BlevinsRN

I work in acute hemodialysis in a hospital. We are trained to do plasmapheresis.

My understanding is that this comes from the Prisma. The FDA put a hold on their shipments because of the possibility of the Prisma machine taking off more fluid than programmed. There were deaths linked to this problem. We were inserviced by Gambro at my facility. The problem is that when you get the incorrect weight change detected alarm, the problem has to be resolved before pressing continue. Most people just keep pressing continue instead of troubleshooting. The prisma doesn't tell you if you have fixed the cause of the alarm. It just lets you press continue and it will alarm again later. (after it has unnecessarily taken some fluid off!) We ordered seven Phoenix machines in December. We are still supposed to receive an eighth machine but haven't because of the hold. I wasn't aware of any lawsuits about this. That's interesting....

I have not heard of that yet. My facility recently underwent our survey and that did not come up. We have 0k and 2k baths. We mix our 1k and 4k. Curious to see if this will be nationwide.

We got the Gambro Phoenix Machines in December. It did take a little while to get used to them. We had old Cobe machines before. The Phoenix machines have much better features. I agree with the poster above about how you can't take any shortcuts. With some things, if you do one step wrong, it can be a little annoying to deal with. We don't really have any issues when the patient is connected though. Our patients say they like them better as well.

The only thing I can think of about the venous needle is that there could be a clot that formed at the end of the needle. Flipping and manipulation of the needle could cause the clot to break off. I don't have any research to back this up. I have just been told this by the more seasoned nurses that I work with. Before flipping the venous needle, I would aspirate and see how it feels. Then, depending on how well it aspirated, I would pull the needle back a little and see if repositioning helps. I don't know.... just my thoughts on the subject

i'm sorry you don't agree with what i posted. i was just relaying information that was told to me in school. i was also told that there are some people that will have 75 questions and 265 questions no matter what. it is somehow randomely done before the test is started. what i wrote in my last post backs up what you said about getting the last question wrong. in my post, i simply explained why "in some cases" getting the last question wrong could cause you to fail. i do not agree that you will always fail if you get the last question wrong. i do also agree with what you say about there being other factors involved. i did not mean to imply that passing and failing is only determined by the number of questions that are answered right. i believe that the questions are weighted. a question that they statistically believe to be harder would count for more than a knowledge level question. i know that there is way more to it than what was in my post but i figured that no one wanted me have a five page post here. i just summarized my opinion. while i am absolutely no professional when it comes to the nclex scoring process, i was simply just trying to help. :)

I don't know if I can explain this very well or not, but I will try. First, solve your problem to see how many ml you would give total. 120mg equals 12 multiplied by 1ml which equals 12ml 10mg Now I'm sure there's a way to set this up but I don't know it. I think it through in my head. 12 ml is a total of the 120mg you want to give. So that means that 4ml equals 40mg. So you would give 4ml/min because that would be 40mg/min. So that is the most you could give in a minute. I don't know if this makes any sense to read, but I hope it helps.

Getting 75 questions is usually a good sign. I only had 75 questions and I passed. Actually, everyone I know that got 75 questions passed. Statistically, more people with 75 questions pass The whole getting the last question wrong thing only applies if you get 265 questions. A Kaplan review guy came and talked to us about the NCLEX scoring process. Pretty much, if you got 75 questions. It either didn't take take long to show that you were competent or it didn't take long to show that you weren't competent. I wish I could draw you a picture to show what I'm talking about. It is hard to explain. If you are a certain distance above the line when you get to the minimum questions(75), then it will shut off and you will have passed. If you are a certain distance below the line, it will shut off and you will have failed. Or is you are close to the line either way, the test will keep going until you get a certain distance above or below the line of competence than it will shut off. People who get 265 questions usually waivered on the line through the whole test. They didn't get too high or too low from the line. That's where getting the last question right or wrong can in some cases matter. If you get the last question wrong and you end the test below the line than you will fail. That is not true for every test though because you could have been just high enough above the line that getting the last question wrong didn't make you end below the line. I hope this helps. It is really confusing to try to read this though. It is a lot easier to explain in person. Actually, it took the guy lots of pictures and 30 minutes to explain it to our class. good luck

My school just began using the HESI for the upcoming students. We started with ATI. Our pass rate on the NCLEX the year before me was bad. In other words, I think that schools use this because they don't really care if you graduate or not. They have to think about their pass rates and their accreditation. It is all about money. I don't mean to sound this negative. I'm just pointing out the business end of it. Because the HESI predicts whether or not the student will pass NCLEX, schools who don't let people who don't score high enough graduate and take the NCLEX. By doing this, they are more likely to have a higher pass rate. The high pass rate is used to attract more students to their school. Also, if their pass rate is not high enough, they could lose their accreditation. A university near me also began using the HESI a few years ago when their pass rate dropped. Their pass rate is 99% now. I hate to think of all those people who didn't get to graduate and become nurses.

