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LovelyRN757, I will be starting with the patho and such coming up in May. Thanks

Is the Admitted Nursing@Simmons FB group still active? I can't find it on the search. I start with the May 2017 Cohort Thanks

Thank you for your post and for reminding us that every professional has to start somewhere just like we all once did. It is always so strange to me when nurses are rude or mean to doctors who are asking questions regarding their patients' day and care. Reminds me of a related problem I have run into at my job. Most (95%) of our patients have the same doctor who also happens to be our medical director. He will come in at 4am, do his rounds and then write his progress notes. I promise the guy will walk into a dark room, barely place a stethoscope on the patient and do this for all his patients before sitting down to write very detailed notes about the patient's assessment. There is a running joke that he doesn't even put his 'ears' in his ears when he auscultates. We are always complaining that he doesn't really perform assessments, never washes his hands between patients, never gowns up for isolation rooms, and never wipes down his scope between patients. All the nurses complain about him. Then, there is this other MD. He is neuro and he is the most thorough person I have ever met. He will spend 30 minutes in a room doing a full body assessment including DTRs and everything. He talks to his patients and family, explains everything. Spend tons of time looking over the patients' charts, labs, consults, nursing notes, vitals, I&Os. Everything! He knows his patients in and out. He spends time locating the nurses and asking about progress, concerns, reactions...everything. He always always suits up fully depending on isolation status, down to booties and hair nets. He is always responsive to the nurses' suggestions and if not, he takes the time to explain fully while something may be contraindicated. You know what, nurses on the unit talk more smack about this MD than anyone else. They complain he spends too much time with their patient, he asks too many questions etc. They hide from him so they don't have to report on their patient, they snap at him if he asks them something. And some are just down right mean to him. It seems there is no pleasing us. We always find something to complain about.

If you were planning on getting a MSN anyways, I say go for it. The time will pass anyways and you may as well use the time to acquire a degree that you intend to get anyways. Going back to school and looking for a job are not mutually exclusive. You can continue to look for a job while attending school (until you start preceptorships). Congrats on your soon to be addition to the family.

#1 Every time I see those guys on the travel channel that get paid to travel the world and document it, I know,, that's what I would rather be doing than anything else. I guess that's whimsical coz it will never happen. #2 Which I am really, seriously, but not too carefully considering. Save up a bunch of $ by doing double for a year then give it all up and go to some remote beach locale and open up a bar with some food bar offerings. And maybe a small guest house/hostel. I could invite all my fellow stressed out AN members to visit for a week and decompress.

Whenever I have worked LTC, we had several hospice patients. The hospice nurse was not responsible for any of the daily pt needs like assessment, medication administration, wound care etc. Those are all the responsibility of the ltc nurse and the hospice pt is treated exactly like the regular pt including calling their MD for orders and change in condition. Except::::: The hospice nurse did bi-weekly visits to each pt but if they had a bunch of patients in the same ltc, you would pretty much see them daily even though they were not necessarily there to see your pt. They did their own assessment, spoke with the pt about concerns, were very involved in decisions about pain management and would usually write pain med/anxiety med orders on the charts. If the pt's pain isn't managed, we (the facility nurses) would call the hospice nurse and she would either come in and reassess, or just change med orders over the phone. One of the most important functions of the hospice nurse in ltc is just sitting and visiting with the pt. The pt's were more likely to share their complaints with the hospice nurse than the floor nurse who was always busy. And finally, being a go between with the pt's family. I can say I really appreciated the information and education offered to the family by hospice nurses. If I had a family member I felt needed intervention, the hospice nurse was always able to talk things over with them and clear the air. If the hospice pt was turning bad, we always called the hospice nurse and she would (depending on how dire the situation was) send a sitter to be with the pt and family in the final moments, and if she wasn't busy attending to another terminal pt, she would also come sit with the family and if needed change roxanol/ativan orders prn. The hospice nurse would also come to the facilty to pronounce and do the final paperwork with the family and funeral home reps. To summarize, HOSPICE NURSES ROCK!!

Please forgive me as I have never worked in a place such as you describe, but your post made me laugh! I am sure to you and to those in the middle of dealing with the issue it is a serious issue. Have you thought about having a security guard to maintain order in the clinic when you are open, and in the parking lot and by the door when you are out to lunch? I did my community health practicum at the local city clinic and they had a guard in the clinic enforcing such rules as no talking on cell phones, everyone must wait in the designated area etc. Maybe if the problem is considered bad/annoying enough by the people with the money, they will be willing to part with some of it to provide a guard.

