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Lev <3, BSN, RN 49,511 Views

Joined Jun 3, '11 - from 'Another planet'. Lev <3 is a ED Registered Nurse. She has '4' year(s) of experience and specializes in 'Emergency - CEN, upstairs, troll bashing'. Posts: 2,864 (53% Liked) Likes: 5,308

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  • Nov 23

    Remember carbon copy paper anyone? It was frequently used at my elementary school. I do remember record players during "Library" at school. I grew up outside and read lots of books.

  • Nov 20

    Quote from cardiacfreak
    We tried this on our step down unit and it didn't work at all. The doctors were asking questions and were getting upset because the nurse would have to ask the other nurse if Mr. So and so had received his metoprolol, or if Mrs. What's her face had less than 200ml out in her chest tube.

    i agree though in certain areas of nursing this would be beneficial, but not in high acuity areas.
    If the doctors would learn how to use the EMAR they wouldn't waste our time asking us questions like whether a patient got a med or how much output they had. It's documented in the computer.

  • Nov 14

    Initial Response:

    Oh no! Your patient has gone unresponsive on you. First thing to do is a quick pulse check of their carotid artery.

    If you do not detect a pulse within five to ten seconds and your patient wishes to be resuscitated, call for help. Send one person to call the code blue and another to grab the crash cart and defibrillator. Then flatten the bed (max inflate the mattress if you know how) and "jump on their chest" and start compressions. The current Advanced Cardiovascular Life Support (ACLS) guidelines from the American Heart Association call for a compression rate of 100 to 120 compressions per minute.

    (If your patient has a pulse, but is not breathing or is breathing very slowly or ineffectively, call for help (code blue) and start providing rescue breaths with a bag valve mask device or “ambu bag" at a rate of one breath every five to six seconds. Give each breath over one second.)

    Getting help - time for some delegation!

    Make sure your charge nurse and the patient’s doctor or provider is aware. Once help arrives, quickly place the patient on the backboard. One staff member should start manually bagging the patient with a bag valve mask device at a compression to ventilation ratio of 30 compressions to two breaths. The other person should hook the patient up to the defibrillator. While your coworker is getting the pads on, continue compressions or switch off with someone if you are tired. In general, someone should switch off doing compressions every two minutes.

    Defibrillation:

    There are two popular methods of placing defibrillator pads. The method seen most publicly is anterior-lateral placement. This is usually the method illustrated on the package of the defibrillator pads seen in AEDs. Anterior-lateral placement is great for defibrillation but not for pacing. Anterior-posterior placement is ideal for both pacing and defibrillation, but requires the patient to be turned to place the second pad under the left scapula. When placing the pads, try to avoid nipples. Quickly shave the chest if chest hair is preventing the pads from making contact with skin. Avoid placing the pads over a pacemaker site to avoid damaging the pacemaker.

    The defibrillator located on inpatient units generally has two modes. There is the automatic external defibrillator (AED) mode - which is similar in functionality to the AEDs used in the public setting. These defibrillators recognize a fatal arrhythmia and advise a shock if indicated. The other mode is manual where a person who is competent at cardiac arrhythmia recognition recognizes a shockable arrhythmia (either ventricular fibrillation (VF) or “V-fib” or ventricular tachycardia (VT) or “V-tach.”). Follow your unit and institutional policies and standards for energy selection if your unit uses defibrillators in manual mode. If using a defibrillator in AED mode, pause compressions while the defibrillator is analyzing the rhythm and then resume compressions until the “all clear” is given before a patient is shocked. As soon as the patient is shocked, compressions should be restarted for a full two minutes. When using a defibrillator in manual mode, compressions need only be paused for the shock and then resumed immediately after defibrillation.



    Lots of things to do:

    Before the resuscitation team arrives there are a couple things that can be taken care of.

    1) Make sure that there is suction set up in the room. It is good practice to have suction set up in your rooms at the beginning of the shift.

    2) Get a second and ideally third IV line and draw blood if possible. Have a liter of normal saline hanging and ready at the bedside. It is helpful to have running IV fluids to help flush medications and to make sure the IV is patent. It is also helpful to have some flushes ready.

    3) Check a finger-stick blood glucose level. Hypoglycemia is one of the causes of cardiac arrest.

    4) Have the patient’s labs, previous vital signs, medications, and past medical history at easy access.

