awheat

I go on Monday, the 6th, for a 0730 surgery. They said I would be going home Tuesday afternoon. No one said anything about a brace or measured me yet, it is all happening so fast. From my time working the floor it took day(s) for fitted equipment to arrive, but then that was on a Medical Floor not Ortho, so maybe I am just jumping ahead and need to slow my mind down. I will do as you say and try to trust the team. If a brace is not provided, then I will ask the surgeon (before D/C for sure). Thanks!

I was told by a nursing instructor in school that "No reputable Home Health Agency would hire a nurse who did not have at least one year's nursing experience". The reason is, you do not know what normal is. You do not know how to recognize when a s/s is a chronic issue versus something critical that must be addressed. Any company who would hire a new nurse with no experience is not putting the patient's interests first - and neither is the new nurse. I know it is hard to find experience but do you really want to endanger your patients?

Which is more appropriate for at home post-surgical recovery from an L-5 S-1 Laminectomy: an abdominal binder or a back brace? I am supposed to do no "bending, twisting, or lifting" for 2 weeks post surgery. I can comply with the lifting part, it is the bending and/or twisting I am worried about and was thinking a binder might help "remind" me not to move inappropriately. Any thoughts? And, by the way, here's wishing all my fellow nurses an early Happy Nurses Week!

I have a question for you experienced HD nurses. I have been working in an HD clinic for 3 months (newbie!) and need some advice. Here Goes: New HD patient, did not know he was ESRD until visit to ER = catheter placement and dialysis, w/ graft put in arm. Coming to clinic for last 3 ½ weeks. Last week, SBP dropped from 140's to 70's during 30 minute cycle, symptomatic. UF off, NS given, T-berg positioning and SBP back up (now 160's). Took 45 minutes to get him asymptomatic (T-berg, Semi-fowlers, High Fowlers, drop, back to Semi, High, standing = dizzy, semi, high, OK for 10 minutes, then tried standing = vomiting). The charge at the time said "I have never seen this before" and I kept working with him. Mind you, I was not re-positioning like a roller coaster - we went from position to position slowly, with several minutes "recovery time" between so that he reported he felt "ok" between each - but talk about orthostatic hypotension! So, EDW was reset by MD, and next 2 treatments we were conservative w/ the pull (over dry weight, but took only 5000 over 4 ½ hrs), with no complications. Then yesterday, he comes in 7.4 over. Charge (different from before) sets him to pull max we can (6800) and I jumped in and was adamant about the probs we had in the past 2 weeks so we set him for 5000 again (since he had tolerated that for last 2 treatments). It was first time sticking graft and he tolerated it great, and pressures were excellent. When he had 59 minutes to go he said my "stomach feels funny", re-check of bp: SBP went from 140's to 80's. And we did the dance again. This time he never actually c/o nausea or vomited. But still, symptomatic. And we only got 3900 off by the time this happened. I asked the charge about next time - should we try a profile for the pull? She said it was the RN's discretion, and since I was an RN "I guess you can if you want to". So, since I have NO HELP from my charge and I want my client to have safe and effective treatments I am asking you guys out there who know what you are doing (because I surely DO NOT) - do you think I should try a profile? Do we need to call the MD about another EDW adjustment? Guidance please. Any advice appreciated.

An adult can put off immediate gratification. If you can buckle down for a couple of years and instead of "doing other things" get a great education that will allow you to be a role model for your child and provide a stable environment then the best thing you can do for yourself and your baby is to "truthfully put your mind to it". You CAN do it. Thousands in your situation do it every year. It is possible and you will NOT regret it.

Start looking for something else & keep your job until you find something else. People in the industry know why nurses are leaving the Med-surg environment in droves, you just need to say, if asked, that it is not for you and you need a different environment that will allow you to perform at 100%. You may have a few "job hopper" interviews but someone, somewhere, will be happy to help you work in the capacity the Lord is leading you towards.

Keep in mind the chairs are positioned for patient safety, so any sticking/adjustment/hands on the access is done by YOU bending over - my back is killing me today due to 3 catheter patients all needing cath care/dressing/on & off/etc in the same shift. Calgon, take me away! And before you mention the "stool", we have 2 for 5 pods, so it is "not fair" for 2 of 5 people to get to use one, so no one gets to.

How is this: RN, no HD experience, chronic clinic setting, rural TX $26.00/hr.

Oh man, you are living my dream! Best of luck in SICU - people (especially family) always remeber how they/loved ones were treated while in ICU - keep up the great tradition of excellent care.

I am entering my 3rd month at an outpatient clinic. I still tense up at the thought of the stick, but now when I get it, I think "yep, got it!" instead of "oh, thank goodness I got it". This is not to say I do not pray before starting each day that the Good Lord be with me and my patients for the treatments. :)

An issue I found with change from PCA-to-RN status is that the nurse is too hard on herself. You say "so I have hospital experience", and you do, and it is valuable. But, it is completely different when you are the one the PCA is coming to, reporting an abnormal situation that needs to be addressed immediately, and you are trying to get report on your other 4 patients, and a physician is on the phone, and your charge nurse just gave you an admit. It is overwhelming at first, and you think to yourself that you have experience, and know what it is like, and why can't you do this like the super-nurse you have always thought you would be? You need to be gentle with yourself. Realize you are new to this. Like CrazyCatLady says, ask, ask, ask! Stay enthusiastic and idealistic, and do the best you can, but know there are days that will be overwhelming, and that is OK. Your shift will end, someone else will take over the patients, and you will get to clock out and go home (and cry if you need to). Best of Luck!!!

If I did not draw it up, I do not give it. If the client wants it drawn up for the next day, and is going to self-administer, then I will draw it up, and label it, then chart exactly what was done.

Call the hospital or not? Patient came in with a subclavian catheter to use while a new graft was healing in her arm. On the end of the 2 ports were claves, not caps. I used to work at the hospital she had her day surgery at (for the graft) and know these claves are what they use on central catheters (not dialysis accesses), PICCs and IJs, that the floor nurse can hook the IV lines up to or give IV meds. All is well in her case, surgery went well, she came to our clinic for HD and we removed the claves and replaced them with caps when we were done. My concern is this - in my time at the hospital, I never saw an HD catheter w/ claves on the end (there was the occasional pigtail w/ a clave, but not the arterial or venous ports). If something had happened and the client was admitted to the floor I can see the possibility that a nurse might inadvertently use the access as a regular IV access. I say this because this facility is notorious for hiring new nurses and cannot keep experienced ones past their contract dates. Also, shift report is only as complete as the 2 nurses involved care to be, and a lot of nurses are too concerned with going home to give a good report. Should we contact the hospital to let them know that there is a potential here for a problem if they are going to do this, or not worry as maybe it was a one-time issue?

Legitimate staffing agencies get their money from the employer side, not the applicant. They get paid by finding a good fit, not by looking in the first place. Find somewhere else. Good luck.

I planned on going for my BSN right away, but the lights of the big hospital caught my attention. After working for 2 years I have NO desire to go back to school and I am a great student who loves school and does well. I say if you can manage it - keep going and get the BSN...there are so many distractions once you start working full-time. Good Luck in whatever you decide.