changeofpaceRN

I know very little about cardiac care (and I've never done hospital nursing) but I have a few questions google cannot answer... I thought why not try here ... Is the chest tube used post CABG the same type they use for a chest tube when they relieve pleural effusion? I'm assuming it is the same idea so.. that's why I really don't know. Has anyone had to leave a chest tube in for more than the 24-48 hour timeframe (post CABG) due to continued drainage? I'm going to post in another forum but may as well continue my questions for anyone who knows more. If there is low urinary output for a few days leading to no urinary output (due to kidney failure) fluid builds in the body.. would this cause abdominal swelling and/or epigastric pain if pleural effusion is not relieved?? Where does all this fluid go if it is not coming out via GI/GU system?

I work as a case manager for a state program (first case management job so other "types" of case managers are new to me). In this state program, we follow those with disabilities so anytime one of our consumers is admitted to a hospital, we get involved to ensure appropriate services are in place upon discharge. Anyway, I have run into a case manager at a local hospital that refuses to discuss the patient with me and will not send any type of records over (regardless of parent permission, id codes). She has referred me to medical records which is a battle in itself. Any suggestions on other avenues I can try? Perhaps I didn't explain it well enough? What sort of info do you need in order to discuss the patient- I thought the patient's code number was enough?

Thanks for the advice. That is the thing with law- it is up to interpretation and even the BON put that in writing when I asked for specifics. They also told me I can submit a declaratory statement to the BON for further review. Luckily, I'm still a 6 months-1 year away from seeing anyone as a coach so I have time to get answers.

Again, thank you steeleworks for your valuable input. You have brought up so many things I haven't considered yet... There is such a gray area in some parts of this. Sure a nurse can use their education to talk about healthy eating but at what point does it cross over to a dietitian? I am trying to work out all those kinds of scenarios since my state is so strict. The program I was eyeing talks about using your license in conjunction with the certification- well, perhaps I will have to find another program that doesn't make you use your license just in case I have to keep them separate. I found the area in my nurse practice act that says what I can do- of course, nothing in that section that is related to billing or alternative therapies. Do you do a H&P and health assessment? I wasn't picturing getting fancy in that aspect. I was considering making up a questionnaire and coming up with goals/steps and suggestions/actions for the issue at hand (based on what is subjective to avoid any issues on the objective end). I am now reconsidering that due to your comment about nursing diagnoses and care plans... because that makes sense! That being said, I am still in my information gathering stage so all of this is very helpful. I wasn't planning on advertising that I am a nurse at first due to my state. Now I don't know because education is education anyway you look at it.. You should write a book, I would buy it :-)

Wow what great advice. I strolled onto allnurses in hopes of finding some answers and sure enough, I am in luck! I've been searching my state's statutes and trying to figure out what is allowed in my state vs what is not (everything here needs a license of some sort). I'm still searching and I will find an answer one day. But what I don't understand is if a nurse writes a nursing diagnosis and care plan for a client, doesn't the nurse still have to be under the direction of a physician? I don't see how a private practice RN can run by itself. Are there any resources to address these kinds of concerns on what a RN can and can't do without their doctors approval? Of course the scope of practice varies by state but my scope of practice is as vague as vague gets....

I can't imagine how you felt but I can certainly understand your anxiety. I was in a situation like that a few times too. I came to the realization that it is MY license on the line and I don't play around with people's lives. If you are not getting the support you need from your workplace, consider your options. I considered mine and went into case management. Now, I'm a manager and work from HOME. Now, I LOVE nursing whereas before I was going to quit and never go back. Before I switched jobs, I couldn't sleep, I would cry before my shift, get into fights with my husband because I was so bitter, angry and anxious. It wasn't fair to myself, my kids or anyone else. It was the best decision I ever made. Perhaps a different unit would be good for you.

