miko014

Heme/Onc, Palliative Care, Inpatient Hospice (with Med/Surg overflow) 3p - 1130p It's really hard to do this because every shift is different, even if you have the same pts. I really have no set routine... Check assignment, listen to report (we tape), check computer for med admin times for each pt, check computer or chase tech for VS...after that, it's just kind of "do whatever needs to be done". Critical thinking plays a huge role in this, and so does organization and PRIORITIZATION, but it might go something like: assess each patient, med admin (inc. chemo) at scheduled times, check orders, implement orders, call docs, pain meds (we do LOTS of pain meds), help techs/RNs/MDs/pt escort/whoever else needs help and/or get help myself, charting, calling MDs, calling family members, doing whatever people need, doing procedures/other misc stuff (hanging blood products, assisting with sterile procedures e.g., chest tube insertion, concious sedation, IV stuff, tube feeds, etc). There is a lot of non-routine stuff that happens...like end of life care for pts and families, discharges, admissions, transfers...we get a lot of direct admissions, which means that they don't come in through ER, so when they get there, they have nothing (no IV access, no orders, etc.). It can take several hours for a doc to come and see those pts and write their orders, which means that we basically have someone sitting there and no idea what we are supposed to do with them. The other night I stareted with 5 pts, d/c'd 2 of them, got another one, d/c'd another one, and then got 2 admissions at the same time. Yikes! Sometimes it's insane, and other times, it's not too bad. It all depends on the pts, what they need, what is going on with them, their families, and the moon (I'm serious, when the moon is full, look out!)

Hello! I work at a magnet hospital...it's a measure of nursing quality ftom the ANCC. It just basically says that the patient outcomes are good, the nurses are mostly satisfied with their jobs (lower turnover rates), good communication between nurses and others, etc. There's something in there about education too...like encouraging nurses to continue their education or something like that. They say that it means that the hospital values nursing, they will work with you, let nurses be decision-makers, etc. I may be leaving something out, but who knows. And I remember someone from our magnet comittee telling us that "magnet" means that it "draws nurses to it and keeps them there". I don't know if that's actually where they got the term or not, but that's how it was described to us. Get this - my hospital spent tons of money getting magnet status, and then just a couple of months after we got it (and not even 2 months into the new fiscal year), they said, "we're sorry, but we are millions of dollars in the hole right now, so you will have to work at 103% productivity and a person short now and then". (We are a not-for-profit organization, but money still matters.) Magnet. Yeah.

I have been charting EVERYTHING on her, believe me! It seems that the general consensus on the unit (MDs, nurses, case managers, even her family) think it's an attention thing (like I said, she has a history of "falls"). Which is weird since my tech was in that room 5 minutes before I was. I have had this pt again and it has been hard for me, but I have managed to keep her under control. I don't deny that she has pain, but it seems to most of us that she has pain and anxiety. She will start to feel the pain and then just freak out and get herself so worked up that the next thing you know she is screaming and carryng on (like a child, as I said before). I have had adult pts who were in so much pain that they cried, and I have never seen anything like this. She acts like a 4 year old at the grocery store when Mommy says "no" to candy. The thing is, her bt is q1h, plus scheduled q3h and q12h, and they added tons of anxiety and psych meds! We never say no! If she can't have her pain meds, she gets her anxiety meds! So I am not as upset as I was, but just shaking my head now. Thank you all for your support!

I know a girl who got 260 and passed. Good Luck! Let us know what happens!

I think I would be upset no matter what, but I am ticked off at her! I really think she did it on purpose because she thought that I wasn't going to bring her her meds, even though the last time I had been in the room (maybe 30 min before), I had told her when I was bringing them, and I had them with me when I found her. I did chart it, believe me! And to my knowledge, this is her first fall in the hospital...she did fall a lot at home, and when I talked to her husband he just said "Oh my GOD" in a really exasperated tone (sounded about how I felt!) and said thanks for letting him know. I don't think he was upset with me, I think he was frustrated with her. I won't know until I go back, I guess. Oh and she said that she "sat down HARD".

I had my first pt fall recently. I'm upset about it, but I'm not sure which part is upsetting me. This pt is a middle-aged, NOT confused person with a hip condition which makes it impossible for her to walk without help. She KNOWS that. On this particular day, she put on ther call light and the PCA went into the room, came out and told me that the lady wanted pain meds and that she was crying. I could hear her crying, so I finished what I was doing (giving someone else pain meds) and then went to get this pt's meds (her scheduled meds - 2 of dilaudid SQ and 60 of oxycontin SR PO, PLUS a sleeping pill). Anyway, by the time I got into the room, I found the pt on the floor. She was sitting up and leaning on the footboard of her bed, and she was bawling. I mean throwing a fit like a child. The more I tried to calm her down, the worse it got. I gave her the dilaudid and got people to help me. She said she didn't hurt herself and that she more or less just sat down, so I wasn't really worried that she was injured or anything like that. We lifted her back into the bed and I took a look at her - couldn't even find any red marks or bruises. Her room is right next to the nurses station and there were several people in there, and nobody heard anything, so I don't think she fell that hard. Anyway I finally got her to calm down and take her pills, and she was able to tell me what happened. Basically she said that "nobody would help me and I wanted something cold for my back, so I tried to get to the refridgerator by myself". She never told anybody that she wanted anything for her back because the PCA had JUST been in the room. I know that it takes a few minutes to get stuff out of the pyxis, but it can't take THAT long, can it? I know that when you are in pain, time has no meaning, but I am still angry about this. I had to call the MD and call the family and tell them both, and I felt like a total jerk! The thing is, I don't know who I am upset with. I am pissed at the patient because she knows better! One of the reasons she is there in the first place is that she had been falling at home. And like I said, she's not confused! But I still feel bad about it, like it was my fault. She fell on MY watch, you know? Neuro saw her today and say that they can't find anything in any of her tests that would be causing her pain. Their theory is that it is anxiety that makes her pain worse and then she gets to the point where she is out of control. They consulted psych but I don't know if they have seen the pt yet. So, maybe there are some underlying psych issues that are making the whole problem worse. Anyway, I feel like a bad nurse! I feel like it's my fault that she fell, and that if I could have just been quicker about getting the pain meds, this never would have happened. But then rushing causes med errors, and that's something I definitely want to avoid. Right now I am just so frustrated that I feel like I don't want to be a nurse any more. I'm not really sure what I expect anybody to say about this. I guess I just needed to vent. Sorry that it was so long.

