Aniroc

I really appreciate these comments and suggests as I too am considering a Masters with a thesis component but have been having problems trying to narrow down the process. Thanks so much!

On topic, but a bit off topic. While in nursing school I worked for a well known agency as a flu clinic nurse. I went to businesses that offered to pay for their employees immunization. When at a large telecom company, I was paired up with another nurse. During the lolls, we'd talk and I found out that she was really into holistic medications and treatments and didn't "believe" in vaccinations and would never get one herself. Here we were, shooting people up with a product she was adamant against. I asked her if it was ethical for her to be giving immunizations given her position. Her response was that she needed the money and it was an easy job. Honestly, I believe that given a choice the majority of people would and generally do get vaccinated. Though if they decide not to, I uphold their right to refuse but I still give all the information, benefit, consequences etc. But this woman? I could hardly stand to work next to her after I found this out. In fact I called the agency and asked not to be placed with her again. They asked me why and all I could say was they needed to ask her opinion on immunization and vaccination and that I was ethically torn working with her.

You don't need any advice...just some kudos! You did a fabulous job. Considering the environment you work in, the information you were provided by the aunt, the policies and procedures set in place at your school you did exactly what was expected of you. People will try to push you around, no matter what area of nursing you work in. You have a responsibility to protect the other students as well as the faculty from getting ill - evident by the principal supporting your position. Pat yourself on the back knowing you did your job and did it well.

I am currently working on a busy medical/ortho/uro/gyne unit and now considering taking my Masters and or specializing. One of the areas that doesn't get a lot of attention, and one that I find fascinating is Nurse Continence advisor. I don't think its a well known area because many individuals are ashamed of discussing their urinary or fecal incontinence. Its a problem that isn't limited to geriatrics, anyone at any age can become incontinent. Being involved in this specialty has significant impact on a persons social life and overall quality of life. A nurse continence advisor works with physiotherapists, urologists, gynaecologists, generalists and performs assessments, urodynamic testing, various non-surgical interventions and works in a variety of environments from clinics to hospitals to LTC facilities. Good luck in your research and do search the nooks and crannies of nursing as there are definitely some interesting and not well known fields that should be explored.

I have only been nursing for 4 years and eventually I would like to teach. I really enjoy preceptoring students and working with the nursing students when they're on my unit. But I wouldn't even consider pursuing a teaching career with less than 5 years experience. Theoretical knowledge is one thing but the practical knowledge and know how is where you pull it all together. I would feel highly uncomfortable working with her and her clinical group. Perhaps you can ask her how and why she got into teaching so soon after graduating. Perhaps she'll be able to share some insights or additional knowledge you weren't privy to before.

There has been some wonderful advice in response to your post. I hear your pain and feel it as I too was burnt out by the time I finished nursing school. In fact I didn't write my exam until one year later as I was depressed and anxious and didn't believe I could be a nurse...at least a good nurse. I had nothing to substantiate my feelings but eventually I came around to writing my exam and getting my first real nursing job. It was hard and challenging and I went through ups and downs. Eventually you get to a point where you realize "wow. I actually make a difference ...or I saved that person by recognizing they were crashing...or I am really good at doing this, but I suck at that etc." It will get....easier. Hang in there. It will take some time to figure out where you want to work. Nursing is prestigious, don't think otherwise. There are many wonderful things to explore in the nursing and not all are hospital or LTC related. Your formal education will soon be over and then the real learning begins. Give yourself a break and don't be too hard on yourself for feeling like you do. Find the one thing you love about nursing and when you need it, take a deep breath and remember what that one thing is. You can do it. You've proved yourself by accomplishing this much already!

Well, patients who have chronic retention or other urological issues that prevent them from long term catheterization often receive SPCs as a way to manage urinary retention. Therefore if after the catheter has been changed and the patient is still leaking or having retention issues, something else must be happening. First thing I'd look at is the stoma. What is its character. Does the peristomal skin look healthy or inflamed, is there tracking, fistulas or hyperplasia. Did they use a new type of catheter that the patient may be allergic to causing inflammation around the site leading to leakage? Some patients are sensitive to latex and need silicone catheters. You may need to check the balloon positioning of the catheter as it may not have been inserted fully into the bladder space preventing proper drainage. If you believe the catheter is in correct position can it be gently flushed with easy return? And lastly, if the patient does have a confirmed UTI what antibiotics are they being prescribed and are they taking them correctly. Its hard to say wether or not this patient will have retention as it depends on numerous conditions. If all else fails, this patient needs to be reassessed by their urologist as chronic leakage and or retention worsens their quality of life. Hope this helps.

