TigraRN

I am sorry it happened. the good thing is that the patient will be OK. Time will pass and you will feel better as it does. I had a similar error and it took me a year to get over it. It teaches you to be careful, for sure.

Yes, I used to have scrubs and each time I was wearing a patient would die. Got rid of the scrubs. And I never ever go to do postmortem care by myself... I just can't. And sure enough, if you forget to bring shears, you will desperately need them!

1:6 in ER, all 6 being MedSurg patients, 1:3 ICU "with a nurse extender" (who cannot be given appropriate orientation time). It really depends on the day. Rapidcare patients ESI 4 - a lot ?.

Rubyagnes, how was your move, can you share what you have learned? please? I am planning on moving to NC as well and looking for an ER to land.

Try setting the record straight with them - tell them "from now on I will not be able to pick up any extra shifts due to ... ". Don't let them make you feel guilty, you are already working full time.

Burping NS bags to save the tubing if a second bolus is needed later.

Calliope26, what happened if you don't mind me asking?

In our facility, you can usually pick a shift a week or so. Also, flexing in and out is easy, if you need more beauty rest or need to come home earlier. Basically, the schedule can be flexible.

In nursing school, we were taught to describe things in the third person and stay neutral. Sometimes I use "I" if something needs to be clear.

1. Checking BG on someone who refused it. 2. HIPAA violation

A patient came in for a glue stick stuck in his rectum. I explained the dangers of using glue the way he did, to what he replied: "Don't worry, it's non-toxic".

It is actually good that you need to insert them every day, because now it is only a matter of time till you become a pro. What I found helpful for myself: 1) do not look for a veing, but feel for it; it needs to be nice and "plumpy" or collapsible. Once you feel it, move around and try to trace which direction it goes. Don't trust your eyes! It could be misleading if you don't feel it. I don't ever poke if I don't feel it. 2) If the patient is a hardstick, or if someone is asking you to start an IV, because they couldn't - bring a hot pack with you and place it on the AC or wherever you are aiming at (antecubitals are usually the easiest and fastest). While you are priming tubing and unwrapping the packing, the warm pack will do its job. 3) If the patient is, let's say, somebody with fragile skin, bruising from coumadin, or you have a feeling it may burst - don't use a tourniquet. 4) If the veins are too tiny - try ripping off the glove on your index finger (left finger if you are right-handed) and after using alcohol swab on the finger, feel for the vein again. 5) if you don't need a large gauge - go ahead and use a 22 of even a 24. 6) never be in a rush, it only makes things worse 7) don't feel bad if you haven't found a vein on one side and had to switch sides a couple times. 8 ) Distract the patient, don't be nervous and never feel bad if you didn't get it, because you really tried. Maybe you could also talk to someone on your unit who is really good at it and ask for their advice, or maybe they could show/guide you? I was super scared to try an IV in the very beginning, but now I really like to start one and always up for the challenge. Good luck!

I once had a needlestick with a contaminated (patient's blood) needle. That patient had a whole array of liver problems. I felt like I went through hell waiting for results, but will not make the same mistake again. Don't feel bad about the patient, they are probably already over it.

Remotefuse, I love this book! In my library it was available as "The life-changing manga of tidying up" which is a comic book. I literally had to stop myself from reading it further so that I could tidy up by category in real life. It's been at least 8 months since I read it and my house is still keeping up.

Mandatory double verification would be helpful for paralytic as well. If we have another RN witness insulin, heparin, amio, why not do the same with vecuronium?

It is ok to like your unit and not want to switch jobs. I feel like this is exactly how I feel as well. People came and go, getting into school and going to bigger and better things, but I am really just happy where I am. Why don't you get a certification or two that is applicable to PCU? I am pretty sure there are certifications/courses/you name it to improve your knowledge base without actually switching jobs. Or, have you thought of becoming a lead? What growth opportunities does your unit offer?

At our facility, we only use charge sheets for foleys, c-collars, slings, crutches/walkers/canes, and other supplies. It can get tiring to fill out all those BG checks and blood draws, glad we don't have to use the sheets for that.

Make lists of things pending for each patient and check them off as you go.

Very interesting podcast. It is scary overall to go through any type of surgery and completely trust strangers in white gowns.

In our ER it is about 6 weeks for transitional nurses and 14 weeks for newgrads. If an orientee needs more time, they get more time. Good luck, I hope you like it! I would say the nurse is ready to get off orientation when they are situationally aware of all their patients, can discharge/admit within 30 mins, can speed up the process and don't hesitate to ask MD to dispo the patients. Safety first, of course, knowing your limits, when you need help, who is the sickest, and helping coworkers. It can be super fun. Especially when you get the unexpected through the doors.

There is also a stroke certification that you can get, SCRN, check out About the SCRN Credential | ABNN Certification .

Having students is taking more responsibility, because you have to explain and teach how things work, teach skills and answer numerous questions. Sometimes nurses have a choice to decline having a student, sometimes they don't. She may have acted in a mean way in your eyes, but the way you are reacting is not any better.

I work in ER and our rooms are divided by curtains. I came in to my new patient and introduced myself. In a moment of silence, I heard a patient next room (not my patient) saying "Your name is TigraRN? I've heard many good things about you". Turns out, she is a nurse on a different unit and some of her patients were my patients while in ER.

One patient came in for a bus pass.

You can use SBAR when they pick up the phone: Situation: Hi Dr So-and-So, calling you to let you know the hemoglobin on patient A just dropped by ... . Background: patient's last hgb was ... . (anything relevant here (GI bleeder, recent surgery, fall etc). Assessment: patient is breathing unlabored 18 RR per min, O 2 sat 95% on RA, skin is slightly pale. Recommendation: Would you like me to do x, y, or z? If it is a voicemail, I just leave my name and extension ans say I need orders. Don't worry, call them more and you will be more comfortable. I hated calling docs in the beginning and now it has become normal.