My school used ATI. They also gave us the option of taking the Hesi test too but we used ATI through all of the semesters. Pretty much all of the students took the hesi and the ATI predicter test. I don't really feel as if ATI is very good. Our test questions were also the same type of questions that were on the NCLEX. They used to do all multiple choice and some dosage calc on their tests. When the NCLEX changed, they began giving us the alternative questions as well, like check all that apply. They also strongly advised us all to take a review course. They had a guy from Kaplan come and talk to us about a Kaplan review course and to give us some study tips. I didn't take the course and I still passed but there were several students who took it and liked it. We also stayed after one day and discussed ways to prepare for NCLEX. I only think they did this because the pass rate of the previous year was not very good and they were afraid of losing their accreditation. They really needed our year to bring the pass rate up. It had always been high 90s before that one year. That's also why they offered the one hesi test to us. They were switching to them for the incoming students because they thought that the hesi was better than ATI.

I don't mean to sound rude but I don't really agree with you. I don't consider your examples listed as demonstrating the use of nursing judgement. Not doing a bp in an arm with a dialysis catheter or not feeding a patient who is slouched down does not require what I would consider nursing judgement. Those are things that CNAs are trained to do. They are taught how to take a blood pressure and what to look for to make sure that an arm is appropriate to use (such as an iv being in the way). Also, they are taught to feed a patient correctly. They did not have to make a decision based on their assessment of the patient. They simply have been taught that you are to feed a patient in an upright position due to risk of aspiration. So as part of the task of feeding the patient, they positioned the patient accordingly to correctly feed the patient. They are taught to do skills in the same sense that an RN is taught to put down an NG tube or start and IV. I bet that many RNs would be angry if the job of an RN was described as only doing skills. There is so much more that is involved. It is a thought process that is based off education and experience that is used to make a judgement of what intervention to take based on their assessment.

I don't know if you would want to do this or not, but you could try getting a hired in a different department. It depends on the hospital I guess. At mine, for example, you could work in dietary, patient transport, supply, clerical, and others I just can't think of right now. This way you can get used to the hospital and become familiar. It can also be helpful later if you work at the same hospital after school when you have friends in other departments. It also helps you understand other departments and what the day is like for them. After getting some clinicals, you could look into transferring. Also, after working in another department you would be exposed to a lot of different floors and areas throughout the hospital. You could kind of get a feel for which one you would rather work in and which people you would like to work with. I don't know if this would work for you or not. It's just an option. Good luck on your job search. :wink2:

I've thought the same things you have. I graduated May 2005. I still feel apprehensive about some things and I still ask lots of questions throughout my shift. I remember very clearly the time before the last semester of school. It is difficult to face the reality that it is almost time to actually become and function as a nurse. Everyone on my floor has been very informative and supportive. Also, a lot of things seem to come together for me in the last semester. I had my best clinical experiences then as well. I would not let the skills be a big stressor. It is hard to say that because I was the same way. I remember how scared I was when I put in my first, second, and even third foley or started IVs. I would always have an experienced nurse come with me and kind of hang around and help out if I needed it. Later on in your career, you will look back on how scared you were about certain skills and you will probably laugh. I have been told this by several nurses and now I can already begin to see what they mean. After you do skills several times, you will get your confidence level up and they will be the last thing on your mind. As for the stress of bedside care, I guess it is not for everyone. You can always try going to a different area like the stress lab or cath lab maybe. I have not been off orientation on the floor long. I am orienting in dialysis now. The days that I am on the floor, I am still overwhelmed and stressed but I think it is how you deal with the stress that determines if you will continue the bedside care. I do speak with very little experience, but I think it is important to have good coworkers and to laugh when you get the chance. Also, if you don't already have a job in a hospital setting, I would recommend getting one if you are able to. I worked as a nurse extern for my last year of nursing school and it helped tremendously. Well good luck. I hope things work out for you.

We use military time at my facility. I'm so used to it, I couldn't imagine not using it now.