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imaginations 4,318 Views

Joined: Apr 17, '11; Posts: 125 (20% Liked) ; Likes: 35
Registered Nurse; from AU

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  • Apr 4 '13

    Encourage the staff to invite the newbies out to post-shift breakfast or dinner. Grabbing a drink after work was a great way for me to bond with my new coworkers when I was on orientation.

  • Mar 27 '13

    No. Count. Sheet.

    Get outta there!

  • Mar 19 '13

    Agree with above that your current unit doesn't sound new grad focused, but a word of caution as you look for a new place...there is also some unspoken sense that you were doing them a favor...'moving from a large town to a small town' to take their job, along with a minimizing of the errors you made along the way. You'll want to avoid that kind of stuff as you move forward as it can come off as lacking accountability. When explaining why you are looking for something else let the new interviewer know that you learned a lot about what kind of structure you need to learn effectively. You don't have to even hint that you need SOME/ANY structure (like it sounds was missing!) but just emphasize what you have learned already and that you want to build on that foundation in a more structured new grad situation. File away those errors you mention in your memory bank...each of them can have just as serious an outcome as a med error (and none should have made it past a good preceptor!). In many places mislabeling meds once gets a written warning and doing it twice gets you shown the door; it can harm the original patient and whoever's name got put on the lab tube. Mistakes in mixing formula can be devastating, depending on the error and who got the wrong stuff and a breast milk error can be a huge mistake. Mistakes in charting can lead to changes in treatment or additional testing. While moving forward, don't minimize those errors, but learn from them and think about what you can do to avoid them in the future. Those are some substantial errors, but again an actively involved preceptor should have intervened. When interviewing, have a list of questions ready for them...are there didactic classes, will you have an assigned preceptor, will you be meeting with the unit educator or manager on a regular basis during orientation...that kind of thing.

  • Mar 12 '13

    Took care of a teenaged boy who had cardiac arrested at home, dad did CPR - long resuscitation. We had him on the cooling protocol, sedated, vented and all the rest. For a week, he lay there.

    Had the weekend off - come back to find a kid in that room, playing video games and doing algebra homework. Thought it was another patient. Nope - same kid!

  • Feb 28 '13

    While I realize mistakes are made, the majority of the time, if you wait 24 hours in the ER, it wasn't an emergency in the first place.

  • Feb 3 '13

    Quote from imaginations
    240mL of formula delivered via gastrostomy at a rate of 360mL/hr.

    That covers the actual amount of formula and the rate at which you delivered it.
    Thanks so much, imaginations.

  • Dec 17 '12

    ALWAYS get an xray to confirm placement. Always.

  • Dec 16 '12

    "Sometimes you have no choice but to connect multiple drips together, but its always important to remember everything that you have connected in that line".

    Seriously, don't even attempt to rely on memory. The nurse that follows you will curse you to hell and back when they come on and spend 20 minutes trying to figure out what line is what, especially if the patient starts to dump. This is when that paper tape comes in really handy. LABEL each of your tubings with the drug name near the connection to the manifold connection. You can see in a heartbeat what is running through there especially if you need to push a med in a hurry.

  • Dec 10 '12

    Looks like someone did not get an inservice on the O2 equipment they are using.

    The device used, which includes size and brand name, will determine the liter flow required to make 28%.

    This is often a documentation error for many in nursing and for Paramedics. They will look at the liter flow and do not understand the entrainment or venturi system being used to acheive 28%.

    To transport, you use a adaptable device which will give approximately 28%.

    Also, if your unit does not have piped in air, the patient is on 28% because there is no option for just humidified air. Also, the patient might actually be on just humidied air and the FiO2 is set at 28% and 4 L to achieve a nice mist.

    Know how each piece of equipment works and don't just memorize numbers. Every venturi type set up might have a different liter flow requirement regardless of the numbers. Never assume.

  • Dec 6 '12

    "I think my lecturer just want us to design the exhalation detector...."

    Actually, there is such a device that is used when a pt (adult or peds) has an endotracheal tube placed to assist breathing; it detects CO2 on exhalation and verifies that the ETtube is in the trachea, not the esophagus.

    Here's the link: Covidien EASYCAP II Co2 Detector @ Covidien EASYCAP II Co2 Detector [EASYCAP II] - $347.00 : @ Summit Surgical Technologies., Shop and save on Medical Equipment, Refrigerators, Freezers and more.

    I hope that helps!

  • Nov 9 '12

    Quote from NicuGal
    I have to disagree about more female providers. The majority of our docs, especially our high risk docs, are male. If you were a patient at our hospital you would have been flagged high risk from your first baby and only been seen by high risk docs. Male or female, it shouldn't matter, if they are over looking something then you need a new doc.
    Quoted for truth.

