ckben

that's a different scenario. the pt. can refuse what they like, nobody's arguing that. but i, as a nurse, am not required to provide bad care to a pt. simply because they prefer it that way. they have a right to good care, and continually giving candy to someone whose blood sugars consistently remain in the 300s despite the insulin treatment we give them is NOT good care. as i said, i'm not going to take their candy away from them, but i won't be the one giving it to them and thus be directly responsible for enabling these habits and further contributing to the adverse effects of their disease process.disagree if you like, but i personally would rather have a healthy patient who is upset at not having a privelege (yes, candy is a privilege, not a right) than an unhealthy one who likes me simply because i will let them do whatever they want. and in my experience, if you simply explain the reasons behind your actions, most people will not get upset anyway. but if you give in and allow the candy, the patient often perceives the issue as not that important, because "if it was really important, then all the nurses would care, and not just some of them, right?"

there's a very good reason that nurses aren't allowed to mix drugs on the floor anymore - many, many, many critical med errors that resulted in patient injury and death. yeah, it sucks to have to wait for meds, but unless your pharmacy has severe problems, they should be able to get emergency drugs to you pretty quickly. to tell you the truth, there are plenty of nurses i know that, if i was the patient, i wouldn't trust to give me the right drugs in a regular situation. add on to that the stress and hurry of an emergency, and it's a recipe for disaster. maybe the system isn't perfect, but in this case i definitely think we should leave the mixing of drugs to the pharmacists. it is, specifically, what they went to school for, and the more checks there are in the system the more safe it is for the patient. i wonder why we're so worried about losing our skills to other professions. i know that i am personally extremely grateful to PT and OT, for example, for everything they do. i know that i could not do everything i'm supposed to do as a nurse and also perform these duties. that's why it's called an interdisciplinary team. we work together to do what's best for the patient. nursing isn't going anywhere for a long time. why do we so jealously guard what is considered "our" territory when the best interests of the patient clearly lie in having the most qualified people perform each task, rather than one semi-qualified person performing it all? or, if you're arguing, for example, to have a nurse whose only job is to perform physical therapy on a floor, do you really believe that the nursing shortage is a lie, and that there will be enough supply to teach nurses to do all these things and thus put these other people out of a job?

i'll add this: when you wake up in the morning and dread the next time you go back to work, even if it's 3-4 days down the road. another thing i've noticed: if you start losing your patience with people and things that you would never have lost patience with before. when you sigh at the secretary for telling you one of your patients called for something, even though you know they're just doing their job. when you routinely come home and start telling your spouse about all the lousy things about your work instead of the cool things you did that day or the rewarding things you saw. when you're asked in a staff meeting to name something the floor is doing right and you have to think REALLY hard...

we've had lots of these same situations. basically, my philosophy is similar to yours in that i will not personally hand them something that is restricted from their diet. i just won't, for personal and professional reasons. but, as you said, if it's something they brought from home (and they can get it themselves), then i don't really feel i have the right to physically take it from them, either. i guess it's kind of a freedom of choice thing. if they choose to have their family bring them candy, that's their right. but by agreeing to be in the hospital, they agree to the care which nurses will give them, which includes giving them an appropriate diet. just my personal feelings, anyway...

start applying now. you can inform your employers of when your preferred start date and when you actually graduate/take the licensing exam. if you wait until you're ready to start working, you may find many jobs already taken by nursing students from other schools (or from your own). when i was a student nurse, we graduated in august. the nurse managers who came to our class to recruit told us to wait until may to apply for jobs. when we started applying in may, guess what? they told us they'd already filled those positions, but maybe in a couple of months they'd have something open up. so, you either have to 1) wait a couple of months on the off-chance that a unit you want to work on might have a spot for you to try for, and mooching off your spouse/parents in the meantime, or 2) work somewhere you don't necessarily want to work because you absolutely have to have a job. trust me, there are no negatives to jumping the gun and applying early.

thing is, i've had a similar situation like this come up lots of times. upon asking other nurses/charge nurses what to do, they usually just say, "chart exactly what the doctor said in your nurses notes, watch the patient real carefully, and call him back anyway if you need to." i'm not saying i would just forget about the patient, but i, like many other people, am pretty non-confrontational and would probably not be able to muster the nerve to get into a pissing contest with the doc at will.

