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Aliareza BSN

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Aliareza has 6 years experience as a BSN.

Aliareza's Latest Activity

  1. That's just it. I think part of us will wonder if we stop now would she have improved had we just given her x number more weeks to let her lungs recover? But I have seen SO MANY families cling to that hope after ventilation and do the trach and peg tube surgery and cling to it only for their parent to only partially recover before the next minor respiratory illness comes along and kills them. It is so hard to lose someone all at once but the nightmare these families don't comprehend is that it's much harder to lose their parent bit by bit watching them suffer and struggle the entire time only to die in the end anyway. I would never want that for myself and I know my mom doesn't either.
  2. I know ☹️. It's so difficult to see her mind still there and active while her lungs stall out and fail. There is so much she's never gotten to see. She has a new grandbaby on the way via my sister, who is heartbroken that she can't even really see her due to of the huge risk COVID poses to pregnant women. I am going to get married and start a family soon and if she doesn't get through this she won't be there to see any of it. Her last wish was that the whole family get vaccinated and that we tell everybody we know to get the vaccine. She deeply regrets her decision not to.
  3. She'll be 60 in September. She was generally unhealthy, maybe getting into pre-diabetic territory and probably had undiagnosed OSA (my sister and I both told her she needed a sleep study but she refused). Her biggest issue is that she weighed 330 lbs at 5'4" when she was admitted. She also has a calcified DVT in her leg and probably RA. She was obese most of her life but really let it go over the last five years and ballooned up into morbid obesity territory again. She did still have a lot of quality of life before this but at least for me I know her lifestyle choices were likely going to start catching up to her soon since her dad was the same way and had DM2 and mobility issues once he got older.
  4. So to make a long story short, she didn't get vaccinated and caught COVID in early June. She was hospitalized on the 11th and slid downhill until she had to be intubated. She got a night's warning so she was able to tell us her wishes regarding the decisions we'd likely be facing in the days ahead and to tell everyone goodbye. I do have critical care and ventilator experience as an RN but left bedside before COVID so I haven't personally done acute or critical care for COVID. I worked in outpatient testing and an outpatient COVID treatment clinic, so I'm not entirely unaware of the possibilities of long term effects. Today is day 8 for my mom on her ventilator. She's down to PEEP 13 and fio2 of 55% but that number hasn't moved in a few days. Her chest x-ray showed some clearing of her right lung a few days ago but no progress since then. We've been told she'd have to be maintaining with 40-45% fio2 and PEEP 8 to try to come off the vent and she isn't there yet. We know that by day 14, they'll want to go the trach and peg tube route if she isn't ready to be extubated. The longer we go, the more things slip (fevers, skin breakdown, delirium) and I frankly don't see her making it to her goal. That leaves us with a very difficult question: do we pull support? She told us that she didn't want to live if she couldn't have a high quality life in which she lived at home independently and could essentially return to work and taking trips and go back to living a normal life. Since she's made Some progress, it's hard for me to know whether she just needs more time or if we're dooming her to life in LTAC hell until the next cold comes and finishes the job. I am in no way seeking medical advice and I don't need anyone to tell me what to do; instead, I was hoping that perhaps nurses who have worked with ventilated COVID patients might be able to tell me about their personal and professional experiences so that I can better gauge the reality of what I'm looking at. I have a decision making conference with her teams and my family on Friday to try and help us make an informed choice for her, and it's one we will have to make as her children since she's single/divorced. I know it's likely not a positive prognosis. Life after an extended ICU stay and significant time on the vent even without COVID is often never the same. Any input would be much appreciated.
  5. Aliareza

    Why do some nurses "hate their jobs"?

