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FacultyRN has 12 years experience.

FacultyRN's Latest Activity

  1. FacultyRN

    IV Push Meds

    I'd recommend looking up the common meds on your unit in your drug manual from nursing school if you still have it. The manual will clearly identify any special preparations (dilution, roll instead of shake, etc.) and the rate of administration. Sometimes, in addition to rate of administration, it'll list a rationale, like may cause hypotension, arrhythmias, etc. of administered too fast. Others specify instructions like "do not exceed 5 mg per minute" instead if a time frame. Like others said, Micromedex could offer you the same if you don't still have your drug manual. It's nice if the previous poster's hospital offers guidance on medication prep and administration in the MAR, but this is not routine. Neither of those factors is a required component of the physician's order. It's also not pharmacy's responsibility to educate the nurses on administration of each med (although they're a great resource). These are nursing considerations, so they're a nurse's responsibility to find out before administering the med. Please disregard the poster who said "you need to forget what they taught you in nursing school. This is the real world." Yes, it is... and the real human lives that are relying on you to provide evidence-based best practices to avoid harm would like you to remember what you learned in this case. Barring a code situation, rates of administration should absolutely be followed. To say that's not reasonable for a busy nurse is really just crap. Make time. It's not fair to patients to receive subpar, potentially harmful care just because their nurse is in a hurry or the unit is understaffed. Medication preparation instructions and administration rates weren't just willy nilly thrown into random pages of drug manuals to throw nurses off, and to act like that's the case by instructing someone to ignore them demonstrates a lack of knowledge, in my opinion. That's not someone I'd want caring for myself and my loved ones. Remember, you may be a new grad, but you are already an RN and held to RN standards. That means YOU get to choose how you're going to personally do things, even if the rest of your unit doesn't follow a best practice, because you have a license and a duty to your patients. Good for you for speaking up, asking questions, and wanting to do things the right way!!
  2. FacultyRN

    I'm the bad guy for not working off the clock

    Good for you for putting your family first and refusing to work without pay in an hourly position. Federal law requires hourly employees to be paid for time spent working. If this new employer wants free labor, that's not your problem. If you were being paid for overtime worked, then staying over for 30 minutes to an hour on a rare occasion would be more understandable. Even then, it shouldn't be an all the time expectation. Many employers have a policy of no overtime for orientees since they're not counted towards staffing, so that could be in your favor.
  3. FacultyRN

    Talking To My Employer

    Orientation is a time for both you and your employer to decide if it is a good fit. Two weeks in is much better than 16 weeks in because they haven't wasted as much time or money. Let them know you have found another opportunity that better suits your long term goals. Leave it at that with no details. Give your 2 weeks notice, but they likely won't have you work it. No one wants to pay for an RN who doesn't count towards staffing with no end goal in mind. You may burn bridges with this health system, or maybe not. I'd sincerely apologize for the inconvenience and let them know you appreciated the opportunity. Thank your manager. Unless you live in a rural area with very few work options, or have been a chronic job hopper, I tend to disagree with people who say stick it out 2 years in a role/place you don't like when a better opportunity presents or never leave during orientation. One of the benefits of nursing is that you have choices! Don't feel bad about doing what's best for you. New grad programs vary greatly in quality, and picking a good one is important to the foundation of your career. As for the other place, your application/resume were current at the time you applied. I wouldn't worry about any updates.
  4. FacultyRN

    Student nurse here. Am i going to be a bad nurse??

    As an instructor, and a staff nurse, I do find these mistakes concerning. You will never be as cautious in administering medications as you are in nursing school, so this is a red flag. If the error was simply an error because you're not familiar with clinical facility policy, like their scanning software, that's not ideal, but meh. If the error is that you gave a wrong medication, dose, route, or something 6 rights related, that is unacceptable from a 4th semester nursing student. 6 rights are preached from day 1, and failing to verify the 6 rights at the bedside is simply sloppy care... and would have resulted in clinical failure for the semester in 2 programs I've taught in. (I hold your instructor or assigned preceptor equally accountable for this. Nursing students should not be independently administering meds, so they dropped the ball.) Inserting a catheter on the wrong patient is inexcusable. This would have resulted in clinical failure for the semester in two programs I've taught in as well. Why would you take a verbal order from an RN who isn't authorized to order catheters instead of verifying that a provider's order existed? Why in the world would you accept a patient's room/bed number as identifiers for ANY procedure? You completed an invasive sterile procedure of a sensitive nature on someone without having any idea who they were. It most certainly does NOT make it "no big deal" just because it's someone who self caths. What if the unknown cath recipient had an iodine allergy? What if you caused a UTI on someone who had no need for the cath? Did you appropriately report this error to the patient's physician and assist the nurse in completing an incident report? Did you document the procedure in this patient's chart or just pretend it didn't happen? Again, I partially fault your instructor or preceptor for lack of supervision. A student shouldn't be performing sterile procedures unsupervised. Slow down. Use your critical thinking. Ask yourself why something is ordered for a particular patient, and make sure the order makes sense before blindly carrying it out. Take time to be safe. I do agree with the previous posters that it's no big deal if you aren't great at IVs yet. Many students never successfully start an IV during nursing school. It's a skill that is mastered with practice. I know my response may seem harsh, but I really find your post startling.
  5. FacultyRN

