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sandyfeet, ADN, MSN, RN 7,919 Views

Joined: Jul 26, '10; Posts: 423 (41% Liked) ; Likes: 413
RN; from US
Specialty: 5 year(s) of experience in Emergency Nursing

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  • Feb 7 '17

    Quote from Daisy4RN
    My response to the OP questions was not political. I find it a little amusing that you infer what you think I mean and assume that I am turning this into a "war" and am responsible for taking the thread "in a direction that the OP doesn't intend".
    I would suggest that anyone regardless of postion/viewpoint (ie pro-life or pro-choice) think about it, do their homework, know the facts (ie critical thinking vs just repeating whatever you hear) prior to attending any protest/rally so that one appears informed (vs foolish) and professional.
    I guess I just don't understand why this bothers you, but I guess we can just agree to disagree.
    I agree with Extra that your original comment, whether it was your intent or not, sounded condescending and patronizing, suggesting that many people protesting against Trump are "uninformed" and don't "know the facts," that protestors likely haven't "done their homework," and that people are just "repeating whatever you hear." It sounds like you must have a different point of view, which is fine -- but not agreeing with you is not the same as being "uninformed."

  • Feb 7 '17

    "You gotta pay your dues if you wanna sing the blues and, you know, it don't come easy."

    Some of the best LPNs who later became RNs, and I humbly include myself in this list, started out in the trenches of LTC facilities and utilized those experiences to better themselves later in their careers.

  • Feb 1 '17

    Quote from brillohead
    I think that for safety's sake, there needs to be a moratorium on admissions for an hour before and two hours after each shift change.

    Sending a patient up at 0700 or 1900 is simply not safe -- either the patient is a trainwreck and the nurse will be busy dealing with the admission paperwork, the admission assessment, and the constantly-popping-up new orders/meds while the patient's other five patients get ignored, or the other five patients get their assessments and meds at shift change, but the new admit gets ignored.

    NOBODY is safe or satisfied in EITHER scenario.

    While the ED might want to turn over the bed and get another patient in there, and the patient may want to get off the ED stretcher and into the not-very-comfy-but-still-better-than-a-stretcher bed, it's not going to be safe to send that person right at shift change.
    The problem is, the patients in the lobby stubbornly refuse to stop deteriorating for two- wait, I just re-read that- SIX hours a day.

    It would be great if hospitalist shifts could be staggered in a way that moved discharges earlier in the day and reduced the number of bed assignments made at 1830 (a chronic problem in every hospital I've worked in). But holding the patients in the ED and subjecting them to an additional change of care there (we're changing shift in the ED at 1900, too) does not improve safety for that patient- it only reduces it for the one who hasn't been seen at all yet.

    I've been on both sides of the equation and I heartily agree that getting OR sending a patient at shift change is not ideal (nothing sucks more than finally dispatching a patient to the floor at 1850 and then having night shift look at you like you're lazy for not having the patient that just landed in your clean bed two minutes ago primped and pressed already). But holding them in the ED does not solve anything- it just delays care for another patient.

    I will say that as both a floor and an ED nurse I've seen PLENTY of delaying tactics regarding taking (and occasionally calling, but less often, as ED is subject to being assigned additional patients if things get bad enough, so there is less motivation to delay) report after 1700 in the hopes that the new admission would fall on the next shift, and that only makes things worse for everyone. If the floor nurse is truly busy when report is called, there needs to be a backup plan in place for the charge or another team member to take report, and if the admission requirements are so onerous that they make it impossible to safely accept a patient, there needs to be either a floating admission nurse or a policy allowing the receiving RN to delay complete admission paperwork till the following shift for admits received after 0600 or 1800 (both solutions I've seen work effectively on real units).

    Holding patients longer in the ED is never the answer, because there are other people who are literally receiving *no* care at all until that bed is freed. If you think a decompensating septic patient arriving on the floor with a line, a detailed H&P, and an admitting doc on call is frustrating, imagine what it's like to pull one from the lobby and realize they're septic as hell and have been slowly worsening for hours, missing a golden window of potential intervention, because there was literally nowhere to put them. That happens.

  • Feb 1 '17

    Well.....this is another age old complaint. If it is any comfort to the OP it isn't just her facility.

