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!

As far as I'm concerned, all this worry about "losing your medical skills" by working in psych is moot anyway--if your love is psych and what you intend to keep doing indefinitely, who really cares? Therapeutic communication and psych assessment are a whole other set of skills that we get to hone that nurses on med-surg floors may not have to the degree that psych nurses do (I'm sure of that, actually), so it's just focusing on one skill set over another--the most relevant skill set to your chosen area of nursing! I say go for what you love--life is too bloody short.

No, you aren't "crazy"! I feel exactly the same way! I'm about to finish nursing school and the only thing I want to do is psych nursing. I just hope I will be able to find a job in it without psych nursing experience (though plenty of personal experience with family members, but I digress ) The only reason I have stuck it out in nursing school is because I dream of working in psych and even becoming a psych NP eventually. Many years ago, I started out majoring in psychology, wanting to be a therapist, but I was silly and quit school to get married. Well, now I'm divorced 20 years later and back where I started. My first love has always been and always will be mental health.

Hi guys, I will be graduating next month with my ADN. I work as a PCT and recently tried night shift for a few weeks and quickly realized I absolutely HATE it--I physically and emotionally just cannot tolerate it and I will be going back to days ASAP in my tech position! I'm concerned because I hear a lot about how new grads are really stuck with just night shift options in the hospital setting, which I have vowed to myself I will never ever do again, even if it means I have to look for job opportunities outside of the hospital setting. This brings me to my question--WHAT job opportunities are available to new RN grads outside of the hospital setting? Psych nursing is my first love and ultimate goal, but I would be willing to take just about any RN position as long as it is a DAY shift. Please throw out ideas. Thanks!

Hi all, I'm graduating in 2 months from nursing school and am currently in practicum. I am amazed at how much red tape and paperwork and stress is involved with nursing and how 12 hour shifts turn into 13, 14 hour shifts so easily. I see how the nurses stress eat during shift and are frazzled and pulled in so many different directions. I am feeling deflated and discouraged and stressed, like this is NOT what I want to do. Does it get better? I am primarily interested in OR or procedures but know it will take a while to get into those areas. Any encouraging words?

Hi guys, Studying F/E and am not sure why my brain is not getting this...I know hypotonic solutions draw water from the vessels and into the cells, decreasing intravascular fluid volume....yet I believe it causes increased urine output? I had thought hypertonic solutions would cause increased urination because they draw more fluid into the vessels. Please clarify this for me...it's kinda driving me crazy

Thank you, guys! That makes me feel better--I definitely cleaned the probe with an alcohol wipe afterwards and just played in cool in front of the patient. I appreciate the feedback :)

I was taking vitals on a patient and the room was semi dark as it was early and the patient had just awakened. I was in the room with the nurse while she was doing something else and she wanted me to get vitals. I proceeded to do so and got everything on--BP cuff, pulse ox, and went to put the cover on the temp probe and put it in the patient's mouth. Temp didn't calculate so I disposed of the plastic cover and put a new cover on the temp probe (so I thought) and put the probe back in the patient's mouth. Still wasn't reading so I took it out of the patient's mouth again only to my horror to discover that the probe cover was NOT ON! It obviously didn't stick on the probe the last time and I didn't really see that since it was relatively dark in the room. The patient and her husband definitely noticed but didn't say anything. I was horrified and didn't say anything either and took her temp with a different thermometer (with a cover on it!) I was so upset with myself afterwards--has this happened to anyone else? I didn't tell anyone about it because I didn't want to get into trouble but I'm not sure if I should tell my instructor because I don't want to have harmed the patient by contaminating her. Please advise.....

Thanks, russodem. I have applied for every scholarship I can find already. However, I didn't know about the nursing consolidated loan after graduation--thanks for that tip!! I may go ahead with Sallie Mae.

Thanks for the comments, guys...Wells Fargo doesn't service the school I attend, so that's not a possibility. It's good to know, dbabklyn, that your Sallie Mae loan's interest rate hasn't gone up much. I guess I'll keep that in my mind as an option but keep looking for a fixed rate loan that services my school. :)

Hi, I don't qualify for financial aid because, although I have a 3.75 GPA, I have "too many credit hours" for attending a community college. I have managed to pay for 1st semester of nursing school with the last of my savings, but I'm about to run out of money and am very nervous! I only work 25 hours a week and just make $11--I honestly don't think I could handle working more than that due to having clinicals, school, and studying to do and am already busy 7 days a week. I can't find a job paying more than that and haven't got any other qualifications to get me more money other than a certification as a medication aide, which I am not sure how much that would help me. I applied for a Sallie Mae student loan and was approved; HOWEVER, it is a VARIABLE interest rate and there is no limit to how much the interest rate can vary, which makes me very nervous--I don't want to potentially end up paying twice the amount of my loan due to interest rates! I'm an older student (in my 40s), if that helps. Also, I've applied for every scholarship I could get my hands on but I've been denied for a handful of them and no word on the others. I'm looking for advice on where I can look for a student loan in the private sector that has a fixed interest rate because I'm having trouble finding that--they all seem to be variable. Thanks!!!!