ReWritten, BSN, RN 2,955 Views
Joined: Jun 21, '08;
Posts: 70 (27% Liked)
; Likes: 49
Did you just get a night shift position and are curious? I've been working for only 3 months on a med-surg floor in a country hospital, so I'll share how it works at our place...
1. Do you find that certain problems can only be addressed by the attending during the day? You learn to prioritize of what is important. My patient last night wanted Dulcolax at 1 in the morning. I'm not going to call and wake up a doctor for that. That can wait for the morning. If our patients need to be restrained, we go ahead and do it and make sure the doctor signs off in the morning. If it's not something critical, it can wait.
2. What limitations might there be by calling the physician on call vs the attending? The only one I know of, the doctor doesn't know the patient. But then again, not all the attending doctors can remember their own patients either... When you call, you just tell them about the patient to get an idea for an order, and sometimes you can make suggestions of what to be ordered. The attending can change it in the morning if he/she desires.
3. Has the attending made comments about orders written by the on-call that is inappropriate for the patient? Nothing I've seen. They'll come by and just change the order if they don't like it. I have seen "arguments" written in orders between doctors, so that's kind of funny...
4. What labs will you call on vs. leave for the attending (besides critical values) for the morning. We only call on critical values or if the doctor specifically states in orders to call him about results.
5. Do you know how the day shift works- Like when the patient can expect to see PT or other consults? Me personally, not really. I just know roughly when breakfast is served, when the doctors arrive on the floor, and typically the patient will know what time they'll have surgery.
6. Is it okay to administer antibiotics without waking a patient and informing them? Yes. They're scheduled... I'm in there at all all sorts of crazy times to give it to them. I try not to wake the patient, so I'll come in, hang it, and leave. Very rarely is a patient going to refuse an antibiotic, they know they need it.
7. Patients who ask for pain pills, a sleeping pill and something for their nerves- how do you approach that? If it's ordered for them, give it to them. If it's not ordered, call the doctor to get an order. Don't leave your patient there suffering just because it's not on their MAR. However, if it's not time to get another pain pill, we'll try to make the patient more comfortable, or give them a cool wet wash cloth to try and ease them. If they already had a sleeping pill, see if they can have a pain pill that might help.
wow. Reading some of these makes me sooo jealous. 32 bed M/S unit. I typically get 5 pts, the most I've gotten was 7 (talk about feeling overwhelmed!). No secretary after 11pm, and we're lucky to have 1 aid. Only time we had 2 aids was when one was still on orientation. This is in rural Texas.
I went to nursing school in AL and got my license for TX. I had a classmate who got her license in AL and then transferred it to TX and the process was long, tedious, and frustrating. Figure out where you want to be after graduation and get licensed in that state. For me, getting licensed in AL would've been faster and cheaper, but in the long run I knew I was going to be in TX so I did that to lesson the headache.
Also, I agree with what Commuter said. However there is no way to tell you how the market will be in a few years.
here I was thinking it was just my hospital experiencing this! I didn't realize it was national. We've been out of morphine for a while (but that doesn't stop the doctors prescribing it! grrr) and I know D50 was gone for a while too.
I always dream of work after I get off shift, and usually they're more stressful than my actual shift. My coworker who has been a nurse for 4years says she still hears IVs beeping when she goes home. Typically on my days off, I sleep alot better.
I graduated in May, passed boards in June. I feel like I applied to every single new grad position I saw in Dallas and surrounding cities, and even positions that didn't specify 1yr experience required. I mostly got rejection letters if I even heard from the hospital after applying.
I ended up getting a job outside the metroplex in August without any problem, and after I was hired, I had around 3 call backs from smaller hospitals in central TX. Maybe things will be different in a year, but I don't really see that happening.
Perhaps not as exciting as ER, but what about Public Health nursing? Would that be an option?
