AggieNurse2B

I dealt with the same issue on a personal level. My grandmother had an AICD, and when we put her on hospice, the MD ordered the pacemaker rep out to "d/c" it. But he didn't write whether to d/c the pacer, the defibrilator, or both. The pacemaker rep disabled the defib but refused to stop the pacer itself, citing that a pacer will not keep a dying heart from dying. I argued that there was no need to have the pacer in a woman who was in MODS and expected to pass at any given moment, completely unresponsive (for days), DNR in place, literally with her family surrounding her, ready to go. I should back up a bit and say that the pacemaker rep took forever to get there to turn the AICD off--12 hours in a patient who wasn't expected to even live another 12 hours. I had already had my brother go to the local Tractor Supply and buy me a big magnet. (I found it odd that the hospice nurse didn't have one? Is this not something they deal with on a fairly regular basis? Maybe not.) I refused to let my mom and her siblings see their mother being shocked just because the pacemaker chick couldn't find it in her busy schedule to get there and turn it off. Anyway, to the OP, I think it was a huge oversight that the MD didn't write to have the pacer d/c'd in the patient. It was cruel and awful that the patient suffered and wasn't allowed to die as a result of this MD's negligence. You did the right thing. In my experience with dying patients, sometimes it takes a bit to begin to feel like you did the right thing. And, yes, 20 mg of Morphine, not 4 mg. Everytime.

I had my very first ECMO pt last week (yay!), and this was the exact scenario. Crashed pt onto ECMO when IABP and Impella failed. Took Impella out, but left IABP d/t risk of bleeding.

I can only say that if a patient or patient's family member ever has me at gunpoint, I hope like hell one of my co-workers has broken the rules and carried his/her gun to work and that he/she is gutsy enough to pull the trigger. I just got my CHL, and I wish I could take my gun with me to work. I'm not so worried about the happenings at the hospital while I'm working, because I feel like I work in a pretty safe unit. I do wish I could carry it with me as I'm walking to/from my car in the parking garage.

Run. Run fast. Run hard. Don't look back. Levo on the floor is an absolute no-no--Very dangerous for patients and very dangerous for an RN with 4-6 patients to be trying to juggle. To me, it's absolutely insane to even suggest something so ridiculous. Our facility doesn't send out vasoactives, central lines or art lines, or insulin gtts to the floor or step-down. Ever. Under any circumstances. We are max 2 patients in ICU--I've only been tripled once in 1.5 years, and it was only for an hour or so. I just can't believe anyone who knows anything about these drugs would even suggest such a thing.

I'm with Esme12 on this one. You, as a nurse, have a duty to your co-workers to inform them of bloodborne pathogens when the CNA/PCT/whomever is dealing with the patient's body fluids. The CNA/PCT/whomever is bound by the same patient privacy laws you are, and I think it's professional courtesy to help them protect themselves. Sure, you exercise universal precautions with all patients, but you KNOW you're extra vigilent with a pt you know is infected. You may not treat them differently, but you're extra cautious. If you say otherwise, you're kidding yourself.

Very simple. Reflect the feeling. That's all you need to know! Psych is not all that bad. Just don't make it harder than it has to be...If the answer looks right, don't second guess yourself.

Wish I could! Especially since I see PBDS test on my internship schedule, which starts in a couple weeks, and I have no idea what PBDS even stands for!

I need a little advice from my fine nursing friends here! I originally posted this in the Career forum, but I thought I might get a few more sets of eyes on it here. I graduate this May with my BSN, and I have my heart set on a particular internship at a particular hospital. I did clinicals at this hospital and on this floor/area this past semester, and the charge nurse knows of my interest. She even called the hiring manager for me and told him to look for my resume when the position is posted in January. (Bless this woman!) I have the name and e-mail for this hiring manager and, although the position is not yet posted, I wanted to make contact. First of all, good idea or not? I'm thinking so, but I'd like confirmation. Second of all, should I go ahead and e-mail my resume, even though I'll be submitting it online in a few weeks when the position posts? (I'm checking the website EVERY single day to be sure I don't miss it.) Any advice would be helpful! Background: I'm a second degree student who (quite literally) sold her soul to the devil in order to get through nursing school and get a job in this particular specialty. Losing this opportunity is not an option. Also related: I had a very professional career in my past life, and I want to emphasize that I'm a professional person. I was successful in some pretty big outfits, but I don't want to bore anyone with the details. Any advice on exactly how to accomplish that?