    I have found this complaint to be universal. Hospitals are decreasing staff and increasing the workload of everyone. I have studied this over and over again. While there are some variations unique to each situation they have many more in common.

    There has been this push to decrease ER wait times. In this present culture of "patient satisfaction" and having to have "good scores" pressure has been placed to get the patients out of the ED ASAP. It has been well documented that longer the wait in the ED from door to door is one of the biggest complaint generators.

    Tufts MC Emergency Room - Don’t Wait in The ER, Wait at Home‎

    ER Wait Watcher
    ER Wait Watcher Massachusetts

    There are factors that are common to many hospitals. ER nurses know that their ED doc's vary greatly as to the efficiency of that MD. Some ED docs are quick and accurate while others...well....lets just say they have 2 speeds. Stop and reverse. These MD's will just get slower, take a long meal break, and dictate the H/P for 2 hours simply out of spite because you tried to get them to hurry (my personal favoutite....NOT!) Many MD's will leave patients in the beds to limit the amount of patients they see that shift and will suddenly disposition the entire department when the next MD is due to arrive...they don't want their fellow MD kick the bejesus out of them for leaving a mess.

    Sometimes the attending/PCP will drag their feet until all of "their" patients are ready for disposition to "see" all the patients at once. This will vary greatly depending on whether or not there is a hospitalist AND when the hospitalist shift begins/ends and do they have another position/shift at another facility to get to that day. Another is where the patient is being admitted; telemetry, step down, ICU and the hospital policy how when the PCP/specialist/attending has to see them personally.

    Then we have staff (nurses,CNA's) shift times and census to contend with. I can tell you that there is always that one notorious floor that will actually hide discharges by leaving the beds unmade and unstripped to appear that the occupant is down for testing. That dreaded shift change patient. You the one...that train wreck that hits the floor and drags you into a sucking void of no B/P that will ultimately crash once all the admission orders, and paperwork, are done and gets transferred to ICCU leaving you with 6 other patients that have not been seen and another admission waiting for your bed....Murphy's Law.

    Why does that sick patient come to YOUR telemetry unit?? WELL....most facilities have policies that when a critical patient is admitted to the ICU that patient must been seen by the ICU certified MD with in, usually, one hour. HOWEVER! IF that patient is admitted to the floor THEN crashes and TRANSFERRED to the ICU the MD, usually, have 8 to 12 hours before the patient must be seen in person.

    See how that works? Crazy isn't it?

    Can it be corrected? Yes, but not without an administration that is willing to hold the MD's nose to the fire. Supported nursing supervisors that run behind these MD's and make them behave and a progressive policy for the staff nurses supported by their management to stop hiding beds until shift change so they can dump on the next shift...I mean why not they have all night...right?

    To fix the really isn't that easy but it isn't just your facility ((HUGS))

  • Feb 1 '17

    As a former charge nurse of a very busy ED, I can say this happens a lot and, although frustrating there are a lot of things to consider.

    As a ED department you are bombarded by the public who demand to be seen, others are too sick to demand anything, some are dying then your trauma's etc. You can have 20 to 30 people waiting in the waiting room or more ( now remember the triage nurse needs to keep the vitals up to date on those patients and most of the time with little to no help) and some of those patients are very sick. Now imagine the stress on that nurse, she is looking at these patients knowing they are very sick and roaming the department looking for a bed and there are none. So the push to move the other patients out of the department is always present, we absolutely don't want anyone dying in the waiting room (unfortunately it does happen).

    The MD along with management want patients moved when there is nothing else "emergent " (Ie we have done the scans we have done the tests , we have given the meds or blood or whatever ) and the specialized unit is what they need. At times those patients can turn very quickly and without warning and it is usually once they get to the unit. Some patients won't tell you when they feel unwell because they want out of the ED as well and onto a real bed so they don't say they have pain etc, other times it is not asked of the ED nurse.

    I never wanted someone who was palliative to die in the ED, it is just not right. Now having a trauma patient die after doing CPR and other interventions for 40 mins is a different scenario. So moving a palliative patient to a unit into a private room with their family to die in the right thing to do, in my opinion.

