mrod

Thank you so much for the advice, it is helpful. I can imagine how hard it is going to be but pregnancy and children are a challenge in itself anyway :) I will be breastfeeding for as long as it works out. I will not just give up right when I would go back to work, I am defiantely going to give it a shot. I just want to figure out the best way to do it. Several other people suggested pumping while driving as well LOL! I do alot in my car after the visit so that will be good time as well. Hey, if that is what it takes, I will make it work. My schedule is tight because I am a Team Leader, therefore I do SOC, ROC, Recerts and D/C's only and fill in treatment visit here and there. I also implement and develop policies sometimes with the Clinical Mgr, sit in team meetings for discussion of patients, go through OASIS training and refreshers, etc. Although my boss is very understanding and always understands when there is a wrench in the day and always helped me out. So if anyone else has done this before and as a plan I am still open to hear some suggestions or schedule plans. Thanks!

I would love to breastfeed my baby but I am obviously a visiting nurse and I am just wondering if anyone did it and how it was done? It would be greatly appreciated because I wouldn't want to not breastfeed my baby because of a job.

I get 32 cents per mile and $20 a week for cell phone. Does anyone know if mileage, cell phone and gas be claimed on taxes? Does anyone claim anything? Thanks

Ummmm...I think so. I had the cha-chas too and it was disgusting! More like undigested food s well. At times I felt like upchucking but never did. That was it for about a week. I know several people that had the same thing. Also, there is a cold of course going around too :-(

"Here's a perfect example: Nurse with maybe half year or more experience in our ICU almost killed her patient the other day letting Amiodarone run in at too high of a rate and couldn't figure out what she was doing and why pt's B/P was low. This same nurse was checking pulses with a doppler a few weeks ago, unable to find even the dorsalis pedis- I helped her find them. She was checking for posterior tibialis on the lateral side of the ankle, and then didn't even bother to get them right with the doppler. THIS NURSE SHOULD BE ON A MED-SURGE FLOOR learning the basics." Not sure if this really matters if she was in the critical care unit or MedSurg...she still did not know how to do it, either way she would of needed to be taught or maybe she just does not know what she doesn't know. Also, basic skills or not.....if you do not use them, you lose them. Now yes, knowing where pulses are and knowing how to check with a doppler if essential in the units but, how about if it is possible she never encountered this??? (Devil's advocate here) You can learn the basics in the critical care units and a good preceptor with teach that but a good nurse will be able to learn from their preceptor as well. I think it depends on the individual. Most critical care nurses are leaders, type A personalities but some are opposite. Some need that 6 month to 1 yr experience while others fly right into the critical care units. I say, go with what you feel and know what you know and know what you do not know...isn't that we we nurses do anyway??

Well December graduation is 3 months away....apply for the Nurse Tech in that dept. There you go you are a Nurse Tech in the ICU. Also being a new grad, it may be to your advantage to do Med/Surg or better yet Telemetry for 6 months before ICU. I was a Nurse Tech in the ICU/CCU/SICU for 2 yrs but I went to a telemetry floor for 6 months and then moved over to the units agai nas a nurse. I think it was for my benefit and 6 months goes by very fast when you are a new nurse! I would try to get in as a tech, if there is no openings....consider telemetry for 6 months and propose that to the recruitors. Also, of course keep in touch with them if you are on another floor and you will get into the unit much quicker. Hope this helps...

I sometimes get tongue twisted with saying short-hand...I think I might be the one that may say "stat" but mean "sat", although I know I say it wrong so to be honest I actually say the whole word when I give report or talk about it- saturation. I know I do that with other words that I get tongue tied with the short-version.

We use both and it depends on preference in our ICU/SICU unit. The standard is the fabric one on top of a sheet. Some nurses still use the draw sheet as well but I do not like the draw sheet because it gets "bunchie" under the skin. The fabric ones stay taught for the most part and I use two usually, that way when when gets up on their neck, you can pull it out and you still have another. The blue ones I usually used for "leakage" like it someone is third spacing and weepie, or when removing an A-line so I won't get anthing dirty or especially for NGT, again so I will not get anything dirty. I like both depending on what I use them for.

