nyteshade 10,360 Views
Joined Aug 25, '08.
Posts: 548 (40% Liked)
Your facility does not want to train you.They want to get you working ASAP. 1:8 is unsafe for an experienced nurse.
Demand your full orientation with weekly reports on your progress. You should have 12 weeks.
Best wishes, it's a jungle out here.
And OP, nursing does not lead to sonography, unless Canada is very, Very, VERY different from the US.
It's not as though nursing entails some sort of 24/7 life-saving burden that is our cross to bear, even off duty.
It is a job and it is most certainly not a calling. Do I lose points for that?
Good lord. You aren't doing yourself any favors posting this thread, OP.
I am a new grad. Young. I came into nursing for practical reasons...helping people is just a bonus. Yes, nursing is "just a job." Work is called work for a reason.
I deal with a very rough patient population. The vast majority are extremely rude, entitled and noncompliant clients who treat the nursing staff like crap. Just the other day, I broke down in tears because out of the five patients I was caring for, four of them were complete nasty, malicious jerks. Even my preceptors agreed that this assignment was unusually ridiculous.
But then I asked myself, why am I here? Surely not to be some butthead's punching bag. As my grandmother always says, "you don't have to take them home with you." You know what is a great motivator? Having financial stability. Great health insurance. A pension. Other fantastic benefits. The ability to help my single mother with her bills and mortgage and to help my special needs brother. To be able to live comfortably and live without deprivation.
Seeing nursing for what it is has helped me survive a brutal unit...not the intangible. If I wanted to help someone, there are many avenues besides nursing. Why aren't doctors shaming each other into being martyrs? Why is this calling only tied to nurses?
A nurse must be competent and safe. While it is nice to care, altruism in this profession is a guaranteed one-way ticket to burn out town. If I only came to be a martyr, I would have quit my job last week.
Nurses are professionals, not saints. The sooner you learn now, the better.
It's probably been said more than once, but I wanted to get my thoughts out while I still know what I want to say on this topic.
Sure, I've read the chart if you give me more than 5 seconds between the admit being paged, and you calling to see if I've looked at the chart.
I've also read what precious little has been charted there. Half the time, the ER has put in a Foley and not charted it. I've seen more IV's started and not charted. So...is that a field start I need to take out and re-start? Or did you start that in the ER? Also, I can't get a good picture of what's going on with this patient if the physician/practitioner hasn't actually written a note. 3/4 of the time at my facility, that hasn't happened yet. And yes, I see that you put in 7 nursing notes about this chart. "Pt transported to CT." "Pt returned from CT." "Up to commode." Those are not as helpful as you might think. I need an idea of WHY this pt is here. It's also helpful to know WHY meds were given. You gave 80 of Lasix? Great! Why? If there aren't any notes for me to read, I can only make an educated guess.
So yeah, when the charting is not great, I'm probably going to ask you a few questions. Please don't bite my head off. I really want to do the best I can for this patient, but if I don't know anything about them ahead of time, it's hard for me to know what to have at the bedside, and what other things I might expect over the course of a shift. See, that's the difference between ER nursing and inpatient nursing. We're pretty much stuck with our patients for the whole shift. You get them for a little while and either send them home, or send them to me.
I realize the tone of this might not come across very well, and that's not the way I intend it. ER nurses work very hard at what they do, and they're very busy. I get that. I'm busy too. But what really cheeses me off is when I'm expected to read minds. Or non-existent charting.
Even when floor nurses have access to the EMR used in the ED, charting on a patient they are receiving often isn't available to them while the patient is still in the ED, and when it is available I don't think many ED nurses realize how useless their charting becomes after the ED EMR has it's way with it. Just in general though, I don't see giving report as being a nuisance, it's a core part of my job and my responsibility to the patient. If I'm going to spend my time and energy working on a patient I'm certainly going to make sure the next nurse has a good understanding of what's been done, otherwise it makes most of what I do pointless.
Patient history, labs, etc usually are available to the receiving nurse, so when they ask "what were all their labs" I explain to them where that can be found in their charting system. Anything notable I'll point out in report (their K was 7 on arrival, now 5.3), but no, I'm not going to look up and tell you what exactly their H&H was, "normal range" is all that matters in report.
One of my biggest pet peaves is "where is there peripheral IV in their arm"? I have serious concerns about a nurse's basic thinking process when they consider that to be a relevant question on report. It's the brightly colored thing taped to their arm.
Hey floor nurses-
ER nurse with a serious question. The question only applies to nurse who have access to the ER's computerized chart.
Why don't you just read the chart?.
It has all the details you ask me about. In fact, I haven't memorized all those details, I just peruse the chart as you ask me.
I don't mean read the whole chart, I mean scan it for the details you want. I have no idea why you need to know ahead of time what size IV and where it is, but it's charted.
As far as a history? H & P, last visit, etc, is all at your finger tips. As far as what time each med was given- when you ask I open the MAR, and read you the times. I even say "I don't know, but it's been charted, I will open the MAR an look". When I say that, I am hoping you will get the hint that it would be faster for you to have already done that. Somehow, you always miss the irony.