    No matter where or how the push comes from, it is really uncomfortable for all nurses and medical staff involved. I know my nurses worried about sending a patient to the units before the patient was stable but unfortunately that sometimes was the "most " stable patient to go. It is frustrating and we sometimes feel like we could direct 747's at the airport better than our own jobs, but that is what health care is all about....or at least in the ED it feels that way.

    I agree that communication is key and the doctors should not be accepting patients that they think are unstable. We had multiple doctors who finally said " No we are not accepting they are too sick", it did get us a couple more ER nurses (which gave us a few more beds )and an additional triage nurse. But if they continue to go along because they feel pressured it will never end.

    Just my own experience I realize that everyone's environment is different.
    Just know that as a former ED nurse we all were frustrated ( at least in my facility)at the state of health care. I absolutely feel your pain.

    I hope it improves for you. All the best of luck.

  • Feb 1 '17

    That's some steep m/s ratios, as pointed out.
    For the ED's part, they get near constant barrages about their disposition times. Door to triage time, triage to provider time, door to cath lab time, admit order to transfer time, etc.
    This pressure is likely the primary driver behind these rapidly assigned beds.

  • Jan 5 '17

    Baby Cherish arrived to the unit on a winter afternoon via medical transport in a flat car seat bed belted securely to a gurney that looked way too big for tiny 5-pound little self. We had been preparing for her arrival to the unit well before her birth the day before. As her arrival time approached, we lovingly prepared the family suite to be as welcoming as possible. We set up a bassinet with beautiful bedding, laid out diapers, made sure the recliner had a baby blanket draped over one arm of the chair. This was a different kind of special delivery: baby Cherish has come here to die. We were there to support that process for the family at our pediatric hospice/palliative care unit.

    Baby Cherish's parents found out about her severe congenital birth defects early in the pregnancy, and because of their religious beliefs, chose to continue to the pregnancy. They also made the choice that when she was born, they were going to let nature take its course, rather than choose advanced medical interventions.

    As baby Cherish was removed from the carset and placed into her mother's arms, I made it a point to call the baby by her name, to emphasize the specialness of welcoming a new baby into the world, to congratulate the mom on the birth of her third child. I told the mom we would not be taking vital signs, and would only listen to the baby's heart and lungs once per shift. Otherwise, the mom was welcome to make her self at home, and we would respect her privacy and support her and her little family any way we could. When I left the room, Cherish's mom was sitting in the rocking recliner holding her baby against her breast,with an expression of great love on her face, and starting to relax. This was not the NICU. This was a safe space for Cherish's parents to enjoy whatever time they had left with the baby.

    As I walked away from Cherish's room, I thought of my friend Nina, who had taught me so much about how to talk to a parent of a baby who has died, or is dying. Ten years earlier, before I was a nurse, Nina lost her baby to severe congenital birth defects, too. She lost her at 20 weeks when she chose to have a therapeutic abortion. Nina's baby, whom they nicknamed Wisp early in the pregnancy, was very much planned and wanted. It was Nina and Ben's first baby. They got pregnant easily, announced it right away, and shared the different stages with friends and family. On the day of the big ultrasound when they were to hopefully found out Wisp's gender, they did not post the expected news, or any grainy black and white ultrasound photos as expected. There was just silence. Then I got a call from our mutual friend, saying that they had discovered the baby had severe birth defects that were not compatible with life.

    We were not sure what to do or how to help. We quietly left gift packages at their door, left messages that we were there for them. A few days later Nina called me up and said they had decided to terminate the pregnancy. Her decision was one of love. She didn't want baby Wisp to suffer, to go through the harsh birth process only to heave lung and heart failure and die.

    Although I had my own views on women's reproductive rights at the time, being a new mother myself put a new spin on what was before a philosophy more than a reality. Now a mother, I imagined myself in her situation, and wondered what I would do. I could not imagine facing the abortion of my own baby, nor could I imagine facing holding my baby while she died in my arms. There was no easy answer, and as I processed my own beliefs, I concluded that there was no right answer, except was was right for each family in each circumstance. And so I supported Nina through the abortion.

