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Good point. As always, depends on trends and additional information.
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Jun 19, 2020 00:52
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Nine of Eight posted:Your preceptor is a fuckup, but I have seen patients so hypernatremic that the doc gave them D5NS so their sodium wouldn’t go down too quickly. gently caress, I've used 1.5% nacl for that purpose. Neuro land can get loving weird.
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Jun 19, 2020 02:15
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It may be the unit culture not to double check insulin/heparin, even if it is hospital policy. I wouldn’t show my friends my 1-2 unit of subcu nutritional overage, but when I was pulling out 50 units of Levemir, I always got that double eyed. Same with heparin - if I’m giving the unit dose sub cut VTE prophylaxis dose, I don’t usually have that checked. But if I’m giving a bolus for subtherapeutic or changing a drip, there’s another set of eyes. Also, with 8 months experience, she’s still running around like a chicken with her head cut off. I didn’t feel good to orient someone for like months.
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Jun 19, 2020 03:23
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Listen to your nurse gut. If it doesn’t feel right, don’t do it. Eight months of experience is NOT ENOUGH TIME to precept someone else.
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Jun 19, 2020 03:49
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quote:Eight months of experience is NOT ENOUGH TIME to precept someone else. For real. Most importantly, even if it’s just for a couple of days.
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Jun 19, 2020 05:18
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Please always get intravenous heparin double checked for all bonuses and dose changes like drat.
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Jun 19, 2020 05:41
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My old unit had me precepting after 3 months on the floor (postpartum). I was on my own after 12 training shifts. There was at least a solid understanding that this was a nightmare due to staffing, and there was a lot of support from charge nurses and others who were more experienced. The daily workflow in postpartum was usually pretty predictable, but when poo poo hit the fan it REALLY hit the fan. Feels so weird to be away from inpatient. I really miss it  .
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Jun 19, 2020 06:52
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Thanks for all the supportive/confirmatory comments folks. Resolution report: I started off by telling my educator that I’d been paired with a nurse with only 8 months experience for two days straight, and she was already horrified. Had a “but wait, there’s more!” moment and told her about the med error, an incident where my preceptor didn’t understand an order and made me call the hospitalist to confirm what I already knew, and an example where she commented on a lab value indicating something that it did not. She was completely mortified and asked my permission to communicate it to the unit manager. I said okay, but you should also know that the unit manager cornered me in the med room and motherfucked my two ER managers to my face, so I don’t really trust her judgement - which is part of why I didn’t go straight to her in the first place and just ran it by her low-key when it was *my* responsibility to renew the fluids. (I understand now that this was wrong, but I was so afraid that maybe *I* was wrong/misunderstood something that I didn’t have the confidence to stand up to a preceptor in the moment - now I do.) I explained that my goal wasn’t to throw somebody under the bus, that I just wanted to not be so anxious about who I’m learning from, and for my preceptor to be a safer nurse in the end. She understood, and came back to me at the end of the day to say that I will never work under someone who hasn’t done the preceptor class (minimum 2 years experience) again and that I will be moved to the ER for the rest of orientation after 3 more medsurg shifts (instead of the planned 8.) I can deal with blowback for 3 days. So it looks like I’ll be making it out of this alive.
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Jun 19, 2020 23:18
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Nice. What was the order she didnt understand?
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Jun 19, 2020 23:55
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computer angel posted:Nice. What was the order she didnt understand? The order was for IVP lopressor with parameters set for SBP >130 and HR >80. Patient came to us from PCU with paroxysmal afib w/ RVR for which she usually takes dronedarone PO. Problem - this lady is altered/not swallowing well and dronedarone can’t be crushed. Hospitalist the day before ordered the lopressor as a solution. She converted to sinus. She was still in sinus. So the obvious solution here is to hold the lopressor because parameters are not met, it’s not indicated. But she made me call because “her blood pressure is high and usually lopressor can be given with a HR of 60.” I tried to explain that 1) her 140/73 blood pressure is not “high” and 2) this was clearly not prescribed for hypertension, but she said I was wrong and need to get the doctor to clarify the order. I should’ve refused to call but I was trying really hard not to make a scene in my first week.