I need a little advice from my fine nursing friends here! I graduate this May with my BSN, and I have my heart set on a particular internship at a particular hospital. I did clinicals at this hospital and on this floor/area this past semester, and the charge nurse knows of my interest. She even called the hiring manager for me and told him to look for my resume when the position is posted in January. (Bless this woman!) I have the name and e-mail for this hiring manager and, although the position is not yet posted, I wanted to make contact. First of all, good idea or not? I'm thinking so, but I'd like confirmation. Second of all, should I go ahead and e-mail my resume, even though I'll be submitting it online in a few weeks when the position posts? (I'm checking the website EVERY single day to be sure I don't miss it.) Any advice would be helpful! Background: I'm a second degree student who (quite literally) sold her soul to the devil in order to get through nursing school and get a job in this particular specialty. Losing this opportunity is not an option. Also related: I had a very professional career in my past life, and I want to emphasize that I'm a professional person. I was successful in some pretty big outfits, but I don't want to bore anyone with the details. Any advice on exactly how to accomplish that?

Uncool. You owe the OP an apology.I graduate in May, and, although I didn't ever have to do LTC in nursing school, I did have to deal with some pretty nasty poo. My first day, I nearly puked cleaning up a patient. Does that make me a bad nurse? Nope. I don't think so. You get used to it, honestly. And after the first semester, your clinicals tend to get better. I've been lucky in that our clinical instructors will advocate for us students. They don't allow us to just be in the hospital to do the work the nurses don't want to do or don't have time to do. We're there to LEARN, and there's not much to cleaning up poop and emesis--You can probably figure all that out on your own! I've been to several hospitals in my area, and it's never been an issue, except once and my instructor nipped that one in the bud. Don't lose heart. Stick it out just a bit longer and see if it doesn't get better. By the way, I think the plastic surgery route or the dermatology nurse would be great. Operating room nurses do such a different job than floor nurses. I venture to say that poop in the OR is an exception rather than the rule. Same with dermatology.

Our clinical instructors use texting to tell us what time to meet for lunch, post conference, or if they need to find us for some reason. It's also pretty handy when we need our instructor for something. Often, we're required to either have the clinical instructor with us when performing a specific procedure or have permission from them to perform it with our assigned RN for the day. It's much more efficient to text them and tell them what room you're in/going to be in, rather than run all over the floor looking for them. Maybe it's because we're students and are scared to death of doing something wrong, but I've never seen another student abuse their privilege of carrying their phones (on vibrate) in their pockets. Admittedly, I have seen regular staff using them for personal stuff, but it actually has been pretty rare. I don't have a lot of experience in nursing, per se, but this is a second career for me. In my first career, I often found that people responded better to management giving them some latitude in making appropriate choices, rather than mandating blanket rules from an ivory tower. Just my 2 cents...

I've written her a letter--Mailed it yesterday. It's hard not to feel helpless, or like what you're doing is not enough, especially when the person is so special to you. My daughter (just turned 8) made her a card that said, "You are everything good." It's amazing how children are so insightful and such good judges of character sometimes! Thanks, again, for the responses, and God bless hospice nurses! (I'm a nursing student, and I just don't see how you do it...But I'm sure glad you do!)

Thank you for your responses. This very special lady is a nun, and she is in a special hospice house surrounded by her sisters. She is definitely not dying alone and lonely. She was a teacher at our kids' school, and she was/is a very happy and upbeat person. She has the neatest, craziest, zaniest sense of humor you've ever seen! She doesn't want 1) her "babies" to see her in the state she's in, and 2) the parents and fellow teachers who love her so much to remember her as she is right now. I understand her wishes, and I want to respect them. I think I'll send flowers tomorrow. And each week until she passes. Thank you again for your responses. Please pray for her. And for us, those of us who will be left to mourn her loss.

