NurseC,RN

Change of scenery for sure. Yeah there's always crappy shifts but if you are consistently counting the hours until the shift ends or your next set of shifts off then a change may be good. I left my previous unit, loved most of the staff/the patient population but trouble sleeping, anxiety before walking into work and dreading phone calls from staffing when I really should have been picking up shifts. But huge difference for me is that I'm no longer in the charge nurse role like I was on my previous unit so I'm in a much happier place knowing I'll only have my set patients and not in charge of a 38 bed med-surg unit. You've got to do what's best for you and weigh the pros and cons

Chart the behaviour thoughougly of behaviors observed, strategies used and pt response. Over time this will help develop a strict behaviour plan between exactly that management, nursing staff and the physician. Include time limits if needed, communication tips and tricks, consequences mentioned to pt if not compliant with staff requests. The more team members you have on board, and comply the easier the behaviors become to manage.

I have worked on a unit where at one point 14 of our 38 bed unit were LTC patients or those awaiting alternate level of care. Yes is it hard when you have acuity ill patients, mixed with dementias and behaviour type patients absolutely but you still have to provide the same level of care that you would for any other patient. If your hospital/unit has volunteer services that can visit with these patients or recreational therapy to prevent boredom/get them engaged activities bring it up with your manager as an option. As for the falls we have used the least restraint policy therefore 3/4 bedrails at most, fall mats, bed and chair alarms Assignment suggestion: ensure that a nurse and health care aide are not assigned the same LTC patient for more then 3 shifts in a row to prevent burnout Four LTC patients on an acute care really isn't the worst of it.

1. Like someone mentioned prepare ahead of time for your shift. I shower the night before, lay my scrubs out, meal prep is ready in the fridge and the coffee is timed so it's a pour and go. 2. Show up a little earlier before report to get organized, get your patient assignment (if your unit assigns before report), write down vital signs, assessment, abnormal findings documented by previous shift that need to be followed up on, labs to watch for, dressing changes, intake and outputs, ambulation during the shift etc. I highlight those important aspects that are crucial for certain doctors or I call it my "hey dummy don't forget this" 3. I check on my patients as soon as report is done so I can lay eyes on my patients, check their lines, IV fluids are set right with appropriate rate, suction and oxygen are functioning at the bedside, bed alarms are on those that need them. 4. Vital signs and assessments. Addressing concerns to bring foreward to the doctor/charge nurse if any. AM med pass depending on patient:nurse ratio I have that day. 5. Ensure patients are set up for meal time and if everyone is settled and no concerns I chart, chart, chart. 6. If you get busy rely on your health care aides, other team members, your charge nurse/nurse clinician to let them know you are running behind. Worst thing you can do on day shift is try and do it all by yourself, and feeling swamped by the end. Hope that helps. It's a change from night shift to days but you'll do just fine and figure out what works best for you!

5) I just don't understand why the doctor was upset why we called a code (regardless of what it was) when he had just saw her & saw her condition. I'm going to protect the patient & do what is best for them. It was at shift change & even during the day it's not easy to get ahold of a doctor. Why would I call the patient's doctor when there is a HUGE change that could be life altering? Let this be a lesson and not a reason to get defensive. If you noticed a change in your patient it's your duty to call the doctor and get the order for Narcan, and you keep calling until you get a hold of that doctor. Patient statuses can change rapidly from the time a doctor rounds and perhaps the physician didn't see those symptoms you described in the moment they were in the room briefly with the patient. You said it yourself "I'm going to protect the patient" so do better the next time.

Preaching to the choir. I had a situation like yours.. We went to nursing school together and after we graduated we became closer and eventually ended up working in the same unit together. It was nice to start at the same time, and go through those new grad situations and have someone that understood "that new girl feeling". But then it became a "did you hear what this nurse did" or just plain gossip that didn't matter. Our conversations strictly revolved around work and her gossiping about everyone, anyone, patients, families, doctors, support workers it didn't matter and I couldn't handle it anymore. She spent more time in the managers office complaining then actually spending and doing care with her patients. I simply asked her not to talk about work unless we were on the unit together because it would literally give me anxiety going into work hearing these stories or how "crappy of a night it was" when it reallt wasn't. I eventually stopped texting her all together, or kept text messages shorter and shorter which eventually lead to her gossiping about me. To say the least we no longer speak now, and she was a contributing factor as to why I left the unit almost a year ago. TLDR... Big lesson: you find out who your friends are. Leave the BS at the unit doors, do your job, if you find your work wife awesome, but always be aware of what some are capable of.