    Years later, Nina still stamps an angel at the top of their family Christmas cards. Wisp floats above her three sibling who were born after her, and their parents. She is always remembered. I make it a point to refer to her by name whenever the subject comes up. When asked how many children she has, she always answers that she has four. Nina taught me to always call her baby by name. Baby Wisp was wanted, loved, and is still remembered.

    As a former pediatric nurse who worked in ICU and stepdown ICU, I have seen my fair share of babies who had severe birth defects, whose parents chose to continue life for as long as possible-- and it is possible to continue life for years, decades. Depending on the outcome, this can be either a gift or curse.

    What kind of life is afforded to children who are given the best advanced medical care? In some cases the children become stabilized, stronger, and they know a life filled with love and joy. This is the ideal situation. I have seen little babies who I watched endure trachs, vents, gtubes, and corrective surgeries grow up into children who smile, know their parents and siblings, go to school, and add joy to the world and their families. My own brother was born with Cornelia deLange Syndrome in the late 1970's. We were not sure what to expect, or how long he might live. His six years of life enhanced mine, and taught me a special kind of compassion I would not have otherwise known. His place in our family was important and special.

    However, I have also seen babies who remain bed bound their entire lives, whose bodies get bigger but they remain even more helpless than a day-old baby, who are not aware enough to interact at all, whose only facial expressions are painful grimaces, who endure countless bouts of pneumonia, sepsis, surgeries to correct dislocated hips, severe scoliosis, painful spasticity of muscles, seizures, and severely contracted joints. Often the care of such children takes such a toll on families that they experience divorce, siblings are neglected, and the special needs child ends up at a long-term care facility.

    It is hard to predict which way a child will turn out when they are an infant first being held in a parent's arms-- when they have to make that very difficult decision to love and let go, or fight with advanced medical technology, or somewhere in-between. When they look to doctors for help in making these decisions, the doctors often shy away from presenting hospice or palliative care as options. They are trained to fix people, not give up and let nature take its course. I think because it's a difficult subject, many doctors are also afraid to lay out the not-so-pretty long-term prognosis for many of these children. And so the non-medical, inexperienced parents are left on their own to decide what would have not have even been a decision twenty years ago.

    When I was 23 weeks pregnant with my second child, I went into preterm labor, and spent the next precarious weeks and months on strict bedrest and medications to keep her from being born too early. I contemplated what choice I would make if she were born at 23 weeks (no medical interventions), or at 28 weeks (give her a chance at life if all looked good). When she was born at 36 weeks and appeared healthy, I was so relieved. But then things went wrong. At three months old she required a feeding tube. She used it for six years. She required therapy to catch up to age level. She suffered horribly with daily vomiting the first three years of life, had endless medical testing, and finally at age two, the diagnosis of a rare GI condition that she has since outgrown. We thought we had our problems behind us.

    Then her knees started to dislocate in 2nd grade. It turns out has a form of an inherited connective tissue disorder called Ehlers-Danlos Syndrome. She not only has mobility issues (had at the age of 12 has already had two major knee surgeries), but the scarier prospect of vascular system issues as she gets older. We have an appointment with a geneticist next month to find out the severity of her syndrome. And to top it all off, she does not respond as well to pain medications as most people, do. So her procedures are more painful than normal and require the use of a special pain team of doctors to get her through them.

    If I had known early in the pregnancy the pain – both emotional and physical-- that she would endure in her lifetime, would have have chosen this kind of life for her? There were times, as I sat holding her through her pain that I could not make better, when she was angry at me for agreeing to the surgeries even through there was no other choice, when she had to ride the special needs bus in her wheelchair for 8 weeks post-op, devastating to a developmentally typical 6th grade girl-- and the night when I finally broke down and gave her a prescribed ativan so we could both get some rest, that I wondered if this was all worth it. But then when she's having good days-- which is most days-- I know it was. And, I had no choice in the matter anyway. I did the best I could given the knowledge I had at the time. Which is the case with most parents of special needs babies and children.

