stn2003

I think a better question to pose might be: would physicians support MA licensure? MA's may work with nurses but they work for phsycians, so who cares if nurses would support it or not? It's moot. My point is, I doubt physicians would support it and this is why: 1. MA's are used as a cheaper alternative to licensed nursing staff. Licensure might mean MA's can vie for higher pay. 2. Licensure would give MA's a definative scope of practice, and alot of the things that MA's are allowed to do while practicing 'under' the license of the physician (nursing and medical duties- like giving injections) would no doubt not make it into the scope of the MA. No flames please, just my honest opinion. And I do not dislike MA's- my mother is one, and she enjoys her job very much. But when she complains to me about the poor wages/benefits and 0 chances of advancement I tell her to go back to school.

Just what exactly is Ohio doing? I am a new grad (Dec) in OH and virtually all of my classmates had positions waiting for them the same month of graduation. I recieved a 2,000 sign on bonus (and only had to stay for six months) and they are going to pay for my continuing education up to 20,000. And not just for nursing- any hospital employee can get 10-20 thousand for pursuing continuing education. I get good benefits for myself and my family, paid BLS, ACLS and EKG classes, and tons of opportunities for free CEUs. Their 401k %match is good as well.

My PCP told me that Celexa is 'weight neutral', and, if anything, it inhibited my appetite for a while. Didn't lose any weight though

I know that you said you were burnt out from what you were doing with Psych, but have you looked into being a MHP (Mental Health Professional) in acute care? They work along-side the nurses on the psych wards doing things like vital signs, group meetings, psychosocial assessments etc. I know a couple friends who did this while waiting for/ while in nursing school and they enjoyed it because it put their background degree to use and paid more than nurse's aide/ phlebotomy wages. (MHPs make around 14ish where I work- our PCTs make 8ish.)

i know others will be able to give you a more thorough list, but here are some things i considered: Nurse to patient ratios for different shifts (or RN:LPN:PCT: patient ) How long and with whom is the orientation? How are shifts split- eight hours or 12s? Is full time 40 hours or 36? How is sick time/ETO time accrued/used? Is there a policy on how soon you can be pulled to another unit? Hourly rate + shift differentials/ incentive money/ OT Do they pay for continuing education and/or BLS/ACLS/PALS/EKG/Certs

I felt scared out of my mind- in fact I think I gave myself an ulcer : P The night I came off orientation (recent), it felt like nothing went right straight out of report. But it wasn't horrible, and I did fine : ) Once I had to go in the bathroom for a few minutes of some deep breathing. A couple days into being on my own I had my first emergent situation (young man having an MI on me : ( ) and my old preceptor just happened to be working that nite. He let me handle it on my own, but popped his head in to ask me how I was doing and did I need help etc. and when I had a ? all I had to do was ask him or anyone else working and they were so helpful. I had a relatively long orientation at a place I have already been an employee at, so I am happy to be out on my own because deep down I know I am ready, and the confidence will build over time.

Taking this subject outside of the peds realm but to med-surg nursing, if I have an alert and oriented patient in with something like chest pain, I am not peeking in their underwear during my assessment. I ask them if they are voiding regularly, is it yellow, does it burn etc and if their bowels are moving regularly, no blood in the stool etc. It is still assessing- just not inspecting. If I have a patient on bedrest with briefs etc I will look to make sure there is no yeast to the groin area or breakdown etc. I am SHOCKED that this instructor expected you to do that! On a side note, I was hospitalized a couple of times as a teenager, and NEVER did I encounter this during an assessment, as my admitting diagnosis was more neuro related. I am sure I would have flipped out. Sounds like your instructor needs a reality check

On my SDU we titrate it on the floor. The other day I had two pts on it that I was keeping track of, luckily they were in the same room because I was in and out so much. One was too tachy, the other bradying down lol. The only thing that bugs me about cardizem is when a doc initially orders it but doesn't give the order to titrate it up to 20 for a HR> than whatever, or wean it off etc, because then you have to call them all night to get the rate changed. Most docs will just give you the parameters and orders to titrate right off the bat though to save them a barrage of phone calls about the cardizem throughout the night. Drips definately have a potential to be a PIA when you are trying to manage a busy team of nine : / I personally try to avoid them : ) Another drip I like to keep clear of is Dopamine. I am paranoid about the site and check it super often for infiltration, because I have seen that happen twice and then you need to call for the Regitine injection etc. and document up one side and down the other plus start another IV and restart the drip, and it is just a time eater!

