Levitas

I ended up buying a pretty powerful/compact LED flashlight that has white, and red LED's. It works great! I used it today on a patient with no palpable, or visible (beyond the flashlight) veins, and successfully started her IV. I'm beyond thrilled :)

Lol. Don't worry, I've got thick skin. The idea of using the light/markings is towards those who are difficult sticks. I've only 18 months experience, but I'm pretty proficient at starting IV's. When someone needs an IV, I'm usually first up to volunteer. Even with all of the practice, there are times I just simple cannot see, or palpate a vessel. Rather than asking someone from another department, I'm trying to use these tools to accomplish the task without consistently sticking the patient, or having to bother another department for assistance. So, to answer your question, obtaining IV access by skill is still very much the popular choice, and will always be my first choice. However, I'm also not against utilizing extra measures to ensure my patient is cared for as needed.

I've been reviewing different vein finding products this morning, and it seems the cheapest route would be a red LED flashlight. The problem with them is, they work better in lower light settings. So you can see the vessel well enough in the dark, but I wouldn't want to stick someone without light, so... I'm wondering, is there a product out there, that we can use to mark the skin prior to puncturing it, that will not cause harm to the patient? Are sterile surgical markers safe to use prior to puncture?

It seems like most of which you wish to learn more about will come simply from experience. Am I correct in assuming that you haven't had orientation yet? If so, you'll likely be paired up with a preceptor, and it's their job to show you the ropes. They'll be your safety net until your orientation is finished (and usually after as well, we all help one another, or at least we should). IV care, as in starting IV's? Anyone can teach you how to do it, but no one but yourself can show you how to master it. Practice, practice, practice. Central line care? Generally there is a protocol on the care of central lines that perhaps are a tad different from facility to facility. At my hospital, we flush the line(s) every 8 hours with normal saline, and heparin, and the dressing (sterile) is changed every 7 days, or as needed. Also good to note that you can draw blood from central lines. Giving and taking report is another thing that you just come to master as time progresses. You'll find that each person wants/gives a little something different at shift change. Some nurses want the quick run-down, such as the important/priority information, i.e. IV site, time sensitive treatments/medications, code status, etc. Others may want a complete run-down (which is generally what I like to give, if they'll have it). Again, the list is long. You'll eventually just come to know what to expect from your fellow nurses, and vice versa. Pay attention to others giving report to each other whilst in orientation. Lab values is another in which you'll just memorize as time goes on. Until then, your facility should have specific ranges available for your reference. Ask a lot of questions in orientation, and even when you get out. Never just assume an answer, always seek it if you're unsure, even if you feel like that you're "annoying" your preceptor with questions, it's their job to answer them.

If I am ever unsure of what is, or isn't compatible, I simply call the Pharmacist. If they're unavailable, I look it up. As others of said, you'll eventually start to memorize what is, and isn't compatible. But until then, use your resources, that's what they're there for :)

I've seen fellow nurses struggle with similar situations. When asked what do to, I always ask them, which decision would you regret less? Will you, a couple of years from now, regret it more if you didn't take the Med-Surg chance? Or would it pain you more to leave the ADON position? I would like to say that money shouldn't be a deciding factor, but that would make me a hypocrite, as I'm in a position where I don't want to leave my current place of employment due to making that nice differential pay. Even if the conditions of said place of employment stress me out to a point of having panic attacks, and at times, being a completely unsafe working environment (working in Med-Surg, by the way). You have to do what's best for you. If that's following your dreams, and goals with working in Med-Surg, surely there are ways to supplement your income (perhaps they'll allow overtime, or PRN at the clinic). Good luck to you. I hope you succeed in your goals.

Couple of questions: I know that you need to be in Med-Surg for at least 2 years before taking the test. It doesn't matter that 3 months of those 2 years were orientation, right? Meaning, if I started a Med-Surg job on March 5th, 2 years later on March 5th I should be eligible? Also, what review book are you guys (above) talking about? What would be the best guide to study, if one exists (I realize that's subjective, I'm open to opinions :) ). Is this like the NCLEX, in that, more than one answer can be correct, and we must answer the most correct answer? Multiple choice only, or select all that apply, as well as picture/audio questions? Any information is helpful :)

I'm willing to wager that a great deal of your experience this last year has indeed stuck, more so than you might realize. I imagine you know medication a great deal more, organization, stress management, the ability to correlate care between all aspects of patient care (physicians, PT/OT, etc.) All of that aside, it sounds like you're maybe looking for a career in something less clinical? If you're wanting to stay within the hospital, perhaps critical care is your niche? You usually only care for 1-3 patients at a time. Less pulling in 15 different directions, and more detailed care to those 1-3 patients. Or even the OR? I don't have a great deal of experience there, but I don't think you're running all over the floor. You're in the room, handling business with one patient at any given time. Possibly Case Management? I have a friend who was an ICU nurse, and she went into Case Management for the better hours, among other reasons. Though, I imagine that can be stressful as well, in its own way. Outside of the hospital? I did a simple google search, and came up with this article that gives 15 different jobs that nurses can do out of the clinical setting: 15 Super Great Non-Hospital Nursing Jobs for Nurses | 2015 NurseJournal.org Good luck to you, I hope you find what you're looking for :)