    It's not fair. It is not fair for a parent to learn of a baby coming, to anticipate a lifetime of joy and love, of “firsts.” And then to find out that the baby has devastating problems. I do not envy the position of any parent who has to make a decision on the fate of their child, whether it be to terminate a pregnancy at 20 weeks, or deliver a baby and let them die peacefully, or to choose to give the baby the best shot at life through medical interventions. Or, in my case, to choose to go ahead with the third knee surgery next summer, because in the long-run it will enable my daughter greater mobility and less joint damage down the road. Even if she is angry at me, and angry at the world and God for awhile.

    As I write this, I think of baby Cherish being held in her mom's arms for their precious time together. I think of baby Wisp being held in her mom's heart forever-- this baby who inspired to her eventually become a doctor and an excellent patient advocate. I think of my own baby girl, nearly a teenager, living a full life of sleepovers, violin practice, and spending way too much time on the internet, even as I hurt for her as she faces a lifetime of surgeries, mobility issues, limitations, and chronic pain.

    As a nurse and a mom and a friend, I have learned that no two situations are alike. No two children are alike. No two families are alike. I have to both put aside my own feelings on the matter, and draw on my experiences so I can relate to the patients with true empathy and compassion while they are in my care. I recognize that each of these mothers, in each of the difficult decisions they made, acted out of love. It is my role to meet the patient and family where they are in that moment in time, to make them feel safe, to support them and make their hearts rest easy that they are in good hands. Beyond the medical training, the pharmacology knowledge, technical skills, charting, and coordination of care with other team-members, it all comes down to one thing, the very heart of nursing. It comes down to love.

    *Note: the names and other identifying details of people in this article have been greatly altered to protect their privacy, and some of these characters are composites of several patients I have had.

  • Jan 5 '17

    Love Being a Nurse: 33 Years and Going Strong

    I pushed my computer top down hearing the satisfying “click” as a sign of the end of my work day. I moved around the counter in the kitchen and fixed a hot cup of tea, pausing to stir in a bit of honey, before taking that first sip. Leaning against the counter, I thought back over my day, working as a Parish Nurse in the morning and making hospice visits for a local hospice company in the afternoon. I smiled thinking how blessed I am to be able to work two jobs and have them blend together well.

    I thought back over the years and remembered my very first days as a young nurse at an inner city hospital where I was hired to work nights on pediatrics. Even now, all these years later, I shiver to think of all that could have gone wrong. For experience teaches us one lesson well: the most dangerous nurse is the one that doesn’t know that she doesn’t know. Somehow, I was able to connect with a mentor who helped me learn and prioritize and become more proficient not just at skills but at making those all-important judgement calls.

    Moving from Peds to Med-Surg helped to broaden my perspective and taught me how to work with a team approach. When I started out, we used paper charts and spent a good deal of time designing care plans for our patients. While I sometimes questioned the day-to-day usefulness of what we did, it certainly helped inculcate in my mind what was important: monitoring change and knowing which changes to focus on.

    A few years later, home health became a good continued training ground, helping me to think critically and to see the patient as more than a diagnosis or a room number. Patients now became family members, part of a bigger picture that involved others in their recovery or decline. Using nursing interventions to help patients rehab at home, I began to put even more pieces of the puzzle of health together. I learned to accept more, judge less; I learned to see beyond what was said; I learned to know and recognize limits of care and also to see unbounded potential.

    Parish Nursing came into the picture of my nursing career when my personal life demanded even more flexibility. With three small children, I found the early and late hours very difficult and was thrilled to learn that such a thing as parish nursing even existed! Starting out as one of the first in the training class in our area back in 1997, the challenges and rewards of this field have continued to hold my interest over the years. The variety is endless between health promotion, disease prevention and nurturing the needy, the job is more than a position, it is a calling. While the leadership of my congregation comes and goes, the relationship building as a nursing professional and a caring individual continue to be rewarding.

    Parish Nurses work in several models: paid, stipend-paid, and volunteer. My program pays a stipend and is associated with the local health system. I work 20 hours a week at my church doing visitation at home and in the hospital, designing and promoting health maintenance programs, and serving as a patient-advocate. Each day is different and demands intense flexibility and willingness to respond to a large variety of situations. Many times, I become involved with eldercare issues, with the care of the dying and with the mourning that takes place after the death.

