pebblebeach

Update since my original post: I left this job - for a few reasons, but a huge reason was that they DID end up hiring someone specifically for this task to handle prior auths - an experienced LPN who was excellent - patients were getting PAs/appeals done in a timely fashion (and therefore, their meds on time, most importantly) I constantly echoed my praise for this person and how valued they were to the RNs and patients overall care - unfortunately, management didn't listen, the LPN quit for a better opportunity - and they didn't replace her. The PA avalanche piled back up in DAYS after LPN left. I immediately started looking for other jobs. IMO, It is now ESSENTIAL to designate a separate position for this need now; the RNs do not have the time - and frankly, it's a waste of a good RN to have them sitting on hold w/ BCBS for 2 hours when they could be... I don't know, giving vaccines, educating patients on their meds, triaging pts on phone whether to go to ER or not during a pandemic, etc. etc. It's a tremendous urgent need that is just going to keep growing, and clinic management needs to recognize that need, or people will get fed up and leave.

Hi clinic RNs, I was previously a bedside nurse who transitioned to clinic life. We deal with a lot of patients on biologics (humira, etc.). The biggest learning curve for me coming from bedside is the barrage of insurance denials, prior authorization appeals, and of course the multiple phone transfers, being on hold, faxes lost and re-sent, and follow-up involved. The RNs who have worked there for years have said that 2019 has been the worst year yet in terms of pushback from insurance, and has taken up more of their time now more than ever. It takes so long to initiate and complete these requests that other clinical tasks are getting ignored. If you deal with a lot of this at your clinic, how is it delegated? I've heard of clinics hiring LPNs or RNs specifically to work on specialty med insurance/PAs, but that's not in the budget. Curious to know what your practice has tried - even if it failed. Thanks.

Don't you feel though that only two shifts is a little bit of a knee jerk reaction to having a different preceptor than the new grad anticipated? My preceptor had a very different nursing style than what mine ultimately is (or what I thought a nurse "should" be like), did some things slightly off-book, but was a respected nurse who cared for her patients safely and efficiently. Ultimately I took the lessons that worked for me and left the habits that didn't appeal to me behind. I had another preceptor for night shift who had some IMO awful habits, was not particularly friendly, but WAS very skilled when it came to meds, IV tricks -- and you know what? Some of our patients like her better b/c she's no bulls***. So, I learned everything I could from her, looked for mentors elsewhere, and came back to her whenever I needed help with an IV. No matter who OPs preceptor is, the floor is going to be filled with personalities and nursing styles she will like and dislike. It doesn't MATTER if you like like or dislike them, or if she finds taking Adderall in front of someone rude or not, because after orientation you're on your own, and it's the pt who matters, not your feelings. And this is coming from a sensitive millennial here (although elder millennial- hard to consider myself in the same group as those that don't remember not having cell phones), so I'm generally not in the tough love crowd, but two shifts in and wanting out? I do have empathy (my first reaction to my unfriendly night shift preceptor was shock... then, OK, so this person isn't my BFF, cool) but I think OP needs to be patient. If it's been 5 or 6 shifts and nothing at all has improved, or worsened? OK, make a plan. It's been two!

When I worked nights I had an alarm set on my phone to take my birth control pill, Lexapro, etc. Now wondering how many new nurses I've traumatized with "She took her Lexapro right IN FRONT OF ME!" ? Sorry not sorry, barely have time to eat a full lunch let alone whisk away to privacy when I need to take my pills. OP, I've also been the lost puppy, but it's been two shifts. It's great to be eager to learn but the learning curve (especially in ICU) is steep and slow vs. nursing school cramming and regurgitating. Be patient.

I have posted a couple photos from work (on a private social media account) with zero mention of patients - just positive reflections ... i.e. on my one year anniversary as a nurse, a selfie of my good friend and I in the break room. I go by the rule also that I wouldn't post anything my boss or coworkers would be surprised by, and I don't vent on social media, certainly not about work anyway. So if our nametags are visible... and someone zooms in on them, that's a punishable offense? (Perhaps if someone doesn't like me enough to report it... yikes)

"This student nurse recently forgot how to prime and hang IV bags and even scan them in." Just defending the slower learners over here in the cheap seats... ? This is a pretty advanced skill for a new student nurse. What is muscle memory to us is brand new to students. Clamping, back-priming, making sure all air bubbles are out, aligning it with the pump and programming the pump? and troubleshooting beeps?! and that slight manual gravity adjustment that can't really be taught to get a secondary in just the right spot -- to do that super quickly and correctly took me a while as a new RN. Doing all of that without repetition of the steps explained to me (yes, multiple times), as a student? No way. Also, experienced nurses have all forgotten to scan a 500cc saline prime bag before, no? +1 to patience