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Jun 20, 2020 01:43
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DeadMansSuspenders posted:Please always get intravenous heparin double checked for all bonuses and dose changes like drat. This. I worked closely with patient safety/quality for a few years and the amount of med errors that occur in a hospital is terrifying. And the vast, vast majority occur when people skip double checks or built in safety mechanisms such as scanning the patient and medication. And don't get me started on ambulatory clinics and the workflows I observed for ordering and administering vaccines to peds. The care free attitude that some of our peers have when it comes to patient safety gives me heartburn. Hughmoris fucked around with this message at 04:23 on Jun 20, 2020 |
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Jun 20, 2020 04:20
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Xepherra posted:The order was for IVP lopressor with parameters set for SBP >130 and HR >80. You're doing well with your thinking clinically. This is why it's important to understand medication indications, and why the same medication may have different indications for different situations. Sure, in a given circumstance I'll give lopressor all the way down to a HR of 60 to control hypertension, but that's not what we're doing here. We're not giving the lopressor here for hypertension, we're giving it as a stop gap measure for rate control in the context of uncontrolled afib in a patient otherwise unable to ingest oral antiarhythmics. This is why your SBP and HR parameters were so high. If the patient is rate controlled, and especially even in sinus, then the lopressor is not indicated. Worry about the pressure when you hit 160 or higher outside of a specific reason to keep the pressure lower. Otherwise your doctor and anybody else is yawning over your call about a 140. Primary care outpatient can worry about long-term effects of an average 140, but it's not a super big deal in an acute setting in a typical case, again outside of some specific reason to the contrary. As far as your call to the doc, sure, you should have refused. But it's not a big deal in this instance, and you're in the midst of learning to balance patient care with the social aspect of peer expectations and unit cultures, so it becomes more complicated. You're already learning to trust your gut, and experience will help you with the not giving a poo poo when someone gives you bad advice. Consider this an ideal learning situation honestly.
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Jun 20, 2020 08:40
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Xepherra posted:
Had I been in your shoes, I might have honestly called about that one just to be safe. However, my thinking doesn’t really relate to her Bp being high either. I’m more concerned about the rebound tachycardia potential with beta blockers. Metoprolol, in particular, can cause intense rebound tachycardia and flip people into abnormal rhythms. This preceptor isn’t necessarily safe and she is also very green, but I would have been unsurprised if the attending wanted the lopressor to be continued. That being said, you really see a lot of weird things when drugs are used for reasons other than the “most obvious” complication. I saw that WAY too frequently with neuro patients and nimodipine. Frequently, nurses would hold this drug for lower Bp’s or HR not realizing that they were putting their patient at risk for vasospasm. I only bring this thought up as a reminder to be open-minded and receptive with preceptors. It sounds like you did the right things in this situation, but it is possible that preceptors will be thinking or doing things for very legitimate reasons that seem counterintuitive to previous teaching. I think as new grads we all run a weird balance between “I totally know better here” and “holy gently caress, anything I do could kill someone.” I know I certainly struggled with being overly confident at times and definitely had a few learning opportunities because of it. This preceptor was definitely not great and I’ve absolutely experienced that myself, but sometimes they do surprise you. Regardless, You handled this situation well and you were totally right. You did good and your “nursing” critical thinking is definitely on point, you’ll do well and ER is such an awesome place to learn nursing skills and reinforce the ones you have! Getting stuck on 3 weeks of med surg is such a weird thing to require of ER new grads.
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Jun 20, 2020 21:34
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Hi folks. I am a 31 year old digital marketer disillusioned with working solely to generate additional profits for random companies. I'd like to do something more interesting and meaningful, and I think nursing could be that thing. Obviously, it's a weird time to be going into healthcare work. Assuming I started an associate's in nursing in the spring (since I think its too soon to apply for fall), what's the earliest I would be in some kind of clinical setting where I was at greater risk for interacting with COVID patients? I'm not going to make plans about whether I would be exposed to the virus eventually (because we'll all be exposed) but just want to know what to expect and how to handle talking about it to my live-in partner, who has been nervous about me working in healthcare. I know attending classes is its own beast and a risky thing, and who knows if school even happens in the spring, but putting that aside, when do associate's in nursing students typically start being around actual patients? edit: Or maybe I should start in the fall if its just classes and nothing in a healthcare environment for the first semester Also, I currently have a BA in writing. blue squares fucked around with this message at 23:16 on Jun 20, 2020 |
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Jun 20, 2020 23:09
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First, you will need to complete usually ~30 credit hours of prerequisites and gen ed. This is your English, anatomy, physiology, microbiology, psych, developmental psych etc. Then you apply to the associates program, and pray you get in. Some places do a lottery, my school did points, but usually you have to apply more than once. Then nursing school is 4 more semesters, and that’s where you would start the actual clinical placements. Think hard about nursing. It’s great, but also terrible in several ways.