    Post Partum VS. L&D

    I have worked both L&D and postpartum. In L&D, every single patient you care for will help prepare you for midwifery. In postpartum, you would gain little to no insight into midwifery. You need to learn about how to manage labor, care for complications, accurately check cervixes (which can only be done through practice), L&D medications, fetal monitoring, pain control, etc. As an L&D nurse, you will also learn to care for transitioning newborns and immediate postpartum recoveries, sometimes women who are a few days postpartum if on mag or with medical complications. An L&D nurse is 100% competent to walk into a postpartum unit and provide nursing care. As a postpartum nurse, your skill set would be minimally transferrable to L&D. (This is not a knock on PP nurses. It's a sweet and fun area to work in.) Another thing to consider is that most reputable nurse midwifery programs require 2 years of L&D experience before starting. Midwives need to be L&D experts. If this isn't a requirement of a school you're looking at, I'd be hesitant to apply to that program. You'll have such liability as a midwife that you want to be held to the highest standards. My students who work night shift consistently struggle with assignments and deadlines more than my day shift students, so that's something to consider too. And a shorter commute will give you more time at home to do school work. Normally, I'd tell a nurse take the extra $156 a day. That's huge! But not in this case... If you're really set on midwifery and can comfortably support yourself at the L&D job, I'd 100% go that route. Good luck, and what a good dilemma to have!
  6. I understand the sentiment behind your letter, and it's always nice to sandwich constructive feedback between positive feedback. New grad RNs are legally held to the standard of RNs from day 1, which can be challenging. I disagree with the previous poster who suggested really sending your message though because it is largely feelings-based. Instead, remember how you felt upon receiving constructive feedback only so that one day, when you're precepting/managing, you can approach evaluation conversations the better way! In the meantime, maybe keep a journal of a few things you are proud of each shift. Then, even if you aren't getting desired affirmations from management, you will remember you're still doing good work and improving each day. Unfortunately one month of orientation is inadequate for new grads, and now your DON is realizing that novice nurses with inadequate training don't magically become experts, but instead of looking at how to better prepare you, she's looking at your shortcomings. If you agree with her feedback and feel there are areas where you need improvement beyond just time/experience, perhaps you could ask for an additional week or two to be paired with a preceptor. Now that you've been independent for 2 months, you'd know which questions to ask, which areas you need to improve in, and could focus on learning to better organize and prioritize your care, little tricks of the trade to simplify your workload, etc. She may say no because of the expense/staffing, but it can't hurt to ask. Either way, take advantage of the experienced nurses around you and soak in their guidance whenever you can. Ask lots of questions, jump in if there's a chance to learn a new procedure, etc. Learning takes time. I wish you the best!
  7. FacultyRN

    Ineffective Compressions

    Compressions should fall between 100-120 per minute, at least 2" deep on an adult, and should allow for complete chest recoil as you said. These guidelines are neither the "jackhammering" nor the "slow" compressions you described. Best done compressions only have a cardiac output of 25-30%. If this was the patient's 4th code within several hours, I'm assuming she was intubated; capnography is a great tool for determining if compressions are adequate. End tidal CO2 during compressions should be at least 10 mmHg. And remember, part of being an effective member of a code team is communication. If you have a concern about the safety/efficacy of someone's intervention, calmly and respectfully speak up. I like one of the above poster's ideas to verbalize the actual rate. "Right now, compressions are at a rate of 143 per minute. The recommended rate is 100-120 for optimal outcomes." That eliminates any kind of you/blame statements. And remember, standards of practice don't change if a nurse personally determines code efforts to be futile (even if correct). As long as the patient is being coded, he deserves best efforts.
  8. FacultyRN

    Abandonment - Legal Question

    (My response to the above-listed quote is below, but I don't know how to correct it from looking like another quote. Sorry!)
  9. FacultyRN

    Abandonment - Legal Question

    Abandonment can't occur until you have accepted a patient assignment. Failure to pick up a shift, or even decline a patient load, is never abandonment. Your facility may tell you it is, and they may really think so because there's such confusion on the topic, but that's incorrect. This is not a Board-reportable issue. Now, if your employer has properly oriented you to a clinical role, you may be expected to help in the unit. Typically, non-clinical nurses aren't even to require the basic orientation RN skills, which makes sense, but also means you shouldn't be staffing a unit. If you have a physical disability that impairs your ability to staff a unit, that's another consideration. Your employer is required to verify your clinical competencies before you accept a patient load independently. Nurses are not interchangeable. Each individual nurse has a unique scope based on licensure, education, certifications, work experience, specialty, and which competencies you have had validated. For example, I spent years as a charge nurse. I have never worked Med Surg. I am not competent to charge on a M/S unit. I would 100% decline a request to staff as a clinical RN on a M/S unit. But no matter what - not abandonment!
  10. FacultyRN

