AnLe

One of our coworkers left our unit after the initial surge died down and became a traveler. Their current year-to-date is double our salary. They have been a nurse for about 3 years. It's making us talk to our Director and HR. Will it change anything? Maybe not, but at least an attempt is made. Two of our coworkers already plan to leave within a month, our two most experienced nurses. We barely hired 1 new grad while the rest are travelers. Some days, there is only 1 core staff member who is charge while the rest are floats or travelers. If this continues, I may want to leave too.

No joke. We currently have our covid patients split up on multiple floors based on care level. I get 6 tele covid patients, but 3 are total cares. Confused feeders who are incontinent and don't appear to be getting discharged anytime soon. But for continuity of care, my load doesn't get balanced even if I ask. We have staff refusing to go into covid rooms for x or y reason, giving me more to do. Our hospital system is offering contracts to work x days * x weeks for a bonus but it doesn't amount to what the travelers are making. Apparently travelers are meant to float first, but sometimes they complain and nurses have to be switched around. The new grad who was hired got a sign-on bonus and makes what I do. How is this fair? I'm trying to provide safe care for my patients and educate my orientee while helping our staff of floats and travelers. If it weren't for the core nursing staff and my fear of possibly working on a toxic environment, I'd go elsewhere.

I haven't had many patients ask if we're vaccinated, especially in our new growing covid section of the hospital. It's almost confession time, if you do. Most of them are unvaccinated for one reason or another. Less than a handful are vaccinated. Back to the topic at hand. I would address the wife's concern by educating her that the vaccine does not prevent you from getting the virus, it decreases your severity. "A small percentage of people who are fully vaccinated will still get COVID-19 if they are exposed to the virus that causes it... no vaccine prevents illness 100% of the time" (CDC, 2021). Just like with flu shots, you can still get the flu. If she feels uncomfortable with her nurse if they don't wish to disclose their status, the nurse is not required to answer due to privacy. Vaccinated or not, the hospital staff will wear face masks and perform hand hygiene as dictated by hospital policy. If they see someone who is not adhering to it, she is free to speak to our charge/director.... is how I would handle it. https://www.CDC.gov/coronavirus/2019-ncov/vaccines/effectiveness/why-measure-effectiveness/breakthrough-cases.html

Our policy currently states that ED will call to give report. If the nurse does not answer, ED will callback in 10 minutes. If nurse does not answer the 2nd time, charge will take report. Our current problem is the ED trying to send patients up during shift change. I have had the issue of the ED trying to give me report on a patient whose heart rate kept decreasing. We avoided receiving report and not a minute later the heart rate was zero. Mind you, I'm on a medsurg/tele floor night shift.

Same in regards to TPN and patients receiving steroids. Another post mentioned IV insulin and IV glucose for potassium shift.

I owe 15k/35k. It was in college for 10 years total; graduated in 2018. I wasn't sure what I wanted until I joined nursing school and didn't look into programs that could help until late in the game. I'm paying my way for my BSN. Started with 11 loans and I'm down to 5. Soon they'll be done.

So much this. When dayshift says they're sorry about not getting to a task, it's fine, just tell me what it is and I'll do it. I get it. They talk to many individuals, get stat orders all day, and the patients are awake who call for whatever reason. It doesn't bother me. What does bother me is when I tell the nurse if the doctor can do the medication reconciliation or if they can order x med for y reason. Then I return and neither has been done.

I don't get mad when that happens. The board can change any moment for balance. Secondly, it helps to get a 2nd pair of eyes on the board, like when people get 2 stroke patients or patients with the same last name and gender, which happens a lot.

I have a coworker who goes in 1.5 hrs before her shift. I'm not sure of she clocks on or not, but she calls the doctor to clarify orders or for anything extra the patient needs. She says she needs to get there early to get out on time. I go on 15-20 minutes early. I work on a med-surg/tele floor and our ratio is 6:1. Our turnover has been better lately, but we still get new people every few months. I just find it helpful to see what meds I need to give and what labs/vitals have been abnormal. A few people of the dayshift staff give a very short report or forget to do things. For example, I had a patient with stat ABGs ordered at 1430 that had never been done. When I questioned her, she said lab hadn't come up yet. I had to mention that lab doesn't draw ABGs, RT does. I had her call the RT that was on, they weren't happy about it. Besides us, everyone else either gets there 10 minutes before or right on time.

I love the crazy mess my work is. Take that as you will. I experience great fulfillment some days and others I get burnout. I've been in medsurg/tele for 2 years now. The staff helps. If you have a supportive staff that you can ask questions or assistance from, it's a godsend. Most of my coworkers have stated they've stayed so long because of the people they work with.

I work night shift. I put in telemetry orders when applicable for one doctor. Stroke, chest pain, seizure, etc. She has stated if a chest pain patient comes in to do one troponin and an EKG. This doctor tends to put in orders rather late. Other than that, I am not comfortable adding or amending any order that I did not hear verbally from a doctor.

I wouldn't. Potassium is very irritating to the veins alone. Running them concurrently would definitely make them go bad. Is oral replacement not an option? There is liquid forms for potassium if the tablets are a problem.

I have a few coworkers who are similar. One has had syncope episodes at work causing her to go home early although her bloodwork looked fine. She has also been out for the flu and other ailments. We now remind her to drink water periodically during the shift and encourage her to eat a healthier diet. She meal preps now. I'm not sure how her sleep is, but at least we can help out with the other two. You're not alone in this.

