Neohippy

Hi, I hope I can get some opinions here. I am a little confused on which path to take. I became an RN (graduated last year) because my job of 16 years became obsolete (the entire profession--medical transcription--no earning potential anymore) and I was newly single again after a divorce and needed a career that would provide for me financially with relatively little schooling. I like healthcare but am finding out I am not enjoying nursing, at least in the hospital setting. I always dreamed of becoming a therapist/mental health counselor but had to get a job where I could earn quickly after a divorce and needed to support myself so I chose nursing, hoping there would be a path for me. I have thought about psych nursing and am interested in this, but am a little reticent because of stories of nurses being assaulted, and I'm a petite female so kind of fear for my own safety. I have also thought about continuing on and getting a PMHNP but my real love is counseling and not strictly medication management. I also know I would probably need psych nurse experience, which I have concerns about due to what I just stated above. I would love to get a master's degree and become a LMHC because the counseling aspect of psych is what appeals to me most, but I hear the market is saturated with master's level therapists and the pay is very low ($40,000 in my area). I need some advice, please--are my fears of becoming a psych RN a little extreme and unfounded? If I were to go for PMHNP, could I get an additional counseling certification so I could do a fair amount of that in addition to medication management? Thanks for any advice any of you can spare.

That makes perfect sense, actually--I never thought about it like that! As I said, I just started L&D and nursing and I guess Pitocin was a bad example to use. I know it is a high risk medication so just assumed there would be meds that would not be compatible with it and was using it more as a hypothetical since we give it a lot.

We always have saline locks connected to the tubing but our patients pretty much always have fluids running, particularly lactated Ringer, and are never really saline locked in our L&D unit. And we have lots of patients on Pitocin for induction/augmentation as well so these two fluids are running piggybacked together (Pitocin piggybacked into the lowest port on the LR line). I am not really asking with any particular medication in mind that I would be giving with Pitocin...I gave Benadryl IV push the other day to a patient on LR and Pitocin. I gave it in the next port up on the LR (since the lowest port was piggybacked with Pitocin) with the fluids running. I know it is compatible with Pitocin anyway, but I just started thinking of what I would do if I had to give something that were incompatible with Pitocin. I just don't want to make a med error and was thinking it through. I thought if I had to give something incompatible with Pitocin but compatible with LR, I could give it in the next highest up LR port with the LR continuing to run and just stop the Pitocin and let the LR run for a minute, then restart the Pitocin, right? I guess I was thinking the Pitocin and hypothetical incompatible med would mix when they could potentially meet at the Y-site nearest the patient, when they run into the saline lock, since it would not be given in the lowest port closest to the patient. Was wondering if I should just unscrew everything and give the IV push right into the saline lock (first flushing with 10 mL NS flush, giving med, then flushing with NS again), then reconnect the tubing. Anyway, I am just a new nurse and thinking about things so I don't make a med error. Hope all this makes sense.

Hi, I'm a new nurse and have a hypothetical question: I have 2 different fluids infusing at the same time, each on their own pump; one is lactated Ringer and the other is Pitocin. They are on their own pumps, but the Pitocin is piggybacked into the lowest port on the LR. I have an IV push medication to give that is compatible with LR but not with Pitocin. I am thinking that the correct way to handle this is to stop the Pitocin and just give the IV push into the next port up (not the lowest port since it is already taken by the Pitocin piggyback) into the running LR over the prescribed amount of time, wait a minute, and then restart the Pitocin. Is this the safest way to give the IV push? I could theoretically disconnect both lines and just give the IV push into the saline lock by giving a 10 mL saline flush, give the IV push med, and then another IV saline flush, then reconnect both lines and restart them, but this may be too time consuming. Please give me some feedback as patient safety in med administration is such an important issue. Thanks!

Update: I talked to my nurse manager, who was extremely supportive and understanding and gave me a different preceptor on the spot and also a lot of encouragement, telling me I was doing fine and was where I should be, etc. She also validated my observations of how I was being treated, as well as other coworkers, who have noticed. I am very relieved because I know my new preceptor, who is wonderful. Looking forward to things getting better now.

Thanks, guys--it is comforting just hearing that you went through the same things (unfortunately!) and survived. Today I am going to work. I hate asking my preceptor questions because she gets this little smirk on her face as if to say, "are you stupid? I can't believe you're asking me this" and then gives condescending answers or her body language sends the message that she thinks it was a stupid question. However, I am going to force myself to ask anyway and be grateful I have this forum to vent on if I need to. Again, thankfully I also have a great family to vent to as well. Namaste to you all :)

Thanks so much for your kind words. I needed to hear that. I was able to speak to the instructor who taught our course today and get some support too. Going in tomorrow and just going to do my best. I've got an appt. in 3 weeks with an MD to talk about the anxiety issues. Will hang in there until then. Thankfully I have a wonderful, supportive boyfriend and family so at least at home I get lots of comfort.

