RNMoxie

I'm not sure on your husband's service connection, but based on the information you're providing, take the PHN job. In my opinion, it's no question. You are in a great position to do so with all factors considered. I'm not sure what type of MSN you're pursuing. While I can almost guarantee working "business hours" in PHN will interfere with the completion of your MSN, the pay, health and retirement benefits, and work-life schedule of the PHN job will outweigh the benefits of the MH position. Working the MH job will give you the flexibility to complete your MSN, but you will have to sacrifice a lot. I am assuming that is why you're debating the two. The PHN position seems like a no-brainer till you mentioned the MSN... practicum is going to be a pain. How important is it for you to complete your MSN? Do you have a plan for it for either case? Can it be done during off-hours?

I need more information to give an opinion. What state are we talking about? Do you have your ASN or BSN already? How long till your retirement? Are you taking over health insurance or is there a partner that is? Background: I worked in the state of Florida in the health department for two years and had my BSN entirely paid for while I worked full-time. The pay sucked (around 60,000/year), but I worked strict 8-4 M-F hours with all holidays off. Maybe I would've stuck around for the state pension, but I got hired at the VA for a federal pension. Retirement is super important to me, but maybe you're young enough to stress that later. Health insurance with the state was only $50/month total for me and no matter how many dependents I had. In private sector, with the ASN as a new nurse, I was making about $30/hr. Tuition reimbursement is there, but terms vary depending on who you're working for. The schedule in private sector is always subject to change. Insurance for me and my husband was about $500/month. You only work three days a week though with ample opportunity for overtime and holidays. Doing public health nursing or mental health nursing won't give you bedside nursing experience; however, it counts towards your total experience. I have seen nurses go into an administration role without bedside nursing experience.

Try to keep her on a schedule. It MIGHT improve. Once there is one stroke, there is ALWAYS a risk of another. To be more cooperative it includes one or combination of risperidone, diazepam, Ativan, haldol, depakote, lithium, doxepin, or buspar. Bupropion, fluoxetine, melatonin, trazodone, and Effexor won't usually touch delirium in my experience despite what is published. Good luck

Imposter syndrome. I'm still dealing it.

Before someone even tells you what went wrong, do you know what went wrong? You literally challenged your preceptor, your instructor, and your DON. Whether you meant to or not, you did. You left your clinical without meeting with your preceptor? You just messaged your instructor? You met with the HR of the hospital without the school? On top of that you have a phobia of vomit or emesis? I'm very sorry, but all things considered, yes, find another career. I'm sure you're hardworking and wanting to help people. Go into social work. Or PT. Or ultrasound. Or respiratory (there is occasional emesis with this). Or biomedical. Get out of nursing.

This is a great post!! I get a lot of "thank yous" from patients, but honestly, I like the ones in writing the most (preferably with cookies, donuts, etc.). But even without food items, when I'm in the break room, it's nice rereading that thank you note and recognizing the last name. Gives me a boost

I work for VISN8, so not your VA. No matter what anyone tells you, the VA is awesome! You will hear from a lot of people already there for years how the grass is greener. It's not. There's a reason no one leaves. The VA spoils you and it's great! I worked private sector, nursing homes, state, nothing compares to federal.

Nurse Beth isn't wrong. You will encounter this practically daily even on a medsurg floor. If the patient isn't AAOx4, just redirect. "What's your favorite meal/holiday?” "Come sit here and look at this video" "Here's a pudding.” "Where was your favorite vacation?” The patient just want attention and to talk, give them the opportunity

I did think of the fire extinguisher, but I didn't want to break the glass or make the patient and staff inhale that. The flush is out of the question. My aim sucks. I cannot hit a cigarette from 5 feet away with 10 mL of liquid. I don't know if I could do it with a cup of 200 mL, especially with the patient moving the cigarette around. I purposely chose the water pitcher liner because I couldn't miss with that.

