S.G.

I just recently got a job offer and it's true that the lady job fair had 3000 applicants for 200 jobs throughout the hospital (not just nursing jobs). I'm on Oahu so unsure about Kona. Every time I've gotten a call about a job for which I've spied, they've asked me if I'm physically on the island. There are too many nurses and not enough jobs so they can be picky about it. It will be hard to find a job in any specialty where you don't have experience. They were open about many new grad RNs working as unit secretaries.

The only time we've ever been able to go to urgent care was with a referral from our PCM because of no available appointments or if we called Tricare first. The system is broken. It's crazy that they'd rather I take my kid to the ER for pink eye than to urgent care!

This is going to be dependent on facility. Many facilities say they are "tobacco free" but enforce as nicotine free on campus. E-cigs were specifically mentioned in my last employee orientation as a violation of policy even if they are nicotine free. I've never worked for a facility that explicitly refused to hire smokers but they have had a policy of no smoking during your shift (including your breaks). I, personally, would have no problem with them but I think it would be very unprofessional to see them used outside of a break room. I think it's a great compromise to prevent second hand smoke issues.

It can't hurt to go in. I've gone in and been given an application, left my résumé on file, and I've gotten calls for jobs they think my credentials fill. I've also been told that I cannot apply in person and have been directed to their online application. It's different for each facility.

It was policy at my last facility to run all minibags as a secondary with a NS flush bag that was changed every 24h. I would set the pump to run 30mL at the rate of the abx. That was the policy. Several nurses set the bag to run in at 10ml/h for patients with frequent abx or patients with IVs that were 24ga. They would sporadically get an order for fluids at kvo if it went on more than a day just to cover the legalities.

Posted in error.

I recently spoke with an ANG recruiter. There are few slots for RNs in the Guard and they are very competitive. The Army will want at least 2 years experience. If you lie by omission about your celiac, you risk dishonorable discharge and loss of benefits if found out so I'd stuck with trying to get a waiver. The application packet can take 6 months or more to come back as well. I'm not sure about the Air Force.

I've found nursing to be very cliquish but I wouldn't say I've encountered "lateral violence". I stick with taking care of my patients the best way that I can and that has including speaking with management and changing policies. I've been active in working with them to change practices and increase patient safety. With that being said, I don't care if people whisper about me behind my back. I do my job and I love my job. I don't have to invite these people over to dinner. I have to work with them toward a common goal. I have a professional relationship with all of my coworkers and a more personal friendship with a few of them. If I felt that I was working in a hostile environment (as opposed to an environment in which I didn't have personal relationships with my coworkers), I'd probably move on to a different unit. ETA - GrnTea has given some great advice.

We use the Morse Fall Scale and anyone scoring high risk automatically gets a bed alarm activated. All Ortho surgeries as well by hospital policy, since they had our facilities highest fall rates, are required to have a bed alarm. High fall risk patients get a sign on their door, a brightly colored bracelet, and a yellow blanket on their bed as well. Outside of policy dictated high fall risk patients, it's a nursing judgement. We chart the fall score and, even if they score low, there's a spot to indicate nursing judgement for moderate or high risk. Most of those nursing judgement reasons have already been mentioned. When I worked in the unit, I put any patient that was awake on a bed alarm because of all the lines and wires. There was a huge risk for tripping over them and pulling out lines causing trauma.

I wear gloves to protect myself, if not the patient. Our radiology dept left some of the central lines pretty bloody after insertion. I don't want my patients' blood on my hands even if I am going to wash my hands afterward. I always clean the line itself when I see blood on it but those things get nasty and not everyone cleans them.

I'll be completely honest here. I got into nursing as a fast track into the medical field. I wanted to be an MD. I originally majored in biomedical engineering (a great degree to fall back on if I decided against med school). Due to family issues I ended up dropping the program in the first semester of my junior year and withdrawing from my classes. I decided that Dec to apply to the nursing program at a local community college. I got a letter of acceptance and then a letter stating I was on the wait list. When I met with the program director she said the acceptance letter was an error in my favor and instead of waiting I was enrolled full time into the program's fall semester. I graduated in 2005. I decided that med school wasn't the way I wanted to go after being at the bedside. I love the nursing model of care and plan to pursue my MSN. I graduated with my BSN a year ago. I love that there is so much variety in nursing. I have so many different interests and can pursue each of them.

Are there any CNAs on the med surg floor? I've been the sole nurse before but the hospital had a policy that the nurse would not be alone. If there was no CNA, there would be 2 RNs. When I worked in the unit, it was 36 beds so I can't really relate to being the only RN there. We had a monitor tech to watch the tele. We did have a staffing ratio of up to 1:3 depending on acuity though.

We used the steri strips in a star pattern with tincture of benzoin underneath. I never had a patient or heard of a patient complain of any sort of blisters near the steri-strips in the two years I worked in Radiology.

Love your post, lindarn!

