RNingBSNing

When I was a new nurse, my very first day on the floor nonetheless, I had a patient who had a colon resection having severe pain that was uncontrolled with his current regimen. I asked the resident for a breakthrough dose of IV dilaudid and he ordered it- a whole 25mL/25mg PCA syringe as a one time dose. It was the resident's first day as well, but that is no excuse. He was able to order it without PCA settings (bolus dose, lockout) literally as just the whole 25mg of IV dilaudid as a one time dose-- and pharmacy verified it. I only realized the error when I went to pull this medication and realized the size of the syringe, which also read: FOR PCA USE ONLY. Thankfully, I did not give this medication and the error was corrected. What a reminder that as RNs we truly ARE the LAST line of defense for the patient when it comes to med errors. You are not alone. :)

Really? Because in my cohort, it was the older students who struggled the most.

Really? Because as a millennial/ Gen Z-er (depending upon whom you ask) it was the older, nontraditional students in my cohort that struggled the most.

Am I supposed to understand, why exactly, this patient's blood glucose was not checked again for an entire shift after a hypoglycemic episode, an amp of D50 and you giving a dose of levemir in a renal patient? Regardless of whether or not you followed hypoglycemia protocol, that is just poor nursing judgement IMO.

Hello all, I am a relatively newer nurse who recently accepted a position several states away from my home state at a large academic medical center. The job was essentially my dream job-- I see an acuity of patients that I would perhaps not see anywhere else and in a specialty I love. Alas, I have been in this new city with my significant other for a few months now and I long to move back home. The city I am from is familiar-- the people, share the same views as I and quite frankly are more educated. Also lower crime. RN job opportunities are not scarce where I am from, but there is no academic medical center like where I am currently working. I am looking for opinions mostly, what is more important to you? Loving your career and every day that you go to work feeling fulfilled, challenged and excited? Or is it your days off when you enjoy the comfort and familiarity of a place with years of memories and live in an area with plenty of friends and family close by. Has anyone else made a similar career decision? Thanks for your responses, RNingBSNing

Agreed. Any thoughts on how employees might handle this sort of situation?

Surgical, L&D, ER. Apparently they are the more 'lucrative' units, whatever the hell that means/matters. We're all out here working hard, we're all taking good care of our patients. What the hell? Side note: Our employer does not give annual or merit-based raises so this is exceptional. I'm still making what I made four years ago.

Pt was a 32 yo male admitted for symptomatic bradycardia likely related to drug abuse. Pt met a friend who was also admitted to the floor who the pt admittedly used to sell drugs to. Exchange of money in front of nursing, security called, pt was told he would not be able to leave room, belongings were searched, contractual agreement made. Pt became infuriated at this and threatened nursing/ hospital staff/ physician. Security attempted to escort pt out of hospital which ended up in a brief scuffle, pt was promptly arrested and d/c'd to county jail. Don't f*ck with us. 🙆

Hey all: here is my humble opinion about the sad state of nursing affairs today and the direction it appears to be heading in the years to come. Feel free to leave your own ideas and opinions on this post. Dear Boards of Nursing, Nursing Schools, Goverment Regulatory Agencies, Law Enforcement and The General Public, Nurses have not failed you, you have failed nurses. Let's start from the beginning; it takes a special person to decide to dedicate their lives to others. Nursing calls a special group of persons to the profession: people who will spend years in school, many late night studying hours, passing exams, meeting requirements and learning about NEXT TO everything with regards to helping and healing. Out of school, new nurses all pass a federally-regulated board exam gauranteeing that they possess the minimum knowledge necessary to carry out nursing duties. At their first job, new nurses pick up extra shifts, obtain certifications, stay late and work themselves to death. Older nurses are forced to work back-breaking jobs late into retirement age because they lost everything in a stock market crash. Throughout the course of a career nurses will work against impossible ratios, the addition of new tasks and requirements for charting, care for even sicker patients but with less autonomy. Nurses will face horizontal and vertical violence, be disrespected by patients and families alike, and can no longer feel safe and protected at work (Utah nurse, Dartmouth-Hitchcock). Many will leave the profession, others will be injured to the extent that they can never work again. Still other nurses may destroy their home lives, turn to addiction or burn-out and give up on safe nursing care. State Boards of Nursing will face a serious nursing shortage lightly, giving nursing schools and nursing educators little incentive to beef up enrollment and (on the flip side) allow employers to mandate unreasonable hours that almost gaurantee nurses will make mistakes-- only to be penalized for them. Nurses themselves will become exhausted, snappy and careless versions of the bright-eyed, loving and gentle souls they once were because we didn't fail you, you failed us. Thank you for reading.

HF exacerbation.

No nutrition consult, physician did not make pt or nursing aware, I guess the physician didn't explicity state that her weight was the reason why, but the pt is very overweight and her history is benign other than HF, HTN. Why, exactly, would a 1200 cal diet be indicated?

For no other reason than that the patient is overweight, the physician placed a 1200 calorie restriction on the diet order (side note, I wonder if she informed the pt of this). I just think that if someone is sick in the hospital trying to heal they need the calories, do we really need to start their diet now? I think it probably just causes more harm then good for the short time that they're in the hospital. What are your thoughts on this?

Hi all, About a year ago I got certified to teach BLS and I've been teaching recerts to my coworkers at my hospital since then. I taught a class on Friday and when it came to choking I remember saying something along the lines of "Now, I've never done the heimlich but..." Big mistake. Of course the next day I worked on the floor and the kitchen delivery person tracks me down to tell me that a patient is choking. I run to the patient's room and, sure as ****, she is clutching her throat with both hands and cyanotic-- not making a sound. I yell for help and, without even thinking, wrap my arms around her and giver her two heimlich thrusts. She coughs up her grilled cheese piece and swallows it again. Yuck. It's all in a days work. When was the first time you saved a patient? ������ -RNingBSNing

Hello, A novice RN here asking mostly for professional opinions. I've noticed that older and more experienced nurses will get report in the morning, take down notes from the night shift on their patients and point any questions directly to the night shift nurse. Then, without looking in the EMR, they automatically start their day by seeing their patients, doing their assessment and getting vitals. Newer and younger nurses I've noticed tend to come in earlier, spend endless time in the EMR looking things up and then get report and either spend more time in EMR or see their patients. I can't really discern if either system works better or not. The newer nurses I've talked to feel like they're catching things they might otherwise miss (low blood glucose on AM labs, Med not given, etc.) but the older nurses seem to think that if any of that really mattered then they would see it on assessment. For instance, a patients blood glucose or potassium could be really low, but does seeing that on a computer screen do you any more good then actually having already assessed the patient?