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Jun 21, 2020 01:02
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Depending on how the covid stuff goes, clinicals may be on hold for a while. We have no students of any kind in the hospital right now to preserve PPE, and most clinicals have been cancelled into the fall.
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Jun 21, 2020 01:49
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Jamais Vu Again posted:First, you will need to complete usually ~30 credit hours of prerequisites and gen ed. This is your English, anatomy, physiology, microbiology, psych, developmental psych etc. Then you apply to the associates program, and pray you get in. Some places do a lottery, my school did points, but usually you have to apply more than once. drat. Right before I read this post I started looking at one of the better schools in my area and saw the prereqs. I figured it being an associate's, there weren't any. I have a BA already from a state school but nothing in the correct science classes. I guess this will take much longer than I initially thought. I'd better take my first classes online in the fall, then.
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Jun 21, 2020 12:09
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blue squares posted:drat. Right before I read this post I started looking at one of the better schools in my area and saw the prereqs. I figured it being an associate's, there weren't any. I have a BA already from a state school but nothing in the correct science classes. I guess this will take much longer than I initially thought. I'd better take my first classes online in the fall, then. If you’ve got a BA already, look into accelerated BSN programs. You’ll still need to do the pre-reqs, but the actual nursing programs are usually 12-18 months or so.
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Jun 21, 2020 14:14
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What would be the fastest way to go from a BA in writing to working as a nurse? My only science classes are in astronomy and one in marine sciences Edit: I guess I should acknowledge fastest is not the most important consideration. I don’t want to be unprepared and cause someone harm. I’m 31 already so I’m impatient to get my career change going but I should be realistic and know that rushing through training could compromise my ability to perform. blue squares fucked around with this message at 17:29 on Jun 21, 2020 |
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Jun 21, 2020 16:52
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Any thoughts on remote nursing jobs? I'm an RN in the U.S. but I currently live in Spain, and the process to get my nursing license co-validated over here is a loving nightmare and I'm pretty sure they'll reject me anyway (they don't seem to understand that my accelerated nursing program truly was equivalent to a four-year BSN, and only see the time I was actually in school). So I'm thinking about other options like trying to do some remote nursing job, but I don't know what those entail -- dealing with insurance and care management, mostly, I assume? If anyone has knowledge I'd appreciate hearing any perspectives at all.blue squares posted:What would be the fastest way to go from a BA in writing to working as a nurse? My only science classes are in astronomy and one in marine sciences I had a BA in Gender and Sexuality Studies, and took not a single STEM class in my first degree. It took me about two years to do all the nursing pre-reqs at a community college, then I applied to a one-year accelerated BSN program designed for people who already had degrees. Honestly it was too short. I don't think an accelerated program should be less than 18 months. They prepared us to take NCLEX and that was about all. So, with pre-reqs plus program I'd say you're looking at a good 3-4 years. boquiabierta fucked around with this message at 17:09 on Jun 21, 2020 |
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Jun 21, 2020 17:03
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I had a year (no breaks) of pre-reqs, since my bachelors was granted more than 5 years before I decided to career change so all my prior science work was not accepted, then my program (a masters entry program that essentially bolts an ABSN onto a MSN) was 7 semesters (2 years and 4 months with no major breaks). Seems like I got more clinical experience in a master's entry program than in a traditional ABSN program though, as I had clinicals in 6 of my 7 semesters (two full years of clinicals). With the ~8-9 months of downtime between finishing my pre-reqs and starting my program, it came out to almost exactly 4 total years to get my ATT, then a few more months of bureaucracy to get the NCLEX done and a license so I could start work - all told it took me 4 years and 2.25 months from when I started my first pre-reqs to when I started working as an RN. So, given that you already have a bachelor's a master's entry program might be worth looking into as well. I felt my program prepared me quite well to start, but even having started 3.5 months ago, I know I still have a ton to learn, and learn new things every shift. Fwiw, I started the process when I was 33, and finished at 37.
