Okey Foley

"bowel obstruction likely d/t all the p***s the pt ate" We notified Dr and it was corrected to "bowel obstruction likely d/t all the peanuts the pt ate". ??

I was on the M/S floor 2 years then went to ER. I did my senior capstone in ER and absolutely loved it, it was always my goal to get into ER as a licensed nurse. I've been here a little over a year now, technically, but I was also out a few months with injury (unrelated to work). So I have the perspective from both M/S and ER. 1: ER is a lot more autonomy. We do need orders for lots of things, and it's a group effort but it's a lot more autonomy than on the floor. The doctors/PAs/NPs value your input, generally speaking. When someone gets roomed with abdominal pain, chest pain, sore throat, whatever -- we have a typical set of things we usually do. It also depends on the provider too, but you get a feel for how they each do things after a while. So if I get a chest pain roomed, they've had an EKG in triage unless they're direct bedded. I then get them on the monitor, do a line AC or above, get all my standard rainbow of labs, do my assessment, and anticipate what we might need for them. Even things like sore throat I know we'll do a covid/flu swab and maybe strep so I can get that done. If they're female and any remote chance of preg, I have them pee and get a preg. It helps speed everything along. Then when Dr puts in orders you can collect and send it down. 2: Be kind to yourself and give yourself grace. I was a good M/S nurse. But it's a whole different world in ER. And the focus is different. You have to dissect what info is important vs. what isn't. You'll learn so much every day. Learn from your fellow nurses, techs, and providers. Patients can teach us too! Be confident to a degree for patients to trust, but humility is important as well. Safety comes first. Use your resources: charge nurse, float nurse, doctors, techs, other nurses, etc. It's major teamwork in ER, rightfully so. As you get your footing, help out others too when you safely can! 3: Agree with previous poster on keeping an eye on Epic for new orders. We communicate with comments on our board so everyone's aware of what's happening with the patient (ex. Need XR, Labs > Need CT, PO challenging, wants pain meds 7/10, etc.). I love this, so charge can see who may be approaching soon d/c and who may end up needing admission. Don't delay doing orders if you can do them right then. You never know what can come in the door anytime. You're constantly prioritizing who could die fastest, who's most critical, who can wait, etc. You can't plan out a day like you can on the floor here. There's no brain sheet. It's all in the computer, and people are constantly coming and going. In the beginning when I got overwhelmed, I'd grab a post-it and write my rooms down and who needed what. I didn't acknowledge orders until I did it. Now I work faster and can keep up better for the most part and know in my head what I'm doing. But every now and then I need my little notes so I keep a folded paper in my pocket all the time just for that. Don't be afraid to ask for help! We do nebs all the time in ER, but on my M/S floors, RT did them. When I started I felt silly I didn't know how to do one. But I told my preceptor I just hadn't done them before, she showed me, and now I know. Had I pretended and not done it correctly, that asthma exacerbation maybe wouldn't have gotten their albuterol/atrovent neb correctly. 4: It's a good vibe. It's the most chill place I've worked as far as personalities. You get all kinds of people in the ER, and it can be fun to just be yourself around these patients and make them feel comforted after a long wait, make a joke with them to try to lighten a mood, be silly with them. But never dismiss a patient's concerns. Even the frequent faces. You never know. Good luck!!

My favorite aspect of nursing is teaching. Here's two good examples of how I've learned over time and pass along to my surgical patients. -Doc wants to place a wound vac on wound day after surgery. Patient says "whatever you think is best I guess?". Later I explain what a wound vac is, how it works, how he can move around, dressing changes, how it helps, why hes an excellent candidate. Doc decided to do it, put in order, but I make sure pt understands the process and why! -Pt had abd surgery, pretty extensive. Feeling pain in different part of abd than where surgery was. She was worried something was wrong. I knew from listening to surgeons about visceral pain and how it's not good at localization. Explained to pt how this is different than say if you cut your hand, you know it's your hand. Your gut doesn't do a good job of telling you where its pain is. She was much more at ease that this was normal and thanked me for taking the time to tell her. I listen and pay attention to all other disciplines: RT, PT, OT, physicians, PA, NP, RN, NA... and I learn from them. I synthesize the information to ensure my patients understand their plan of care and can make informed decisions. That is my #1 goal as an RN.

Seconding that this is an excellent book. When I read it, I felt so understood like all of these things my family and classmates thought were so weird. I learned that these things don't make me less, they make up part of who I am. I've changed over the years and am more outgoing, but I am still introverted for sure and gain my energy by being alone. But reading this book helped me accept very fundamental things about myself. Having a coworker come up to me and say "how can I help?" when I'm drowning is one of the best feelings in the world. Even if it's just giving a synthroid for me at 0600, it can make a world of difference.