Why was his blood sugar low? Was he too zonked and did not get to eat his meal? Did anyone follow up with the lack of meal intake? Maybe then the sedation could have been caught before RRT was necessary. Like others already said, just because you are on the patch doesn't mean you can't get IV fentanyl. This seems like a teacheable moment for all involved. The MD could probably have more closely considered the renal issue. The nurse that gave it could have considered other prn orders before giving the IV fentanyl. Closer meal intake monitoring and follow up is probably called for. And,,, if the nurse was looking for the PCA to get the blood glucose level because that was the only machine available, then maybe there is a lack of supplies issue (that would be a shock right??) Then again, I could be completely wrong.

When I was about 5 months pregnant, I worked 1st shift at the nursing home. I must have forgotten to hydrate coz I was leaning on my medcart infront of a resident's room getting ready to pull their meds. All of a sudden, I start seeing stars, try to lean back on the wall but ended up going forward into the cart, which the wheels were unlocked. I ended up head/face first on the cart then the floor and my medcart ended up on the other side of the hall. The poor resident who had witnessed the whole thing started yelling for help and I woke up with my coworkers and several residents looking down at me. Lesson learned::::Always keep hydrated.

You did the right thing by getting EKG and continuing to monitor. In this case, also report to the charge nurse and they will advice further based on their experience and unit protocol. Most importantly, once the monitor tech has notified you (and the charge nurse) of the changes, she should not be talking to other nurses or non-nurses about your patient and her opinion of what you are doing/not doing. PS..all units I have ever worked at have a protocol for all these things. Like what labs you would want to draw etc.. "What stressed me out was I had to take care of pts and monitor tech started to stress me out by keep talking to other nurses and then I had to explain it to them the situation or none-nurse staffs and what I got from them is "I am not doctor." I am new grad, it already stressful enough to take care of patients with these situation as I am scared they will go unstable, yet dealing with others and their questioning make me second guess myself and become doubting myself. "

Yes..you are not supposed to make any copies. But as demonstrated by OP's predicament, lack of a triplicate paper trail has a way of coming back to bite you on the caboose. Most original incident reports I have seen have a carbon copy. (Facilities get too cheap to keep buying originals so we just write on copies therefore ensuring no 2nd copy) What I have done before when I knew or felt something may come back to bite me, I write the original report that goes to the DON, make copies for the ADON, Administrator and quality control. While I do not keep a copy for my self, it is really hard and takes a lot of planning and agreeing between lots of people for 4 copies of a report to disappear. The way I figure it, by the time all these folks go to stand up on monday morning, they all have the report and are aware of what happened without one person twisting the event to suit their CYA needs. And also, no privacy violation here. just me.

Walden currently allows students to enroll in the FNP specialization in the following states: Alabama, Alaska, Arizona, California, Colorado, Connecticut, Delaware, Georgia, Hawaii, Idaho, Illinois, Indiana, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, Ohio, Pennsylvania, South Carolina, South Dakota, Texas, Virginia, West Virginia, Wisconsin, and Wyoming. Check back often as more states will soon be added to this list. For assistance in deciding which online degree specialization fits your goals, request information or speak with an enrollment advisor by calling 1-866-492-5336. A list of international toll-free phone numbers is available for students outside the United States. Note on Certification The MSN nurse practitioner specializations are designed to prepare graduates to qualify to sit for national nurse practitioner certification exams, which are required for practice as a nurse practitioner in most states. Because no graduate program can guarantee that graduates will be permitted to practice as a nurse practitioner upon graduation, we encourage students to consult the appropriate Board of Nursing or state agency to determine specific certification exam requirements. Walden enrollment advisors can provide information relating to national certification exams; however, it remains the individual's responsibility to understand, evaluate, and comply with all requirements relating to national certification exams for the state in which he or she intends to practice as requirements vary widely. Walden makes no representations or guarantee that completion of Walden coursework or programs will permit an individual to obtain national certification. For more information about nurse practitioner certification exams, students should visit the American Academy of Nurse Practitioners at www.aanpcertification.org, the American Nurses Credentialing Center at www.nursecredentialing.org, or other nurse practitioner certification exam websites. (copied from Walden's website on 9/24/2012)

I found this article pretty interesting, and the comments after the article even more interesting. What do you guys think about banning stuff like pb&j due to food allergies, and how does your school (or your kid's school) handle this issue? http://shine.yahoo.com/parenting/pb-38-j-worst-weapon-kid-bring-school-215000284.html

sounds like every ltc I have ever worked at or considered working at.

