VegRN

The nurse that gave me report was there when I caught the error, it was a mistake, she felt awful about it.

Yup, I was being careful, as I mentioned, the previous nurse programmed it incorrectly and when I received the patient I went in right away to check the drip rates and noticed it was programmed wrong.

The rate was set at 40meq/hr. Total dose in bag was 60meq/500 mls and it was programmed to run over 90 minutes. I caught it after it had already been running for 45 minutes.

I am an experienced nurse and need feedback on a med error I caught. I received a patient who had a potassium level of 2.3, in checking the pump settings during handoff, I saw that the potassium was programmed to run in over 90 minutes, the patient had received half the bag, 30meq in 45 minutes in a peripheral IV. I stopped the drip, checked her tele rhythm and notified the Md. I work at a teaching hospital, the doctor (an intern) and later the oncoming nurse seemed to not be concerned. The nurse that incorrectly programmed the pump, myself and another colleague were very concerned about arrhythmias and phlebitis. I suppose experience level could be a factor in the differencing reactions but I am wondering what you all think. Thanks so much!

I am an experienced nurse and am curious as to what you all think about this. If a patient is complaining of pain and they are specifically requesting IV pain meds but they are tolerating PO and have oral meds ordered, what do you do? If you don't want to read the whole post, long story short, are we required as nurses to treat the pain based on what we think is appropriate given our professional judgement or are we required to give them the specific pain medication they ask for? I tend to think it is the former but in the absense of safety concerns, I will do the latter. Had a patient last week that complained of knee pain, was admitted for an unrelated reason. Hx of sleep apnea, was supposed to wear CPAP at night and during all naps and refused. Pt received IV pain meds just prior to me coming on and was sleeping soundly for the first 4 hours of shift, woke during assessment, drowsy and fell back asleep, sleeping through machines beeping, staff coming into the room to fix them, per report often falling asleep during conversation when doctors are in room. VSS but this is when patient is woken, I wouldn't be surprised if he was desatting during periods of sleep. Midway through shift, resting comfortably when I walked by room and dramatic display of pain when I entered room to assess. I gave him PO pain meds when he asked for IV pain medication because he was tolerating PO, they last longer and I was concerned about his level of sedation, I explained all of this to him. He was not happy about this and complained to the charge nurse about it. I kept titrating up his oral pain meds through shift, reevaled him every 30-45 minutes and he was comfortable and sleeping though waking much more easily than with IV pain meds. I got the impression that the charge nurse wanted me to just give the IV meds to make him happy despite my concerns with his sedation level. I let her know that I didn't think it was the safest approach given previous level of sedation, hx sleep apnea and refusal to wear CPAP and that if she felt it was appropriate that she was free to give him IV medication. She did not. When there are no safety concerns and patients request IV pain meds over po, I strongly encourage them to take the PO because it will provide longer lasting pain relief and generally most of them are going home in the next day or two and need to make sure their pain is controlled with PO pain meds. If they want IV pain meds, I will give them a dose now and closely monitor pain through the shift and titrate up oral pain meds so they are satisfied with their level of pain control. I appreciate your thoughts on this, thanks so much.

I make very close to 100k a year. 98k to be exact last year and will be right at 100 this year with recent raise. No overtime, 3-12 hr shifts a week, pacific nw. Night shift, float pool. Have been an RN around 10 years, BSN.

I would have to agree with the poster that said you may have a coworker that developed a resentment against you. Since you are agency staff, sometimes people assume you make more money and automatically hold you to a higher standard than core staff. How else would the nursing supervisor know you were in the chapel napping unless she was tipped off by someone else? I really appreciate that you chose the chapel though. I work nights and am not someone that wants to or even can nap at night. I really dislike it when I finally get to take my lunch break, I enter the breakroom and there are people with all the lights off sleeping in the breakroom. Where else am I supposed to eat?? And of course there are sometimes multiple people that mash all of their breaks together into a full one hour nap which makes it hard on the non sleepers.

Think twice before continuing nursing school. If you already don't like it, that is a red flag. On the other hand, it can be a vehicle to help you get you to where you want to be so think about what you want to get out of it. I went into it for a lot of the same reasons that you did, good pay, benefit and a stable job. I grew up dirt poor and didn't want to be financially struggling like my parents did, I didn't know what I wanted to do so I became a nurse because it seemed flexible career wise . Nearly a decade into it, it is safe to say I almost resent my job and feel trapped by working only 3 days a week for nearly 100K a year, hard to leave that. I guess a lot of people would love to have my problems now so I can't complain that much. The thing is, it is stressful, nurses have all the responsibility and none of the authority and anytime something goes wrong, the nurse is the first to get blamed. I guess I just feel like it is such a disempowered profession and it eats away after awhile, you can try to be assertive but it gets tiring going against the grain so much. The good thing is that that you can always drop down to part time and work towards something you really want to do. That is my plan anyway.

