AngelRN27

Hey OP, I graduated from Keiser's Miami campus RN program in 2012. Right now I'm actually finishing up my BSN with them as well (RN to BSN program) after having practiced as a nurse for about 4 years. I cannot express how glad I am that I chose Keiser for my nursing education. I can't speak for other campuses, as I'm not sure what the hospital systems are like in Tally, but our clinical education was top-notch. First of all, we had THE BEST sites for clinical rotations around. Again, this might be a bit different up there because I'm not even sure what hospital systems you guys have--but down here in the Miami/Ft. Laud area, there are at least 3 large hospital systems I can think of (with each of those having multiple facilities and specialty hospitals). Compared to peers that I later met in the professional arena, we really had it good with regards to the quality of clinical rotations. I literally saw everything, and got to actually DO a hell of a lot more than any of my peers. We rotated through every specialty with lots of hands-on time. The majority of our professors had professional ties at these institutions, so they often had actual relationships with departments we floated through. Some of the areas that I got to see and spend clinical practice time in included: Trauma ICU (Jackson Ryder--nationally renowned), NICU (neonatal), OR, ED, and I did my final practicum in the Pediatric ICU at Miami Children's Hospital (now: Nicklaus), another nationally renowned unit (Practicum is essentially your independent "exit" clinical where you practice alongside a professional preceptor, largely without any professors hovering over you). While all of this might sound like what you expect from nursing school, many of my peers mostly rotated through several skilled nursing facilities (i.e. nursing homes) and then a couple of med-surg floors. IMHO, this is nowhere near "enough." Beyond the clinical advantage that I truly feel we got at Keiser, our professors were all extremely knowledgeable and had rich experience to draw from. All of them had 15+ years of experience as nurses, many with 20+ years, and a large majority (if not all?) were then nurse practitioners. One of my professors was even an NP/JD--she was a VA nurse, became an NP, and also became an attorney. Where have you heard of getting an instructor like that?! As you might already know from hearing/investigating around campus, Keiser's RN program is quite rigorous. They require a lot of you and you will undoubtedly have peers that will fail-out. All of our classes start out at a max of 22 students, and I graduated with 14. Nonetheless, our NCLEX pass rate down here is 100%. They also front-load clinical rotations. In other words, you will be in clinicals within the first month of class. From what I hear, this is not common among nursing programs. It sounds daunting, but I wouldn't have it any other way. I guess you can tell I loved my educational experience. Sorry for the rant. Overall, my tips would be to get involved and stay involved. Study groups are important, being PRESENT and volunteering for procedures and practice times in the clinical setting is super important, as well as making relationships along the way. Getting a nursing job is often about who you know, especially in the beginning, so make a good impression wherever you go. Keiser grads tend to have a good reputation, so that will also help. Also get comfortable with nursing care plans. The more efficient and comfortable you are with these, the smoother your nursing education will go. This might not make sense yet, but you will see what I mean (LOL). Finally, like the other poster mentioned, you will have to make some large adjustments to your personal life. You did not really include any personal details in your post (that's ok) like whether you are married, have kids, are taking care of older adult parents, etc. If any of these apply, you will need everyone to help out with these factors during nursing school. The financial aspect goes without mentioning. Some of my peers worked during nursing school (weekends only, in the hospital or clinic setting) but it was very tough. I personally worked 60+ hours the year before nursing and between what I saved up and some family help, I was able to go a year without working (lived with family--no rent). You will have to work that part out as well. Sorry for the super long reply. I love this stuff! LOL, good luck, and enjoy your education! You will actually miss it! And the better you are prepared as a student, I honestly believe that this will make you a much better nurse in the long-run. Excuse the following arrogant rant, but, I am known for being a bad-ass nurse, and I attribute it not only to my passion for it, but to my education. Regards, Angel RN, PCCN

This thread should be moved to LTC. This is not the same as LTACH.

Thanks for the info! Def some things to consider.