I completely agree with all of this, but if there are no spare films available to you except for in the kits, what else do you do? I wish more of the individual supplies in our kits (right now blood culture bags and port access trays come to mind) left some of the critical items in it (biopatch, angelwings) out separately, so that if you need another you don't have to open another kit. I always wonder who makes the decision of what is packaged together and separately, why is there suddenly a new brand of tape, etc. etc. Medical waste is such an overwhelming problem, as a new nurse I feel swamped enough by simply staying on top of my tasks right now, but at some pt in my career I would like to focus on it. I worked as a tech on an ortho unit years ago, and somehow this hospital could afford a pack of Pampers wipes (like- Costco size ones) for each patient in the admission bucket. The pt would usually ask for more during their stay. Well, come discharge, there's 3 unopened Pampers packs left in the room that have to be thrown out bc the pt has a history of MRSA or something -- meanwhile they could be used by parents who can't afford wipes. That one really got to me. Maybe opened kits/leftover supplies in non-iso rooms can be donated to a nursing school?

I feel you. It took me years in therapy to stop comparing myself to others' issues, i.e. "well my childhood was fine, my parents are great, I've never been abused," etc. etc. It's my belief now after a lot of self-work that every single one of us has experienced trauma in some way. Go to one appointment - what's the worst that could happen? Sending you good vibes, you'll get through this!

Yes. I wouldn't worry so much about the label (bipolar vs. "just anxious") right now. All feelings -- annoyance, hopelessness, flat -- can be "normal," the deviation is how loud the volume is on those emotions. For me, without help, the volume is on full blast. You said you have a prescription for Lamictal. Assuming this was from a psychiatrist? Do you have a therapist in addition to a psychiatrist? (I recommend both, if you can afford it.) If so - bring up the concerns specifically about nursing. Notice when you get annoyed at work, how often, etc. so you can get to the root of it. Yes, maybe the person is just annoying. But does it feel like you're crawling out of your skin, or like you can't focus because you're so annoyed? Therapists can help with those things. Psychiatrists help when you need an Ambien prescription because you can't sleep between shifts. Are you open with your close friends or family about this? That can help immensely. I journal, old-school pen to paper. It helps with identifying how soft or loud I am on that volume scale. Journaling when adjusting to a new med is useful too, literally a sentence or a couple words everyday -- "felt nauseous, more depressed than yesterday, etc etc." It helps to have a timeline and then be able to go back to your MD with that. I'm able to be a good (good enough, sometimes) nurse because of the above -- my small little support system - therapist, psychiatrist, family, friends -- and my meds. I can't tell from your post if you're a new nurse or experienced nurse, but from a newer nurse struggling on night shift, I struggle too, it's a battle like any other illness. You're not alone. Don't worry about the label for now. Feel free to message me on here if you want. ❤️

Agreed. I have the positive attitude part down and I continue to work on good habits. I've definitely heard of instances where RNs bring in a doctor's note to get out of night shift after a v. short time on nights. In contrast ... my coworker with sickle cell? She could NOT adjust to nights. She was a fighter until the bitter end, though.

It wasn't my intention to scare -- I'm sorry! I just wanted to be honest about my experience, as nights is not for everyone. I have had to find solutions to the nausea, mental health, etc. and as long as I am consistent, I know I will survive night shift until a spot opens up on days. I did forget to point out (as many have already) that the teamwork on nights really is great.

