PeachTea7

Hi Everyone, Does anyone have any experience on Inpatient Psych Nursing? I am considering gaining experience in Psychiatry as I am contemplating doing my masters NP in Mental Health. I would like to gain experience before investing time and money in a higher degree. My background is Med-Surg and CCU. Any feedback, will be appreciated!

David, thank you for your insightful post! Sounds like you used to work in a very similar Unit like mine. Yes, I am using my time to do exactly what you mentioned: provide quality care to my patients, I have time to chat with them, ask them health questions when I want to know more about their conditions, when my patient does not know, I have plenty of time to review reports/results/H&P from Providers. I have this hunger for wanting to read it all and not necessarily "know it all", but rather understand better my patient and what they are going through. I think what pains me the most, it's when the Unit is closed! We don't have patients and there are not telemetries to oversee from the Med-Surg floor. It really kills me to just sit there, stare at the computer all day and complete seasonal/yearly required nursing education by the Dept of Education from our Hospital. I have already completed all of the ECCO Modules from the American Association of Critical Care Nurses. It was an extensive set of modules in the computer about CCU topics, it was so extensive to cover the education material that it took me 1 year to complete. Although, we are a small Unit and most of the critical patients either transfer-out or get a code status change... I like to take notes in my notebook. It's where I keep notes about everything I have learned at work, even though is a small unit, there is always some thing to learn. I want to savor every minute of it. But sometimes I have too much time in my hands and want to use it wisely before the years pass...!!

Thank you so much! I was thinking of pursuing a higher degree in nursing such as a masters degree in nursing or NP. However, I am a little reserved about my future plans at work and wouldn't want people (my coworker) knowing my future educational plans. I honestly don't know why am I so particular about this, but the more people know about you, the more they ask and check on you, there is an expectation and sometimes some people don't want to see you do better or greater than them. On the other hand, I have watched other nurses complete masters degree in nursing education and most of them get jobs in Colleges and teach. Most of them have told me that they are ready to leave the bedside and willing to also get a Pay-cut to teach. Most NP programs online and hybrid, require NP students to secure their own clinical, rotations, and preceptors. And added stressor on top of learning and becoming a practitioner/provider. Not sure if I am being negative or realist.

I have completed the cross-training education/training for the ED and PACU. Since I was a Med-Surg nurse, I did not needed to complete any training when I float there. The hospital itself does not require or has a need for nurses with certain or specific credentials. All they promote is for nurses to have a certification of some sort.

Hi Everyone, For the past 3 years, I have worked in busy Med-Surg and COVID Units as a new grad nurse. Currently, I am working in a small rural CCU Unit of 5 beds closer to home. Most of the patients' acuity is low, and the ratio of patient:nurse is 1 to 2 patients. Additionally, we also monitor patients with telemetry (maximum 1 nurse can monitor 2-3 telemetries). Sometimes, the patients' census in the Unit is low, Really Low! To the point that there is only 1 patient or just telemetries to monitor. I have used my time wisely since I have so much time on my hands, to the extent that I have completed all of the required education for the Unit plus the yearly educational stuff from the Dept of Education, and I seem to have a lot of time in my hands now that everything is completed. We could go to other floors in the hospital and help out, but this is not always needed. I understand that I should be thankful to work in a low-paced environment after working in busier and big units. Should I continue my education at work? Perhaps look into getting my CCRN credentials, although I don't have exposure to critical-ill patients? Study towards a higher degree in Nursing? What would you do?

Hi Everyone, For the past 3 years, I have worked in busy Med-Surg and COVID Units as a new grad nurse. Currently, I am working in a small rural CCU Unit of 5 beds closer to home. Most of the patients' acuity is low, and the ratio of patient:nurse is 1 to 2 patients. Additionally, we also monitor patients with telemetry (maximum 1 nurse can monitor 2-3 telemetries). Sometimes, the patients' census in the Unit is low, Really Low! To the point that there is only 1 patient or just telemetries to monitor. I have used my time wisely since I have so much time on my hands, to the extent that I have completed all of the required education for the Unit plus the yearly educational stuff from the Dept of Education, and I seem to have a lot of time in my hands now that everything is completed. We could go to other floors in the hospital and help out, but this is not always needed. I understand that I should be thankful to work in a low-paced environment after working in busier and big units. Should I continue my education at work? Perhaps look into getting my CCRN credentials, although I don't have exposure to critical-ill patients? Study towards a higher degree in Nursing? What would you do?

