gonzo1 18,734 Views
Joined Jun 8, '05.
Posts: 1,719 (46% Liked)
I agree, but I picked up a patient last night that was intubated and didn't have one. I thought that was unusual but the reporting nurse said it didn't matter.
When you're agency and/or travel nurse the charge nurses and managers will go over your charts with a fine tooth comb looking for mistakes. It's just part of the job. I (giggle) always say to myself "they're getting to see how great charting is done"
It is against the law to go and change someone else's charting so the nurse that does that is putting herself up for a big problem.
Sounds like you work in kind of a hard place.
I've used my malpractice insurance services twice. They were great and I highly recommend it to all.
I did a travel nurse contract in their ER in 2009. I loved it. For the test study up medical math, and then if you have taken CEN or TNCC etc you will do fine. I did pass it, but there is a pretty high fail rate. It's worth it, because if you have Parkland (esp ER) on your resume you can write your own ticket anywhere. At the time each nurse had between 6 and 15 or so pts. That sounds like a lot but they make it work. Parkland really respects their nurses and makes sure their doctors listen to your opinion.
I have heard that the ratios are smaller now. Also it's a teaching hospital so the residents do a lot of our work so they get the practice. But you will see a lot. My attitude was "I gotta try this" and it worked out great for me. Only place I ever cryed when it was time for me to leave. They asked me to stay, but my husband wanted to get home.
Not bad for a beginner. Usually you want to leave out stuff like who the pt is and the dx as that is already noted in chart. also you can go through and slash out most of the time you used pt as we know who you are talking about. for example just put
refused miconazole at 2100, awake, lying in bed, watching tv. you don't need to say "when I left room" you could say "lying in bed, watching tv with no needs at 2200"
you will learn to use fewer and fewer words as time goes by.
we all do
document what you see and hear. If lungs sound clear document lungs sound clear. Don't worry about using too fancy of medical language or such. Keep it simple. Remember if you don't chart it, it wasn't done.
For example, try to chart everything you do for a pt such as treatments, warm blankets, pillows, speaking to their families, doctors and any education you provide.
Just use common sense language and avoid abreviations as we are using them less now for safety sake.
Just chart what you did and when, and sometimes why.
For example: Crutch training given to pt and family, pt demonstrates safe use of cruthes.
or: 1800 ADA diet provided, pt ate approximately 90 % with assistance from wife.
Or: bedside commode provided for pt due to unsteady gait and weakness. Pt assisted to bedside commode. large bowel movement noted. pt requires assistance for hygiene
I have read a couple of books on documention and they helped a lot. Look in the nursing section at Barnes and Noble or other book stores.
I document as frequently and as much as I possibly can because this will refresh my memory on a patient if I am ever brought into court.
It also lets the higher ups know what you were doing and when so you have proof you were not eating bon/bons all night.
I have often been told I am a good documentor
I spent several years in the ER and now ICU. I have seen doctors cry, firemen cry, EMS, nurses and all the rest. At first it is hard to control your emotions, but as time goes on you learn to get the job done, then cry. I gotta say, there is nothing more gut renching then seeing a fireman cry. But I have nothing but respect for those who cry.
Most of us agree that when you don't cry anymore then you should probably get out
I was fired from my first nursing job during orientation to ER. I went to med/surg for a little over a year at a different hospital and then transferred to ER. Was there for about 5 years. Went travel nursing. Moved to another state. Started looking for ER work and got fired from an ER job after 4 weeks.
Took another travel job to get my confidence back up and went and got another ER job. Got fired from that about 4 weeks in. But the ER director told me to go ask the ICU director for a job. So I did. They hired me and I love them and they love me. Later found out that their ER hires and fires lots of people and regular employees refuse to float there because the ER nurses are mean to them.
So, my career summed up is fired 3 times. Made a DNR by a hospital x 2. Worked in over 34 ERs over the 10 year span. Most I loved and fit right in. Nursing is a strange, but wonderful world. There is not just one, but several places that are dying to have you. Neither of you know it yet though.
What helped me is that I had worked so many places, for so long that I did have wonderful references. I can also always fall back on travel nurse jobs if I want to.
Trust me, getting fired was devastating for me, but I did sit back and reflect on what I could have changed to keep from being fired and I actually identified a few things.
The nice thing about getting fired as a new grad on orientation is you just tell the next place that the last place wasn't a good FIT. That's what I did. I have some friends that went through 4 and 5 jobs the first 2 years because nothing worked for them.
I hope that as the years go by you will find nursing turned out to be wonderful for you, like it has been for me. One last thing. A couple of my favorite nurses that are now "way up" in nursing were initially told by people that they were losers and would never be nurses. So keep working at it.
I've done quite a bit of agency and travel nursing ER. As a travel nurse you will be expected to get TNCC, ACLS, PALS etc on your own. Your travel agency is not going to help you. You are expected to hit the ground running and may only get a 4 hour orientation at each new location. Some places I got no orientation.
You will also have to have a physical before each contract, provide immunization records and get a pee test. You will become very adept at taking care of things yourself.
I suggest you get a copy/printer/fax machine because you are going to be sending records back and forth to agencies like crazy.
It was very educational and I gained enormous experience. It can be fun and it can be miserable. Enjoy the ride.
If my patients make it to 705, warm, pink and dry.
All the other things listed make it a great shift.
I always steer away from people who make statements like, "I always say." Mental health issues run the course from someone who is afraid of spiders, to psychopaths. I think we would be hard pressed to find anyone that doesn't have some sort of at least small fear or phobia. I work ICU, ER and psyche and have seen nutsy nurses in all these positions.
From my experience a person who is really mentally ill won't stay in psyche nursing very long because they aren't really there for the patients, but to help themselves. I've seen a couple who only lasted a few months. Just like all other types of nursing there are all kinds of nurses who work psyche, some are extremely well adjusted people from normal homes and some have issues of their own. It's this mix of personalities that make for a strong unit where everyone can learn and grow.
EKUGRAD, you sound like an awesome person and they are lucky to have you.
You need to do something about this right away. If you have signed wastes for this nurse you are going to be investigated as well as him because it is highly suspicious looking that these meds are being pulled out twice and one wasted. Even one incidence of this is highly suspicious. You will be investigated too when pharmacy notices this, and they will.
You have put your license on the line.
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