Always carry a med book around and never give a medicine without knowing what it is for- follow that rule. The one time you stray from it, the patients mom, wife or someone will ask you what it is and what it should do and you will look like a fool. Besides, it is for the safety of the patient and it doesn't hurt to verify that the dosage being given is within normal limits. As far as your skills go, I started out as a LPN and aside from a dummy in the lab, I didn't get much hands on experience. I graduated without ever doing a foley and a boat load of other things. I was lucky to find a job with a wonderful nurse that showed me EVERYTHING. The group I worked with was so excited to show me new things and couldn't wait to pawn off some of their treatments or orders so I could get my experience. Either jump in and volunteer now or hope you get a great preceptor. No one expects you to be perfect but by the end of my 6 weeks of orientation, I was confident enough to be on my own. I would even ask your clinical instructor for more practice if she sees it on the floor.

Mersa- American... I've only heard it spelled out a few times

Once I saw this question, I decided to post. I saw my husband less than before when I worked 3rd. I became a zombie during my days off and had no energy to even get up and play with my son. I would sleep in the day that my shift started and try to nap again in the afternoon before I went to work. When I got home, I would sleep from about 830-2pm then nap again before work. It was hard to get quality sleep because there were UPS trucks driving by, lawnmowers, kids selling stuff so I'd hear the doorbell, kids playing outside and running by.. dogs barking ect. I couldn't get use to the noise even with a loud fan and black out curtains. I tried ear plugs but they annoyed me. Anyway, I ended up losing a lot of weight (not the healthy way) and my health and married life went downhill. I had to make a choice so I went to days. Granted, I was never a night owl before. I did it for 2 years and I'm still working on fixing my body and marriage 2 years later. It works for some people and others it doesn't. I know understand why 3rd shift workers are paid more and they deserve it! This isn't a life sentence, you can always change shifts down the road if it doesn't work but I made it work for 2 years. Good luck.

no you don't have to respect the medicine at all. you have to accept it but you don't have to like it.. hence the ethical problems many of us deal with. some medicine does work and others are over prescribed or just prescribed for the hell of it. poly-pharmacy (which is an issue for about 90% of my residents) is actually killing them through interactions.. how curative and life saving is that? there is a pill for everything and another pill to fight that pills side effects and so on and so forth... to the op, i got out of the ltc setting because it was ridiculous and i did feel like i was a pill pusher. i went into another field and still use a lot of meds but not nearly as many. i found an area that works for me so there is hope... start exploring your options but don't give in. i have bankers hours now :-)

So what if every patient decided to wait in their car? I'd have to admit it is much more fun to wait in the car and listen to music or chat on the cell phone. Should you stand in the parking lot yelling out names? How the heck do you go around looking for someone you don't know? That is just plain ridiculous and I have no words for the "intelligent" people you work with (note the sarcasm)

My last LTC facility had a standing order for neuro checks if the pt had a head injury. I would always call for an injury like that no matter what the hour.. a minor skin tear can wait until the AM. I call to save my butt even if that means getting yelled at. I don't take it personal and I know they get paid waaaaaaaaaay more than I do so they can answer the phone. Oh and yes, you should have time to take your break and eat. Some nights are worse than others but you should at least get SOMETHING. Some nights I was able to have 1-2 hrs of down time and other nights I have 20 in the whole shift in LTC... find time to eat!

In my state.. you need to be an RN with at least 5-8 years of experience (a BS counts for 1 year of experience and Masters is 2 years total). He still needs to work a regular nursing job for the other part of the required experience.

Some people are so annoying. No one is degrading an LPN in their post so cut out the "poor me" whining. She has the same experience as the LPN. As a RN, we go to school longe, held to a different, more involved job description AND home health agencies get paid more for RN's so it makes SENSE that RN's start out at a higher wage. The LPN is already making $2 more per hour than someone who has been there 1.5 years less. If logic comes into play, and an LPN doesn't start out at the same pay scale as the RN, that must be one heck of a raise for her to be paid more at this stage in the game. We are taking about a $4+ per hour pay difference from when she probably started. Bottom line is you are probably not being paid fairly at this place for your "highly" RN work. After all, without an RN, I guess the initial assessment visit wouldn't get completed for the LPN to go work it. But yes, it is very possible to make more as a LPN with years of experience. I know this because I was one and I made plenty more than others I knew. The difference was in how many years of experience I had.