Please don't say that you don't have time. That doesn't make sense. Think about the difference between reading something, and having it read to you. I can scan a chart for 2 minutes, and know just about everything. Add to this the fact that I really don't know all the details you want- I just kind of guess. As an ER nurse I may have received that same PT with a 1 minute report. It's all I need.
There is no question that it is faster and more accurate to scan the chart.
So- why don't you?
The I think the worse was one time I was getting a hip fracture patient and the ER nurse could not tell me which hip it was, and if it was broken. I was told "Um, they have a hurt hip." Seriously? I get we're all busy, but that blew my mind when I received that report!
I do like to know access, if there's anything running (fluids, antibiotics, etc), mentation, latest vitals, prn's given that might be continued on floor (usually last dose of pain meds, or if something for blood pressure, etc). I try to skim the chart if I have time, but it can be hit or miss, and most of the time the physicians have not entered their notes, so I'm just seeing a lot of "gave patient warm blanket."
I have two serious, not intended to be snarky, questions too.
Why does the ER try to call report ahead of shift change as in:
"he won't be coming on your time but can I give report now?"
The receiving nurse on the next shift is the one who needs the report, not me, in order to provide basic nursing care.
Is the oncoming ER nurse expected to assume responsibility for a human being in her care and know nothing about the patient?
I admitted a GI hemorrhage pt with an INR of 8 and the ER nurse responsible for this person had no idea how many units of blood products were given and actually said "I don't know anything about this patient." The off going ER nurse called "report" to the unit on the previous shift and apparently forgot to address the orders for blood products.
I read the chart, which was a waste of time, because nothing was documented about transfusions, there was a triage note, two sets of VS three hours apart by the tech and not one other factual piece of information to go on.
For me, this is honestly not a difficult issue because I don't spend time on nonsense. Something like the example of missing the show for a diagnostic test...oh heck no. I keep my voice calm, but that would have gotten a firm, "I understand enjoying a show, but in the hospital your illness/injury is the priority. It is impossible to take a TV show into account when sceduling tests." And then discuss it NO further.
Complaints addressed to me about the food or the TV, will be responded to with the phone number to the kitchen or buildings & grounds. The food is not my job. It's just not.
Shouting or aggression from visitors get addressed with security. My charge nurses and managers support our need for a safe working environment.
I can honestly say that I don't give the survey a single thought when care planning. I am a good nurse, make the best clinical decisions I can, am kind and empathetic with people, and I make them as comfortable as possible.
I can't fix stupid. Yelling about missing a game show is stupid.
It’s 0700 and the night shift is scrambling to give report as us day-shifters struggle in with our coffee breath and slightly askew hair. Part of the way through patient history of the terrible triad (coronary artery disease, diabetes, COPD…) I hear through the grapevine that not one, but BOTH of our CNAs have called out. My ears perk up like a hunting dog and I scramble. I interrupt my own report in order to find the best-working COW (computer on wheels) and a fully functioning dynamap. Of which I sadly realized was no where to be found. It makes for a terrible time post cardiac cath if all the MP-5s are claimed and there are no dynamaps equipped with all of the appropriate fixings (temperature, blood pressure, oxygen monitor). Needless to say, I felt as though I was drowning before the day had truly started. As report finished and we had rounded in each room, I could see the gleaming flat screen TV, the arm-chair full of overstuffed pillows, toiletries strewn about the room, and our 6-page menu stuck to the floor in some sort of goo. The manual blood pressure cuff on the wall was either falling off, missing parts, or not there at all and the thermometers on the walls wouldn’t turn on. We were operating at a 5 to 1 flex ratio with patients post cardiac procedures, on a multitude of drips, BiPAPs buzzing, and rapid responses flooding in.
I am no expert in funds when it comes to profit and not for profit hospitals. My father always corrects me on the rant of “where did this money come from?!” “Where did THAT money come from?!” (He would tell me that it’s from a different allocated fund). To be completely honest, I am sure that it does. What I would like to know is when did flat screen TVs with more than just local cable and overstuffed arm chairs become more important than an extra doppler on the unit? Or maybe an extra staff member?
There has been a shift in healthcare in the last couple of decades (even the last hundreds of years). I sit and talk with my grandmother often who was a nurse when they sterilized the baby bottles in the NICU and had steel bed pans for the adults. Then, thermometers were made of glass (eek! mercury) and there were visiting hours. She explains the vast differences between the times on many accounts, and seems perplexed with “the way things are going”.
In truth, there are many things that we are doing right. What I think is a good reminder to patients and their families is that we are at work to help heal and to help give comfort. Sometimes this means that you are going to miss your 2100 showing of “Blue Bloods” (though I do love a good moustache)! It’s not that we don’t want people to feel safe, comforted with mutual trust but we ALL do want to do a great job. Personally, I want to have the opportunity to catch your sepsis before your blood pressure tanks and your organs start to shut down. Is that so much to ask?
