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.

So, I have had an LPN student for the last four almost 5 weeks. I have spoken with her and her teachers about my concerns regarding her ability to perform assessments and relay important information, decide what assessments need to be preformed based on the patients condition, lab work or disease as well as ability to safely administer medications. She was put probation with her last evaluation and had specific criteria to meet. On her next shift she did not meet any of the criteria. She did not look up the reasons why pt were on the medications ordered she missed 3 medications for 2 different patients as well she did not report her assessment findings, which included a pt with a low grade temp that several hours later when she told me about it progressed to a high fever. She admits that she does not look up the uses, how to administer or the monitoring required for medications. I have worked closely with her and tried to help her understand the medications and diseases she works with. I have allowed her significant time at work to do her research and prepare her self for safely caring for her pt's Her immediate teacher was very supportive of my findings and assured me if at any time I felt the student was unsafe I could send her home. At the end of our last shift, I told the teacher that I did not feel the student was safe. With only 5 shifts left, I felt that there was too much improvement needed for her to be safe at the end and that I did not think she could finish her preceptorship working at the level she was currently functioning. Here is the kicker! I got a call last night, the student will be back on my next shift prepared to work and take on a full load. that all she needs to do is come in the day before and do her research and she will be prepared. Did I mention she only has 5 more shifts until she can work independently on an interim license? I said NO! You will have to find someone else to help this student. What is going on here? How can they try and push someone through that can does not demonstrate safe practice?

When I was in school, 3 years ago, I was taught to always flush. This created negative....... positive.......the correct pressure in the IVI (IV- infuser) It is what I do but with 3cc of NS q8h.

Well it is done, I spoke with her teacher this AM and let her know how the night went. Missed two meds for one pt and an IV med for another. DId not think a low grade temp was a concern and only told me about 2 hours before the end of the shift. Once she told me the pt temp had elevated to 38.5. Luckily blood cultures had already been drawn the day before. So now, with only 5 shifts left of her preceptorship/program, it lies in the hands of her teachers. I am sure that will what is in the best interest of the public. Thanks to everyone for all of the supportive words and encouragement. :heartbeat

With hgb it could be low d/t a bleed or rehydration (a dehydrated pt put on IV fluids) or any other issue. We have pt with low hgb NPO frequently for G&E's and other procedures. Low HCT could be over hydration. Take a look at these websites, I am sure you will be able to find the answer with some work. Good Luck! http://www.heartpumper.com/hematocrit.htm http://www.questdiagnostics.com/kbase/topic/medtest/hw4260/results.htm

Wow! What a response. It is nice to see how supportive everyone is, thank you. I remember being a student and know that I would have liked the extra help and tips. But now I realize that it is all being wasted. Looking up the same med 3x in one shift and still needing to explain that yes you have to read the uses for the drug, you can't assume that biaxin is for liver failure. I spoke with her teacher tonight and will speakwith her again tomorrow AM...ugh this AM. I will suggest that she not come back. Beachbutterfly: I live in Canada we use a different scale for all most all of our labs, makes it confussing. Here normal Hgb is 120-150. LOL!

I wanted to thank everyone for their replies. On our next shift I spoke with the student about my concerns. I told her that her practices were unsafe and that I had a lot of concerns with her basic nursing knowledge. I took the entire assignment and she spent 3 hours looking meds and diagnosis. When I asked her about timolol gtts. She replied it is for BP, but when I asked what condition it was treating, she could not tell me. She had stopped reading when she got to PO and not read on to eye gtts. Later that day we met with her teacher. Her teacher had not gotten the email I sent and was shocked to hear the news. Her teacher was ready to pull her off the floor, but I urged the teacher to give her a chance to prove herself. The student was strongly spoken to about the risks she is taking and told that she is at risk for failing. The teacher asked her if while in school she had to make med cards and notes for each pt. She said yes, but did not think it was needed now. So the teacher said she would return the next day with a contract that would detail strict requirements for the student to live up to. The teacher stressed the need for her to study medications and know why she was giving it. Do the 8 rights and 3 checks. Wanting to boost her moral I offered for her to give one of my pt's newly order medications. I answered her bells and tended to her pt 's while she researched Humira.:typing I printed off info for her to take home about Crohn's, confident she saw the writing on the wall. So the next day, I asked if she read the info on Crohn's and reviewed the medication. No she had not! She had family over and did not get to it. Later that same pt lab work came back and her Hgb had dropped from 96 to 83. I showed her the labs and asked what she should be assessing. She replied "I don't know" I asked what hgb is "It has to do with your blood" I pressed further "It has to do with your sugars" I asked her to sit down and look up hgb. When I came back, she was reading about what causes hgb to drop. "Great! What is the first thing you should assess?" She read the list "Severe blood loss, bone marrow ....., malnutrition." She felt malnutrition was most important. During her first week we talked about GI bleeds and blood loss in great detail, she researched it and I gave her handouts. we work on a GI floor! Her teacher came later that day with the contract. I told her teacher about the day the lack of research, the hgb and other issues through out the day. The teacher was blown away when the student told her she did not do any research to prepare her for her day. The contract says that the student has to have 60% of the workload tonight, med cards, research about the conditions of her pt and assessments that she will do, all written out and ready for me and the teacher to see. I suggested she sit down for a while to write out medications and conditions so that she could prepare. She did not, I suggested that she spend time with the chart of one of our new pt's and she did not. Instead she stood by the nursing station listening to some of the nurses talking.