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Jun 22, 2020 20:38
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boquiabierta posted:Any thoughts on remote nursing jobs? I'm an RN in the U.S. but I currently live in Spain, and the process to get my nursing license co-validated over here is a loving nightmare and I'm pretty sure they'll reject me anyway (they don't seem to understand that my accelerated nursing program truly was equivalent to a four-year BSN, and only see the time I was actually in school). So I'm thinking about other options like trying to do some remote nursing job, but I don't know what those entail -- dealing with insurance and care management, mostly, I assume? If anyone has knowledge I'd appreciate hearing any perspectives at all. A co-worker of mine did a year working from home taking calls from patients with Humana insurance. They sent her a computer and secure phone, she said she never interacted with a live person during the interview process or time working there, and she made $40/hour giving half-scripted information about disease processes to the clients. I'm considering making the switch because the hospital system is getting worse by the day and the pay is very competitive where I live compared to floor nursing. She only stopped doing it because she felt cooped up in her home office and the hospital had a CNIII position opened up. She still makes less than what Humana paid and she works nights.
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Jul 18, 2020 22:24
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Where is the nursing thread that isn't about school? Edit: Guess Ill add something. I had a BS and MS in other fields, then got an ADN in 1 semester of prereqs (just micro and sociology), and 4 semesters of nurse classes. It's ok but I want out. It was like a plan C as my MS didn't work out like I wanted. excellent bird guy fucked around with this message at 12:07 on Aug 1, 2020 |
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Aug 1, 2020 11:56
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excellent bird guy posted:Where is the nursing thread that isn't about school? This is the everything thread. What shall we discuss today? I got laid off from my job in nursing informatics down south back in May. Just started a new position and the difference in the teams and culture is night/day. I'm sure there are some great academic hospitals out there but the one experience I had was pure shite, end-to-end.
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Aug 1, 2020 15:51
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I made the jump to active duty Air Force clinical nursing from ICU and it has been a ride to say the least. The ‘roni has made everyone lose their minds. I do mostly telehealth and what highly educated people say out loud to me is bonkers.
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Aug 1, 2020 16:22
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djfooboo posted:I made the jump to active duty Air Force clinical nursing from ICU and it has been a ride to say the least. The ‘roni has made everyone lose their minds. I do mostly telehealth and what highly educated people say out loud to me is bonkers. I had 2 patients this week ask me how I’m going to intubate them with their mask on. They were serious.
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Aug 1, 2020 18:18
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amethystbliss posted:Any other school district nurses in here? I recently accepted a 0.6 FTE while also keeping up my inpatient mother/baby per diem gig. Been there for the last few months, seems too good to be true, waiting for the shoe to drop. Considering taking a 1.0 FTE if they offer it for next school year and quitting inpatient altogether. Quoting this old post for its hilarity. Ah, the days when I thought school nursing would be less stressful than inpatient. My job these days consists of a ton of reopening task forces/committees and trying to obtain scarce supplies so we can perform hygiene theater. At least we're starting in distance learning for the next few weeks.
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Aug 1, 2020 23:31
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I am in psych now. There are a lot of former nurses that lose their mind and get an IM every night for acute psychosis. I am going to DOC next. I am over it. Dementia, PD, and Schitzos all in the same room, having melt downs, fist fights, self mutilations, and bullshit medical emergencies every night. We have riot shields we use like several times a week. We are outnumbered by about 30 to 5 (med nurse, floor nurse, and 3 techs on a good night). The paperwork is actual paper and stacked to the loving ceiling. lol fun times.
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Aug 2, 2020 06:55
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Hughmoris posted:Informatics is the chillest of jobs. Providers want me (to fix things), med-surg nurses want to be me. AH I remember this post. If you are interested in emar type stuff, my current facility (I am a traveler), had a programmer that made a custom computer system 20 years ago. He retired and now nobody knows how to maintain it. I get a lot of SQL errors and can't DC the meds oftentimes. But it's weird because all the orders are paper, the computer just provides an overhead of what's going on, but I don't think anyone really looks at it except as busy work for the nurse.
