NamasteN

there are no "always" and "alls" in life or in Med/Surg. Sometimes I get out out on time which means 730 and many new grads go to med/surg but not all. what is it like? crazy, busy, never ending, varied, hectic, frustrating, enjoyable, interesting and more. and all in the same day! an average day : My alarm goes off at 0445, I leave my house at 0600 and arrive at the parking lot at 0645. I get on a shuttle bus that takes me to the hospital. 0700-0730 (or so) get report. 0730-0900 vital signs, introductions, assessments, insulin for diabetics, troubleshoot IV's, talk to doctors, case managers and make plans for admits, discharges and operations/tests like echos etc. for the day. 0900-1100 med pass, focused assessments, round with the docs if I can catch them, and keep doing all of the above. In addition, work with the aides if they need help with bathing etc. 11-1200 insulin again, charting, assess and keep doing everything as above. first pts are coming back from OR and new ones are going. admits and discharges. troubleshoot. 1200- 1400 or so there is usually a little lull where I run and wolf down some cheese and crackers or oatmeal and if I'm very lucky go grab a cup of coffee. Not a real break per se, but a quickie. 1400-1700. chart, pts coming back from the OR, dressing changes, insulin again and assessments. usually around 1700 when I think, "I got this" all hell breaks loose and someone goes downhill, a doctor freaks out over something, someone falls, or IV's go bad. always admits and discharges, family members want explanations, people puke, bleed and poop themselves. the fun never ends! In between I help my colleagues who might be having a worse day than me. 1700-1900 assess, vital signs, chart and try to be ready for report to the oncoming shift. If I am very lucky I may go grab a bottle of water and a snack to bring to the desk to eat while I chart. If this sounds hectic, it doesn't even begin to explain reality. It's non stop all day, 12 hours mostly on my feet, mostly putting out "fires" and troubleshooting. This is a normal day with no real tragedies. 1900 start giving report and hopefully be done by 1930 but almost never does that happen. I usually leave by 2000 (8PM) take a shuttle to my car and am home by 9 PM. asleep by 945 PM .

Nursing jobs are very competitive in my area. Most hospitals want a BSN and I have an ADN. So I travel 50 minutes one way to the only hospital in the area willing to take a new nurse.

I am torn and want your take on this situation. I have a resident who fell and has a compound fracture of the ankle. She has dementia. Family doesn't want anything done except comfort care. The resident is also hospice care. Being given Roxanol TID, 0.5 ml, and 0.25 ml PRN Q3H. Last night I noticed her leg is red to the knee. The bone is showing at the ankle, the bruise extends to the foot, the ankle is red bruised and swollen. No temp, BP 108/64, pulse 105. O2 sat 93 on room air. I gave her all the Roxanol I could on my shift but noticed no one else is giving the PRN. She was moaning and restless. I am an agency nurse so probably won't be there again tonight. My question to all of you is this. Is it ok for a family to allow a resident to die of pain and infection? The supervisor says we are managing her pain so that's it. I guess I mean as a human being, take off your nurse hat for a minute, is this ok? I guess casting and setting makes no sense? I just feel so sad about this. What's your opinions?

For better or worse, here in NY most LTC facilities have several units. One for dementia pts, one for stable but very sick pts and one for rehab. It doesn't matter which unit I am on, they are all hard. The 40 dementia pts are screaming, falling and fighting. The stable ones have 10-15 meds apiece including up to 20 of them being diabetics and are very demanding. The rehabs are straight out of the hospital, considered sub-acute and have wounds, pain meds, PT, everything they had in the hospital except now they share a nurse with 19 other patients. LTC is off the charts unsafe and nuts. (for the most part) [/COLOR][/font]

I too am coming from LTC where some evenings I am the only nurse with 40 patients. Looking forward to now being an RN at a hospital with 4-6 patients. I realize they will be more acute, but still it has to be easier than 40 no mater what!

