrying. I would only choose ITT tech as a last resort.

I don't want to give the impression that I look down on your work, I have the utmost respect for nursing home nurses, however the reality of the situation is that nursing homes are less attractive to many nurses because of the high patient to nurse ratio, I have many friends currently working with 30-40 patients per shift. I find this very scary as do many other nurses, thus making it more likely for nursing care facilities to have positions available for people who absolutely need a job. As a post recession new grad, I spent months looking for a job in the hospitals I was familiar with, then the ones I had heard of, then trying to google every one in a two hour radius. Not so much as a call back in 5 months, meanwhile I walked into just one local nursing home, filled out an app, was interviewed the next day and was offered a job on the spot if I could work full time. I only wanted part-time/per diem because I planned to continue looking for work in a hospital and planned on working at both. I was up front with them and they told me to keep them in mind if my situation changed. I was also told by friends that their mangers would schedule a interview if I submitted an application at 3 other facilities. So in my experience nursing homes in my area are very receptive to hiring new grads. After careful consideration I decided to hold out for a hospital job and a month later finally got one. To the writer of the original post, nursing homes vary in how they hire, some use electronic forms via their website, others rely on paper applications. I would prepare for each interview by considering what you have to offer their facility, and providing concrete examples based upon projects, clinicals, volunteer work, and previous jobs. Come ready to answer questions about why you chose to apply to their facility, what you think about nursing homes, and questions about how you cope with difficult situations/people. If you have a portfolio bring that along with your credentials, several copies of your resume, and bring some business cards if you have any. Greet everyone you come in contact with a smile and a warm hello, when getting/submitting your application if it is a paper copy, and again when going into the interview. Having worked in many different fields and never walking out of an interview without a job offer, I can tell you that in order to stand out you need to show curiosity and eagerness to learn about all the "great" things about the company by asking questions about how many people they have on staff, how many have been there long term, what their company values are, stuff like that. Basically they are already showing their hand that they need someone by interviewing you, by slowly and carefully (NOT OBVIOUSLY) turning the tables and interviewing them back you are framing their mindset back to how desperately they need to find a good person to fill that position. If you can demonstrate that you are the kind of person they are looking for, they are way more likely to look past your inexperience and offer you a job before someone else does. Also look at the interview itself as a learning experience. I have honed my interview skills by always asking if they have any advice for me on my interview skills. If you time it right, it reinforces that you are valuable, constantly seeking to improve, and will land a job somewhere else if they don't snatch you up. While the preceding advice may seem manipulative and may not work 100% for you as an individual, I urge you to consider my approach, and then start thinking about what your own style is and structure your all answers and questions around highlighting all the great things about yourself. Good luck!

Chicago, $26/hour starting pay as a new grad before $5 night differential. Yearly reviews for raises and yearly bonus.

My brother is a ff-emt, he tells me that he is a glorified taxi driver for every fall down drunk in his area. Don't take it personal and next time someone says that to you just call him a cabby, and tell him he's right, and that he reminds you of one you saw today... I'd make it more descriptive though maybe a ****** *******. As a guy I can tell you most "manly men" respect you if you can dish out a good burn.

Ok, I appreciate being around women all day too, I work well with my female colleagues and appreciate what they bring to the table be that personal insight, a unique perspective or the female presence they all have, but we are getting away from the bottom line. The reason I chose to be a nurse is that I love being there for people. I have a personality that helps me to brighten up a gloomy day, put people at ease, comfort those that are upset, and I work really hard to stay one step ahead of what each of my patients need. These aspects of my personality would be just as suited in tons of different fields. The difference between those fields and nursing is that at the end of the day I know I have made a meaningful contribution to someone elses life, being able to do this gives context to my own life and makes it richer. It's not all roses. Now and then I have experienced very subtle discrimination against my gender from my former instructors and peers. It was never about my skills/intelligence/ability to provide quality care, it was always about nursing being a women's role. Being the person that I am, I always voiced my understanding that nursing in recent history may have been a refuge for women who were repressed and discriminated against in the workforce at large. Sometimes I follow this up with some teaching "nursing care was originally provided by men (think monks caring for travelling pilgrims and knights caring for soldiers) Where do they think that the iconic red cross symbol originated from?" The point I am trying to make is that men have and always will be a part of what it means to be a nurse. Our contributions have been and will continue to be valuable. If someone makes fun of my choice I usually just joke right back and by the end they or their friends are always laughing with me. It's way too easy to win when they bring a spoon to a gun fight. Think up some funny male nurse jokes or look online for some, it's hard to dislike and not respect someone that can make you laugh. Finally I want to say that we as nurses and specifically MALE nurses are role models. We have to respect ourselves, our patients, and our greatest allies/sometimes greatest critics... our female colleagues. Please do not objectify or sexualize them especially here in cyberspace. It is so easy to take a faceless post and project it onto the nearest male nurse. This topic comes down to stereotypes, we shouldn't be putting out any that we aren't willing to live with, so I feel it is important to talk about this one too... Men are often thought of as dogs/predators/creeps out to objectify women. This is one aspect of our gender that has harmed our image as male nurses. The word nurse is one that is associated with trust and understanding, there are polls out there that support this. While I don't think it's fair, the reality of the situation is that we have to be vigilant to not reinforce any notion that we are on the floor checking out our coworkers this is a slippery slope that can lead to mistrust and doubt of our professionalism. Women have dealt with this for so long, it is only fair if a bit ironic that we have the face the same obstacle. I appreciate the female form as much as the next guy and I agree that it is wonderful being able to work with intelligent, beautiful, and caring women every day, but it is all about context here. Let's do our part to always be sensitive to these issues. Sorry for the rant, -Dennis

The following is my opinion, my intention is not to hurt feelings, or belittle. If you can see a shred of truth in this, my hope is that it will put you on a path to success, whatever direction you choose to take. The NCLEX RN is a MINIMUM safety test, if you have to claw tooth and nail to climb up to passing someone did you a disservice. It takes knowledge to pass sure, but your ability to use your nursing judgement and critical thinking skills is where the science of nursing meets the art of nursing. It is my belief that your frustration with trying to cram with practice questions is not helping you in the way that you require. The purpose of these questions is to gain familiarity with the format of the NCLEX, clearly you are familiar with what you will be seeing, having done it 6 times previously. It appears to me that you lost your path somewhere along the line, does your problem go all the way back to the principles/fundimentals of nursing, or tying together your pathophysiology/pharmacology with these principles? I can't tell you. What I do know is that there are no do overs in the real world. I wish I could be less harsh, but the reality is that making decisions as an RN can have serious consequences to people that are trusting you to heal them or ease their suffering. I urge you to consider that being close to the minimum safety threshold is just not good enough. There are no second chances or do-overs when you have someone's well being to account for. Maybe you need to examine what your options are at this point and see if "close enough" is good enough. As a nurse, you will be the last line of safety for your patients. It's not enough to simply follow orders and complete tasks, that is what unlicensed healthworkers do. Ask any nurses you know, nurses question orders and withhold treatments all the time based on new information and sound clinical reasoning. To not do so could cost you your job, license, and even worse. It truly pains me to write this, but I feel you could benefit much more from an honest call to concern than a "you can do it". I hope that you can recognize that you are missing a critical part of your nursing toolkit, and either work to correct that or figure out another path for yourself. Either way an honest examination and some soul searching will be the first steps toward healing and getting past your worries and troubles. I wish you nothing but the best and success in whatever path you choose to follow. Sincerely, Dennis