ICRN2008

I've been off of work for a year (staying home with my kids) and now I'm thinking about going back (prn or casual position, not full-time). Any tips to get back into the game? I think I'm going to be pretty limited by the fact that I will only work weekdays, day shift. I have a BSN, 3 specialty certifications and 10 years of work experience in healthcare (7 as an RN). I'm open to starting my own consulting business as well, but I honestly have no business experience.

I think every nursing job is stressful in one way or another. I've worked both at and away from the bedside. When you work bedside, your shift is brutal but then you turn your patients over to another nurse and leave. Working in infection prevention or occupational health, I was on-call 24/7, was salaried exempt and had to get the job done no matter what. That often meant getting calls at 5 am and working 60 hours a week with no overtime. I also had to be interviewed by Joint Commission and OSHA surveyors. That's a different kind of stress.

I'm considering returning to work at some point this year, but I will not be willing to commute longer than 30 minutes each way. And no more than 2 days a week.

The previous response was great. I found the "Getting Started in Occupational Health Nursing" CD by AOHP to be super helpful, along with my local AAOHN chapter for education, networking and support. And, of course, the AAOHN Core Curriculum Be prepared to spend a lot of time studying at first (in your off hours) but I find it to be a quite enjoyable field. This is especially true if you have a good support network of colleagues you can turn to when you're new.

I've been out of the game for a year now, but have not worked full-time in 3 years because I've been home with my children. I've started networking with old colleagues and found that I've received a pretty positive response so far. Attending local conferences in your specialty and taking an old colleague out to lunch are great ways to start. Our local community college also offers a refresher course if you've been out for 5 years or longer.

When I worked the floors I found that rounding every 15 minutes to half hour cut down on the number of call lights for things that could wait, by at least 80%. I also made it a point to chart on the mobile computers near the patient's rooms instead of at the nursing station. We had one nursing assistant for the entire floor, which meant that each nurse got help for one out of his/her five patients It was insane.

I currently work in occupational health and I am responsible for the following: Writing policies and procedures for my department Writing protocols for others in the department Designing systems for documentation and retention of employee health files Worker's compensation and OSHA log Assist with administration of FMLA and work comp Primary responsibility for temporary light duty and ADA accommodation programs Immunizations and TB testing First aid and triage of injured workers Education of staff and managers re: employee health topics (ie. bloodborne pathogens, FMLA, etc, etc). Absentee tracking, especially with regards to infectious diseases in conjunction with my role in infection control Also, many day to day tasks such as ordering medications and vaccines, attending trainings for state infectious disease reporting, immunization registry, serving as a liason to the health department, work comp company, contracted occupational health clinics and local ERs where our employees go for their pre-employment physicals and injury care. A lot of what I do is understanding both the clinical and legal aspects of a situation and making a good judgement with both in mind, as well as many administrative tasks such as policy writing, budgets, etc. I do not recommend this as a job for a new graduate because you really have to have a good nursing knowledge base, plus understand the legal aspects and be able to hold your ground in cases that can in rare circumstances become unpleasant (especially with regard to FMLA, short-term disability and work comp). You'll work very closely with the Human Resources department, so you'll also have to develop a good relationship with them. In some cases, you'll report to a human resources director who does not necessarily have a medical background. The rewarding aspects are working with employees, helping to better their health, putting forth new safety initiatives that really make a difference, and being able to work with a relatively well population during business hours (generally 8-5 Monday - Friday)

Oh, and we had to document the IV site assessment hourly as well. This came after a few lawsuits for infiltrated IVs. We managed to do our hourly rounding, but we usually only had four patients. Even then, we were running around the entire shift and often didn't get any breaks.

In peds we were required to document hourly: Patient alertness, position and activity (ie calm, crying, etc). We had to do hourly pain assessments on all patients in pain, especially sickle cell patients on PCAs. We had to document IV VTBI and PCA injections attemps hourly as well. It was difficult to say the least, especially when we only had one CNA for the entire unit, and he/she was assigned one patient with each nurse.

There are many vector-borne diseases that are making a comeback. I just read a book about the Yellow Fever epidemic in Memphis around the turn of the century, and it certainly serves as a cautionary tale for us today. I know that many people are opposed to widespread spraying of DDT and other pesticides or draining wetlands, but in certain areas this may be necessary if trends continue. Scary!

At the peds hospital I worked at, the rapid response team consisted of a critical care RN, critical care RT (many times our team from the helicoptor would come by), out team's resident MD, and the senior resident. A few times I had to call in the RRT because the resident MD was too pigheaded to ask for help. I once had a kid whose HR dipped into the low 40s while awake, and it took forever to get someone to order an EKG. That was pretty scary, but he did okay.

I am still learning, having just started in infection control. I can tell you that our practice right now is not to do titers on new employees who have already gotten the series. Many times it will come back negative, but doing the series over again isn't necessary to maintain immunity. A few employees who have sustained needlestick injuries have elected to get the recommended booster injection. We still do a titer 2 months after the series is completed on those who are newly immunized against Hepatitis B. I was surprised to find out that there are still nurses and other health care workers who haven't been immunized.