I love my secretaries!! I work overnight shifts and it really stinks when we do not have that overnight secretary or aid...it is wonderful to have them! I was also a nurse tech before I became an RN and understand the work so I appreciate it when we have them. I agree- heartfelt thanks to Techs/CNAs & Secretaries! :bowingpur

Well that is the thing about the Tele, I hated it....the type of nursing and the floor as a whole and also management. I was always extremely interested in critical care from the get-go but I also had an interest in home health. With that said, I can do 3 nights in a row in ICU and then I have 5 days off, that way this allows me to take one day and do per-diem day shift somewhere.

I have been a nurse for a year now in Massachusetts. Not the Boston area, south towards Providence, RI and the Cape. I started on a telemetry floor for the first 8 months and then recently started in March of this year on a ICU/CCU/SICU. In fact I get off orientation starting on Tuesday! Anyway, I work 36 hours, overnight 12 hour shifts with some 16 hour shifts because overtime is ridiculous where I work. I was looking into working somewhere else per-diem. I was thinking of a rehab facility or home health care or something but not sure if it is all worth it. My father works in home health care and he really likes it but he has been doing this for a couple of years now (he is almost 60 and this is his slow down RN career towards retirement as he calls it). I mentioned per-diem at his company doing visits one day a week or admissions. He did tell me that the paperwork can be overwhelming for someone who does it 1 day a week but he will look into it and call me back. Then there are the rehab places and long-term skilled facilities that are always looking for extra help! Wondering if that is a good choice?? Now some people ask me why I do not just pick up extra time on my unit since I LOVE critical care....well for one I cannot pick up an extra overnight, I mean physically, I cannot. Most of the shifts available are overnight or 3p to 11p, not bad but I was looking to mix up my skills a little bit. Critical care is mentally draining for me right now because I am new at it and wanted just to see what else is out there. Any suggestions or experiences in per-diem that anyone could share with me? Also, when I pick up the 16 hour shifts the first 4 hours for me is time and a half and also additional $7 as an incentive for overtime. Pretty good money for overtime but does an 8 hour shift per-diem compare? Thanks!

Hi, I have one that I have been working on all morning because I am starting the ICU/CCU/SICU in a week. I took all the ideas of other people and put one into my own. Here it is if you are interested. Mrod Oops....it did not upload? Anyone interested can give their e-mail in a PM and I can send it.

Thanks Lucky1RN....but I am not sure what you mean because I try to maintain the same sleep schedule on my days off but I cannot sleep. Do you mean stay up all night on my days off and sleep most of the day???

I always look this up in a drug book as well but off the top of my head and the drugs used often on my unit is that I always dilute Ativan and Morphine. We do not dilute Lasix or Digoxin or Protonix but we push very slow sometimes if need be on a Excelcier Pump ( a small little pump that can deliver 10 cc synringes) but like I said I ALWAYS check with the drug book or call pharmacy.

