[numalenurse]

Originally Posted by Blanco600

I found that if you have a keofeed NG tube to give meds down, if the crushed med clumps, you will most likely get it stuck in the tube, to avoid this headache, try mixing your med in thicket(if you are lucky enough to have some and it is not contraindicated for your patient), this will keep the med from clumping and keep it separated out enough to send it down that small tube!

I've been told that applesauce mixed in H20 works also.

[numalenurse]

Originally Posted by ram8836

This is a wonderful site. Iam a new grad started orientation about two weeks ago. I love my co workers and I love nursing, but i get so frustrated because iam not looking at the big picture, iam so focused on tasks that i feel that iam not focusing on the pt at times. So when it comes to giving a report i feel like iam stupid please help. Any Advice?

Wow! This is the very reason I decided to stop being a 'guest lurker' and join this group. The very reason! Also, I just finished my 2 1/2 wk orientation in a LTC and have discovered it still takes me nearly 3 hours to pass meds to only 23 pts. Of course this also includes B/S, and G/T feedings, but everyone else seems to pass there meds to twice the nurmber of pts in literally half the time. This week I will have an entire section to myself..30+pts and frankly I'm scared! How does one gain speed passing meds WITHOUT med errors?

Pls answer this post as I only have 3 days before Dooms Day!

Thanks

[janfrn]

Hmmm, you're working in long-term care. It's taking you longer to pass meds than it does the other staff... who have been there for some time already. Could it simply be that they already know all the residents, know what they take and when and it's just familiarity that allows them to be speedier? I work in a PICU where things change very rapidly and I seldom have the same assignment two shifts in a row. But when I do, I find the second shift goes much more smoothly than the first, simply because I know the basic issues and the basic routine, no matter what has changed in the interim.

Also don't forget that a lot of what you're doing now is "new" to you, especially skills. An OT told me it takes 1000 repetitions of an action for it to be second nature. Practice really does make perfect. So when you're doing a blood sugar check, you're still to a certain extent breaking it down into steps... "Okay, assemble the equipment. Load the lancing device. Turn on the machine. Take out a strip. Key in the information. Swab the finger. Pole the finger. Collect the blood. Put the strip in the machine. Apply pressure to the finger. Read the display. Write down the number. Figure out the insulin dose. Etc..." Think about how different it will be after you've done a thousand.

My advice? Don't put so much pressure on yourself. Watch how others organize themselves, how the organize their meds, how they keep track of what they've done and still have left to do. Then find an organizational method that works for you. If you rush, you'll make mistakes.

[huami4264]

Originally Posted by francine79

I have only been a nurse for a little over a month. And I know one of the biggest fears is having to call the Doctor. So far I have had great success in not having a doctor yell at me (even the one's the other nurses have said aren't very nice) or treat me like I'm stupid. I don't know if it is luck but here are a few tips that have helped me out.

- Always make a list of the things you need to mention.
- If calling labs or test results I always look up what the previous one's were in case they ask.
- If I'm told I have a return call from a doctor I always grab the chart and take it with me in case I need to look something up (& so I can write the order)
-I try to anticipate what they will order so I can provide them with the right info needed for them to decide what orders they need to make
- When working nights I always go through all my patient's charts to make sure they have some type of pain medicine ordered or assess if pain is an issue with the patient so that If I need to get an order I can do it at a decent time of night. I have had several patients admitted with chest pain yet not a single pain med was ordered.

I also work on a floor with tons of different doctors, all of which none of their signature's look like their names. I have started to make a little book with a photocopy of each of the physician's signature and their name for easy reference.

Hope these tips help!

great tips... i'm gonna print them...

[Robinsmanatee]

Hi, I'm a new LPN and I wanted to thank you all for your advice about your first year of nursing it all makes sence and I will remember the words of wisdom you all have provided as I start my first year as a new nurse!

[didiboRN]

Amen. These are many of the notes I've made to myself in my first year as a nurse... an excellent summary.

[ELKMNin06]

Originally Posted by MrsGPR

Excellent advice! I LOVE how you used examples to illustrate your point!!!

I do have a quick question: what exactly does the RN assessment consist of - in real life? Is it system specific? Or is there a full "review of systems" assessment for each and every patient on your assignment? I am ashamed to admit how long it takes me to do a full ROS assessment on ONE pt - let alone 7 - 10!!! (Neuro to Integ!!)
Just curious as to how it works once you are on the floor and faced with a heavy pt load...
Thanks guys!!

The more you do it, the more routine it becomes. In five seconds of seeing/interacting with the pt. you know so many things (w/o even touching them)...The very first thing I want to know is- is my pt. alert and oriented...this is as simple as looking at them..oh, Mrs. Jones is sitting up eating dinner talking with her family...alert...ask her a few questions while introducing yourself...now you know how oriented she is...you can observe her breathing pattern, color, any abnormal sounds...All this takes place in a very short time...You walk into the room and think..what is off? How does my pt. look? Are the moving, breathing..etc..Then you start there...

Just walk in and survey the situation...does anything critical stick out to you?? Pt O2 sats 88, struggling to breathe...?? That prob needs immediate attn....If all the serious stuff is ok..then just go head to toe...

If you walk in and the pt is A&Ox4..breathing ok....vitals in check...start with neuro..A&Ox4..PERRL..tongue midline..oh and i see that his mucus memb. are pink and moist... and then lungs then heart (usually at the same time..), pulses...I usually do quite a few of these together..ill do pulses while im doing a neuro exam with the LE...And since im down by the feet anyway...I make sure they are warm..are they getting blood...can i feel the pulses...cap refill...all that takes all of 5 seconds..since i do most of automatically and simultaneously with my neuro exam...ABD distended and firm....mental note..check last BM..maybe he needs a laxative...Prob no ileus as pt has BSx4. He has a foley cath, with clear, yellow urine..adq...output...pt denies pain...

Thats my assessment in a nutshell plus a few other things depending on the pt The actual assessment takes about 5 minutes its quick...head to toe...not to say im out in 5 minutes, pt. interaction takes quite a bit more time than 5 minutes!

[massin1218]

Hello and Congrats! to all new nurses out there. I am still an aspiring nurse student and I am getting mixed feedback on what's awaiting new nurses when they go out into the workplace. Is there really a nurse shortage or do newly grads face the posibility of having to compete for a position?? Does it depend on the state?? What is the real situation in NY, if there are any NY or NJ nurses out there??? Please share your comments with us, Nurses-to be students. Thanks a lot.

[verynewnurse]

hi alongbella, i have the same problem and feel the same way. i think the most important thing is to stay put, not to give up. we should speed up as we get more experience and get used to routine(means be more organized). good luck.

[Lizstill]

Originally Posted by challenged annie

hey who ever says dont talk about well in college we were told to do it differently. Im a qualified nurse and its important to bring about up to date evidence based practice. People who talk about not saying what you have previously learned are most obviously old school and holding the nursing profession back. unless you read journals every day its usefull to have new faces to explain new ideas. If there not practicle then we will just say and give explanation. too many qualified nurses make short cuts which is where mistakes lye

Thank you! I have had to mention how I was taught differently a couple of times and did get slapped once. I was just puzzled and trying to clarify. I was so shocked an experienced nurse would be so offended by my innocent question. I guess insecurity doesn't always go away with experience.