WHen I have patients that act like this...and I'm talking about those that have the mental and physical capabilities to toilet themselves and mobilize to the washroom or can ask for help etc... I first tell them how unacceptable their actions are and that I have more critical things to do then clean up someone who should know better. They're wasting my time when I can be helping Mrs. Smith over there use her new knee replacement. They wouldn't do this at home in their own bed so I insist that they do what they'd have to do at home. First I get them to the washroom and make them wash themselves or shower if possible. An attends is put on if one wasn't previously. As they're doing that...I pull out new sheets and have them waiting. I make the patient assist me in making their bed. I specifically have them take off the wet sheets and put them in the hamper. I make them cavi-wipe the mattress and I do the same on the other side. I have them help me make the bed. I actively involve them in dealing with the consequence of relieving themselves on purpose - i.e. getting out of bed, actively cleaning themselves and being hygienic, making the bed and reminding them every hour on the hour while i am on shift that they must use the washroom to prevent an accident as it is their responsibility to keep them and their environment clean for their safety and others. I never threaten the use of a foley (cause some of them want that as a reason to stay in bed), and I talk candidly about real urinary incontinence, the health consequences of incontinence as well as social shame and isolation that goes along with real incontinence that such actions often result in people going to nursing homes which isn't always the best choice. Give clear expectations, define consequences and more so follow through and document in the nursing notes and in the care plan.

I agree that it was a partial obstruction by a clot. If all else fails I also deflate the balloon very carefully and readjust to ensure that a clot isn't caught around the cuff and not obstructing the catheter. Then, I would go back to the urine port and flush direct with hopes of flowback or drawing in of any clot. Also, prior to any irrigation, I make the patient move around ALOT sometimes their own body movements can dislodge a clot in the right way to allow everything to flow.

Since no one has answered this question I'll give it a go. I work on a busy surgical unit and have a lot of urological patients who require continuous bladder irrigations post TUPR or TUR or if they come in with hematuria. Your first clue about when to irrigate is in the word "continuous" Essentially, this means that irrigation fluid is constantly streaming into the bladder and exiting via the catheter at a constant flowing rate. You control the rate of the irrigation with the flow-meter wheel until there is a continual flow that flushes blood clots and sangueous drainage along with urine without causing a blockage which would then require manual irrigation (and can require some real strong muscle strength!). Generally the surgeon will order "Run until CBI clear". But what does "clear" look like? After most uro procedures the output is sanguenous with some blood clots present in the returns. Some nurses believe that once the clots have finished passing - that means "clear" even though the output may still be quite red with some residual tissue or sediment still occasionally passing. Other nurses like the outflow to be at least cranberry to light pink without clots or sediments, in order for it to be "clear". I am somewhere in between. I generally start reducing the rate of flow once the blood clots have cleared until a nice cranberry colour is obtained. I then reduce further over night to watch the output and drainage quality. I have them mobilize in the morning to watch first passing to see if its too sang or if more clots appear or if its clear. If in MY the drainage is "clear" and the patient is comfortable, I then call the surgeon if they haven't come in to assess their patients to get an order to clamp and d/c the cbi and put to straight drain. I hope this helps!

What a great visual aid for those choosing a specialty. Still doesn't make it easier to choose which pathway though!

Actually, when you get a vaccine you body IS being tested. Vaccines, most of them except for live vaccines, contain small parts of the dead enemy. Its enough to activate your immune system to recognize the intruder and start making antibodies against that foreign body. Besides that, your body is tested everyday agains the heaps of other common viruses and bacteria that we come in contact with. While there is some guess work with which influenza virus they make vaccines for, its based on pattens seen in the rest of the world the year previous. They can detect its type and travel pattern hence make the appropriate and most common influenza vaccine. ITs not a shot in the dark but a very educated guess (though still a guess).

NYBaby, thanks for your response to this thread. I've been nursing for a year now and lately, I'm on the path to burnout. I'm on "holidays" at the moment getting refreshed before I go back to work and I really want to try and cut down on all the "extra" charting I do. In nursing school I was taught narrative but its hard to change. The fact of the matter is I have to. Flowsheets, focus charting (which my hospital does promote) and no-nonsense documentation is an way for me to become more efficient with my time. You're response was just the wake up call I needed. Thanks.