    I hate my job because my hospital's administration finally drove the nurse manager who'd been running my unit for 15 years out. She'd gotten 95+% HCAHPS scores every year, carrying the hospital, but the other med-surg managers hated her because she didn't buy into the administrative BS and ran her floor in a practical way. Their way didn't work and hers did. She protected us. My new manager straight up tells us at the bottom of every schedule that the floor is more important than our personal lives. We cannot have a weekend off at all no matter what. We must swap with someone else to make it happen if we want it. We can request other days off, but we will not know if we got them off until the new schedule is out, and they are not guaranteed. My patient ratio went from 4-5 patients with 2 nurse aides for 20 patients, to 6 patients nearly all the time with 1 nurse aide split between my floor and the floor around the corner. That leaves 1 aide for 27-35 patients. It is not feasible whatsoever, especially with the acuity level of the patients being so high. Many nights we do not have an aide at all because they all quit due to poor treatment and overworking. The patients are brutally demanding and we are not allowed to stand up for ourselves even when mistreated. In the month since my manager left, 3 nurses have followed, and 4 more are set to within the next month. I would as well were I not stuck there due to being a new grad. We are chronically understaffed and now we're being forced to work outside of our normal schedules, meaning we never know when we'll be off. My 1 year is coming up soon, and I'm tempted to start looking elsewhere. Problem is, most other hospitals within a 1 hr commute area are run the exact same way. There is only 1 hospital that isn't, and it never hires new grads and rarely hires at all. Nurses don't leave because they know they're standing on the "other side" in the only place with grass left. I picked this profession and even this hospital after careful research, and I still saw poor administration roll it right downhill into hell extremely quickly. It's demoralizing to know that this is what the majority of employers are like in this profession now. The job isn't bad; turning healthcare into a business is bad. A pay raise wouldn't fix it. Appropriate staffing would fix it. Allowing us to tell patients the truth would fix it. Standing up for nurses instead of letting patients and their families walk all over us would fix it. A manager who saw us as people and not just bodies to fill time slots would fix it.
  6. Aliareza

    Differences in US nursing vs the rest of the world

    I disagree with this entirely. When our system goes into downtime overnight, I usually jump for joy. I get all my assessments in before the downtime starts and then all I have to do is maintain the patient. Giving AM meds during downtime is heaven. I get the MAR, circle the meds (instead of writing them on my brain sheet), pull them, double check against the MAR, and then open them all and give them to the patient (after checking identity of course). If I had to do it through the EMAR, I'd have to scan the patient, check the identity, scan each pill, enter reasons on giving a PRN, and probably enter reasons on every single drug for giving them "early". Most of the AM drugs that night shift gives are scheduled for 7 am, and can officially start being given at 6 am. There's no way to start at 6 and give 6 patients their AM meds (you wake most of them up and they need toileting, which is a lengthy affair for post-op joint patients). I start at 5, which is accepted practice because the administration knows that we can't start at 6 and be done by 6:30-6:45 to start giving report to the day shift. Thus entering a reason for giving an early dose on every single med for most patients. Computerized charting is faster for the daily assessment I think, but much more cumbersome for giving meds. The additional safety features make it worthwhile (I *really* like knowing I'm not going to accidentally make a med error), but soooo time consuming. Oh, and then not having to double chart the pain assessment and reassessment for PRN pain meds is great. All I have to do is write "Pain rated at level 7, present in hip. Pt describes pain as stabbing, shooting pains. Administered 1x Norco 10." instead of going through the process of doing drop-down menus and checkboxes for every single little detail of it.
  7. Aliareza

    what's nclex test scheduled time like?

    At my site, there was an 8 a.m. and a 2 pm slot. I had a bit of a drive to get there, so I chose afternoon. The day before, I did the recommended pre drive to ensure I could find it. I checked with the secretary to be double certain I was in the right place, and she offered me the chance to come in early once the 8 a.m. crowd finished. She rightly assumed that not all of them were going to take the full six hours. I got a call the next day at ten a.m. and took my test at about noon. I was done by the time the other 2 pm people began to arrive xD. I took my test in the boonies. Surely other places will also have afternoon slots. However, I'd ask off from work if I were you, just to be sure. Plus who needs work stress on nclex day?
  8. Aliareza

    How Physically Demanding is Your Job

    I work on an ortho unit and it is very physically demanding, as you have surmised in your original post. When I come in, I know for a fact that I will likely spend my entire morning just passing meds to my patients, getting daily assessments done, dealing with doctors rounding and morning PT sessions, and helping out with movement in general. Nothing gets charted until after I've eaten lunch, which may be at 1 pm or it may be at 3 pm, depends on the day. The exception is if I have a patient going for a procedure who requires their daily assessment charted beforehand. The running joke on the floor is that ortho nurses become ortho patients, and it's very true. I've known a number of the long-time floor nurses to have injuries, back injuries especially, that necessitated surgery. The recoveries usually took a while. You'd be crazy not to take short term disability as a benefit on our floor. I stay on my feet basically all day. Some of that is because I'm new and not as good at organization as some of the long-time nurses, but most of it is just the very physical pace of the floor. With that said, I've seen med surg floors be much worse due to their patients being much sicker in general and having much more required care.
  9. Aliareza

    Woes of A Foreign Nurse

    Amen to every single word of this!
  10. Aliareza

    Woes of A Foreign Nurse

    This is very interesting to me. My boyfriend's mother is Filipino. She moved over here and worked in retail for a while to get a sense of the language before going to nursing school. I also worked with an older Filipino nurse with a similar story. I never knew there were programs for nurses from foreign countries like that, or that the Philippines were so disadvantaged. It sounds incredibly difficult. Congrats to you and everyone else who has the strength of will to make such a huge leap.
  11. Aliareza

    But all the Nurse is doing is sitting down. Why cant the help?

