Jul 11

Career Update: Part 1

So I started out in Cardiac Telemetry as a new grad. I knew right out of school that I wanted to have  Telemetry as a foundation for my practice. If you are starting out as a new grad in the US, Tele is a great start. From Tele it is much easier to navigate into specialty areas than moving from Med-Surg. After about 18 months I was fatigued with my job. I worked on the biggest unit in the hospital which was split into regular Tele, Med-Tele, VIP unit, and observation unit; as well as being floated to MICU, CVSD, Maternity, Med-surg and the new sister hospital which had opened a good 20 min drive from the main campus. I had started working on days as a new grad as I thrive under pressure. I learned so much in the first 6 months and definitely found my groove, understanding my patients, documentation and the docs. I found that I really enjoyed working the observation unit as it was high turn over, fast paced, and a bit of a mystery of what the ER was bringing up. One time I had a pt come up dx: Chest Pain. I gave her morphine, did an EKG, put her on O2, call the doc – she was immediately sent to the cath lab. This pt should have been a cardiac alert, turned out that she had 100% occlusion in the Circumflex – she was dying. I loved that I was on the cusp of something, it was fast, it was more challenging than the other units and I liked it. After about 14 months on days, I switched to night shift. Our night shift staff was thin, a lot had left and they were struggling, and to be honest, I needed the pay increase. So I did nights for the last 5 months of my job and started looking for other opportunities.

I landed a job at another hospital, again it was a non-profit hospital, but in an affluent area. I was working in CV-Step Down, sister floor to CVICU post-CABG/TAVR pts mainly. I was thrilled that I was moving deeper into the cardiac specialty, this is what I wanted. After 3 months in my new job I wasn’t happy. I was working nights, the staff were burned out and it showed. I found that the acuity of my patients weren’t all that different from my prior job. Post-open heart really only meant, possible Afib – start Cardizem or Amiodarone drip, chest tubes – usually 2-4, Dermabond midline chest incision and leg donor site, and lastly a foley. There was nothing really interesting about it. The fun happened in the OR, ICU and then during the day when the chest tubes were pulled, I missed out on all of that and just ended up changing the chest tube dressing and drawing blood from the central line.

I started to feel depressed; I started dreading going to work. I wondered if I was looking for something better that didn’t exist. I thought nursing was this great expanse of possibilities, but here I was feeling crappy after changing jobs from a crappy position to another one. I considered if I just wasn’t made for nursing. I’ll be honest, I never planned on being a nurse, I didn’t grow up dressing up as a nurse and putting a stethoscope to my teddy bear – that wasn’t me. Life brought me to nursing, and my ability to take on a challenge, think critically, enjoy interacting with people, had made this a good choice for me, but now I was here in this place where I was unhappy and couldn’t quite figure out how to fix it. So I did what I thought I should do and start looking for another job. Now I was looking for a higher level: ER, ICU, ICU specialities.

Ironically I reapplied for some of the jobs I had applied for when leaving my first job. I really just felt like I had nothing to lose. I did get a call back for an ER job at a Level II Trauma hospital right on the highway. It is one hospital within a large hospital system, which means there are a lot of jobs available without actually quitting and having to learn a whole new system over again. So, I booked the interview and figured I’d wing it, at the end of the day, I still had a job, even if I didn’t get a new one, the bills would still get paid haha!

Stay Tuned for what happens next…!

 

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Feb 13

Too many hours, too little sleep from @ScrubsMagazine #nightshiftproblems

You can read the article >here<

From the Spring 2014 issue of Scrubs

There’s a lot of talk these days about how detrimental it is for hospital patients to have their sleep interrupted.

Given all we know about the health ramifications of short-changing sleep, it’s a topic that deserves discussion. But there’s another sleep issue with implications for patient welfare that’s not getting nearly enough attention, says sleep expert Ann E. Rogers, PhD, RN, FAAN. That’s nurse fatigue. Rogers, the Edith F. Honeycutt Chair in Nursing at Emory University’s Nell Hodgson Woodruff School of Nursing in Atlanta, says it’s a critically important issue because it affects the health and safety of nurses, their patients and the public.

The long hours (75 percent of nurses work a 12-hour shift), the rotating shifts, the propensity to work through breaks and the stress of the job create the perfect storm for sleep deficiency in nurses, says Rogers.

“Our studies show that nurses devote half their free hours sleeping. In other words, if you have 12 hours free between shifts, you sleep about six hours.” But who has 12 hours free between shifts? On average, nurses put in an extra 50 minutes after their shift officially ends, so the hours on duty are much closer to 13. Tack on the commute time (on average, about 25 minutes each way), do the math and you’ll find there’s not a lot of time left over for shut-eye. In fact, using Rogers’ formula, that leaves about 10½ hours of free time after a 12-hour shift, and that means well under six hours of sleep. Not enough when seven to nine is the recommended amount. On top of that, “Sleep loss is cumulative,” explains Rogers. “So nurses who work 12-hour shifts on consecutive days and are sleep deprived become more and more affected cognitively.”

On the face of it, the sensible solution would seem to be a return to the eight-hour shift, but as Rogers explains, that’s not likely to happen.

“Nurses like the 12-hour shift, and while they don’t like mandatory overtime, they don’t want any restrictions on their ability to work overtime.” One study showed that 80 percent of nurses are happy with current scheduling policies. Results from the same study, however, showed that levels of job dissatisfaction and burnout increase with an increase in the shift hours.

While the evidence clearly points out that the extended hours nurses work pose a threat to patient safety and to their own health, there are ways to mitigate some of those effects.

