Constance7

What a night. I also am a night nurse on a floor that feels out of control more that it feels in control. What caught my attention is the patient who was found unresponsive after his dose of dilaudid. 4mg is a lot, how often was he getting it? I have seen at least three people in the last few months go under and the dilaudid seemed to be the reason. I realize that when used properly this is a very effective drug for pain management, yet addiction seems to be on the rise at my facility with this drug. I notice that people who start receiving dilaudid usually go from being doubled over by pain before administration to asking how often they can have it and requesting it right on schedule with no outward apparent pain at all. Just for clarification I am not a nurse who denies pain meds and I try not to be too judgemental, but it does make me wonder. I have a friend who was hospitalized for bacterial meningitis about a month ago. I was her nurse and we were medicating her with dilaudid 2mg IV Q2h prn for a migraine r/t the meningitis. After about three days into her stay she told me the migraine was almost non-existent but she still felt like she wanted the dilaudid because it made her feel so good. This is not a person with a history of drug abuse of any kind. This is a topic I ponder on frequenly as a nurse. We have patients that are full of cancer, end stage, and I have had to beg a doctor to medicate better. I also have anxiety issues, always have, and I take 10mg of lexapro QD. I am not a person who likes to take meds of any sort but let me tell you this has taken the edge off. I feel a lot better and my house is a much happier place. I realized that I was bringing the stresses of my job home and my husband and three boys were suffering as a result. Just a suggestion though, this is probably not the answer for everyone. I hope things begin to feel better for you, sounds like a busy floor with a lot happening all at once. Good luck!

Congradulations! I did the exact same thing as a new grad. I agreed to a two year contract on a med/surg floor with 14 telemetry beds. I am not discouraging you but I would like to be honest. I speak from experience when I say that there may very well be many negative issues on a floor that needs to bribe nurses to stay. And once you enter into the contract you are stuck there regardless if you like it or not because of financial obligations. Unless that is you are willing to pay back the thousands of dollars they are probably offering. But here is the positive side. I am a firm believer that the foundation of nursing begins on a med/surg floor. Many of my older friends who have been RN's for many years tell me that respect is never gained until you do at least two solid two years on a med/surg floor. You will be exposed to a large variety of ailments in a relatively short amount of time. The pace is fast and yes I do work with MANY nurses who are 100% burnt out. It is demanding, the patients are always changing, and there is not much structure at times. But I honestly feel that after my stay with this facility is done I will be able to transition over into almost any type of nursing. My blood drawing, Iv starting, and assessment skills have grown tremendously in two years and I know that I have 2 things to attribute this to. One- the fact that I did choose Med/surg first, and two- because I have made a 25 year nurse my best friend. She has helped me grow and I learn from her on a daily basis. I would be lost at times without her! Good luck in your career and enjoy graduation, you earned it!:yelclap:

Practice Practice Practice! Search out all IV starts and try. Rely on feel, not look. With hard sticks some of their best veins are not visable to the eye, yet are like pipelines. The best veins are bouncy, if visible you dont want to stick in a y. You will probably hit a valve. Confidece is also key. If you think you can do it you will more often. After prepping site find the right angle that works for you for insertion, stabalize the vein. Once needle is in and you see flash advance just a little more before retracting needle. Apply pressure to site just above insertion site(this should prevent blood flow all over until you can attach flush) Hope this helped a little- let me know. Good luck

I have been working as an RN for about two years now on a busy med/surg floor and tele. I have not forgotten the feelings that all new grads feel, yet few are willing to admit. This site is amazing and just by seaking out information you are all growing daily even if it does not feel that way. There is so much that I have yet to learn but do I feel COMPETENT? Yes I do, and so will you if you give it your all and stay focused. Nurses do eat their young. That is the most truthful thing I have heard. Never really understood it until I became a nurse. Remember this- you only ever will feel inadequate if you allow someone to make you feel that way. Try to stay away from the negative attitudes that some of the 25 year nurses have developed. We may not be as experienced as them but once upon a time they were the ones asking all the questions and feeling insecure. How easy some of them forget. My day came after about a year and a half of nursing and for the most of you your day will come to- I had a pt who was diophoretic, hypotensive and was complaining of pain in right upper quad of abdomen. Just had a feeling "something is not right" Ekg showed major st depressions- indicative of an MI. Called the doctor and he said to give him maalox. As an advocate for this person I requested that we please draw a troponin just to be safe, he insisted that this was not typical chest pain but agreed. This person ruled in for a massive MI and although I was sad for him it gave me great pleasure to call the doctor back with the results. His reply simply was send him to the unit and have them call me for orders CLICK. But that is ok because at that moment I knew I was a nurse. And your moment will come to and then there will be many more to follow. It's nothing that we have to brag about or even share with co-workers because in my opinion the BEST nurses are the ones that are seen consistently giving the highest quality of care they can- not the ones who talk about it. Believe in yourself always because we need more good nurses. In time it will all come- I promise.:)