    When the resuscitation team arrives:

    The “code” team is made up of critical care staff and may include nurses, a physician assistant or nurse practitioner, a respiratory therapist, an attending physician/hospitalist and/or a resident physician.

    The respiratory therapist should take over bagging the patient. In some hospitals respiratory therapists routinely intubate while in others they just assist with intubation.

    The PA or doctor may recommend a 1mg dose of epinephrine. Epinephrine or Adrenaline is a poten vasoconstrictor which is a naturally occurring catecholamine in the body, responsible for the “fight or flight” response of the sympathetic nervous system. Per ACLS protocols, a dose of epinephrine can be given every three to five minutes. The lower concentration of epinephrine (1:10,000) is used for cardiac arrest contrary to the epinephrine in epi pens used for anaphylaxis.

    The team will try to find and reverse the possible causes of the cardiac arrest. These are known as the "Hs and Ts."

    Other medications given during codes:

    Narcan - given to counteract opioid overdose.

    Sodium bicarbonate - given for hyperkalemia and acidosis.

    Calcium gluconate/calcium chloride - given for hyperkalemia or hypocalcemia or suspected calcium channel blocker/beta blocker overdose.

    Magnesium sulfate - given for hypomagnesemia, hypokalemia, V-tach, or Torsades de Pointes.

    Dextrose - given for hypoglycemia.

    Amiodarone - antiarrythmic sometimes given after the first shock for V-fib or V-tach arrest.

    TPA - may be given in the setting of known embolism, pulmonary or otherwise.

    Lidocaine - not part of ACLS algorithms, but still given at times for wide complex tachyarrythmias such as V-tach.

    IV fluids - given for hypovolemia/support hemodynamics.

    Note: When a patient does not have a pulse, there is no need to inquire about a patient’s blood pressure. Without a perfusing rhythm, there is no self regulated blood pressure. Effective compressions can create a good blood pressure but any blood pressure measured while the patient is pulseless is really a waste of time.

    Intubation:

    The patient may be intubated with an endotracheal (ET) tube during or after the resuscitation attempt. Once the patient is intubated, tube verification is done by listening for breath sounds in both lungs and by listening to the stomach to make sure no gurgling is heard (indicating esophageal intubation). Watch for abdominal distention which can indicate esophageal intubation.

    Tube placement should also be verified through some sort of carbon dioxide (CO2) detection - either through waveform capnography on the monitor which shows end tidal carbon dioxide (EtCO2) or through a clip attached to the tube and bag valve mask which changes color when it detects carbon dioxide after the patient is bagged a couple times. EtCO2 measures the amount of carbon dioxide present at the end of exhalation and is normally 35 to 45 mmHg. Sometimes it is monitored during resuscitation attempts to gauge the quality of compressions and to help determine if spontaneous circulation returned indicated by a sharp increase in EtCO2.

    Link to a video about end tidal CO2 for those interested


    Once intubation occurs, the patient should continue to be bagged at a rate of six breaths per minute until the ventilator is attached. If the patient survives the resuscitation attempt, final verification of ET tube placement will be done by chest x-ray.

    Rhythms:

    Note: Effective compressions can look a lot like the V-tach shown in the first rhythm video below. Make sure to pause compressions before analyzing the rhythm.

    Ventricular Tachycardia (VT) - Rate >100 usually >120, can have pulse, must shock immediately if no pulse or unresponsive.



    Torsades de Pointes “Torsades” - A type of VT, no pulse, give magnesium IV push



    Ventricular Fibrillation (VF) - No pulse, must shock immediately



    Asystole



    After the code:

    Most patients do not survive resuscitation attempts. Some survive but with very diminished brain function. Do not expect your patient to wake up after CPR. The ones more likely to wake up right away are those who were successfully shocked immediately after the occurrence of a fatal shockable rhythm like ventricular tachycardia.

    To give the patients the best chance of consciousness after cardiac arrest, patients are cooled temperature of 32 to 36 degrees Celsius. The cooling process, also known as targeted temperature management (TMM), is usually initiated in the ICU.

    A debriefing process, either directly after the code, a couple hours after the code, or scheduled for another day is a good way to help staff members deal with any feelings they have after the resuscitation and to allow staff members to ask questions.

