INtoFL_RN

I'm not an OB nurse, but I just happen to be an RN who is 36 wks pregnant with baby #2 - very uncomfortable right now as well! All I can say is hang in there!! :) I don't know if this is your first baby or not. I really don't see why a doc would grant a request for an elective induction at 37 weeks for non-medical issues. Yes, these last few weeks can be really difficult on your body and emotions. One thing I learned from my experience (in this pregnancy and the last) is that you should be open to letting go! The world won't end if your house isn't spic-n-span. Allow yourself to rest, put your feet up, and enjoy some alone time. You'll look back eventually on these last few weeks and wonder where all the time went! Good luck to you :)

Our hospital is putting forth a pretty good effort to address this, and thankfully our docs are cooperating well. It's a JCAHO thing, which ultimately leads to a reimbursement thing. Since we are a small community-based hospital, they take these types of things very seriously. On admission, a pharmacist is responsible for obtaining from the patient their list of home medications and verifying the dosages. Then the attending MD is to review those meds and individually circle whether or not to continue or DC within 24 hrs of admission. Circling all is not acceptable! PRNs MUST have an indication listed. We are not allowed to say "one to two tablets" either, it has to be written as "12 to 25 mg PRN nausea" or whatever. On discharge (or transfer to another unit), the MD tells the secretary to print up a form that lists all the patients' current meds. They must individually circle whether or not to continue each med. The original home medication form from admission is kept in the front of the chart, so MDs should be referring to that as well when writing DC orders. Since I work in a cardiac unit, most of our patients can be DC'd with a standard form based on diagnosis that states their activity restrictions, diet, etc. I have rarely had to call docs back to clarify some sort of discharge issue. I'm really glad we have this system in place. We do enough hand-holding and secretary work for these docs sometimes!

One of my strategies is to get to the Pyxis early in the morning and get all my meds out that I will need for the "0900 med rush". This may or may not work for you, depending on how your unit is set up. All of our pts have their own med drawers inside the locked med room, so it is perfectly kosher for me to get the meds out ahead of time (except for narcs, of course). I do my initial med/route/dose/etc. check, then put the meds in a ziplock bag inside the pt's drawer. When it's time to pass the meds, I bring in the MAR with the meds to the pt's room and go over what meds they are getting with them. If I need to draw up any IVPs, I draw it up in the med room first, and write the med&dose on the syringe. As for meds that go with dressing changes (like polysporin for sternal wounds), I wait to give that until it's a prudent time to change the dressing. For instance, I'm not going to change it at 0800, when the pt is going to shower at 1000. Things like this, you can use your "nursing judgment" on, I think. Always best to check policies, of course .

the advice you've been given so far is all great. i can add a couple things... -since you're at a teaching hospital, make sure you follow the "chain of command" when calling docs. -at the beginning of your shift, glance over your patients prn meds to see who doesn't have things like pain meds/sleeping pills/laxatives ordered. get these calls out of the way early in the evening to avoid a hassle later. -rely on your fellow nurses for advice before calling a doc! i found out that you can save a lot of calls to a doc just by asking your charge nurse or an experienced nurse for advice. -utilize things like sbar communication when calling a doc in the middle of the night. sometimes they aren't quite with it, and having a clear, succinct report of the situation is really helpful. a lot of times, docs can get grumpy just because they are frustrated with us not having all the info that they need to make a decision. don't assume that they always remember what patient you're referring to just by name alone. here's an example of sbar (copied and pasted from a website): dr. jones, this is deb mcdonald rn, i am calling from abc hospital about your patient jane smith. situation: here's the situation: mrs. smith is having increasing dyspnea and is complaining of chest pain. background: the supporting background information is that she had a total knee replacement two days ago. about two hours ago she began complaining of chest pain. her pulse is 120 and her blood pressure is 128/54. she is restless and short of breath. assessment: my assessment of the situation is that she may be having a cardiac event or a pulmonary embolism. recommendation: i recommend that you see her immediately and that we start her on 02 stat.

