If you don't know...please ask!

franciscangypsy · Dec 21, 2010

You want to bring the BS down slowly and controlled... if it comes down too quickly it can cause cerebral edema. We have an endocrinologist that has us actually hang a D5 gtt with an insulin gtt once the BS gets into a certain parameter to prevent this from happening.

I didn't know that. Thanks for sharing.

Ariyala · Dec 21, 2010

I agree 100%!! No one knows everything, and we can't remember everything, ask ask ask!!!!!!!

carolmaccas66, BSN, RN · Dec 21, 2010

OK I'm going to put the cat amongst the pigeons with my answer. Feel free to criticise!

I work as an agency nurse. I go to anywhere & everywhere & was told by some UNREALISTIC agencies that we should know everything. Now, I have worked with RNs who have 30-40 or even 50 years experience who do not know 'everything' & have admitted as much. Most go into a specialty & learn more about that area than anywhere else.

I have done odd shifts in the ED/ER or specialty wards, & have ALWAYS TOLD the agency that no I don't have much or any experience in such and such an area but hospitals take u as they are so short staffed. And every ward/hospital has their own procedures they like followed which as agency RNs, we are not always briefed about as there simply isn't time for a long orientation (often there's no orientation at all, as it's too busy. We're just expected to pick it all up as we go along).

Then when I do get on the floor & ask the shift coordinator (usually a clinical nurse or senior RN, or a clinical nurse specislist/clinical nurse coordinator), questions they either look at me like I'm a total moron & make nasty, acerbic remarks to my face (which I DO NOT tolerate), or complain loudly and constantly, so anyone can hear, that they wanted 'an experienced nurse in that particular area'. More than once I have had to pull these nurses aside & tell them to take it up with their nurse manager or the agency, NOT me, & I threaten to leave the shift but funny, they always say no as they are too busy.

So MAYBE, just a suggestion here folks! you all have to look at how you treat other staff and the way in which u answer a question (not just talking agency here). And also, don't blame me if your nurse manager cannot get her staffing priorities right, or can't find a more experienced RN for ur shift. Contact the NM/agency first to find out the story, then talk to the nurse in question.

If we do float (some nurses I know work for hospitals and just float to different areas), the nurses in one particular area could perhaps help out by being more approachable & ask: 'What has ur training covered, do u know about these particular types of pumps?' or whatever it is, & quickly go thru their procedures.

And please, please DON'T talk to other people like they're idiots!! It's extremely humiliating when other staff can overhear & smirk when ur putting us down. Just try to be helpful and go thru the procedure/s with us once, then check if everything is OK.

And please also don't keep saying: 'I'm 2 busy to show u this particular thing'. If ur not happy with the nurse, take it up with ur NM or shift coordinator and let them know ur concerns who can then speak to the staff member. Maybe the nurse in this particular incident felt too timid to ask anything, because the nurses in ur area were too aggressive (as they usually are when they've worked in one area for a long time). No-one likes newcomers much.

Remember, we come on these shifts to help you, not to be blamed for everything and anything.

And I also challenge anyone to post on here that 'they know everything' about nursing. No, you don't, and I will argue with you anyday about it. You may know a lot about your area, and u should be helping out anyone who comes on to help YOU, by asking them questions re their knowledge.

Every RN has different experiences and levels of knowledge, & we should all be helping each other out whatever area we are in, or are sent to.

And perhaps this particular nurse needed some extra assertiveness training, or had had bad experiences on other wards with aggressive nurses, did anyone think to as her why she was so timid and offer help?