http://www.arjohuntleigh.com/admin/files/20100723162630.pdf probably still need two people to safely move a 200# quad patient

I promise you and any experienced nurse will tell you this>>>>>>> The day you get an abnormal lab that turns into something bad and has a negative outcome for the patient,,,,this same doctor will swear to high heaven that she never said don't call and no one told her about the abnormal labs. You my dear new nurse will be left hanging out on the chopping block all by your lonesome. Your DON will not back you up, your unit manager will not back you up. If there are no parameters,,,,,always call abnormal labs esp. stuff like pt/inr, hgt/hct, wbc, cr/bun. I would call all my abnormal labs until this doc decides to put out some parameters. Also please discuss this with you DON/DNS and quality control persons. They may be able to talk to this doc about putting out some parameters.

Oh yeah...favoritisim, nepotism and all isms you can think of exist in nursing. I once worked in a nursing home where the Admin was sisters with the DON, sister in law with the MDS coordinator, ADON and Admin Assitant were brother and sister to the DON's hubby, the admissions nurse was cousin or sister in law, Staffing coordinator was the daughter of the MDS, both secretaries were the daughters of one of the unit managers, who was sister to one of the other people, the business office lady was another sister of the ADON. It was crazy!! I mean the whole place was a family reunion. Woe unto anyone that complained about an employee to anyone. You never knew if you were talking to that employee's mom/sister/cousin/in-law. Of course the family got all the good shifts, never got reprimanded and got the prime vacation days off while us the other peons were left to suffer in silence. Of course this was in the south and even after I left that place, I realized most other places in the area were pretty similar in hiring practices so I could just hang in one place and shut up, or move to a different geographical area. I am not sure how there doesn't pop up a conflict of interest. Good luck!!

Oh that's too bad you did not get the care you wanted over there. Well let's see who is rounding today,,,there Dr. (insert very difficult to pronounce Indian name here), then the attending is (Insert another foreign name here), residents are (even more foreign sounding names here). Charge nurse is (insert foreign sounding name here), and so on and so on... Then apologize to her royal highness for not having ANY non foreign Docs on all night. Excuse yourself and have one of your brown skinned accent having coworkers go in to see if she was comfortable or needed anything. Would have been fun just for laughs.. Like someone said, you can not fix stupid, but you sure can have fun at stupid's expense.

My hospital does not stock ANY basins. If you want to give a bath, you must use wipes. Our linen cart doesn't event have wash rags, just full sized towels. (WHY?!?). When I started, I would be in supply room forever looking for them. Oh well.

To add to all the good advice, do not let your frustrations start showing. Even without realizing it, once we start getting frustrated about a situation, it will start manifesting in different ways and interviewers can start to pick up on it. Go to every interview with the enthusiasm of your first interview, but with the skills, knowledge and confidence gained from all your previous interviews. You will land a great position. Just a matter of time.

Do not be bullied into taking an assignment you do not want! If you NEVER SIGNED any document agreeing to this contract, this recruiter is a bully (maybe worse) and by threatening you, he is probably breaking a few laws. Is he the only employee of this company? I am sure his superiors will be interested in knowing what this guy/gal is doing. Keep all your emails and let him leave you voice mails so you have a record. Beat him at his own game.

yep. Some patients/family/visitors just need to hear how it is and how its gonna be. Enough hand holding

Put in your notice, go to the other job. Do not mess up your last 2 semesters. If after graduation you choose to go back, at least you will still be in good standing. Maybe you can stay PRN if that's an option

TX911, First, I applaud you for doing what many of us fantasize about doing every shift. At my job we are chronically short staffed, we are supposed to have assignments based on acuity with the max being ten, but every shift, we come in, with acuity of 15+ and barely any CNAs. Running multiple patients on vents and multiple drips all on strict isolation etc etc...every horror story you can think of,, my unit has. Every shift, I come in, I see my assignment, and swear am NEVER coming back,,yet I keep going back like a fool, mostly because I know if I leave, my coworkers will be in even worse situations. I wish I could just follow through with my gut feeling about this place, but I guess I lack the follow through. The problem with these places is they keep saying it will get better, they are hiring more staff, they are looking for agency coverage etc etc. Like you, I have been on this job right at 1 year, and if anything, it has gotten worse every day.

For some reason, I have not found people from previous classes. Classes started Mon 8/20. So far so good. The program looks very doable (I hope)