keftirific

Thanks for the reply. What do you mean by you backed out the door? You quit? Today my FA wasn't there. Day after Thanksgiving so I get it. What I don't get however, is he would transfer a seasoned PCT to his other facility for the day, which resulted with us being short. Two of the remaining PCTs have only been independently on the floor going on two weeks. One had her patient load doubled. I'm not great at setting up machines, plus I was suppose to be precasting with a nurse (who wasn't even told she was precasting me today do to a change in schedule). Everything was behind. One patient left because they were tired of waiting and another lost an hour of treatment time because they had a scheduled pickup time. I was hectic to say the least and because she was so stressed, my preceptor (who barely preceptor me), said she was going to call in for the first time tomorrow and not come in. Is this normal in dialysis? I know there are plenty of applicants for PCT positions. Why aren't there PRN PCTs to fill in? My co-worker said my FA probably saves $$ by shorting us and likely benefits himself with the company somehow by doing this. I have no clue.

Hello all! Today I completed week four of my training as a dialysis nurse. So far, I think I like dialysis, at least in theory. My questions and issues are in regards to the blatant disregard for basic infection control, (hand) hygiene, and other protocols that I have observed from most PCTs and some of my nurse colleagues at my clinic. Should I just look the other way and simply follow protocols in my own practice? Can their negligence negatively effect me or my license? Do PCTs work under under my license like CNAs? (I suppose I need to check with my BRN.) Should I just get my training and some experience and go work in acute care or change to PD? I spoken up a few times about these issues. Some PCTs have acknowledged, for example, that they should wear gloves and use hand sanitizer or wash their hands. They'll do it for a minute while I'm there and then go back to their very potentially harmful ways (given that infection is the second highest cause of death in HD patients). After I watched a PCT dump a bunch of bleach into our bleach crusted cleaning containers (they're suppose to be cleaned daily) instead of using the beaker beside her to measure the amount to make 1% and 10% cleaning solutions, I thought maybe it doesn't matter if the solutions much more concentrated. However, according to the Scripps Research Institute (https://www.scripps.edu/newsandviews/e_20060213/bleach.html and this article https://www.ncbi.nlm.nih.gov/books/NBK214356/) it does. The 1% and 10% solutions that we are suppose to make are the mark to clean and disinfect and "Improper use of bleach, including deviation from recommended dilutions (either stronger or weaker), may reduce its effectiveness for disinfection and can injure health-care workers." The next day I mentioned using the beaker to another PCT. She shrugged and said we're always in a rush. I understand that not long ago our clinic was chronically short, but that hasn't been the case since I have been there. People get their breaks and there is downtime on the floor. I'm planning how to bring my concerns to my FA, but as he has made clear to me, he has no clinical background and pretty much leaves that stuff to us. I am not trying to make enemies, but I think that is what will happen if I push for change. As an RN what I know does matter is hand hygiene. Time also cannot be used as an excuse for acrylic nails. Half of the nurses and PCTs in the clinic wear acrylic nails, which is against company policy. The PCT who I followed today had overgrown nails that needed to be filled and were visibly brown and unclean underneath. To make matters worse I did not once see her wash her hands or use hand sanitizer between bare hands and gloves and she only wore gloves when she could potentially come in contact with patient's blood. She didn't want to put her gloved hand into the bleach saturated water to grab a clamp because "there some blood in there and you know." At least she wore gloves when she set up the machines. The day before I watched a PCT put a machine together without any. (I mentioned that she should and she agreed. She put some on, but later I saw her without any again.) How important is it to wipe the graft or fistula with betadine for 60 seconds. I recall that in the OR betadine is "painted" on and that it is the contact time, not dry time that matters?? (I'll have too look that up too.) Then again it's not like I've observed a PCT wait for the betadine dry after their two or three seconds of wiping. They do like to repalpate that wet betadine... I regularly hear about our patients dying. Three this month. Three last month. Maybe that is normal with this job given the state of so many of the patients. But I don't want to hasten anyone's trip to the grave due to carelessness. Then again, I figure these things will go on whether or not I am there. I don't have the finesse to change this culture and I think it would be dumb to try. Can what they do negatively affect my license and career? If not, maybe I should stick around just worry about the standards to which I hold myself. Be the change? Then again, maybe I should just bide my time so that I don't fall into the habits of those around me. What do you think? Thanks!!