And also, are you kidding me? YES! 100% Yes! I will initiate aspiration precaution without hearing back from neurosurgery first. The patient is lying flat! That is responsible nursing judgment. I don't need an order. What world are you living in? And for fluid intake, 90% of the time, fluids are given while under anesthesia in PACU. You should know as a nurse that PRN pain medication is only given if the patient asks for it or if there are very obvious signs of pain. I find it all strange that I need to explain all of this to you since you are supposed to be a nurse. I'm not saying that to be insulting. I have new nurses that I've precepted that understand this. Why is all of this such a foreign concept to you? Has scope of practice and care plans changed that much? If you had a patient lying flat, you would need an order to initiate aspiration precaution? What if they had seizures? Did you need an order before placing bed padding?

I love this response. When I first went into bedside nursing, it was HCA. It provided many traumatic experiences to the point where I thought I'm just a terrible person and an even worse nurse. I try to do everything in my power now to uplift other nurses and healthcare staff. I never want to be the nurse manager that doesn't support. I'm saving this as a screenshot because I love how grounding it is.

While I appreciate everyone's support so far, is anyone here in admin or some type of leadership role? Not to put another layer on it, but I want to apply to a leadership role, assistant nurse manager. I have a feeling this action might impede that. If they ask what I should've done, anyone have a good answer?

Anyone who is ordered to lie flat on their back is considered an aspiration risk when taking anything PO, I don't care if you're 9 to 99. Add on top of that that you're 69, less than 24 hours from anesthesia, and just had spinal surgery messing with various nerve responses... I stand by my reasoning. I will be happy to supervise your PO intake to make sure you don't choke, that is my job as a nurse. I can intervene if something happens, but I am not going to let my patient eat or drink alone. There is such an order as "NPO except for medications.” Again, until neurosurgery tells me otherwise, I'm not going to move you. I am more concerned about you having full function. I am going to avoid any potential injury to the surgery like my patient trying to extend to reach for water or trying to sit up right after spinal surgery. Once the all clear is given by the neurosurgeon, I'll help you do cartwheels in the shower. The first hours after spinal surgery are very important. I wish the doctors or nurses explained this to you. You deserved better.

I had a patient recently decided to light up a cigarette on a medsurg floor. Not sure where he got the cigarettes and lighter, he was on our floor for weeks and never did this prior. I only had him in my assignment for a day and a half. He's AAOx4 with multiple behavioral corrections and a schizophrenic diagnosis. Full grip strength and strong upper extremity ROM. A tech and LPN were trying to convince him to put down the lit cigarette he was puffing on. He kept moving the cigarette threatening to burn them or holding it out of reach. I heard the commotion next door when I was with my patient on oxygen. I processed for about 10 seconds the best resolution with my main focus being to put out the fire hazard, avoid injury to the patient and staff, and ending the cigarette smoke throughout the hall. I filled a water pitcher with water and threw it on the cigarette getting the patient partially wet, but extinguishing the hazard. In other words, I threw a bucket of water on a patient. The same question keeps running through my mind. What could I have done to handle this better? Will this come back to haunt me? My nurse manager does not seem to be upset with me. I haven't been called to be reprimanded... yet. Can I please get some outside perspective?

OK, so to give you an idea of what it is now like... On a medsurg floor the RN has 5-7 patients. There are no LPNs, they usually only work in nursing homes. Techs, or CNAs, have about 15 patients on a medsurg floor. Working on a surgical floor myself, I will not move you or even put your legs up fresh out of surgery till I get the all clear from neurosurgery. Figuring you were a tech in the 1970s, you're either in your 70s or 80s now. Based on that alone, it would be reasonable to believe they made you an aspiration risk, I'm not letting you have anything PO lying flat. They more than likely gave you fluids while under anesthesia or in the PACU. If you needed your face wiped, please tell me. For food, again, I'm not letting you eat till you can sit up. I'm not putting any water or food in your mouth due to aspiration risk. It sounds like the doctors could've explained this to you better, they should tell you this preop. However, the nurse could have also told you this postop. I'm not saying that everything that happened to you makes sense. There is some rational to the process though.