Hi guys, I'm a new grad who has been working for a few months in L&D--I was hired as a new grad. I received 2 months of classroom time and am now in my 3rd month of a preceptorship on the floor, working at first two 12 hour shifts and now for the third month three 12 hour shifts per week. I had to sign a 2 year contract to agree to work in L&D for 2 years in return for the training. My problem is I am extremely anxious at work and because of that, I sometimes forget things or make stupid mistakes and feel that makes me look even more stupid to my preceptor, who already intimidates me. I did well in nursing school and even in clinicals received praise from instructors. I worked as a tech for 9 months before becoming a nurse and did very well and my employers were pleased with my performance on busy floors, so I know I can handle multitasking generally. However, I'm really struggling here. There is so much to know and the highly litigious nature of L&D has been drilled into my head by my preceptor and others so much that I am gripped with fear. I have been told that the doctors will turn on me in a heartbeat and throw me under the bus so to watch my back and make sure I now what I'm doing. My preceptor basically sends me on my own to do things now and I appreciate that in some ways because I feel so nervous around her (she has a strong personality), but when I forget things instead of helping me in a kind way she is hard on me and I feel degraded and shamed. She is very knowledgeable and skilled and has been doing this for like 25 years, so she knows her stuff, but personality-wise, it is a mismatch. I can truly say I've been doing my best but I feel like I can never measure up. I beat myself up as well because in my anxiety, I know I space out sometimes. I don't want to get too specific in case anyone in my dept reads this. I don't know if it is the nature of the work in L&D that isn't right for me (the slow one minute, fast paced and potentially very serious the next), just being a new and inexperienced nurse, or both. I wish I could transfer to postpartum, where it is slower paced and more predictable, but I signed a contract to specifically stay in L&D for 2 years. The anxiety is intense and I find myself sometimes crying at work and when I get home, which is getting old. I made an appointment with a doctor now that my health insurance is in effect because I believe I have had untreated ADD (inattention, forgetting things, etc., my whole life) and definitely have anxiety issues. I am not sure what else to do. I guess I'm just needing support or advice. Thanks.

Well it seems we have a consensus here! :) I thank you all for your input and plan on doing as suggested--fulfilling my 2 year contract at my current job and then keeping my eyes open for psych opportunities.

Hi guys, I graduated in October 2013 and was hired in the orthopedics unit of a local hospital, for which I am extremely grateful since so many people have had trouble getting jobs in my area. I do, however, still dream of becoming a psych nurse practitioner eventually as psych has always been my first love (I applied to many psych jobs when first graduated and heard nothing). I still plan to get my BSN and then am thinking of looking into a local master's program to become a PMHNP. My question is this: Since I will have had no experience in psych, will I be hireable as a PMHNP if I go that route? Thanks.

Thanks, Asystole :)

Hi, Infusion Nurses :) I am a new nurse and have read that the routine changing of peripheral IV catheter sites q.72-96 hours is discouraged now and that IV site should only be changed "as needed" (meaning, I assume, any complication that develops like phlebitis, infiltration, etc.) My question is this: If there are no complications, what is the maximum amount of time a peripheral iv catheter can be left in? On what day on average does an IV "go bad" and have to be changed? Thanks in advance.

Thanks Sandseaandstone! I saw that book and thought it looked good. How's it going in L&D? Excited and nervous at the same time :)

Hi guys! I'm a new RN and about to start an L&D RN job. I will be provided with 2 months of training, including classroom time, but I would like to start brushing up myself before I begin the job in a few weeks. I am reviewing my Power Points from school but I would like to know if anyone can recommend additional materials to get me prepared for this position? Thanks in advance!

Hi, I just graduated with my ADN and am moving to Ft. Lauderdale to be with my fiancé. I am nervous because I have heard the job outlook for new grads is not great in previous posts, but I'm wondering if anyone who lives in the area from Lake Worth to Miami (I'm willing to look from this far north to this far south) can tell me which facilities--hospitals/LTCs/psych facilities/dialysis centers (you get my drift--ANYWHERE!)--will hire new grads? I'm sorry if this is a redundant post as others probably have asked, but the posts I have seen are not so recent. I'm willing to work pretty much anywhere to get my foot in the door in the nursing world. I have 7 months experience as a PCT so don't know if that will help me in any way. Only thing I can't do is night shift as I physically and emotionally cannot do it. Thanks for any help. As I said--tell me anywhere that would hire new RNs, not necessarily just hospitals. I appreciate it!