MaraG.

I have been working as an LPN for almost 7 years now. I've enjoyed it and found great reward from my career. I applied for the RN program and was accepted 4 years ago. Long story short, we started a family just before I was offered a seat, so I was unable to start classes. Now, 2 kids later, I have a seat, paid my deposit and I am ready. However over the last 6 months, I have not enjoyed my job at all. There are so many contributors. We have increased acuity, increased chemo administration which increases workload for the ward, increased patient load, increased care for patients (its not uncommon to have 3 total care/over head lift patients in your assignment) and pending staff mix changes coming. (The employer is reducing the number of RN/LPNs on the ward and replacing with Care Aids- pt load looks like it will increase from 4:1 to 9:1 on days and 5:1 to 12:1 on nights) I have not enjoyed my job for months now. I find it stressful and unsatisfying. The work environment is pessimistic and like a pressure cooker. Everyone is in fear of losing their job, including nurses with 30+ years of service. All of this is making me question my career path. I love the science, I love the problem solving, the interaction with sick people, helping, and learning. I am not sure I want to work in acute general medicine anymore. I used to love it, everyone different. Nothing is the same, one person CHF, the other pneumonia, pancreatitis, and lung cancer. Kept me on my toes. I am looking at maybe a specialty? Or community nursing? Maybe research? Any words of advice or ways I can get the most out of my schooling/practicums? (BTW the practicums/preceptorships are in question now with the staffing changes in our area. Looks like not enough nurses to facilitate students learning on the ward)

I have used some of the following questions: What is the greatest challenge that a nurse will face on this unit? What are the RN/LPN relationships like? What is the staff morale like? What is done to help keep a positive spirit when things get tough? As an LPN, it seems every unit has a different approach to pt assignments. Is there a team approach to care or are the assignments fairly autonomous? How often is there turn over? Are there educational opportunities available, such as wound care classes, palliative care in-services? What is the LPN/RN ratio? If none of these questions work for you, then take a look on line a some web sites that can help you develop your own questions. Hope that helps.

When I was in school I bought 5 scrubs (tops and bottoms) that were different styles and colours. I made sure that they could be mix and matched. This way I could use different combinations throughout a set or two and I could "test drive" a few different types of scrubs to figure out what I liked and did not like. Turned out that some of the details I thought I like drove me nuts and some details I did not think much of are now ones I look for. Now a few years out of school, I have about 15 pairs, some of which are "Crap I forgot to do the laundry" scrubs. Most of which are the ones I first bought. I also have about 4 or 5 pairs of maternity scrubs. Some of the details I like are: -lycra knit waist (kind of like maternity pants but not actually maternity pants) -minimal pockets (too many pockets I loose stuff) -a more fitted top, be it ties in the back or tailored-like, not boxy like some of the older style scrubs are. -cotton blend, otherwise I get too hot -shorter legs or easy to hem (being not even 5'2" most pants are too long) I buy my scrubs from a local company, I think they make all of them, 3/$80 per set. http://www.professionaluniform.com/

I could not imagine going back so soon. Where I live we get 1 year mat. leave. Plus I continue to accumulate vacation. So in the end I will take my 3-4 week vacation at the start of my mat leave then at month 11 of mat leave my hubby will take the last 4 weeks while I take my next 3-4 week vacation. Does that make sense?? So I think that we have it pretty good here in BC!! If I took my full mat leave and did not give any to hubby I would have 14 months off!!

Go in with an open mind ready to learn. I am an LPN but I can tell you that school "work" in the hospital is a lot different from actually working in the hospital. Remember you boundaries and what you are allowed to do and not allowed to do. Take notes throughout your shift of things to study and review. Don't be afraid to look things up (meds, diseases etc) Have Fun! Good Luck!

So far I have ben lucky, only 1 iso patient. (VRE in her urine) I think that my CNL has purposely assigned me to low risk assignments. But I am still early in my pregnancy, so we will see how things go from here. I work with great people who help out a lot. Very lucky.

Thanks for all the replies. I hope that I can work until week 36. I would like the early time off to enjoy the quiet while it is still around, lol. I do work with a group of good people. They have done a lot for me, especially when I was getting grossed out by smells.

