trixie

Hi- I work at a community hospital with a 13 bed ICU. Currently, the nurses in ICU document a shift assessment q2h; this is a complete head to toe assessment. Is this similar to charting in other ICU's? Thanks, Trixie

There are still physicians at the hospital where I work ordering milk and molasses enemas. Is anyone else out there still using these?! If so, what is the procedure followed for mixing and administering? Thanks

I would guess most areas of the country are similar to mine. The nurses all know one another or know someone at another facility. They all ask each other unofficially about people frequently. YES - I think mentioning scheduling difficulties (or even hinting at such) in an interview bumped you to the bottom of the list. No nurse manager needs MORE scheduling difficulties. You have to make it seem like you will revolve around them, not the other way around. Keep trying!

Dead people used to freak me out. It got easier. Hang in there!

Perhaps working in a dr office. Or in a mental health unit. It is not impossible, but will not be easy for you. The problem with the situation is that most employers want you to have some basic med/surg experience that will be difficult for you to obtain with your physical limitations. Perhaps you need to speak with someone in the nursing program that you want to enter before you go any further.

" forget med-surg, it is not relevant. Yeah, it's good experience but it's not what you want to do and you can learn the same skills elsewhere" Told you someone would disagree. People that disagree with this statement generally don't have med/surg experience and don't know what they are missing. It IS relevant, esp if she lost a job because she wasn't catching on quickly enough.

I was the only RN on the L&D unit (left with a LPN). We had no patients. My former SISTER-IN-LAW came in as an outpatient and of course the doctor wanted her to have a VE. UGH! I discussed it with her, she was okay with it, no problem. But it was somewhat uncomfortable. Most people I know say they feel better having someone they know with them - so the discomfort may be just on your end. But we have definitely switched assignments around for the comfort of all involved. Not a big deal.

What I see lacking in your experience is Med/Surg from an acute care facility. Many feel (and may post) that it is not needed. However, with a great mentor and med/surg experience - I would bet you would see your skill set improve. It seems you jumped into L&D/midwifery without this. I have seen others do it - but wouldn't advise it. Even a few years in med/surg will teach you much about organization, prioritizing, etc. What goes on in LTC facilities boggles my mind and I can't imagine that ever being my cup of tea. Best wishes to you. Don't ever give up on your dream - just tackle it a different way.

If you have instructors as I did in college - never refer to them as magazines (even though RN bills itself as RN magazine I believe). Professionals have journals, not magazines. Pluses and minuses with all - but I preferred RN, also.

I would not mention it. You did not misrepresent yourself when you filled out the application. Hopefully this experience will be better than your last!

To answer a question from one reply: I have been a nurse for 18 years. Med/Surg, L&D, Nursing Supervisor, Nursing Informatics Specialist. When I referred to "Fork in the road", what I meant was how nurses (?people?) all tend to start out at pretty much the same place - as a new nurse. We all have that initial learning curve. Then some people just level out and never take the initiative to learn more, improve their practice, or become excellent in any way. Others continue to learn, grow, help others and really make you proud that you are a nurse just as they are. I was not referring to any career path and choosing a new job. I would like to add that I do acknowledge that some places are just BAD places to work (or be a patient!). But I have seen the whole attitude (for better or worse) take a turn when just one or two staff members either come on board or leave. It is amazing. This can happen with staff (and each shift is different) and management. I agree there are many people in managment positions that are not leaders. Hope that explains things. Great thread. Thanks for the comments!

I would ask pharmacy to change the time, would go ahead and give at 1800 as ordered (our system just gives a warning message). I never ask others to document for me.

That's okay if your current manager interprets it as "I'm not leaving yet". WAIT until the specialty of your choice becomes available. Don't settle for less just to escape what you are doing now. It may be worse in the end. Everything happens for a reason and I would bet this is your que to not take the job.

I started out and did Med-Surg for a year. Then I worked L&D 14 years. I think the time management skills that I learned doing Med-Surg and the basic skills I learned are invaluable. The best way to move into a specialty is to apply when there is an opening. Keep your attendance rate high (nobody wants to hire someone that calls off a lot), be an excellent team player, and do not apply for too many jobs within your organization. Keep applying for those in the area of specialty in which you would like to work. This will make you not seem desperate to leave the area in which you are working.

Our charting does not automatically carry over for shift assessments. In most fields, the nurse CAN hit a button (f5) and it will recall the previously charted information. I am not sure how often this is used, but I would suspect a lot. I can selectively block fields that we will not allow them to recall info. I specifically use these a lot in comment boxes, as I found nurses were just mindlessly copying the same comment over and over again. This was especially annoying when the comment contained a spelling error! I also thought it would be a red flag to a lawyer in a lawsuit that the same info was written in the same exact way in the comment area. You will always have a few who slack on the work and just copy whatever the nurse before them put down. This happened on paper, also, so it is not a computer specific issue.

I worked 2nd shift (3p-11P), every other weekend/every other holiday for the first 14 years of my daughters life. At times she would be upset when I had to go to work. I told her to look around. Did she like the home she lived in? Did she like having food in the fridge? Did she like to have toys? Then mommy had to go to work to pay for it. She then understood the relationship between work and money to provide for us. It also made me really try to make the most of the time that we DID have together. But yes, I had guilty days... When I missed school functions/ball games/birthday parties, etc.

