emmjayy

Covid combined with the way hospitals are run has made me hate nursing. I hate feeling like I exist to get taken advantage of. I am currently looking for a non-bedside job and as soon as I can leave, I will.... and I have no plans to ever come back. Good job, healthcare, you took a relatively new nurse and in 3 years' time, you burned her out to the point that she never wants to work in a hospital again!

I just applied for a nurse case manager position at an insurance company, dealing with worker's compensation cases. I am not totally clear on what this kind of job entails, but applied because it's a remote position and I have a solid administration/legal background to draw on from my career before I became a nurse. I'm just looking to hear from any nurses who do this kind of work - stress level, what your day typically looks like, and what would raise red flags for you in this kind of work environment. Thanks!

Deleted b/c it's not worth the fight.

Yiiiiikes. I remember having wicked high levels of anxiety about taking the NCLEX and now seeing people's testing dates getting pushed and testing centers being closed? I'd say y'all deserve a shorter/easier NCLEX just for the pure stress you are being put through! You've worked so hard to get through nursing school just for this final hurdle to be in a state of flux ?

There's certainly irresponsible sharing of statistics and models, with no context given to the numbers and sensationalized language throughout. For example, my local paper breathlessly reported two days ago "grim forecasts" from the Gates Foundation stating that by April 8, we would have 25,000 people needing to be hospitalized with COVID in NYS, and "only 13,000 hospital beds will be available." As of today, April 8, we have less than 4,000 people hospitalized with COVID! Statewide! Give me an *** break. Additionally, I've seen a shift happening to obscure how underwhelming the reports of new cases and deaths are... in the beginning the news was reporting things like "5 new cases a day! 10 new cases a day!" and now are reporting new cases and deaths in percentages.... "Today, we have 75% more hospitalizations in {COUNTY} than we had 3 weeks ago." No kidding! We had 3 hospitalizations 3 weeks ago and now we have 25? STOP THE PRESSES, the apocalypse is here! Just... puh-lease. We all know that the average person consuming these panic-inducing reports isn't going to do the math or contextualize the numbers, they're just going to panic. It's irresponsible. It's the equivalent of screaming fire in a crowded movie theatre, and it should be illegal.

So basically, the hours you work on your project each week count as your clinical hours. Honestly, I don't know of anyone who could possibly spend 10 hours per week working on these project components LOL, but I just said that that's what I spent and no one had a problem with it. I probably did spend 10 hours per week total stressing out and worrying over all of it! DON'T WORRY about the ISP. Just copy and paste the "learning objectives" that you think match each project and put an estimate of how many hours you will work on each component. Just make sure the hours add up to 100 and make sense compared to the size of each project. Hint - the weeks you do literature reviews really are quite time-consuming. You're not alone in your feelings about week 1.... I actually cried in frustration at least twice during that week. And I am the type of person who very easily understands assignments and has never had issues in school! That ISP is complete garbage imo, but just muddle through as best you can. The professors tend to grade very forgivingly, and my professor in the capstone course agreed with all of our complaints and basically gave my class a pass on the ISP because even she was confused by it.

So.... I was laid off from my job in an elective procedural area a few weeks ago (I'm in NYS, for perspective). I was told at the time that we were going to get a massive surge of patients and that I would be redeployed back to the ICU from whence I came (I just left the ICU within the past couple of months). Cool, I don't mind temporarily going back to help with a national public health emergency. The days went by, the cases in my county ticked up at a glacially slow pace, as of today we have a whopping 350 cases in a county of half a million people. We have had 5 deaths. Our hospitals are bleeding money, the hospital I am based at is like a ghost town. We had 12 patients in our COVID ICU this weekend, 4 of whom transferred to a regular COVID floor because they were doing better. Our number of new cases is dropping daily. Statewide, the same thing is happening. The only hospitals that are swamped are those in the NYC area, and let's be real - those hospitals are a zoo to start with, given that NYC doesn't have enough hospitals to care for its population even on a good day. Meanwhile, we have our governor essentially fear-mongering about this. We have him seizing ventilators and considering DRAFTING healthcare workers to go work wearing trashbags as protection in NYC. We have people calling the cops on their neighbors for letting their kids play outside together, and snitching on those businesses that are trying to remain open to pay the bills and keep their employees from becoming jobless. This economy was due for a correction, sure, but this isn't a correction - this is a government-created crapfest that needs to end immediately. The media has VERY irresponsibly invoked panic in the general population, refusing to focus on the fact that the vast majority of known infected people recover without requiring hospitalization. Instead, we get news article after news article obscuring details - "27 year old, healthy man dies of COVID!" when said man was MORBIDLY obese. Or, "Healthy grandfather dies of COVID!" then admitting later in the article that healthy grandpa had "a few" underlying conditions. Cut the crap. In the words of FDR - "The only thing we have to fear is fear itself."