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Aug 2, 2020 07:37
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excellent bird guy posted:AH I remember this post. If you are interested in emar type stuff, my current facility (I am a traveler), had a programmer that made a custom computer system 20 years ago. He retired and now nobody knows how to maintain it. I get a lot of SQL errors and can't DC the meds oftentimes. But it's weird because all the orders are paper, the computer just provides an overhead of what's going on, but I don't think anyone really looks at it except as busy work for the nurse. Traveling psych? Sounds like that could be a little rough. And yeah, if you're burned out on psych definitely get out. That's one thing I love about nursing, so many fields to get in to if you tire of one.
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Aug 5, 2020 21:08
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I moved a year ago to take a clinical supervisor position in a new hospital, in a different state, with my then fiancee. It turned out the unit was in much rougher shape than I was initially given to understand, the office time for what I was sold as a mixed floor/office job in non-existent, and our already terrible staffing got further hosed by COVID hiring freezes. Supposedly they're bringing people on but it's like... 3 experienced nurses and maybe also some travelers, a drop in the bucket to what we need. The last one they oriented lasted a week, before using a car accident as a reason to break her contract. There are no staff left there that have been there longer than me but less than 5 years, and the old heads are all beyond crusty. A 44 bed cardiology/vasc/post surgical/med-surg unit that they want to expand to the 50s and soon want taking LVADS. Highest patient turnover in the hospital, the surgical floor being the only one that even competes. Most nurses routinely at 6 lately, with the post ct surgery 4 to often 5 and its a rare day we don't have 2+ primaries, sometimes no techs at all. Our surgeons are notoriously willing to cut anything so there were 8 post cts deaths last month and even more long term morbid. The last 3 shifts the HOS/ facilitator/ whatever you call them has had me calling my manager at 5 am to come in because float pool can't get me past 8 nurses, a number at which the charge nurse would have a full patient load on top of unsafe staffing. Meanwhile my company just published their quarterly earnings and the company as a whole beat EPS estimates by 300%. I've got this good crew of younger nurses that I can see burning out before my eyes and I feel like a serial abuser. The personal risk doesn't mean much but I could certainly see myself getting named in a medical error lawsuit for supporting this grossly unsafe staffing. I don't really have a question, I just wanted to tell some people who might know how it feels.
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Aug 6, 2020 06:34
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As an aside does anyone else work somewhere with no time clocks? They tore them all out saying that we should be using Kronos on the PCs for clock in, but we don't have enough wows or PCs for day and night shift to be on them at the same time. Imo it's basically wage theft and I'm torn between quitting literally today and staying so that I can look into unionization resources. awkward_turtle fucked around with this message at 14:34 on Aug 6, 2020 |
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Aug 6, 2020 13:54
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awkward_turtle posted:As an aside does anyone else work somewhere with no time clocks? They tore them all out saying that we should be using Kronos on the PCs for clock in, but we don't have enough wows or PCs for day and night shift to be on them at the same time. How do you note your hours? On paper instead?
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Aug 6, 2020 14:51
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Hughmoris posted:Traveling psych? Sounds like that could be a little rough. And yeah, if you're burned out on psych definitely get out. That's one thing I love about nursing, so many fields to get in to if you tire of one. Yep, it's really not all bad. Just a major gamble like anything else travel related if it it's hell job or nice and easy. I've seen both. Went to psych thinking it would be a break from county jail. But one cool thing about this job is I get to talk to other travel agents, and from what I'm thinking the Department of Corrections will be at least a lot better funded and more professionally operated. Nothing will ever be worse than medical intake at the county jail of Baltimore region. god worst experience of my life but it gives you some perspective.
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Aug 6, 2020 16:03
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awkward_turtle posted:As an aside does anyone else work somewhere with no time clocks? My hospital doesn't have time clocks, but I'm in Canada and also unionized. awkward_turtle posted:I moved a year ago to take a clinical supervisor position in a new hospital, in a different state, with my then fiancee. It turned out the unit was in much rougher shape than I was initially given to understand, the office time for what I was sold as a mixed floor/office job in non-existent, and our already terrible staffing got further hosed by COVID hiring freezes. Supposedly they're bringing people on but it's like... 3 experienced nurses and maybe also some travelers, a drop in the bucket to what we need. The last one they oriented lasted a week, before using a car accident as a reason to break her contract. There are no staff left there that have been there longer than me but less than 5 years, and the old heads are all beyond crusty. A 44 bed cardiology/vasc/post surgical/med-surg unit that they want to expand to the 50s and soon want taking LVADS. Highest patient turnover in the hospital, the surgical floor being the only one that even competes. Most nurses routinely at 6 lately, with the post ct surgery 4 to often 5 and its a rare day we don't have 2+ primaries, sometimes no techs at all. Our surgeons are notoriously willing to cut anything so there were 8 post cts deaths last month and even more long term morbid. The last 3 shifts the HOS/ facilitator/ whatever you call them has had me calling my manager at 5 am to come in because float pool can't get me past 8 nurses, a number at which the charge nurse would have a full patient load on top of unsafe staffing. Meanwhile my company just published their quarterly earnings and the company as a whole beat EPS estimates by 300%.