Twinklebelle- You are receiving the "who the hell does she think she is" treatment. Sometimes those of us who are "doers" make the pass the buck people look bad (okay, most of the time). That's the hard part about being a team player and helping others even if they haven't helped you (and never do). But it is all about putting the patient first, so hold your head up high, keep on keeping on, prove yourself, and you will move past the pass the buck people! :)

It may or may not be obvious if some is retained. How you can usually tell if there is retained placenta is how the mother's uterus is behaving. If her fundus isn't firm, won't stay firm, and she is bleeding more than "usual", it's a safe bet something is still up there...

Expressing an interest to whomever is implementing in your facility was a great way to start! I got started (like most of my career paths) by accident. I took the initiative to computerize some very outdated documentation in the Nursing Supervisors' office (my position at the time). The Director of Nursing took notice, and mentioned to the Nursing Informatics person in the IT dept that I was computer saavy. She then taught me some basics on the side and I actually did both jobs for awhile - without asking for extra pay, complaining, etc. She liked my work. A position opened up in IT for a 2nd informatics person and they brought me in. I am now going to get my Masters Degree in Nursing Informatics. In short, going above and beyond and being a team player will get you far!

I was fortunate to have been oriented to the world of nursing by wonderful team players. They considered the work to be everyone's work. They were highly organized nurses who put the patient's needs first. If there was work to be done, it didn't matter to whom it was assigned. Not all nurses work according to this principle. There will always be those who, when their assigned work is completed, are not willing to help others. I have heard comments such as "she never helps me, why should I help her?" Early on I tried to differentiate between coworkers that I loved to work with and those that frustrated me. I carefully looked at all of their traits to determine whose work ethic to emulate. The nurses that I most loved working with were ultimate team players. They not only asked if you needed help, they anticipated what you would need and just jumped in to help. No strings attached. I believe that learning to be a team player has allowed me to advance in my organization. I never use the phrases "It's not fair" or "It's not my fault". We all know life isn't fair; there is really no need to point it out or whine about it. I also believe in taking personal responsibility for one's actions (which could be the topic of another article!). If I made a decision or did something, I took responsibility for it. It didn't matter if it was good or bad, I owned up to it. Unfortunately, the majority of people do not do this. When a position would open within our facility, I would often hear people complaining about or at least discussing why certain individuals get promoted, while others languish. Each person is a novice when they start their career. I truly believe after the person has advanced through the novice stage they come to a fork. They can either choose the path of excellence or the path of mediocrity. Those that choose the path of excellence excel in their field. They are excellent team players, take responsibility for their own actions, and advance their careers. They inspire others just by being around them. Their enthusiasm is infectious. They love what they do and strive to make a difference. They are often chosen for promotions. Those that choose the path of mediocrity excel at nothing. They just trudge through each day and are there only to collect a payday. They don't take pride in their work. In fact, their work is just a job, it is not a career and it certainly doesn't define who they are. Instead of being inspiring, they are often dreadful to be around. They take no responsibility for their actions and usually will whine that things aren't fair and that it is someone else's fault. They are rarely promoted. I know what fork in the road that I chose after my novice time was complete. Are you at that fork in the road? Have you long passed it, but realize that you chose the wrong direction? It's never too late to double back, take the right direction, and become a true team player.

Absolutely! They are a new patient, so at our facility, if they are born alive, they have their own medical record number, visit number, and chart.

Hello! I was wondering how units are banding their mom's and baby's. We still hand write bands that have matching ID numbers on them for mom and baby (mom gets one and baby gets two - one on wrist and one on ankle). Then they both get a printed one from the hospital system that has barcodes on it for ID and medication administration. The baby also gets a security bracelet - so 4 bands for the baby! Thanks, Kim in PA

Hello! We have implemented Bedside Medication Verification on all of our inpatient units. Pediatrics is not happy. They place the young child's wristband on it's ankle, then they must "dig" to locate it to scan the patient when giving medications. This is especially a problem at night. I am not a pediatric nurse, so I have no solution for them. What is everyone else doing??? Thanks, Kim in PA

I agree with mydesygn. The problem with using a staffing clerk is that they do not KNOW the nurses and their skills. This will lead to a "nurse is a nurse" type of thinking, which we all know is not true. Yes, I work is a relatively small (approx 250 bed) hospital, but I generally know my nurses, where they currently work and for how long, and where they worked before! A staffing clerk may not know that one of the PACU nurses was a nursing supervisor 2 years ago, etc. I think if they were going to do that- it would work better in reverse- have a "clerk" do bed management and let the nursing supervisor deal with staffing issues!

I am a nursing supervisor at a community hospital. We all work traditional 8 hr shifts. Daily, our units print a report that lists every pt on their floor, a spot for the census at the top, and room to write on pts. They are encouraged to only write on pts that have something significant that we need to know about. The dayshift supervisor picks these up from each unit about 2:30p. We then review the hospital staffing, adjustments that have been made, call offs, etc. Then we go over the census on each floor, and read what was written. Then the next supervisor makes rounds, redistributes the reports, gets a feel for whats going on. How do other supervisors give report to the next shift??? It seems what was written on one shift, isn't necessarily what is important on the next shift. I can't wait to hear what others are doing! Thanks in advance!