RschIVF40

I agree with icumaggieRN and Meriwhen. Also, if you end up writing a recommendation letter for nursing school for this relative, they may then expect assistance regarding another recommendation letter when they graduate and start looking for their first job as well. I am in total agreement that you suggest that this relative utilize recommendations from their instructors or employers, as these individuals would be able to better assess this relative's traits and/or working style than yourself since you barely know her. Best Wishes!

Sorry to get in on this conversation at the last minute. I would move forward from that situation and not get overly stressed about it, but rather utilize it as a learning situation and just NOT repeat doing this sort of thing. In the future, I would be very cognizant regarding not sharing information about patients with family members even if it is "general terms the nature of the injury" as well as the "gender" of any patient with family members or friends or even other patients. Although we all have difficult, challenging or unusual situations that arise at work, it may be best to just discuss how you handled your day, or various situations (i.e. I was able to effectively resolve an extremely emotionally challenging situation today), as opposed to discussing any information regarding the patient. I agree with "onedayitllbeme" regarding reviewing HIPAA as we all need support. Best Wishes

Although I'm getting in on the tail-end of this convo, I've done rsch at work as well as am doing it for my PhD. You mentioned you have no research background. Conducting a research study requires quite a bit of work and can be very time-consuming and specific protocols must be followed as per the IRB. Thus, it may be more challenging to get funding from the NIH without previous research experience. That being said, perhaps if your clinic partners with another clinic (or MD office) with research experience, you could then move forward with conducting the research. Better to learn from those who have actually done research before to assure that the study goes off without a hitch especially when patients are involved. Research can be very rewarding. Best Wishes!

I agree with RunBabyRN, and the other comments regarding that fact that it may depend on your geographic location. In my experience, I've seen individuals with dreads at the MA, LVN, RN level, including management, as well as PA's & MD's. I have not heard that anyone was told to get rid of them as long as your dreads are kept clean, neat and pulled back (as required of any other long hairstyle during working hours, so as not to interfere with one's work). The main focus is attendance, skills, experience, personality, service excellence and quality.

I agree with what the other RN's have said regarding: 1) checking what the patient had previously and how they reacted to it; 2) giving the med that is the weakest / lasts longest, & 3) keeping the benzo/narc close by in the event it is required. I'd also check back with the attending MD to apprise him/her regarding the patient's BP & shortness of breath & continued request for pain meds. I'd also make sure to document everything ( i.e. following up with the attending MD or HBS MD, as well as your concerns) in the event that the patient has a negative outcome. You didn't mention the patient's diagnosis, so it is not clear what they are suffering from, nor did you mention how long they had been on all these pain meds. Some patients experiencing long-term chronic pain, are in fact actually just anxious and depressed due to the chronic pain and thus, may be more hypersensitive to pain. They may just "feel" as if they need more pain meds, when in fact, they do not. Taking that many pain meds over a long period of time can affect the pain receptors in their brain. Chronic pain is difficult to treat, especially if the patient is weak. Caution is essential if the patient has a low BP along with breathing issues in order to prevent over-sedation, etc. Good Luck

Hi all...Just a note, this survey has been extended through TUESDAY, DECEMBER 23, 2014. Thank you to all who may have already taken this survey. For those who have not...... The survey focuses on gathering feedback from clinicians & clinical staff including: NURSES, psychologists and other clinical staff who work or have worked in the field of IVF (In Vitro Fertilization), Fertility (REI) or Women's Health, and who have worked with patients undergoing IVF cycles regarding decision-making around embryos and embryo disposition decisions. Please see research survey invitation for survey link.. Thank you again for your time!

You might try applying for temp / volunteer work in family or internal medicine as a way to transition into this field...just a thought Best Wishes

I agree with RN403 and anh06005..I would also see about finding, perhaps, a senior RN and ask to "buddy up" / partner with that RN to get some additional on-the-job tips that this RN has learned throughout the years. Review that RN's charting may help you see what charting deficiencies you may be missing... Also, depending on where you work, some places (i.e. larger hospitals), often have RN educators as well for the RN staff. If your clinic / hospital has an RN educator on staff, you may ask to meet with that individual for some additional one-on-one coaching.. Best Wishes!