I know that there can be minimum qualifications for hiring someone, but can they discriminate against someone because they have "too much" education.? I would think that if they made this a written policy as opposed to an informal practice they may be opening themselves up for a lawsuit. There has to be some way for new grad RNs to gain experience for advanced practice programs in such a way that it doesn't leave employers high and dry when all their new grads quit after a year. What about a lower-paying Post-BSN residency program that focuses on preparing nurses for grad school?

PS I hope it's not urgent because you're taking an online test. Because if so, it's cheating to ask others for help....

G stands for gamma, A stands for alpha, M stands for mu, etc. Greek letters

We had stickers printed out on our unit because of a new IV initiative. It includes date, time, number of attempts, 22 ga or whatever, how IV was secured (statlock, tegaderm, etc), flushes easily and good blood return check, and RN signature. Sticker gets put into the progress notes.

If you want to be pre-med and be serious about it, then you will have to spend some time during undergrad doing research in a lab, heavy duty volunteer work, honors classes, or some other activity that will make you stand out during the med school admission process. If you major in nursing, you will instead be spending your time at clinicals and in classes that in the long run may not help your chances of admission. If you are very serious about med school, then go for it. However, make sure that is what you really want to do, because med schools don't typically accept applicants who don't have a good understanding of the profession (with its pitfalls as well as benefits) and a strong desire to succeed. Working during undergrad might be forgiven during the admission process if the work is meaningful and you can articulate what you learned from it (some examples that come to mind include research labs, health unit secretary at a hospital, or caretaker at primate research facility). However, I can guarantee that working as a nurse will only HURT your chances of admission, because med schools generally like people who are "clean slates", not those who might have a hard time transitioning from one role to another.

Many states do not allow phone triage by RNs without specific physcian protocols. LPNs, because they cannot assess and evaluate, cannot do phone triage. I doubt that MAs can either

When I worked inpatient peds hematology, I had some pretty young adolescents on HUGE doses of morphine or hydromorphone via PCA. One guy had to have a special concentration of morphine prepared (5 mg/1 ml versus the normal 1 mg/1 ml) because otherwise we were changing the bag multiple times per day. I think his dose was 10 mg q 10 minutes on a PCA- something crazy like that. He was still up and talking.

I'm trying to think back to when I worked in the lab and used to run 24 hour urine proteins often. I'm sure I've seen them that high before. If you're around long enough, you see everything. High levels like this could also happen with Bence-Jones proteins from a multiple myeloma patient....

My pay is poor by comparison, especially considering that I'm salary and don't get paid for overtime. On the other hand, I work M-F day shift, which is nice.

Maybe she was a medic in the navy? I have heard of medics in the military whose scope of practice is such that they used to be able to challenge PA boards - but I don't think that can happen anymore. Clearly, no matter what she did in the military, she is not currently a nurse or a PA and should not be referring to herself as such.

As a side note, the Joint Commission has issued an advisory addressing bad behavior among health care professionals. Per one of our risk management people, this is mostly aimed at physicians who yell, scream, intimidate and throw things. Prima donna behavior should be included IMO because it impairs team communication. At first I wonder why they felt that they had to come out and say this in an advisory, but after a few personal experiences and stories by other nurses, I no longer need to wonder... http://www.jointcommission.org/NewsRoom/NewsReleases/nr_07_09_08.htm Congrats on a job well done.

Pseudo refers to Pseudomonas. This is an opportunistic infection found in severely immunocompromised patients as well as those with cystic fibrosis who cannot effectively clear their secretions. It tends to be highly resistant to antibiotics. http://www.emedicine.com/med/topic1943.htm Acinetobacter has the potential to be highly resistant to antibiotics as well http://www.cdc.gov/ncidod/dhqp/ar_acinetobacter.html http://www.emedicine.com/MED/topic3456.htm As a student, I would suggest that you voice your concerns to your clinical instructor or faculty member if you have specific concerns about your learning environment. You seem to have a good handle on basic infection control procedures. Don't let your preceptor's poor example allow you to develop bad habits. :)

Please note that many of the lotions listed above contain oils that can have an adverse affect on the integrity of latex gloves. Water-based lotions approved by glove manufacturers should be used in these cases. "Is it all right to use hand lotion before putting on latex gloves? Yes, as long as the hand lotion is water-based. Check the labeling to make sure the lotion does not contain any oil. Oils, such as mineral oil, or petroleum based products, such as Vaseline®, can weaken latex, allowing the glove to tear. Just because a lotion easily washes off does not mean that it is water-based. Please note that oil-based lotions do not affect vinyl gloves." https://www.eqplusinc.com/Articles.asp?ID=125 "Nitrile also has the benefit of being resistant to any breakdown from oilbased products,î Truscott says. ìNitrile would be an excellent product to use if you are working with a lubricant, milking tubing or performing various procedures requiring contact with an oil-based substance, Oils can breakdown latex where youíll notice your fingertips getting tacky or elongated whereas Nitrile does not." http://www.endonurse.com/articles/infection_control/593_461feat3.html