as a nurse, i spend a good 2-3 hours a day minimum charting. this isn't because i like charting or because i have nothing better to do. believe me, i would rather be in patient rooms all day. i may be sitting at the nurses station, but believe me charting is work. it allows me to provide a record of what i've done during the day (because how else would anybody know how we've taken care of our patients?), not only so that doctors, other nurses, physical therapy, etc. will know what we've done for our patients, but also how they are progressing and what their current condition is. in addition, if i want to protect myself in a court of law or in front of the board of nursing because of an adverse event, then i need to be able to prove that i did everything i could for my patient. also, should a sentinal event occur, proper documentation is VITAL so that we can learn how to better protect our patients in the future. if you see me sitting at the nurses station, don't automatically assume i'm taking a break or just chatting with my coworkers. pay attention and see if i'm actually working or sitting like a bump on a log. and please don't assume charting is voluntary or unimportant. it's one of the most important things we do.

frankly, these nurses sound lazy. not only that, but apparently documentation of patient care is more important to them than actual patient care itself. if you charted that you did the assessment on their shift, would that protect them in a court of law? no, it wouldn't. it would actually incriminate them, since they neglected to assess the patient they were assigned (if it wasn't charted, it wasn't done. and lawyers as well as JCAHO know how to check which shift each nurse was working at a specified time). i can't believe that, if you've got the patient and the paperwork ready for them, and all they have to do is assess the patient (which takes all of 5 minutes if you are really slow), they are still so lazy and ungrateful as to try to get out of charting, too. i know charting's a beyotch, but it HAS to be done by each nurse each shift. i would just tell them that if they don't chart their own assessments for their own shift, that's considered patient abandonment. therefore, by my refusal to chart for them, i am forcing them to protect themselves and their licenses. they'd probably hate me for it, but i doubt they'd ask again. as a better alternative, i'd inform the nurse manager of the situation and insist that somebody do some teaching or inservice on the situation and the proper way to handle it. they may not take your reasons coming from you, but they will (grudgingly and b*tchingly) take it from management. and if there are still problems, you can remind them that "Sally, NM said it's to be done this way, so that's how it's to be done. Didn't you make it to that staff meeting?" in the meantime, it might not be a bad idea to get together with the rest of the night staff and determine if anyone else is charting for them, and explain your reasoning for why it's not a good idea. if none of the night nurses does this for the day shift, then not only will they stop taking their anger out on you personally (instead, it will be displaced to the entire night shift), but after much griping they will either shut up and and just do what they're supposed to or go to the nurse manager. who, if you've already explained the situation to him/her, will just tell them that you are doing the correct thing and they need to get their acts together.

my sister-in-law and my mother both had reactions the first few weeks they worked nights. not with vertigo, but with severe nausea and reduced appetite. i'd say give yourself time to adjust (flip-flopping days and nights does NOT agree with some people, and don't ever let anyone tell you "you're young, you can handle it"...what a big load of bull), and if it doesn't get better, go back and see your doctor again. incidentally, it could be a sign of something else, and working nights at the same time is coincidental. you could be pregnant as the above poster said (why do we always assume that any sick symptom in a female is a sign of pregnancy?). or, like in my personal experience, vertigo coupled with nausea was my first clue that i had meniere's disease. but unless you have associated ear ringing and difficulty hearing, you don't really need to worry about that. so just watch your body and try to keep track of what things make it better and worse. basically, there IS a reason this is happening, and it may be totally unrelated to your job, so rule out other reasons before deciding that your job is the main cause.

what you are describing sounds like what we call prn - you have to work predetermined shifts (ex. 7-3 or 7-7), but can generally pick the days you want to work ahead of time. i think this is what you were describing. what we called per diem is something entirely different. you worked your normal 36 hours, then signed up for extra shifts above those regular hours. so, you worked your three 12-hour shifts, then could sign up in 4, 8, or 12 hour increments whenever you wanted to (but they had to be the regular increments (7-11, 11-3, 3-7, 7-3, 3-11, 7-7, 3-3, or 11-11). then, if the floor didn't need you to work those shifts, they would just cancel you for all or part of them. the upside was the per diem pay was over twice as much as regular pay, so they only used per diem nurses if they really needed them. i really only have hospital experience, but i have never seen any unit allow nurses to work whenever they wanted in terms of shifts times. even CNAs, PCTs, techs, etc. had to work established hours unless the floor was in a severe bind.