The government has a website that helps entrepreneurs develop small businesses. If you go to the US small business administration, they have a "tool" to help you create a business plan, in addition to a number of resources. (click on the left hand-side on the 2nd link to access additional resources for creating the business plan, (i.e. executive summary, market plan, strategic planning, etc.). I've attached their links are below. Please note, this is generic to all businesses, not specifically to nursing business plans....fyi Hope this helps! Create a Business Plan | The U.S. Small Business Administration | SBA.gov How to Write a Business Plan | The U.S. Small Business Administration | SBA.gov

Hi all...Just a note, this survey has been extended through SUNDAY, NOVEMBER 30, 2014. Thank you to all who may have already taken this survey. For those who have not...... The survey focuses on gathering feedback from clinicians & clinical staff including: NURSES, psychologists and other clinical staff who work or have worked in the field of IVF (In Vitro Fertilization), Fertility (REI) or Women's Health, and who have worked with patients undergoing IVF cycles regarding decision-making around embryos and embryo disposition decisions. Please see research survey invitation for survey link.. Thank you again for your time!

You might try volunteering for an entry-level research position as a way to get experience in the field at a hospital research dept or at a company that conducts clinical research trials, or try looking for a temp part-time entry-level research position, as a way to gain experience in the field.

Saying lots of prayers for a speedy recovery. Best Wishes!

I agree that it is challenging asking patients so many questions. At the front desk, when the patient is registering, they are just asked, "Any changes to your current address or phone number?"...our patients are fine with this. Specific to medication reconciliation and/or other questions, I start off with letting the patient know from the get go, that I need to ask them a number of questions that they may have been asked in the past, but in order to provide high quality care, I just need to confirm these again for the MD. I also let them know that I will get through these quickly as possible. I too, use humor to defuse the situation as well, especially when I can tell a patient is starting to get upset because of the questions.

I agree with roser13, that Ebola does not seem to be as much of a "stigma" as HIV/AIDS was "back in the day", mainly because it doesn't seem to be transmitted by sex, although my understanding is that Ebola can be found in semen (and other body fluids) once the person's symptoms appear. I'm not sure what protocol that Texas hospital utilized to care for the Ebola patient as well as remove their personal protective gear following caring for that first Ebola patient. It also isn't clear whether they wore full "bunny suit" protective wear, like the healthcare workers utilized in caring for the Ebola patients in Africa, or whether they only wore gowns, gloves and masks. I would agree that certainly, by not wearing eye protection, shoe covers, and a surgical cap, when caring for these patients could potentially lead to Ebola transmission if the caregiver was inadvertently splashed by the patient's body fluids if the caregiver had an open cut. I would also hope that the hospital followed the CDC protocols as they stated in caring for the patient as well.

I agree with what others have posted regarding this issue. And, not to berate you regarding the "forgetting to lock the med room", but that is a major issue, however, this certainly doesn't excuse your supervisor's behavior. That individual should have had better sense than to do what she did. Supervisors and Managers are supposed to "lead by example", not participate in making the situation even worse. Very, very poor decision-making on her part. I am not exactly sure where you work, but if you are in a hospital then you should have a compliance department and should be able to contact that department anonymously, to submit a complaint against your supervisor for her behavior, along with submitting an incident report regarding the incident. Most hospitals I've worked at have also had a "no-retaliation" policy as well, meaning that once the situation is investigated, the supervisor is not allowed to retaliate against the employee for turning that supervisor in, for example, by giving that individual a bad performance evaluation or by making things difficult for that employee. Best Wishes

I can understand your frustration. As you do have your nursing schooling background, some general ideas that come to mind include: pharmaceutical sales (if you like sales and people), health "coaching" for individuals, like in a gym or health spa around lifestyle changes. Or, taking more classes in business / management, or getting a nursing home administrator certification may then allow you to move over into a healthcare management / administrator role. Best wishes!

I'd have to agree with Nola009 and firstinfamily.. I've had my own share of healthcare issues / pain that developed over many, many years and have learned to work through these. If nursing is your true passion, you certainly won't have to worry about just "standing" as there is always work to do! However, If business / mgmt is the other path you choose, yet you prefer the healthcare field, perhaps you can merge the fields and go into healthcare administration (in a hospital / clinic / doctor's office). That way, you would be able to limit the amount pressure on your joints as you definitely spend your time walking as well as sitting at your desk. (Just a thought) Some things that have always helped me include: writing out a list of my goals, (education goals, and life goals), as well as writing out my "action plan" to attain both, along with the needed steps. Taking each step one at time should also help to reduce stress. I've also found that using positive affirmations (i.e. "I can do this!", "I will be successful!"), is much more helpful, as opposed to thinking negatively about oneself. I've also found that thinking / caring for others, has helped me not focus so much on my own pain / discomfort. I can understand that is may be a challenging time for you, but I am sure you can accomplish anything you put your mind to. Best Wishes!

