EarthwormRN

Wondering what you all would do in this scenario. A patient came from an outside hospital on ceftriaxone for "suspected UTI", as well as urinary retention and acute kidney injury. He had been on it for about a week. I couldn't find any old culture results at the prior hospital. Most often UTIs are caused by e.coli so ceftriaxone would normally be adequate. We redid a UA and culture anyway and the culture ended up being positive for an enterococcus species. I was training a new nurse and instructed her to let the doctor know that the culture came back and ask if she would like to change the antibiotic. The doctor responded dismissively and said something along the lines of "thanks, I can take care of my own patient". The new nurse was embarassed to have been spoken to that way. I questioned whether or not my instructions for her to notify the doctor were necessary. My thought was, it was kind of late in the evening (1530ish) and sometimes the docs finish up and go home between 1600 and 1700, then stay on call until 1900 if needed. I figured it would be better for the patient to get the proper antibiotics as soon as possible instead of waiting until morning in the event the doctor didn't see the new result until the next day. What are your thoughts? Did we do the right thing or overstep?

I have moved from one facility to another and I am being trained differently than what I have been doing with wounds the last 4 years. I'm not clear on whether or not the nurse I am orienting with is just extra cautious or I too should be assessing sites the same way she does. I assess the site when the dressing is due to be changed, PRN (strikethrough, pt c/o increased pain, got wet in the shower, erythema noted around dressing, etc) and on admission. My orienting nurse peels a dressing up and looks at the wound Qshift, and sticks it back down if its not due to be changed. If anything I would assess Qshift, but I'd be more inclined to clean and re-dress because of infection risk. If a doctor or wound specialist says change Q3days, why expose it to infection every shift? Or change it early when it wasn't needed? I understand an infection could get missed on day two without visually seeing it, but if it does become infected it would start to ooze or the pt will have increased pain. Both of which should be assessed Qshift. Thanks in advance for any of your input.

Thank you for your answers. I feel better now. I'm always always learning new things. Even when i feel like I'm pretty comfortable with my knowledge i get challenged with a question i am totally unequipped to answer.

My stance has not changed. I have been hearing more and more people complain that its all just a trend to be anti gmo right now. Which is irritating, these are the same people who believe the reports that "prove" global warming is not happening. I wish that websites posting "research studies" had to be screened for efficacy. Anyone can say they did research and write a really good study on it. But if its just some joe shmoe making it all up..people will still buy it.

A family member of my patient asked if his grandma could have the fluid drained through a tube. First i told him i wasn't sure if we could do that procedure here. Its a small rural hospital. Then i said since she was elderly and her progression of chf is severe the fluid may reaccumulate and the risks involved wouldn't be worth the procedure. This patient also had pneumonia but the chest xray didn't show a pleural effusion. My question is can you even drain the fluid from inside the lung rather than in the pleural space with a thoracentesis or does that only work for pleural effusions. After going home i kept wondering if i had misinformed the family. I did however explain that we were dieuresing her with lots of lasix and that was a safer alternative to pull the fluid off.

I have been a nurse for 2 years. My experience consists of primarily assisted living and long term care. Just after graduation I breifly worked on a swing bed unit on night shift with 20 patients by myself. Due to lack of traing and no one to help me with questions I quit because I didnt feel like it was safe to stay. Now I have transferred from LTC to the acute/swing bed wing in the same hospital and I really feel like a rookie. I am having no problem with medications and treatments, that is the easy stuff. But I am brushing up on my head to toe assessment skills, knowing when to alert the doctor, admits/discharged/transfers, and giving good thorough reports. Its been about 2 or 3 weeks since i have started and Im doing okay. I have not harmed anyone. But being the only rookie in the department I feel like my every move is being judged and monitored by the other staff and Ive always ben the worrier of what everyone thinks of me and my work. Please any advice to help me feel more comfortable or share your own stories of when you were new, would be greatly appreciated. Thanks.

Love it!

I do it! I love my job and although the drive gets tiring and I often think I should get a job closer, I end up staying because its a good place to work.

"I'll get you a Snickers, you act like Frankenstein when you're hungry."

1. State you work in ----------------------------------------------------------WA 2. Years of experience --------------------------------------------------------2 years 3. Specialty/unit and work setting (clinic, hospital, prison, etc)------------LTC 4. Hourly Pay (base rate) or salary-------------------------------------------$25.66/hr + 10% per diem 5. Differentials (if any) --------------------------------------------------------$2 evenings, $4 nights 6. Union? -----------------------------------------------------------------------i think so