GM2RN · Dec 21, 2010

OK I'm going to put the cat amongst the pigeons with my answer. Feel free to criticise!
I work as an agency nurse. I go to anywhere & everywhere & was told by some UNREALISTIC agencies that we should know everything. Now, I have worked with RNs who have 30-40 or even 50 years experience who do not know 'everything' & have admitted as much. Most go into a specialty & learn more about that area than anywhere else.
I have done odd shifts in the ED/ER or specialty wards, & have ALWAYS TOLD the agency that no I don't have much or any experience in such and such an area but hospitals take u as they are so short staffed. And every ward/hospital has their own procedures they like followed which as agency RNs, we are not always briefed about as there simply isn't time for a long orientation (often there's no orientation at all, as it's too busy. We're just expected to pick it all up as we go along).
Then when I do get on the floor & ask the shift coordinator (usually a clinical nurse or senior RN, or a clinical nurse specislist/clinical nurse coordinator), questions they either look at me like I'm a total moron & make nasty, acerbic remarks to my face (which I DO NOT tolerate), or complain loudly and constantly, so anyone can hear, that they wanted 'an experienced nurse in that particular area'. More than once I have had to pull these nurses aside & tell them to take it up with their nurse manager or the agency, NOT me, & I threaten to leave the shift but funny, they always say no as they are too busy.
So MAYBE, just a suggestion here folks! you all have to look at how you treat other staff and the way in which u answer a question (not just talking agency here). And also, don't blame me if your nurse manager cannot get her staffing priorities right, or can't find a more experienced RN for ur shift. Contact the NM/agency first to find out the story, then talk to the nurse in question.
If we do float (some nurses I know work for hospitals and just float to different areas), the nurses in one particular area could perhaps help out by being more approachable & ask: 'What has ur training covered, do u know about these particular types of pumps?' or whatever it is, & quickly go thru their procedures.
And please, please DON'T talk to other people like they're idiots!! It's extremely humiliating when other staff can overhear & smirk when ur putting us down. Just try to be helpful and go thru the procedure/s with us once, then check if everything is OK.
And please also don't keep saying: 'I'm 2 busy to show u this particular thing'. If ur not happy with the nurse, take it up with ur NM or shift coordinator and let them know ur concerns who can then speak to the staff member. Maybe the nurse in this particular incident felt too timid to ask anything, because the nurses in ur area were too aggressive (as they usually are when they've worked in one area for a long time). No-one likes newcomers much.
Remember, we come on these shifts to help you, not to be blamed for everything and anything.
And I also challenge anyone to post on here that 'they know everything' about nursing. No, you don't, and I will argue with you anyday about it. You may know a lot about your area, and u should be helping out anyone who comes on to help YOU, by asking them questions re their knowledge.
Every RN has different experiences and levels of knowledge, & we should all be helping each other out whatever area we are in, or are sent to.
And perhaps this particular nurse needed some extra assertiveness training, or had had bad experiences on other wards with aggressive nurses, did anyone think to as her why she was so timid and offer help?

Wow...huge chip on your shoulder. Maybe it's time for you to move on from agency.

The posts before yours have already agreed that no one knows everything, so we can put that argument to rest.

If the nurse in the OP had asked about the order or the proper way to titrate an insulin gtt and had gotten the types of responses you wrote about, that would be an entirely different story. The point is that she didn't ask at all.

As for your comment, "we come on these shifts to help you," well, that's not entirely true, is it? You are there for a paycheck; otherwise, you'd do it for free.

highlandlass1592, BSN, RN · Dec 21, 2010

OK I'm going to put the cat amongst the pigeons with my answer. Feel free to criticise!
I work as an agency nurse. I go to anywhere & everywhere & was told by some UNREALISTIC agencies that we should know everything. Now, I have worked with RNs who have 30-40 or even 50 years experience who do not know 'everything' & have admitted as much. Most go into a specialty & learn more about that area than anywhere else.
I have done odd shifts in the ED/ER or specialty wards, & have ALWAYS TOLD the agency that no I don't have much or any experience in such and such an area but hospitals take u as they are so short staffed. And every ward/hospital has their own procedures they like followed which as agency RNs, we are not always briefed about as there simply isn't time for a long orientation (often there's no orientation at all, as it's too busy. We're just expected to pick it all up as we go along).
Then when I do get on the floor & ask the shift coordinator (usually a clinical nurse or senior RN, or a clinical nurse specislist/clinical nurse coordinator), questions they either look at me like I'm a total moron & make nasty, acerbic remarks to my face (which I DO NOT tolerate), or complain loudly and constantly, so anyone can hear, that they wanted 'an experienced nurse in that particular area'. More than once I have had to pull these nurses aside & tell them to take it up with their nurse manager or the agency, NOT me, & I threaten to leave the shift but funny, they always say no as they are too busy.
So MAYBE, just a suggestion here folks! you all have to look at how you treat other staff and the way in which u answer a question (not just talking agency here). And also, don't blame me if your nurse manager cannot get her staffing priorities right, or can't find a more experienced RN for ur shift. Contact the NM/agency first to find out the story, then talk to the nurse in question.
If we do float (some nurses I know work for hospitals and just float to different areas), the nurses in one particular area could perhaps help out by being more approachable & ask: 'What has ur training covered, do u know about these particular types of pumps?' or whatever it is, & quickly go thru their procedures.
And please, please DON'T talk to other people like they're idiots!! It's extremely humiliating when other staff can overhear & smirk when ur putting us down. Just try to be helpful and go thru the procedure/s with us once, then check if everything is OK.
And please also don't keep saying: 'I'm 2 busy to show u this particular thing'. If ur not happy with the nurse, take it up with ur NM or shift coordinator and let them know ur concerns who can then speak to the staff member. Maybe the nurse in this particular incident felt too timid to ask anything, because the nurses in ur area were too aggressive (as they usually are when they've worked in one area for a long time). No-one likes newcomers much.
Remember, we come on these shifts to help you, not to be blamed for everything and anything.
And I also challenge anyone to post on here that 'they know everything' about nursing. No, you don't, and I will argue with you anyday about it. You may know a lot about your area, and u should be helping out anyone who comes on to help YOU, by asking them questions re their knowledge.
Every RN has different experiences and levels of knowledge, & we should all be helping each other out whatever area we are in, or are sent to.
And perhaps this particular nurse needed some extra assertiveness training, or had had bad experiences on other wards with aggressive nurses, did anyone think to as her why she was so timid and offer help?

