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I am a new grad (4 months in so far) so take this for what it is worth. Both days and nights are very busy on our unit. I work a medical tele unit in a 900 bed hospital that takes 5 both days and nights. During days, we have a UC, charge with no patients, unit manager, CNM, techs with a 9-1 ratio and doctors on the floor. Nights we have a charge who often has to take 2 patients if we had anyone on call before she can call that person in, 12-1 ration for the techs, no UC, no docs on the unit, no manager, etc. Days typically starts with 5 patients, but very often they are discharging patients and having patients off for lengthy tests, so they frequently do not have 5 on the floor all day. We almost always start with 3-4 on nights and are all the way to ratio by morning. I do 1-2 admits almost every shift. I think it's a little telling when we fight to see who gets to start with 4-5 rather than 3-4. My nights are so much easier typically when I start with 5 rather than 3-4. I have done admits and discharges and I find admits to be way more time consuming. ER tends to send unstable patients in pain and I often wind up tied up in a new admit for 90+ minutes. At least once a week one of the nurses is calling response on a new admit and they often wind up leaving for the Unit before they ever get settled. Waiting on a doc to call back at 0300 when your patient is in afib w/rvr with nothing by po lopressor ordered is stressful. I think both are very busy. Personally, I like the flow of nights - fewer tests, docs, families, etc. Nights do have 24 hour chart checks, careplans and a few other daily charting requirements that days don't have to deal with. I don't think we should have more than 5 on nights, but 5 on days seemed like far too many when I precepted there. I don't know if with more experience it wouldn't have been quite so overwhelming (I really didn't have my time management down at all before I switched to nights).

Really? You stand by the decision not to tell the nurse information about her patient? I don't care how rude she is; how difficult she is to work with or how hard she is to get along with. You are a studen tasked with assisting the staff in their care of the patients. Just because a patient's vitals are "in limits" is immaterial. That patient could have been trending high or low an the "in limits" vitals could actually be a significant change. You are not yet the nurse with the right to decide what information is or is not valuable. While you may not see these nurses assessing their patients or otherwise following right behind what you are doing, even the mean nurses are most likely concerned about their licenses and will be caring for their patients around you and your fellow students. You need to learn, but you don't speed things up for most nurses. Take the time to learn what you can from the unit. If nothing else, take the lesson in how to work with people you don't like.

I wouldn't necessarily say it was easier, but definitely more familiar. I graduated this spring under a quarter system. First quarter was crazy hard because it was new and unfamiliar. The method of testing was new and the information was difficult and challenging to understand. Our 2nd quarter was very difficult because we had twice as many credits and expectations were higher. 3rd quarter was probably the most difficult because it was still a huge number of credits and our second pharm class was a doozy. 4th and th quarters felt like a vacation compared to 2 and 3. But, we still lost people because there was a lot of information. By then most of the people who would never make it through had been weeded out and in those later quarters losing people was hard. 6th quarter was rough for a lot of people and we lost almost 10% more of our class during the psych/neuro quarter. The last quarter was tough. So much going on getting ready for graduation, nclex, job hunting, etc. We only lost one or two our last quarter. What I am trying to say is that each term has its own challenges. The further into the program you get, the more comfortable you will get with the method of learning and testing. But, each term you will have new instructors - some of whom are much better at writing test questions than others.

I don't think that there are any hard and fast rules. I often read that X hospital only hires grads from Y program or only hires BSNs or ADNs or people who work there, etc. I think that there are a lot of things that you can do as either a BSN or ADN student to increase your chances of getting a job as a new RN 1 - work part time as a PCA while in school 2 - take a preceptorship if at all possible for your capstone term 3 - work hard in your clinicals, talk to the staff, get the names and contact information for the nurse managers and introduce yourselves if at all possible

I am thrilled to say that you were right. I was hopeful that the whole thing last week was just a big formality, and it was. The HR recruiter asked the standard -- tell me about a time when you had a customer and what you did, what you did when something went wrong, and how you handled a conflict with a co-worker. Then it was off to the nurse manager and we simply had a conversation in which she told me how they schedule, how they work holidays, her expectations - on time and present, etc. I got my verbal offer the next day and accepted and my offer letter arrived 2 days later. Yippppeeeeeeeeeeeeeeee!!

I am hopeful that it is on the formality end of things. But, I don't want to make any wrong moves, etc.

So, I'm looking for some help. I have my first interview scheduled in 3 days and I want to make sure I am well prepared. I graduated last month and have been in ongoing discussions with the Nurse Manager of the floor where I had my preceptorship. A position opened up and the Nurse Manager called me and wanted to know if I was still interested. She said that she told the HR person not to send her anyone else because she had someone in mind for the position. Anyway, I think I have a very good chance of getting hired into this position. At this point, I want to make sure that I don't blow it. So, what should I expect from HR? I am meeting her at 10 and then I meet again with the Nurse Manager at 10:30.