I know how you feel. I have been a nurse for 2 years and even with that under my belt, I feel like I won't even have a chance at an interview. If I had my bachelors I'd have an easier time, but right now I only have an associates. I have been looking into getting my BSN through on online school but I'm not sure yet if I want to start now or wait a bit longer. I have looked at midwifery schools as well and I did find one that has an ADN to MS Midwife bridge, buuuut of course in the application process it strongly recommends some sort of experience in pregnancy, labor/delivery or something to do with newborns. I have though about asking our local midwife about volunteering in their clinic and I have found some classes to be a childbirth class instructor or lactation consultant. I haven't committed to anything yet, because there are so many options, I'm not sure which one would give me the best outcome. Volunteering would really up your chances, especially if you volunteer at the hospital you want to eventually work at. Once they know you, they might overlook your experience and let you right in. Wish you best. :)

Hello, I am a nurse working per diem in a hospital in a small town in washington state. Many are hired right out of nursing school (I was). This hospital has a clinic, LTC, Assisted living, Swing beds (basically rehab), acute beds, and ER. Unfortunately, there is no labor and delivery In this hospital LPNs are able to do IVs with certification (which many hospitals seem do not allow anymore) It is rural healthcare if that is something that you are intersted in. For now, we are in desperate need of a nurse on the long term care wing and I can honestly tell you that its the best long term care I have ever worked in. The turnover is low, the CNAs are great, and my boss is very very nice, not the kind who hovers over your every move, but offers constructive critisism when needed. As much as I love it, I prefer not to work full time and my boss really wants me to take this position. I offerred to fill in until we find someone else. So far its been about a month. We don't get a lot of applicants due to the small area, but if you are willing to move, this is a nice small town and a great place to raise a family. Also note, if you eventually want to work in acute care, many of the LTC nurses move to acute care or another department within a year or two of employment. Info: LTC wing has 25 residents and only 1 nurse is on duty per shift, but they are pretty low maintainance. Evening shift 5 days a week, 8 hour shifts, every other weekend. Pay is really good for a long term care position, I won't say exactly a number but I was pleasantly surprised. the name of the facility is Columbia Basin Hospital, in Ephrata, WA. Please apply, you won't be dissappointed.

Honey I shrunk the nurses.

I have this patient who asks for ativan every day at 7pm. I was told by my supervisor that I need to offer alternative ways to calm her down before giving her the ativan, such as offering food, water, one on one, back rub, visualization etc. Well this patient refuses to take part in the other methods and sternly says I wouldn't ask for it if I didn't need it. But at 5 oclock, she will say bring me an ativan at 7, and I think how does she know she will be anxious at 7 o'clock? The only time she doesn't end up getting the medication is if she doesn't ask for it, if she does, she bullies me until I cave and I cave pretty easy. I talked with a fellow nurse on a different shift about how "pain is what the patient says it is" but is anxiety what the patient says it is as well? I think yes, but i wonder what my supervisor thinks. How should I go about this situation?

Oh and what exactly do you mean "Likely get slammed for this"?

Thank you! This is very helpful. The style is different from what I'm used to but I think I like it better.

First of all, thank you for taking the time to read it and for any advice on changes. I am applying to the oscopy unit at my local hospital, it is pool position for varied shifts. The requirements include: Graduate of an accredited school program RN Licensure required Experience is preferred REQUIRED KNOWLEDGE AND TRAINING: 1. Graduate of an accredited school of nursing. 2. Current RN licensure. 3. Completion of formal hospital and unit-specific orientation program. 4. Must be currently certified in BLS, and recertified annually. 5. Must possess basic computer skills related to Windows navigation, mouse usage, keyboarding, email communication and password management. GENERAL FUNCTION: A clinically competent, registered, professional nurse who delivers care to patients through the nursing process of assessment, planning, intervention, implementation, and evaluation. Effectively interacts with patient, significant others, and other health team members, while maintaining standards of professional nursing. This is my resume: NAME, RN [email protected] XXX-XXX-XXXX #### ADDRESS, CITY STATE ZIP PROFESSIONAL PROFILE Attentive, compassionate, and well-trained Registered Nurse with valuable hands on experience acquired in Acute Care, Rehabilitation (Sub-acute), and Long Term Care Units. Excellent assessment, organizational, time management/prioritization, and communication skills. Effective leader, Goal-directed, results-oriented professional, skilled in developing a productive team with patient and family-focused support. Exceptional ability to build rapport, able to work collaboratively with physicians, fellow nurses, and a host of supportive healthcare providers and agencies for total and comprehensive nursing care. Areas of strength include: Problem Solving / Decision Making / Critical thinking Flexible / Assertive / Adaptable Descriptive and Precise Documentation skills Self motivated / Energetic / Personable Efficient computer skills/ Type 70 words per minute EXPERIENCE **EMPLOYER 3*** - Staff RN part time and per diem - Long Term Care March 2012 to present Assess, dress, and bandage wounds, place and care for catheters, practice sterile technique, triage emergency situations as needed, monitor blood sugar and treat hyper/hypoglycemia appropriately, monitor narcotics and report side effects, check and order supplies, communicate with providers and team members. Work together for the best interest of the patients and their families. Manage and supervise assistive personnel. **EMPLOYER 2***** - Staff RN, CNA - Rehabilitation (Sub-acute) Unit RN: March 2012 to June 2012 / CNA: April 2008 - June 2011 RN: Assess patients, administer medications and implement necessary treatments. Practice phlebotomy, place and care for wound vacs, IV therapeutic administration and monitoring, monitor blood glucose and provide insulin as needed, provide healthcare education to patients and families. Communicate with providers and team members. Provide pain management and assist patients with rehabilitative equipment. Manage and supervise assistive personnel. CNA: Train new staff. Assist nursing staff in the care of all patients including but not limited to transferring, bathing, hygiene, and feeding. Provide quality patient care. Manage confidential patient files. **EMPLOYER 1***** - LPN Sept 2011 - Nov 2011 - Seasonal Provide immunizations for children and adults age 4 and up. Educate patients on possible side effects of immunizations with reasons to seek medical attention. EDUCATION and CREDENTIALS Associates Degree of Nursing - ***COMMUNITY COLLEGE**** - Jan 2008 - Dec 2011 RN License # RN###### BLS certified, last renewed October 2012 AGAIN, THANK YOU SO MUCH FOR ANY TIPS. :)

