cota2k

This is always a sticky subject. What is safe? Our VIP of clinical practice has a goal of about 5:1. That's 1.5 hours per patient on a med-surg, post-Op floor. Nurse Assistants do all the baths, pass trays, and answer call bells. We have few LPN's left, and when they are on they do the glucose monitoring, and pass some meds. We currently are also using the outdated Charge Nurse sitting at the desk, taking orders, and accomodating the docs (yes, one even makes sure a certain doc has a particular chair.) My day staff, longer tenure, chronologically advanced, believe 4:1 is really pushing the limits. My evening staff and night staff don't say much. They regularly have 6-7:1, call-ins change everything. I have told my outspoken, safe ratios nurses that the ICU has positions available. The are never over 3:1. However. They have no aides, no secretary, and no Charge Nurse waiting on everybody. They also have ventilated patients, and patients on cardiac drips, etc. I'm a new manager, and I haven't worked a med-surg floor in some time. I recall nurses giving baths, doing all the meds and glucose monitoring, and answering call bells. I was on Telemetry floor, generally 6:1 ratio. It was busy, and very tiring. As a rural hospital the docs know the limitations and put the higher acuity patients in the ICU. I put determining the acuity/ratio on the Charge Nurse. The Staff Nurses and Charge know the patients best. If someone is more acute, or has more IV meds, Blood Transfusions, recent post-Op complications, then that Nurse should have a "lesser" assignment. I also expect the Charge Nurse to go down the hall and help out (admits, meds, call bells...) The times are changing. Med-Surg units are more acute, the patients are more complex, nursing has become more technical, and the fiscal expectations are perhaps outragious. Unfortunately, Nursing is being asked to do more and more, with less and less. I stress team work and communication. Ask for help. Document changes in patient presentation, and let the docs know what the patient needs. The Nursing Process. What is the plan, where do we need to change the plan. I don't know if this helps anybody, but I feel better getting it out of my Sunday morning brain.

Our Senior Leaders have been trying to reduce infection rates, as everyone in Nursing is. Recently, a memo was sent to all employees that if anyone witnesses an unsafe practice it is their reponsibility to immediately take measures to stop the unsafe action, document the incident (including time, date and location), and report it to their supervisor/manager for potential discipinary action. As a manager I've received very negative feeback that this is "tattling", and will only create animosity among the varied departments (Nursing, Lab, Therapies, Housekeeping are all included.) I've explained that the incident reports need to be completed, and when the "offending" empoyee is redirected they should know they will be written up; no suprises. Has anyone else experienced this in thier facility? If so, how did you, or your manager, handle the backlash? Thanks!

I was on med/surg and a Pt went unresponsive. The quick action/adrenaline rush changed my life.

I remember my first code as a student. Big guy, witnessed arrest while working with an outdoor contracting co. He was beyond blue and his eyes were someplace else. So much work compressing his huge upper body and in the end he was pronounced dead. The work was exhausting! I was soaked in sweat and my calfs hurt for two days. As disappointing as it ended the experience was priceless. I now work in the ER, many codes, many heart breaks, many ibuprofen and leg massages. In the end we look in the mirror and say we did our best.

I made the transition a few years back after one year of tele/med-surg. We are also small town America; far more drama vs trauma. It was difficult at first mainly because I was still raw. You describe far more experience than I had, and with a good preceptor and support after that you'll probably be fine. There are horror stories about ER nurses and their difficult personalities, but I have not seen them in our small ER, or from the ER Nurses from other facilities I have met. As for the cases that come in; you'll be trained, Doc's are staffed 24 hours now, and the biggest lesson I learned is that you are never alone in the ER. There is always somebody around to back you up. Good Luck! Make the leap, you'll Love it!

Thats right Roy F. I married a person not a profession.

12 hrs is a long time to be locked in a bunker overnight. I work in an increasingly busier rural ER, overnights are 630p to 7 a, and by 4 or 5 you R spent! I came in to NSG as a second career, so I'm no spring chicken. The nap getting ready for a night shift and the time spent sleeping to "catch up" costs me another day. Also consider your family; some days, I am told, I can be "grumpy". However, I am able to work on my BSN and still get my scheduled shifts in. I also get to pick my kids up from schol so they know I am part of their life as do their friends. This is important to me as they approach the limit testing teens.

in nsg school i broke down and invested in custom orthotics. pricey, but my 40+ year old hips, knees and back are happy! I wear 'em in newbalance or nike walking zips, extra wide. good to go!

nsg school can be a full-time job w/tests and care plans. running track will be a great way to decompress. Also after graduation the crazy nsg shifts (3 * 12 hr shifts) could allow time for training. good luck and enjoy the learning

can you compromise with a 'high and tite" cut? otherwise...yeah a mohawk will be stereotyped.

After two years of ER practice I still consider myself new. I always find myself amazed at the lack of humility the patients present with. Granted they have no idea what we are doing in the next room or even on the other side of the curtain but, even after a simple explaination you can get the "i don't care" vibe. The complaints and responses to delays... a patient will put the blame back on (the nurse) for everything; it is never the patinets concern and they never will accept responsibility for their actions or comments. Behind the scenes i will say that nurses can be the most understanding professionals I have ever met. I beleive WE have all been there and when it's time to vent WE listen to each other. But, man...one of these days...

currently in ER but , i'm a little frustrated with being between the "old" clicks and the uninspired newbees. also, outdoor concert and carnival (beer tent) season is coming; if I wanted to wrestle intox i would have been a cop. looking for a change...

Our press ganey scores avg about 85%. So, as there is always room for improvement I came up with a couple of suggestions. Expresso or cappacino in the waiting room, and hot moist towels in the bathrooms. My gold star: Between retavase injections while the RN is just "standing there" we could give pedicures. Soak the feet, rub the bunnies, trim the nails, maybe some clear coat? Pumice? Wouldn't that just be a special touch during their long ED wait for Mercy Flight transport to a cath lab? I guess if you live through an ED visit maybe you should not complain.

Cliques! Opposite weekends have alternate personalities: one weekned has the lifers on days, and the A-Team at night. The opposite weekend has the misfits on days, and the Freak Show at night. When ever a swap takes place, sparks fly! being the new guy in ED, I was a misfit, now I've been bumped (much to my dismay) to the Freak Show. I Love the ED, but the Cliques are wearing me out, and I hate overnights!

I just saw your post, and I notice that you are half way through your wait. It is painful, I remember the anxiety. I got home, had brew and got outside with my kids;lot's of distraction and fresh air. I too had 75 questions, it seemed like half my graduating class had 75 questions, and the majority (for what it's worth) passed. I know the number of questions doesn't reflect pass or fail, but think of fit like this. If you passed, congrats! If not, at least you didn't sit in front of a computer stressing for 5 hours answering 200 of the craziest scenarios imaginable. Good Luck, and don't for get to breath.