SHGR

You stopped to make a video when a patient was yelling he couldn't breathe? Surely you are not serious. This might be a troll post, but I'll respond anyway. Maybe do some self-reflection, how you could have handled this better next time. open the patient's door, holler for the CNA to get in there and help you. Then report the CNA for sleeping on the job and abuse. Go up the chain of command. Be the change you want to see.

So sorry you went through this, OP. I am glad to hear you spoke up and reported this person, who had likely done the same thing to others.

^^^THIS!!^^^ every student needs to understand this, from day one in first-ever clinical.

I think you are being a bit harsh, MMJ. The OP has thanked other members for their advice and stated she understands the opportunity being presented to her- though upset initially. I get it, we want what we want when we want it, but not everyone has the ability to change their mind when presented with good advice!

Right, I was thinking the same thing, maybe that it is more of a QI project. Without seeing the article, I wonder if the "interview" was more of the kind of interview a case manager would do when working with a patient. The lack of IRB mention is a red flag that this is not a "research" article but more like a new initiative for a health care organization to reduce readmits etc.

My answer here is based on my experiences as a clinical instructor in the last semester before graduation. So when my students finish with me, they are ready to be precepted as new grad GN/RNs. I concur with many of the previous posts here, that the manner in which you ask questions probably is causing your preceptors to think you lack independent critical thinking skills. Here is what I tell my students: don't ask me a question that you can easily look up in a source, like what the definition of a word is, or what a medication is. When you have looked up what you can, come to me with questions about things that still don't make sense to you. I expect that they know the evidence-based resources and make use of them. They need to be developing critical thinking. Things are always changing. Specifically regarding the insulin, I've seen doses from one unit (humalog) to more than 100 units (lantus) and since so many patients on our clinical units either have diabetes or are having blood sugar management, I feel like it's pretty basic knowledge that insulin syringes come in several sizes including 100 unit; insulin dosing is based on so many factors. I would expect a new grad to double check the dose with the preceptor or another experienced nurse, as 70 units is somewhat unusual; but I want them to already have looked to see what the patient had been getting and what their blood sugars had been running, are they on steroids, that kind of thing that showed they had a basic idea of the relevant things about giving insulin, not just a "Wow, that's a lot!" kind of thing. It looks like insulin, in a 100 unit insulin syringe, up to the 70-unit mark. Also, personally I would have given the pain medication, then hung the antibiotic (Press-Ganey and all that) but there are other ways to do it too as others mentioned-- have a solid rationale for all of your actions. I would recommend to you, OP, do some role-playing, practice a more independent learning style, maybe spend some more time in your drug guide and get more familiar with the common medications. Even try videotaping yourself because that can be surprisingly eye-opening. Best wishes!

The recommendation for DNP by 2020 was just that. It is not a requirement or a mandate. However, many programs converted from MSN to DNP in anticipation. The rumor persists and there was never an official retraction or statement that it is not required and not happening. As far as ADN entry to practice, you may be thinking of the Magnet 80% BSN requirement or the push for majority BSN by 2020, but ADNs can still sit for the NCLEX RN and still comprise more than half those who enter practice.

Most nurse educators are MSN-prepared. Academia seems to be the only place where you would actually get paid more to have a doctorate, but why not find out whether you enjoy teaching before taking the extra step?

One of the best things about nursing was that it made me a better person. More mature, because I had to grow up pretty quick. Not that I was immature or bad before that, but I had to get better structure and organization. More able to take things in stride, because no matter how bad my life seemed, I wasn't the person in the bed (I worked oncology/hospice for a long time). Smarter, because I was always learning. Better able to deal with all kinds of people, because I wasn't very good at it previously and I had to learn pretty quickly. I had fabulous mentors along the way. I can honestly say that becoming and being a nurse was the best thing that I could have done. It made me grow, polished me, opened doors. Yes, it makes you cry sometimes, but it's worth it. Also, the pay is pretty good, which means that even if you don't love it, you have money to do the things you really enjoy.

You are correct that APAP is not an NSAID, I was just making a point why specifically APAP would have been ordered and not NSAIDS.