I had a doctor literally scream at me when I worked in the unit. It was 1am or so and a pt's labs had come back with a significant drop in her platelet count in addition to an increasing blood pressure. Anti hypertensives weren't working and the plt count was critically low. Given that she was on a heparin drip, I was concerned about HIT. I paged the house MD because critical care doesn't cover overnight. He suggested the issue was fluid overload and ordered CVP monitoring and lasix. I was fairly new to the unit but not convinced his orders were what was needed. He refused to assess the patient and wouldn't order further labs for the am. I spoke with my charge nurse and she agreed. We called the critical care doctor. He screamed at me for calling him while he wasn't covering the patient and told me to call the house doc. When I explained the situation, he ordered a slew of labs and d/c'd the heparin. He then called the house doctor and hollered at him for not taking care of the patient. The house doctor then showed up in the unit to yell at me and my charge nurse. My charge nurse backed me up and the night nursing supervisor backed both of us up. The patient did in fact have HIT. I was freaked out about being yelled at by 2 doctors in one night but I protected my patient and my license. I hate being yelled at but I will do what I think is right regardless. I'm not going to blindly follow just to prevent stepping on toes and getting yelled at. I may not have done what I did without the support of my charge nurse because I was just so new. It sounds cliche but I knew there was more wrong in my gut and didn't trust that particular physician and my charge nurse agreed.

This is the thought process I was following. You were able to voice it much more eloquently. As you've already said, the studies are flawed and can show no evidence that a BSN would improve the patient outcomes from an experienced nurse. I have never heard if someone finding a study that does not include these experienced nurses in its confusions that the BSN is of benefit. I do believe that it would benefit new grads but, again, there is no "real" evidence without a study excluding experienced nurses. Thank you for your opinions.

Thank you for your response. Very interesting indeed :) I had actually not been able to think if a practical application for my theories course. It's actually very refreshing to think I may use that information down the road just as you have done. It's good to see theory applied to what I find to be an interesting topic of discussion.

This is exactly what I was thinking! I'm not sure that we can get an accurate study to prove that a BSN itself actually has a causative effect on patient outcomes. I don't see way to actually do the study. And that could explain why I hadn't come across anyone addressing this issue. All the studies lump every BSN together and every ADN then compare the groups but cannot account for previous experience or education. I have difficulty putting much faith in studies that leave so many obvious flaws.

I think some of the push has to do with the ongoing battle of nursing to prove that it is a profession rather than "just a job". It has a very low entry level if education compared with other professions. It seems like the flawed research is used to push that agenda. Just my opinion though.

I did not research this particular topic. I have done past research on BSN patient outcomes and did not find this aspect addressed. I find it a bit harsh to say I'm lazy for not repeating an in depth search. No, I didn't read every thread on ADN vs BSN in the forum. The sheer number if comments was overwhelming and I, again, I did not see this aspect ever brought I to question. So, yes, on a forum this size it's easier to start a new topic that people perceive as the same in order to explore a portion if the discussion not previously discussed. Call it lazy if you will. I don't often spend hours researching when a question is sparked by sheer curiosity. Rather than starting a project for curiosity, I asked if others had come across information. It is not the same as asking someone to research for me. This isn't a work or school project. It was a random thought related to the other mentioning a of the ADN vs BSN threads I had seen. If you feel like I'm bearing a dead horse, feel free not to respond. The ADN vs BSN may be a dead horse. This isn't about that battle. My curiosity is about the research itself. People use the research to claim better patient outcomes are a result of higher education (in this case a BSN). If the research is going to be used to make such a broad claim, I wonder if any research has actually been done to see if there is an actual relationship between the BSN and outcomes or experience. In my opinion, higher education improved critical thinking. So does experience. It seems logical to me that BSN nurses would have better outcomes than ADN nurses given that so many BSNs were previously licensed and practicing. They have the combination of experience and higher education. I curious about what the results would be with RN-BSN students removed from the equation. I don't have the resources to even attempt such an undertaking as to do that sort of study. The research is lacking a flawed. I wondered if others had thoughts such as mine. I did not wonder if they would look for research for me. I will try to be more clear about what I mean in future.

We don't need a doctors order to push meds in a code if ACLS certified. Maybe that's different from state to state though. The last facility I worked for did a big push for nurses to start giving meds immediately during a code and not waiting for the entire code team or the MD. It's within our knowledge, scope, and training to do such. We do need orders for transfer and post code care from the MD though so I certainly hope he shows up! When I was a nurse in the unit, my pt coded and the PA on call slept through the code. We just called him after the pt stabilized and asked for orders. He came to the room the second time the guy coded.

Having just read the first post (I intend to read more), the topic in that thread is not what I'm curious about and does not differentiate research articles with a difference between RN-BSN and straight BSN patient outcomes. It's the same old ADN vs BSN without differentiation of those BSN nurses who were already practicing RNs that actually had me thinking about this topic.