I know that nurses have difficulty allocating their time with the increased pressure from patient flow coordinators to “treat and get them out” or to address multiple social concerns and battles between family members. It’s not for lack of trying. As a floor nurse I get more calls about a TV not working, anger at not being able to have a diet with salt, frustration that someone forgot their iphone cord and their phone is dead, or that the internet is terribly patchy and they can’t watch Netflix. Like I said before, how do we fix the idea that hospitals are not hotels but rather places of healing that warrant a focused approach on labs, tests, assessment, addressing a plan of care, holistic approaches to care and outpatient follow up? Where is the line drawn?
In the past year I’ve had patients elope for cigarettes who’ve had NSTEMIs, invited friends to visit at the bedside to give heroin or cocaine IV through a PICC line (by barring the door, mind you), and get in a full-on yelling match with nurses because we sent a patient for an ultrasound and they missed “The Price is Right”.
It is a difficult line for each one of us to walk. Communication is always key, but sometimes words can fail. I’ve explained on multiple accounts why we do the things we do, and how our number ONE priority is patient care and prevention. At times that trumps an extra lounger in your room, or me refusing you to have take-out when you are going for an EGD in the morning.
Always in the back of my mind I want to know when (if it hasn’t already happened) will our interventions of prioritizing register in our patient satisfaction scores? Is there a differentiation between patients being dissatisfied with their stay due to things in the hospital’s control, or rather that they didn’t get to maintain their normal routines that warranted a hospital stay that likened a Hilton experience?
I don’t write any of these things to accuse patients in any way, or to declare that our duties as nurses do not include ADLs and kindness in our daily care. But the chatter continues between nursing professionals of the staffing shortages, equipment issues, and the stress of meeting expectations that seem to be near impossible to fulfill.
Where do we go from here? Where is the line? What is our place? Should the nurses get surveys concerning how their hospital allocates funds and writes up scopes of practice? Should there be a public service announcement video for each patient and their family upon arrival notifying them of the hospital’s roles in patient care and what their satisfaction surveys really mean for healthcare?
I know that this article is loaded with multiple issues, it is difficult to stay on task when one thing reflects another. But with all that said, the issues facing us today ARE focused on money, are reflected by patient satisfaction surveys and are loaded with resources dwindling and the expectations rising. So, my friends, what do we do next?
I'd rather have my pleasant thoughts than to go in there thinking like that. I'm allowed to be excited and I'm allowed to go in with that mentality. It's not very fair for those "experienced nurses" to kick you down. I think it's good to go in with a positive attitude. That's just me though. Sorry you guys don't think it's realistic to think like me, but its going to keep my head up on my tough days. Thanks for the advice though!
I would hate to have you as my nurse. I feel for your patients.
Well, it's happened.
Despite my best efforts to provide excellent care, I've been involved in a serious error.
I say "involved" rather than "made" not to avoid my role but to recognize that it was a chain of events that led to the error.
I'm sure many people are familiar with the concept of the Swiss cheese model of medical errors... in order for the error to happen, all the holes have to align to provide a path from the patient to the error... and in this case... unfortunately... they did... and the very last hole ran right through... me.
So, now I'm one of 'those' nurses... the ones who are so easy to criticize... to shun... to ridicule... though thankfully, I've thus far been treated with compassion and empathy by those around me.
A whole host of thoughts and emotions accompany the experience... fear, shame, humiliation, self-doubt, frustration, anger... and a few that I cannot even name (I'm just not a wordsmith)
I've no idea of the repercussions though I'm hopeful that all the talk about creating a non-punitive environment in which errors can be explored and preventive measures developed is sincere and that I can play a role in educating our docs and nurses in how to avoid another event like this.
I'm thankful for my colleagues who've listened and encouraged... and who've recognized that I'm not some lame-butt doofus who's carelessly nor mindlessly working on patients... and who've recognized that they could very easily be standing in my shoes.
Still... I feel shame and humiliation... and whatever other nameless emotions accompany having to accept that, despite my best intentions, I have hurt another person who was counting on me to help them... To Hippocrates or whomever, I have to say, "I have done harm." To that patient I would have to say, "You did not receive from me the care that you have a right to expect" and, from the patient's perspective, the reasons don't really matter...
Now, for some perspective... it really could have happened to anyone... it was one of those "seconds-count" emergencies... with sequential system failures, any one of which would have prevented the error-train from ever having arrived at my station... though it did... and my chosen role is to be the person at the end of the line so it's not something I can shirk.
The truth is, though, that despite my strong desire to tuck tail and run... and perhaps the desire among some to demonize me or toss me under the bus...
I am a BETTER nurse today than I was last week - precisely because this has happened... not only regarding the specifics of this event but in ways that will impact every moment of nursing career henceforth.
I am moment-by-moment learning how to live with this new recognition of myself... how to bear the scarlet letter that I've now affixed to my scrub tops.
What does the face of a serious error look like? For me, I simply have to look in the mirror.
Be very careful out there because you never know what you don't know... until you do...
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