During report listen closely. See your most critical patients first. If time allows do a full assessment- if not focus on the admitting diagnosis.Ex- CHF, listen to lungs observe signs of edema, check Iv fluids are correct-site patent, pain if any, how alert they are. Lead sheets are huge. This is your bible and will save you in the middle of a crisis when you need to know something quick. After all meds are passed and patients are a little settled try to go to charts and observe their history and any results of test. This makes you a better nurse because in report you can give the info that confirms a real important thing- you know the people that you have been caring for all day. When your patients want to talk be honest. Listen for a few minutes then tell them that you would love to stay and talk but there are other things you need to do. Explain that if you get the time you will come back and talk for a few moments"once things settle down". Most of the time they honestly will understand and will not be offended. Time management is something that will come as you progress into a seasoned nurse. Everyone has a different way of getting the job done, in the end it is all the same regardless of the path choosen to get there. Try different techniques until you find the one that works. Dont give up because you are well on your way! Good luck, hope this helped a little bit.

Thank you Lisa. I know that there are a lot of other nurses that will disagree with us but let's keep doing what we are doing. There is very little recognition given to Nurses from upper management. Our patients are where we get 99% of our gratification. We and all other nurses that share this opinion will be the nurses that the patients remember as the ones who took the time to care. When we choose our profession we knew that there would be moments that would prove to be "annoying". Some Doctors forget this and assume that they are above midnight calls. I have total respect for the majority of doctors that I work with and they all know I care about their patients even when they may be too tired. We choose this profession- it did not choose us. Lets do our best Nurses.

Breathe! You did not do anything that any other nurse has not done. It was an honest mistake and you took the right steps to right the wrong. As nurses we all have made a med error or two. It sounds as if your patient was fine and there was truly no real harm done as a result. I do not believe that you will lose your job. You probably will get spoken to and the best you can do is admit the mistake and I promise you that this is a mistake that you will never make again. Since it was regarding insulin you will double and triple check before administering. And something to remember is this- IT DOES NOT MAKE YOU A BAD NURSE. Just chalk it up as lesson learned. Good luck!

Honest answers in my opinion. Yes my GPA fell during nursing. It went from a 3.4 to about a 2.8. Nursing is challenging and towards the end I just wanted the degree more than the A. I was burnt. Dont waste time studying for the N-clex until your senior year. It will take away from your nursing classes. The preparation you can do for nursing school is to remember 1 thing. It is one of the hardest things you will ever do. But even in the darkest moments you have to remember the reward at the end. And yes they probably will watch you like a hawk. I seen many male students singled out and I believe it was because they were males. As cliche as it sounds there is no such thing as a dumb question. Always ask- better to be safe than sorry. Good luck in nursing school!

I do believe that during a code there has to be a bit of humor @ times to break the staleness in the air. But at the same time I am old school in the way that this person is/was someones father, mother, son, daughter ex. As professionals we owe this person respect even in the moment of death. I am not ridiculing you for your behavior because we all have to do what works for us and let's all be honest- what keeps us sane. This is a hard job we have Nurses.

I am a nurse on a med/surg floor and also work tele. Many times I call a doctor in the wee hours of the morning for something as simple as MOM. We all know that there are patients that will not rest until they have moved their bowels. I realize that as a night nurse these doctors do not want to be bothered for simple things, but as an advocate for my patients I have no problem adressing their needs regardless of the time. So not ALL night nurses pass the buck- I'm sorry you have that problem @ your place of employment.