eukaryote

I think you did the right thing. You assessed the pt's vital signs and found he had a high blood pressure and increased pain. You gave the blood pressure medication that was scheduled *at that time* and gave appropriate pain medication per the order. His blood pressure could have been elevated because of pain, or because he was due for a blood pressure med, or some other reason. I would have done the same thing, and then rechecked the blood pressure in 30 minutes, and then an hour. If it was still elevated, then I would have initiated the protocol. If I had called the doctor right away, the conversation would go something like this. "Hi doc, my pt's blood pressure is 188 systolic. They are in pain and have a blood pressure med scheduled." Doc: "Did you give the med?" "No, not yet, I'm instituting the hypertensive protocol." Doc: "Well give the med and call me if it's still high in an hour if it's still elevated. Click."

Like the previous poster said, it is a core measure for stroke patients to be on ASA, antithrombotic and a statin by day 2 of admission. There is a risk of conversion, like you said, but it is small. I also work in a stroke center, and I've only seen it once. This isn't research based, just my opinion, but I would say the risk of the pt. throwing a secondary clot would be greater, particularly if they are in a-fib and/or immobilized d/t the stroke.

Our floor also accepts these types of medical patients as our hospital doesn't have a step down. The floor I work on hyponatremia is often managed (SIADH, etc..) I admitted a patient this weekend with a Na+ of 113, K and low Mag...can't remember what it was. These patients have to be managed closely, but as long as they are otherwise stable and assigned to an experienced RN, I would not send to the unit.

It's really important for floor nurses to understand the way the ER functions. It's literally crazy down there. I've had to float there a few times, and yeah, I can understand the need to get ppl outta there! When they call report, we usually do a short SBAR, I view the appropriate info in the computer that I need, labs, radiology, ect and just need the absolute skinny. Also, I make sure they know I just need the basics - anything critical pls address since it could be awhile before I have orders. ABX, blood, whatever - just send it with the pt. and I will complete it. That stuff doesn't need to be completed in the ER.

Does the ER have an admissions RN? We had a similar issue to this at our ER, and they hired an admissions RN which has been immensly helpful. The problem I have with quick throughput times and not getting report on ER patients, is that often patients come to our floor and the attending will see them upstairs/when they are ready. This could mean we have patient on the floor for an hour or sometimes more with no orders (we cannot implement or view the ER orders). If we receive an unstable patient, or a patient with no report, this is a huge patient safety issue. I recently got an ER patient - in report they told me she was stable, BG was 73. On a hunch I checked the BG when she came up to the floor - it was 23!! I had to page the attending 3x and had to override the system to push d50 - THREE times because it took the attending 45 minutes to get back to me (which we are allowed to do with d50 on my unit). I was about to call a rapid. This is an extreme example, but a good reason floor nurses need a good report. If that patient had just been sent up to the floor without a report, in the middle of something crazy or at shift change and had just been left sitting in the room, there could have been a very poor outcome for that person.

The problem is that if it's stocked and labeled in that patient's med cart, they are being charged for those meds one they are deposited by pharmacy. That is why you should not give them to another patient (other than that it violates the 5 rights). Ask for pharmacy to stock those meds in the accudose for single use, or unfortunately, you will need to return the discharged patient's medications to the pharmacy so they are not charged for unused and unopened medications. Then, have pharmacy stock the correct meds for the correct patient (if you can't do the accudose thing above).

Seriously. My daughter has epilepsy and I have witnessed hundreds upon hundreds of seizures of any and all types. Never once has she injured anyone and/or herself for that matter. If she ever wanted to be a nurse I would be thrilled because of all her experiences and empathy for others with health issues or disabilities.

How could she hurt someone during a seizure? By falling on them? I know plenty of nurses w epilepsy, and even met an NP w epilepsy the other day. Epilepsy has a spectrum of effects on a person, however, most people who are well controlled live normal lives and function just like the rest of us.

Being a CNA is much more physical toll on the body then being a nurse. Nurses endure other kinds of stress, at higher rates than CNA. I have been both. Being a CNA can be backbreaking work. I had shifts where I cared for 14 pt without sitting down the entire 13 hours. As a nurse at least I get to sit down once in a while to chart or make phone calls. However, I'm much more stressed out as a nurse. Just my .02.