    Sources for information and BLS and ACLS algorithms:

    Adult Basic Life Support and Cardiopulmonary Resuscitation Quality

    Adult Advanced Cardiovascular Life Support

    Here is the link to a good code blue simulation video. I watched several of these and found this one to be the most accurate and informative. Many videos had lapses or delays in compressions that made me cringe. LINK

  • Nov 14
  • Nov 7

    BNP 172,474!!!

  • Nov 6

    Quote from Ruby Vee
    Document -- PSN or incident report or whatever. Also talk to your manager about this. If he's well known for doing this sort of nonsense, you'd like to do that.

    I once took a verbal order from a physician who later denied having given the order. (This was a LONG time ago, when verbal orders were common.) Another physician had witnessed the interaction, so I had back-up. My manager popped out of her office with a Polaroid camera, for those who remember what that is, and snapped his picture. She then put it up on the bulletion board in the break room on a huge, bright red poster board with letters one foot high saying "Do NOT Take Verbal Orders From This Yahoo!" Within hours, he was in her office begging to be told what he could do to get his picture taken down! No one EVER had problems with him again. (Except the one time the cardiac surgeon punched him, but that's a whole 'nother story.)
    Sounds like an awesome nurse manager. A rarity today.

  • Nov 6

    "Hi my name is Dressagern. I'm a nursing student from XYZ university and I will be working with your nurse "Sheila" today until "3 pm". How are you feeling this morning Mr/Ms Smith?"

    Then you can go on to explain what your responsibilities will be.

    Really the most important thing as a student is to know what you don't know and don't be afraid to say "I'm not sure, but let me find out for you."

  • Nov 5

    Just happened tonight

    Me: the doctor said you can eat now...can i get you a sandwich?

    Patient's daughter: starts talking abt the food in the cafeteria

    Me: do you want anything to drink?

    Patient: ill take some ice water

    15 minutes later..daughter comes out into hall

    Patients daughter: any word on the order?

    Me: oh you mean from the cafeteria? Oh we dont order food for patients from the cafeteria, but you are more than welcome to bring something down for her.

    Now do you want a turkey sandwich or roast beef?

  • Nov 1

    Saying "she's here all the time" is the type of triage language/tunnel vision that gets people killed.

    I agree with your ESI 1 designation. If she wasnt symptomatic (diaphoretic and tachypnic) then she would be an ESI 2. HR alone with a borderline BP and symptoms can put her in ESI 1 territory because either a) she will need fluid rescusitation and/or b) chemical/ electrical cardioversion (if afib rvr lets say)

  • Oct 31

    Post your NCLEX related questions on this thread.

    NCLEX-RN test plan:

    lite https://www.ncsbn.org/2013_NCLEX_RN_Test_Plan.pdf
    longer https://www.ncsbn.org/2013_NCLEX_RN_..._Candidate.pdf

    NCLEX-PN test plan:

    lite https://www.ncsbn.org/2014_PN_TestPlan.pdf
    longer https://www.ncsbn.org/PN_Test_Plan_2014_Candidate.pdf

    Pass/Fail Rules (Computerized Adaptive Testing (CAT) | NCSBN)

    The computer decides whether you passed or failed the NCLEX using one of three rules:

    1. 95% Confidence Interval Rule
    2. Maximum-Length Exam Rule
    3. Run-out-of-time (R.O.O.T.) Rule

    See the links for helpful videos...the number questions you had does not determine whether you passed or failed.

    Question: Is it true that candidates who receive the minimum number of items and the last item is "easy" will fail the examination?
    Candidates cannot reliably identify which items are easy and which are difficult with regard to the NCLEX scale. At the end of an examination, a candidate is usually receiving items that they have approximately a 50% chance of answering correctly. Typically, candidates regard items that they can answer correctly only half the time as difficult. The candidate's sense of what is easy and what is difficult is relative to their ability. Because the examination is adaptive, both high and low ability candidates will think the items at the end of the exam are challenging.

    Question: If a candidate fails with 75 items, does this mean they did very poorly?
    This means that it took only the minimum number of items for the scoring algorithm to determine with 95% certainty that the candidate’s nursing ability was below the passing standard.

    Question: If a student runs out of time, why are only the last 60 items looked at?
    To ensure adequate content coverage, candidates must answer at least 60 operational items to pass the NCLEX. To be consistent with the minimum number of items required to pass the NCLEX, the run-out-of-time stopping rule reviews candidate’s ability estimates on the last 60 operational items answered.

