Electrolytes in a nut shell

It’s Getting More Difficult!


I received the results from my first submission in the mail. The result also included a message advising me to slow down. I am not permitted to finish the course work in less than 12 weeks without permission from the university. The university instructors want students to have time to absorb the course material that the students are learning. Racing through the material in a mad dash to the finish line is not acceptable. I call my instructor and I agree to slow down. It is just as well. Module 9 is next and the topic is Fluid, Electrolyte, and Acid-Base Imbalance.

Module 9: The fluid intake and output section was a breeze but fluid transportation, Osmosis and oncotic pressure is a more difficult topic. We learn the different types of intravenous fluids and why that solution type is given. The role of kidney, heart and blood vessels, lungs, skin, and glands play in fluid volume and imbalance is discussed. How can they possibly condense this subject to one module? The module even goes into a discussion of the electrolytes and normal lab values as well as the reasons for the abnormal values. Oh we are not done! The pH, acid-base levels and how to determine if an imbalance in acid-base is due to a respiratory event or a metabolism event, are all discussed. Because the topic is so intense the module is divided into 2 sections. Section II discusses Blood and Blood Administration. This blood administration topic is a welcome reprieve from the acid-base topic. My head is full. I have to review this module more than once.

Rn Refresher Course Review Volume II

Volume II


The module tests are mailed to the university. There is a two week wait period before you hear back. However, I am impatient and I am doing more modules so I can mail the next batch of tests as soon as I get the feedback on the test results. Because I am out of work I am stressed. Working on the modules and doing the tests takes my mind off the fact that people are not beating my door down with job offers. I feel like my future is out of my control. But I can lose myself in this busy work and not worry about my lack of employment. I feel like I am doing something to help myself to secure future job opportunities by increasing my marketable skills.

The modules are getting more challenging. I am using the internet to look things up. I am also referencing the University library. Many of the reference links in the documents no longer work. I have to hunt to find the reference material mentioned in the modules. The broken or outdated links are because the on line version of the course will be released soon and the hard copies have not been updated. Invalid links are a little painful but I would prefer to have the hardcopy of the manuals. I am still happy that I did not wait for the on line version. My laptop is out of commission so I would have to work at the desktop computer for long periods if I did not have the hard copy.

Module 6 is actually the last module in Volume I. I did not discuss this module earlier because I did not include the module in my first submission. Module 6 introduces nurse and patient safety. The number of deaths from medical errors is staggering. I want to learn safety measures that I can implement to protect my patients and myself. I do not want to be a statistic. In an effort to reduce medication errors, abbreviations are discouraged. A person’s writing is often difficult to read. For example the handwritten U (unit) could be misread as a zero (0) or the number four (4). MSO4 could be interpreted as Morphine or Magnesium Sulfate. Entering orders on line and avoiding abbreviations help reduce reading and interpreting orders incorrectly. Most medical schools and the associated hospitals in the United States are in the process of developing Hospital Information Systems (HIS). I hope that the hospital where I will work will have a HIS system where medical doctors can enter their orders. I do have a terrible time trying to read hand written orders and I frequently have to call the doctor to get orders clarified.

Volume II starts with module 7, Pharmacotherapy. This module also has a nice section on Blood type. The blood typing is explained well. The pharmacotherapy section divides drugs into classes or categories. Categories include things like Anti-Influenza (very timely since we are into the flu season), Antiviral (non-HIV) such as Anti-Herpes and HIV Antiviral (sexually transmitted disease information is very important today). Precautions, side effects and administration of each class of medication are introduced. Obviously additional just in time reference information will need to be consulted when preparing for medication administration.

Module 8 is Medication Administration. I know! You are thinking, there are a lot of modules on medication. I agree but administering medications is a big responsibility. The patient’s Six Rights are reviewed. I thought there were Five Rights but it seems another Right has been added, Right Documentation. The Six Rights are: 1) right client, 2) right medication, 3) right dose, 4) right route, 5) right time and 6) right documentation (documentation is to be done immediately are administering the dose). The Medication Administration Record (MAR) is an online system for medication administration. I am looking forward to checking this out. I not familiar with the system but I am looking forward to experiencing it.

Module 8 is the end of the medication modules. Module 9 changes the topic to Fluid and Electrolytes. I will pick up with module 9 in my next post.

The Nurse Refresher Modules VOL I

The twenty three nursing modules are in 4 volumes. The course will address a Medical-Surgical Nursing review.

I cannot wait to get started. So I dig in. I am unemployed so I devote myself full time to my studies. I want to finish the course work as soon as possible. The time line for finishing the course work is 12 weeks to 9 months. Of course I want to finish in 12 weeks and do my Clinical Requirement as soon as I finish. The director warns the refresher students that we may have to wait for the clinical part because there are a limited number of preceptors.

Volume I contains six modules. These first modules are both easy and interesting. Contemporary nursing discusses the nursing role today, the nursing changes, the nursing shortage, and the changing client demography. North Carolina now has a higher Spanish speaking population than it did 15 years ago.

 The legal and ethical aspect of nursing is another module. We can no longer easily access records of clients for whom we are not responsible. The new HIPPA and privacy acts now protect patient’s rights. Nurses need to be very careful to protect patient’s privacy in both what we say and in any notes that we jot down during nursing report.

Nursing Diagnosis and the nursing plan of care are discussed in two modules. The nursing plan is now much better structured than it was when I left nursing over 15 years ago. The hardcopy Kardex has been replaced with formal plans of nursing care complete with source references. I am looking forward to seeing the nursing care plan in action during my clinical experience.

