Back on med/surg after 15 years

[unknownjulie]

So, just to underline how clueless I am . I did not even know there was a chamber to look at. I'll go find one the next time I work and take some time actually looking at it! Thanks!

[guest52816]

So, just to underline how clueless I am . I did not even know there was a chamber to look at. I'll go find one the next time I work and take some time actually looking at it! Thanks!

I am talking about the sticks that come in PICC dressing change kit.

It is clear, plastic, with a rounded tip, that you use to clean area.

The rounded tip, is the chamber.

[Swellz]

You'll catch on to all that nonsense in no time. There's no replacing the experience you have, even if others don't appreciate it. I'll come work with you and you can teach me things lol.

[JKL33]

Wow, this job is hard! I hit the wall this week. I made it through my two, 12 hour shifts but I feel just barely. The first night it was almost 9pm and then I had to go back the next day. Not only am I working these insane hours, but I am also trying to take care of my two remaining kids at home that are 10 and 11.

Things are just so strict now in the hospital. While being preoccupied with scanning things multiple times and asking double identifiers to the patients I am having trouble finding the time to really consider "does this patient need this med? And should I be giving it?". For instance, a big dose of Levimer being ordered order along with scheduled humalog, along with sliding scale humalog for someone on a diabetic clear liquid diet that might go to surgery later...Plus the shot of heparin....Everything scanned, but I sure as heck didn't give any of it. And then overdoing the IV fluids and noticing the pedal edema creeping up.... All the calls to the doctors basically telling them what to do. Which I am happy to do, but my actual job and focus is scanning the meds and giving the meds! I don't really have time to be constantly rearranging things! And what I mean when I say this is that "the management focus is on the scanning and documentation" but MY preferred focus is on the actual patient health. There just isn't enough time.

I did have trouble this week also. It involved accessing what I would call a "port-a-cath" but evidently, they are now called "infusa-ports". The needles and dressing are just totally different. I'm used to dressing changes of central lines using betadine, and my young preceptor appears to think I'm an idiot for even thinking this. I didn't know how to pop the chlorhexadine stick, did not know to shake it, and did not know I had to forcefully press down while trying to use it. Then I caught her talking about me at the nurses station basically mocking me in the presence of other staff. I was so tired all I said was, "Don't make fun of me too much". Which really wasn't terribly assertive... I probably should have said something like, "You know, everyone can hear you talking"...Oh, it was awful... Also, I am used to feeling the needle hit the metal at the back of the port and that's how I know I've advanced the needle enough. I don't know if they are made of cheap plastic now or what, but my preceptor didn't even know what I was talking about...

There are some older nurses on my unit that I am connecting with more, since I've been there awhile. It seems like tons of new grads and then, my unit appears to actively trying to recruit us older/experienced nurses- so they have a mix. it's nice to be able to joke about carrying insulin vials around in our pocket for our 4 labile diabetic patients with people who understand how things used to be. Never policy, but what you actually used to do to get the job done...

I'm getting through it. Taking longer than I thought it would... Thanks for the supportive messages!

Good observations.

Re: the gossip incident - you said just the right thing. Don't get snarky with people like this; never lower yourself to others' level. Seriously. Who in their right mind feels superior because they know about some minor thing that someone who has never seen it before doesn't know about (like chlorhexadine sticks/swabs)? Please.

Re: things I italicized. My friendly advice would be to make sure you aren't talking too much. Come here to document your experiences as you have been, or else keep a diary - but don't hand people fodder for gossip on a silver platter. Just don't give them anything to pick apart or stand around tee-hee-ing about. Also, make sure you aren't being self-deprecating with the things you do choose to say out loud. Humility is good. Self-deprecation is often insecurity, though. So "zip it." :)

Hustle. Be conscientious (as it sounds like you are), and avoid any verbal diarrhea about the way things used to be.

Will look for the next installment.

[unknownjulie]

Another week gone. This orientation just will not end. I am working four 12's every week.

I wrote longer post but was not still signed in, did not have the presence of mind to screenshot it, and I lost it.

Anyhow, the claves, claves, claves.... Something I am not used to working with or calling by name. My primary IV tubing has been changed. My rollerclamp has been taken away and I can never get it to prime right. I no longer have the distal port to use for slow IV meds. The one between the patient and the pump.

I am taking care of 5 patients with the help of my preceptor. I have no idea how I will every care for 6 or 7 complex medical patients. The phone is new that i have to carry around, and it never stops ringing...

It is almost like slow-motion torture. I can't just go into a room and hang an IV med, assess everything, program the pump and walk out. There are 10 extra steps inbetween being able to actually get anything done. I am speaking about the computer and scanning of course...All the math done for me and each screen to page through to review it all...

There are less med errors that is for sure!! I couldn't make a mistake even if I tried to!

Anyhow, I am trying hard to be patient and I know I will get up to speed eventually!

The young women who seem to be the ones using the narcotics and benzo's are still haunting me. Liver/kidney failure and early dementia. I hate to see this happening with so many young people. Maybe men are doing the same things, but I am not seeing them on my unit. Perhaps the women are hit especially hard by this type of drug abuse. So so sad.

[TinyDancer01]

Sounds overwhelming! How awful about the drug issues. My daughter in law works on a step down unit where half the people are admitted due to drug related issues. Very sad indeed and scary. Are you still glad you jumped back into this? Please let us know the parts you are enjoying! Still trying to decided if I want to come back or not. Thanks for sharing!!

[DowntheRiver]

I'm in my early 30's and I would not have been able to pass that physical. That physical sounds ridiculous.

[unknownjulie]

Yes, I'm glad I am doing this! I am bored to tears at my other sit-down job. I like the variety and the exercise. One day a week should be good, and I also like feeling like "I have options". I was really worried I'd never get back into an acute medical unit again!