    Question: Is it possible for the LPN/VN examination to end before 85 items or the RN to end before 75 items?
    No, this is not possible. The LPN/VN examination length ranges from 85-205 items. The RN examination length ranges from 75-265. It is possible, however, for a candidate to be administered fewer than the minimum amount of items and to run out of time. In that case the candidate would not pass because they did not receive a complete examination.

    Question: Are candidates randomly selected to receive maximum length examinations?
    Items are administered following the principles of CAT. Candidates are NOT randomly selected to receive a designated number of examination items. As a candidate takes the examination, items are selected based on the candidate's response to previous items. The exam ends when it can be determined with 95% confidence that a candidate's performance is either above or below the passing standard, regardless of the number of items answered or the amount of testing time elapsed (six-hour maximum time period for the NCLEX-RN examination and five hour maximum time period for the NCLEX-PN examination).

    Question: Do candidates have to know and answer all items in a test plan category correctly?
    Candidates do not need to answer all items in a particular test plan category correctly to pass the NCLEX. The NCLEX is a prelicensure assessment used to identify candidates that can demonstrate sufficient nursing ability to practice entry-level nursing. Pass/fail decisions on the NCLEX are based on global entry-level nursing competence, not by subtest areas.

    Question: On the Candidate Performance Report (CPR), what does “Near the Passing Standard” mean statistically?
    “Near the Passing Standard” means that the scoring algorithm is not able to determine with 95% certainty whether a particular candidate’s ability estimate is clearly above or clearly below the passing standard in a content area. In other words, the candidate’s 95% confidence interval for his/her ability estimate encompasses the passing standard.

    Source: How the NCLEX Works | NCSBN

    Question: What are the cognitive levels of the test items on the 2013 NCLEX-RN® Test Plan?
    Since the practice of nursing requires the application of knowledge, skills and abilities, the majority of items on the examination are written at the application or higher levels of cognitive ability using Bloom’s taxonomy and revised taxonomy (Bloom, 1956; Anderson and Krathwohl, 2001). These “higher level” items require more complex thought processing and problem solving. For example, a pediatric client undergoing a medical procedure may additionally have a mental illness and therefore all factors must be considered in order to prepare the client for the procedure and to correctly answer the item.

    Question: What percentage of test items are allocated for nursing practice specialty areas such as Pediatric Nursing?
    The framework for the test plan is based on “Clients Needs”; therefore, it is not possible to specify the percentage of test items that address a particular nursing specialty such as Pediatric Nursing. Nursing content related to this nursing practice specialty can be found in many areas of the test plan. At first glance, it may seem as though the only test plan category to assess Pediatric Nursing competencies is the “Health Promotion and Maintenance” category where age-related activities are specified; however, a more detailed analysis reveals that many test plan areas address the care competencies required for Pediatric Nursing. It should be noted that there are similar analogies for other nursing practice specialties and sub-specialties such as Psychiatric Nursing and Geriatric Nursing.

    Source: Preparing Students for the NCLEX | NCSBN

    Question: When will I get my results?
    Candidates whose board of nursing participates in the Quick Results Service* can receive their ‘unofficial’ results 48 hours after their exam date and time (a fee is required). Official exam results are available only from the boards of nursing/regulatory bodies (BONs/RBs) and will be mailed to candidates approximately six weeks after taking the exam. Pearson VUE and NCSBN do not provide exam results. *only applies to candidates seeking licensure in the U.S.

    Links to all BON/RB websites and contact information are available on the Contact a BON/RB page.

    For more information about getting NCLEX results, visit the Results Reporting section.

    Question: If I fail the NCLEX, when can I take it again?
    Candidates must wait a minimum of 45 days between each exam. This length of time is determined by the board of nursing/regulatory body (BON/RB)s validity dates. The NCSBN retake policy allows candidates to retake their exam 45 days after administration of their exam. Candidates who have applied for licensure/registration with a participating BON/RBday period, unless limited to fewer retakes by the desired jurisdiction of licensure/registration. Candidates are encouraged to contact the BONs/RBs for their policy on NCLEX retakes.

    Once you reregister for the NCLEX, the length of time determined by the BON/RB will be reflected in the new ATT’s validity dates.