Hello everyone, My current schedule has dramatically change from 4 days of 8 hr shifts to 3 - 12 hr shifts. I have noticed that with 3 - 12 hr shifts, I have a couple of more days to rest in between shifts and I am very happy about it. It’s not perfect by any means because some days I have to do 3 - 12’s in a row in my new CCU job. I have began to think of ways I can pay a high credit card balance and prepare for Christmas… So I was wondering of ways to make extra income since I have already stopped the use of my credit card, and I am working really hard to pay it off, and use it ever again for any unnecessary expenses. Seriously! But, it gets tricky when I have worked 12 extra hours a week and get deducted so many taxes in my paystub for that week when I used to do 30 hours a week and picked 12 extra. My tax preparer has advised me to be careful having a second job/per Diem/side hustle because that means I have to pay more taxes at the end of the year due to my combined income with my partner. When I used to work 30 hours a week and I picked 12 hours… I got taxed a lot in that particular paycheck. So I wonder… if it was even worth it after all…. How does someone get out of debt and try to get more money for her family if you get taxed more in your paycheck or at the time taxes are due. I honestly don’t see working more a win-win situation. So how do people do it then? Now that I will start working 36 hours a week, how do I go about saving and trying to make some extra cash every week without being ‘penalized’ by paying more taxes… At my current job, nurses are not allowed to work more than 60 hours a week. Anything over 40 hours a week is OT based on my current job. Please help! I don’t know if I should have a per diem position in an outpatient clinic in another hospital or work in the same hospital and pick an extra 8 hour shift or 12 hr shift? so confused.

JBMmom, Thank you so much for your excellent input and advice! I am hoping to learn as much as I can and if the unit is closed due to low census. Help around in another unit. I was thinking of applying to another Hospital for a per diem position in an ICU so I can see and learn more if they are willing to give me a good orientation and preceptorship. But I don’t know if they will be willing to take a nurse with little CCU experience for a per diem experience.

Thanks for your input from the ED. You definitely made me laugh because you write and respond like most ED nurses would. I have to be honest… we picked on those quick reports because of our preceptors. I still consider myself a somehow new nurse with 3 years of experience. All of the preceptors that I have had, have mentioned to me to make sure that I get a “good report” because ED nurses just want to “dump” patients really quick in the Med-Surg floor, or need an empty bed in the ED. So I have been told to check quickly in the system, that vital signs look somehow stable and ordered from the ED were completed. It is the way tje teach us and trained us… In my experience, I have had reports from ED were V.Lactate/Troponins were not drawn but they were ordered. Or elder patient was really drowsy and I spend my last two hours of my shift giving Narcan because my elderly patient got too many opioids in the ED. But, what I mean… is that we learn from our preceptors to ask questions, demand to ask if patient has an IV, a Foley, oxygen, because report can be too quick sometimes. I have one particular ED nurse who doesn’t call to give me report and just brings the patients in. I never give ED nurses trouble or ask questions. I get the point of transferring patients quickly because someone else needs the bed. I get it.

Thank you so much! You definitely seem to have a very clear idea of the dynamics of an ICU unit in a critical access hospital. Everything you said was absolutely right! For the most part, I am concern that the unit can sometimes be “closed” or patients are not necessarily too sick to really learn critical nursing care. And on top of that working 12 hours in a slow unit can really drag time. During my interview, it was brought up that I will learn if I put in the work and initiative to learn. I can be asked to help around in the ED or other units. So, I will be definitely be getting out of my comfort zone which is Med-Surg. Thank you so much for the link! I am very excited! Cannot thank you enough for the link to so much knowledge! ;)

Hello everyone, I will soon start working 12 hour shifts in a small Critical Care Unit in a small tiny (critical access hospital). I have no prior experience in critical care so this is a big change for me. 1. What tips do you have for 12 hour shifts? 2. If you have experience in critical care, what books/resources/videos to learn? 3. How long did you study to get your Critical Care nurse certification? Thank you so much!

Thanks!

