Larry3373

Suck it up, and find another job. Also get rid of the attitude that your problem is this older nurse. More than likely you contributed to getting fired in some way. Since you can only control your actions, I suggest finding another job and kissing some butt till you make it through orientation (being facetious, but you get the point).

About 11 months

To answer the OP, the PCU I worked for had many ambulatory patients that could take care of their own hygiene for the most part. Some of them were pretty sick as they had recently undergone heart surgery or were awaiting a heart cath. If your PCU gets all the heart cath patients the many of the can ambulate after 4-6 hours femoral, or immediately if it was a radial heart cath. We occasionally got some overflow from other floors. At least you have a tech, but don't abuse that. She/he is only one person, and they have things to do also. Sometimes you are going to have to clean some poop, empty vomit or sputum. That's just the nature of nursing, and you're not always going to have a tech around to do it.

The basic idea is when you read to ask yourself how you would apply the information in a given scenario. For each objective you should make yourself some flash cards showing what you as the nurse would do and in which order you would do it. For example, if you are studying chest pain or acute coronary syndrome, ask yourself how you would apply that info to a patient who walked into your emergency department complaining of chest pain. Not saying this is true or false because I haven't looked it up in a while, but it used to be MONA or morphine 1st, oxygen 2nd, nitroglycerin 3rd, aspirin 4th. They want to see how you would apply the information you are learning and what is your priority in any given situation. The basic premise is that you should be prepared to take the NCLEX on graduation.

https://allnurses.com/nurse-practitioners-np/acnp-jobs-990136.html

Oh I'm sorry, I read your post again and it seems like you meant what states are acnp able to find jobs. Not sure about the states you mentioned.

My research has revealed that acnp can work in specialty practices like cardio, neuro, etc or surgery. They also can work as hospitalists. I have seen them in the icu as well. ER may be difficult because they would want you to be able to see all ages.

I transferred to float pool after almost 4 years bedside including 2 years in the ICU. I'm not sure I would fare well working in every unit of the hospital (excluding L&D and surgery) if I did not have that background. I would say it depends on the orientation and educational opportunities offered. At my hospital, float pool means we work in every unit. We are full time employees that are paid more than 10 dollars an hour extra for working float pool. So the advantages are that my check looks great, I know where most supplies can be found in the hospital, I get to meet many new people, and I'm building a great resume. I do believe that I might have made some serious errors by now without 4 years of nursing experience. Again, with a great orientation and some awesome coworkers, perhaps I could make it as a new grad, I don't know. Maybe float pool doesn't float to the critical care areas in your hospital. You can always try it out, and if you're not comfortable with your orientation, you can resign, or ask to be assigned to one unit only.

I agree that anything is better than nothing. I know a few people that started out that way and were able to find acute care positions later. It looks better than no experience at all, that's for sure. You may be able to get your student loans extended if you call them.

My 2 cents is this. If you stay for a while you will get better and your anxiety level will go down. That being said, there are plenty of other areas in nursing that you would likely enjoy more. The problem is that most of them require a good bit of experience, and the easiest way to get on of these positions is to stay in that hospital and transfer. Outpatient surgery and pacu in particular is low stress in my opinion. Interventional radiology or cath lab both seem cool and not particularly stressful. I personally enjoy the ICU, because once you know what you're doing it can actually be pretty fun with the added bonus of only having 1-2 patients to focus on. Peds is easier imo because the parents do most of the adls and are always in the room. I wouldn't apply at med surg or telemetry if nurse patient ratios are a concern. In any case, the experience you are getting now sounds like it will look good on a resume and help you to land that dream job. Hang out a year if you can, but if you can land something better (where you know you want to be long term) then go for it.

It may have been causing the patient some discomfort, but it might also have caused discomfort if you tried to start an iv and were unsuccessful a few times. Then you would have needed to find someone else, which would require a third attempt. Also I can say from working in the emergency room, that an iv is started in the AC often because this is a larger vein, which makes it easier to hit and obtain blood for labs.

I worked just over an hour away for nearly a year. There were days when I struggled to stay awake on the long drive home, but most of the time it was fine. Just take a good nap the first day and go straight to bed each day until you have a day off. I agree with a pp about not sleeping all day on your first day off. I tend to get my days/nights mixed up when I do that. The good thing is that the 12 hour shifts can allow you to schedule several days off in a row so you can have a mini vacation before you have to go back to work.

I can answer number 2. Try becoming a patient care tech and working at a local hospital before you graduate. Then you are more likely to get hired after graduating. The best thing to do after that is to try to get your New York license and start applying. If you cannot get a job in NYC right away, try applying where you are now to get some experience. You also may be able to land a position that would require a longer commute from NYC. To answer number 3, you can call and ask to speak with the nurse manager, explain your situation and ask for an interview.