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Aug 6, 2020 16:21
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Question for those I’ve seen posting about working in informatics: How do you like it? What is your schedule like, and what is your normal day-to-day routine? I’m getting pretty burnt out on inpatient and am trying to figure out my next move. I’m looking into doing an MSN through Grand Canyon University, I had previously done 4-5 classes for an education degree and I’m pretty certain at least a couple of them will count towards it. Any advice would be greatly appreciated!
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Aug 11, 2020 06:15
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Eat My Ghastly rear end posted:Question for those I’ve seen posting about working in informatics: I have a coworker who is taking grad classes in informatics. All I have to add is what he said, he participated in an 'epic rollout,' which is an Emar software. I think he said his dream job is to work for Epic and help with education and customer support? That's really all I know of the subject but you are in luck since there are posters itt in the field.
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Aug 11, 2020 06:32
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My sympathy card is starting to run out. Our mental health system (usa) is just bad and sad. The other night one of the guys was out in the yard, stomping his feet, screaming, pitching a fit like he does almost every night about shift change. Usually if you ignore it he stops. Sometimes these mental health techs will talk to him like a child or a patient and it really pisses him off. So I usually let it go. But he goes up to an old lady, a mean old lady fwiw, and punches her in the mouth. So I call a code, we get people from other departments, the shield, all the works. He goes into his room. I call the on call to get order for haldol benadryl and ativan IM. Well he was very cooperative, went right into locked seclusion. He pulled his pants right down and he got his shot. His drugs that he wanted. While the lady I had to contemplate whether or not she was to get stitches. She wouldn't let me exam her, she'd scream and cuss at me to get the gently caress away from her, as per usual (I eventually got it cleaned up with steri strips). What I'm saying is, it's hosed that a patient wants to get his drugs, so he physically assaults another patients, gets what he wants, then goes out on his way out of seclusion an hour later just doing his normal thing. That's just one example, this kind of thing happens most nights.
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Aug 11, 2020 12:23
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excellent bird guy posted:I have a coworker who is taking grad classes in informatics. All I have to add is what he said, he participated in an 'epic rollout,' which is an Emar software. I think he said his dream job is to work for Epic and help with education and customer support? That's really all I know of the subject but you are in luck since there are posters itt in the field. My wife isn't a nurse, but works on the Epic implementation team at her hospital. There are quite a few nurses that do work with her. Some have been pulled from the floor to assist with the implementation, others have worked in EMR systems/informatics for quite a while. You don't need a degree in informatics to transition, but it'll help. Since they're the largest by market share, if you want to work for Epic, it's something good to get into. My wife had worked with Cerner in the past and was working in hospital reporting systems in her current hospital. She moved onto the implementation team for something more interesting and also did it to gain the certifications and experience, knowing that this is a key to a pretty well paying job that can be done remotely in the future.The key is to find a hospital that is transitioning to Epic. They paid for her certifications and have bonuses for each implementation date as they roll it out over the hospitals in the group. She's been working remotely for 5 months now and they currently have no plans to go back to the office. She's pretty busy, but a 40hrs/week, salaried, work from home gig that's been labeled as absolutely essential (as in, we've dumped too much money in it now to stop) is a pretty good one to have in the middle of a pandemic.
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Aug 11, 2020 12:43
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White Chocolate posted:How do you note your hours? On paper instead? The "time clock" is entirely digital, you access it from a PC or lately from one of our care connect phones. The removal of the physical clocks is just kind of a head scratcher, it only makes it harder to get your time right.
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Aug 15, 2020 08:52
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