WOW!! Sorry to everyone who asked me a question directly and I did not respond to - things have been kind of crazy over here, I switched jobs, then got switched back to work COVID ICU... just very hectic. I will try to answer folks now though ? @TnG33 - I would 100% recommend GCU over Capella. Based on comparing experiences between myself and co-workers in Capella, GCU is way easier in terms of weekly posting requirements, etc. The nursing school I went to was affiliated with the hospital I currently work at, and the school/GCU had an agreement that my nursing school would push their students towards GCU for their BSN, and GCU would accept my hospital as a clinical site. Not sure how it works for folks who don't have this arrangement. For the preceptor, you just need an RN with a BSN to sign off on your work a couple of times. I asked a friend to do it for me. It was not a big time commitment for her at all. I worked full time during my entire BSN degree and had no trouble at all with it. Are you being required to perform an actual clinical experience such as you did while getting your ASN? I never had to do practicum hours in the "real world," I just counted the time I spent working on the course each week as practicum hours and said I did 10 hours per week for the 10 weeks. For my scholarly activity, I attended a meeting of a committee I was already on. I based my project on that committee's purpose (in-hospital resuscitation events). That way, the scholarly activity tied in to my final report. But really, you could attend grand rounds at your hospital, Schwartz Rounds, or just show up to any committee meeting and write about it - it doesn't have to relate to your research project. The scholarly activity was a very short assignment and I got it done in week 2 even though the write up was not due until Week 9 or 10. Yes, you still have DQ assignments every week regardless of if you did the scholarly activity that week.

Basically just organize as much as you can at the start and make sure you are very clear on what is due each week. And follow the rubrics exactly in order to get A's on all your assignments. There is a 10 week journal to complete that is due in the last week, stay on top of that. You need to attend a "scholarly activity" and do a write-up on it, which is due in the final week - I did that very early on so my last week was fairly chill because I already had all the assignments done! Basically the course revolves around writing a research paper that is due in week 9, and each week you take one step towards the paper - a PICOT statement paper one week, a literature evaluation the next, a literature review, etc. The nice thing is that you can use your previous work to build your final paper. The course walks you through the steps you need to take to branch out and conduct/present your own research in your career. It's nice practice, but tedious haha.

They did! I am officially finished with school! Happy, happy day :)

Cross your fingers for me..... I apparently screwed up and didn't submit some B.S. documentation in the appropriate folder with one day to go in the class and no option to re-submit.... so am now waiting on tenterhooks to find out if I am going to be allowed to graduate. I'm so angry and upset and worried about it all. Thought I was going to be done, but now may be facing 10 more weeks of nonsense and another $1.5k for tuition for a class that I have successfully completed everything on, just accidentally clicked the wrong button and uploaded the wrong file into the wrong place.

I don't know how to upload my sheet, but I like to know drips, lines, drains, vent settings, diet (usually a tube feed), skin issues, Tmax, blood sugar frequency, rhythm, lung sounds for previous nurse, last neuro assessment findings of previous nurse, and a space for ALL the labs (ABG's, CBC, CMP, ICA, coags, and other randoms like lactic acid, troponins, pro-BNP, etc.) - and multiple columns so I can trend the labs on my sheet instead of having to log in to the computer and look back to trend them. I keep the back blank to write down the patient's PMH/HPI/24 hr events, and imaging (date, type of imaging, results). I usually just write all this stuff down at the start of the shift and then never refer to it again but it does help cement it in my brain and gives me a starting point for when I report to the next shift (e.g., at the start of my shift the patient was on 50 of propofol and 15 of levophed, I got the prop down to 10 and the levo is now off). It's really a matter of what works for you though. If you are coming from med-surg, you probably already have a system that works that will just need a bit of tweaking. At the beginning you will be very dependent on your report sheet though and may even want to have one with boxes for each hour so you can annotate meds that are due, labs that need to be drawn, things that need to be assessed, etc. I also used an hourly box method to write down hourly I&O's/temps/blood sugars/etc. when I didn't have time to log in and chart them in the moment.