Congrats on the gig! I started out in a new grad orientation program too, and we started out on nights. I have always been very sensitive to sleep, and my psychologist strongly advised me to not go on night shift, but it really wasn't a choice. So I went into it with a positive attitude and pretended I could be a night person. I've had a hard time. I do all the tricks -- blackout curtains, the original Dohm white noise machine (go big or go Dohm), essential oil diffuser, eyemask, etc. Sleeping between shifts isn't a huge issue now. In the beginning I would have so much adrenaline from shifts getting home that I couldn't turn my brain off -- give that a few weeks and I was tired enough to let that go, lol I've never been the sleepy type on the job, I'm the opposite -- engaged and high-alert (sometimes to a fault -- fine line between alert and anxious). The big problem for me is my days off. I've read all Googlable advice on this: Set an alarm if you nap - GET UP no matter what - and switch yourself back to a daytime schedule. (Or stay nocturnal all week - which I tried once and was so dreary I never did it again, but it may work for some) So, I finish the three shifts consecutive (I prefer that, btw - continuity with pt care and with report is wonderful) and the fourth day is the day to switch back. I will nap for a couple hours, wake up to the alarm and feel like the crankiest human on the planet & like I haven't rested at all, or I'll "listen to my body" (fine line there, again) and next thing I know it's dark (AM or PM? who knows!) I have several missed calls from concerned friends & fam, and I haven't hydrated in 16-18 hours. My mood may be lighter, but my body feels like it's been hit my a truck. I think only graveyard shifters who have experienced this crash can relate to that feeling. I've also never dealt with nausea before and have discovered I cannot eat on nights. (Coming from a big snacker who loves food, this sucks) So I will try to have a healthy meal when I get home or before work, and then bring a smoothie or something my stomach can handle during the shift. I've lost 14 lbs since starting night shift and not in a good way. I've added iron, Vitamin D supplements, and Miralax to my daily routine (don't even get me started on the change in BM habits... my GI tract doesn't know what the hell is going on) My mental health has taken a hit for sure. I have managed my depression pretty well for almost a decade now with a combination of therapy and SSRIs, but having that baseline history of depression added to chronic sleep debt (and sometimes forgetting to take my med because I was so strung out at first w/ what day/time it was) I have had... rough weeks. Two days particularly come to mind when I felt truly bottomed out. Waking up crying, feeling worthless, the whole lot. Thankfully I have been in that spot before, and even knew as it was happening -- "this is chemical, you're exhausted, this is temporary" Still lousy, though. All that said, I know this is not forever. Nights are not for me long-term. The pay is nice, but I'd rather get paid less and feel like a functioning human on my days off. One hack that has helped, I carpool with a coworker on our days that we are scheduled together, and we play goofy songs (Spice Girls, etc) on the drive and sing like fools, it helps my mood so much on those days coming into the shift. Or if I drive solo, I'll sing my heart out to Aretha Franklin or something equally over the top. Whatever works! Keep us posted how you're doing. Wanted to share from the perspective of someone who is on nights but not thriving, but I know I'll get through it.

GREAT movie ?

Thanks, Kareegansee! I will definitely keep my options open, and plan to keep in touch with the Neuro ICU director (we're only a couple floors apart at the facility). I see you're in the SICU, is that where you started out as a nurse?

I'm about to start a BMT residency and this post was super, super helpful, especially the patient education resources. Thank you! edit: oops, that was supposed to be a reply to buckeye nurse RN

Yes :) It was super helpful for me to type it all out on here, and I did end up going with the BMT offer. Thank you!

Hello everyone! I am a newly minted BSN interviewing for my first job as an RN. I had two interviews this week for a 1-year graduate nurse residency program. (The residency program provides extra education, about 5 months of orientation, and several hands-on in-services and training sessions, etc. - still salaried/full-time, just newbie status) I had one interview on a Bone Marrow/Stem Cell Transplant unit. Patient population mostly leukemias, multiple myeloma, aplastic anemia, etc. I am interested in oncology from both a personal perspective (cancer in family) and nursing-learning perspective - I think the research happening with stem cell transplant biology is super exciting and this facility is doing some really cutting edge procedures with their patients. 36 beds, pt ratio is typically 4:1. Incredibly impressed with the unit (they just poured tons of money into it, and it shows) especially the focus on family integration and comfort for longer LOS. Another interview with Neuro ICU. Equally impressed with facility and family focus. Equally excited by research and technology available to this unit. Patient ratio is 2:1, sometimes even 1:1. 40 beds. Got offers for both units. Same facility, same pay and benefits. I did not have access to the ICU in nursing school, only 1 day of shadowing at clinical. I did, however, float often to an oncology floor as a CNA and loved it. The BMT unit said I will likely be working nights, the Neuro unit said I will likely be working days. However, I am willing to work both. Also, I was super impressed at the longevity of the nurses on the BMT unit. Most I talked to had been there over 10 years. Got the impression at Neuro ICU, most nurses were young, and are using the job as a springboard for another opportunity later (CRNA school, etc.) On BMT I also enjoyed that the staff celebrated "birthdays" (first day of transplant) by putting balloons on the patient's door - they emphasized that they are like a family on the unit. I liked that. I am super excited about both of these and know neither choice will be a mistake, but I was hoping some nurses with experience in either specialty can offer some perspective to a new grad nurse deciding between the two. There are these nursing grads who are very "I'm going to be critical care/peds/etc. nurse ALWAYS and I LOVE IT" and I'm like, you haven't even started yet?! I know what interests me, I know I have curiosity for both areas, and I know I am willing to work hard and learn as much as possible. I guess - I don't feel I have earned the experience to say I will ONLY work in a certain area, because who knows what I will thrive in? My long-term plans are possibly NP, but no interest as of now in CRNA or anything further. My strengths (from my mere CNA and nursing school experience) are therapeutic communication and I tend to be extremely thorough, my weaknesses are perhaps needing to prioritize which tasks I am thorough with - there isn't time to be thorough with everything (or anything, some days), I also have been working on handling criticism since I left the womb (getting better every day!) :) Any tips would be appreciated, and I'm so honored and pumped to join this wonderful community of nurses!