Need to understand more about what was going on. Why was she asking you for help with a bed change? Was it a code brown? Bariatric pt. about to fall off the bed? Did patient vomit? Was pt. agitated? Confused with tons of lines? Was it a patient with a hip fx lying in a puddle of stool? While she had no right to yell at you, I can think of a lot of reasons why someone would ask for help and be frustrated when they were told "no" for whatever reason. In my experience most CNAs are completely capable of handling a bed change on their own and don't ask for help unless they REALLY need it. I would be mad if a CNA yelled at me too, but I'm a grown-up and having been in both roles, I understand the frustration on both sides. Instead of being angry at each other, try to see things from the other person's perspective for a moment. You are a team, and bottom line, need to work together and help each other out. I just don't see someone flying off the handle for no reason. I think there is more to the story like something might have been going on with the patient that put her at risk. Was there someone else that was able to help her?

If you're a military spouse, you can work as a Red Cross volunteer nurse at Tripler. It's unpaid, but it counts as experience and I know of a few people who've eventually been hired that way. Otherwise, you need to have 3 years as a civilian nurse to work there as an RN. I know some nurses have gotten in working as a contractor. Otherwise, the job situation for new grads is very grim. I am local and worked as a CNA after graduating, but ended up moving away for my first RN job. Please take the advice people give you very seriously. Of my graduating class, only a few local people had jobs within the year after graduating while everyone who went to the mainland pretty much got a job right away.

I would say that it depends on the area you live in and the facility's policy. In my area, it's common for new grad RN's to work as a PCT for up to a year after licensing before securing a new grad position - it's a very competitive area. I did this in fact. I wouldn't recommend it though. Working as a PCT has a different set of priorities. It's a good way to get used to the floor and to handling a busy acute care patient load, but you will lose your critical thinking skills quickly. So, if you do it - do it for only a short period (3 months or so) or not at all. It's also difficult not to cross boundaries, because as a trained nurse you will still think like a nurse and want to act accordingly.

No it wasn't offered online when I took it. And honestly I don't recommend taking pharm online. It's a really crucial class to understand for nursing. The Maui one is the notorious online one.

I took pharm at Windward. I won't lie, it's a tough class...but she offers tutoring. I found that I knew my drugs way better than the students who took the Maui or Leeward pharm. so if you want to learn, take Windward.

Thank you, I did mention it. It was not a big deal. :)

Hi, I got a call and was asked to interview for a unit I had not originally planned for. I'm very excited, however, one of my husband's extended family members is a physician on this unit. I didn't list this person on my system application as a relative, because, we don't really know each other and I would not consider extended in-laws my relatives. I feel I need to disclose this to the manager though because of conflict of interest or something. How do I go about doing so tactfully?

Thank you everyone for the great advice! Just wanted to give an update and say that my preceptorship is going awesomely so far. You are right, I have made a few mistakes but I have looked at them for opportunities for growth and reflection; and I know that they make me a better, more responsible nurse. My preceptor has been awesome at guiding me through the nursing process for each patient and helping me to process all the crazy things I have seen (my floor is high acuity). I am learning so much and getting to practice all kinds of new skills. Even though I am scared, I never turn down an opportunity to try something new. So far I feel like nursing is slightly terrifying, exhilerating, nerve-wracking, and awesome. Watching a patient get better and go home, or cope with their pain, makes it all worth it!

Hi! I am in my last semester of nursing school and starting a 300 hour preceptorship in my specialty of interest. I am super excited and want to learn as much as I can on the unit. Just wondering if there is any advice from preceptors or post-preceptees out there on ways that I can be useful and make a good impression to the staff on the unit? Any advice would be appreciated!

This is great advice. Thank you for bringing me back down to earth! I always get so worried that I'm doing everything wrong. And as students there's so much pressure on us to be perfect and if we don't follow the perfect path (CNA in school, med-surg after graduation) then we're just gonna be screwed. I have to keep reminding myself to just accept things and know that I am doing the best I can. I am really excited about my preceptorship and the blessing in disguise has been that since I'm not working I have time to really prepare. I joined ONS and completed some Classes (cancer basics, genetics of cancer) and got my ACLS. Hopefully this will help me too.