Okay, I have been doing the overnight shift for 8 months now. But first, let me tell you about my sleep pattern before I started overnights. Before I was an RN, I worked in business and worked the 9a to 5p Mon through Fri, in bed by 10-11p and woke up 6 am. I slept through the night, never, ever has insomnia, I am the type that I hit my head to the pillow and I fall asleep right away. My husband always said I could sleep anywhere, anytime like on a picket fence. So then I became an RN and started the overnight shift. No problems....I would go to bed right away after working all night and if it was my first night on and I needed to work the next night I would sleep from 8:30a to 4p no problem, all the way through. If it was my night off the next day I would sleep from 8:30a to about 1-2p perfectly. For a while my first night off I would fall asleep around 8-9p and wake up around 4a, no problem with this because the second night off I would go to bed between 10-11p and wake up at 7a. Okay NOW- for the last month on my nights on, I sleep perfectly durting the day, all the way through and fall asleep at 8:30a right away. It is the nights off that are affecting me now. My first night off, I am not tired at 10p and either I toss and turn all night and hardly have a good deep sleep like I usually do or I cannot sleep at all. This happens even on my second night off like tonight. I have a cold so you think I would be even more exhausted. Well I went to bed at 10p, comfortable and even took some melatonin and nope.....did not sleep, laid there tossing and turning from 10p to 4a. Here it is 5a and I am typing in the pitch dark. So anyone have problems with sleeping at night on their nights off? Like I said I feel like I sleep better during the day than at night and NEVER, NEVER had a problem sleeping my whole life. I do not want to give up night shift, I love it and the differential difference pays for our vacations and car insurance! One more thing, yes I work out 3 to 4 times a week and I drink tons of water and take my vitamins. Has anyone resorted to sleeping pills? I just started melatonin and nope, not working. I used to love working out before I go to bed...it had the oppositie effect on me. Sweat like crazy, get tired, take a nice shower and sleep like a baby. I might try this next...I am hopeless right now, please help if this has happened to anyone else!

WOW! This is exactly how I feel!

Well in general when stroke occurs in association with atrial fibrillation, patients have a greater mortality and morbidity, longer hospital stays, and greater disability than those without atrial fibrillation. Maybe one of the reasons he put him on Aspirin and not Coumadin or something because Aspirin is much safer than Coumadin because it is less likely to cause abnormal bleeding, including even strokes from bleeding due to the Coumadin itself. So since he is already at risk (previous stroke/TIA and age greater than 75) and probably because he received the stroke because of his a-fib....Actually in studies have shown that the use of coumadin vs aspirin with a-fib, coumadin was assessed with a significant lower incidence of CVA and cardiovascular events, but significant higher incidence of major bleeding, about twice as much as aspirin. I have heard that the majority of people with a-fib should be on coumadin with a goal INR of 3.0 but people who had a stroke and not on antiplatelet meds shouold be intiated on ASA 50-325 mg. I also heard that patients with lone atrial fib and no thromboembolic risk factors, the annual rate of stroke is 1%, and these patients seem to have little to gain from anticoagulation, therefore these patients may be prescribed aspirin if no contraindications exist. What is his PMH? Is this his first stroke? Has he had TIA's before? Was he on anticoagulation when he came in for his a-fib? What about his SBP? Hypertension and of course CHF is a risk factor for a cardioembolic stroke. Also sometimes restoring sinus rythm is not the best because the rate of stroke and death are not better with rhythm control than with rate control and anticoagulation. There is also a huge risk for toxicity with anti-arrhythiics as well. Just some thoughts, look into more information and I hope this helps.

In addition to above response: * Diagnoses, Conditions, Complications COPD, (the heart and lungs are married), Diabetes, HTN, hypotension, a-fib, brady/tachycardia *Medications Cardiac meds - remember O2 is as drug as well and is used often not only for CHF but for chest pain *Labs, Procedures BUN and creatine, glucose and CBG, D-Dimer, know your code status of your patient! *Nursing Skills CP assessment and your basic and advanced interventions *Classes that assist the Tele nurse CPR, ACLS and all in-services *Organization/ "Brain" Sheet for Time Management Get strips as soon as you get in and take a peek at your chart. Get a system that works for you, everyone is different. We get a report sheet printed when we come in. Some people use one sheet for all pts and some use a seperate sheet for each person. Some peopole write down vital signs and assessment on their sheets and others carry the flowsheet with them. Look at your MAR's when you start so you won't miss a med later on. Play around with it and watch other people to get an idea of things. *Tools in your pockets before the shift starts IV caps, piggyback caps, flushes, alcohol swabs, sharpie, scissors *Most important change of shift report information code status, positive or negative MI, abnormal labs, tests and labs coming up or next day, IV drips running It takes a little bit but I found that orientation is a prime opportunity to discover what could and could not work for you and then try it out. Good luck!