Hi everyone...Just another reminder.....this survey is still going on and has been extended through FRIDAY, OCTOBER, 31, 2014. Thank you to all who may have already taken this survey. But for those who have not yet taken this survey... This survey focuses on gathering feedback specific to clinical decision-making from nurses (as well as physicians, psychologists, and other clinical staff) who work or have worked in the field of IVF (In Vitro Fertilization), Fertility (REI), or Women's Health and have experience working with patients undergoing IVF cycles specific to embryo disposition decisions. Thank you again for your time!

I agree that this is a very tricky situation when it comes to HIPAA and caring for friends. I'm assuming that your best friend was aware before her hospitalization that you are a nursing student, as well as where you work part-time as a CNA? Maybe, maybe not. In my experience, unless you are "assigned" as her CNA / nursing student, (i.e. because there are no other available staff to cover your best friend on the unit), you would NOT be able to "check" / "follow-up" on her situation for any friends (or family members) as that would certainly be a HIPAA violation. The fact that you are her best friend is irregardless of the situation. Just makes the situation more emotionally challenging to deal with. I would also NOT share any information with her friends, no matter how well you know them. If they continue to hound you with questions, I'd remind them that all medical information specific to patients if strictly confidential. I'd refer all family member to the attending physician and let your mutual friends know that they would need to follow up with her family. Unfortunately, no matter how well you know your friend or her family, when working in a medical situation, this may be challenging, you need to separate the person you know as "your best friend" outside your work, and start thinking of her and treating her just as you would any "patient". If your supervisor or nurse manager requires that you cover this patient (your best fiend), because there are no other staff available to cover her, you then would have access to her personal medical information. You'd need to keep any and all of her information confidential and not discuss this information with anyone (just as you would do with any patient). Again, the only time that I've seen hospital staff (i.e. an RN) communicate information to the family regarding a patient, who may be "a friend / best friend" who is hospitalized is if that individual has been directly assigned to cover the patient by their supervisor or nurse manager. Communication with family members regarding a patient's condition may be accepted by student nurses / CNAs depending on your hospital's protocols. In the hospital I work in, this is done by either the registered nurse or the attending physician, as opposed to student nurse / CNA, however, your hospital may have a different protocol / policy regarding patient status communications with family members. Again, if you are uncomfortable with any questions being directed toward you and/or if you are uncomfortable being asked to care for the patient (since she is your best friend), since confidential information would be disclosed to you, I would decline caring for this patient if at all possible. If not, and your best friend eventually finds out that you were assigned to care for her, (I can't tell from your post when she is conscious or not)...and your best friend gets upset (thinking that you were previ to "confidential" information that she doesn't want you to know, for example: perhaps her labs show something she is afraid of being disclosed to her family (like that you weren't even aware of)....just remind her that all medical information is extremely confidential and that it's not your place to discuss anything with her family (even though you are her best friend and very close with her family) And, just don't mention that you are aware regarding anything you think she may be embarrassed about (if she threw a tantrum, had a bladder scan, lab issue, etc. Just keep her care in the hospital as professional as possible. I would follow your hospital's standard protocols. Again, I would refer any questions from the family to the attending physician. Hope this helps!

While I can certainly commiserate regarding the frustration of being pulled in many different directions, and the periodic lack of CNA support. I've been in the same situation many times before and I have also found that discussing these issues with my DON regarding needing more support / responsiveness from the CNAs I work and have worked with, has allowed me and the RNs I work with, to focus on dispending meds as well as caring for our patients in addition to providing the CNAs with a sense of direction / expection. The CNAs that I work with are better able to anticipate needs as they have a set of expectations that includes a checklist with hourly / daily duties. The RNs work more closely with the CNAs as well so the CNAs know what to expect. On the other hand, I also have had the unpleasant experience of being a hospitalized patient (in a different hospital than I work in), which was not the most pleasant experience, so I can definitely see both sides. Although I wasn't in ICU, in my case, I had a joint replacement surgery, so I was in severe pain.. Due to some complications, my hospital stay was extended. Once the catheter came out, it was all I could do not to cry until someone, anyone (I didn't care who), can to assist me. I was not keen on using a bedpan, but I was rudely informed on the first day after my catheter was removed that I HAD to use the bedpan as there was no one who could take me to the bathroom. As I had a joint replacement, I was not able to maneuver well, and yes, I tipped my bedpan as I was getting off of it...definitely not a good thing to have a wet bed, especially when you can tell the RN who came to change the bed was angry. I didn't say anything or tell her who I was or where I worked. After sitting in a wet bed for 30 mins, I was roughly "assisted" to a chair while I screamed from of pain. All I can say is, although it can be challenging to be overwhelmed with work and lack of support, I think it is important to at least take a deep breath before helping each patient and remember why we all went into the helping profession in the first place. I don't think anyone wants the patients to "feel" / "sense" the angst we're going through especially because we won't be able to fully focus on their needs if we're overwhelmed and not feeling supported ourselves. Although some days are worse than others, if things don't get better then it's either time to speak to the higher ups regarding the situation or perhaps time to look for new opportunities. Best Wishes!