Kudos to a much needed post. I'm a former traveler and agency nurse, I know exactly what you mean. It's a whole different level of stress..the staff nurses resent you for being there but want you there to lighten their load. You have to be assertive, confident and allegedly know everything about everything.

highlandlass1592, BSN, RN · Dec 21, 2010

Wow...huge chip on your shoulder. Maybe it's time for you to move on from agency.
The posts before yours have already agreed that no one knows everything, so we can put that argument to rest.
If the nurse in the OP had asked about the order or the proper way to titrate an insulin gtt and had gotten the types of responses you wrote about, that would be an entirely different story. The point is that she didn't ask at all.
As for your comment, "we come on these shifts to help you," well, that's not entirely true, is it? You are there for a paycheck; otherwise, you'd do it for free.

This poster does NOT have a chip on their shoulder. Have you ever worked agency, per diem or as a traveler? If not, then I respectfully submit you don't have a clue as to what it's like. There is an expectation that you "know everything". Staff nurses resent you for the mistaken impression you are making a ton of money therefore you should know "everything without my taking the time to help you". And in some instances, I was flat out refused help as staff sat on their bottom at the nursing station.

Actually, the original post contained the point that the staff member in question DID ask someone and was told it was fine. Re-read the post.

As for the comment "you're not doing this to help, you're getting a paycheck". Yes they are being paid but they are also there to help. Which is a point that seems to elude some staff...and based upon your post, you could probably be counted amongst those numbers. Agency staff should be welcomed with open arms, supported and made to feel welcome. That was what the poster was referring to. The hoops you have to go through to staff with an agency are amazing...and no matter your skill set, you are presumed to be an idiot by staff till you "prove" yourself. People can be good nurses but just aren't familiar with how "your" facility wants things done. Keep that in mind the next time you deal with someone not familiar with your unit. Trust me, they will appreciate it.

mentalhealthRN · Dec 21, 2010

Not for nothing but I doubt any of us--agency or not would work for free, no matter how much we love our jobs. lol. I am going to be "sweden" here and say I think that, yes, in this particular instance, not knowing how to read a titrate order and just ignoring it is not okay.....and yes this nurse needed to ask if not sure. That being said... I do understand the general concept that often times nurses can be not so friendly when approached with these questions and so a nurse becomes afraid to ask questions. Both parties can be guilty. It needs to work on both ends. Nurses must ask when they don't know or aren't sure and when on the other end of it and being asked questions we must never act annoyed or irritated with being asked. I know it's hard when your busy to stop and help but like someone else said we are all nurses and in this together and we have all been on both sides of a knowledge deficit.

So agency or not we all need help sometimes being reminded of how to do something.......and how much a nurse knows often has no relationship to if they are fairly new or "seasoned"....never assume. I have worked with some newer nurses who knew a hell of a lot and seasoned ones who were not so knowledgable and vice vera, you never know. I have also worked with agency nurses who needed a lot of support with what to do with the psych patients but when suddenly my patient became medically unstable they were able to jump in and taught me a few things along the way....and I was thankful. We all have to work together people. Some days we are the teacher and others we are the student.

tyvin, BSN, RN · Dec 21, 2010

"Amen" :up:

GM2RN · Dec 21, 2010

this poster does not have a chip on their shoulder. have you ever worked agency, per diem or as a traveler? if not, then i respectfully submit you don't have a clue as to what it's like. there is an expectation that you "know everything". staff nurses resent you for the mistaken impression you are making a ton of money therefore you should know "everything without my taking the time to help you". and in some instances, i was flat out refused help as staff sat on their bottom at the nursing station.
the poster in question here came across as over-reacting to the op; hence, the "chip" observation.
i have never been a traveler/agency, but i have worked per diem as a float nurse when i was brand new to the hospital, so i do know what it's like. besides, i don't live in a vacuum so i'm aware of the attitudes that some nurses have.
i didn't disagree with anything that this poster said (with one exception, see below). however, there is, and should be, the expectation that an agency nurse is competent in the area in which he/she is seeking to work. so even though no one should be expected to know "everything," the agency nurse has a responsibility to make sure he/she will be competent anywhere he/she is asked to work, or don't accept that particular assignment. now, i have no idea of the kinds of questions this poster and other individuals are asking, so this is not a comment on this individual poster's competency, but a statement regarding the expectations of agency nurses in general.
as for "making a ton of money," maybe you are and maybe you aren't; i don't care. but let's not pretend that agency nurses don't make way more per hour than most staff nurses. having said that, it shouldn't make any difference when it comes to getting any needed help.
actually, the original post contained the point that the staff member in question did ask someone and was told it was fine. re-read the post.
the nurse in question "checked" with someone else who told her "it seemed fine," but she also told the op that she didn't know how to read the order even after checking with someone else, so she obviously did not ask the other nurse how to read the order.
as for the comment "you're not doing this to help, you're getting a paycheck". yes they are being paid but they are also there to help. which is a point that seems to elude some staff...and based upon your post, you could probably be counted amongst those numbers. agency staff should be welcomed with open arms, supported and made to feel welcome. that was what the poster was referring to. the hoops you have to go through to staff with an agency are amazing...and no matter your skill set, you are presumed to be an idiot by staff till you "prove" yourself. people can be good nurses but just aren't familiar with how "your" facility wants things done. keep that in mind the next time you deal with someone not familiar with your unit. trust me, they will appreciate it.

sorry, i'm not buying the "they are also there to help" comment. while it is helpful to the other nurses when agency fills a hole so they aren't left short-staffed, i don't buy for a minute that that is the motivation for the agency nurse to be there. there is too much animosity and resentment coming through the poster's comments for me to believe that.

maybe a case could be made for wanting to be there for the patients, but if money is not a large part of the motivation to be an agency nurse for most of them, there are other options; otherwise, no one would put up with the kinds of things that this poster wrote about, and that i have experienced. that's part of why i am no longer per diem.

Ruby Vee, BSN · Dec 21, 2010

i have the utmost respect for agency nurses, float nurses and travel nurses. their specialty is learning quickly and fitting into a unit instantly, and for the most part they manage that admirably. there are a few bad apples, but then there are a few bad apples everywhere.

i have no problem answering questions about where things are and whether or not dr. x usually wants his patients extubated early. most of us don't have problems answering questions, and the few that don't seem receptive to questions may just be overwhelmed. don't let someone's perceived surliness stop you from asking questions when you need to know the answers!

mswhitern · Dec 22, 2010

MCKNIS...thank you sooooo much for sharing this with me, as a new nurse, still looking for employment, I will take this information on with me.

thanks again...

MunoRN, RN · Dec 22, 2010

Just want to throw this out there to everyone, but if you are encountering a new patient diagnosis, skill, treatment, etc. and are uncomfortable with it, please ask for help.
Case in point...was receiving a patient from another nurse (very seasoned with 20+ years of knowledge) at 1900 who was placed on an insulin gtt at 1600. The FSBG on presentation to the ER read HI and the initial blood glucose was 1250, coverage given. The gtt was started at 1600 and second blood glucose was obtained at 1710 reading 850, no coverage given. No bolus given and no change in gtt made. At 1900 go in to check FSBG, and result now is 442. Questioning nurse why no change had been made, and with a blank stare she says, "I don't know. I don't know how to read the order sheet. I checked with ****, LPN, and she said that it seemed ok." I love all of our LPNs, but since when do we check an IV gtt with an LPN? Needless to say, myself and the charge nurse sat down with this seasoned RN regarding how to read the insulin gtt order sheet.
All in all, we are in a profession of caring and preserving the lives of many. If we make a mistake, it can, and does cost people their lives. PLEASE, PLEASE if you do not know how to do something, are uncomfortable with something, speak up and ask! Asking never hurt anyone, but not asking has! No one knows everything, and some know more than others (not me), but we need to get the boldness to stand up and be patient advocates, not guessers!

I'm confused about which way you expected her to adjust the drip. It sounds as the the pt was in DKA, which should be a different insulin gtt algorithm than a regular insulin gtt protocol. If it was started at 1600 with a BG 1250, and was then 850 an hour later, we wouldn't have given coverage either, in fact we would have decreased the gtt to not exceed a BG drop of more than 200/hr. Were you upset she didn't turn it down?