That's so good. Sometimes we say more by saying less.

I work on a surgical floor and we work very closely with the WOC nurses. I have the hope to become a WOC nurse after some more experience and finishing my BSN. On surgery we see a lot of wounds, especially with some of the big abdominal wounds we see wound vacs. Our floor is primarily GI and urological surgery, so we do a lot of ostomies, which go hand in hand with wound care. I'd totally recommend a surgical floor!

Definitely agree with this one. I very much believe in patient autonomy - and this includes them making not so great decisions. I can always educate and suggest things, but ultimately it is their decision. Along these same lines, I used to want all my charting to be beautiful and perfect. Just not realistic. I absolutely chart, and make pretty good shift notes for each patient especially with any significant events. But there is no reason to go over the top with it -- I'd rather spend the time with my patients, as long as I am charting to cover myself and communicate to the care team.

What is the thing that has been the hardest to learn for you as a nurse over your career? Early on, midway, or late. I've been an RN just over a year now, and for me one of the most difficult things has been learning to be assertive. I still find it difficult as I was very timid growing up. I'm getting better especially when I keep in mind it's for my patients' well being (I.e. ambulating after surgery, sc heparin/injections, q2 turns, etc).

Sometimes it's easy to get caught up in something happening and hard to back up, see a bigger picture and remember fundamentals. Things like this really reinforce the importance of fundamentals. Like buck said, this patient maybe would have needed bipap no matter what. Good reminder for me too that retaining CO2 could cause the high pulse ox and ABG would be a better tool.

I work on acute surgical floor and depending on the pt and MD having a few pain med orders is not unusual. Tramadol with IV morphine PRN for unrelieved severe pain I personally think is safe as long as her pressure is high enough. 99/60 is lower end, but with SBP >90 I wouldn't be concerned. Want to see what others say too, but this is my experience. I think it's more important pain is managed and you also tried nonpharm modalities too.

I really struggled with this in school. Airway - the physical airway. Think obstruction of a straw. All the way from the mouth to the bronchioles. In pneumonia, mucous and fluid could block that "straw" of the airway. Breathing - act of lung expansion, inspiration and expiration. As Wandering said, examples with pneumonia are too shallow d/t pain or congestion, tachypnea in attempt to compensate for not getting enough oxygen.

I am in my 3rd semester of my ADN. Last week I had my "team leader" experience where we work with our five peers and make sure charting is done, are available to help, coordinate with the instructor, nurses, and my peers. I used to really struggle with confidence and was so shy and self-deprecating that I could never speak up. Now I have been in therapy since September, got out of an abusive relationship, my dad who'd been sick for a very long time passed away -- and I've been finding my voice. I'm a very eager and positive person, I truly find the joy in anything. I got feedback and it reinforced what I was thinking, that now I'm struggling with the opposite end of the spectrum, with being overbearing and nitpicky. I do not mean to be, I'm just 1) so enthusiastic that sometimes it's very hard for me to put on the brakes and 2) go by my checklists to ensure things are done, and if they are missing (ex. all the charting), I let my peers know. I can't figure out where the line is, does anyone have suggestions?

Hey everyone, I'll be graduating this December and am currently looking into jobs in my area and I'm struggling with what is difficult to get into (which I'm okay with!), and what is just not realistic. Many of our hospitals now are BSN preferred, though they absolutely hire ADNs (Raleigh, NC). Within any specialties with babies, however it seems to be more challenging. I did my OB rotation and absolutely loved L&D, Nursery, and Mother Baby (Postpartum). I really found myself drawn to the babies. I'm mostly interested in pursuing NICU and there are lots of reasons why (I'll list below if anyone's interested, but not critical to this post). I am willing to relocate basically anywhere. I've traveled a lot all over the US but lived in this area since I was 8 and would love a change of scenery. I'd be open to staying in Raleigh too, however. Does anyone have any suggestions or input on areas I could look into possibly applying to? I understand I cannot be as choosy in this first job, but at least I would like to start working with babies since their physiology and care is so different. NICU, Special Care Nursery, or Mother Baby are the three units I feel fit this. I do not have CNA hospital experience though I did work hospice home care and in LTC. I am working on my NRP certification right now and will have it over the summer. Why NICU: -during L&D seeing small human come into the world and wanting to work more with the baby than with the mother -working with the newborn nursery RNs -love lectures on baby physiology and adaptations from fetal state - saw video of NICU in class and researched on my own: NICU create "external womb", parent teaching, critical care (challenging and complex), all body systems, both tough and compassionate, support little ones fighting from the beginning, longer term relationships than floor nursing (aspect of hospice I love), lower patient ratio able to focus on each baby more I appreciate anyone's input!

I got my letter today, I'm in!

Yeah! Awesome for you :)