My suggestion is that you start with your state's Department of Public Health to check their requirements regarding foot and nail care standards around this. Podiatrists are required to follow the Department of Public Health's requirements for foot care and nail care, so this should help outline public health requirements / policies and may point you in the right direction as to what is required to start this business. There are also standards for nail care for Cosmetologists as well, as they deal with nails / nail care, so there should also be standards for them as well. After you have the DPH standards / policies for foot and nail care, you can then move on to obtaining a business license, etc. There should be an outline of how to start a small business in your state in your state's main government's website. Most states have this sort of thing. Below is a link to the U.S. Small Business Association that may provide resources for you to start your new business. Best Wishes! http://www.sba.gov/tools/sba-learning-center/search/training/starting-business

She received approval from her boss to leave work early. She didn't feel well enough to drive, so one of her co-workers gave her a ride home. During the ride, the abdominal pain and waves of nausea continued to grow in intensity. As her co-worker chattered away during the drive, her mind drifted to the appointment she just had with her OB/GYN approximately two weeks prior as that visit was unsettling. She had gone in for what seemed like the hundredth time to complain of continuing issues around severe dysmenorrhea and menorrhagia. She mentioned this all to her GYN and stated that she thought that these issues may point to endometriosis as she had a close family member who previously had been diagnosed with endometriosis by another MD. That family member was unable to have children and was forced to have a hysterectomy due to various complications from endo. As she relayed her fear regarding this to her GYN, she reminded him she was newly married and was concerned that she wouldn't be able to have children. He continued assuring her that she was "fine", "everything was normal". Her GYN told her she'd just have to deal with these symptoms as these were part of "being female". She wasn't exactly satisfied with the answers he provided and didn't truly feel she was being heard. However, she hadn't even thought of going to another OB/GYN for a 2nd opinion, as she just didn't have the confidence to question his medical expertise. This MD was a senior physician in his practice and had an excellent reputation in the community regarding his experience and knowledge in the field. As she was thinking about her prior GYN visit, a wave of severe pain suddenly snapped her back to reality. When her co-worker pulled into her driveway, things started to take a turn for the worst. While her co-worker was assisting her into her house, all of a sudden she felt an intense, sharp pain in her lower abdomen that made her scream out...The pain could only be described as a sharp, tearing sensation on her right side. When it happened, she doubled-over and screamed out from the excruciating pain. Suddenly, she had an overwhelming feeling that she was going to die and prayed to God for help. As her husband wasn't home from work yet, her co-worker quickly dialed 911 then called her husband to let him know what was going on. The ambulance crew arrived quickly and transported her to the hospital emergency room. When the ER MD arrived at the patient's bedside in the emergency room, he could tell she was in severe distress. The MD reviewed her history and followed standard patient assessment protocols along with ordering labs, a pregnancy test, and an ultrasound scan to check for an ectopic pregnancy. Her husband was sitting next to her when the MD came back to discuss her results. The patient was diagnosed with peritonitis which she was informed was due to a ruptured appendix. She was told she needed emergency surgery to clean out the infection in her abdomen and remove her ruptured appendix. She then met with a general surgeon who reviewed her surgery plan. She was reassured that this type of surgery was a very easy, routine surgery and would leave just a very small scar. When she woke up from surgery she was still very groggy. While she rubbed her eyes and tried to focus, she stifled the need to cough because the pain in her abdomen was excruciating. As she started moaning, the floor nurse assigned to her assisted her with her PCA pump. The patient felt on her abdomen and was surprised that she had quite a bit of bandaging covering her entire lower abdomen. She asked the nurse about the bandaging. The nurse didn't say much other than that her MD would be in shortly. The patient suddenly got a sinking feeling. Something didn't seem quite right. The nurse gently patted her arm and suggested she squeeze the "tummy" pillow that had been placed on her stomach to assist with the abdominal pain during coughing spasms. She was also reminded to use her "breathing toy" as well. As the patient struggled to maneuver herself in bed, she noticed her husband dozing in a chair in her hospital room. Suddenly, a physician she didn't recognize waltzed into her room. She had no idea whom this MD was, as he wasn't the general surgeon or the ER MD she previously met. She was in the middle of wondering what was going on when this MD introduced himself as a "specialist". She noticed the department listed on his lab coat was embroidered "GYN Oncology". The specialist greeted her husband as if they had previously met, so she was a little confused. When she looked at her husband, she could tell he was trying to remain calm, but the look on his face scared her. Just as she was wondering what was going on, the specialist informed her that he was called in after her surgeon opened her up in the operating room. He then told her that there were some "complications" that came to light during her surgery for her ruptured appendix and corresponding peritonitis. As the specialist spoke, she looked at her husband who gently held her hand while he stood at the bedside. Her husband never cried, but she could see that his eyes were moist, as if he was going to start tearing up. In addition to a ruptured appendix and peritonitis, the "complications" uncovered in surgery turned out to be stage II high-grade ovarian cancer. After the general surgeon initially opened her up to remove her appendix and clean up the peritonitis, he realized she had oc. The GYN oncologist was called in to validate the ovarian cancer, which was confirmed via pathology. The GYN oncologist had spoken with her husband in the middle of her surgery to explain the surgical complications, her additional diagnosis, and the proposed treatment plan. A total abdominal hysterectomy was performed with a recommendation she also have chemotherapy. The patient was in total shock as this was a lot of information to take in. As the GYN oncologist reviewed the findings, he mentioned she should consider herself "lucky" that the oc was found at this stage, which he stated only happened by chance because her appendix ruptured. The patient wasn't sure if this was supposed to make her feel better or scare her...At that particular moment, she was just confused and numb. She had multiple questions...How could this have been missed? Why didn't her GYN listen to her when she saw him? Was it her fault? Was it his fault? How could this happen to her and her husband? If this had been caught earlier, would she still have lost her ability to have children? Was she going to die after all? As she sat in her hospital bed with these thoughts and questions swirling through her head, she hadn't even noticed that the GYN Oncologist had left her room and her floor nurse was at her bedside.The nurse gently touched her hand and said, "I'm really sorry. I know this must be very difficult for you and quite a shock to you and your husband. My aunt had ovarian cancer as well. She's doing fine now, but I understand how challenging receiving this sort of diagnosis can be. My aunt spoke with a psychologist following her diagnosis, which really helped." The nurse squeezed her hand gently and continued, "I'm here if you need to talk." Her husband thanked the nurse. The patient was silent, but then finally broke down in tears. The patient was finally discharged from the hospital and successfully completed her chemo. She was eventually deemed "cancer-free". As a result of her experience, she made the decision to go back to school with the goal of becoming a nurse. She felt it was important to let go of her sadness and anger and to utilize her challenging personal experiences in a positive way...by helping patients realize there is a light at the end of the tunnel, in addition to working closely with physicians to facilitate opportunities where they may realize that it's important to pro-actively listen to their patients instead of dismissing them. If you have an interest in women's health issues and would be interested in participating in a brief on-line PhD student research survey that is focused on clinician decision-making specific to embryo disposition discussions with patients, please go to my survey thread here on allnurses.com. This PhD research is titled: Factors affecting clinician decision-making in IV.