Okay, regardless of whether you have your own private policy or whether you are covered through your employer, you have insurance. The plaintiff in a lawsuit already knows that, as an employed nurse, you have some sort of insurance. But, they are not suing you because of the insurance. They are suing you because they are going to sue anyone they can think of to hopefully catch the right people, or at least those with deep pockets. The problem comes into play when you and your employer have different objectives. The hospital is the "main" insured and the nurses are insured, but are not the lawyer for the insurance company's main concern. You do not want to have your attorney have a potential conflict of interest and to be more concerned about another client than they are about you. If something happens and you ever took care of the patient, you will be listed on the complaint. It doesn't matter what your insurance policy is. Even if you have your own, you are still not going to be the "deep" pocket defendant.

You are welcome. We spent a lot of time on prioritization questions. Stable v. unstable Acute v. chronic actual v. potential newly diagnosed v. diagnosed 24+ hours ago fresh surgical v. old surgical or medical unexpected symptoms v expected symptoms It is important to look for those things. Looking at it this way (I made this up myself and I'm not a test writer, so it's entirely possible that the answer is arguable. But, I was trying to illustrate a point in prioritization questions) 55 year old COPD patient with pulse ox of 89% 60 year old stable after MI last night 20 year old back from PACU after appendectomy 30 year old newly diagnosed with diabetes who do you see first? Answer . . . . . . . . . . . . . . . . . . . . . . . fresh appendectomy questions says the MI is stable. Sure, he could deteriorate at any moment, but at the time of the question, he was stable, so he is low priority COPD patient is chronic and 89% is not unexpected in a COPD patient. Therefore, he is stable and low priority New diabetic - he is unstable because he is newly diagnosed, but per the surgical beats medical, the appendectomy is higher priority than the diabetic.

I think Ashley said it all beautifully. The only other thing I wonder is that you said that the instructor is rubbing you the wrong way, yet your classes don't even begin for a week. I am wondering what necessitates enough contact with an instructor a week before classes start that could leave that much of an impression. She may well be on her break as well. If you are asking lots of questions before you even begin, she may just prefer that you wait and get your questions answered at the same time as your classmates. I know it is natural to be anxious and nursing students tend to like to know what will happen. But, in nursing school much of the time we need to focus on what is happening.

Absolutely those are all possible signs of a severe allergic reaction, but just because you have itching or a red rash does not mean that the patient is in the middle of a severe allergic reaction. At this point, this patient has a potential problem. On the other hand, patient with hearing changes is experiencing an actual problem - ototoxicity. Actual problems trump potential problems. One thing that my NCLEX prep class instilled in me was that when doing prioritization questions do not think about what might happen in the future. Read the question for what is happening right now. Absolutely, if that patient develops respiratory distress, etc., they would become the priority.

The tele floor where I am hoping to start next month has 30 beds is 1:5 days, 1:6 nights with techs at 1:10, plus a unit secretary and charge nurse who does not take patients.

I actually had basically the same thing happen to me. I went to go get my test and my kids were with me. Well, the lab wouldn't let me leave them in the waiting room by themselves (at 8,6 and 4) for the minute it takes to fill a cup. So, I had to take them home and had to pee so bad that I did. Then, I drank like 3 bottles of water on the way back to the lab because I was afraid I wouldn't be able to give them a sample. Well, my urine was too dilute. I found out when the department secretary in our nursing department called and asked me to retest within 24 hours. I went back. Talked to the lady in the lab who suggested caffeinated soda rather than water if I was ever in that situation again. The soda wouldn't dilute my urine and the caffeine would help with my need to pee. Anyway, I wasn't hiding anything, but I was terrified too. Long story short -- I passed my retest and last month I graduated from nursing school. I am now scheduled to take NCLEX in 10 days. :)

I wonder what your other choices were. There are things that you can do for a patient with a high potassium level that are neither transferring (which is very rarely the right answer - instructors and NCLEX want to know what you know, not have you pass the buck) or administering a medication. Administering might be the right answer, but without knowing the other choices, I cannot really say. As far as in the real world, no you cannot technically administer the kayexelate and then get an order. Often your patients will have standing orders which would allow this. Otherwise, a K+ of 6.1 is worthy of a stat call to the doctor after checking vitals. While waiting for the doc to call you back you will likely have the tech get ready to run an EKG and hook the patient up to tele, make sure that the patient has IV access and get ready to administer kayexelate and/or D5W with insulin (depending upon whether patient is symptomatic). You should be staying with the patient and having the techs and charge nurse work with you to get ready for the anticipated orders. There's obviously more, but that's a start for a new nurse perspective.

I had all of my pre/co-reqs out of the way before starting the nursing program. I am also a non-traditional student with 15+ years in a previous career. I also have 3 children who were 8, 6 and 4 when I started the program and a husband who works long hours. Certainly it helped not to have to put the time into these other classes. However, it was also an advantage because I already had my anatomy, physiology and pathophysiology courses out of the way. Technically our program would allow you to take those during your first three terms. So, those students were at a disadvantage in terms of their base of knowledge to combine that with the nursing coursework. I was still busy all the time, even without other courses to handle. Between my children and my schoolwork, I didn't have a lot of time for anything else. But, it was worth every moment!