Our small community hospital's compliance officer says that we can err on the side of giving out general information rather than withholding it (unless that pt has asked to remain confidential/non-disclosure) and still be HIPAA compliant. I usually give a very generic (and quick) response to family members over the phone and then offer to transfer the call to the pt's room.

I started out as a new grad in tele as well. I loved it so much that I'm still doing it 4 years later. Learning the ins and outs of cardiac rhythms was and still is fascinating to me, so I didn't have a hard time picking it all up right out of school.

The posters on this thread have made great points about this. The best thing I ever did for my career started before I even graduated nursing school - I got a job as a Student Nurse Extern at a large teaching hospital during my junior year of nursing school. I worked under an RN's license, but was able to take 2-3 patients on a Progressive Care floor doing everything (except giving IVP meds and blood). My experience from working made clinicals look like a joke...there we could only take 1 patient, not start IVs, not interact with physicians, and sometimes give meds. Puuuuleeease. Nursing school has its merits, but it is not modeled after reality. I like the idea of having to do a semester long "residency" after graduation, it makes a lot of sense!

I tend to believe in the benefits of vaccination not only for individuals, but for public health as a whole. I vaccinate my child, and I got the Hep B, influenza, and pertussis booster for work. My mother-in-law is very anti-vaccine, but she seems to be also misinformed. She thinks that because she is over the age of 60, her body is "used" to all the different flu strains and that the flu vaccine with just make her sick. She freaks every time my son goes in for a well-child visit and gets multiple vaccines. She is also a person that believes in the power of supplements and vitamins. She takes 1000's of % of her RDA of every vitamin thinking that it will keep her healthy. I'm not one to jump on every new vaccine that comes out though, especially for kids. I am wary of the long-term studies done on some of these before they get put on the market.

I was out for a little over 2 years. I applied for only one job just because it was a day shift per diem position in an area of nursing that I was familiar with. The position was filled just as soon as I applied. I kept my resume on file with them for a few months, and lo and behold, the manager of the unit called me to offer an interview. During the interview, I just emphasized my experience and my ability to adapt easily. I never took a refresher course, but not that much changed in 2 years. I got the job. I will say it took a good month to get back into the swing of things, and a good 3 months to get my time management back to normal! I think it's great that you've taken a refresher course and are willing to work hard to get yourself back to work. I don't understand why a new grad is better to an employer than an experienced nurse who has been out for a while. New grads may be "fresh" out of books, but they are new to everything else (in most cases). Good luck to you!

I'm not an OB nurse, but when I was in our hospital's ACLS class a month or so ago, the nurse next to me was leafing through the materials for the OB-ACLS class. From what I saw, it really isn't "advanced cardiac support", mostly just more of an in-depth look at how to deal with OB emergencies (like hemorrhage/DIC, etc). Of course you'll probably have more trained personnel around you to handle such emergencies (just like when using ACLS). But it's good to have the ability to start interventions when needed. As far as I know, our L&D nurses aren't required to have ACLS, but have to take the OB class. Some like to take the ACLS just for their own information.

While the arguments against the tracking devices are all good points, I still like the one we use on our unit. It really does aid our communication. The first hospital I even worked at had no tracking system at all, they overhead paged everyone for everything. Talk about pts not being able to rest! All we ever heard was "so and so, go to rm 17". It was so frustrating b/c the person paging us couldn't say over the intercom why we're needed. Makes it very hard to prioritize things when you're needed in 2 or more places at once. A year later, we got the Hill-Rom system, and our lives changed for the better! Sure, we all grumbled about lack of privacy and such, but then we realized how much better we were able to function. We all ran non-stop on that unit so even if management wanted to track us, they could see that were truly not getting breaks/lunches and had to clock out late regularly. The unit I work on now is a very busy PCU that is comprised of two very long hallways. It is so nice to be able to find someone to help or talk to just by looking at the locater on the wall. It's also been nice in staff emergencies without having to pull the "code" alarm. And BTW, we "disappear" from the tracking system when we leave the unit. At the end of the day, most of us leave our locators in the break room lockers so we don't lose them and get charged $75.