    Question: How many times can I take the NCLEX?
    NCSBN does not limit the number of times a candidate may attempt the NCLEX. Based on its policy or law, individual boards of nursing/regulatory bodies may have additional restrictions on this basic requirement, such as longer wait time between retests and limitation on number of exam attempts. Candidates should contact their board of nursing/regulatory body for exam retake rules specific to that jurisdiction.

    Question: Have any studies been done on how long a candidate waits after completing a nursing program and the chances of passing/failing the exam?
    See the research study on NCLEX Pass Rates: An Investigation Into the Effect of Lag Time and Retake Attempts.

    Question: What is the average number of items tested per candidate?
    In 2012, the average number of items (questions) administered per candidate was around 119 on the NCLEX-RN and 117 on the NCLEX-PN.

    Question: What is the average length of candidate exam?
    Currently, an average RN exam lasts for 2.5 hours and an average PN exam lasts for 2.3 hours.

    Question: How many candidates run out of time?
    Currently, about 2% of NCLEX candidates run out of time on their exams. This percentage has been consistent since 2005. The run out of time rates are similar for the NCLEX-RN and NCLEX-PN.

    Find more information about how CAT determines a pass or fail result when a candidate runs out of time.

    Question: How many candidates receive the maximum number of items
    About 20% candidates receive the maximum number of items: 265 items for the NCLEX-RN exam and 205 items for the NCLEX-PN exam.

    Question: What are the current statistics of the likelihood to pass the NCLEX on 2nd, 3rd and 4th attempts?
    A research study addressing the relationship between retake attempts and NCLEX performance was published in JONA: Healthcare, Law, Ethics and Regulations. Bibliography of this study is as follows:

    Woo, A., Wendt, A., & Liu, W. (2009). NCLEX pass rates: An investigation into effect of lag time and retake attempts. Journal of Nursing Administration: Healthcare, Law, Ethics, and Regulation, 11(1), 23-26.

    Source: https://www.ncsbn.org/2321.htm

    Question: Is it true that the screen just stops without specific indications that the exam is completed?
    No. There is a message that appears on the candidate’s computer screen, which states “Examination is ended.”

    Source: https://www.ncsbn.org/2325.htm

    Question: What is an alternate item format?
    An alternate item format (previously known as an innovative item format) is an exam item, or question, that uses a format other than standard, four-option, multiple-choice items to assess candidate ability. Alternate item formats may include:
    • Multiple-response items that require a candidate to select two or more responses
    • Fill-in-the-blank items that require a candidate to type in number(s) in a calculation item
    • Hot spot items that ask a candidate to identify one or more area (s) on a picture or graphic
    • Chart/exhibit format where candidates will be presented with a problem and will need to read the information in the chart/exhibit to answer the problem
    • Ordered Response items that require a candidate to rank order or move options to provide the correct answer
    • Audio item format where the candidate is presented an audio clip and uses headphones to listen and select the option that applies
    • Graphic Options that present the candidate with graphics instead of text for the answer options and they will be required to select the appropriate graphic answer

    Any item formats, including standard multiple-choice items, may include multimedia, charts, tables or graphic images.

    Question: Is there a certain percentage of alternate items on the NCLEX examinations?
    There is no established percentage of items with alternate formats that will be administered to candidates. The NCLEX examination is computer adaptive and items are based on the candidate’s ability. There are alternate item types in all areas of the test plan, across all difficulty levels.

    Question: Is it true that if a candidate misses any medication calculation questions they will automatically fail the NCLEX?
    It is NOT true that if a candidate misses a calculation item they will automatically fail the NCLEX examination. All items "count" the same.

    Questiono multiple response items have less than 3 correct responses?
    Multiple response items are described as having five or six options with a minimum of two correct (key) options. Items contain the statement “Select all that apply”. At this time, NCSBN requires the candidate to utilize their comprehensive knowledge to determine the appropriate amount of applicable maximum correct answers to each item. In short, we disclose how many, at a minimum can be correct; however, we do not disclose how many at a maximum may/may not be correct.

    Source: https://www.ncsbn.org/2334.htm

    I hope this is helpful.

  • Oct 28

    I will point out that for people with kidney stones especially, foley insertion or even being straight cathed can cause the ureter to spasm which is very uncomfortable.