Hi all, just a $0.02 here - I am a Nurse Corps scholarship recipient which helped cover the bulk of a 2017-18 1 year accelerated nursing program. I am incredibly grateful & honestly did not think I would get it. I just wanted to add that if you are not the most financially savvy with taxes, loans, etc. - you may have a steep learning curve after receiving the scholarship. Again, EXTREMELY grateful, but I've had a difficult time coordinating between Nurse Corps and my school's financial aid. A lot of times it feels like there is miscommunication and I am responsible for making sure there's no gaps. I don't find the portal incredibly helpful -- the messaging system is such that you ask a question, someone gives a bare bones answer, and then "closes" the conversation, so you have to start a new topic over again to respond to the same question. The search tool is kind of a nightmare and is often outdated, so you have to individually check each site to make sure it is still compliant with HPSA scores. For about 20-30 potential sites, this can get frustrating. There's just a lot of individual case by case scenarios with this scholarship and you have to sometimes be very annoying and persistent with phone calls and questions to get things straightened out. This was a new hat to wear for me, as I hate having to "bother" people, but I've gotten pretty aggressive over the past few months with getting to the bottom of things. It just gets... complicated before things are simplified, and you might get some surprise requirements along the way that you didn't expect. That's my 2 cents. (SUPER GRATEFUL I KNOW KNOW!) Good luck to all

LOVE your signature/quote btw - so true. A blessing and a curse to feel everything so intensely. That is terrible that your diagnosis was used against you. Makes me so angry. With ADHD, I feel like I will always disclose because I take the lowest dose possible of Adderall, and if it shows up on a drug test I feel like that could put me in jeopardy. All the yellow tape with stimulants these days, I don't want to mess around. With my depression/anxiety though, I guess there is no reason they HAVE to know about it... but ugh, why can't we be transparent if it's a medical diagnosis we are successfully managing!? And if there was an emergency, like an asthmatic who may need albuterol in an emergency, there might be a 911 day when I need help or need to take a day off to get myself together - how is that any different? Stigma is the worst. Can I ask if you don't mind, was it an issue of a medication you disclosed you were on that your supervisor didn't trust? Or the diagnosis itself? I am a newbie/almost done student nurse and this makes me nervous for future jobs. "You'll probably have to work twice as hard as a neurotypical to be considered successful."

There's no way that would disqualify you. If that was the case re: ADD/ADHD and everyone answered truthfully, a lot of healthcare workers wouldn't have jobs! :) I have intermittent depression and ADHD and I take meds for both. I always disclose that info with job/school applications to cover my butt (if something were to come up on a random drug test). You should be fine.

Yes, the cost is super high and definitely a big stressor. To anyone reading that is considering Drexel or starting at Drexel - apply to ANY/ALL nursing scholarships that you can find. Even if you don't think you won't get it or you think your GPA isn't high enough. You'll never know when a small scholarship may help you out with a grand here or there. Every little bit counts. I applied to a ton of random scholarships first quarter and it was such a pain to do all those essays in the middle of classes, but I ultimately received one and it was completely worth the effort.

I am in my third quarter of the Drexel ACE program and I agree with all of the above ? (except that CNAs think they are the s**t... I was a CNA and other than being a little more confident in a bed bath, I don't think I'm better than anyone else, haha, in some ways I think I'd have been better off without the experience - it got me set in my ways!) Good luck to all starting the program! Stick to what the poster says above and you'll do great!

The media has lazily been placing blame on psychiatric meds for shootings since the '90s. With Columbine, one of the boys was on an SSRI (Luvox, I believe) and there were stories then about the possible "side effects" of SSRIs leading to homicidal behavior. Now this with the Valium. Millions of perfectly imperfect humans rely or have relied on psychiatric medicine to get through a difficult time to meet the other side. I would not be here today if it were not for a GP who finally saw my depression as if it were hypertension and prescribed me Lexapro and Xanax to pull me out of a very dark place when I was 18. I have not hurt a fly in my life nor have the many, many people who have taken these medications (and in many cases tapered off of them without trouble) successfully. Frankly this headline just gives me a massive eyeroll and if nurses agree with it, they need to check their biases at the door. (And maybe re-read the Davis drug guide for actual side effects of psych meds.)

Thanks for sharing! I've taken out two private loans since April - I feel your pain @embrothers

Same here re: new awardee email & not getting an email yet. Still feels too good to be true! I have my fingers crossed. Not sure any of us know the answer yet, but if the contract starts retroactively July 1 (I've been in school since spring 2017 - accelerated program), will we receive a retroactive stipend for July, August & September? Or will the stipend start once we are notified? I've never received a scholarship before ever (especially one of this magnitude) so I'm very confused how this all works. Feels like free money floating around and I don't know how we get actually get it!