having worked both telemetry and med/surg, i can honestly say this is NOT good advice. the patients may be less sick, but you will have more of them. and they and their families will NOT be less demanding, i can promise you that. no, telemetry and and med/surg can be just as hellacious as any other critical care setting.

in all honesty, i probably would have just said, "okay thank you." then i would have gone straight to my nurses noted immediately and charted what he said, using direct quotes. what a jerk.

in terms of: patient safety: shouldn't matter IF you are doing all the checks you are supposed to. and if you aren't, the two patients in one room isn't the problem, you are. this kind of goes along with medication errors... communication/confidentiality: this is a major problem, especially in regards to HIPAA. i thought most places had gone to all private rooms for this reason (an exception being EDs). also, most patients don't care to have someone sitting on the other side of a curtain listening to everything that's wrong with them, particularly if their health problems are of a sensitive nature ("so, roll over and let me look at your rectal abscess"). cleanliness: like the medication errors, if you're doing what you're supposed to be doing this isn't an issue from your perspective. it's mostly an issue related to the shared bathroom. with all sorts of bodily fluids that can leak on the toilet/sink/floor, not to mention twice the equipment for collecting urine and stool (and how often do we wash those?), this can easily become a very nasty situation. and even if none of that occurs, how disgusting is it to habitually share a bathroom with someone you don't know, even if they're healthy? i've worked in areas that have semi-private and private rooms, and the places with semi-privates have converted to privates. i think this is a better idea for everyone involved. patients don't have to worry about someone else being obligated to hear about their health problems. they don't have to worry about their family making too much noise (well, even excessive noise in a private room can be a problem, but it's obviously more of an issue in a semi-private room). they don't have to sit and listen to other people's families chattering. it's really a better deal. the major pro i see to a semi-private room is that sometimes the patients strike up a friendship, or at least a companionship role with each other and support each other. but to be honest, i didn't see that happening much. usually the two people just tried to ignore the other side of the curtain. i think being in a private room must bring the family closer to the patient. not only can they decorate how they want, watch whatever tv they want, etc., but they don't have to be considerate for the other patient in terms of confidentiality and noise level, as mentioned above. as far as VIP rooms go, i'm all for it. if it's a room for employees (i.e. large, nice OB rooms for employees who have their children at the hospital), what a nice way to show appreciation. if it's a room for someone who is a pillar of the community, what a nice way to show appreciation. if it's a room for someone famous or influential in the community, well, you wouldn't want that person leaving the hospital and telling people they know about the bad or even so-so experience they had. you want them to tell people they were treated right. not only is that good word of mouth for your hospital, but often people with money and the means to do so will give back to the hospitals that they feel took special care of them. no, i don't think everyone who has money should get a VIP room, but they can serve a good purpose.

i personally feel that there is absolutely no excuse for taking a phone order and not writing it yourself. you cannot ask anybody else to do that for you. is there anybody who wasn't taught that in school? i don't think i'd want to be a patient on the floor where this kind of practice is allowed...