  • Oct 21

    Quote from GOMER-RN
    Does anyone have any advice on how to help a new RN tone down the attitude and learn how to be a good nurse without alienating staff.
    Quote from GOMER-RN
    This RN was previously employed in our department as a tech, and while the RN has learned a lot about the department, they did so in a non-nursing role.
    I'm not sure if this new grad is "one of those" but some techs think there is not much difference between a tech and a nurse and they think they can actually be an RN..."it's not so hard...they get paid more to do the same thing..." Common thought among some techs I've worked with. They fail to recognized the level of responsibility we have and the stress we are under. I'm sure you realize this already.


    Quote from GOMER-RN
    The RN has a tremendous amount of potential, but lacks the critical thinking, knowledge and skills that comes from on-the job training and doing in the RN role.While this RN lacks the critical thinking, knowledge, skills and prioritizing (just to name a few), what this RN does not lack is a tremendous sense of self and an overwhelming cockiness that is not well-received on the unit. This RN has already reported several senior nurses for what the RN deemed were "breeches in protocol" when, in fact, the senior nurses were 100% correct for the way they cared for their patients, this RN was just not aware of different techniques used by nurses for many years. This new RN has already made very unprofessional comments and has degraded the techs and some new nurses in the department in numerous ways.This nurse may possess some good theoretical knowledge learned in school and may have some good clinical skills, but I fear that the attitude of "I don't need to see this or that because I've already been there or done that as a tech" is going to be to the detriment of the patient.

    I think that with this particular new nurse you have to be very very direct about what your expectations are. He may be so caught up in himself that unless communication is direct, it will go right over his head. You need to have a little sit down with him (as others have suggested) in private or maybe go outside. It should be in the form of a heart head heart sandwich. Has your workplace made you watch those silly customer service videos?

    My conversation with such an orientee would start like this:

    **Person's Name**, can I talk to you? I need you to hear me out and then comment

    **Person's name**, you have a lot of potential. I see a great nurse in you. But you really really need to calm down on the attitude. It's not appealing. It's not appealing to me, it's not appealing to your colleagues, and it's not appealing to **Manager's name**. You've been a tech, you know how this ED flows, that's great and that's to your advantage. However, you aren't a tech anymore. You're an RN and you need to start thinking like one and acting like one. I'm here to help you. I've been an ER nurse for 13 years and I've learned some things along the way. I'm here to help you become independent and get off orientation practicing safely. I want you to be a good nurse, but I don't want you to alienate your colleagues on the way. Reporting the nursing practice of experienced nurses is not a good start. You are a new grad. You need to solidify your own practice before you can critique the practice of others, including the other new grads and the other nurses here. And even when you actually know what you're doing you have to be very very careful so you don't turn people against you. You have to watch your mouth. If you piss off the techs, they won't be there when you need them. Again, I am saying this because I care and I think you're going to make a great nurse. You just need to tidy up the ends a little. I want to work with you and I want to help you succeed.

  • Oct 21

    Quote from GOMER-RN
    Does anyone have any advice on how to help a new RN tone down the attitude and learn how to be a good nurse without alienating staff.
    Quote from GOMER-RN
    This RN was previously employed in our department as a tech, and while the RN has learned a lot about the department, they did so in a non-nursing role.
    I'm not sure if this new grad is "one of those" but some techs think there is not much difference between a tech and a nurse and they think they can actually be an RN..."it's not so hard...they get paid more to do the same thing..." Common thought among some techs I've worked with. They fail to recognized the level of responsibility we have and the stress we are under. I'm sure you realize this already.


    Quote from GOMER-RN
    The RN has a tremendous amount of potential, but lacks the critical thinking, knowledge and skills that comes from on-the job training and doing in the RN role.While this RN lacks the critical thinking, knowledge, skills and prioritizing (just to name a few), what this RN does not lack is a tremendous sense of self and an overwhelming cockiness that is not well-received on the unit. This RN has already reported several senior nurses for what the RN deemed were "breeches in protocol" when, in fact, the senior nurses were 100% correct for the way they cared for their patients, this RN was just not aware of different techniques used by nurses for many years. This new RN has already made very unprofessional comments and has degraded the techs and some new nurses in the department in numerous ways.This nurse may possess some good theoretical knowledge learned in school and may have some good clinical skills, but I fear that the attitude of "I don't need to see this or that because I've already been there or done that as a tech" is going to be to the detriment of the patient.

    I think that with this particular new nurse you have to be very very direct about what your expectations are. He may be so caught up in himself that unless communication is direct, it will go right over his head. You need to have a little sit down with him (as others have suggested) in private or maybe go outside. It should be in the form of a heart head heart sandwich. Has your workplace made you watch those silly customer service videos?