Good for you on your desire to change! I would check out websites such as shape.com to determine what to bring on the first day. It also depends a lot on what you will be doing at the gym, cardio, strength training, classes etc. Asking at the gym might be a good idea as well. Good luck

I would have to disagree with you, at least in the work situation that I used to work in, I did not see a problem with it. In this situation, all the meds were individually barcoded and in a patient drawer, they were sent up from a central pharmacy. Patients were not charged for meds until they were scanned by the nurse. If one patient did not have a med then we sometimes borrowed it from another drawer since the patients were not yet charged for it and all meds were barcoded which verified that the med was correct prior to administering it to the patient. Now, if it was not barcoded, was a patients own or there wasn't a scanner to verify that it was correct, then I see what you mean about it being questionable.

This needs to be reported to the BON. Can't you report while remaining anonymous so that it will not affect your job? Perhaps you could give information to the BON which is general enough (or a limited number of specific situations) so that they could investigate. I agree with the other posters, this is way illegal. Trying to give you orders? Wow. I also can't believe that someone with no formal training can give injections after they are "trained" by a doctor but I guess if the state allows that, that is another story. Seems risky on the Dr's license and potentially unsafe for patients.

Why not see this experience as an opportunity to get past some of the fears of being around men? I think it would be an injustice for you to drop out of nursing school because of this. That would mean your abusive father is still controlling your life. As previous posters indicated, check out the student health services to see about mental health help.

Thanks all for the comments. Yes, I also learned to take shifts whenever they are offered. I also casually wondered if the agency punishes nurses who decline a shift by canceling you first for x amount of days later. I looked into other agencies in the area and it seems that they all staff at the same 2 hospitals and the one I do most of my shifts with has some type of contract for the hospitals in where they get the shifts first. I live in an area with much higher than average unemployment rates and pickens seem to be slim. I am hoping they will pick up in January. Thanks again!

yup, this is true. I have several nursing licenses and all it takes is filling out the required paperwork, $$$ and waiting. Some of the states require you to submit fingerprints for a background check so that adds on the dollars and wait time too.

Honestly, this job sound awesome to me. However, I think this opinion may be affected by the fact that I am unemployed and have been trying very hard to get a job for a few months.

Nurse80'sbaby- yup, sounds like we are in the same boat. I never thought it would be like this either, when I was hired at previous jobs, the main requirements were a pulse and a license for excellent job opportunities and I was offered jobs on the spot. Not like this anymore. I applied for unemployment as well. Fortunately I am in one of the states that allows you to collect unemployment if you quit a job to move with a spouse but, they have to investigate it and it will be over a month until I see any money. It is depressing how little the unemployment check will be but hey, at least it is something. I am looking into other areas of nursing as well such as subacute and home health. I do fear that it could be hard to get a job in an acute care setting again after being out of acute care but hey I guess it is worse to have no experience in the meantime. Thanks all for your support. I really appreciate people sharing their experiences.

Hi Zacarias, I am sorry that you are going through this, it must be tough. I can really empathize with you though because I have had and still have some of the same problems although now it is to a much lesser degree. Years ago when I was an NA, I used to get so anxious giving a patient a bath that I contemplated quitting nursing school to be a supply stocker in the hospital (I am not kidding). I have to agree with the previous poster that recommended seeking help. this point in my life, my anxiety and depression are much much better due to seeking help for it. Even when I was a poor student, I was able to get a low cost therapist and see a psychiatrist for meds. Here are some specific recommendations from my experiences. I strongly recommend that you make sacrifices with your finances and see if your family or friends can help you out with expenses in order for you to seek help from a qualified mental health professional. 1. When you get anxious worrying about people being snippy or the emotions of situations, focus on the task of the matter, not the emotions. Even though the anxiety is there, focus on the task, don't try to push the anxiety away but instead continue to shift your focus on the task. 2. Despite being anxious about going to work and not being able to sleep, force yourself to go to work anyway. Missing work because you are anxious just reinforces avoiding your problems and also reinforces calling in. Something that might help is prior to your shift, right down all the things that you are scared about and set it aside. When you are done with your shift, look back at the list and write down everything good that happened and a list of everything bad that happened and try to keep these columns balanced. For the list of everything bad, pick one of two things that you will work for your next shift and set specific goals to achieve that. 3. Really really try not to take what other people do or say personally, it is usually about them anyway. If someone is snippy to you, maybe they are having a bad day or maybe they are just always like that. And a few people go out of their way to make others lives miserable, just don't engage the bad behavior. 4. One book that helped me is this, "The dialectical behavior therapy skills work book" by McKay and Wood. This therapy was developed for people with BPD but is helpful for anyone dealing with overwhelming emotions. It helped me a lot with my anxiety. I wish you a lot of luck in seeking help for this. It does get better, trust me, I've been there. If you would like, feel free to pm me.