I figured this would be the forum to come to with a question like this...I've never done peds nursing, so I don't know all the tricks to get kids to take their meds! I have so much respect for what you all do! My 20-month-old has been dealing with persistent conjunctivitis. We saw an ophthalmologist today and are trying a new antibiotic drop. Problem is that it's ordered QID....ugh! When we only had to do the drops BID, he was pretty good. He'd lay down and pretty much let us put the drops in. Now he freaks as soon as I hold the drops above his eye. DH and I have tried distracting him/having him look at something in the air, I've tried putting the drops "in" his stuffed animal's eyes first to show him it's OK, and obviously holding him down is the last resort. Anything else I could be trying? Thanks for your help!

Can't think of a bunch right now, but some that come to mind are insulin and oral hypoglycemics. Try to know the different insulin's onset and duration, what can be mixed together and what can't (like Lantus - can't be mixed in same syringe as other insulins). Seems like most pts in the hospital today are diabetic, so it's important to know

I just took ACLS a couple of weeks ago, and it wasn't that bad. I second what Chip said above - understand what the drugs do, don't just memorize what drug for what rhythm by rote. The class now really focuses on quality CPR, so if you ever get stumped during your mega code, just tell your team to continue CPR . What helped me study was practicing giving instructions out loud. I made a pile of 3x5 cards with rhythms on it. Then I'd look at the rhythm and pretend to direct that code based on that rhythm. It really helps you put it all (compressions, airway, shocks, drugs) together. The ACLS book this year was pretty good, although the pretest on the CD-ROM is way more difficult that the actual test given in class. The final test really focuses on fundamentals rather than tricky questions. Good luck!

While I'm not familiar with ripivocaine in particular I did find info on Lidocaine toxicity. Check out this link...Emedicine Lidocaine toxicity Toxicity from ripivocaine makes sense, if the block was administered incorrectly AND the patient had hepatic insufficiency from the ETOH. I have seen Lidocaine toxicity once - it was a very large dose administered by an inexperienced resident via an unusual route. The pt coded/died and we heard through the grapevine that his autopsy showed lethal levels of lidocaine.

I would have a problem with it if the nurses on the unit aren't trained in basic EKG interpretation and rely solely on the MT's assessment of the rhythm. Reading tele strips is not always cut and dry. I've worked on a unit where we had a MT and now work on one where we do not (we carry pagers to alert us to arrhythmias and run strips q 4 h). When I worked on the unit with a MT, there were good ones and there were not so good ones. I always checked my own strips when we had an MT; I just think it's the responsible thing to do since you are ultimately accountable for your pt!

At our 200-bed community hospital, IV Lopressor cannot be given on the unmonitored M/S unit, the pt. must be in at least our PCU. The PCU admission criteria states that pts must be on the monitor at all times, and the ratio is 1:3-4. Our hospital has a list of what drugs/drips may be given on the different units - does yours have such a list? You might want to check with your manager or director for the policy on this. Sometimes docs just start ordering things that aren't necessarily in line with policy. I think it's asking a lot of you guys to have to take frequent vitals with so many patients. I've never done VS that frequently when giving Lopressor IVP to monitored pts- just VS before and VS 15 min or so afterwards. Routine VS are q 4 h anyway. Besides, if your pt develops symptomatic bradycardia, are you equipped with the time and expertise to deal with that? If you don't feel comfortable, you should have a long talk with your manager.