I graduate in December and had been hoping to follow the advice that is commonly given on this website which is to work as a PCT/CNA or intern while in school. Well here I am with o e semester left in school and still jobless. Unfortunately, I live in an area with a tight job market where most tech and CNA jobs go to foreign educated RNs waiting for their license and a huge glut of nursing schools. I applied to so many positions for CNA/pct, coop, internship and nothing materialized. But it was not for lack of trying. So, in the meantime I have been volunteering with our local medical reserve core, dept of health TB clinics, children's hospital, domestic abuse shelter. Basically, anyone who will take me. I also work part time for a physician's office (a surgeon) that I worked for before starting school. She has been gracious enough to let me come in and work "prn." Now, going into last semester with my capstone and research, I feel that it would not be a good time to start a new job. I'm hoping to put my best foot forward during my preceptorship and hope they will keep me. (Doubtful, but doesn't hurt to dream). I did at least get lucky enough to get my preceptorship on my dream unit and dream hospital so this feels exciting. But now after reading here I feel worried that I did not get a job as a CNA. Anyone else have positive stories about new grad employment who didn't work in school?

Hi, I am a massage therapist and have been licensed for 15 years plus BSN There are in fact many nurse massage therapists! Many of them work in palliative care. Please check National Association for Nurse Massage therapists. You can also join American holistic nurse association. I went to school in CA and licensing is done now through camtc.org Since you are already a nurse your best bet is to do another associates program at a local community college. I'm sure most of your undergrad will transfer over and you may only need a semester or two. Good luck!!

I understand your frustration. I too live in an area where I am a cultural and ethnic minority, although were I am 80% of the population is Asian or Asian-American and am often assumed to be a foreigner soley based on what I look like. Which is extremely annoying, to tell you the truth. I find myself often fielding questions and being called derogatory names by patients, and even other professionals unfortunately. I just tell myself they do it out of ignorance and are just unaware of how people from other cultures live. I just wanted to share this with you because people of all cultures tend to do this any time they are the ethnic majority and aren't exposed to other cultures. I like what the other person says about using it as a time to educate. The caveat is that it is exhausting when you just want to be treated like everyone else and not constantly have to feel like you are "justifying" your right to existence.

I should also add for clarification. The way that we have been assigned patients really depends on the clinical instructor and charge nurse for whatever semester and floor we are working on. I have had instructors who chose our patients for us, after discussion with the charge and seemed to pick patients that had dx that went along with whatever system we were studying in the didactic portion of our clinical. Other instructors have allowed us to go in the day before and choose whatever patients look interesting and had the most procedures going on. During my last semester, we were assigned a team lead for each week. That person went in the day before, and discussed the patients with the charge nurse, and they assigned us patients accordingly - the instructor had nothing to do with it. By the end of the semester, we were assigned to an RN vs. patients. This allowed us to follow the RN throughout the day and learn how she prioritized her day. It also helped us to understand a lot of things that you don't get to see in nursing school like care conferences (which we attended), discharge planning, and orders...(I could not understand how orders were entered into the computer until my last semester).

I specifically meant "total care". I was on a neuro floor where most patients where bed bound, needed assistance with all ADLs, trachs, restraints, comatose, the whole deal.

I'm currently in a 6 semester BSN. We do 14 week rotations (actually 16 weeks but last 2 weeks are non-clinical). Clinicals are 2 days a week and we are generally on the floor for 10 hours. 1st semester we took one patient and assisted CNAs with anything they were doing, answered call lights, etc. 2nd semester we took 2 or 3 pts. depending on acuity. 3rd semester was OB and peds. Peds we started with 2 pts and ended with 4. For l&d we only took one pt in hopes that we could assist with deliveries but generally followed our RN and assisted with all of her pts. In mother/baby we took 4 mothers (so technically 8 pts). 4th semester was complex care and we started with 2 patients and were expected to handle all pts for the RN we were assigned to by the end of the semester. Our 6th semester is either an ICU or ER preceptorship so I suppose our location will determine how many patients we handle. In all semesters except for the 1st we are expected to do total care, full charting, assessments, and pull meds as well as IV starts, even in peds and EXPECTED to communicate with the physicians and other members of the health care team. Pt is scheduled for dialysis? We were fully expected to pick up the phone and call down to dialysis to see what time they were planning to pick up pt, communicate labs and meds and to find out which meds we could be expected to give!. In my program. we must obtain RN and instructor verification before administering intravenous cardiac meds, narcotics, or insulin. We also are not allowed to adjunst PCAs by ourselves or chart from the care plan (in Epic) our Dar notes and assessments are labeled "student note" but we were expected to follow the care plan and chart accordingly. However, by the end of our 4th semester most of us were allowed to chart from the careplan.. Depending on the pt, we also need the RN with us for certain types of trach care, such as when cleaning and removing/replacing non-disposable cannula.