Fired After Fifty: Redux

Several years ago when I was laid off from my LTC job due to low census, I remember despairing of ever finding another job. I was in my early fifties then. At the time I had a bad knee that had ended my floor career despite surgery, and to add insult to injury I'd gained thirty pounds due to inactivity. I couldn't imagine who would want to hire me. But I had barely drawn the first few unemployment checks when I got two calls: one for another LTC, and one for an assisted living facility that I fell in love with at first sight.

Fortunately for all concerned---at least at the time---they fell in love with me right back, and before I knew it I was working at this beautiful residence and making the kind of money I'd only dreamed about. After about a year of working there, I decided that I'd finally found the "forever" job I had been looking for through my entire career, and made up my mind that it was the one I would retire from when I reached the appropriate age. Read More

What's your facility's policy? new PIV tubing to new CVL

Does your facility require you now change bags/IV tubing again after only three hours because it is a new line? One co-worker said it is a must due to CLABSI risk. (I could understand that if the hubs were not scrubbed appropriately or previous lines were old). I could not find any policy from my employer or a study that substantiates claim of increased risk. Please tell me what your facility requires or links to any studies you might have read on the matter. Read More

Long shifts = Higher levels of burnout

You may experience burnout sometime in your career. Recognizing the symptoms of burnout is the key to recovering. Please share any experience, tips, or articles on how you prevent and treat burnout. Read More

Thank you for preceptor!

I am finishing up a semester with a preceptor who has been great. She has taught me a lot, advocated for me to have opportunities to shadow other physicians in the practice, and ended up precepting me for many more hours than she had originally planned. I want to do something to thank her. I am planning to write out a card of course, but am wondering from those who have precepted... what are your thoughts on gifts from students? What types of things did you appreciate getting, and what would you rather do without? Read More

Who has both AANP and ANCC certifications? Should I?

I just graduated from a FNP program last week and started studying for the AANP certification exam basically because thats what all of my peers had signed up for. I know there are slight differences between obtaining recertification. Do you think it is attractive to employers to have BOTH certifications? I'm already studying for both anyways and its just an extra $240. Read More

What Experience is More Valuable? CNA, EMT or EKG Tech

After reading about the hardships of finding a job as a New Grad, I was wondering if anyone can give any suggestions on how to be proactive and gain experience beforehand.

Does working in medical field beforehand make a Really Big difference? If so, what would be a better course of action if you have time before getting into a nursing program -- getting a CNA certification or an EKG Tech or EMT? Please share your experience and which course of action you would take (CNA, EMT, EKG Tech certification). Read More

Life and Death

As nurses, there are some times that we all have to take care of patients who, due to circumstance, due to mental anguish, due to mental illness, or a combination of all of these things are desperately seeking ways to end their life. On the same shift, or in the same week, or in the same day we also are often taking patients who facing a terminal condition, are desperately seeking to live. How do we go from one extreme to the next and still feel intact? Read More

What does "primary care" mean?

My hospital is thinking of getting rid of CNA's and go to primary care. What does that mean exactly? If it means what I think it means, it means we are in for PURE HELL!! Read More

What exactly do physicians do again?

So I'm not trying to step on any toes here, but I am just a little shocked at two experiences I've recently had and I want to know if this is normal or just two bad cases...

First, I worked at a small critical access hospital and we had to call a rapid response on a patient. All of the nurses rushed in and worked their magic while I watched over the floor since I was the only PCT and all of the nurses were busy. 20 minutes after the rapid was over, the physician came calmly and slowly walking down the hall and asked our nurses about the rapid. She was two months pregnant and took frequent hour long naps throughout the day and really just didn't seem at all concerned about the rapid response.

Now I've transferred to another hospital in the same network but it's a bigger hospital with all of your expected units. So last night I was watching our telemetry monitor and a patients heart rate dropped to 40, 30, 17... I alerted my nurse and we ran in. The woman was gray, not breathing, and by that time had no pulse. We called a code blue and I started compressions while the nurse got her oxygen. In a matter of minutes the code team was there and took over and once again I found myself monitoring the floor because the nurses were in the room working on this patient. About 10 minutes after the code started, the physician came walking up like he had no care in the world, stopped outside of the room and looked in for a whole maybe 8 seconds, and then left! He didn't ask a single question, walk in the room, hell, he probably didn't even know the patients name!

I've just found myself really outraged both times that the physicians did NOTHING. Is this how it normally goes? To me it just seems like doctors prescribe the meds and the nurses do, well, everything. Read More!

Help! At my wit's end with reconstituting a med

I can't take it anymore. I have wracked my brain trying to figure out the math or even best practice on this issue. In desperation, I turn to you, o mighty nursing think tank!

Behold, the most baffling med math I've ever seen:

My homecare patient gets an uncommon drug in a weekly infusion. To keep me slightly more anonymous, and for ease of readability, we shall call it MiracleDrug (TM). The order: Infuse 4 grams of MiracleDrug IV over 30 minutes every 7 days. My patient gets 4 vials shipped to his home every week for me to infuse.

Easy, right? Here's the problem. MiracleDrug is not a standard 1 gram per vial. Depending on the lot number, it can be 1100 mg or more per vial.

MiracleDrug comes with 4x20 mL vials of sterile water to reconstitute into. Per the drug insert, I use a transfer needle to put all of the diluent in the MiracleDrug. Simple, straightforward med math means that I draw up, say, 65 mL of reconstituted drug to make 4 grams.

The problem is that there is quite a bit of MiracleDrug powder in each vial, so when I reconstitute it, each vial contains probably 25-30 mL altogether. But unlike most meds, there isn't an insert to say "add 18.7 mL sterile water to equal 20 mL of reconstituted medication at a concentration of 58.4 mg/mL". Instead I'm adding 20 mL to equal an unknown volume. Read More...

Time Management

I have been working in Home Health Nursing and I have an opportunity to work in Long Term Care. I was wondering how you guys manage your time on the floor. Do you pass meds first or do assessments and treatments first? I would like to work 3-11 since it is part time. Read More

Nursing Researcher interview

I have a project for my MSN course to interview a nurse researcher either in the academic or hospital setting. If anyone could help me out that would be great. All I need is a few questions answered. Id really appreciate the help if there is anyone out there. Read More