Shanua

It's routine for recent graduates who pass the NCLEX to work as a CNA or PCT until they start the nurse residency or move for a new job where I work. No one has a problem with it. I think hiding it may get you into trouble there though.

I started as an adjunct doing clinical. You may contact the faculty directly with interest. Adjunct doesn't always pay the best, it depends on the school, experience and qualifications. But it does put your foot in the door. The MSN program I went to required 135 hours of clinical towards education - I could count my adjunct teaching but observations with educators, teaching classes etc all with mentors.

I made a expected schedule of the day. You should be doing your first assessment and vital signs at this time. Your med pass at this time. Your second assessment at this time. A list of expectations of the day. I also made a charting check list. It gave them what they should be charting and when and tips on how to do it. The students have a sheet that they have to be checked off prior to clinical. The students I work with can be in clinical before formally checked off on all skills. They are checked off on all meds and IVs before clinical but other procedures are learned throughout the semester.

I was an adjunct with a BSN but was required to be enrolled in an MSN program. Most BSN's can teach at ADN programs. A general rule of thumb is you should have one degree higher then what you are teaching. They prefer MSNs for teaching at the university level but can file exceptions with the state board. Each program is different.

Take what the students say with a grain of salt. Sort through and determine the feedback you can learn from and is applicable. There's is always feedback you can't change (the content of the course, the passing standards, the testing) but you can improve your teaching. You can ask for specifics. Try a flipped classroom where the students teach. Try case studies or other methods. Students today are hard. Lectures aren't always where or how they learn. Ask other instructors. Observe other teachers. Ask more specific feedback. What can be improved? and how would you do this? Students can usually offer good suggestions and things you wouldn't think of.

We use it for alcohol withdrawal. I like the fact that we use an order set with all the medications (MVI, Thiamine, Librium, Haldol etc) and Ativan per CIWA. Some patients do request the Ativan and will manipulate the scale. It an be helpful when giving the higher doses, to ensure reassessment and to able to communicate to physicians.

Everyone has different techniques. I've seen BP cuffs or ace wraps instead of tourniquets. I also have some nurse that don't use a tourniquet when they blow. It takes practice and some people are just naturals. It sounds like you are doing very well really.

I think you're feeling normal for a new grad. That being said this job is not your job for ever. There are lots of other options. But every unit/job has a learning curve. You may be stress for the first part of any job. I do recommend vacations. I recommend taking classes - My patient coded my first shift, my response was to sign up for ACLS. Talk to your manager and see if they have recommendations or thoughts. Shadow on another unit. Find a mentor. Find ways to destress - yoga, exercise, etc. Every job has some level of stress but it varies and how you can handled it varies.

The hospital I worked at tried this a few years ago. They faxed an SBAR to the floor. It didn't speed up anything. They called to get the bed, when the SBAR was faxed and when they were bringing up the patient. It didn't contain a lot of the information a nurse wants and didn't speed up the process at all. They went back to verbal report. If a nurse is busy the charge takes report and settles them in. ER works with the floor when they are busy and the floors works with ER. It is a team.

The hospital I work at is starting something like this. It's not a binding contract but something to show that we've educated on the fall risks and put the patient on fall precautions. AMS patients can have family member sign. It's more to raise awareness and there is a huge push to decrease falls. It's starting October 1st so I'm not really sure of all the details. In no way is it a contract that will reflective negatively on the nurse if she has a fall. It's not legally binding to fall back on patient either.

I still work with them. Not very many but a few. They are either "grandfathered" in or must be enrolled in an RN program. All are required to be IV certified too which helps a lot. The attitude of them makes a difference. The one that I work with that is grandfathered in takes great care of her patients and has a great attitude. I trust her more then a new grad RN any day. However, I have worked nights where they made half of my staff and with 8 admits it was not a fun night. They have limitations and sometimes it can greatly break my night. Working an new RN that worked as an LPN is a huge difference so in that aspect I think it's a good thing.

It's possible you still qualify for a residency or new grad program. My hospital requires it for anyone without acute hospital experience. We've had nurses who've worked in clinics or outpatient areas go through it and new grads. Anyone that hasn't been a nurse in the hospital. There may be options for you.

ER Techs transport generally. ER nurses do frequently though. There are 16 beds in the ER and only 2 nurses after 11pm (2 on days, a 10a-10p, and a 11a-11p). A tech is scheduled every night. Sometimes if they are busy or it'll be a bit they ask the floor nurse or charge nurse to come get the patient. I have never turned them down. It's a team situation. Most of the ER nurses are great and more then willing to work with the floor nurses and vice versa.

I work in med/surg. A nurse with 6months is still new. It takes a while to be comfortable and to have time management down. It may not be where you want to work forever but take somethings into consideration. Do you want to work in L&D at the same hospital? How soon are internal transfers allowed? My hospital has a policy of 1 year for a new grad but exceptions are made. Can you float, orient or shadow in L&D? Many of the nurses I've worked with who didn't like med/surg and weren't sure what to do shadowed units that had openings. My current boss is pretty nice about things like this and just wants people to be happy. Previous bosses blackballed or enforced policies strictly. You'll find what works for you. But at this point being slow is pretty normal.

Good advice. Find what sets you apart. Do you have a certification? Did an internship? Took ACLS, PALS, etc. I put my capstone and internship experiences on my resume to show that I did have experience in the facility that I wanted to work in. One of my friends got hired at a peds hospital after a year because she took PALS even though she had only worked on a med/surg floor. Showing an interest and making an effort can set you apart.