LaurieEllen1973 2,131 Views
Joined: Feb 1, '10;
Posts: 33 (12% Liked)
; Likes: 8
Not sure if this will help, but I made up an example "brain" that I make for myself to keep track of my patients.
I make one of these for every patient I have, usually on the back of the MAR I print for them (that way you've got your meds with you at all times, too). Some charting systems will make lists of what you need to do over the course of the day, but I find that I remember things better if I write them down myself.
This one breaks down where I put what and explains the layout.
This one is a mock-up of a basic patient you might see using the above format.
Again, feel free to ask if you have questions!
I was physically ill most of the time as a new grad in med/surg. What helped me was to make friends anywhere I could. Let the RTs, CNAs, senior nurses, etc. know how much you appreciate them. Always ask for help or clarification when you're unsure about anything...even if you're only a little bit unsure.
You'll learn to organize and re-organize as time goes on. You'll also run into fewer things that are completely new to you and get better at navigating around those constant bumps in the road.
You can do this. Your confidence just needs time to grow.
A classmate of mine accepted a position that sounds very very similar to this. She is outrageously happy, enjoys her set hours and found she loved it even more than the bedside experiences she had in clinicals.
If jobs are scarce, you should accept it. You can continue applying elsewhere.
This isn't medical related but every time someone says "pitchers" when they are speaking of "pictures" I want to scream.
"Orientated". I got 'orientated' to my job today. Mrs. Smith is alert and 'orientated'. . .
There have been a few threads like this and it seems everywhere somebody says O2 stats!
It always irks me when people say amNiodarone instead of amiodarone, or the multiple ways in which people butcher metoprolol.
LOL!...I cannot wait to get started in E.D. Full Time in 2 weeks! Getting out of Med-Surg and going to E.D. I am sure I will get a belly full at times (like I do now), but where else other than health care can you get such a flippin' accidental comedy show?...lol!!
Just wanted to follow up to say I got the job!!!!!!!! I'm super excited!!!
Well, I called Wednesday like 5 times and finally got the nurse mgr. on the phone. She was really apologetic, saying "sorry it took so long, I actually just got your resume yesterday, you should hear from HR very soon."
I waited till Friday then called HR like 6 times, kept getting the recruiter's voicemail.
Then I got home and there was a message on my phone... I GOT THE JOB!!!!!!!
I only have to stick it out at my craphole job for a few more weeks..
Thanks so much for the replies & encouragement!:icon_hug:
My unit is 100% BMT. I typically have 3 patients on nights. I come in, get report, go through orders and results from the day. I read the MD's and NP's charting on them from that day. I look and make sure all labs I need are ordered (we have standing orders for things like glucose checks, electrolyte checks, coags, CBCs, etc).
Around 8pm I start passing 9pm meds. Many of our patients have hourly meds. It's not unusual for me to have meds due on at least one of my patients every hour throughout the night. I'd say 75% of the meds are IV. Tons of IV antibiotics, Cellcept, Tacrolimus, Cyclosporine, IV electrolyte replacement (done based on labs q12h), lasix, antiemetics, steroids, etc.
We give chemotherapy with a fair amount of frequency (as pre-transplant prep).
Most of our patients are on TPN.
We do run cardiac drips on my floor. This includes a fair amount of pressors when patients are septic. We also will run things like amiodorone and cardizem for arrhythmias, and occasionally do a drip for HTN. We also do insulin drips, occasional antibiotic drip, occasional continuous chemo, occasional continuous Tacro, occasional continuous abx. Amicar drips are another drip we see fairly often. And of course opiate drips.
Expect to give tons of blood products. Red blood cells and platelets are our friends. We also give albumin and FFP with some regularity.
We do vitals at least every 4 hours and I&Os at least every 4 hours.
Expect to have a large amount of patients on isolation. We've had times our whole unit was on isolation.
The hardest part about BMT nursing is managing lines. All of your patients will have central lines. Some will have more than one central line. Many will have a central line on one side of their chest and a mediport on the other. Some get femoral central lines and chest central lines. Some get a PICC and a central line. I often have patients with 6+ lines of central access and still have a line crunch. If your patient is getting 2 IV immune suppressants, one of those will be running at nearly all times. These generally have to run alone. Most patients have TPN. Add in electrolyte replacements, all of the antibiotics, any drips, and you're in for a fun night of checking compatibilities and switching lines over. You need to be meticulous with planning out your shift med wise and keeping your pumps and lines organized.
You'll draw more cultures than you can shake a stick at. You'll never start an IV and rarely draw blood peripherally.
One thing that's unique about BMT nursing is that your patients will be much younger than your typical oncology patient. As such, when they're feeling well, they're often quite independent and fun to be around. This is a huge plus in my mind.
Thorough assessments are huge. Things can go from good to very bad remarkably quickly. It keeps you on your toes.
For me, my nights vary wildly from the very quiet (dare I say boring?) to the can't-keep-up ones.
You'll get to know your patients very well. They'll be there for a looooonnnnnngggg time. Great if you like your patients. Bad if you don't. You'll have frequent fliers that are constantly getting readmitted.
Sepsis, electrolyte disturbances, hemorrhage, DIC, arrhythmias, anemia, thrombocytopenia- those are the main fun things we get to frequently deal with.
Keep in mind that anyone going into transplant has all of their other medical conditions they're bringing in with them. These will all get worse as they get overall more unstable. As a result, you'll deal with more variety in disease condition than you may thing.
Good luck! BMT is a frustrating and sad, but very rewarding field.
My first job after nursing school was on a BMT unit. Even though it is a highly specialized area, I had a great experience and learned a lot about both oncology and ICU nursing. We kept all our critical patients and were required to complete our hospital's critical care orientation. Therefore, I would have been qualified to apply to any critical care unit in the hospital. I easily transitioned to a general Hem/Onc unit at another hospital where I worked until I left bedside nursing. I loved BMT and would recommend it to anyone who is interested. Good luck!!!
ditto everyone else. another BS did not help me at all in the nursing world, EXCEPT at my facility those with any BS get paid $1 more per hour........so in about 50 years that degree (and student loan) will pay for itself....or something like that.
i truly don't understand why nursing does not acknowledge any other BS. seems like a narrow focus to me. anyone else know??
Ain't nobody got time for that
Due to budget cuts, the pediatric unit was forced to take overflow patients from the adult floors... and some patients were taking their room assignments quite literally.
"I'm sorry but your parents requested the alternative immunization schedule..."
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