I am all for teamwork. In fact I believe that without teamwork its makes my job as a nurse very difficult. As part of a team, sometimes we have to do things we don't want to; such as taking on extra patients when there are sick calls and being the "in-charge" during nights or for the last few hours of the day. I hate having that extra responsibilty (I am a new(ish) nurse with less than a year of working experience) but I do so for the sake of sharing the workload and working as a team. Last night we were extremely busy, so busy that I and several other nurses couldnt even take a break. Two of our patients were going sour and the call bells rung all night for the usual things like toileting, analgesics etc. As the pcc last night I was in charge of the unit and staffing for the day shift. It so happened that we needed to get a constant for our extremely demented and potentialy violent patient, a replacement LPN for a sick call and the regular PCC on days was sick but not replaced. As of 5am this morning, I had no one not even a single staff member on overtime to be fully staffed. To top it off, one of our LPNs needed to be off the floor from 11-2 but would at least be returning. Without our regular PCC, I needed to have someone in charge of coordinating patient care. We have a clinican who used to be a PCC until just recently and due to circumstances on the floor I thought it was more than appropriate to ask her to take on that role for the duration of her shift. However when our clinican came onto the floor she flat our refused to be the PCC citing "management" as her reason that some else had to do it. I asked her to explain further, and all I got was a head shake and "No, I will not be the PCC it has to be one of the RNs. Thats per management". I am nearly agaste. This is the same nurse who told me the day prior how important team work was. Now I feel as if I and the rest of my team mates have been slapped in the face for our naivity. We needed a PCC today more than we need a clinician. I needed her to step up to the plate like the rest of us have to. In the end I had to pull an RN off the floor instead and further the load of each remaining nurse for a total of either 6 or 7 patients. Our standard ratio is 4:1 for acute medicine. It just boils my blood that while the rest of us are expected to make consessions to provide care for our patients, those in more "elite" positions, such as that of the clinican, are exempt. It doesn't say in my job description that I have to be "in charge" but I do it even if I don't want to. This episode has made me loose respect for this nurse. I know that the PCC I chose to be in charge will still help out the rest of the floor nurses, which will be much appreciated because she a senior nurse who will be leaving for the ICU soon. And while she is helping out one of our sick patients, the clinican can continue to make sure that our fluid balance sheets are done correctly, that we've updated our care plans and reading through charts while the rest of the "team" is being run off their feet. Thanks for letting me rant my frustration.

In my hospital, the ratio (not regulated) in acute medicine is supposed to be 4:1 but it is often 5:1 or even 6:1. To be honest, it is difficult to give holistic quality care to acute patients even at the 5:1 ratio so I can't even imagine caring for 9 patients. That sort of ratio is an adverse event waiting to happen let alone nurse burnout.

Hi Newbie, I hear the distress in your message and can empathize with what your going through. As a new grad myself, I had many concerns transitioning from being a student protected by the veil of my school to being independant - on my own with all the responsibility of patient care on my shoulders. But I have good news for you. First off, remember what it was like to start nursing school? The nerves, learning all this new scientific medical stuff? Well you did it! And it is quite the feat. You've graduated and have a piece of paper that proves you did. That means that you have a repitoire of skills and knowledge you've accumulated and can use whenever you need it. Don't forget that you've come a long way already. Us nurses we never stop learning. That includes learning to remember to recall on all our past experiences while we were students. There were hairy days in clinical but you made it, didn't you. Remember that when you're faced with a difficult day of patient care. You also have to remeber that you are never alone in nursing, ever. You have other staff nurses, managers and educators who WANT to help you. So when you're presented with something you don't know or are unsure of, there is no shame in asking for help or education. If someone turns you down, keep asking till you find someone who will. Afterall, you want to give good patient care, not shoddy care. When you feel those tears coming on, ask yourself what are they about? Is it nerves, is it fear? You said its hard to put your finger on it and I know that feeling as well. For me its just being overwhelmed. But I always remember that I am one person and I do one things at a time. Prioritize quickly the things that are must do now, need to do today, and nice to do if I have time. If you need to bounce off your ideas to someone else, find someone you respect and admire and ask them if you can share your plan with them. Before your night shift, think about what you want to achieve for that night. Perhaps you want everyone to have good hygiene and oral care (provided there are no emergent issues). Make goals for yourself so that you have some direction. During those shifts where your patients are very acute, ask your team mates for help. Tell them (politely) what you need done for your other patients so that you can concentrate on the ones that need you now because they're very sick. When your team mates ask you for help, remeber to recipriated. Start creating bonds with your shift-mates. A little help goes a long way and both ways. In time you will start feeling more assured of yourself and the care you give to your patients. I can only reiterate that you can do it. You've already proved it with your degree and with being hired by your hospital. Chin up, girl. You're gonna be a great nurse.

BC is the abbreviation for British Columbia, Canada's most western province. I understand and have experienced the deep seeded conflicts between varying levels of nurses. I work hard to communicate effectively with the entire team and to do the best I can for the patients in my care. And that also means understanding what each professional does so that the care can be coordinated efficiently. And if an LPN is greater at a certain aspect of care than I am, I have no problem admitting that. LPNs are highly trained and educated to work within their scope of practice, just as RNs are. We need to mutually respect what each does. I'm sorry that your friend had to experience such terrible disrespect. LPNs indeed are an integral part of patient care and should be recongized for their great contributions to patient care. Some nurses aren't up to date on the value of each type of nurse so we need to *kindly* remind each other what it is we indeed do. It should never be out of malice, but of understand. Always.