I use to work as a manager of a a few retail stores. Interviewing potential employees and being interviewed I learned a lot about the whole process. I found that people I remembered were the ones that were honest and did not give generic answers. I avoided people that had issues such as tempers or appeared too eager to work. (I will work all the shifts you give me, OT weekends you name it I'll do it Tthis is a hard order to fill, say no to one shift and you have not been honest to your employer. Doing hiring I knew it and was always put off when this was the answer. I enjoyed the people who sat in there and just had a conversation with me, talked about the questions I asked and were honest appeared organized, and prepared for the interview. Had questions for me about the job or the company. Being interviewed, I found that I was most relaxed when I reviewed potential questions that could be asked, thought about the answers and how they applied to the job. When I did my research about the company and had insightful honest questions. When I was asked about my greatest weakness, my answer right now, today, it would be one of two things. 1. When I have a student and they are struggling part of me feels responsible for helping them be successful. I try to stand back and let them learn on their own but sometimes I find that to be hard. 2. I tend to play by the book. If an order is written, I like it to be transferred to the MAR and co -signed before I give a med to avoid errors. Sometimes, this can be a challenge because people are busy and they don't share the same school of thought. Below are a couple of links to potential questions and suggestions on how to respond. My advice is to relax as best you can during the interview. Review the questions and have an idea of how you would like to answer them. Good Luck! http://bhuvans.wordpress.com/2006/08/19/50-common-interview-qa/ http://www.redgoldfish.co.uk/cvinfo/toughquestions.aspx Questions for you to ask: http://career-advice.monster.com/job-interview/interview-questions/nurse-interview-questions/article.aspx

Thanks for the replies all. I hope that I can help her along and get her ready for the working world. It's hard because the course is so short and in 3 weeks she will be done and writing her exam.

Chapis - thanks for your reply. I hope that she takes advantage of the time i plan to give her to look up all of her meds. Virgo- There is a lot covered over 3 semesters. They touch on some things and go in depth with other things. CHF is covered in great detail. Left sided heart failure vs right sided heart failure. You are expected to know enough A&P to be able to admin medications safely. Erin- I too remember what my preceptorship was like. It was a challenge d/t the transition you speak of. I do ask my student to look things up, but we do it together. We ask each other questions and try to apply the knowledge right away. The LPN preceptorship in our province is so short, only 165 hours. There is an expectation on the student that they will transition from student to entry level LPN during that time.

I have an LPN student who is on precpetorship right now. She is at the half way point in her time on the acute care ward I work on. Her mid term eval is coming up this week and I have concerns. I have already sent an email to her teacher about the concerns but want to see if anyone else has any good ideas on how I can help her prepare for licensing exam and new career She is compassionate with the patients and very helpful. However, I am mainly concerned about her level of knowledge with medications. She looks some of the meds up but is unable to connect them to the reason the patient is on the med. (Septra DS - her reason the pt has new hemmroids/prolapsed rectum. She did not connect it to the pt's UTI) A different pt had leg pain d/t an extensive DVT. I asked her what medication would she would chose Gravol or Diluadid as these were the only two prns ordered. She replied- "Gravol is for nausea, so dilaudid." When I asked why dilaudid- "Its an anti-coagulant, it will help reduce the size of the DVT and lessen the pain it is causing." Noticing a knowledge gap, I offered to sit down with her and review the medications of a pt she has had for 7 shifts. She could not tell me what any of the medications were. Even with reviewing the meds together she had a difficult time understanding why the patient was on any of the medications. Such as, Lasix. We reviewed the uses of Lasix, she felt HTN was the best choice. I asked her about the pt's edematous legs and CHF, she replied "Cardiac Heart Failure?" I explained what CHF was and she had no insight about this disease (I think I have heard of that) and why lasix would be given. She gave another pt morphine without checking he ID band. She is very green to acute care and I have concerns about her ability to problem solve. She was unsure if she had to do vitals sign on a night shift. I told her yes indeed you do along with all of your assessments. At the end of our HS round I asked and she had not done any assessments. Again, I explained to her that you need a baseline and esp if a patient has been c/o abd pain during the day......a short time later that pt rang having abd pain and nausea. She shows potential. She takes feedback and applies it. I can see a difference from shift to shift with time management. But I am concerned that she does not have the knowledge to complete the program. Her midterm eval is this week and I plan to discuss this with her before her teacher arrives. Also I will reduce her assignment and give her time to look up all of the medications her pt's are on. Then review them with her, and unless she has a good understanding for those medications, she can not give any of them out. It feels mean, but I am not sure what else to do. I want to ensure that the safety of the pt's is first.