Been there,done that 44,556 Views
Joined Aug 4, '09.
Posts: 5,359 (73% Liked)
It's always been my policy to lay my eyes on the patient first thing.
I don't say that you shouldn't trust the outgoing shift report. I say, TRUST AND VERIFY. And there's nothing in a bunch of labs or H&Ps that you can't get at the bedside with a good physical assessment.
This may differ based on the shift too (I work 7p-7a) but I always pop in and introduce myself before looking at anything. A quick visual gives you info like how they appear (writhing in pain? Are the drowsy? Are they diaphoretic?) Speaking to them "Hi my name is smf0903 and I'll be your nurse tonight. How are you feeling?" <--their answer gives me a few quick answers. "I'm going to look over your chart and then I'll be back. Is there anything I can bring you when I do?" <--this can save me a step or two when I do come back and let's the patient know that I WILL soon be back into their room.
I don't do a full assessment until I've skimmed the chart. Usually by then there are meds to pass and I like to know things before passing meds (labs, vitals, etc). Then I do my head-to-toe assessment.
I'm not sure there's a wrong or right way, you find what works for you
You are there to treat patient, not chart or numbers. Therefore, whatever is written there is important only in conjunction with patient's condition.
Two guys, same age, med/surg, both have Hb 7.0. at 6 AM. One is ESRD on dialysis, feels fine, A,Ox3. Another one is on watch for upper hip/groin contusion and DT, 8/10 back pain, dizzy, confused x1- 2, sweats all over, asks for water all the time. Not knowing anything else, even without vitals, even not knowing anything about "retroperitoneal bleed" and acute ETOH cardiomyopathy, a nurse should direct her attention to the guy #2 because something obviously going on wrong with him. It would be nice, of course, to know if the guy #1 has Aranesp on board and his protein was upgraded by dietary, but that can wait. Guy #2 gets tele, VSsq1, doc gets called for fluids, U/S, etc., . and sorry, no water till we know what's going on with you, buddy.
Perusing a chart of the guy#2 will get no useful info except baselines, which would be nice to know but not the first priority (and, honestly, departing shift RN should know them).
It is all named "clinical thinking" and comes with time an experience to almost everybody dealing with sick people, providing there are opportunities to access patients several times a day and analyze results.
Regardless of the agency parent company, the personnel in each office conduct their business how they see fit. The DPCS, clinical supervisors, and staffing coordinators in any given office can be as different as night and day from one day to the next, when there is a change of personnel. Sending the nurse to a meet and greet with the family without first giving the nurse a rundown on the patient's medical condition, starting with the 485, plan of care, is a warning sign of an agency that might be free and loose with day to day precautions. This is particularly telling when a nurse has already identified herself as being new to home care. One would think that there would be increased efforts at support rather than trying to get her to commit with a "hard sell".
Here's the hard truth about pediatric private duty agencies- they just want to fill the hours the kids are assigned with a body and they generally don't care to waste too much time on training. I was a clinical manager for a pediatric home health agency that had a large private duty population for 3 years. I did not work on the private duty side but my impression was that all you needed was a pulse and a nursing license to be hired into those cases. One of my colleagues who managed the PDN cases in our branch was constantly at odds with our recruiters and Clinical Director because she would turn away nurses who did not have the appropriate experience from high tech cases like pediatric vents and TPN. I also was often criticized because I wouldn't use nurses who came in and did not have pediatric or oncology experience for my chemo cases. Sorry, not sending someone who's never touched a central line access a port and push chemo on her own in a home.
The question is not so much if nursing is a "bad" or "good" job.
The real question in my opinion is:
1. Are you able to deal with the realities of today's healthcare systems and todays view on nursing ?
Wish is to provide care and make an impact on people's health or illness.
Reality is that healthcare including nursing is financially driven and impact can be very limited as you get tangled up in documentation, never-ending tasks lists that turn you into a task master - the chances of errors are higher and your critical thinking skills are not honored to the full potential.
2. Are you able to deal with working nights, weekends, holidays when perhaps most of your friends and families are not working those days?