    My conversation with such an orientee would start like this:

    **Person's Name**, can I talk to you? I need you to hear me out and then comment

    **Person's name**, you have a lot of potential. I see a great nurse in you. But you really really need to calm down on the attitude. It's not appealing. It's not appealing to me, it's not appealing to your colleagues, and it's not appealing to **Manager's name**. You've been a tech, you know how this ED flows, that's great and that's to your advantage. However, you aren't a tech anymore. You're an RN and you need to start thinking like one and acting like one. I'm here to help you. I've been an ER nurse for 13 years and I've learned some things along the way. I'm here to help you become independent and get off orientation practicing safely. I want you to be a good nurse, but I don't want you to alienate your colleagues on the way. Reporting the nursing practice of experienced nurses is not a good start. You are a new grad. You need to solidify your own practice before you can critique the practice of others, including the other new grads and the other nurses here. And even when you actually know what you're doing you have to be very very careful so you don't turn people against you. You have to watch your mouth. If you piss off the techs, they won't be there when you need them. Again, I am saying this because I care and I think you're going to make a great nurse. You just need to tidy up the ends a little. I want to work with you and I want to help you succeed.

  • Oct 21

    Quote from GOMER-RN
    Does anyone have any advice on how to help a new RN tone down the attitude and learn how to be a good nurse without alienating staff.
    Quote from GOMER-RN
    This RN was previously employed in our department as a tech, and while the RN has learned a lot about the department, they did so in a non-nursing role.
    I'm not sure if this new grad is "one of those" but some techs think there is not much difference between a tech and a nurse and they think they can actually be an RN..."it's not so hard...they get paid more to do the same thing..." Common thought among some techs I've worked with. They fail to recognized the level of responsibility we have and the stress we are under. I'm sure you realize this already.


    Quote from GOMER-RN
    The RN has a tremendous amount of potential, but lacks the critical thinking, knowledge and skills that comes from on-the job training and doing in the RN role.While this RN lacks the critical thinking, knowledge, skills and prioritizing (just to name a few), what this RN does not lack is a tremendous sense of self and an overwhelming cockiness that is not well-received on the unit. This RN has already reported several senior nurses for what the RN deemed were "breeches in protocol" when, in fact, the senior nurses were 100% correct for the way they cared for their patients, this RN was just not aware of different techniques used by nurses for many years. This new RN has already made very unprofessional comments and has degraded the techs and some new nurses in the department in numerous ways.This nurse may possess some good theoretical knowledge learned in school and may have some good clinical skills, but I fear that the attitude of "I don't need to see this or that because I've already been there or done that as a tech" is going to be to the detriment of the patient.

    I think that with this particular new nurse you have to be very very direct about what your expectations are. He may be so caught up in himself that unless communication is direct, it will go right over his head. You need to have a little sit down with him (as others have suggested) in private or maybe go outside. It should be in the form of a heart head heart sandwich. Has your workplace made you watch those silly customer service videos?

    My conversation with such an orientee would start like this:

    **Person's Name**, can I talk to you? I need you to hear me out and then comment

    **Person's name**, you have a lot of potential. I see a great nurse in you. But you really really need to calm down on the attitude. It's not appealing. It's not appealing to me, it's not appealing to your colleagues, and it's not appealing to **Manager's name**. You've been a tech, you know how this ED flows, that's great and that's to your advantage. However, you aren't a tech anymore. You're an RN and you need to start thinking like one and acting like one. I'm here to help you. I've been an ER nurse for 13 years and I've learned some things along the way. I'm here to help you become independent and get off orientation practicing safely. I want you to be a good nurse, but I don't want you to alienate your colleagues on the way. Reporting the nursing practice of experienced nurses is not a good start. You are a new grad. You need to solidify your own practice before you can critique the practice of others, including the other new grads and the other nurses here. And even when you actually know what you're doing you have to be very very careful so you don't turn people against you. You have to watch your mouth. If you piss off the techs, they won't be there when you need them. Again, I am saying this because I care and I think you're going to make a great nurse. You just need to tidy up the ends a little. I want to work with you and I want to help you succeed.

  • Oct 15

    I think that careerwise, LTC is better than a non nursing job. Please recognize that LTC has lots to teach every nurse, even those coming from acute care.


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