"But for my mental sanity, I finally feel like I have an 'out' from nights and that makes me so excited. " To me, this trumps it all. You really want days! And it's a better quality of life. Yes your daughter will go to day care more, but actually she will see you more, since you will be there for holidays and weekends. WEEKENDS!! I know $450 is nothing to sneeze at, but in my experience something always comes up. Can you cut back anywhere? Take serious stock of your finances. It sounds like this new job is what you really want. Try not to be a slave to the money. Do without to gain a better life. IMHO.

I attended a community college, 2 year program and have found that most associates programs do a lot more hands on than the BSN programs. I have a lot of experience with all the skills you mentioned with the exception of chest tubes. Unfortunately, a lot of hospitals do not allow students to practice. So new nurses are unprepared. You catch up fast though.

You will also make more on weekends. The difference in pay is not worth the debate. Go where you put all the exclamation points ! :) Magnet hospitals are the bomb!

For COPD higher amnounts of O2 are not the answer, but delivery system is. Use a non-rebreather at no more than 4-6L/min. Face mask is useless. Give a neb tx, sit upright, slow deep breaths. If it's only on exertion, need to rethink PT

I did it last week, got the good pop up passed. So did all of my nursing school class. Not sure if this means it works ALL the time, but it does work. You have to use a valid card and be prepared to pay the 200$ which if you are going to take the test again you are going to pay again. Parts of This thread just goes to prove that nurses really do eat their young haha.

Look up Mike Linares on you tube and facebook. He has a website as well and charges for his Nursing Made simple, but I got enough free stuff from those 2 places. He's cute, smart, funny and breaks it down to understandable basics.

I always made index cards and carried them around. Reading out loud helps me too. Another thing I did was watch youtube videos of procedures. Hearing someone else do it out loud helped me. Love the NCLEX RN books as well, Exam Cram and Saunders. I would underline key concepts in my books, them write out those sentences, then break it down to cards. By then I had a good grasp. All I did in school was study, every spare minute. LPN to RN as well :) good luck!

I guess it depends on your style of learning and studying. Our program had us purchase the Saunders NCLEX review and we read that along with out Med-Surg book for each topic and did the questions. We also had Kaplan and did those throughout. I also had the NCLEX Exam-Cram book by Pearson who is the company that writes the tests. I had no desire to take the NCLEX more than once, I cared deeply about my grades in school, (some fellow students were the "I don't care about my grades as long as I pass" types) and I just want to know everything we are supposed to know. So all that being said, I studied for the NCLEX every day all through school. I did NCLEX questions on the topics we learned then after school and before the NCLEX I kicked it into high gear studying pretty much 200 questions a day. So you have all kinds of test takes responding. It is up to you to know yourself and how confident you are. The NCLEX is nerve-wracking enough, I didn't want to take any chances! :)

This is actually a very old practice. In the 'olden days' there were no such thing as disposable depends. But this doesn't mean to not clean the patients. I have worked in LTC and in hospitals and I can tell you that no one ever takes responsibility. The nursing home says the hospital caused it and vice versa. I do know that in LTC that kind of excoriation is seen less. In my experience. That is why the LTC facility does a full body check when the client returns from a hospital visit, to document every inch of their body. No matter what the cause or who's to blame, the patient is the victim.

I could have written that same post. Took my NCLEX yesterday too, and had almost all alternative formats. Everyone says that means I passed because I had all higher level questions. But I feel like I was punched in the stomach. I did the PVT and got the good message so cautiously optimistic until I can find out tomorrow for real. I am an LPN and at work today I knew I was thinking like an RN. :) Hang in there, you are not alone. Hugs from one scared nurse to another.

LPn at age 50, after teaching middle school for 15 years. Now at 57 just became an RN. Bet I'm older than you! í ½í¸Š

I feel like I'm having a heart attack! Just got home from taking the test, I had probably 2/3 alternate format questions!! So many meds and no trade names, just generic. Arrgh! But I did the 'trick' and got the good pop-up, is it 100% reliable? I dont think I could go through this again!

Do you have the Kaplan course? Did you watch all of the videos? Especially helpful are the decision tree and NCLEX review videos that specifically teach you how to break down the questions. Go back and do all of the Kaplan stuff if you have it.