This student was on their very final clinical placement, for which this school of nursing does not require a clinical instructor's physical presence. They come up periodically during the week to see how the student has been doing, but it's an experience where the student is assigned to a nurse, follows their schedules/assignments, and perform nursing skills under the one nurse's direction. It's seen as a stepping stone to new grad orientation. Many students complain that they need their phones to look up information, but all the computers have Micromedex, UptoDate, and Google very easily available.... not sure what your phone can offer that's better than all of that. Also, I constantly see them scrolling through Instagram, which is not going to give them any trustworthy information about pathophysiology, medications, how to manage lines, compatibility of drips, etc. and have literally never seen a student using Epocrates or any other medical education app. So the "Oh, I need it to look things up" excuse is a crock IMO. I got through school without my phone with no issues, graduated in 2018 so it wasn't that long ago! Like I said... I absolutely love a receptive student. I had one a few months ago who helped me tremendously with my very unstable patient whose belly surgery had gone bad and she had more questions for me than I knew how to keep up with. My day went more slowly than I'm used to but it was okay because I could see her learning. Be that student :)

I've had mixed experiences with the students I've gotten. Very rarely do I get a student that I enjoy and get to teach things to. Most of the time they are just lazy and on their phones constantly. I hate that and I will give any student who does that a really hard time (recently told one that she had the option of putting her phone away and learning, or exiting to the locker room until she could tear herself away from her phone while I wrote her clinical instructor an email about her behavior). I'm an ICU nurse so it's like... hello, come learn about this incredibly unstable patient that I am attempting to fix because I KNOW you've never seen anything like this before. I find that a lot of students in the ICU are "code-chasers" and don't really care to learn about what it takes to prevent someone from coding... they just want to do CPR. I love to teach about drips, EKG's, lines, pathophysiology, how to correlate lab values to patient's symptoms/meds, etc., but I hate it when I am all geared up and ready to teach and the student just sits there texting or scrolling through Instagram because the patient isn't actively coding.

Heck no, you should not work extra if you don't want to. I have been a nurse for 1 1/2 years and can count the number of times I've picked up extra shifts/overtime on one hand. I speak up about schedule abnormalities too, and absolutely refuse to be screwed over when it comes to holidays, being scheduled for shifts that I wasn't hired to work on, etc.. As a result, I am just as happy with my schedule as very senior staff are, while my peers are miserable and angry all the time. However, they let themselves be screwed over by management and never speak up for themselves, so they will continue to be taken advantage of until they realize their worth and go to bat for themselves. There is NO REASON for you to work when you don't want to and NO REASON for you to be constantly shafted when it comes to scheduling, either. Speak up for yourself and don't feel bad at all. This is just a job, friend. If you died tomorrow they'd have someone else to replace you within a week, so don't burn yourself out for a job where you are entirely replaceable!

Awesome, thank you for this. I think it will help me to realize that I'm just giving them meds to take the edge off and make the procedure comfortable, rather than doing it to knock them out and keep them from self-extubating or hurting themselves/staff :)

Anyone have anything to add to this? I have gotten burnt out, absolutely fried to a crisp on ICU and am applying to IR (among other procedural areas). I don't think I mind the sound of taking call, am familiar with sedatives, and am detail-oriented to a T. In the ICU, I watched over my patients through many types of bedside procedures, so I feel familiar with timeouts and documenting new lines/drains/etc. I've also managed plenty of reactions as well. The only thing that I am really worried about is administering the moderate sedation without the safety net of a breathing tube in case things go too far. I'm worried that my time in ICU has maybe desensitized me to what a good dose of midazolam/fentanyl is for someone who ISN'T intubated.

I guess I count as a millennial, although I do recall not having cell phones (born in the early 90's haha!) My night shift preceptor was also a "cut the S***" kind of nurse, held my hand for one shift and promptly dropped me on my butt for all the rest of the shifts I worked with her. She would sit at the nurse's station and when I came for help or sat down to chart would pepper me with questions that made me feel incredibly stupid. She also always seemed to know what was going on with my patient before it even happened. This made me feel slow, frustrated, and angry that I always seemed so behind. It also made me learn. Because of that preceptor I have no doubt that I am not just a better nurse, but a better ICU nurse. I hated being with her for the first week (until I figured out her style and saw the point of what she was doing). Now, I have a lot of respect for her and appreciate what she did for me, and we are actually good friends now that our preceptor/preceptee relationship has come to an end. Definitely agree that OP needs to have some patience and figure things out.

