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Is it still bleeding? I'd put a square of gauze over the stitches and cover it with an occlusive dressing. Accidents happen -- just make sure it is well-covered and you wear gloves when necessary.

I find it hard to believe, especially in this economy, that someone would latch onto a nurse as a 'meal ticket' and expect to be kept by him or her. I'm an RN and I make a good amount of money but certainly not enough to be the sole breadwinner in a house (with all the customary bills and particularly when there are children involved). A deadbeat is a deadbeat, no matter what your profession. If you can afford to keep a spouse at home, more power to you. I would love to be a SAHM. If keeping that person is taking AWAY from your household and your future and that of your children -- that person is a parasite looking for a host. Don't be it.

I don't think anyone here is anti-ADN. If you've been around this site for any length of time, you'll see some variation of this thread over and over again. In my opinion more education is never a bad thing and it is something to be encouraged. What usually happens, though, is people get very emotional and defend their own degrees and it evolves into an 'all RNs are the same' and 'I'm just as good as you' sort of argument. We've all worked long and hard for our degrees and credentials, whatever they may be. A well-rounded education is only part of what makes a good nurse -- and until we have a standardized entry level into clinical nursing that is the way it will stay.

I work in a prison surrounded by men who stare at me like they have never seen a female before. I strive to look as plain as possible. I wear minimal makeup, I pull my clean hair back from my face, and wear clean (not ironed, thank you very much, and not fitted either) scrubs and that's about what they get. Moisturizer and chapstick. My one indulgence is my patent leather leopard print Danskos.

I think you should share your medical information. It is important information for them to know if you should have a diabetic emergency while at work -- it could mean the difference between life and death for you. There are many, many nurses here that have diabetes, hypertension, you name it... it didn't stop them from being hired and it won't stop you. Although I am going to buck the trend and say unless you are very confident corrections is a difficult environment for a new grad. You are just learning your assessment skills and you have inmates lying to you, making up symptomology, manipulating you -- you are really 100% on your own a lot of the time. I came here several years of experience and it was still a steep learning curve. I've seen new grads really struggle here. It's difficult. You need to be confident and assertive and very clear-headed during emergencies. You'll see a lot of them.

Are you serious? Why would you convert to mcg? Divide 25 mg into 450 mg and you'll have the necessary volume. I'm quite sure you can manage this yourself.

When can you start? No, really, when can you start? I've been in my corrections job for YEARS now so I can't offer specific advice. I'd be clear on maintaining boundaries, being firm/fair/consistent, resisting manipulative behavior. Prison dispensaries (at least this prison's dispensaries) are like doctor's offices or emergency departments -- you have to be able to ascertain who is really ill, who is manipulating you, and who you need to worry about and possibly resuscitate. Prisons are violent places and you need to know basic trauma care and stabilization. Here I can go several consecutive shifts without anything extraordinary happening -- come in the next day and have someone exsanguinate on the tier. Or die in the yard. Or have his throat cut and die on the way to medical. Or get stomped by his cell buddy and have brain matter all over the gurney. Or hang himself. These are all things that have happened on my shifts just in the past couple of months. I LOVE my job but prison/corrections nursing isn't for the faint of heart.

No. There is no reason for medical to be involved in strip searches. That is a custody issue. We're not involved in cell extractions either but we do treat inmates (and, to some extent, assist officers) for chemical exposure.

When I first started taking drug tests they would ask what medications I was taking. Now they don't. If, for some reason, you test positive the person that interprets the tests will call you (using the number you provided) and discuss it with you, ask you about any OTC or prescription medications you are taking and do a more specific test. I know how you feel, though. We just recently had an incident at work and were all drug tested, right after I had taken a boatload of sudafed and nyquil to get through my weekend. I saw in a couple of places that nyquil can test positive for methadone for 2 days following ingestion. I'm still not sure if that's true but I haven't heard anything. So no news is good news. Try not to worry! And you can always request a repeat test. If your employer is interested in working with you they'll usually grant that (although I've heard of some nurses have to pay for it themselves).

I work in corrections and here nobody can carry a cell phone, not the medical director, not the warden. It's a safety issue because of inmates getting control of phones and making escape plans or coordinating gang/drug efforts on the outside. Here we have cell phone detecting dogs and they have found cell phones in the hundreds on the compounds which means they are getting them from visitors (with inadequate supervision and pat downs during and afterwards) or from employees (your average cell phone would sell for about $1k to an inmate). This is a special situation, though. When I worked psych I carried a cell phone. So did everybody else. It eventually became a problem because people were paying more attention to their phones than the patients, especially when they were 1:1 for suicidal precautions or behavior management. I think they are a wonderful convenience if used appropriately and as necessary but not as a source of entertainment or a diversion.

Cell phones aren't permitted at my job. We go through a metal detector, our belongings are packaged in clear bags that go through a scanner, and we have pat downs. No cell phones, period. No exceptions. At first it was an adjustment but now I don't even notice. I do call my phone once a shift or so to check messages but my family knows how to reach me here.

I live in Salisbury and I've never had any problem with violent or property crime. I think, like anywhere else, there are good areas and bad areas and it is important to be aware of your surroundings so you don't create an opportunity to be victimized. Crime is actually down a few percentage points although the reporting of it is up. If you have any specific questions, feel free to PM me.

Wow, I can't imagine that. Our census tonight is 6. I'm the only nurse here, which is fine because there isn't much to do. One night I worked and had one patient all night long. That patient had the best nursing care of her life!! Where I work we can't have any outside materials -- no books, magazines, movies, nothing. So all I can do is do actual work-related things or use the internet for very limited purposes (everything good is blocked).

