LoveSbux

Oh Ashley. I have no idea how you do the job you do. I cannot even imagine having the strength to go to work and deal with the situations you speak of. You're a special, special person.

Most of the new grad programs where I live (central NJ) have gone by the wayside. I was hired as a new grad by the hospital where I was already employed as a paramedic; my unit then hired another new grad who had been a tech there....most of the newer nurses who were hired as new grads, at least on my unit, had been with the hospital as techs or unit clerks before getting the RN. For me, it was a six-week orientation with a preceptor and then I was cut loose. Scary at times but the other nurses are so helpful I'm never really alone if I need help. Good luck and keep looking!

Yup, this exactly.

I had five years as a paramedic (all patients on portable monitor and the majority getting prehospital 12-lead ECG as well), and I had ACLS as part of that job's requirements.

I know of at least one male L&D nurse at my hospital.

i'm a new grad on a tele floor (i've been working since february, on my own for 3 months now). since it's my first job i can't really compare to a regular med/surg floor but we do occasionally have a fair number of med/surg (non-tele) patients. in our whole hospital there are only 2 or 3 units that are not tele capable so we tend to see everyone mixed up. we don't get many ortho patients at all, and relatively few surgical patients though. so--it's a 30 bed unit and our usual assignment is 5 patients. my unit specializes in heart failure, lvad, and post-transplant patients (once stable enough to come out of icu). a nurse with a transplant or lvad patient only has a 4-patient assignment. what is a typical shift like? i work days, 7am-7:30pm. i come in, and depending on how early i am, print ecg strips, check labs, and look over my patient care summary for the day. i try to get my brain sheet organized before taking report. report is usually done by 7:30, i check to see who needs insulin/8am meds, and assess those patients first while passing meds. then i see the rest of my patients, try to chart assessments on 2-3 of them, participate in interdisciplinary rounding (with the case manager, social worker, head nurse, and sometimes physician advisor), and start working on 10am meds. after that i try to finish charting on my other patients but it doesn't always work out....then deal with lunchtime meds/insulin. between 1:30 and 2 things seem to calm down and if i had a busy morning i might not eat lunch till then. the afternoon consists of dressing changes, more meds, more charting (try to get education charting done in the early afternoon and then we do/chart a 4pm assessment as well). dinnertime meds and insulin, finish charting, etc etc etc. how much personal care would you say you do compared to a typical med/surg floor? our floor generally has 3 techs, each with an assignment of 10-12 patients (the unit also has a 4-bed intermediate care unit and one tech will cover that area as well) though lately one tech has been dedicated to a 4-patient group needing more frequent observation (delirious, disoriented patients). they tend to take care of most bathing but if my patients need help getting to the commode or on/off the bedpan, i *think* i wind up doing it most of the time. i may be wrong, they don't always tell me if they helped a patient with that, but i tend to answer the call bells very quickly and i just do it if i'm already in the room. how mobile are your patients? depends on the day; the majority of our patients are elderly and come in with chf exacerbations or pneumonia and for the first few days they seem to be bed bound/chairfast. we do see a good number of post-cath patients and a lot of them were ambulatory and in good health before coming in; they tend to get up and walk the halls asap. what are the main tasks you do during your shift? see above, i think i covered that :-) do you feel like you are always running around, behind, or that things are more manageable? usually running around, but manageable. on mornings when i have patients with a lot of early requests or procedures or lousy vitals i tend to run behind but everything does get done...eventually.... does that help? quite a dissertation...

You're lucky to be in this predicament in today's market! I'm from NJ and a new grad as well so I know firsthand how hard it is. I think I'd eliminate the NY job from my short list unless you think you could work that one and the Morristown gig at the same time...are you considering taking two of the positions? The drive and tolls would be a deal-breaker for me assuming you are closer to St Joe's and MMH. What specialty do you feel you'd like more? I don't think I'd like ortho/surg, then again it depends on the population, maybe they'd be terrifically motivated to get out of bed and get better...or maybe not. Respiratory step-down at MMH, like trachs/vents? That's great experience if you're looking to move to critical care eventually. Hate to answer a question with more questions but just trying to give you more things to think about. :-) Good luck!

On my unit, morning vitals are done between 0700-0730; BP meds are usually scheduled for 0800 (coreg is usually given with food) or 1000. If the patient's BP or HR is close to the cutoff (there are parameters entered by the doc usually) then I will recheck prior to giving meds. The parameters depend on the patient; HR cutoff is usually to hold if lower than 50 or 60, and BP if lower than 90 or 100.

This is a big decision for me too...I signed a contract at my current employer stating that I would have my BSN within five years. Sounds like a no-brainer, right? Except that I already have a non-nursing Bachelors and plan on getting a master's degree, and there are a few bridge to MSN programs around me. So I plan to work for 12-18 months, figure out what kind of master's program I want, and go from there.

Check the programs you're looking at applying to. The big ones around me require at least one year of "strong" ICU experience, and say that OR does not count. I'd say your best bet would be adult ICU (med, surg, trauma, neuro, whatever) then PICU. Or take whatever you can get your hands on in hospital, med-surg to start if you have to, and work up from there to an ICU. Around here is near impossible to get an ICU job as a new grad.

I'm a new RN (still on orientation) working in acute care and while I had to take a course for IV certification nobody ever mentioned PICC certification to me. I do need to be checked off on PICC and central line skills (blood draws, dressing changes, removing a PICC) during my orientation but my preceptors have been letting me perform these skills after discussing and reviewing the procedure. This may be a facility-based restriction (ie. the facility never certified that he was competent with PICCs)....I hope it all works out for your friend.

Where I work there is hourly rounding but the techs do the even hours and nurses the odd hours. I find myself in every patient's room within half an hour either way of when I'm due and sign off on it then. Our director does round at least once a day and asks the patients if we have been taking good care of them, answering their bells promptly, etc.

Are you using butterfly needles or straight needles? I prefer butterflies; it's similar to starting an IV in that you see that flash. I'm not very good at using a straight needle.

I agree, if the patient didn't seem to be in pain and said he didn't want anything, I wouldn't have given it either.

I'm a brand new nurse as well but come to nursing with five years of paramedic experience and therefore about a million IVs under my belt. Not as many on kids, but I can still give some suggestions! I would guess that the hematomas without flashback are, as you said from, going through the vein. The most common error when this happens is that your angle of penetration was probably too deep. If you think about the vein as a straw, holding the needle more parallel to the vein (so a 15-30 degree angle) would make the back wall further away from the pointy needle, right? If the vein is easily palpated, you probably don't need to stick the needle in too deep or too fast to penetrate it. After you get flash, you drop the angle even further, almost parallel with the skin, advance the needle and catheter another 1-2mm to ensure the catheter is in the vein, then thread the catheter off the needle. A lot of people think that if there was no flash, there is no need to apply pressure after an unsuccessful stick. Not true--apply pressure either way, check the site after 30-60 seconds and evaluate whether it's bleeding or not. Put an ice pack on if you think a hematoma is going to develop. Hope that helps a little. -Alison