For patho - definitely sepsis. Differentiating the types of shock (cardiogenic vs. septic vs. hypovolemic). Liver failure (all aspects - from how it affects mental status to why these patients bleed like crazy to why you can't keep their sugar under control). How ETOH withdrawal affects the body/ETOH withdrawal timelines. Respiratory failure/treatments/signs of flash pulmonary edema. Renal stuff - what electrolyte abnormalities to expect, common reactions to dialysis and how to treat it, the presentation of a patient who is overdue for dialysis. Understand your different drips that affect blood pressure and how your heart works - my ICU uses phenylephrine, norepinephrine, vasopressin, epinephrine, dobutamine, diltiazem, and amiodarone very commonly. Less commonly, we use milrinone, dopamine, and esmolol but I know the cardiac ICU uses those drips more frequently. Know how they work and when they are indicated. We mix many of these drips on the fly in emergency situations, so I made a sticker I stuck to the back of my badge detailing how to mix standard concentrations of each drip along with which diluent you use (most get mixed with normal saline, but vaso and epi get mixed in D5W, important to remember). Also it's important to know your sedatives/painkillers!! Propofol, precedex (another one you might have to mix yourself), versed, fentanyl, morphine, dilaudid, phenobarbital, ativan... all commonly used for various indications. Finally, it never hurts to sit down and interpret all the tele strips for all the patients on the unit if you have some downtime. This will help you get good at interpreting what you see on the fly and knowing what different rhythms look like.

Wow. You're two shifts into your ICU orientation as a new grad and are upset that you aren't doing a lot? I think you need to understand that it is very normal for ICU nurses to have trouble trusting new grads with their patients. These patients are UBER sick. What you should be doing right now is a lot of watch, learn, and ask questions. That's pretty much it. I didn't start giving handoff report until about three weeks (12 shifts) into my ICU orientation. I wasn't allowed to touch drips and meds until I'd studied them and understood what they did, what to look for when administering them, and why my patient was on them. Meds we use in the ICU are very different from the ones used on the floors and it can be difficult to understand what they do or why one med vs. another is being used. If your preceptor isn't telling you things, YOU need to take responsibility and initiative and ASK her why she is doing things. Ask her about the drips, the vent settings, the interventions, what she is observing/hearing on her assessment, then ask if you can see/listen for what she's hearing, etc. Even better, look up the drips you see commonly and tell her what you've learned and ask her to help you fill in the knowledge gaps. Ask her how to zero an arterial line, draw off a CVAD, etc. It sounds like you need to express interest to her. And, it's not really her job to introduce you to people. Yes, it's nice to be introduced, but you are just as capable of introducing yourself as she is of introducing you. To your final point of calling her "OCD" and "has to have things her way" and characterizing her as a lunatic - you bet your butt that we are OCD and want things a certain way and behave a little crazy about our patients. We are often the only ones standing between our patients and death - this is not an exaggeration. These patients are the sickest of the sick and so fragile that the slightest mistake could cause them to die. About six months ago, we had a patient on the unit whose nurse (who was a new grad fresh off orientation) didn't pay attention, she pulled off her oxygen, desaturated, carted, and DIED. Because her nurse didn't respond to the alarm saying she was desaturating. This is why we are so OCD, because if we slip our patients could literally be dead. It's a lot of responsibility and it is very tough to pass that responsibility off to someone who we KNOW is inexperienced and doesn't have the knowledge base to handle things. You need to communicate with your preceptor about what you need, your learning goals, and make a plan together about how to get you there. If people are saying she is a good nurse, good preceptor, and she is well-respected on the unit, it is a little crazy of YOU to be characterizing her as a joke of a preceptor after two shifts with her.

Hey, all. I don't know if we have any other folks struggling through the GCU capstone course right now, but what the heck! It seems like the most pointless busy work. I was under the impression from other posts on this forum that we would be writing a substantial (20+ page research paper) but the final submission for the class is a 1,000 - 1,250 word paper plus all sorts of B.S. documentation of the 100 hours that we supposedly completed along with a journal and some stuff that our mentors are supposed to rubber stamp. I'm on week 4 of 10, praying that I can get through this with my sanity intact. I've definitely had some poorly designed and frustrating classes, but always seem to come out the other side with A's, so I'm hoping to keep this going for the next 6 weeks so I can graduate and say GOODBYE to continued formal education.