We don't generally draw labs from IV starts, either. And I would agree that the best thing for your skill and confidence level is practice. I work in a prison so I am usually starting IVs on healthy and muscular young(ish) men. Sometimes they have big, bulging veins that I can hit without a tourniquet. Sometimes they are IVDAs and their veins are crap. It's just practice and you learn far more from the difficult sticks than you do with the easy ones. I will start an IV in hand or wrist veins. If you are anticipating keeping an IV in for the length of a hospitalization it is best to start lower because if that one goes bad or if it's just time to change it, you'll need to go up from that site. So if you start at the AC you have far less veins to work with. I also like a couple of good unconventional sites, like the upper arm or the backside of the forearm. It's fine to start in the hand. Use an AC as a last resort. It's often uncomfortable and positional. The site that really hurts, in my experience, is the underside of the wrist. To answer your questions: I stick at about 30 degrees but once I get a flash I drop to a lower angle to thread the catheter. Like the previous poster I sometimes attempt to float the catheter past the valve. If you can't get past it by repositioning the needle or floating the catheter I'd try a different site. It's also helpful to learn the topography of the vasculature -- by tracing veins and watching how they bifurcate and how much actual vein you have in each direction you can make smarter choices and have more success. The more time I take planning the insertion and examining the veins the more successful I am. My advice: take time to relax and focus on what you are doing. Sit down if you can. Look at both arms before choosing a site. Do as many IVs as possible and then you won't be such a stressball when it comes to doing them. Good luck!

Probably a good few months. Maybe as long as 4. I started out feeling sort of zombielike during my days off but my problem is that I'm a light sleeper and I had trouble sleeping during the day. Now I have darkening shades, I go to sleep with the TV on, etc., and I can sleep longer and better so that I'm more alert during my wakeful hours. You worked 5 12s in a row? Ouch!

Nights is hard. It's such an unnatural schedule. I try to take a quick, 2 hour or so nap before going in on my first night. On my last night I go home and sleep until 1 or 2 pm at the latest (then I wake up and do energizing things like drink coffee and/or workout). Then I go to bed sort of early (before midnight usually) and wake up at a normal time. There are times when I am REALLY tired and end up sleeping until 4 or 5 pm and then I'm up all night long while I'm at home. That's no good. Your body might need an adjustment period until you feel less tired on your off days. How long have you been on nights?

Just recently I underdosed someone. I work in a prison infirmary and we had a trainwreck of an inmate here. We get our Vancomycin in vials to be reconstituted and then added to minibags; it comes in 1g vials and the order was for 1.25g. I didn't notice this until my 3rd night, of course. What's worse is that I mixed the bags for the oncoming nurse, as a courtesy, and the doses were all wrong there, too! I called our medical director, filled out the proper forms, the guy died anyway. And not for lack of antibiotics but still. Once when I first started working here I gave an entire envelope worth of pills to the wrong inmate. Including a narcotic. And I've totally done the entire bag of stuff infusing in 10 minutes thing. We don't have pumps here, we have these 'flow regulator' things that are dials on the end of the IV tubing. I set that to a respectable rate and clearly I did it incorrectly because the next time I glanced into the cell that bag was empty. Great thread! I agree that everyone will make mistakes and the mark of a good nurse is what he or she does after the mistake is recognized.

I don't think it was inappropriate at all. There's no reason for a patient to be verbally abusive, regardless of your specialty or what their medical problem might have been. Thankfully I work in corrections so I don't have to deal with that. If an inmate did half of what you described our interaction would have been terminated and he probably would have gotten a ticket and a free trip to lockup.

I think everyone thinks they failed, regardless of their actual result. I passed with 75 questions, first time. Good luck to you!

Well you'll find out if you go in for an interview and facility tour. Ask a lot of questions. We don't have CNAs/PCAs at my facility but we do have a couple of CMAs (medication aides) -- they do the general population pill call and sometimes deliver KOP (keep on person, the medications inmates are allowed to keep in their cells) refills to the housing units. It's funny, nursing has so many abbreviations -- I opened this threated expecting it to be about a PCA pump (patient-controlled analgesia)! Our inmates don't have those, not even in the infirmary. :chuckle

I don't understand why administering medications would be outside of your scope of practice. At my facility the inmates in general population come up to pill call (and only for those medications that aren't KOP - keep on person) and the RN (lucky me) is responsible for doing medical rounds and pill call in the segregation units.

Well, you're right. That is difficult. If an IM refused to come down to medical for insulin rollout I would document him as a refusal. Of course that doesn't help if you have to keep going to him around his meal times. I would say if he is so brittle he needs that much medical attention then maybe he should be in the infirmary. You have enough to do without catering to him after each meal. If someone pulled that with me they would be at medical at insulin rollout or in the infirmary or not getting insulin at all. Just my .02.

I like unisex, drawstring-waist. No elastic. I actually prefer unisex scrubs all around. No cutesy prints or shirts that tie in the back.

How long have you been there (i.e. how long was your nurse externship?), what area are you working in, what is it about your environment that you consider unsafe? If you can I'd advise staying and trying to work with your nurse manager. It is totally normal to feel overwhelmed, underconfident, etc. Many places will be willing to extend your orientation rather than lose a new grad they've spent time/money on. Maybe there's a nurse educator that can help you in your transition or maybe there's an experienced and organized nurse that can teach you some tricks to stay on top of things. If you absolutely have to leave, I'd smile and say that your last position just wasn't a good fit, you felt like you didn't have the support you needed and tell them exactly what you need. If you're coy and say what they want to hear you may end up in the exact same position. Oh, and ask to job shadow. Because nurse recruiters don't always tell the truth. :chuckle

I'd guess supply and demand. There are a larger number of nurses willing to work in area hospitals -- at least here -- so they don't have to pay higher salaries to attract them. I went to corrections from a psychiatric hospital and make $5 an hour more.