I graduated in May... I started applying for jobs/residencies around February. I wanted to go into a residency program, but they are overwhelmed with applicants, and some programs only take about 10 people, that it almost seemed pointless to apply to them (that's just my opinion).
When June came, I just applied to open positions and was recently hired to one. My coworkers are pretty supportive and knowledgeable, so I feel like I'm getting decent on the job training now.
It's only been 2 weeks since I started working, but I work nights and I also precepted nights too. Not only is the shift differential nice, but nights have a slower pace to them. Yes, I don't have a secretary or a tech half the time, which can be frustrating, but I feel less stressed out.
Sleeping, I get home around 8 on a good day, sleep about 9-3 or 4 if I'm lucky (I haven't had a chance to buy black out curtains or cover my window up yet) and go to work. On my days off, I kind of go back to day time hours. When I asked my coworkers what they did, they too replied that they switch back to day time hours. I typically drink an energy drink around 1 or 2 to keep me through to the end.
I graduated in May, passed NCLEX in June, and I was just hired for MedSurg/Telemetry. I don't actually start for another week. It's not in the hospital I want (But hospitals in Dallas are pretty much done hiring new grads right now), nor the floor I desire, but I'm soooo thankful to get a job so quickly! Plus, I'm not terribly far from my home. I think the experience I gain on this floor will help me tons before I work myself into ER or ICU.
As my professors excitedly told my class, C's mean Continue. No use worrying about it, nursing school is quite difficult. Hiring people don't look at your grades/GPA unless you're trying to get into a residency program, than it might be an issue. Otherwise, no worries!
I failed Med-Surg 1 the first time. I felt pretty defeated and upset about it because it was the first class I had ever failed in my entire life and let nursing school be the best time for that to happen! It wasn't the fact that I didn't know the material, but because of my horrible test anxiety and my professor made the tests ridiculously hard. I think about 10 of us failed that class?
Anyway, the awful point of that was I had to wait an entire year before I could retake the class again, since it was only offered in the spring (but now they've started fall admits so the class behind me was able to be just a semester behind rather than a full year like me). So I worked on a minor in psychology and finished that.
The following spring I took the class again and passed it with flying colors, and felt much more confident in the clinical setting compared to my classmates. I also did much better on my HESIs and even got in an ICU for precepting (hard spot to get in my nursing school), and I'll graduate in 5 weeks.
The moral of the story is: even if you fail, don't beat yourself up over it because things will work out in the end as long as you stay passionate.
How does your school determine preceptor spots? My class is 130 people, and they determine ours based on our HESI scores and what clinical faculty have reported on us. The only people in my class that got L&D were people who scored extremely high in the OB HESI and did well in the class.
I personally think you should chose the one you're most interested in, that way you can get a feel if this is the area you really do want to work in after graduating. However, given the economy, you might not be hired into an OB position, as the case for my friend last year. She precepted Postpartum and ended up getting a job on a neuro floor and was completely lost for a while because she didn't precept on a med/surg floor.
Given that case, I think med/surg would be better... but really, I don't think it matters. I precepted in Neuro ICU, and I've yet to find it giving me an advantage over other applicants so far in my job search.
I just finished my preceptorship in a NeuroICU, and we had the same thing. The first time I experienced it, the pt in the room had just passed and we had taken him down to the morgue when his call light went off and no one was in there. The nurses told me that they do have a ghost in the unit. It's a female ghost (I can't remember the story), and she'll also be in rooms with patients and press call buttons when the pt is obviously unable to do so (on vent & knocked out or even one time the call button was by the sink).
I'm really not trying to be a negative nancy, but I just wanted to point out it's actually a violation of the contract you sign before taking the HESI test to share actual questions. Technically you're not even suppose to talk about the questions (of course that doesn't stop anyone), but I wouldn't want you to get in trouble by the company/your school for doing such.
That being said, good luck studying. Maybe you can talk to your professors about doing some of the case studies that Evolve offers. I've done a few and like them, and remember some of the stuff I learned from them when I was taking my HESI today.
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