Hi all...Another reminder.....this survey is still going on and has been extended through Oct. 31, 2014. Thank you to all who may have already taken this survey. But for those who have not yet taken this survey... This survey focuses on gathering feedback specific to clinical decision-making from nurses (as well as physicians, psychologists, and other clinical staff) who work or have worked in the field of IVF (In Vitro Fertilization), Fertility (REI), or Women's Health and have experience working with patients undergoing IVF cycles specific to embryo disposition decisions. Thank you again for your time!

Hi all...Just a reminder.....this survey is still going on and has been extended through Sept 30, 2014. Thank you to all who may have already taken this survey. But for those who have not yet taken this survey... This survey focuses on gathering feedback specific to clinical decision-making from nurses (as well as physicians, psychologists, and other clinical staff) who work or have worked in the field of IVF (In Vitro Fertilization), Fertility (REI), or Women's Health and have experience working with patients undergoing IVF cycles specific to embryo disposition decisions. Thank you again for your time!

I've worked for over 15 years in Women's Health in an OB/GYN practice with 15 OB/GYNs. It can be very exciting and very busy depending on how extensive the practice is. That practice did the standard OB/GYN exams, i.e. paps, pelvic exams, as well as LEEPs, Colpos, and diagnostic hysteroscopies. It can be very rewarding field. Best Wishes!