I actually didn't know that GMOs were in the supplements too. Personally, GMO anything scares me because we have too many scientists trying to play god that we are changing the whole face of this planet. It is a relatively new research with no long term testing and now with it being available in basically everything we eat, it will be impossible in the future to discover whether or not this has any kind of lasting effect on people and their bodies, where would we find a control group when everyone is eating this stuff. I'm no researcher, but I'd love to become one. What scares me the most is what's the reason behind hiding it from Americans? If there's no potential harm, then why not just let the public know with labeling. They claim it will create unnecessary fear. Like the government is worried about unnecessary fear.. I don't buy it. Europe does it. And if I want to choose to purchase and ingest only natural products created by the earth, and not by a lab, then that should be my choice. What are your thoughts?

I like the idea of going beyond tradition. Or in this case, going backwards to an old tradition that has research backing it this time. Thanks for your response. :)

Is this widely available as a position? I have never heard of an opening like this. After learning more and more about natural healthy solutions to illness by changing diet and lifestyle as apposed to chemical solutions to health problems, I have decided I don't want to pursue this type of nursing if I am required to force-feed medications to people which are probably hurting them more than helping them. Can anyone tell me if they have had a job like this before and what kind of training and work they do? Thank you.

That is a great idea, I think I will do just that. Thank you!

I have considered volunteering for the red cross, but from what i can see and I could be wrong but, there is no volunteer position where I could utilize nursing skills. Unless passing out cookies and drinks counts as a skill. I suppose I could call and ask, but I'd prefer the clinic setting anyway.

This is sort of an ethical dilemma, I wonder if I am getting myself into trouble. I do not believe in god. I am more spiritual with nature and do not follow the bible. I was raised christian and understand christian values and I remember most of what I was taught, but I am not devout and discontinued going to church in my teens. I'd like to volunteer at this christian based non profit medical clinic because I want to volunteer my nursing skills but in the volunteer packet it requires I sign a statement of faith, that I believe in god and my faith is true, which it is not. I am afraid that if I tell anyone I am a non believer they will tell me to go elsewhere.. but I find that to be unfair. I am not going into a church to worship. I am going into a clinic to provide medical care to under-served and underprivileged individuals (who by the way are not required to be christian in order to receive care). I have not seen any other volunteer opportunities in my area where I can use my nursing skills so this is where I want to go. IF I do sign it, my plan is to cordially talk about the religion if spoken to about it and not tell anyone I am a nonbeliever. I have had many patients in the past of whom I have read scriptures to by their request and even talked about religion with them and they didn't know, nor did I ever tell them that I don't actually share the same faith with them. I also wonder, if I do sign it and someone finds out it was a false statement, what will likely happen? Thank you, any input is appreciated, and please no bashing on my belief. You will not convert me. I am a good person, with good morals, and I don't need a leader to help me distinguish right from wrong. (In this case, I feel if I sign it, I am part right/ and part wrong - but my desire to help the community is more beneficial)

Thank you guys for your answers. That helped me a lot. I will start applying right away :)

I currently applied to endorse my nursing license to be able to work in georgia. my original license is for washington. One of my questions is: Can I apply to work before my endorsement is final? I know I can't physically offer to work for someone yet, but I saw something that said I couldn't "offer to work" without my license active. Also, after endorsing my license for georgia, does that void my current license in washington, or will they both be valid at the same time? I just renewed it in september this year. My last question is: for those who have applied for endorsements, I know it says up to 6 weeks for processing, but does it really end up taking that long? Thanks : ) Any input is appreciated. Have a great day!!