I started out as an RN on day shift, and I think it is the best way to start, hands down! I switched to nights a year after graduation, and it was so boring. I really felt like I was "on my own" on night shift. Days have so many opportunities for learning. I'll just list some good things about being a new RN on day shift (of course these can be argued either way): 1. You will develop good time management on days because of all the things going on - meds, meals, visiting family, am care, etc. 2. Docs are available and willing to talk with you if you have questions 3. Most meds are passed during the day, so you will develop a good knowledge base 4. Starting nursing is difficult enough...adjusting to a new sleep schedule on top of the stress of a new job is really tough 5. You can observe procedures during the day if your orientation includes this 6. All departments are fully staffed during the day (like dietician, physical therapy, etc...you can learn a lot from these guys) That's all I can think of for now, I'm sure others can add more. Good luck to you! :)

I have a job interview next week, and I have no idea what to ask for as far as compensation goes. I have been out of nursing for 2 years, but am looking to work per diem days on a cardiac/tele unit. Salary.com says the 25th percentile salary for my area is $29/hr. It seems awfully high to me (I'm used to working for $17-19/hr!). Should I go for it and ask for $29/hr. or see what they offer me first?

I can't answer all of your questions...I share a few of them myself! I have been toying with the idea of going back to work since I've had a baby. I have worked in cardiac step-down as well. I'm not quite sure what the lingo is out here in CO, since I haven't worked here yet :). I have a friend that works at U of Colorado Hospital in Denver. She is working in the cardiac unit, and participated in an internship right after she was hired. She did sign something that said she had to work there for a minimum of 2 years. I have no idea how much she makes, though. In my web surfing for jobs, I have found that Exempla Good Samaritan Hospital in Lafayette, CO has a critical care internship. http://www.exemplajobs.org/ has more info and contact persons. As for wages, I checked out www.salary.com I actually have an interview next week at a hospital in Boulder, and I'm trying to decide how much to ask for wages! Good luck to you :).

I am trying to get my resume and references ready for a job that I am applying for. I've been out of nursing for a year and a half, since the birth of my son. My last job, I was only at for 6 months (I quit because of husband's job relocation), but the previous job I was at for 3 years. This job I am applying for wants 3 references. Do I get all 3 from my last job that I was at for 6 months, or one from the job I was at for 3 years? And as for letters of reference....do they need to be current as of this year? Thanks, I am so bad at this whole job ettiquitte thing!

I live outside of Boulder (in Erie), and I can't comment too much on the job market, but I can comment on the cost of living and housing. I've been keeping my eyes open for RN positions, and there seem to be quite a few, they just aren't the "choice" positions. Mostly night shift in various areas. In our area, there are quite a few hospitals - Exempla Good Samaritan (Lafayette), Avista Adventist (Louisville), Boulder Community, and Longmont United. As for cost of living - not nearly as bad as CA, but the taxes are high here. Sales tax differs between towns, so it's anywhere from 8-11%. A gallon of milk runs about $3. We bought a 3 BR/2BA 1600 s.f. house last year for $262K. This is a great area to live, though. Money magazine rated Louisville as the #5 best town in America to live. We moved here from Florida last year, and we want to stay here forever! :)

I took some time off from nursing after the birth of my son last year. Now I'm itching to get back to work, but I haven't been the best at keeping updated in the latest nursing practice. Will this create a problem in getting hired? I am a fast learner, and I hope that once I get back to working, I will get the hang of it quickly again! :) What are some ways to make myself stand out from other applicants, given that I've been out of the field for a while?

I'm trying to figure out if I should even bother applying for this job...It's exactly what I'm looking for as far as scheduling is concerned. M-F days only, per diem. It's in a day-surgery center. The only problem is, I've never worked in PACU before! I worked in a PCU as an RN for 1 yr (and a student for 2 years), and a cardiac step-down unit for 6 months (I quit when I had my son). I've done ACLS and all that. My biggest obstacle is that I haven't worked in a year since I've been staying home with my son. Should I go for it, or will HR just laugh at me?

I have worked at one Magnet hospital, and one hospital that was in the application process. There was nothing special about the Magnet hospital. In fact, it was worse than the non-Magnet hospital. The nurses were treated poorly by the physicians and by the management. I have no idea how they managed to GET Magnet status in the first place! If I were you, I would go with the hospital that you KNOW has a good reputation.