    As our last child headed off to college, I began to look around for another nursing job that could help fill the financial cracks that tuition seemed to open up. When my sister-in-law died in the hospice house in our area, I felt sure that this was just where I needed to be. Hospice work blended well with my parish nursing and the home visits, the care of the dying and the whole-family aspects were simply a continuation of parish nursing and home health. Working prn for hospice pulls from all my years of experience: skills in assessment, nursing judgement, and teamwork all play a part in my work as a part time hospice nurse.

    What are some of the stand-out lessons of this long career?

    1. The relationships matter the most. As the saying goes, “No one cares what you know until they know that you care.”
    2. Kindness and compassion go on forever and pay out the biggest dividends in your own life.
    3. Staying up-to-date and becoming an expert in your field is both energizing and essential to long-term survival as a nurse. Graduation is just the beginning of the learning process!
    4. Everything will change. The more we lean into it and move with it, the happier we will be—not that all change is for the good, but we have a better long term prognosis as nursing professionals if we are willing to look change straight in the face and address it.
    5. We all make mistakes. Being willing to own our mistakes, to do our best to correct them and then to learn from them and move on will help us have long-lasting and satisfying careers.

    What about you? Where have you been on your nursing journey? What would you add to my list of “stand-out” lessons?

    As I set my tea cup in the sink, I looked out the window in time to see the sun sink over the horizon. Gratefully, I took off my work badge and set it aside, ready to regroup for another day!

  • Jan 5 '17

    “All you do is sit around until a baby is born,” “your job must be great, all you do is sit and hold babies”, “be happy, you’re in the happy part of the hospital.” I have heard it all. My job as an OB charge nurse is nothing like sitting around, holding babies in the happy part of the hospital. Many of you know that OB nurses care for the fetal demises that come through the unit, but we also see much more unhappiness. Abused mothers, drug addicts, and drama within the families are more common than the hard-working, married couple with jobs in the world. That's not to say I don't love my job; I love my job.

    As an OB charge nurse, I want to give you a “day in the life.” I frequently get asked what I do all day at work when I am in charge...well here it is.

    5:00 am - Wake up and get ready for my day. If I don’t start the day with a cup of coffee, I will have a headache by 7 am, so there’s where it starts. I get showered, make sure my family is set for their day, and off I go.

    6:20 am - I arrive to work. Yes, I am one of those. My shift doesn’t start until 7 am, but I need to know what I am in for. I get dressed into my fancy scrubs, work shoes, and pull out my nurse toolkit (pens, highlighter, pencil, stethoscope, badge, vocera holder, and notepad), and head to the breakroom. I always put fresh coffee on for my coworkers. Always take care of your tribe. I may or may not take a cup with me, depends if my son was up during the night (so usually yes).

    6:50 am - I glance at the hallway. I can tell you if the night was bad or not if the hallway is a mess. Somehow, before 7:00 am, everything is cleaned up. We have the respect for each other not to leave a mess. Take care of your tribe.

    6:58 am - I am awaiting my crew. I glance at the assignments and plan (ha) how the day will run. Here they come, “coffee's on, ladies.”, and we await the report.

    7:00 am - We listen to report about the floor, not a detailed report, but enough to get us an overview of who is in labor, who has issues everyone should be aware of (family drama usually), and what is scheduled that day. I take over as the charge nurse and tell my coworkers what I will do for them. Sometimes, I am lucky enough not to have a patient to start with; I am pretending this is one of those days.

    7:15 am - I say goodbye to the night shift, and offer them a cup of coffee. Wish them a safe drive home, and say a little prayer for each of their safety (take care of your tribe). I start my QC checks. I always will start with my operating rooms. There are two of them. I have a scrub nurse, but I always try to make sure these are ready to go because you never know what the day will bring. I check all of the QCs in the unit, including, three crash carts, refrigerator temps, discard old medications or specimens, clean dirty equipment (even though I have an aide, don’t ever think you are too good for any job), and check to make sure I have some labor rooms set, as well as a triage room. If I can get through that without too many interruptions, it’s a good day. I think about my family, try to call my husband, sometimes, I just get a text from him letting me know everyone is off to school and that he made it to work.

    8:00 am - Our first scheduled inductions is usually scheduled at this time. I help as much as I can with that patient, as well as answer phone calls from various departments, answer physician questions about patients, and start getting the postpartum patients ready for discharge or post op care.