Get an NCLEX review book either Saunders or Exam Cram. Read the section you're studying in class and do the tests. It's good practice for the NCLEX too. I also carry index cards everywhere I go. If I get a break at work, (I'm an LPN) I whip them out and study. Best of luck. One more thing, if at all possible don't work full time.

That's exactly what I did. The first year of RN was mostly CNA stuff you learned in LPN school. Then we went straight into Cardio/Pulmonary. The things I needed to review were head to toe assessment, wound assessment, vitals, abnormals, lab values etc. everything else is going to be stuff you learned in LPN but at a much deeper level. You will hear the topic and think oh ok I know this then a paragraph in you're madly taking notes and as lost as the student next to you. It was not hard to "reset my thinking" not sure what your teacher meant by that but some of my profs were not fans of LPN's and were hard on us in lab. I know I had picked up some bad habits in the nursing home so you might want to review skills, like trach, and catheter insertion and sterile procedure. You'll be fine, have an open mind and get ready, it's hard!

Definitely oversimplifying for the purpose of giving an example. ? That is how the test works, I was trying to let the person asking the question realize that there is no need to memorize every single thing, in order to pass you need to be able to apply what you know to bedside situations.

I would add that it is entirely possible to know which questions are higher level passing ones. They ask you to analyze or assess. Lower level "fail" questions are recall/facts. Ex. these are your patients K+ levels, what does it mean? is a passing question vs. Is 5.5 a normal K+ level.

In order to pass the NCLEX your practice scores should be in the 65 and up range. If you are still scoring so low you are making critical thinking mistakes. Kaplan has many strategies for analyzing questions. I am fortunate that my school purchased the program for us. You may want to consider that since you are having so many problems. Here are a few tips from the Kaplan training videos I have watched so far, 1. always identify what the topic is. Similar to when in school you had to find the "main idea" of a sentence. Eliminate all extra fluff. 2. Eliminate choices. Most likely you can eliminate one or two answers just because you know. 3. DO NOT use background info or read into the question. If you find yourself saying "yeah but" or "what if" you are reading into the question. Only use the info you are given in THIS situation. Look for priority answers. The passing questions on NCLEX are critical thinking questions that involve analyzing, prioritizing etc. Look for words like MOST important thing for the nurse to do. Look for patterns in the answers. what are the answers asking. are there three that talk about the same thing? that is your topic. do not make up a set of circumstance to fit the questions sitation, again stick to the info given and only that. NCLEX world is a perfect nursing world. there are no limits on time, equipment or staff. if the best answer is "sit with the patient" don't be thinking "oh yeah right like I have time for that". In NCLEX world you have the time. You always have an MD's order. Never pass the buck. If there is something a nurse can do, do not answer "call the MD". Memorize lab values. They will show up as your patient has these labs what should you do. Always use therapeutic communication with everyone, patients, colleagues and families. Eliminate answers that are authoritarian, (do what I say), are Yes/no answers (are you in pain), or ask why (why are you sleeping on your sutures). Don't say "don't worry" to a patient in any form, or focus on nurses experience. (Oh, I know how you feel I had colitis once). Do not delegate assessment, teaching or evaluation. Also a lot of passing questions are based on Maslow, know that. In Maslow pain is considered psychosocial so ABC's come first. Then you need to know which pt. to see first. Unstable before stable, real problem vs. potential, ABC's, acute before chronic, unexpected outcome before expected. I hope these help. The book EXAM CRAM by pearson is written by the people who write the NCLEX (pearson) I used it for my LPN exam and am using it now to get ready for the RN. It has every topic with questions and a CD and online resources. Best of luck.

Try the Kaplan program. They offer a money back guarantee. Do you have an NCLEX prep book? I found the EXAM-Cram series to be excellent as it is written by Pearson, the people who write the NCLEX. Sounds like you need to practice HOW to test as well as straight up knowledge. There are strategies to taking multiple choice tests and that book will help greatly.

Look at Sage in Albany, NY. about a 15 month program.