Hey MorganRNBSN! As a fairly new nurse with almost 4 years of Med-Surg experience. I can tell you that experience is everything in nursing! I have a lot of respect for those seasoned nurses because they usually have “been there, done that”. I have learned a lot during my first years of nursing and improve a lot on my skills to the point that I have been receiving compliments by two clinical instructors and a couple of nursing students over the last two years. I have also been encouraged to consider teaching clinicals. If you find that a specific unit made you feel burn out! Transfer to another unit, or hospital. I worked my first year at a busy community hospital and was challenged a lot and worked really hard. But the unit was not well managed and my hours were crazy: 40 hours a week on a busy Med-Surg floor. I waited a year before thinking of going somewhere else… I applied at a smaller hospital and I am very happy working in a Med-Surg floor. Most clinical instructors have a vast experience in one or two fields and that definitely shows when they are teaching students. Those type of instructors give the best education and tips!

Thank you so much JBMmom, I really try hard not to ask stupid questions at all. I usually stick to only asking basic questions: pain? Last BM, skin issues? IV? Did this patient walked? I can’t tell you enough how that small piece of quick information helps you prepare for the day. Was the patient too heavy with severe back pain that could only use a bedpan? has the patient had over 3 loose stools last night? Now I need to collect a sample next time it happens! It really sets your day off… but if a nurse doesn’t know/remember…. I usually say “it’s okay, I can look it up or ask the patient”. There had been other occasions where I wasn’t told about any skin problems but when I do my assessment. I find a bad wound! On The other hand, I have been asked by a seasoned-almost retired nurse: what type of Pacemaker my patient has, or what is my patient EF in a Med surgical floor. those questions always embarrassed me because I honestly don’t know and she ask me when we have nursing students on the floor.

Hi Emergent! I haven’t asked other nurses yet. but sometimes* when the charge nurses hears the hand off report that I get. She usually tells me: log into the computer and make sure that the night nurses completed the Labs/orders. Sometimes, I have noticed that they forget to complete the 6AM Labs ordered. But by the time, I noticed…they are far gone. But, even the charge nurse has mentioned to me that I am Zero confrontational. I am not nitpicky at all during report. I am more of the type of nurse that says “I had so and so for the past 2-3 days, can I just get an update?”. I think you really pointed out things that by common sense I could get out of the patient’s electronic medical chart. But sometimes, just knowing ahead of time if a patient has a Mediport, central line, IV is infiltrated or patient had over 3 BMs last night goes along way and help you prepare what needs to get done first in your shift. I usually only asked if the patient had pain/BM/ambulating status. if I get a “I don’t know” answer. I usually follow by saying “it’s okay, I will look it up or ask the patient”. But, I just can’t help but wonder why they give me report so quick. I have worked evenings and days so I can’t blame one particular set of night nurses since I have received a really quick report from day nurses when I worked evenings.

Thank you so much Davey Do! As a young nurse, I don’t think I have the right to tell other nurses how to adequately do their job or being professional… I don’t want to be the one telling others how to work and have principles. I find that people usually show who they really are through their work performance and the things they do anyway. So teaching an old dog new tricks, it’s not my cup of tea since they could be lazy.

I have been a registered nurse for over 4 years now in Med-Surg. I have given and received hand off report countless of times at this point in my nursing career. The other day, I was just thinking about the types of hand off report I get from Night Shift nurses and I am often left with quick reports. Is anyone else experiencing this? I come to the floor… and most nights nurses are ready to go home… when I approach them to relieve them from their shift. They provide a quick report, so quick that they jump around and don’t provide details such as patient’s ambulating status, skin problems, IV sites, last BM. When I inquired, they say: they don’t know, or they forgot to ask. On the other hand, when I am giving hand off report to evening nurses, I am the one looking for them in the floor. I feel disrespected because I am looking for them! Sometimes, they go into their assigned patients rooms to do their assessments and I have to kindly remind them that I need to give them report so I can go home. I get a long pretty well with my co-workers but I am wondering if I am being passive or not assertive at all. Because quietly frankly, I feel disrespected by both shifts in different ways.

It annoys me but I don’t let it get to me at all. The only times that this has happened is with just a few patients so over the years… it’s not bad at all. The main reason why it annoys me is because I am more than Nurse. I have a name and it’s on the board! So, if they try to call me: Nurse, I politely say: I am so and so… and if you forget it, it’s okay! My name is on the board! LOL!