Hi all, I am new to agency nursing and am getting the lovely experience of being canceled nearly every single shift. I have been cancelled about 90% of the time and am wondering whether this is normal in general or whether it is a seasonal thing in where there are less staffing needs throughout the holiday. Thanks for your input.

I have less than half of the years of experience as you and am currently having trouble finding a job as well. I have applied for over 40 jobs in the last month alone and and have had one interview of which I have heard nothing in the way of a job offer. I have had a good amount of rejection notices which I prefer to no response if they are not interested in hiring me. The other jobs say they are "reviewing my information" and a few say that they have sent my info to the hiring manager although I have not heard anything in the way of interviews. I agree with ICUMarshall about the lack of common courtesy towards applicants seeking employment. Phone calls not being returned, no indication of whether they are actually hiring for the jobs posted in the immediate future etc. It is so discouraging and just seems so cold and heartless.

Thank you all for the replies, it is nice to know that I am not the only one in this situation. My specialty is med surg, maybe that is not the right specialty to be in right now? Critical care seems to be the specialty that is more heavily advertised as needing nurses in my area. On the same token though, there seems to be lots of med surg jobs but either they are not filling these jobs or they are not prioritizing hiring during the holiday season. Thanks again everyone for the posts, and keep them coming! Are there areas of the country where travel nurse contracts are more plentiful? I am considering doing this if I do not find anything in the next few months. I would basically travel anywhere in order to preserve my skills, my sanity and to get a bit of money in my bank account. ( I have a license in a nursing compact state)

I recently had to quit my job due to my husband being transferred across the country in his job. At our new city, the unemployment rate is higher than average, 10% but, I thought being an experienced nurse with great references, national certification and leadership experience that I would have no problem finding a job. Well as far as I can tell right now, I was wrong. There are lots of jobs posted and I have applied to about 35+ jobs in the past 5 weeks and 50% of them have sent me rejection notices thus far. The remaining jobs I have not heard anything from or they tell me that I meet the minimum requirements and my "application is under review" (and has been for 2-3 plus weeks). Other than what I mentioned, I have not heard much. Also, these hospitals are mostly large and all say essentially, "Don't call us, we'll call you" although I did call a few of the numbers to enquire since they had a nurse recruitment number posted. In the meantime, I signed on with a staffing agency per diem and Have been cancelled 90% of the time even though this particular agency has ads posted all over saying they are in dire need of experienced RN's (so frustrating) Am I overreacting? Do I just need to be patient? Is anyone else in the same situation? This is so frustrating.

I understand how you feel and am glad to hear that someone else has the same dilemma that I have. I am a med surg RN and am seriously considering going to graduate school. I feel guilty sometimes too about wanting to advance since bedside RNs are so needed. What helps me is thinking about what I want to do rather than what other people need me to do. I really want to go back to school because I liked school, like to learn new things and am interested in a different career. Also, bedside nursing is so stressful that I don't think I could do it forever and I for sure do not want to work every other weekend and half the holidays forever. I still enjoy it but the excitement has waned over the past few years. Bottom line is that you have to think about yourself and what you want to do with your life. Good luck to you!

1. Does your unit use any alternative/contemporary healing? If so what kind? The hospital I used to work at used massage and acupuncture. With Md approval, pts could make appointments for these services. 2. From your experiences how effective is contemporary healing? I have not really noticed wheather it is effective. Pts usually like that it is available though. 3. Do your patients ask for alternative treatments? Alternative therapies were not well advertised. There was a flying in most of the patient rooms. it did not seem to be widely utilized. 4. Are there any disadvantages of using contemporary healing? None that I noticed. 5. What would you change in your practice in order to improve or incooporate contemporary healing? Perhaps notifying patients that it is available would help. The downside is that the treatments must be paid for out of pocket at the time of service.

You should go ahead and apply to the program. Nursing is so varied that there I am confident that there would be nursing jobs that you could do despite your limitations. Things that come to mind that are not physically strenuous are insurance claim review, management, administration and case management. I have a friend that works at a hospital with a blind doctor. Now if he is able to do that, I am certain there are jobs that you can do. You sound like a smart and compassionate young man. The nursing profession would be lucky to have you!

Lori, thank you so much for the advice!