Most importantly, says Rogers, recognize your own limitations, make sleep a priority and don’t accept an extra shift when you should be catching up on sleep.

Jan 23

Nursing Hiring Guide: Resources to Help You During Your Job Hunt | Monster.com

Nursing Hiring Guide: Resources to Help You During Your Job Hunt | Monster.com.

Searching for a job in nursing or looking to make a career change? We’ve pulled together all the articles on Monster Healthcare to help you write your resume, nail the interview, and thrive in nursing. And don’t forget to check out openings on Monster to find nursing jobs in your area.

Knock It Out of the Park: How to Win the Nursing Resume Game

If you’re ready to resume working on your nursing resume, you know it has to shine just the way you will in your new job. Go forward with these expert tips you need to get the job you need. It might even be bigger and better than you expected.

Read the entire article here.

Jan 13

Cardiac Enzymes… The Little Red Flags

Have you heard of the term “Cardiac Enzymes” and thought: enzymes – GI – heart – WTF? That’s ok. In a nutshell, when heart muscle is damaged a series of markers are released which we can pick up in a blood draw. This is vital information, because as you may know, people are weird… I’ll rephrase that, people present differently, some completely asymptomatic, hence the weirdness.

So this is a tweet I posted from a while back, look at that troponin, the normal values for my facility are right there so you can see how off the scale it is! This dude was in trouble.

So there are the TROPONINS – the most specific cardiac marker and the release times are quite prolonged, but you can use this guide to help you determine what you are dealing with:

So what about the other indicators? Well look at this graph to see the time they are released. Although Troponins are cardiac specific, this does not mean we discount the others, its all evidence of cardiac breakdown.

MB band of Creatine Kinase (CK-MB). An “enzyme” marker for myocardial infarction, the MB band of CK-MB is indicative of injury in many muscles, but its release is a highly specific indicator for MI. It is only elevated for 48-72 hours afterwards, though, making it less useful than troponin I for diagnostic purposes.

Jan 12

Agency Nursing vs Direct Hospital Nursing – The Pros and Cons

Have you interacted with agency nurses on your unit at work? Are you a new nurse who plans to do travel nursing in the future? Are you a seasoned nurse who needs a new challenge? Are you a home bird who is climbing the ladder within your own healthcare facility? – These are all scenarios where looking at agency nursing and hospital nursing can help you get where you want to go!

Agency Nursing: What is it?
This is similar to being in a “float pool”, you sign up with the agency who then finds suitable jobs for you in your local area or for travel. These are usually short to long term contracts anywhere between 12-24 weeks long. They offer great benefits, often stipends for relocating, travel, living expenses etc. Also they have health and dental coverage, as well as 401k in most instances. It all sounds too good to be true, well yes. They usually require a minimum of 2 years experience in your specialty area, although they have been known in certain circumstances to take RNs after 1 year. Whats the other downside, well as with all things being new is a challenge, the fundamentals don’t change but the environment, people and protocols do. If you are a quick learner this is for you. Other cons to agency nursing is that, as I have seen at my hospital, agency nurses aren’t always treated that well. I have seen agency nurses floated to different areas each shift, having to constantly adjust. One nurse on my unit I hadn’t seen before, I asked if she was new, she told me she was an agency nurse hired for my unit 3 months ago, but this was the first time she’d actually been assigned to my unit! I was shocked, she didn’t seem to happy with the arrangement either, as my hospital opened a sister hospital 2 years ago, and everyone gets quite disgruntled with the call a hour before work to have to float there. Though this isn’t necessarily typical, it is something to keep in mind, staffing know you are not “one of them” so don’t expect the usual employee treatment 100% of the time.

Direct Hospital Nursing: To contract or not to contract?
To some degree it is always better to skip the contract, but for new grads you really just have to take whatever comes your way (beggars can’t be choosers!). When to contract? Well as a new grad with no other options – yes, if it is for a job that includes a lot of training, such as going up a level of care – from tele to ICU for instance, this may be an option, particularly if you won’t be moving anywhere for approx. 2 years, then why the hell not? Its worth taking the contract to get the training, experience, and then you can move on after to some major $$$. When not to take a contract? When it doesn’t include everything you want. If it isn’t perfect for your needs don’t do it. You’ll only regret it, the regret will make you unhappy, and eventually that will show up with you at work… (don’t be THAT nurse!) Bottom line is you’re going to be stuck for 1-2 yrs, if you’re not 110% sure, then don’t tie yourself down.

Jan 12

No Posts? No Worries? Gimme your thoughts!

So I’ve been MIA for a hot minute, not for any particular reasons except life is all consuming. I’m still working in the same field, unit etc. I’ve now worked days and nights and know the pros and cons of both. Nursing school is far back in my rear view mirror (where I’d like to keep it). I’m currently on the job hunt, looking to advance in more acute care, but remaining in cardiac, ‘cus thats the stuff I like. I’ve considered posting more regularly since its a new year etc. While I’ve been gone the blog has continued to have traffic which I find pretty amazing. I see potential but I’m not sure what direction to take it, more educational stuff? More on-the-job reflections? Memes/funny stories? I’d like some feedback so please check out my poll, depending on response I’ll pick this beast up again (if there are multiple options you like, you can vote more than once!) Many thanks for reading and happy new year! JaeJxRN

Nov 6

Top 10 highest paying nursing specialties – Repost

Top 10 highest paying nursing specialties (via http://scrubsmag.com/)

After you finish nursing school, or if you’re considering going back for more training, choosing the right nursing specialty becomes your chief focus. With so many specialties to choose from, many prospective nurses find it difficult to just pick…

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