Here in OH I think you only need to report mental illness if it is Bipolar or Schizophrenia that is a current issue/you are recieving tx for. I have heard from the grapevine it does result in follow up paperwork.

here is one from experience... elderly pt. ambulates down the hall furthest from the station with pt and walker, gets diaphoretic and sob at the end of the hall, complaining of chest pressure. down they go, semi-caught/eased to the floor by pt. pt goes unresponsive, stops breathing, no pulse. and another... you come out of report 8am-ish, start making your rounds. patient care tech comes up to you and says mr. so and so won't wake up for his breakfast and looks kinda funny. go in to assess and there are no signs of life, he is a full code.

lol only four? Recent Vitals Abnormal assessment findings/labs--->any follow up Allergies Code Status

Last nite stunk. One of my patients had a HgB I had another pt. newly on tube feed that just was not tolerating it well at all (bolus feedings) tube placement was correct, but he was just not digesting it well according to his DR, and he vomitted up a large amt of it. He is on aspiration precautions already : ( So i notifed the PCP, who basically said call GI, who changes his bolus feedings to very low continuous. His lungs are sound clear, sats are good, residuals are low, so middle of the night we start TF as continuous per orders. This morning he had another vomitting episode, nearly of everything we given : ( Luckily I was in the room at the time, he desatted on us/needed suctioned and there was definate fluid in the lungs this time. So i called GI again, who puts the TF on hold. I have to bug her and bug her to order a PCXR for the possible aspiration : / She talks about ordering a ABD xray, but doesnt want to in the end. Call primary who wants to order, the xray, but doesn't want to step on the other doctor's toes. Talk more with primary, who eventually decides to order it. Make up your mind people!! I am wasting precious minutes of my life and time I could be spending on pt. care playing the phone game . Ahh. I feel better after a vent. Luckily, of my other pts, I only had 1 mental\refusing meds/tx pt acting beligerant who decided to walk into another pts room in the middle of the night to argue with him, lady with a pulled out IV that 'didn't know what happened to it' , another LOL with no IV access that needed scheduled IV meds (thanks days) who of course has no veins (House Sup got it in on her, bless her heart) and multiple PICCS and Ports that I had to do line draws/flushes for all night. All in all it was busy, but I don't feel I did a poor job handling it as a new grad. Or at least I am telling myself that for comfort Makes me appreciate more those that want an ambien and there door shut for the night lol. Back again tonight for more fun. Thankfully it is my last day for the week.

People are not routinely diagnosed with seizure disorder after a single seizure, it would only be if they persisted. A single seizure could be cause by severely off kilter electrolytes, infection/high fever, sever HTN, etc. There are a variety of cardio/neuro causes that may cause seizure-like episodes as well. If the seizures persisted seizure disorder may be investigated, as well as brain injury, tumors etc.

1. How many beds do you have? 32 tele beds. 2. How many nurses play into the total mix? 55-60ish. 3. How many different shifts do you have (we have 5) 2-core 12 hour shifts-days or nights, but people can sign up for extra hours in 4-8-12 hour increments 4. Does senority play a factor in who gets first dibs? Nope. First come, first serve when the schedule is out in the schedule book to be filled in. 5. What constitues a weekend? Every third SAT-SUN for day shift and every third FRI-SAT for night shift 6. Do people have to rotate shifts? People rotate weekends (work every third) but people do not have to rotate from days-nights. Some people do for extra time though : P craziness lol. 7. Who gets to sign up first for the schedule. If you are lucky enough to be at work when the schedule is posted, you sign up first lol. 8. What region is the hospital that you work in? Midwest Ideally, we need 8 nurses and a CN to staff our unit when full, and we can get floats from the other floors to accomplish this, but our Managers put the schedule out a good two months in advance for a six week block so they can assess the needs of the unit, make any changes they might need to/discuss those changes with staff, and then post the schedule in plenty of time for people to take a copy home and know well in advance their hours. Seems to work pretty well. Our night shifters are also *asked* to sign up for one-two sundays a month, because people generally don't sign up for them unless asked. Also doesn't seem to be a big problem. Generally, people tend to have different sets of days that work well for their lifestyle- for example, I work with a nurse who can only work fri-sat-sun because that is when her hubby is home with her kids and she doesn't have other childcare. Other nurses like to work sun-mon-tues and have the rest of the week off, some nurses like to break their days up because they don't like to work multiples in a row. The flexibility is nice. People have the ability to trade days with other staff after the schedule is posted. Hope this helps : )