As many of mentioned, this type of anxiety associated with our position is quite common, especially if you're still relatively new. I've been in Med/Surg for about 18 months now, and though my anxiety levels are no where near as high as when I first embarked on my own, I honestly still have a panic attack now and again. (I realize that this isn't healthy, I am going to see a physician next week to talk about it.) Point being, it does get easier. You do get faster, more organized, and you're able to stay on top of your patients' conditions, labs, and even interpersonal issues. Even with less than 2 years of experience, I am a preceptor. I tell my orientee, as well as the other new nurses, to try and not sweat the small stuff. I always tell them, as well as myself, whilst doing patient care, focus on what you can do at that moment, and worry about the future when it comes around. Focus on priority of patient needs, and work your way down the list. Once you get the hang of controlling what you can control, not sweating everything at once, and priority of patient care, I feel like the rest comes along with experience, and time. This way, your patients stay safe, and you stay sane, which sometimes is all we can do at the end of the day. Don't succumb to the stress. At times you might feel small, and inept, but I assure you that certainly isn't the case. There are people relying on you, so you have to take care of yourself in order to take care of those who need you. You're likely doing a lot better than you imagine you're doing. Keep it up! Stay positive, if you can. You'll make it :)

I've been working at my hospital for over a year now. It was great when I started, because there were so many people I went to school with working there as well! Our hospital and school are linked financially, so they tend to hire new grads from our school more often than not. However, through out this year, many of my friends have left Some left for greener pastures, others just work on different shifts. Which is bound to happen, I know, but I miss them all greatly, and while working with them, felt it made my working experience a more home-like one. Don't get me wrong, I still love working there. Even with the oh-so-common issues that we all suffer through, i.e. short staffing. But also recently I've been asked by a number of co-workers if I wanted to transfer to the ICU. I mean, frequently asked. While I'm interested in a higher acuity setting, the ICU is extremely hard work (I'm talking manual work). Night shift ICU nurses are tasked with giving the baths, weighing the patients daily, and though wounds should be done 24/7, it seems like night shift gets tasked with that responsibility more often than not. I know I shouldn't be concerned with that stuff, because it's just part of the job. But primarying those already high acuity patients is strenuous enough without adding the extra manual responsibilities. I feel like that makes me whiny, or even slightly superficial to have that affect my decision. But I can't help how I feel. Another consideration is working in the ED. I've been more and more interested recently in considering a position in the ED, but never attempted to look prior due to a lack of self-confidence. I'm feeling less worried that I won't be able to handle it, but my concern there is not working weekend-option (as I am now) and losing out of my shift differential (as I'm the only person creating income for our family). So, there are my problems, or possibly none at all. Should I consider a position in the ICU (which, by the way, offered me a weekend-option position)? Should I try and find a weekend-option position in the ED? Stick around in Med-Surg for more experience? Ultimately, I know, it is my decision, and one that I'll have to make alone. But I guess I'm sort of curious as to what y'all might have done. Talking these things out sometimes give me perspective, and help me make an informative decision. Thanks for reading my rant :)

There are always the basics that will likely apply to most patients. Risk of Injury Knowledge Deficit Ability to return to previous living arrangements Some others that could apply to your patient: Infection Risk of infection Nutritional deficit Alteration of comfort Are you at work now? We usually have to complete a care plan on admission, and our admission has to be done within 24 hours of the patient hitting the floor (started within 4 hours). I don't know how it is at your facility, but at ours, we can start a care plan, and any RN can go in, and edit/add/remove as needed at a later time.

If you really wanted to do correctional nursing, then go for it. However, I see an advantage of taking the Med/Surg position, and that is, if you didn't like it as much as you originally thought, there (might) be the possibility of transferring to a different department (maybe back to Psych, if they have it, and you want it). Ultimately, even if we all shared our experiences with you, only you can tell where you really want to be. I'm in Med/Surg myself, and never had any experience with correctional nursing. Med/Surg is absolute chaos at times, but that's a reason why I enjoy it. There is usually a great deal of charting, and a lot of time management... Overwhelming at times. I like it because there is seemingly always something new. I was never fully keen on the idea of long term care. I think in your mind, you're already leaning towards one. Go with your gut.

Nurse glorifying, and nurse cynicism, neither bother me really. Honestly, I think we've earned a bit of glorifying. The idea that what we do every day is thanks enough really is fine with me, but working day to day in a relatively thank-less job, I don't really see an issue of expressing how awesome we are on a t-shirt. Especially since some of those are humorous. I especially enjoy the one that states, "RN - does not stand for refreshments, and narcotics." I guess the cynic ones sometimes make me laugh too, honestly. Not that I always agree with what they're stating, but I have a sense of humor, and it can be twisted at times.

^^ What should be, and what usually is, varies in almost every environment :) I don't have a problem getting vitals, I just don't like waking up the patient. And the charting, mang. Nurses usually chart their ADL's every other hour, and the techs in between. Primary care? Charting every hour, vitals, cleaning patients, toileting, feeding, meds, I think we get the point. It's a lot. Now, if it were only vitals + nursing care, then yeah, that's a great deal easier. We also have very limited Dynamaps, but we're good about sharing. I work with an excellent crew of nurses.

If I'm doing primary care, yes. If we have a PCT on the floor, I still wait for my vitals to pass meds... Unless they only have something like Protonix, or Insulin. But pain meds, cardiac meds, etc., definitely. In fact, we had to primary 5 patients a piece last night (I had an admission as well). Admissions while doing primary care is even worse, because you have to do everything: Vitals, weight, inventory, tele (if they need it), plus all of the nurse stuff - The works. I obviously survived, but it was busy for sure. I had two total care patients, one in which I was constantly suctioning to prevent from aspirating. With talk of snow coming tonight, I'm not really excited about waking up to go in tonight :) At least I'll already know my patients, and my assessments will be that much easier.