    I know this feeling, and I've been on both sides of it. Point blank, being an aide/CNA sucks, hard. I basically got paid a dollar more than minimum wage to clean up all forms of grossness, toilet people, and be responsible for 10-20 (depending on if I was alone or had a helper) baths and bed changes daily. After breakfast, lunch, and dinner (all of which were eaten on the 7a-7p shift), there'd be at least half of the patients on the floor needing to all go use the bathroom at the same time. Understandable, but very stressful, especially when most of them are elderly, so they can't hold it long and failure to get them there on time meant a very soiled occupied bed change + patient cleanup. Even ten sets of vital signs can take more than 2 hours to get when so many of the patients need you to help them use the bathroom while you're in the room or get them a coke or call so and so or any other number of things relegated to the aides. As a nurse, I still don't feel I get paid well enough to do all the things expected of me. As an aide, I really didn't feel like I was compensated well enough. I would never have made a career out of that. It would've physically broken me down to do it; my back, knees, and feet hurt every day after going home because all I did was haul people around all day, change beds, and give baths. I'd be the one not getting my breaks, while the nurses, who were only responsible for five patients versus my ten or twenty, often got theirs. So yes, I know both sides of the coin, and I keep it humble. I help the CNAs when I can. I also don't put up with any attitude because I know exactly what it's like to be in those shoes, so it's easier to realize when I should cut slack vs. call one of them out on their crap. I think we'd all benefit from that kind of perspective.
  12. I feel really bad for OP after going through the first two pages of this thread. OP, I finished nursing school not too long ago and this is what I can share: I am an excellent student. Got A's in my pre-nursing courses mostly without trying too hard (exception of Anatomy II ) and really breezed through everything. At first I did the same with nursing school, but when I got heavy into med surg, it kicked my bum. No longer could I study the day before the exam and know it well enough; I had to start immediately after each lecture, going through and taking notes and making sure I stayed caught up. Clinicals were technically zero credit hours, but they took up so much time they may as well have been a class. Between picking up patients the day before, doing pre-clinical paperwork, going the next day, and then doing post-clinical paperwork, it was a 2 day a week commitment on top of my classes. So point blank, I had no time my last year of nursing school. I'd want to clean up my room/bathroom once a week and could only find the time to do it once a month at best. I'd wear every piece of clothing until it was all dirty to avoid having to do weekly laundry. I was also working PRN at a local hospital, so it only compounded the stress. My boyfriend and I were long distance at that point as he finished up some of his schooling in another state, and what he did that I found so wonderful was just being there. Even if we couldn't watch a movie together or play a game together, simply being on call with each other via Skype was enough to make me feel like we weren't abandoning each other. We both tried to organize family and friends time around time with each other so that everything stayed in balance and we got to be there for one another as much as possible. For example, weekends were stressful for me because I worked most Saturdays and my unit exams were always on Mondays. On Sunday, the entire day went to studying for the Monday exam, and my boyfriend knew this and would routinely do his own homework that day and then go out with his friends at night. Now that I'm working as a nurse, he always asks me how my day was when I get home and lets me rant a little. He does the dishes for me, and I do our laundry on my days off (I have a LOT more free time now that I'm good and settled in as a nurse!). We clean the house together. When he knows I've got to be at work the next day, he'll hang out with me when I get off work until I go to bed. He offers to go get me food if I don't feel like cooking, and then makes sure I stay on track with getting in bed. Even though we don't sleep at the same time, he always comes in and lies down with me and scratches my back to help me relax/make me sleepy. Obviously, the two of us are extremely close. We both enjoy a lot of independence while still kind of revolving around each other, and we like it that way. Don't let other people make you feel guilty about your relationship with your girlfriend. What some people find smothering and clingy, others find natural and comforting. It's all good as long as she's on the same page with you and neither of you are giving up study time for time with each other (school comes first! always!). Good luck with your relationship and your studies :).
  13. Aliareza

    Do We Need More Nurses?