Hello, Hospice nurses! I wondered if you might share some information with me. A lady who is very dear to me is on hospice care right now. She has pancreatic cancer and the doctors give her about 30 days. She is about 200 miles from where I am, so I can't pop over and pay a visit, and she doesn't really want any visitors--She's too tired to receive them, and she doesn't want all of us, who love her so much, to see her in the state she's in. She is extremely religious, and she has already donated all her belongings to my children's school (where she taught until now) to be sold. Here's my question: What do you recommend, as far as sending her something to let her know we love her and are thinking about her? I mailed a big envelope with drawings my kids have done for her, a card, and a few pictures. Somehow, it doesn't feel like enough, but I want to avoid being "selfish" and sending things just to make ME feel better. Does that make sense? Are flowers appropriate? I just don't want to send anything that would be more trouble than it's worth, but I do want her to know we care. Suggestions?

I'm a student, so take this with a grain of salt. I have been in clinicals where nurses were on Facebook on hospital computers, and I thought it was very unprofessional. Agreed. But I do have small children, and I appreciate being able to carry my phone in my pocket in case of emergency. I've never responded to a call on my personal cell phone except once when my child was ill...And even then it was a very abbrieviated conversation. Also, I have an iPhone with apps on it that apply to my job, and I use it as such. It has proven to be quite handy, and I'm glad my clinical instructors haven't thrown a big fit about it. As another poster said, you can't make a rule for everything--Sometimes, you just have some sense about you and be adult enough to not need a rule. Kind of like you can't make laws to fix stupid. Stupid can't be fixed.

Yes, it's an app that syncs with Google's free calendar. So you can type all the info in your google calendar and it syncs to your phone whenever you open the app on your phone. And when you're in class and need to put something on the calendar, you can do it on your phone, and it will sync with your google calendar. So get a google free calendar first, then download the CalenGoo app. Like I said, I made a new calendar (which culminates into just ONE calendar to have to look at) for each class. So each class is a different color. I put deadlines, assignments, chapters to be read, etc. in there. And then I'm sure to add all my personal stuff, too, so I know what's going on and who's going where. I promise you'll get this part figured out after just a few weeks and, although life will be hectic, it will be manageable. Also consider downloading MedCalc (free and completely awesome), Epocrates (I just use the free version). Pocket Lab Values is indispensible at clinicals, in my opinion--even had my clinical instructors using it. It was about $9.99 or so, but worth every single penny. I also occasionally use University of Maryland Medical Reference (free). I, as well, got my iPhone just as I was starting nursing school, and it's been a lifesaver. I considered getting a new laptop, but the iPhone was a much better investment. It was for me, at least.

I'm a third semester nursing student, so I'm all too familiar with how you're feeling right now. About the middle of my second semester, I bought a plaque that sits in my bathroom so I can see it every single morning when I wake up. It's an Eleanor Roosevelt quote: "Do one thing every day that scares you." As a nursing student, I never cease to be able to find that ONE thing every day that scares the beejeezes out of me! Seriously, you must get a good planner. I have an iPhone, so I use CalenGoo. I have each class coded in a different color, as well as personal stuff and stuff for my kids. I sit down at the beginning of each semester and put every single deadline, assignment, etc. in that calendar. Once you have that done, you take it ONE day at a time. Everyone else is just as scared and freaked out as you are, so take heart. You're going to be fine. You'll feel much, much better and more in control after all the kinks get worked out--Usually in about 2-3 weeks. Hang in there!

Oh, how I wish we had "limitations." Classes at our school usually raise and spend around $10k on their pinning ceremonies. AS IF we have so much extra time to plan and carry out fundraisers. Just a little gripe...I'm done now and on to being more positive!

We're almost done building our new nursing building at my school, and a very high profile individual donated the money for it. I'm trying to find a way to get a hold of said very high profile individual to see if he would be interested in speaking at our pinning, since we are the first class to graduate out of the new building he funded. Fingers crossed, but I don't expect to be able to land him. Way too busy giving money to other worthy causes...Wonder what it would be like to have so much money that it's actually WORK to give it all away??? I digress... LOVE the idea of an Outstanding Nursing Student!