I work in a large hospital (just found out the exact number yesterday...1059 beds), and, on our unit at least, we have to get an order to use feet/lower extremities for any kind of stick. Not to say that we never do it, but we have to have an order for it. I don't know the reasoning behind that (probably something really simple that I just never thought about), but I do know that it hurts like...well, you know...to stick feet.

Absolutely...especially if she had anything besides regular insulin after her HS check. I'm always a bit more nervous about covering people during the night anyway because if they drop too far and you think they are just sleeping, it could be awhile before anybody notices anything is wrong. Bottom line, ALWAYS cover your butt - get the one time order! I'd mentionit to the doc, but you need more than one number to show that her BS is out of control. I'd either recheck her during the next few nights or see about an order for an hA1c. Just my two cents!

I work in a teaching hospital...we just got magnet status a few months ago. There was a huge fuss about it while we were trying for it, then when we got it, they spent a little time congratulating us, then a few months later told us that, despite the fact that we were only 2 or 3 months into the new fiscal year, we were down $6.7 million (eww, long sentence, sorry!). We are now expected to work at 103% productivity (as of last count, my unit was at 104%), cut our supply budget, etc. Some departments will be losing staff, but we won't be affected because we are variable staffing...we'll just have to work a person short "now and then". Wonderful! Our caseload did not change at all...I work on a busy heme/onc floor with no monitors, and we have 5-6 pts each for days and eves, and 8 each for nights. We have 3 techs on days/eves and 2 on nights. We have an average census of 30-35 with a max of I believe 38. Our acuity fluctuates but is normally on the high side, sometimes very high. But, since we don't have tele (yet, they're trying to get us 8 tele beds), if someone needs frequent monitoring, you have to do it yourself. VS q15 min? Okay, then go take them by hand q15 min. Have 3 of them at the same time? Good luck doing anything else! I've worked on the same unit for 4 years, but have some experience on a few others, and it's pretty obvious to me that the units that make money (L&D, Mother/Infant, the new Cardiac floor) get a much better deal than the rest of us. I'm not complaining about 5 pts, mind you, I know it could be a lot worse, but at the same time, I feel like they should share the wealth, you know what I mean? And I'm not talking about just for staff either. We have volunteers who bring around cookies and coffee for patients and family members, which everyone loves. In 4 years, I have seen it on my unit ONE TIME. We actually have to buy the coffee ourselves and families who want it have to pay 25 cents per cup. The patients can have instant or else have to wait for it to come up from dietary or pay for it. Is that not ridiculous??? Sorry, didn't mean to change the subject, I'm just sayin' that I don't think that magnet status really means anything!

Thanks guys! I appreciate the help. Does anyone have experience in any of these "other" nursing areas that they could share? I'd like to hear what people think of these jobs...or anything that anyone has to share, really. Thank you all again!

Oh sure, it's nothing major. I just have very sensitive skin, and my hands just can't handle all the washing (and alcohol rubs) that is invilved in bedside nursing. They're always cracked and bleeding, or else itching to beat the band. Lotion helps a little bit, but I can't stand having my hands so itchy all the time. I've been to the dermatologist and there's really nothing to do about it except avoid the "irritants'. I've shadowed a case manager, and that's really not something that appealed to me. I'm sure there are lots of options that would not be direct patient care, or at least less hand washing. Like I said, I like my job. I wouldn't leave it if I didn't have to! I appreciate the replies! Thanks everyone!!!

Hi all! I hope this hasn't been covered in a previous thread...I just wonder if anyone can give me their opinion on a dilemma I am having. I am fairly new to nursing. I work on a med/surg/onc floor at a large, busy hospital. I love my job, and I love my coworkers, but I am having a medical problem of my own which makes it very difficult to care for patients. The trouble is, when I got into nursing, bedisde nursing was the only thing I wanted to do. Now I worry that I may have to get out of direct patient care, and I don't know what to do. I have never really looked into any other alternatives, since I love my job so much. So, does anyone here have experience with a non-patient care nursing role? If so, what did/do you do, and what do you think of it? I don't want to leave my job, but there may come a time when I don't have a choice. I have my BSN, by the way. And as far as going back to school, I'm not ready for that yet! Thanks a lot for any advice you can give me!