I precepted on an MICU my last semester. I had a great experience, made a couple of good catches and had a very good relationship with my preceptor and the other staff on the unit. There were no positions available when I left. However, I told the nurse manager that I was interested in her unit and she indicated that she would call me if anything came open. She called today! I was in a meeting and missed the call, but her message said that a position was coming open and she hoped I hadn't taken another position yet and please call her to see if we can schedule an interview, etc. I spoke with her later and she went through the process with me (she's heading on vacation tomorrow for 2 weeks and the position apparently has to be listed within the hospital and then posted on their external job board). Anyway, I'm looking at probably 3-4 weeks before I can expect a call from HR to interview. I am so anxious. I am going to mail a thank you card tomorrow for the call and the opportunity. I don't want to get my hopes up too high, but new grad opportunities are pretty scarce around my area right now. I haven't told anyone except my husband, so I needed someplace to shout at the wind.

The signs/symptoms of DKA can be figured out from the initals of the disorder. D - dehydration. Think about all of the signs and symptoms of dehydration - low BP, Increased HR, increased temp, dry mucous membranes, confusion and irritability, etc. K - ketones, kussmauls, K+ A - acidosis, acetone breath, anorexia d/t n/v The old hot and dry ... is a good way of remembering, but it only helps with the skin s/s and doesn't help with the rest of what is going on. One thing to consider with your sister is that people often feel cold when they are feverish. Her perception of her symptoms does not mean that she wasn't feverish. On the other hand, as many have said - we are all individuals and just because a textbook says DKA patients have fevers does not mean that will hold true for every DKA patient.

I agree that studying smarter is better than studying more. However, if you are spending lots of time studying and barely passing, I would suggest asking for help from your faculty rather than simply changing your study habits. Presumably if you knew how to learn the information better, you would already be doing so. I definitely started studying smarter in the last 2 quarters of my program. But, I was already an A student and focused my studying on the forest, rather than the trees. My grades did not suffer as a result and I found myself better able to think through questions having a better understanding of the overall picture. I would get bogged down in the specifics and would worry about very specific details. They can still be important, but understanding the overall picture and being able to reason through those specifics is more important. The specifics are very interesting and I have a wonderful time researching the effects of disease on my patients and how their specifics correlate to what I am doing. Anyway, I would not recommend simply decreasing your study time without a plan on how to study smarter. Lots of people change their study habits out of necessity or burn out, but that doesn't always work out for them. Study smarter, not harder. But, make sure you know how to make that transition.

Are you really sure that your textbook tells you to give someone FIVE pieces of candy or EIGHT ounces of OJ? Sure candy and OJ can be used, but the amount is the problem. This isn't a question that requires guessing, it requires knowledge. Just because a topic isn't covered in lecture does not mean that it is isn't something you are responsible for. There is far too much information to cover in a nursing program and our instructors provided highlights of important topics, but we were always responsible for all of the information in the chapters. If you don't want to be a nurse, then definitely move on to another career. However, don't let a couple of bad instructors stop you if it's your goal.

Specifically you don't have to work as a CNA to have connections in the hospital. Nurses who work on the floor are a great source of potential help to employment. I absolutely agree that, at least in my area, getting a job as a new grad can be difficult. It is all about connections and those don't have to be a result of working as a CNA. I highly recommend participating in a precepted semester if at all possible. Working one on one with a nurse with the ability to show off your critical thinking skills over the course of 150+ hours is worth a great deal in terms of giving a nurse manager a look at your potential ability to transition from student to nurse. Certainly showing up and doing the job of a CNA as delegated on a unit over time will get you knowledge of the staff, and manager. I recommend making connections with the nurses you work with during clinicals. Critical thinking, excellent clinical skills combined with connections made in a precepted position are definitely a combination well worth looking at as opposed to a CNA.

While I agree that having a job in healthcare while in nursing school can be a great in for a job, I don't think this statement is true. There are absolutely reasons for a hiring manager to choose a new grad without experience over one who has experience in health care.

Your school is not going to risk its clinical site placements in order to allow you to refuse a vaccine. The clinical sites don't have to allow exceptions (except possibly medically verifiable exceptions) to the vaccination rules. You aren't an employee, you are their guest and the hospital has a responsibility to protect their patients from you bringing in disease to already compromised patients.

I graduate in 2 weeks. Our clinicals have built from term to term. I am now in my capstone course in a preceptorship. I have slowly built up and am now doing total nursing care for 4 patients. I have one more week left and may get up to a full load of 5 patients on an intermediate care telemetry neuro floor. I receive report from the day nurse. Do my initial complete assessment. Pass oral, sub-q, im, push, piggyback meds. Chart on my patient. Prepare the nursing careplan form. Suction, cath, etc. - a variety of nursing skills. Delegate to PCAs. And, so on. My preceptor has to be there for blood administration and any procedure that she is not comfortable with me doing on my own. They build slowly to this stage. While I do not feel ready to take care of my own assignment, I definitely feel like I am getting close.