    The "shortage" all depends on where you work and what you'll deal with to have a job. There is no shortage of day shift nurses in high paying areas. There probably isn't even a shortage of night shift nurses in high paying areas. But in areas like south Georgia, where I decided to relocate to start my career, most of the graduating students have jobs as soon as they want them. It is not difficult to get offers in a variety of areas. The pay is low but so is the cost of living. I was perfectly willing to take a night shift job. So yeah, if you are willing to make your own way and find available opportunities, there is still plenty of need for nurses. If they're not needed in your area, find a place where they still are. If I ever do go the route of higher education past BSN, it'll be for nursing education so that I can either be an instructor in a hospital's education department or at a college. Those jobs don't pay as well as patient-care jobs, so I have a good shot of finding a job that'll keep me happy. Choose wisely, and you will, too.
  14. Aliareza

    Withdraw 401k for living expenses while in school?

    It truly depends on your situation. It can really hurt you at tax time to do something like this. The only way I'd advise it is if you know you're going to have extra room and can avoid paying so much of the penalty. I'll give you my real life example. My husband quit his job last year to go back to school. He'd been working there for 7 years, so he was fully vested and had $9000 in his 401k. He took the payout. Right off the top, they took 20% of it, which they are allowed to do. 10% covers taxes, 10% is a penalty fee for early withdrawal. The tax portion, we mostly got back, because our combined income was $10,000, so even with the payout, we only "made" about $20,000 last year. I had a lot of dental bills (needed a lot of work, had no dental insurance), so I claimed ~$3,000 in medical expenses on my taxes. This is where they double-dip to screw you over. Even though the $9,000 in 401k distribution was not earned income, it contributed to the amount we had made (our AGI). I had to get over a threshold that was 10% of my AGI, and anything over that, I could claim to reduce the early-withdrawal penalty. That left me with not very much. The government took about $1000 of the $9000 between leftover taxes and the withdrawal penalty. We also would have qualified for earned income credit of ~$400 had we not had that extra income from the 401k distribution. Even though it was not "earned", the government counted it and denied us the earned income credit. It was very worth it for us because we still got about $7,500 of it in the end, and the extra $1,500 the government took was what my husband's company had vested him anyway. We gained money. Most people are not poor enough to benefit in that way, and even though we were, he still lost $9,000 toward retirement, and that's something we'll have to spend a lot of time making up for. I never would have touched it had there been any other plausible way to send both of us to school, but there wasn't. Now I'm a nurse, and my annual salary is $45k. Putting off school to work a min wage job and save up for tuition would not have been worth the wasted time where I could have been earning a much higher salary. Your long run almost definitely looks different from mine, though. For most, it would never be worth it to withdraw from a retirement fund.
  15. Aliareza

    Failed the nclex, need help

    I'd recommend you do LaCharity's Prioritization and Delegation. You can buy the online access and get the exact same content that's in the book (I prefer online because answering a question and seeing the answer ASAP is better for me than answering 20 questions then flipping to the back of the book to look up the answers). It's not a teaching book -- it only has questions. But of all the things I used to study, nothing could kick my bum like those LaCharity questions. Some modules, I couldn't even get half the questions right. It'll really test you. The wrong answers are just as important as the right answers, too. I used Hesi's Comprehensive NCLEX RN Review guide to study for my exit HESI, and I felt it did a really good job of concisely covering a review of all the things I learned in school. I used it particularly for psych, as it is one of my weakest areas. I'd recommend it as a good base of knowledge. I had Saunders and Davis' big comprehensive books, but those were just daunting to me, and to go through every bit of the around 1000 pages of material seemed like a huge waste of time. Focus on what you know you need, and get a brief review of everything if you can afford the time to do it.
  16. Just the intolerance, I promise . I'll admit that religion in and of itself makes me uneasy. If faith is the basis of belief in something/someone instead of rational thinking, literally anything can be justified. And indeed, it has. The South has quite unashamedly used religion to justify racism, sexism, homophobia, and transphobia just in the last 50 years. Religion is the excuse for many deeply-held personal prejudices. Despite that, I chose to live in the rural south. Cost of living is low, and there were many job opportunities for new grads. You can enjoy a very comfortable life as a nurse in south Georgia :).