Module V discusses the aging population in the United States and the nursing shortage as nurses retire in large numbers. I am hoping that retiring nurses will leave job opportunities for me.

Module VI discusses patient and nurse safety. I will talk more about safety when I discuss my findings during my clinical experience.

MY first Submission consisted of the first five modules. I have an op-scan sheet for each module. I complete each sheet with my student ID, name and answers. We are given a student ID when we sign up for the course. The university does not use our social security number as an ID anymore. Yeah! The maximum number of modules I can submit at one time is five. I must wait two weeks before my next submission. The instructor has two weeks in which to provide feedback.

While I wait, I start looking at the next modules. I can always read ahead and take the exams at the end of each module as long as I do not submit the module questions ahead of time.

Finding my way to RN Refresher

Now that I decided to go back into nursing, how do I do that? When I worked in nursing almost 20 years ago I was reluctant to let anyone know that I was a nurse. The phone would ring nonstop with people trying to recruit me. Now, I used the computer daily to complete several on line applications but I did not get a response. I applied to travel nurses and called Nurse Contractors. People looked at my CV and saw that I had not done bedside nursing in some time and did not call.
 

One recruiter told me that I needed a PPD test, recent CPR certification, and a competency test that their company offered. I took the Provider CPR course offered through the Red Cross ($70). I got a PPD test from an urgent care location ($35). I went to the recruiter’s office, took the competency test and passed. I sat back and waited for the phone to ring. Nothing! I called the recruiter and he said jobs were few in this economy but they were trying to find me something.
 

I decided to take an Advanced Cardiac Life Support (ACLS) class. The course cost $170. The cost was painful since I was out of work. However, I could deduct the cost on my taxes. I took the course and it boosted my confidence. I could still read the cardiac strips and make good judgments on treatments. I had not forgotten everything I knew. Well OK, I had to study the material again and some things had changed but I could still do the work.
 

Surely the ACLS certification would give me the edge I needed to get a nursing job. After all, my RN was current. I may not have been doing bedside nursing but I never left the medical field. Working in clinical research, I stayed current on all the latest medications and treatments.

The only offers I got were out of state and I did not want to move. I just did not know what to do. I called one of the hospitals and asked to speak to someone in HR. They advised to take the RN Refresher course but also warned that did not ensure a job.
 

I was lucky; there are several Universities and schools in my area. I found several offerings on line but I did not know which to take as all the schools meant a great deal of time on the road. Finally, I called the Board of Nursing. They were very helpful and advised me to take a course that was developed for returning nurses. They gave me phone numbers and contact information.
 

I called Wake AHEC, an affiliate of WakeMed and the University of North Carolina Area Health Education Centers. I paid $100 for orientation. There were other people just like me trying to find their way back into nursing. Wake AHEC offered a correspondence course through the University of North Carolina. Preparation was under way to make the course an on-line course. However, I wanted to do the course while I could still get a hard copy of the course material. We would have 9 months to complete the course. We could get an extension if we requested in writing. There were 23 modules in the course with a test at the end of each module. A passing grade of 85% was required on each module. I left orientation and drove that very day to the university. On 29OCT2009, I signed up for the Wake AHEC RN Refresher course for the bargain price of $480.
 

At last after three months without work, I found the road or the direction that I needed to return to a career in nursing, I hope. I could hardly wait to start the course.
 

The Beginning

The warning signs for Clinical Research Associates (CRA) started in the fall of 2008. There was no work. There were no new projects. If new projects were starting, the projects were across the country and CRA services on the East Coast of the United States were not needed. Many of the new projects were going to India, Brazil, and Mexico. We whispered among ourselves.  How can the company stay afloat with no new contracts? How long could we fly under the radar? Corporate or someone had to be reviewing our monthly billable time tracking reports. Surely the company would keep the experienced CRAs. After all, a sponsor company would not want to award contract work to a CRO who could not provide a percentage of quality monitors. Surely the company would keep some of the new CRAs as the new CRA would be cheaper to employ. Many of the new CRA included former nurses, and Clinical Site Coordinators. The medical knowledge must be valued by the company.
 

By early 2009, I was canvassing everyone in my department and other departments for work. I was willing to do any task.  I am sole bread winner and could not afford to be unemployed. I worked on many different projects and made sure I always had billable work on my time tracking report. By the spring of 2009, our pay was reduced by reducing the number of hours we were allowed to work. I do not know many who worked a 40 hour week. Most people I knew were salary and worked 60 hours a week or more. Projects were ending. This meant many of us were busy with Closeout Visits, Project Review and Trail Master File Review. I managed to volunteer myself for many of the projects.  Still there were no new work contracts coming to my part of the world. The first of the layoffs started. People were given two weeks’ notice and were gone. Those left behind picked up the slack by doing their own work plus the work of the people who left. As the projects winded down, more people were let go.
 

I had been applying for new jobs since January with no luck.  Although I had over 10 years experience in the research industry, I just did not have enough experience in the CRA role. There were another three rounds of layoffs. Because I was an RN, I was selected for training in the regulatory department and thought I would be safe for another couple of months. The company was expecting a large project. The project fell through. The work could be managed in Mexico more cheaply. Three more weeks with no work and I was swept up in the fourth layoff. I filed for unemployment on 01 AUG 2009.
 

I was laid off with about 15 other nurses. Some had many years of CRA experience. I kept in contact with many of the people. We supported each other with phone calls and email. Unfortunately other CROs were experiencing the same financial markets. The other CROs and many Pharmaceutical companies were also downsizing. Unemployment was now at 12% in my state. By September I started exploring a nursing career. Nursing was my first love and I was good at it. It would be like going home.