I went through a crazy long process getting rid of Facebook... first I downloaded a complete copy of my Facebook data for my own records. Then, I went through and used a script to delete every comment/like/interaction I'd ever made (this took two weeks, even using a script!!), contacted every person who'd tagged a photo of me and asked them to take the photo down, untagged myself if they refused to remove the photo, used the script to delete every status update, downloaded all my photos and then deleted all of them, changed the contact information I couldn't delete to fictitious email addresses/phone numbers, and basically turned the account into a completely empty "shell" account. I then changed the name on my account and let it sit for awhile before I used the permanent delete option (e.g., don't log back in for two weeks and your access to the account is gone forever). The purpose of letting it sit empty with a fictitious name was to hopefully give FB the opportunity to perform a routine back-up of my account and hopefully over-write their saved copy of my full account with the empty shell account. I truly mistrust Facebook's use of my data and wanted to give myself as much of a chance to cut free of it as possible. This may seem sort of crazy (I can acknowledge that ? ) but during that process I learned just how much Facebook intrudes on your life. It is devilishly difficult to extricate yourself from the site, they purposefully make it tough for you to mass-delete things or truly control the privacy of your information. They save information on you that you really have no idea they were saving until you go looking to find out about it. I'm sure it's only gotten worse over the past couple of years, as well!

Here for the comments. I have just been tapped to precept a student during their capstone placement just before graduation. This is not quite the same as training a new hire but is still kind of intimidating and overwhelming to think about, since I have been in the ICU for just over a year at this point! I do vividly recall what being a student in the ICU felt like, so I want to try to make sure I make the student feel welcome, explain everything that is happening, etc. I am a little nervous about explaining all my thought processes because I feel like much of what I do is instinct at this point and it may be difficult for me to slow it down and talk through what is happening. I am also feeling a little insecure now about my knowledge, because I will have to explain the why's of everything and I want to make sure I do a good job! It is going to feel a little weird, watching over my patients and watching over my student to make sure she has a good experience and learns a lot. I think I am going to learn a lot as well, since I will be brushing up on a lot of things to ensure I can teach them successfully. I think my strategy will be to encourage my student to ask questions and to have her first follow me and watch/ask/perform assessments with me, then start having her perform some of the tasks with my supervision while discussing why we're doing them. I'm really big on tracking and trending labs/vitals/I&O's as well, so we will definitely do a lot of that while correlating to the disease process we are dealing with and talking through what our next move will be. I never really realized how much thinking and knowledge goes into critical care until I had to start thinking about how I'm going to teach these things to a newbie!

I hate social media as it exists on Facebook, Twitter, and Instagram. I think people over-share, are addicted to the attention they receive on it, don't think through the consequences of their (virtual) actions, and rely on it as a crutch to make themselves feel validated or worthy. As a nurse, I never post a single word about my job on a forum where I can be easily identified. Even here, I shy away from posting particulars about patients/situations. I used to be sort of prolific in discussing patients (no identifiers) on here, but reeled it back in when I sat back and thought about how I really have no idea who is reading my comments. I pretty much stick to commentary such as this, and commiserating about nurse burnout in the ICU section. I deleted my Facebook permanently about two years ago, don't miss it in the slightest or regret this action. I still have an Instagram account, but I don't even mention that I'm a nurse on it and mainly use it to post cute pictures of my dog and family when I feel up to it. I don't think that social media (esp. media that can be linked explicitly to the user) should be used as a therapy substitute, a platform from which to complain about your job at great length, certainly should not be used to discuss patients, etc. These are my values and I try to stick to 'em. Can't make anyone else follow suit, but I do highly recommend it for your own piece of mind! It's a crazy world out there, anything you can do to decrease the crazy you invite into your corner of it can only be a good thing!

I went in as a new grad, am almost a year and a half in, realized about six months ago that this is not for me. I am sticking it out a few months longer because I want to get my CCRN (scheduled in less than a month!!) and I want the pay raise my facility offers that comes with a certification. I am not the type of person who makes quick moves, though. I've always been more comfortable staying in the misery that I'm familiar with rather than moving into a situation that holds unknowns until I'm 100% ready. I have been looking around at other jobs for awhile, but am definitely going to stay put until I have my next step figured out. The one thing that has helped me feel less miserable is that I'm formulating a plan for getting out rather than just trying to push on.