The document is actually a collaborative effort between the CLPNBC and the CRNBC (the RNs college) as of 2008. Currently, both RNs and LPNs scope of practices are being reviewed and are changing to reflect the HPA (health professions act). This document is to help identify ways to work more effectively within the two designations. On a side note, LPNs will soon be joining the Nurses Union instead of the general Hospital union. Although there is controversy about this, I am glad to see this happen. Good to know that BC will be bringing their programs in line with other provinces.

hi fiona, yes i am a new grad, but not new to health care. not that it should matter, but i have worked as a unit clerk and a care aid in an ltc facility. i am a nurse that gets very involved with her patients - i don't shy away from adls, toileting but i am responsible for coordinating and managing the care plans plus a whole schlew of ghastly paperwork (gosh i wish we'd go electronic already). i'm in bc and i have learned plenty about good nursing care from lpns and aids. our lpns are full scope and work to their full capacity in the areas i have worked (emerg & acute medicine). i think lpns are indeed underutilized and am quite glad to see and work with them more and more. i realize that the lines between lpn and rn are often blurred, so i did a bit of research and found the following article which helps summarize the differences. i will attach the pdf file (from the college of lpns of bc) if anyone want to know the bc perspective and too see how blurred the responsibilities and scopes are. i am unable to copy the main differences table directly into the post...so you may want to look at the pdf directly (page 7ish). as i have said, all nurses (becuase that is what we all are) are important. lets not forget that and put our differences aside, work together and provide great patient care that we are proud of! i'm a nurse first and formost because i have great compassion and empathy, everything else is gravy. [color=#231f20][color=#231f20][color=#231f20] table 1 lists some of the similarities and differences between the levels of education and context of practice rns and lpns in british columbia. table 2 lists the differences and similarities in practice expectations between the two groups. (note that in both tables differences are set off in italics.) Nurses_Working_Together.pdf

I echo the reponses that it may very well indeed be best to stick to one unit rather than float. When I interviewed for my position, I talked to my manager about this. We talked about some of the issues New Grads have such as the shock phase in their transition from student to fully operational nurse. No one can make that decision for you, but personally I decided to stay on the one floor and not apply elsewhere so that I could get used to working on one floor, know their paperwork and routines inside and out. I've committed myself to at least 6mths to really consolidate my practice and ease comfortably into my profession. Do whats right for you.

I don't know where any of such "peon" remarks are stated, but there is no need to bash anyones profession or position. LPNs, aids, techs, RNs and all other health care professionals are all important to the health and wellness of the people we work with. Each profession and degree has something to contribute, but if we don't work together and make brash assumptions then it is the patient that ultimately suffers. It should never be us and against them, me against you etc. Working together to manage patient care safely is a joint effort. The point pf my contribution to this posting was to think about the broader implications of advancing yourself (and for those in your care) in nursing science applications.

With the advanced options, you can also look for scholarly articles. You can even set the parameters to give you certain dates and wether they are accessible or not.

@Commuter - and that could be why corporate is insisting that the LVNs iget their RN. Most often, such positions are given to RNs, with a few exceptions. My post was just to help see the broader implications of getting the RN designation - more status, more options and more income.

First off, I think its wonderful that your organization recongizes your success in efficiently managing your units. Kudos for doing such a wonderful job. We all need managers like that! Secondly, if your already getting your RN you'll start seeing the differences between the levels of nursing. As you say, all good nurses need to "care, think , react, and have good documentation", however with your RN designation, what comes into play is your nursing theory and systemic inquiry (critical thinking). Its all the why RNs do what they do and its looking at the broader complicated picture (think determinants of health and beyond hospitalization). I have a lot of respect for nurses (lps & rns) and aids and what each brings to the table with their designations and experience. Lastly, with RN beside your name, you'll have greater responsibility, be more professional recognized and have many more oportunities that wouldn't be there if you weren't an RN, like administration, research, public health, education and so on. There are differences and as you progress through your transition, you'll see them. Keep up the great work and high standards!

Just wanted to say that this is an awesome thread! I'm about to start my new grad position in Medicine and want to develop a good routine/method to start me off right. Its commentary such as what I have been reading here that really helps out us newbies get our heads on straight. I think the best advise that I could give (because i have been lucky enough to work as an undergraduate nurse with two F/T preceptorships) is to make use of all the time you have in a patients room. Think ahead, survey the enviroment and patient for priority care, and if you need help ask for it! Then chart when you have a breath and then make your rounds again. Keep a good flow and eventually you'll cycle through all of your assessments, charting and priority care.