    9:00 am- The lactation nurse arrives (thank goodness). Breastfeeding, as natural as it is, is always a problem. Some baby can’t latch on; another mother has flat nipples, and another wonders if her baby is getting enough milk. There is only one lactation consultant and limited nurses. I step in to help who I can, when I can.

    11:00 am - The pediatrician arrives, and the Pitocin is started on our inductions to try to have new babies by the end of our shift, ideally. Now, the office is calling. They are sending over a patient who thinks her water broke at 4 am this morning, every 10-minute contractions and hasn’t felt the baby move. There goes any lunch I thought I might get that afternoon.

    12:00 pm - The triage patient arrives, it turns out I know her, or she knows me. I delivered her last baby. I don’t remember her, but she said she'd never forget me. That’s why I do this; I tell myself. The day is good. I am in the happy part of the hospital, but still haven’t held a baby, or sat down. I check to see if she has ruptured her bag of water, it is not, but she is 5 centimeters, and she's due. Let’s have a baby! I phone the physician, admit her into the computer, and start her IV.

    1:00 pm - Another call from the office, they will be sending over a patient for a repeat c section, she is in labor, or sounds like it from the phone call. I have the aide prep a bed for a section (we add a different mattress), and go through my nurses to see who could take the next patient. Everyone is crabby, I take that back, hangry. No one has eaten lunch yet, and the pediatrician just left. She put in her orders for discharge, but the first patient to go isn’t going to leave until 2 pm. Unfortunately, that nurse will have to take the c-section.

    2:00 pm - My patient needs an epidural, she's booming contractions out and cannot take it anymore. She is 6 cm. The c-section patient has arrived, she ate an 8:00 am, but is contracting. The doctor says to get her admitted, and we’ll have to do her c section. I am trying to find an assistant, let other nurses know, the anesthesiologist, and try to prep my patient for an epidural and delivery.

    3:00 pm - My patient received her epidural. She is progressing! I need to find a nurse who will help me with my delivery. In the midst of the patient relaxing after her epidural, her blood pressure drops to 60/40; she is symptomatic, and the baby is in distress. I push ephedrine with the physician at the bedside, as well as administer O2 via facemask, bolus more fluids, and pray that the baby recovers, or we will be going back to the OR before the other patient.

    4:00 pm - Thankfully, the baby ("my baby" is what we always say when it's our own patient) has improved. The C-section patient is ready to have a baby. Prepping the OR and counting the instruments, as well as arraigning a code pink team, and the team prepares for delivery. The patient is prepped for spinal anesthesia and laid down to a left tilt. The circulator takes over, on her own, and back to the floor I go before my patient delivers. I make a second batch of coffee because I didn’t eat. I sneak a cookie from the break room for my breakfast and lunch.

    5:30 pm - The c-section went well, mom and baby are recovering. My patient is 8 cm and sleeping. We’re tired and ready to go home. I figure out staffing for the night shift and clean the triage beds from earlier. Just in time, another triage patient arrives who is bleeding. I find another nurse for, and luckily, after an hour, that patient is safe to go home.

    6:30 pm - Almost quitting time, but wait, my patient is complete and ready to have her baby! I prep her for delivery.

    6:52 pm - Delivery time! The patient delivers a healthy baby girl with no problems. I can have a nurse step in my place at 7:00 pm.

    7:00 pm - The upcoming shift received a report. I stop and say thank you to all my coworkers for their help. Always take care of your tribe.

    Throughout my day, you will notice, I held no babies. I did everything but sit, and that day, no sadness, but always lots of drama. If you want an adrenaline rush and an ever changing day, become a labor and delivery charge nurse. You have to be able to multitask and think on your toes, and you must always remember to take care of your tribe!