It looks as if the norm is to have one of the clinical instructors or lecturers. Wow. I think our school usually selects someone from the community, but I think I might suggest we use our dean. I took a class from her this summer, and, if she ever gets bored with nursing, she could always take her comedy act on the road. Great speaker, great instructor, great dean. Thanks for all the input! Keep the suggestions coming!

I am on the pinning committee for my class, and we need a keynote speaker. Any ideas? So far, we've come up with one, but he's terribly cost prohibitive. Just wondering what other schools do for speakers. We're having to pay for the entire ceremony ourselves--even the pins--so cost is an issue. (Strangely, the university doesn't pay for anything, but they mandate that we have one.) We would like someone who is relevant to our new careers, but we can't pay an arm and leg!

I'm just a student nurse, so take it with a grain of salt... I had a similar experience with a patient's husband while doing postpartum. I walked in and introduced myself as a student nurse, and he immediately rolled his eyes and wanted to know why some crappy student had been assigned to his wife. "Why is she getting some inept student while other moms on the floor are getting 'real' nurses?" Lovely. I explained to him that, sometimes, people who have student nurses actually get BETTER care because the student only has one or two patients and can devote a lot more time to each individual. "Real" nurses are usually short-staffed and don't even have enough time to go to the bathroom. Said jerk-of-a-husband began to complain that he wasn't feeling well and that perhaps I should be taking HIS vital signs since he was the one who would end up with the very large hospital bill for it. So I did. I took his BP, and it was 152/110. We had a nice little chat about the dangers of hypertension, and I insisted he make an appointment with his MD immediately. Long story short: By the end of my shift, I was the very bestest nurse he and his wife had ever had...And this was their fourth L&D/hospital stay! Amazing. He was a minister, and he even said a special prayer over me. Now, I'm guessing that, had you had the time, you would've turned that husband right around. Trouble is, very few nurses have that kind of time anymore.

No, I don't at all get the idea it was poorly run. They started out with 30 students, and I think they're graduating around 22 or 23 in August, at least two of whom are attorneys, oddly enough. I believe they decided it was just too much material in not enough time, and they really wanted to focus on quality. The students doing the program in four semesters seem to be much happier, and the drop-out rate is much lower.

One more little tidbit...And others here may not agree with me, but I'll state my opinion anyway. There are some accellerated programs out there. TWU had one, but killed it this past semester. I originally applied for that program and couldn't get in, but thank GOD for small blessings! Those people went through hell, and I'm ever so happy I didn't get in. I was offered a spot in the regular nursing school class and took it. Best thing I've ever done. I'm finally where I'm supposed to be.

I'm in the TWU program in Dallas right now, but TWU has a very nice, shiny new campus there in Houston. (Tax Accountant/Consultant turned nurse, here.) There are a few things you should know... 1. The history and government requirement is non-negotiable, as you must have these four classes in order to get a degree in the state of Texas. Or so I've been told. 2. TWU only looks at the pre-req grades--Nothing else. And your entrance exam score. Whoooolllle 'nother post there! I believe the pre-reqs are Chemistry (watered-down version), A&P 1 and 2, Microbiology, Human Growth and Development, 2 Histories, 2 Governments, and Nutrition. So, those are the only grades considered in your application. Seriously, I was baffled at the simplicity of the application--Literally, name, address, entrance exam score, grades in those few classes, and $30. 3. TWU, as well as most of the other schools, is very competitive. When I got in last Fall, there were around 700 applicants for 120 slots. I've been told it's easier to get into medical school! 4. I like the TWU program. Our instructors are fabulous, very encouraging and helpful. The program is very highly respected, and most all grads have jobs when they get out. The Houston program is run a little differently, but I have a friend who's going through it right now (second career) and likes it. 5. Call a hospital and ask to shadow a nurse. It's the best way to figure out what a nurse does all day! 6. Go for it. Nursing school is challenging and time-consuming, but so far, I don't regret it for a moment. I was so tired of my job; tired of apologizing for being a nice person. Nice people don't get anywhere in Big 6...5...4 firms. 7. One more thing: TWU just added a DNP program. You have to get your MSN first, but it may be something that would eventually interest you.