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I agree that it depends more on the acuity than the number of patients you will be assigned, although 8 still sounds a bit excessive. I worked on a M/S surg floor with a patient to nurse ratio of 4:1 on days, and although that sounds great, our patient acuities were very high. I agree that you should request to shadow an RN at the facility before agreeing to take a position, especially if this will be your first job after nursing school.

I think you did the right thing. I would have also explained to the patient that it is my duty to keep them safe, and I did not consider it safe to administer the narcotic considering how bradycardic they were. I would have then called the physician and explained what was going on and reported the bradycardia and asked what was being done/going to be done about it. I would have been more concerned about the drop in heart rate than anything else. You always have every right to refuse giving a medication to a patient if you feel as though it comprises their safety. I have done so on multiple occasions, as have many of my nurse colleagues. Also, don't forget to chart!

Just a couple tips: RESEARCH your travel agency VERY well before signing on with them. Also, it's very important to thoroughly research the housing/area they place you in (if you choose their housing) and also the hospital at which you will be assigned.

LOVE my Danskos! Only shoes I can wear for 13 hours without getting a backache! :)

Practice questions! I learned through Kaplan that it's more important to focus on strategy when test taking rather than knowledge, since it's impossible to know everything that will be on the test. Focus more on different test taking strategies, such as never choosing an answer that makes an absolute statement, such as "never" or "always", etc. Hope this helps!

I think you did great great, especially since this was your first emergency. A good reminder to always take our patients seriously when they tell us they "just don't feel right". Great job!

Maintaining proper blood glucose levels after surgery, especially in diabetic patients, also has a huge effect on wound healing. I took care of a patient who developed an abdominal wound dehiscence following surgery primarily due to consistently high blood sugar levels. She had to be transported immediately to the OR to have emergency surgery!

Vaseline! You can thin it out with a bit of water if you feels like it's too thick/greasy, or you can just use it to spot treat. It also works well for dry, chapped lips!

The negative comments your instructor has made to you prove her ignorance. Excellent nurses come with all types of personalities!

Yes, if you're considering graduate school. I am currently applying to a DNP program at a very competitive nursing school, and I know that this particular college takes a close look at their applicant's GPA. As far as being hired into a facility after nursing school, I think connections are more important than GPA. I was hired as an RN on the same unit that I worked on as a nurse intern while in nursing school. I expressed interest to my manager before gruduation and she actually opened up an RN position for me. Obviously, this will not always be the case for everyone, but I think that getting your feet wet while in nursing school will help you establish both clinical experience and connections, which may come in handy after graduation!

If you feel like your safety/license is in danger, don't return. However, if you feel like you can endure a few more weeks without comprimising your safety/license, then I would recommend giving a two weeks notice. It may feel like an eternity, but it will probably pass by faster than you anticipate. You can then return to your old psych job, while looking for something else if you're concerned about benefits. Good luck!

I agree with the fact that it depends on the hospital. I worked on a General Surgery unit at a facility in CO that had a ratio of 4:1 on days, and 5:1 on nights. Although the ratios were great, we did get VERY high acuity patients, some of which definitely should have been on a step down unit.

Patient: I neeeeed pain medication (in mumbled jargon with eyes half closed) Nurse: But sir, you appear very drowsy and can't keep your eyes open long enough to tell me how badly you require pain medication Patient: Suddenly pops eyes wide open and clears up speech long enough to say, "No, I feel fine, I just neeee........" then falls back asleep Nurse: Ok sir, well I'm going to let you rest now, but when you're awake and coherent enought to complete a full sentence, we can re-consider some IV narcotic pain medication Patient: But I'm in paaaaiiiin!!!!!!!!! zzzzzzzzzzzzzzzzzzzzzzzzzzzzzz :)