Don't feel bad for saying no to extra shifts. You are not obligated to say yes. As Rose_Queen said, staffing is management's problem. They can/will figure it out. I always considered how my schedule would look like and how comfortable I was for that day. Also, you can pick up a shift and be floated to another unit.

I work in a medsurg/tele unit in a 39 bed hospital. We're currently understaffed. Charge has to take 6 patients along with the other 5 nurses. We are supposed to have 3 aides, but usually it goes down to 2, sometimes 1. Although, according to our 10 year veteran charge nurse, the norm 3-4 years ago was to take 7-8 patients. Yikes! I'm already struggling with my 6. Shift starts at 1845 and I don't sit down until 0100. Assessing, medication administration, answering questions, ensuring their needs are taken care of takes a long time. My preceptor would tell me, "15 minutes AnLe. I'm going to call you to make sure you come out on time." If I am performing my job as we were taught in nursing school, without taking shortcuts, wouldn't it take longer than that? For the first 6 months of working, I would stay until 1000, to chart. Now, the latest is 0830. My admissions take around... 20 minutes to 1 hr to complete. I will say that I have seen a few instances where the charting appeared falsified. For example, I say appeared because the patient should've been on a waffle overlay to help prevent pressure ulcers with a Braden of 15. I got an order for one, because one didn't exist and applied it. When I went to chart, every day she had a waffle overlay documented. Could they have removed it that day? Maybe. The patient was oriented to self, she couldn't answer me. The are so many times I want to message our director or MIDAS something to shine a light on it. Patient care comes first, it's been a long shift and it's already 0830, I need to return tonight so I'll be leaving - which is why those messages never happen.

What I found to be helpful for this is jotting down any prn BP medications into my brain sheet and when to give it. Example: hydralazine-SBP>160. It also helps when your patient has high BP and they don't have any PRNs available. Will you always need it? No. It just made it easier for me to be aware of it.

I gave a patient hydralazine 20mg IV push instead of his furosemide 20mg. (I had the hydralazine for a different patient in my pocket.) I did not do my usual routine of labeling bags and storing all patient meds this way. I reported it to my charge, director, and on-call physician; I work nights. Patient's BP did not change. I checked his BP q30 min for 2 hrs per on-call physician. I was so ashamed and was/am paranoid about my med administrations now. I think about it often. Had a talk with my director and received a written warning. Patient was fine, had no complaints of any kind besides myself keeping him awake. He discharged soon after.

I expressed such feelings to my director when I first started. He said he expects me to have tunnel vision. Just to ensure my patients are safe and to know when something is wrong. If something is wrong, follow the MEWS card we have, tell our charge or get the input of another nurse. Later, as I gain more experience and get comfortable in my role, I will expand my vision and eventually look at the greater picture. Ask any nurse available a quick question if you have it. It's better feel safe about what you're doing. A lot about nursing is nursing judgment. Secondly, I always looked up information I was unsure about on days off, so I could be knowledgeable for my patients. It doesn't matter if the nurses around you think you ask too many questions or take too long, as long as the patient is safe. (I'm still that nurse after 1.5 years.)

I had 2 patients assigned to me with ulcers. These people had been in the hospital for more than 2 days and no one had: taken pictures, documented in the chart, or completed the ulcer paperwork we are required to do. I stayed until 9am (I'm night shift) to complete both ulcer paperworks, midas, dr notifications, and initiation of orders. No where in report did I hear about 1 patient's ulcer OR the never been seen 3rd ulcer in my 2nd patient.

I've been on my medsurg/tele unit for more than 1 year now here in Texas. I work nights. We always get 6 patients. Sometimes it is frustrating and other times it's an ok night. Our unit frequently needs help, especially if someone gets pulled to PCU and we have a float nurse with us. Depending on where the float nurse is from, they won't administer IV antibiotics or deal with someone who has a wound. Usually they can't take tele patients. There was one point in time where we had an excessive amount of stroke patients so a nurse had to take 2 strokes.

All in all, I will go and speak with our director and get their input on a few questions I have; also to see how my performance has been. Thank you for your responses! It has given me more things to think about and get settled with before returning to the hospital.

The patient was alert x4. They had cellulitis to the legs and they had received pain medication prior to me going in to turn them. I informed them why turning every 2 hours was important. They were already frustrated with being at the hospital and we were just awaiting placement for them. I overthink things a lot, which my preceptor has stated. She says to just go in there, inform them of what you will do and it won't take much of their time. It's easier to say that in the morning, than at night when they're sleeping.

It hasn't even been a month since I passed my boards and I'm orientating at a hospital floor I wanted. I am currently stuck though. I had a patient who is to be turned every 2 hours, but they do not want to turn. They are adamant about it. Even repositioning, placing pillows under the arms, or performing some ROM exercises, they refuse. The patient had stated how previous shifts treated them like a bag of meat. A nurse who had them previously said that they made them turn. Then work is saying to increase patient satisfaction. I made my rounds and I tried to convince them to allow me to turn them. I'm just very conflicted. Should we just turn them on the bed even as they refuse? I understand we are trying to prevent pressure sores and I did explain it to the patient, but where is the line drawn?

With the omnicell I frequently used and the meds I obtained during my final semester, I don't recall it having different dosages in the area it indicated. Sure, some meds had different packaging than others, but they were the same dose. I want to say that yes, the hospital is picky in how things are dispensed.

Oh ok, I'm sorry. In the hospital I'm at, they're extremely specific. I was very interested in knowing that you were able to administer meds without your instructor or a nurse present. We weren't able to do that in school.