3. Are you able to deal with uncertainty and are you comfortable with being uncomfortable?
If you answer "yes" - nursing might be still perfect for you - if you answer "no" you would have more problems adjusting to the realities of nursing. Many new graduates get disenchanted within a few weeks /months and get discouraged as they discover that the reality is very far from what they were told in the program.
I think that in the near future healthcare systems will have to make a decision how to use RNs and if the model of primary nursing in facilities is do-able given that we are looking in less linear but mostly interrelated processes / decision-making and such.
4. Are you able to get through a very competitive program that will require you to focus on academics and clinics ? Nursing school is demanding
5. Can you leave your drama for the lama? Joke to the side - there is an endless amount of drama in nursing because we are dealing with real life people who are totally frustrated by the healthcare system and their inability to navigate it. Nurses and other healthcare professionals are frustrated because money dictates what we do and common sense does not necessarily prevail. Drama within families, staff, from administration - the list is neverending. Personally, I have tolerance for a good amount of "reasonable drama" - meaning the frustration gets expressed in a very emotional way - but it can such life out of you if you encounter high drama nurses or high drama floors every single day.
Good luck with your decisions.
Depending on what you feel drawn to you might also want to look into other healthcare professions.
Administration at Wrongway Regional Medical Center believe Happy Employees = Happy Patients. Therefore, in order to make morale high, Administration is utilizing visual reminders:
I think you are taking this way too hard and getting upset too easily. From what I read, you were verbally offered a job. Then a week and a half later you passed NCLEX and called back. No answer, so on day two you call again and no answer. Now today (when is today? Is it day three or did you wait a week or what.) which sounds like Day 3, you call again and are upset already.
Welcome to medical hiring. It is not unprofessional. You are not the only new grad. They could have interviewed people after you who wowed them more. They could be looking to hire multiple people and are getting that all in order before contacting you. We didn't hear what was said in your "offer". You could have misunderstood an actual offer of employment with a regular "we like you and would love to hear from you when you have a license" type thing. Which would not be an offer and more of just a call back and they will think about it. The person that you spoke with could be in vacation or in meetings or doing any number of other things and will contact you back when they get a moment.
Leaving a message every day may ruin this opportunity for you. The professional thing to do is at least wait a few days between contact so you don't seem so pushy and give whoever it is a chance to review your interview and such.
Lastly, the DON offering a job isn't as important as HR offering one. The DON may feel like they need another nurse in staff and want to hire you. HR knows the budget and if they can offerd to hire you. You wouldn't be the first and, and won't be the last, who gets shafted because HR CAN'T hire due to budget and the DON overstepped in offering without verifying first.
Slow your rolls. Give them some time. They may just contact you back. I can't even count how many times in multiple fields I have been told a day I will get called back by, and it's days later that they actually call. While you wait, polish up your resume and cover letter and get to applying more places as a back up.
It really is not complicated, she's a selfish jerk. NO is the only right answer,
: What are the specific issues that have stained you two? For example, child care, time together (or lack thereof), finances, communication, life values and goals, etc. Are those problems fixable, and if so, how? Do you WANT to fix them together?
Yeah, renewing is cheaper than taking it over again in a few years should you change jobs. Plus renewal classes are 1 day instead of 2!
Hundreds of codes in the 20 years I have been in EMS or nursing, know of 2 that have walked out.
Was it a waste for those 2?
Just be detached and chart all crazy behaviors and statements thoroughly. Continue to be professional and informative. Blame all HIPAA constraints on the Federal government.
I really don't know your whole story but bits sound familiar. As far as the poem being bashed, i don't in anyway think she is saying what she went through is the same as what the holocaust victims went through. Change the poem a little,
They bullied the heavyset nurse but I didn't speak up because I wasn't heavyset.
They bullied the new nurses but I didn't speak up because I wasn't a new nurse.
They bullied the older nurses but I didn't speak up because I wasn't an older nurse.
They bullied the Christian nurse but I didn't speak up because I wasn't a Christian nurse.
They bullied the slower nurse but I didn't speak up because I wasn't the slower nurse.
Then they bullied me and there was no one left to speak up.
Bullying is out there. There is intimidation, exclusion, belittling, unfairness, etc.
"NEVER say you're sorry! It's a sign of weakness". - NCIS GIBBS rule.
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