Hey there fellow EC grad :-) I actually couldn't stand bedside nursing anymore so I don't do it! I'm now a clinic manager so I still have patient contact but in a doctor's office setting...I don't plan on doing it forever. What about insurance companies? What about government like healthy start and educating women/teens? STD, TB, WIC or something similar? Have you thought about a different path other than LTC? I tried teen drug detox and rehab and it was really interesting but too frustrating for me... at one point, I considered nannying for a family... the minute you say nurse, heads turn. My main thing is I sacrificed salary for happiness. I had to make life adjustments to follow this path but I'm not miserable like I was and every time I come on here and read everyday stories, I know I made the right choice for me.

I guess I'm the odd ball out. I work 5 days a week and have about 13 pairs of scrubs.. I work full time, mom to a toddler, pregnant, and in school FT for my BSN- I don't have time to do laundry and iron every weekend for work. I also have a separate laundry area for work clothes so I can keep up with regular clothes:D

You can start building your supply at home by pumping extra when you can and storing it in the freezer, you can pump during your lunch break and hopefully 1 or 2 other times during your shift (if nurses can get away for smoke breaks, this shouldn't be different as far as time spent away from the floor). They also sell "portable" pumping machines that can milk you while you drive.. I know it sounds weird but the health of your baby makes the difference.

You will have your good days and bad days (in the beginning it seems like more bad than anything else but it is just adjusting to different situations and getting organized IMO). After you gain some more experience, look for another area of nursing. I switched to public health and I LOVE my job now.. I went from crying before my shift to being fine about going to work.. big change for me!

I'm going to give you a few things to think about.. I'm TRYING not to be negative. If this is a dream of yours then GO for it. If it's something you think you want to do to "care" for people, look into other things. Caring for people went right out the window with all the paperwork and pill pushing that comes before patient care. If you can't find an accelerated RN degree (since you already have a BS) then you will most likely go the LPN route since it is 1 year. I was once a LPN and my salary wasn't anything to write home about. Could you live on 15-17 per hour with not so good benefits? Do you have childcare for overnight when you have to work or stay late? A lot of places have mandatory every other weekend. There are a lot of things that changed my mind after becoming a nurse. I am now a RN and I am happy doing what I'm doing but I can tell you that your teaching salary is still waaaaaay above what I make as a RN. My position now can only be filled by a RN so LPN's have a smaller job area to play around with.. Good luck with your choice- If I had to do things over, I would have chosen a different route.

YAY! Congrats and good luck!

Not sure where you are moving from but FL is one of the lower paid nursing states for some reason. You might have better luck making that through an agency.

I work in a clinic seeing the uninsured/under insured OB patients, those in need of STD treatment and those needing regular exams. I teach about abnormal paps, how to prevent STD's or how to deal with current problems. I participate in OB counseling sessions. We chat about birthing options, what to expect, how to care for baby, help locate resources for corificeats and other needs ect.. There are other PHN that work specifically with drug abusers, AIDS patients, TB patients ect.. there are so many different avenues. As far as experience, I had some time in substance abuse programs, I had a minor in psych and that was it. The title "RN" was the only real requirement- I happened to be in the right place at the right time. The downfall is the pay but I thought my happiness was worth the pay cut.

Yes! This was my favorite too. I liked watching surgeries ect without being responsible for anything.

Well, I kind of made the same choice as you! I worked for 2+ years in a SNF and hated every second. I KNEW I didn't want to do hospital nursing- ever. I even went on an interview on an ortho floor and almost ran out of there. Everyone clicks with something different. I think if I HAD to do med/surg in order to be a nurse, I would have quit my career. Thankfully, there are plenty of options. I work as a Public Health Nurse and I LOVE it. I get to do more teaching than anything else during the day. I know I am making a difference and I'm able to be the type of nurse I know works for me. Some days I wonder if I'm making a mistake but I come on allnurses and read the posts/stories and get panic attacks from the comfort of my own home. I know that the hospital arena is not for me. It's not for everyone. I know some nurses who LOVE med/surg. Thank goodness we all have different interests so we can care for different groups of people. I'd be interested in research or administration one day.

To be honest- night shift was NOT for me. I too had a hard time adjusting to my days off and sleeping during the day instead of night. It was hard to rev up before work when everyone around me was relaxing. I felt "alone" when I was at work even if I surrounded my my co-workers. I do better being at work when I know all my family/friends are at work at the same time. I sleep much better now after those few years.