You are absolutely right! It is technically a medication error because I am administering the medication at a slower rate, but I tried to follow the policies for IV therapy on my floor. It strictly states how certain medications need to be handled by Med-Surg/ ED/ CCU/ Maternity nurses. After I called the CCU nurse for support, this nurse took over and the provider ordered the medication again and gave it IVP to decrease cardiac workload. In fact, I don’t even think that patient’s condition was appropriate to the floor and we tried to get the patient hemodynamic stable before sending him out to a larger hospital. Thank you so much for your input!

Thank you so so much! You are absolutely right! After the Physician was notified by the CCRN nurse that The Metoprolol was started IVPB due to the policies of the Med-Surg floor, he immediately placed another order for the CCU nurse to administer IVP because he said the medication needed to be administered faster. I will improve on my communication skills with Physicians and Providers.

Hello everyone, I work in a small rural hospital (critical access hospital) in Med-Surg. Last night, I received a patient from the ED with stated complain of left chest pain. FYI: the patient visited the ED twice this same day for stated complain of left chest pain and was sent home! (Yikes)! Patient returned to ED later that day. While on the ED: Pt was placed on tele: SR. Pt received 4X 4mg Morphine IVP and sent to my floor. From the moment I received this patient on the floor, patient is holding his chest. MD notified and in to see patient. few minutes later, I gave PRN Maalox due to history of GERD and heartburn. Few minutes later, I administered 4mg Morphine IVP. Drew labs and Troponin is critical 8.145. VS assessed, EKG done. Tele monitor in place. Provider comes to bedside, stays with patient and asks me to override nitro patch order in Omnicell. I notified provider I cannot override this order. Provider then asks me again to override order for Nitro SL 0.4mg and he will put orders in a minute. Patient received nitro SL 0.4mg. Provider leaves Pt’s room and puts orders for nitroSL, ASA, and Lipitor and Trop lab. Patient received meds STAT. Trop came back at 11.564! At end of my shift, provider puts STAT orders for Heparin drip, heparin bolus, Metoprolol IVP. I was starting to give hand off report on another patient when provider interrupts and ask me to give Lopressor IVP STAT. (BP:166/87 HR 89). I tell the upcoming nurse that I cannot push Lopressor 5mg IVP on the floor. I call CCU nurse, and I am told by both nurses that I can hang it IVPB in a 50 mL bag of NS. I connect patient to VS machine to assess BP/HR. Patient is already on tele. I start the infusion. I call Shift director and CCU nurse to request one of them to monitor my patient while the infusion is running. CCU nurse comes in and assumes care of my patient. Patient received additional Lopressor doses by CCU nurse, Nitro drip, Heparin and Morphine while on the floor. Patient is then transferred to a level 1 trauma center, Patient is safe, hemodynamically stable. Question after long rant= I scanned the Lopressor 5mg IVP in the eMAR. The medication was administered as IVPB at a slower rate. I documented everything about the Lopressor administration in my nursing note. BP and HR are within normal limits. BP: 126/87, HR:72. Should I be concerned that what I scanned (Lopressor IVP) does not match what I documented in my nursing note (Lopressor IVPB)? Due to the seriousness of the patient scenario, acute MI, critical Trops! Should I have done things differently? Should I have bothered transferring this patient to CCU? I feel like I got involved in the middle of chaos and I was doing my best to keep patient alive and safe. But I don’t want to jeopardize my license. *Hospital protocol states only ED/CCU nurses can administer Metoprolol IVP. All RNs can administer Metoprolol IV. *Must monitor BP/HR and place on a Tele monitor prior, during, after infusion. Please share your thoughts! I need advice! Can’t sleep!