Agreed. I broke my foot a couple years ago and it just was not that painful even though it was a comminuted fracture. Ice and elevation really worked wonders. Obviously another patient's experience may be different, but after the initial snap it wasn't really that bad. (I just mean, don't assume that a fracture must be super painful). Also, fun fact NSAIDS are seen as detrimental to bone healing Do Nonsteroidal Anti-Inflammatory Drugs Affect Bone Healing? A Critical Analysis

This is fascinating. The online version took more of your time as an instructor? How so? the online discussion? Learning the tech? I found BlackBoard to be a non-intuitive interface; using it for creating tests and content was clumsy for me. I can see the online infrastructure being expensive to maintain, now that you describe it in those terms. It's just less visible than a classroom in a building with heat, staff, etc.

Great article! Thanks for writing these. I second everything, especially the part about really wanting students to succeed and being willing to support that. It's definitely true that having a student who is not successful is difficult emotionally. I hope students read your articles to get our perspective! Knowing why things are the way they are definitely helps in accepting them. About the disturbed energy fields thing though...NANDA retired this one, mercifully, in their last update due to lack of supporting evidence (yay!)

Hi Caffeine, thanks for posting. I have two follow-up questions for you- Are you an ADN or BSN? In what specialty do you use percussion?

oh dear OC I hope it is your GB and not something more serious!!

Public institution, not proprietary. I'm not complaining, just wondering what justifies the cost besides the market.

How did you not know that you would hate the drive ahead of time? Commute length, time, and stress are usually a huge consideration before taking a new job. It bothers some more than others. Why is it your responsibility to ensure your hours are conducive to child care, and not your husband's?

Oh, my husband just answered this for me. "Because they can."

I have taken a few online courses at the graduate level, and they have varied widely in structure and quality. One thing really baffles me though. Typically an online course costs more than a typical graduate level course. I cannot figure out why. It seems as though the courses are all "turnkey" for the instructor/mentor, as the content is all put together with no changes from term to term. There is no physical space to maintain. Students are responsible for learning the content independently and having the online discussions. All this is fine, as I am an independent learner. The online course I just finished was the worst though. The mentor was basically AWOL for most of the term. I learned a lot from doing the readings and such, but the online "discussions" consisted of students posting their initial discussion, then generally "responding" to other students with chunks of text from their own initial postings. They usually posted the minimum of two response posts, but it didn't matter as the only one attempting to actually have a discussion was me. We got feedback so late on our papers and projects and still don't have a lot of our feedback or grades. I want to give the mentor a scathing final eval, but since I don't have grades yet, I am a little worried about possible retribution. But my bigger question is, considering all this hands-off basically automated process, why do the online courses cost so much? They should be way cheaper than an in-person course.

OP, you had the right attitude toward your med error- freak out and realize what a big deal it was. That could have been a sentinel event. However this could be a blessing in disguise. If pt had HS BG of over 300, got 100 units of basal insulin and fasting BG was then over 200, it sounds like their insulin needs are much greater than what is prescribed. You'd have to look at their trends and patterns as well as age and other factors, but it would be a good opportunity for you to call the provider with an SBAR and turn the error into a positive. Learning experience for you, more appropriate diabetes control for the resident.

Have you considered moving to another area to find work as an MSW rather than a complete career change? Maybe find something in an LTC setting or even home care?

In my MSN program it was so difficult for any of us to find preceptors. It was easier for me as a CNS/educator student than those who were in the FNP track, for sure, but still difficult to find someone willing to have me tag along for hundreds of hours of their time. I did indeed want to pay it forward. My MSN/Ed preceptee was so unprofessional that I will never do it again unless it is mandatory for some reason. I won't go into details here, but I was really surprised at how difficult it was to help someone else for no reward.

One of the things I loved about the unit I was a clinical instructor on, was that I was part of "we" from day one. All of my student groups were we. That meant answering call lights and such too- it was we in every way. Great unit to be a part of. I hope my next unit is the same way!

Thanks for your responses, guys. It must be a whole different world in school nursing for real. In hospitals, we just walk in and do whatever, it seems, so I am mostly used to that whole paradigm. Sad that you can't just do care without having to worry about getting accused. It is very rare in acute care to have a caregiver accused of abuse. It happens though (once that I know of in my 20+year career).

You school nurses post a lot and I love your threads! I'm confused about this one. I've worked special rec camp where I straight cathed campers, and family medicine where we cathed and U-bagged kiddos, so that's my frame of reference here (though genital and breast exams get a chaperone for opposite-sex providers). Why, when nurses and CNA's do all kinds of personal care, is it different in a school setting?