don't forget that in many places, you will never know when you will be getting off of work. if the end of your shift is 7:15, you may have a high chance of still being on the floor waiting for the oncoming nurses to get there or to finish getting report from other nurses. and it may be likely (maybe even certain) that you will have charting to finish which may take you up to 2-2 1/2 hours to complete, depending on how much happened during your day. so you may have to learn never to plan anything for the evenings of days you work since you don't know if you'll still be working or not. speaking of paperwork, i hope you like it, because you will be doing lots and lots of it. many care plans, which have NEVER been useful to me. i don't need some generic form to tell me what needs to be done for my patient, i need to assess them. it's also fun to fill out documentation on safety rounds, stating you were in the room every two hours when, in fact, anybody who looks at your charting will see that you filled in all of these particular slots for 8, 10, 12, 14, 16, and 1800 hours at 8:30 in the evening. you'll forget to chart important things, but you'll remember to chart "pt. lying in bed, watching tv" quite often. you'll get calls on your spectralink phone every 5 minutes because another patient has called requesting something from you, or phyical therapy wants you to premed the patient NOW for their exercises, or the husband helped his wife to the bathroom and someone needs to help her take her shower but the CNA is busy so you'll have to do it yourself right away because she's already sitting on the shower chair naked. oh, and rest assured that every time you are cleaning up poop or are sterile for a dressing change, your phone WILL ring, and you won't be able to answer it. expect that, and expect to get griped at later by whoever was calling because you didn't answer. if you're diabetic, don't count on being able to always eat when you need to. a small (think bite-sized) snack may suffice, but only if you remember to take it before you start feeling your sugar drop. often, 2-3 hours can go by in what feels like a few minutes, and you're wondering where all your time went. also, be prepared for the chance of developing kidney stones. i've known several nurses who have this problem. you can't carry water around with you. according to OSHA and most hospital policies, you can't have any liquids at the nurses stations or where you chart - only in the break rooms. think it must be easy to get 2-3 minutes during the day to run in and chug something quickly? sometimes, but sometimes not. and microwaved meals? only if you're lucky. more likely you'll be eating that for dinner after your shift is over, and only consuming ready-to-eat food during the day (sandwiches, crackers, etc.). i've had many a 12-hours shift with only one bathroom break, and i often can't help but wonder at the color and stench of my own urine which is so abnormal from the norm. have a good memory? if not, get ready to have long, extensive To Do lists. oh, and try to train your mind before you graduate to displace yourself from your stress. the key to getting through your day? force yourself not to care that you have one patient with a dangerously low blood pressure complaining of chest pain, another with difficulty breathing who needs to be suctioned, and two asking for pain meds ASAP (not to mention that patient who hasn't called you and thus hasn't been seen by you for 3 hours). if forced relaxation doesn't work, be prepared for bursts of anger and possibly a shower of tears because you can't keep up with everything and nobody else can help you because they're all in the same boat. not know everything about nursing? well don't worry. you won't know everything at first. in fact, for the first couple of years you'll feel like you know nothing. gradually, you'll get to where you feel comfortable in your area. then, you'll change specialties and start all over knowing nothing again. also, get ready to clean up the messes the shift before you left behind. i've worked days and nights, and i can say that both shifts are guilty of this. rest assured that many, many days you come on shift, you will spend 30 minutes to an hour just trying to finish up the most pressing matters before you even begin to start your morning routine. you must be a counselor to be a nurse. patients want to know what you know about their conditions, and they want to know what you think the next steps in their recovery process will be. families will want to know what you're doing for their loved one and will bring up problems that you will have to fix ASAP just to keep the peace, even if you know them to be minor problems. patients will gripe about everything from the weather, to the condition of the room, to the nurse they had on the previous shift, to how many times the phlebotomist stuck them, to the food, etc. etc. and you will have to listen and be sympathetic even if you personally do not agree with them. probably the worst thing about being a nurse is the non-compliant patients. i know everyone has a right to live the way they want, but i personally feel my time is wasted when my patient with end-stage renal disease stops by sonic for a limeade on their way into the hospital because they can't breathe due to fluid overload. or my hypertensive patient is refusing their blood pressure meds because "it feels too low" when their blood pressure gets less than 190 systolic. or my double-amputee diabetic patient has their family sneak them snickers bars. if it's simply a lack of education, that's fine. i can and will take the time to educate them as best i know how. but so often patients KNOW what they need to do, and just don't do it because it's inconvenient for them. no, i stand corrected. the worse is having a patient with open wounds i wouldn't wish on my worst enemy whose family won't let them take any pain medicine stronger than tylenol when they're around because "everything else makes her crazy." and try convincing a physician the pain medicine they ordered isn't strong enough or isn't working. they may have specific ideas on what they want to do for their patients, but they aren't the ones being yelled and cussed at by patients and family members alike because they've maxed out on their pain medication and you can't legally give them any more. sufficiently discouraged? believe me, there is plenty good to nursing, and i think everyone should give it a shot if they truly believe this is where their hearts lie. but everyone should also be aware that there are many, many problems with nursing in this country, and we have a long way to go to fix them.