I am 16 weeks pregnant, saw the doctor today and she expressed some concerns. She is worried about the amount of lifting nurses do. I assured her that those I work with are very supportive and help me a lot. I do boosting always ensuring that the bed is in trendelenburg. I do assist when patients need to be turned and find it a little hard as I am small and some patients do resist. She seemed to be worried about this and strongly urged me to use my judgement and if I am in doubt don't do it. Then she did my BP. I have always had a low BP. But right now it is a little lower than normal. (Norm 98/68 today 90/64) She told me again to be careful working and to be aware of signs I might faint. I am not worried as I know my body (or at least I use to) I think I use my judgement and take proper precautions for my safety as well as my baby. But I am worried that I will not be able to work as long as I would like to. At my last appointment one of the others Dr.s in the practice suggested I would not be able to work as long as I would like (referring to night shifts) I had hoped to work until about 35 weeks. I have made arrangements to have a preceptor student until I am about 23 weeks pregnant (except for 1 week around New Years) after that I am not sure if I will have access to any students. I am an LPN so some of the student programs are not available where I live (the RN students have a lot more opportunities to get paired up with a nurse in the hospital) So my questions to you are how long did you work for? What special precautions did you take when lifting or turning patients?

Ok I think I know the answer to this one but!! I got into a almost heated "discussion" about it with a co-worker. I asked her to give Morphine and 2mg Ativan to my pt (he has pancreatitis and ETOH withdrawal full DTs). She looked at his MAR commented that the dose ordered was 10mg q4h I said Yes his butterfly is primed with 10:1. About 2 hours later she told me she only gave 2mg Morphine and 2 mg Ativan. She misunderstood me. I spoke with the pt and he opted to wait until the the 4 hours was over so he could get the full 10mg at HS. Cool!! He knew to call if he changed his mind and wanted the remaining 8mg sooner. At the nursing desk she told me that was wrong. I could give the 8 now and he could get another full dose four hours after the intiial dose. Confused? Order 10mg Morphine SC q4h prn my understanding: 1730 - 2mg Morphine given instead of 10mg 1910- made aware of lower dose- offered pt 8mg declined as he wanted full 10mg at HS Next full dose 2130. She is saying: 1730 - 2mg Morphine 1910 - 8 mg Morphine to make full 10mg 2130 next full dose or conversely 1730 2mg morphine 2030 8 mg Morphine 2130 10 mg morphine the pt still gets 10 mg in 4 hours. ??????? Ugh No! Isn't the body still metabolizing the 2nd dose? and If you go with the last example wouldn't it 18mg over 5 hours?

Yes I wrote it this evening. The last hour of my night shift this morning left me with a lot to think about.

someone's family member almost died in my care today. I acted fast and with haste hoping to give you just another day. As you lay in the bed sheets moist with sweat, the oxygen mask helping you to catch your breath Skin as hot as the noon day sun, your temperature causing the medical team to run. As the lab collects valuable information from your veins, I silently beg, IV therapy needs to poke you again. Wires placed around your heart, conduct information that is just one small part. An Xray will help make it clear, quickly I know you do not a lot of time left here. It is just as the doctor feared, those wires make it clear. Irratic lines from your heart I know you don't want our hands to part. With muffled speech through the mask, Calling your family is my next task. I can see the fear in your eyes, I know I might just cry. With no one at your home, I hate to leave you alone. The falling rain and my shift comes to an end. I leave you in the hands of my friend. As I look out the window at the rising sun, all of the raindrops show a colorful display I hope that you are able to stay another day.

Thanks for the replies. It is both the sites and smells. The stool in the toilet did not smell, but it did leave skid marks on the bowl as it flushed down, that was gross! Mints are a good idea, I will try that. I sure hope that the second trimester is better. I am so hungry and have a crampy stomach which both keep me awake most of the night.

I am 9 weeks pregnant and have been on vacation for about 3 weeks now. On my last shift I noticed that my usually strong stomach was a little sensitive. The site of urine soaked tissue on the floor made me gag (I mean soaked- as if the man put the tissue on the floor and played target practice) I did not think much of it however!! Since then, the smell of someone passing gas, the site of stool in the public toilet that someone for got to flush all made me gag. I work on on a GI floor! I deal with a lot of.... pooh and bad smells. Any suggestions on how to over come all of this? It is not just the smell it is the site. My patients, co-workers and myself thank you in advance!

Thanks for all the support.

Turns out that the instructor asked my co-worker to take over this student, she declined. Apparently one of the higher ups asked that the student not come back to our floor. I feel bad, I wish I could have done better, but you can only do so much with what you are given. I really wanted her to succeed and get hired. My understanding is that she can now redo a portion of her schooling and try again, I am sure she will be a much stronger nurse for it.