Does anyone do 50/50 Day-Night rotation? I am currently on a tele floor 7p-7a, 36 hours. I will be moving to a CV Step-Down unit in Jan and the shifts are day and night rotation (still 12 hour shifts). The manager explained to me that it will be 2 to 3 overnights a month with the rest days. Does anyone find this a drag or does it work out okay? Thanks!

Wow, thank you so much for the advice. After reading your reply and then thinking, I have not really transferred from student nurse to RN. I think it will come in time but your reply really put it into perspective. The only question I had is when you were talking about the labs. Someone told me on the floor that you should have all the labs so if you need to talk to the doctor you can have everything in front of you. I know it is available in the computer, butwouldn't it just be helpful to have it in front of you? How about if there is a code on the pt, you have the info. I was thinking about caring around the report sheet with me from the night before. It is a profile sheet that the last shift works on and then continues, like you mentioned about continuity. Although it is not "required" on our floor so some write the report and some don't and that is okay. I will get this and thanks again :wink2:

I am a new grad since July working on a tele floor. I have a great preceptor that teaches me alot of things, has patience and a personality. I am basically on my own but with that preceptor "crutch" for another 4 weeks (by myself Nov 2nd) and things are going well. Yes, it is overwhelming but it does get better everyday. I work overnights from 7p to 7a. My assignment can be anywhere between 3 to 5 patients which 5 is the max. I am a little anxious about seeing my patients and the time I am taking before I see them. I get in around 6:45 and start looking up my patients in the computer. I am looking at PMH, triponin levels, any BNP's, TSH and all other labs including aptt and INR (even though I do not give the coumadin, that is another thread question I will be sending) anyway, I also look up who is consulted and why, tests to be done on my shift or the next am, etc. Now lots of times when the RN leaving gives report they start to talk to my preceptor only which bugs me because they ALL know I am still with her but if she is sitting somewhere else I have to leave my computer and walk over to where she is and listen without looking up things as they talk. See, she is looking up in the computer she is at as they talk. So I am thinking this could be a reason why I am so slow but not really by that much. So by the time I look up say 4 patients, get report it is about 8:15 p. I get my VS and do my assessment on all my patients, it is now about 9 pm and then I combine most of my 8's and 10's together unless I have a couple of BP meds that I can give at 11. So, when does everyone else see their patients? I literally feel like I am running around with my head cutoff from 6:45 to about 1 in the morning! Is this normal or am I just way to slow? I just do not feel comfortable not knowing most about my patient before I see them and doing a good assessment I believe is important. Also, some RN's look at the chart while researching, how can they have the time during then to do that! I don't!! What is everyone elses routine, any suggestions?

I know exactly how you feel!! I just graduated myself and passed my boards about a month ago and I started on a tele floor. This whole month is classes every day except 4 days I am with my preceptor. I have been on the floor twice, once was to "observe" and the second time I just passed a few meds and observed as well. I am super nervous as well....my first day I was afraid and thought to myself that I could not do this nursing thing either. But I find that everyday gets easier and I cannot help myself to keep trying to put the pieces together. I am taking advantage of this time as well, to see what people do and don't do, who to ask, who not to ask, all that good stuff. I want to get the ball rolling here but I feel the same way you do. I will be 3 twelve hour nights and patient ratio is 4-5, (it is 3-4 during the day). Good luck and we can do this!!!

Southcoast Hospital Group (Charlton, St. Luke's and Tobey) $24.70 base (new grads) $2.80 evening diff $4.50 night diff $1.80 weekend diff They also pay for your NCLEX-RN review course

congrats to all, i passed!!!!!!

yes i passed!!!!!!!!!!!!