[jag nurse, RN]

Another week gone. This orientation just will not end. I am working four 12's every week.

I wrote longer post but was not still signed in, did not have the presence of mind to screenshot it, and I lost it.

Anyhow, the claves, claves, claves.... Something I am not used to working with or calling by name. My primary IV tubing has been changed. My rollerclamp has been taken away and I can never get it to prime right. I no longer have the distal port to use for slow IV meds. The one between the patient and the pump.

I am taking care of 5 patients with the help of my preceptor. I have no idea how I will every care for 6 or 7 complex medical patients. The phone is new that i have to carry around, and it never stops ringing...

It is almost like slow-motion torture. I can't just go into a room and hang an IV med, assess everything, program the pump and walk out. There are 10 extra steps inbetween being able to actually get anything done. I am speaking about the computer and scanning of course...All the math done for me and each screen to page through to review it all...

There are less med errors that is for sure!! I couldn't make a mistake even if I tried to!

Anyhow, I am trying hard to be patient and I know I will get up to speed eventually!

The young women who seem to be the ones using the narcotics and benzo's are still haunting me. Liver/kidney failure and early dementia. I hate to see this happening with so many young people. Maybe men are doing the same things, but I am not seeing them on my unit. Perhaps the women are hit especially hard by this type of drug abuse. So so sad.

I feel for you. We truly are expected to do SO much. The incessant phone ringing, everyone on bed alarms, multiple steps to do, for what should be something simple...I get it. It's tough, and it's overwhelming. I don't think the powers that be--the rule makers--have been on the floor in awhile. We're just expected to do more and more, and we had better never make a mistake!

Believe me, we are all rootin' for ya and can relate. Keep us posted!

[unknownjulie]

Two more weeks have gone by and I am still not off orientation! Had I known how difficult this was going to be, I am not certain I would have done it. I am still making rookie mistakes.

I did not know that ALL "U/A's" are now "U/A, CNS's". I did not know how to print the labels or a fix them, or how the bar codes go etc. Just clueless. Something that used to be so simple. Just getting a urine sample out of a hat has turned into a multistep process, that must be learned and remembered.

I am taking care of 5-6 patients mostly alone, but do not have time to take any type of break, and it appears none of us really do. We have the phone with us 100% of our shift, so that says it all. Of course, we also are required to punch in and out so it appears a break was taken. This work environment will hopefully be ok for one day a week once I get up to speed. Sometimes we have 7 patients each though. No way I could ever do this fulltime. I would get sick or injured. And I still may not be able to even hack one day per week. I pretty much have a constant migraine on work days. I wonder if feeling competent in the past was just a dream, another person perhaps...

Anyhow, back to reality. I am noticing many small hospitals going out of business. With the Baby Boomers finally retiring en mass, I wonder if the entire system is about to collapse. Nurse staffing cannot possibly be cut any further. There are no more cuts to make. There are still pockets of wealth where hospitals can make money, but with the scrutiny on insurance payments, and the numbers of Baby Boomers that will require care, I just wonder what will happen. I just wish we had a comprehensive national system of clinics to provide at least a low level of care to everyone. People who want a private room could pay for it, but allow the rest of our inhabitants at least some basic level of care with everyone provided for. Forget about trying to make money off the sick. Just such a wrong philosophy.

I hope you all are surviving your workweek!

[guest52816]

Two more weeks have gone by and I am still not off orientation! Had I known how difficult this was going to be, I am not certain I would have done it. I am still making rookie mistakes.

I did not know that ALL "U/A's" are now "U/A, CNS's". I did not know how to print the labels or a fix them, or how the bar codes go etc. Just clueless. Something that used to be so simple. Just getting a urine sample out of a hat has turned into a multistep process, that must be learned and remembered.

I am taking care of 5-6 patients mostly alone, but do not have time to take any type of break, and it appears none of us really do. We have the phone with us 100% of our shift, so that says it all. Of course, we also are required to punch in and out so it appears a break was taken. This work environment will hopefully be ok for one day a week once I get up to speed. Sometimes we have 7 patients each though. No way I could ever do this fulltime. I would get sick or injured. And I still may not be able to even hack one day per week. I pretty much have a constant migraine on work days. I wonder if feeling competent in the past was just a dream, another person perhaps...

Anyhow, back to reality. I am noticing many small hospitals going out of business. With the Baby Boomers finally retiring en mass, I wonder if the entire system is about to collapse. Nurse staffing cannot possibly be cut any further. There are no more cuts to make. There are still pockets of wealth where hospitals can make money, but with the scrutiny on insurance payments, and the numbers of Baby Boomers that will require care, I just wonder what will happen. I just wish we had a comprehensive national system of clinics to provide at least a low level of care to everyone. People who want a private room could pay for it, but allow the rest of our inhabitants at least some basic level of care with everyone provided for. Forget about trying to make money off the sick. Just such a wrong philosophy.

I hope you all are surviving your workweek!

I wish you were having an easier time at work, but know that your experience is typical.

It is why I do NOT miss working med-surge.

My current job, at a subacute rehabilitation hospital, isn't a walk in the park, but it is doable.

We do not carry phones, even though I sometimes wish we did.

There are no ED admissions.

But there are other issues to deal with.

You must understand that there are simply no good nursing jobs.

I have worked psych, med-surge and now rehabilitation, during my two-year tenure as a nurse.

None of these jobs have been enjoyable. But med-surge was by far, the LEAST enjoyable.

Continued best wishes. You CAN do this, if you want to.

I truly believe a person can put up with just about anything for 12 hours.

While it will get easier, it will never be enjoyable.

Keep us posted!

[guest52816]

I would also warn you again working off the clock.

Should you get hurt, WC will not cover you, as you were off the clock.