  • Jan 5 '17

    Quote from Cisabel
    She finally said, "Hmmmm. I already have a student nurse that is in her last semester. I need to focus on her and help her graduate. Where's your clinical instructor? Can you just be with her? If you have questions, you can ask. I just need to focus on my other student."
    She told you that she needs to focus on her senior student. Any time spent with you detracts from the student that is about to graduate. How is this NETY? Why did you not go to your instructor and state "My nurse already has a senior nursing student and needs to focus on her"?
    Quote from Cisabel
    Let's fast forward this day. My patient went to dialysis, meaning I will not have anything to do for 4-6 hours of my 10 hour day. Because my patient was gone.
    Now your patient is about to be gone for 4-6 hours and you still haven't talked to your instructor about being assigned to another nurse.
    Quote from Cisabel
    This is living proof that the advice that some nurses give about why nurses eat their young...
    Actually, no this wasn't an example of nurses eating their young. She was defending her senior student's right to get one on one preceptorship before she graduates.
    Quote from Cisabel
    If you are a nurse and do not want a nursing student, JUST SAY IT!
    She did say it when you met her. "I have no time for you, I need to focus on my senior student, go find your instructor."
    Quote from Cisabel
    It is very unfortunate that there are some nurses out there that do not want to teach. The cornerstone of nursing is teaching. You must teach the family and patient constantly during their visit.
    She was teaching her senior student. Yes, an important part of nursing is teaching patients, not students. There is no requirement that I teach students.

  • Jan 5 '17

    I will comment on one aspect of your post: the fact that your nurse stated up front that she already had another student. When I have a student, one of my primary concerns (other than teaching) is the patient's comfort level with having a student watching/participating in their care. Not all patients are comfortable with it, and the ones that are should not have their good graces trampled upon by allowing their convalescence to become a side show. Multiple nursing students at the bedside, regardless of how helpful, gracious, and kind they are, can make patients very uncomfortable. Some patients may be nice to your face and say nice things to you, the student, because they don't want to hurt your feelings, but will tell your nurse to find a way to keep you out of their room. Yes ma'am, that really actually truthfully happens. It is MY job as a nurse to protect my patients and honor and respect their wishes regarding their care and their dignity.

    Having BEEN a patient who has had a student (med student) angrily huff at me when I refused his observation at my very intimate, private, embarrassing exam, I can tell you that I really didn't give two beans about his imagined entitlement to gawking at my medical care for his learning experience. It was MY BODY and I said NO. He should have accepted that with grace and moved on. I had to become rude and abrupt with him to get him to leave.

    The nurse who you have so quickly judged as being mean and "not wanting to teach" may very well have been an excellent teacher who loves to teach. As Pepper The Cat stated, the person you need to be angry with is your instructor, for not doing his/her homework before making assignments. Whenever I am assigned a student nurse, the instructor always ASKS ME first. The failure is not with the nurse, it is with your instructor.

  • Jan 5 '17

    From the post written, the nurse did tell YOU up front and then YOU proceeded to interrupt her throughout her shift because YOU are in need of learning, correct?

    YOU are paying the school to teach YOU, YOU are NOT paying the nurse to teach YOU, correct?

    Are you making a connection yet and realizing just how selfish YOU sound, correct?

    Doubt it because this post is all about YOU and YOUR needs, correct!

    There is NO NETY going on here, correct!

    Did YOU not take the time, effort, and initiative that YOU spent bothering the staff to instead go bother the clinical instructor that is actually getting paid to help YOU learn and let them know the nurse's concerns, correct?

    Are YOU even serious right now...correct!?!

    "I volunteered my services"...WOW...just WOW...

  • Jan 5 '17

    Perhaps your instructor should have just assigned you another patient.
    Rather then placing blame on a nurse who is already busy with a student plus whole full assignment you should place blame on the person who is being PAID to educate yo

  • Dec 29 '16

    Instead of judging and making each other feel less, why don't we lift each other up and educate and encourage?

    How to decompress after a traumatic experience.
    Finding the impossible to find vein.
    Handling escalating situations/ de-escalating techniques.
    How to talk to other caregivers when they snap at you.
    How to talk to patients who have just been told devastating diagnoses.
    Understanding type A personalities/understanding introverts.
    Orientation and what to expect.
    A day in the life of X specialty, understanding the other specialties.
    What to expect if you make a med error/if a patient falls/IV line infiltrates?

    Why does it have to be "are you too fat to be a nurse"

  • Dec 29 '16

    They're called nursemares and I've had plenty in 35 years. Ugghh.