Good Morning All, I am currently at a crossroads when it comes to deciding what program to pursue. In lieu of seeing an advisor as I am still a couple of months away from completing my BSN, I wanted to post here for some advice. Background: *please skip to the next paragraph for my core question(s) if BG doesn't interest you* I have been an RN for almost 5 years, 4 of those years in MICU and step-down. I will be completing my BSN this summer. Originally, as I truly love patient care, I was planning on pursuing an NP degree in Acute Care. However, as I've gone through my BSN program and have also grown exponentially at work, I came to a glaring conclusion: though I love the bedside, it will inevitably wear me down far before retirement age and I will always be a "slave to the system" (that is--crazy shifts, random & chaotic schedules that are not conducive to healthy work-life balance, and the politics that are felt exclusively at the bedside). To clarify: I am not naive to the politics that exist all throughout healthcare, but those of you that work at the bedside might note how the politics in that capacity tie you down to sometimes making decisions that are incongruent with what you want/need for your patient... anyway: this has led me to consider the administrative/managerial side of nursing & hospital culture as I've always been a natural leader, and have also come to enjoy many facets of this arena as I've worn different hats at my current organization (though I have not completely left the bedside). I wanted to hear from those of you currently in programs such as the MHSA (Masters in Health Services Admin) or Healthcare MBA programs, or those who have completed similar ones and are now in the real-world workforce, to find out which one you think is more suited for managing units or hospitals? What kind of positions did you land? Which one might be more suited for a Nurse? Is a nursing background even an advantage for such programs/careers? Some people even suggest just getting an MSN? Any and all insight is welcome. For those interested, I will almost certainly pursue this at Florida International University (FIU) as it is local and has a GREAT national reputation as a business school. Thanks, Angel

Thanks for the advice, BuyerBeware. My choices are limited because (1) I need to stay local and (2) as per what I've been able to find on my own, there aren't really that many ACNP programs out there, at least not in my area. There are PLENTY of MSN programs (with varying tracks/"concentrations") but it's not too easy to come by a program for acute care. If it weren't for my specific end-goal, I'd go straight into an MSN program, but I don't think that any MSN programs will truly help me in attaining an ACNP as it now stands. Again, I welcome any suggestions for other schools/programs out there... or if anyone that has pursued the route of ACNP has any advice at all, it is most definitely welcome. Unfortunately, I don't personally know any ACNPs so I don't have any mentorship as of now. Everyone is really going after FNP in my area and within my networks. Thanks again!

The rationale behind starting distally and working proximally is that if you blow/damage a proximal vein (further up) then all veins communicating with that vein will run into that same clot/occlusion/injury. Therefore, whatever is being administered through that IV will not reach central circulation, OR could cause further harm if leaking into tissues (depends on what happened to that proximal vein).

This thread should be moved to LTC; LTACH is not the same as LTC/SNF/Rehab/Nursing Homes.

Good Afternoon All, I am finishing up my BSN in 2017 and plan on pursuing my ACNP (Acute Care Nurse Practitioner) soon after. I wanted to get some input on the programs that are available in the South Florida area. I live and work in Miami, FL. The two programs that seem the most "viable" are those offered at Barry University and University of Miami. I have been digging around researching program requirements and length of study. It seems to me that FNP programs are a dime-a-dozen, while ACNP programs are a little less common. Any current students or recent graduates of Barry or UM's ACNP programs? Thoughts? Tips? Regrets? Any other good programs nearby? Some background: I have been an RN for 4 years. Worked at a SNF for one year then moved on to a LTACH. I work MICU and telemetry, also work as house supervisor, occasionally also function as Infection Control or Clinical Educator (small LTACH--a handful of us wear many hats PRN). Plan on moving to a large teaching hospital and work critical care once my BSN is done (many don't consider LTACH ICUs to be true critical care, despite the patient population). PCCN certified. Any thoughts, suggestions, tips are welcome! Thanks, Angel

Thanks for all of your responses. I already prepared a new spreadsheet (by name) and printed it for use by charge nurses. I left for vacation after that and will be returning to work tonight, so I will see how it's worked. Thanks again! Angel

Thank you for all the replies. I think I'm going to suggest we use a list of staff names instead the method we're using now. It's essentially a tiny printed Excel calendar and the names are printed in. Therefore, when it's time to cancel, you have to look for the scheduled staff members' names and go back and see who was canceled most recently, etc. I think it would be much easier BY NAME than by date. Thanks again for the input. It seems like a silly problem to have, but as some of you mentioned, the ROYAL FUSS that occurs when we call the "wrong" person to cancel is extremely frustrating. Angel

We tried that originally, but then apparently the spreadsheet wouldn't save right across all users on our intranet... not really sure why.