  • Nov 9 '12

    I have to disagree about more female providers. The majority of our docs, especially our high risk docs, are male. If you were a patient at our hospital you would have been flagged high risk from your first baby and only been seen by high risk docs. Male or female, it shouldn't matter, if they are over looking something then you need a new doc.

  • Nov 7 '12

    Thank you everyone!!

    First let me clarify the time of orientation:

    We do 6 weeks on a the step down unit and then 14 weeks in the ICU. So it still is quite some time. I now will be doing 16 weeks instead of 14.

    my strengths have been great charting and keeping up with my "tasks". It is just that when the unexpected happens, I get thrown off a little bit.

    I am taking all of your advice and thank you for the encouraging words. I have made a list of topics to study by studying the previous patients' diagnoses. So if I had an ASD that day, I will read about the surgery and diagnosis the next day. I figure that's the only real way to tackle so many of these cardiac diagnoses. I think the problem I had (after coming down from my initial shock) was that my preceptor would tell me I was doing a great job every day and then have such an evaluation; Basically my boss did not think I was independent enough to be on night shift and I have been working on that!

    I have asked my preceptor to step back and not jump unless she sees something grossly wrong and allow me to talk to the doctors myself. I realize to work in such a unit I have to really use my critical thinking skills so it was hard to not compare myself to my friends on med/surg floors who are already off orientation. I am happy to announce that as long as I keep on track, I start nights this upcoming Sunday. I will keep everyone updated.

  • Oct 17 '12

    We have to view this situation with alot more maturity and better insight.

    There appears to be a misalignment between the knowledge/skills of a university-educated nurse and the demands of the health-care system, particularly the hospitals. This is because for many years, nursing education in Australia has not prepared nursing students for "nursing" but rather for "research" and "leadership". A simple read through some of the nursing programs in Australia will underline this point, hence, the deficiencies many Australian-educated nurses confront when they try for overseas registration. As such, the universities are not producing employees - nurses - with valuable resources with which to contribute to the health-care systems. For instance, many new nurses are quite competent in showcasing their knowledge in the "lived experience of an illness" yet are unable to properly dress a wound or attend to an emergency. This leaves our hospitals, and indeed the patients, in a very critical position (no pun intended).

    Hence, the hospitals are forced to look elsewhere to "fill-the-gaps".

    It is not too surprising to find that many hospitals, particularly the private sector, are very willing to employ foreign-educated nurses (FENs). FENs are better trained, more competent and possess skills which meet the immediate demands of our hospitals. For instance, all nursing students in India are required to attend a fourth year in which they study midwifery. As such, they also qualify as midwives. Their skills/knowledge are immediately transferable/applicable to our healthcare system because it is resource which we can easily capture and utilize without too much expense.

    The nursing profession in Australia is "over-professionalize" and this stems from the "over-conceptualisation" of many nursing programs. In other words, I learnt far more in my first month of nursing at the hospital than three years of a Masters' program.

  • Oct 17 '12

    Here are some tips for taking vitals on a sleeping child. I've learned them from my own practice and from taking care of my kids and other family members.

    Speak to the child first. Don't just ambush them with your touch. They need to feel safe in their beds and know that any intrusion into their space will come with warning signs, or they'll never really relax.

    Tell them what you're going to do before you do it. Even the pre-verbal kids can take this in on some level.

    Touch them gently before doing the procedure. Stroke their hair or an arm and talk to them. If they open their eyes, show them the stethoscope or thermometer.

    DON'T ask them if it's okay to take their temp or B/P? This implies a choice which they really don't have, and it sets up both child and nurse to be unhappy. If you ask and the child says no, then what?

    DON'T say you want to TAKE their temp or B/P or pulse. Kids learn pretty early that taking something from them leaves a hole where that something used to be. Instead, say you need to check their temp, etc.

    Give choices they actually do have. Right or left arm for B/P. If only one arm is suitable, ask if they want the B/P first or last.

    Let them listen use the stethoscope to listen to their own heartbeats. Then transfer the earpieces to yourself.

    When you are done, thank the child for helping you to help them get better.

    Even if the child doesn't fully awaken, keep talking gently and narrate what you're doing. Thank them when you're finished.

    Try to coordinate with the interruptions caused by other disciplines. RT has to check some of the same vitals before and after a treatment. Ask parents to call you if the child gets up to use the bathroom or wakes for some other reason. If you have scheduled meds or the likelihood of prn meds, do your vitals with these things. Use some common sense.

    Vitals at three hours or five hours isn't the end of the world with a kid who is fairly stable. You can also do a preliminary check and (with a soft word) touch the skin, listen to the respirations, get a reading on the depth of sleep, and so on.

    I have seen nurses who do a beautiful job of taking nighttime vitals with a minimum of disruption and others whose lack of courtesy and skill have upset kids and parents alike. I admire the former and wish the later would get a clue.