    Rude nurses

    This thread leaves a lot to be desired and is filled with cattiness. I'm sorry your first week was hard. I always loved working 7/1 and being there with brand new docs to help them find their footing, but other nurses feel differently. I even worked with a nurse who would take off the first week of July each year to avoid interns. Different personalities, different levels of patience, different interests in teaching... There's no excuse for acting rude to anyone on the interdisciplinary team, regardless of clinical background (or lack thereof). I think some nurses like knowing when docs have a nursing background, and I think others act ugly towards them and have some ridiculous traitor mentality. Try to focus on your work, and being kind and approachable while doing it, more than caring what people think about you. Once they see that you're competent, they'll probably be a bit kinder. If not, meh... It's nice to have friends at work, but not necessary. Good luck!
  11. FacultyRN

    NP vs MA vs MD power struggle

    Can you put together a brief in-service to share with the providers and staff outlining your education and scope of practice, and clarifying that while you want to be a team player, your team is now licensed providers? If you are alotted 20 minute slots to see patients, you don't have 5-10 to spend on rooming, waiting while someone provides a urine sample, vitals, and whatever basic intake is done before the patient is provider-ready. (But I don't need to tell you that!) I think clear communication about your role is the way to go, and sooner than later before your current struggle has turned into a you vs everyone situation.
  12. FacultyRN

    New Nurse Precepting a New Grad Nurse

    I would say you're honored that she thought of you, and look forward to precepting once you've gained your own experience, but you are not comfortable training another new nurse with only a few months of independent experience under your belt. Thereare many situations, routine and emergent, normal and complicated, that you have yet to encounter. You are still learning your organization's policies, resources, interdisciplinary communication and expectations, clinical judgment, competence with clinical skills, time management, etc. You deserve time to focus on those things, and the new grad certainly deserves time to work closely with an experienced resource nurse who can help start her career on the right foot. You might be an outstanding new grad, but you are still a new grad! Even if you already said yes because you felt put on the spot, I'd contact her and say you've thought about the situation and have changed your mind because you're concerned about your ability to practice safely while precepting this early in your career. Learning to set healthy boundaries for yourself at work is essential and will serve you well for years to come!
  13. FacultyRN

    New grad RN, absolutely hate nursing

    Alternatively, those who excel at what they do clinically and want to share their love of the profession with others so that they, too, can excel teach. But you could've probably guessed my stance from my screen name. OP, nursing isn't for everyone, and that's totally ok! I think the suggestions to look into health research, informatics, and pharmaceutical/medical devices sales are good ones. Another idea may be to obtain a secondary school teaching certification for health sciences or science. If you'd be interested in law, an undergrad nursing degree could serve you well working with med mal cases. Or you could always pursue a completely unrelated graduate degree. Or somewhat related training like sonography... So many choices!
  14. FacultyRN

    Med reconciliation

    Nurses obtain the medication history, which is the list of prescribed, OTC, and herbal medications the patient is really taking at the time of the visit. This in itself isn't true reconciliation. Sometimes, this may involve entering "unknown white oval pill for blood pressure daily" on the list. I've also always made notes about non-compliance by listing prescribed medications the patient should be taking but admits he or she isn't, and the reason. (I don't know anyone who loves this process!) True medication reconciliation is a provider's responsibility. This is because you, as a registered nurse without prescriptive authority, can't choose to continue, discontinue, adjust, or hold medications on the list. The provider should be reviewing the list for duplicates, outdated medications, unsafe combinations of medications, etc. before placing prescribing any new medications. One of the hospitals I worked in had a hard stop built into Epic where ER patients couldn't be discharged until the provider had clicked that he/she had completed the med rec. You'd be amazed how many lists still had antibiotics from 3 years ago, duplicates, etc. Many providers treated it as a box to check, not an opportunity to promote safety and medication compliance. With that said, if the patient in this scenario received the prescribed dose for the hospital stay, and that dose fell within a safe range, it's hard to think of it as a double dose. I would think of it more as a communication error than a med error from a nursing standpoint. I admire your accountability and desire to learn from this situation!
  15. FacultyRN

    Looking up patients on Facebook

    I would consider it a HIPAA violation because these students/nurses are using a patient's protected health information (name) for personal use. PHI should only be accessed and used on a need to know basis by team members who are currently assigned to the treatment team, and only for therapeutic purposes. If nothing else, it is a violation of patient privacy and professional boundaries. I don't want my care team reading about my personal life and looking at pictures of me if I am in the vulnerable position of patient. Anything that could harm a therapeutic nurse-patient relationship should be avoided. Nurses shouldn't pursue personal relationships with patients - even if said relationship is just creepy online lurking out of curiousity.