Hi Itcnurse4u! I made a similar cheat sheet. It's nice to know that I'm not alone. My co-workers look at me like a crazy person for taking the time to make it at home. I'm currently 2.5 months (only three, eight-hour shifts a week though) into my first ever nursing job, at a SNF. I see a mix of LTC and subacute, usually around 20, but up to 26 patients. How many patients and what acuity are your patients? I'm trying to figure out what is reasonable because... I'm on the cusp of quitting. My fellow nurses tell me that it's impossible to complete all of the treatment orders and assessments, especially if there's a change of condition, transfers, and or bunches of orders. I think most of them just don't bother but chart as if they did. Some patient are like, "what are you doing?" when I assess them, ask for a pain score, or count respirations, as if no one done such a thing with them before. Some patients get mad when I won't give them extra Tums and act like they have somehow triumphed when they refuse their meds until you break it down and say, "This one is to keep you heart working well..." They then take at least that one. It all takes time, but I don't feel like I'm doing extra. I feel like what I'm doing should be the minimum. None of this would bother as much if all or most of the patients were staying stable or improving, but I watch too many deteriorate. Among other things, I've seen red, purulent, oozing (one slightly bloody) G-tube stomas on two patients. Thinking I should chart a change of condition and call the doctor, I showed one to a supervisor and the other time to a very experienced nurse. The supervisor waved her hand at me and said it was fine. The experienced nurse said that, "if was infected you would know. It would stink, be painful, and warm..." I figure that's what it will look like if no one deals with it now. Why should we wait for that? I watch patients deteriorate and I wonder "what if everyone had done more?" Is this just how it is? Should I have just done the COC and called the doctor anyway or just chart what happened? Following the doctors orders, I did a COC for low BP on a patient and my co-workers were like, "why?" Won't going over their heads cause a riff even if I think it's the right thing? It's my license... I should just part ways with the SNF system now? I appreciate your feedback!

What school did you go to? So the school did require GEs? You just had them covered?

University of California, Davis does. As a clinical research coordinator I have worked with a person with a Ph.D in nursing who was NOT an RN. A the person wasn't the only non-RN in the program either. Interestingly, the person wasn't very upfront about this fact. The person would say that having a PhD from UC Davis was more important than the type of PhD. It seems that unlike registered nursing, in research, which school and who you advisor is, really can make a difference in your career if your goal is to become a principal investigator (i.e. run the show). Not being an RN has not at all slowed the person's career, but the person's research is not directly related to nursing either. It's more about public health policy. The person works as a professor at a university, as a consultant for a large well-known company, and on other projects on the side. So again, long story short, yes you can get a PhD in nursing without being an RN.

Hello, All you had to take were the nursing courses for your BSN? What program were you in??! I am in enrolled in an RN to BSN to MSN program at the U. Texas at Arlington online. I have two non-nursing bachelor's and I frustrated by the fact that Arlington and just about every other program that I've look at requires that I complete MORE general education classes on top of the nursing classes. Arlington requires that I take 5 GE courses--a lit, government, 2 political science, and something else... I've completed one nursing class at Arlington and I considering jumping ship to a direct RN to MSN program in research nursing. I think that I might also want to be an NP. I have no desire to go backwards for the BSN should I make that decision in the future! Based on the comments in this feed, I'm not sure if the direct MSN is the way to go in the long run. I appreciate your thoughts!

From what I've gathered from other threads, the research, vulnerable populations, and the capstone are the only nursing courses that really require some energy and studying. I believe the person said, "everything else is pretty much filler," "and you have to read for research." It's actually nice having only one class to focus on at a time. And there are 10 days between classes, at least between my first and second class.

Hi. I just started the program and I'm in week 3 of 5 of the first class. The course keeps you busy, but it's not difficult. There's a lot of reading and there are short video lectures for each week, along with short quizzes on the reading and lectures. You're required to post on a message board about three times a week for participation credit. Each week (each unit) there is an assignment. So far there's been one assignment about APA writing and formatting that was pretty simple. Just follow the rules presented in the text and powerpoint. The second assignment was to write a paper about nursing philosophy and theory. The paper is based on the readings and your personal opinions. All of the assignments have a very detailed rubric for you to follow so that you exactly what is required. Like I said, so far it's been a good bit of work but nothing mind boggling. I'm a slow student, that is I read slowly and probably more thoroughly than necessary, I test slowly, and think too much. (Trying to break the horrible habits.) That said, you might just breeze through. The difficulty is probably also dependent on your background. Been to school lately? Written a paper in APA or some other format before? Good at BSing through writing prompts? Hope that helps! Anyone have any comments on what's to come in the program? I came to this page looking for information. Thanks!

Are you saying that shifts are 16 hours long?? Are there part-time jobs?

Nurselabs says: Detached retina - area of detachment should be in the dependent position. Googled "dependent position detached retina" and a textbook says, "After surgery for a detached retina, the client is positioned so that the detachment is dependent or inferior. For example, if the outer portion of the left retina is detached, the client is positioned on the left side. Positioning so that the detachment is inferior maintains pressure on that area of the retina, improving its contact with the choroid."