Hello everyone, I work in a small rural hospital (critical access hospital) in Med-Surg. Last night, I received a patient from the ED with stated complain of left chest pain. FYI: the patient visited the ED twice this same day for stated complain of left chest pain and was sent home! (Yikes)! Patient returned to ED later that day. While on the ED: Pt was placed on tele: SR. Pt received 4X 4mg Morphine IVP and sent to my floor. From the moment I received this patient on the floor, patient is holding his chest. MD notified and in to see patient. few minutes later, I gave PRN Maalox due to history of GERD and heartburn. Few minutes later, I administered 4mg Morphine IVP. Drew labs and Troponin is critical 8.145. VS assessed, EKG done. Tele monitor in place. Provider comes to bedside, stays with patient and asks me to override nitro patch order in Omnicell. I notified provider I cannot override this order. Provider then asks me again to override order for Nitro SL 0.4mg and he will put orders in a minute. Patient received nitro SL 0.4mg. Provider leaves Pt’s room and puts orders for nitroSL, ASA, and Lipitor and Repeat Trop lab. Patient received meds STAT. Trop came back at 11.564! At end of my shift, provider puts STAT orders for Heparin drip, heparin bolus, Metoprolol IVP. I was starting to give hand off report on another patient when provider interrupts and ask me to give Lopressor IVP STAT. (BP:166/87 HR 89). I tell the upcoming nurse that I cannot push Lopressor 5mg IVP on the floor. I call CCU nurse, and I am told by both nurses that I can hang it IVPB in a 50 mL bag of NS. I connect patient to VS machine to assess BP/HR. Patient is already on tele. I start the infusion. I call Shift director and CCU nurse to request one of them to monitor my patient while the infusion is running. CCU nurse comes in and assumes care of my patient during Lopressor 5mg IVPB administration until patient is transferred out. Patient received additional Lopressor doses by CCU nurse, Nitro drip, Heparin and Morphine while on the floor. Patient is then transferred to a level 1 trauma center, Patient is safe, hemodynamically stable. Question after long rant= I scanned the Lopressor 5mg IVP in the eMAR. The medication was administered as IVPB at a slower rate. I documented everything about the Lopressor administration in my nursing note. Should I be concerned that what I scanned (Lopressor IVP) does not match what I documented (Lopressor IVPB)? Due to the seriousness of the patient scenario, acute MI, critical Trops! Should I have done things differently? Should I have bothered transferring this patient to CCU? I feel like I got involved in the middle of chaos and I was doing my best to keep patient alive and safe. But I don’t want to jeopardize my license. Although I am happy that patient is safe. please share your thoughts! I need advice! Can’t sleep.

I think she was trying to steal a patient from someone. I had the admission patient and there was another pt who was CMO in the entire unit. She interrupted my dinner and ask if I wanted to just give her my admission and it took me by surprise. Now I know, what to say next time someone interrupts my dinner and wants to take my only patient: “it’s my only patient, I can give you report at 10, so you can get VS and assessment done early”. I have been seriously considering getting a higher/advanced degree. I’m currently finishing the last semester of my BSN degree online. But I have been a nurse for 1 year and 4 months. So, I don’t want to jump on the first wagon before considering my options well and getting more experience. But I have the itch to just continue education! This low census job, might be the perfect opportunity to study a little bit at work. The thing is that I am not a chatty person and some of the nurses like to engage in small talk. I rather be reading a book, watch Youtube or Netflix but I don’t want to be rude and unprofessional. I also don’t want to get in trouble because ‘someone’ told my manager that I brought homework to work, and I am not taking care of my 1-2 patients. There is always someone watching... and talking behind your back, you never know!

Thank you so much for your input and recommendation. I am definitely consiering getting a per Diem position just in case if I am call off for the day.

Hello all nurses, After working in a COVID unit for practically 8 months in a floor without unit coordinators and CNAs (sometimes we have one CNA in a 30 bed floor) I decided to leave after feeling exhausted working 5-8’s= 40 hours a week. I got a new job but it is 4-8’s= 32 hours a week but after two months in this new job, I am finding myself feeling very frustrated with the low census in this small rural hospital in general. Most days, I care for 1 to 2 patients in med surg. But most days is just one patient and I have to give it up at 7 pm to the night shift nurse because they need to take of someone for the rest of the night instead of waiting for me to give report to them on this one patient at 11 at night. I don’t miss my old job but I haven’t been able to find a “happy medium” in nursing job. In my previous job, I had little help and about 4-5 patients to care for in a med surg floor, being the last one to leave most nights due to documentation and charting on late night admissions. Don’t take me wrong! Patient satisfaction is high in this hospital but I am not feeling excited to go to work. If we don’t have patients to care for, we are given the choice to take the day off with pay or not pay from earned time and optional to be placed on call. With the current pandemic and unemployment, I cannot afford to just sit home and use my earned time due to low census. But if I don’t use it, then my paycheck comes shorter that week. I though the situation was going to pick up and the census was going to get better. But I hate going to work to complete required “nursing education” instead of working because there are one or no patients. What would you do? Should I look at a larger hospital for a busier job? I can’t stand just sitting around...