Everyone I know in south MS able to find a job with no difficulty

I'm enrolled in an emergency dual role nurse practitioner program at the university of south Alabama. Basically it's just the family and acute care nurse practitioner certifications all rolled into one. A large part of my clinical rotations will be in the ER.

Take the peds ER for the experience. I worked for nearly a year at an icu about an hour away. You essentially will lose 2 extra hours of sleep per day. However, the ER will give you critical experiences that will help you wherever you go after that. Many ER nurses struggle with PEDs patients. It will be very helpful to be able to focus on the peds population for a while. Also, you will see everything in the ER. ICU is more specialized and you will mainly see the patient population appropriate for ICU care, and even more specialized because you will be working in a neuro ICU. I wouldn't give it a second thought, go with the ER. Additionally, I would stay with my parents and save money/pay off those loans as long as they will allow you!

I've had a couple patients who have done this. The "seizure" only really happens when someone is around, and there is no postictal state. Try picking their hand up afterward and dropping it on their face to see if they will slap themselves, lol.

From Medscape.com: Carbon dioxide retention from depression of hypoxic drive has been overemphasized. Despite the widely held belief that too much oxygen causes significant respiratory depression, multiple studies in the literature dispute this view. With administration of oxygen, PaCO2 rises, but not in proportion to the very minor changes in respiratory drive. Carbon dioxide retention is more likely a consequence of ventilation-perfusion mismatching rather than respiratory center depression. While this complication is not common, it is best avoided by titrating oxygen delivery to maintain the PaO2 at 60-65 mm Hg. Medscape: Medscape Access Author Zab Mosenifar, MD, FACP, FCCP Geri and Richard Brawerman Chair in Pulmonary and Critical Care Medicine, Professor and Executive Vice Chairman, Department of Medicine, Medical Director, Women's Guild Lung Institute, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

You have to look at each person individually to assess their baseline. Many times a patient with COPD may live with higher than normal CO2 levels in the blood and lower than normal O2 saturation. It used to be believed that some COPD patients were more dependent on their hypoxic drive to trigger respirations. This means that if you give a person with COPD too much supplementary oxygen, it might slow their breathing further and actually cause them respiratory failure. Since the normal person relies primarily on CO2 levels to trigger respirations, and the COPD patient relies more on the level of O2 in the blood to trigger respirations (it was believed), then it could actually be dangerous to give a COPD patient too much oxygen. From what I have read, this has been proven false. Look up the term "hypoxic drive" for more info. The bottom line is when dealing with patients, you have to assess what is normal for them, and if there is a sudden change from their baseline, you would address it accordingly.

If an ED will allow them to only see adults, I don't see why not. My understanding is that for the fast track they prefer an FNP due to the fact that they can see all ages.

Acute care is designed for setting like icu, specialty practices such as cardiology/surgery, or other inpatient roles like hospitalists. FNP is designed for primary care in the outpatient clinic, or urgent care, or emergency dept fast track. You will see some fnp rounding on inpatients, but this is supposed to be the exception, not the rule. At my hospital, fnp are not able to round on ICU patients at all.

Some free resources include all of Mike Linares YouTube videos and David Woodruff's videos. The latter is the editor of critical care made incredibly easy. Mike Linares has a website too and it is Simple Nursing, but you have to pay for a membership as I recall.

Yes, I kind of alluded to this in my comments above. The Consensus model is attempting to better define the roles of various types of nurse practitioners and other APRNs like CNS. This is one of the reasons I'm working toward two specialties rather than FNP only, so that my scope is not as limited to outpatient once this consensus model is translated to law on a state by state basis.

FNP (family nurse practitioner) can see all ages. Most people choose that track thinking it will offer them more job opportunities. The acute care NP (AGACNP), is designed to work with more unstable patients, such as ICU or just inpatients in general, but limits you to adults. You can also use it in a specialized practice like surgery or cardiology. ER is a bit difficult because they see all ages, which is why my program offers a dual role that includes both FNP and AG ACNP in a slightly condensed program. Some may believe that unnecessary since an FNP has been sufficient for many to work inpatient or in the ER. However they may be operating outside of their scope of practice at times, and may be subjected to lawsuits or board problems at some point. I would rather cover myself and get both specialties. Psych NPs seem to do very well and are in demand in my state. My guess is that it takes a while to get an appt with a psychiatrist to get one's psych meds (Xanax for example), and therefore NPs fill this role nicely since they can prescribe in my state. Again, as a PP mentioned, check what type of NP is in demand in your state, but also check the prescribing laws and if you are independent or must collaborate with a physician.

I would look up YouTube videos. David Woodruff has several videos on body systems that are free and very good. He is the editor of Critical Care Nursing made incredibly easy. Speaking of that, you might try reviewing some of the made easy series like the one for medsurg or whatever your weakness is. Also Mike Linares has some free videos on YouTube, or you can pay for a subscription on simplenursing.com. I would do what I suggested, plus take a few questions each day and read all your rationales.