JessicaE

I agree with GrnTea about your first nursing diagnosis...it's all skewed and mismatched, but not too horrible for a first try! :-) But I DISAGREE with GrnTea about not including giving appropriate Abx on time on your care plan, for reasons below: See this site for why I said Risk for Infection/Sepsis....and scroll down to the bottom where it lists Nursing Interventions associated with that diagnosis. One of the items is: ADMINISTER MEDICATIONS AS INDICATED (on page 5 of 13). This is a VERY important nursing intervention to the prevention of the spread or development of further infection. Sepsis Septicemialso, from your original post, it looks like you were not given a chance to actually assess the patient yourself, but given the lengthy list of what all is going on with the patient....several of the listed assessment details fall right into line with the criteria for a Risk for Sepsis nursing diagnosis. AND, this site also lists "administer antimicrobials as ordered" as an appropriate nursing intervention for Risk for Infection: Sepsis nursing diagnosis: EHS: Nursing Care Planning Guides - Care Planner: Diagnosis: Risk for infection: sepsis

How about something to do with her risk for sepsis R/T multiple sources of infection (UTI and leg)?? Throw in her noncompliance with diabetes management, and you have the perfect storm for sepsis. Seriously, if she gets septic with her recent episodes of HTN, dehydration, and chest pains/possible MI, it could easily kill her. I would say that a nsg dx related to that would be of great importance. Interventions could include giving ABx doses on schedule, changing her Foley per the latest TJC guidelines for CAUTI (if applicable), and educating the patient on urinary and wound care. Who knows? Maybe no one has told her in the past to wipe from front to back...sometimes the simplest things escape us. Good luck!

Definitely go for the Children's Hospital experience. If you can handle the worst with kids, then pediatrician office work will be a breeze if you decide you don't like the hospital setting. It's not so easy the other way around. You'd pretty much have to start all over trying to go from peds office to children's hospital...

A few thoughts of mine below. But first, I was a new grad back in 1999. Started in a busy trauma center ER, then CVICU after a year in the ER...since then, I've done NICU, PACU, case management, and now currently I write courses/blog for online nursing educational sites and do freelance editing for medical textbook publishers. 1) As a new grad, pick a job that will not make you feel so busy you feel you are unsafe. This advice could apply to any nurse, but some thrive on the hectic, and seem to do just fine. I am not one of those. That eliminates position #1 on the med/renal floor. 2) Friendly co-workers are INVALUABLE, whether you are new or not. You will enjoy the job and learn more if you are able to relax and laugh some during even the crazy shifts. Not to mention feeling at ease being able to ask whatever questions that come to mind, no matter how stupid they may sound. That eliminates #3. 3) Option #4: Oncology is one of those particular specialties that you can either handle, or you can't...it is truly a love or hate thing. I, for one, would not do well in oncology because several of my elderly relatives have died from cancer. BUT, I do VERY well in NICU, even when the infants die...and not everyone can do that. Only YOU can decide that for yourself. It could be a great job...but I suspect that a 50% turnover rate indicates more than just the emotional aspects of the job were hard...I suspect there is more to the story of that unit than just that. So, I'm in agreement with your first instincts. Go with the slower-paced, friendlier, shorter-commute position. You may very well make up the pay difference just in the savings in gas costs, rather than driving up to downtown. Also, while you are a new grad, take every opportunity you can to hone your assessment skills...particularly of lung sounds, heart sounds, pedal pulses, etc. In addition, develop the valuable art of allowing the patient to feel in control of his/her healthcare, while keeping them from running you over and keeping them within the guidelines of the "standards of care." Openness and honesty with professionalism and tact will take you farther than any other skill. That and the ability to start IVs in scalp veins! lol ;-P