Fellow managers/supervisors: I work at an LTACH facility and recently we've been in somewhat of a census drought, which of course has led to census-related cancellations often--especially of nursing assistants. Our facility is small, so charge nurses on the floor handle cancellations and staffing issues for the oncoming shift. Currently we keep track of cancellations on paper, which are later transcribed into our electronic scheduling software by our CNO. The trouble is keeping track of who is due for cancellation--that is, who has gone the longest without being cancelled due to the census. It's a tedious process, and sometimes we get it wrong... I was wondering how you all keep track of this type of thing? Is there a software out there perhaps? I know it's likely that most facilities handle this type of thing with nurse supervisors, which we don't have here, but perhaps they're in the audience! Thanks in advance for any advice or insight. Angel

I straddle the fence on this one... My university taught us both IV & foley insertion, as well as the maintenance of both. They were introduced with "theory" (common practice/indications/cautions) and then were followed up by "skills labs" which we were required to accumulate a certain amount of hours in, in order to then attempt our "sign-off." This consisted of a full walk-through and demonstration on a dummy. Each student had two attempts to pass this demo perfectly in order to get their sign-off. Only students who had successfully completed this process could attempt/practice those skills in the clinical setting. I appreciate that this is how my school handled most (if not all) hands-on skills. It made the majority of us more confident as we knew that we were taught the process from A to Z. We were also truly lucky in that our clinical professors usually worked on the units that we visited as clinical sites (at some point in their career-- or they worked on a neighboring unit, and had seen many of the nurses around) so we were often provided with awesome hands-on opportunities. That being said-- as many posters have mentioned, a skill such as IV insertion is something that requires a good amount of practice to get any good at, and that's something that will occur on-the-job. I don't necessarily think it's something that needs to be practiced in nursing school, although, again, I really appreciate that I was given the opportunity to. PS. I had no idea prior to this post that it was so common not​ to explore these skills in school.

I realize that the CCRN is more comprehensive, but just as an aside, I passed the PCCN with 83% only using the resources provided by the AACN. No DVD's, no expensive reviews. Their resources are pretty good, so if you have a good amount of experience and a good foundation, don't spend too much money. My PCCN score was exactly the same as my SAE (self assessment provided by the AACN online) score, despite the SAE only having 50 (or 60?) questions. Good luck!

^^^ This. The gut is not sterile, so I'm not sure how effective using sterile water for NG/OG tubes would be. Did those of you who use this method at your hospitals have some sort of evidence-based back up for this practice? It's uncommon for hospitals to install policies without some sort of foundation outside of either research, practice norms, or some sort of association recommendation (such as the CDC, for example).

Hello, How new is this SOFA scoring? I currently work a PCU/ICU and haven't heard of this yet. We currently use the SIRS method. I am also PCCN certified (granted by the AACN) who uses the latest evidence-based practice and they still publish SIRS information. Just curious about how the SOFA scoring works, what it entails. Thanks

Hello BendyEm, I assume by "site" the NG, you are referring to insertion? (that's not really a term we use in the US) Personally, I have been working ICU/Step-down for 3 years and have never even heard of an MD inserting an NGT, that's like having an MD get a peripheral line for you! LOL. Anyhow, here RN's insert the NG with a medical order, verify on the spot via the classic method (air bolus and auscultation of the stomach) and then order CXR by protocol to positively verify placement. Tube feeding/med administration can begin after CXR confirms placement, if need be. My hospital does not require any in-house education for insertion of NG tubes. Usually, the newbies will ask for support anyway, but we do not need any sort of approval by our educator to insert as our nursing license covers this. Good luck!

I don't know that your practicum site/area plays a huge role in the direction of your career, IMO. I was lucky enough to get my first choice as my practicum site, which was PICU at our local, nationally renowned children's hospital. I loved it & learned tons, but it really had no bearing on where I worked thereafter. While I applied for jobs as a new grad, not ONE prospective employer ever asked me about my practicum site, though it was listed on my Resume at that time. I even applied at the same children's hospital that hosted me for practicum (where I was well-liked and had plenty of contacts) but I consistently got the "unfortunately, we aren't currently hiring new grads" spiel. My first job ended up being at a LTC/SNF which was rewarding, but not quite what I was looking for. I moved on to LTAC (see the LTACH threads-- this is comparable to ICU/Tele/ICU Step-down in larger hospitals-- except with ridiculous ratios!) and have been there for 2 years now... My point in all this is that, although you may have a clear picture of where you *eventually* want to be, there are plenty of paths that lead to the same destination. Not only that, but as sure as you may be now, many times nurses change their minds after being exposed to a certain area of nursing that perhaps they didn't even know existed... As a new grad, you really can't be picky. Just do great wherever you go and things will pop up for you! Also, take your time to gain valuable experience once you do get to critical care. In my experience, bedside expertise really makes a huge difference for our ARNPs and CRNAs... there is a world of difference between them, and those that sort of went straight into advanced practice. Good luck and have fun!

