[foxairelynn]

I'm a nervous wreck on ICU orientation and find myself forced to take breaks at times just to regroup! I've only got a year of med-surg behind me, and that was 12 hour nights. Boy, are days different!

[Medicine Eagle]

Breaks???? What is that! LOL In the ER everything seems STAT. I can go for 12 hours with just a 5 minute smoke break once in a while. I can count the times I have had a 30 minute lunch break on one hand in 10 years of nursing. And hey don't feel bad I have had shifts where I wanted to choke a pt with the call light. LOL Everyone likes Propofol (Mother' Milk as the ER calls it). I always ask the ER doc for meds for my ER pts. Makes everybody happier. Pt quiet and wait is easier, I am happy cause no pts cussing me out, and family goes to eat so I am not standing there answering questions for an hour. Having a sense of humor is how I have survived. You can take 5-10 minutes unless somone is actively dying or soon to be! When I worked the floor years ago I would start out by pulling pain meds for each pt right off the bat. I would offer it to them right away. Saved a lot of steps. And again happy pt. happy nurse. If they did not want them now they usually did sometime in the nest hour. I also watched my pain pumps if they were getting low go ahead and get the next one ready, otherwise you will be in the middle of something serious when the pump goes dry. Try to plan ahead as much as possible. Relax... I can't even count the days I have left the ER thinking you can all just bite my butt, I hate my job. Only to get up and do it all over again. Sometimes it is a love/hate relationship. There is no where else I would work, but that does not mean that I am always a happy camper. Also I hate days. I can't stand having Administration up my butt and do my job. I am strictly a nights worker. People are usually cooler and the F bomb does not shock anyone including the Docs. Not arround the pts of course. It isn't just that it takes time, most of the time it is finding where You fit the best.
Good Luck and Take it Easy,
Tired Brave Heart

[RNnewgrad]

Originally Posted by begalli

I can only describe how it is on my unit. Fortunately, we have the staff to cover breaks keeping within the max ratio in the state of CA of 1 nurse to 2 patients. We take turns being the "float" nurse for the unit. There can be anywhere from 1-3 floats depending on the census.

Float nurses do not have an assignment except for the rooms that they cover for breaks, to help out in emergency or code situations, and to just help out the nurses they're assigned to with general things like baths, turning, etc. The float nurse is in the count and is usually a mentor type of person who has experience and can help out with problem solving with the newer or less experienced nurses (the way the floats are assigned make for a good match with the less experienced nurses).

When my breaks are covered (or when I'm a float), the RN covering is looking after ONLY my patients so I'm able to delegate things while I'm away such as doing blood sugars, gases, suctioning, etc.

I know I've said this before, but we take all of our breaks that are afforded us by law, we're practically forced to take our breaks. Rarely do we miss a break, I mean rarely! And if we do, we are paid for the 30 minute unpaid break and a report is filled out (don't remember what kind of report, that's how rarely). I think my hospital (or at least my unit) takes the law seriously (probably because of the union).

The float asks each RN (not more than 3-4 nurses beside themself) what time they'd like to go and coordinate all breaks making sure everyone gets all of their time before the end of shift. For a 12 hour shift, that's 3-15 minute paid breaks and a 30 minute unpaid lunch/dinner break; 8 hour shift is 2-15 minute breaks and a 30 minute lunch/dinner break.

When I first started out, I felt really frazzled. I felt so behind all the time. It took time for me to utilize my resources...like my float. It's hard to learn to delegate and what can be delegated and to who. It took me a good year at least to feel comfortable being kicked out of my room to take my breaks!

I've been known to tell docs that I really genuinely wish I could get everything done at once, but I just can't. Usually that disarms them and they realize where I'm coming from. With our docs, if you don't get defensive, they're cool.

It really makes me sad that nurses everywhere don't get those so important rest periods, even if for only 10 minutes. Sometimes, I think, one gets so bogged down, they really need to just step away or a mistake will happen. I find this especially when I'm orienting new grads or new nurses to the unit - I have to literally tell them to GO, I can do the gas, or GO, I can turn your patient, or GO, that can wait 15 minutes!

With this great experience, I don't think I would work anywhere that doesn't encourage an RN to get out and regroup.

Wow! Where in CA are these hospitals?? I moved here to do an ICU intern program, which I've since completed, under the impression that I would be encouraged to take breaks and have someone to relieve me. If it's a busy night, 2 out of 3 usually, I do not get a break. I may be able to eat during charting or after baths or between brown codes or during a doppler or family visit, but I can never leave the floor. Unless I make a quick trip to the kitchen to get Jevity and use my cell for 10 seconds.
I consider the reason to be that all the rest of the nurses around me, my 'buddies' as our hospital calls them, are all super busy too, and not taking breaks either. We have mentors, but they are not allowed to give breaks. Don't ask me why. That would be ideal. But, I def do not want to be a boat-rocker because I learned not to make a fuss about the way things are done while in nursing school. I want to stay on people's good sides so my work life doesn't become miserable!
Is my hospital terrible?? I'm starting to wonder!

[jjjeep4]

be encouraged.....20 plus years of active level1 and 2 icu experience here......and I still truly enjoy my job....!!!

icu has different stressors....but...here are a few pointers......
-try to keep perspective...and prioritize.....

- incorporate physical cares with assessment....so that you do not have to do both separately....try to make your assessment seamless with your interaction with patient....

-have a basic plan.....learn to quickly read the previous 24 hr of md notes and orders.....use those nursing care plans that you studied so hard....

- practice circling all abnormal labs.....do it quickly without looking at the hi/lo limits.....then double check to be sure that you got them all...it will help you rapidly identify abnormals...and will help you later..
.
-make a true report sheet....including spots for....
name/age/dx/primary md/consulting md/hx/allergies/date of admission/hx of hospitalization/shift report/review of systems(ie. resp/cardio/vent settings/nutrition/tx......especially labs to be done and pertinent tests and results.....and especially....a place for questions for the doc...you can add to these questions both in report and throughout the day.........practice taking report and putting things in the same place every time....within 2-3 weeks, you will probably revise it but also develop habit so that you get fast....and it will just go better......try not to use the premade kardex/sheet....when you write it, it helps you remember.....


-keep a couple protein bars in your bag.......drink water.....
agan......................be encouraged...there are those of us that still like it.......alot!!!
j.