caroRN 690 Views
Joined: Apr 19, '11;
Posts: 6 (83% Liked)
; Likes: 7
I cannot stand PIV dressings with gobs of tape on top. If I can't see the insertion site clearly, it drives me nuts! Tegaderm and maybe two pieces of tape only people! And never over the insertion site! Tape the J-loop all you want as long as you don't cover up that Tegaderm. If the dressing is loose at all, I'll change it. That being said, I'm hesitant to change heavily taped dressings that aren't loose because I'm afraid of inadvertently pulling out the PIV while taking off all that tape. My patients are usually all very hard sticks and we can't afford to lose access.
I have a brain form I made and I have to use it. I feel like I'm missing info if I don't.
I think I'm one of the few people who document IV starts and discontinues in our EMR. I hate it when they don't show up in the EMR. If it's a PICC or CVC and wasn't documented in the EMR, I'm even more annoyed (even though there is nothing I can do about it). We often have tunnelled IJ's and I hate it when people call them SC.
I like to use as much of the IV fluids as possible also. There is no reason to program for 900. I always program for 1000 and there's plenty leftover at the end.
I have a huge aversion to starting NG tubes. I don't mind most other procedures but NG tubes are just not my thing. Once they're started I'm fine.
I'm also a stickler for doing things the right way and I hate shortcuts or lazy nursing.
I'm in my first year as a surgical floor RN. My first code was pretty traumatic for me too and there wasn't even blood or the other concerns involved like yours. You sound like you were very on top of your patient's condition and you asked for appropriate interventions. You did all you could do.
I was very disturbed with my code for some time. My patient coded on the floor, was brought back enough to be transferred to ICU where they then passed. There was nothing I could have done to prevent the code or the change in the patient's condition but it still bothered me. I actually went to see a therapist for a while because it was very disturbing for me. I'm doing much better now but it still bothers me a little when I think of it. I think firsts are probably always a little harder...
Most new nurses and nursing students are concerned about nursing skills in the beginning. I'm finishing up my first year as an RN-BSN and I'm here to tell you it gets better. In nursing school, I wish I had believed all the instructors who told me that I didn't need to worry about skills. You'll get the skills over time.
The fact that you're concerned about providing good patient education at this time is right on! You're focusing on the important parts for this point in your nursing education/career. You may blank but that's okay. I have to tell patients from time to time that I can't answer their questions. I always tell them "I'm not sure about the answer to that and I'd hate to give you wrong information. Let me go look that up and I'll get back to you." Or if it's something I can't answer or something best deferred to the MD, then I'll write the question on their dry-erase board in their room so they remember to ask the MD when he makes his rounds (I work nights). If it's patient education for some kind of intervention (like incentive spirometry or something), I've printed out a patient education leaflet and used it as a prompt for my education if needed. At the end, they have something to refer to also! And I remember better the next time.
As for your nurse instructor not letting you do much, can you ask her to let you work on certain goals at the beginning of each shift? Sometimes, nurses have trouble giving up the reins in my experience. Asking sometimes prompts them to make use of a teaching moment. Also, as Flare mentioned, walking in with confidence will make a difference - with your nursing instructor as well. If you still aren't getting much experience after asking for more practice from your instructor, consider asking to work with a different nurse. Some nurses are better than others at teaching students and finding the balance between allowing the student enough freedom to learn by doing and providing enough supervision for safety and reassurance.
I doubted my choice of nursing when I was finishing up school too. Hang in there. In my experience, it gets better. You like the subject matter and you genuinely care for your patients. You'll be great!
I have occasionally seen PIV's in the shoulder/chest/breast in hard to stick patients but recently my hospital (or at least my floor) has stopped this practice because of the increased risk of infiltration and complications from infiltration. These patients are better served by a PICC or central line anyway. Maybe time to call the doc for an EJ if you need immediate access and PICC or central line cannot be completed for some reason?
I rarely wear makeup to work. I use cover-up for the occasional blemish but that's it.
I started out in nursing school wearing makeup and also when I first started my job. My problem is that if I wear it, I find the urge to rub my eyes increases - gross while at work! I'm just concerned about it increasing my chance of introducing some nasty bug onto my face or in my eyes. Not that I'm rubbing my face with dirty gloves but it's just gross rubbing my face during the shift.
I've been blessed with a reasonably good complexion but challenged with sensitive skin. I find the more I leave my skin alone, the better it looks. If I had visible skin problems, absolutely with the makeup.
I have scalp psoriasis so my hair is nearly always down in back but half-up in front as necessary.
Thank you! I was starting to feel like I was the only one who did an assessment!
I'm in my 4th week of orientation and I don't feel comfortable unless I do a quick head-to-toe like yours. I've been getting pressure from some of the other nurses on the floor (not my preceptor) to skip a formal assessment because we don't have the "time". Come on - assessment is part of our job. At the very least, I'm still new and I need the shift assessment so that I can tell if there's a change later in the shift.
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