Our facility has a q4hr oral care policy (also shared between RN/RT when possible) but our policy for rotation of the ETT is qshift and PRN as someone mentioned above. We also use the Hollister holder as another poster mentioned. My facility hasn't had any ETT related breakdown for over a year, per administration, so I guess this policy/technology works. Generally, the tube "belongs" to the RT's, but depending on the pt load, the shift, what's going on-- RN's can rotate the ETT if need-be. Our RT's are big on teaching, so the majority of our RN's feel very comfortable with tubes. You should never go all-in if you don't feel safe or are unsure at all of the best practice. I prefer to have someone in the room with me (another RN or grab any RT) when moving the ETT, just in case...

Hmmm... not sure exactly what your preceptor meant, but in the clinical example you presented, everything sounds right. The interventions you mentioned (administering bicarb/initiating bicarb drip + increasing RR on vent) seem standard to me, especially for that pH. I would have to agree with FlyingScot's response.... but in this case we have more control because the pt is already on a vent... It all depends on the pt and the context.

I'm not sure that there is any one thing I could tell you to "review" to help... one of the biggest things you may need to get used to that we don't really work with much in LTC is lab values. You will get used to what is emergent and what is "okay," but you need to be aware of signs and symptoms associated with certain electrolyte imbalances or other abnormal labs. You also want to know what the usual treatment is. Apart from that (like most of nursing) you will do your learning on the job. It always helps to have a good foundation from nursing school, but that depends on a lot of factors, not just you as a student nurse. Plus, you can't really do that over LOL.

Good Morning! I currently work night shift at a LTACH and I also started my career in LTC/SNF. Very big change, but if you're a quick study, critical thinker, a doer, and enjoy somewhat of a fast pace, you will do just fine. It helps immensely if you love to investigate and learn while on the job. While it is true that the night shift is a little "less busy" than days, that is really only true in regards to MD correspondence and (as the last poster mentioned) the absence of administration on the floor. Not that there is anything to cover up, but anyone will tell you that just the pressure of having admin. around sort of makes the shift more tense, so I appreciate not seeing them much LOL. The last poster also mentioned that one of the challenges on night shift is the lack of help and/or resources. Working nights in LTACH you have to be very creative and resourceful in solving problems as you will not have many people around to solve problems for you. Also, I'm not sure if this is just at my facility (although I've noticed this in a regular ICU as well) but most of the codes tend to be on nights. We also get more admissions on the night shift, believe it or not (that one is backed by national statistics, btw LOL). Anyway, make sure you learn all you can, investigate where necessary, ask questions, and you'll do well!

You definitely should not regret your decision to call a rapid response. In this situation, you were acting as pt advocate and perhaps saved the pt from a respiratory arrest or at the very least some respiratory distress. I do agree, however, that the medications should have been staggered somewhat. I know that the pt requested pain meds + ativan but seeing as they both depress respirations, I would have started with pain coverage then given anxiolytics afterwards. Either way, you did the right thing and it's all a lesson learned.

Some things you become accustomed to, others you don't. Some people can't deal with smells, others shy away from seeing sputum/respiratory secretions... it all depends. And I disagree that wearing a mask is offensive. It's part of PPE. I highly doubt that anyone would question your use of it, and if they did, PPE can easily be explained away...

To be fair, graduating with honors and taking extra clinical courses/certification courses also does not indicate anything about your ability to function clinically in any setting. My nursing class had many stellar *academic* students that just weren't confident or adept when it came to performing skills or thinking on their toes in the clinical setting. It seems as though you are somewhat "blanketting" the topic as well... Clarification: I do agree with your point that not all students or new grads are the same; I also started in ICU Step Down and did just fine. Classmates of mine started in TICU and also did well. I disagreed with your argument as to why this is true, however.