heartbeat2

There maybe reasons as to why she is acting this way, sounds unprofessional to me and not a way to be an effective leader. You may want to meet with her prior to your evaluation and ask directly for feedback. A good technique to use is after you listen to what is said, summarize what you understand has been said to decrease miscommunication. She may feel like she's not been welcomed or may be used to a different style of interaction... It depends on what your goals are as to how to procede. Your job is stressful enough without the added stress of a negative nurse manager. Good luck to you and your co-workers.

I was a labor and delivery nurse that due to a broken knee could no longer work in my area. My hospital now lets me work as a monitor tech where I watch many patients on several floors: up to 48 patients at a time. I have asked in the past what other hospitals do, and what their policies are. I know I look at things a bit differently because I am a nurse and have the liability so engrained in my mind, to do what's best for the patient and then myself. I teach BLS, am ACLS certified even when I was working labor and delivery. Also, does anyone have any suggestions on where/how to become certified in telemetry? Thanks:redbeathe

Sometimes pauses are a result of medication and may need to be adjusted. If undermedicated, the rate can become quite rapid, overmedicated, very slow. Also, is this a new onset of A-fib or chronic? A-fib has the increased risk of blood clots forming in the atria since they aren't emptying fully. If the patient converts to a sinus rhythm watch for signs of stroke, MI, PE. Hope this helps.:redbeathe

I am very interested in becoming certified in telemetry. Is there anyone that can recommend an on-line or correspondence course? Thank you.:redbeathe

My first impression of the tracing you mention is IVR...idioventricual rhythm. The first time I saw this it was like my P wave just melted into my QRS and it had gotten wider then my P wave just emerged out of my QRS and had returned to it's normal morphology. AIVR is accelerated idioventricual rhythm: a rate above 40. Hope this helps.:redbeathe

I had a TEE done to see if I had a defect. The bubble went from the right atrium to the left atrium. A clot could do the same thing. I don't know if this is the only reason it is done.

I would love to speak with anyone here re: telemetry, I went from L&D to telemetry after breaking a knee and am having a few BIG issues. I would love to have someone tell me how their hospital handles issues like "how long is too long" for a pt. to be off their telemetry monitor and things like this. Who is over you telemetry units. How many patients does one person monitor. What is the layout of your telemetry department. I don't mind helping anyone with ?'s re: going to mother/baby, post partum, or L&D:balloons:

I would love to speak with you. I worked labor and delivery for over 20 years and dearly love it. I broke a knee 2 1/2 years ago and couldn't work l/d since but am trying hard to get back if my knee one day will let me. My hospital placed me in telemetry for recovery time. They didn't have to do it but I'm forever grateful that they did.

Have you ever worked with a Dr. that goes into the patients room and talks a great deal.... and usually in circles, and actually says NOTHING! When the Dr. leaves and you are standing there...the patient and or family will ask, "what did he say". lol...I go get him or beep him and tell him the patient has ?'s for him. We had Dr.s give their patients our L&D unit number for them to call us with their ?'s. One dr. said he wasn't going to return this one patients call. I called her back to let her know that I had spoken with her Dr. and had not received any orders. That if she felt like she needed to be seen to come to the hospital. Boy was he upset with me. (I think he was going to tell the patient that I'd not given him the message) One Dr. would have a number of patients in labor, and we were busting our britches to care for them, IN he walks and breaks everyones water, orders a ton of epidurals, and pitocin augmentations!...now a once managable situation is no longer...oh and I would be the one following him room to room doing this and he would be upset that I'd not gotten the first patient admitted by the time WE had seen his last patient. Sorry but it does take about as much time for him to chart what he did as it does for me to clean up after what he did, and on to the next patient.

To me, I see a difference in the way the public perceives nursing since they have become customers instead of patients. May account for the number of years passed and the increase demand on what nurses do. To be fair, what most have seen nurses do is from TV shows. Not sure how much people get from even the higher tech shows, and always a dr around like in ER. (some of those shows are so way over the top we know they aren't true) Also, from the patients point of view, We are both (waitress and nurse) in the field of service. My response would depend upon how the patient said what he did: smarty or ignorant.

This is one of the hardest things to deal with, how much is too much and how do you know it. First, you want to make sure the fundus is firm. There are times when you massage, yes the fundus is firm, but does it get firmer when you massage. This will usually decrease the "trickle" you may easily see. We would do pad counts and we kept the same one under the patient until it is about soaked if the patient has heavy bleeding or if we are concerned about the amount of blood loss. You will be able to tell the difference just by how heavy the pad is. When in doubt and a more experience nurse isn't available right away, keep the pads laid out on a chuck in the recovery room area, or in the tub if you are in the patients room. Let the nurse in charge know what's going on. Keep a watch on the patients bladder. A full bladder will not let a uterus contract as needed. If the fundus is firm, and the bladder empty, then you are usually looking for lacerations or possible retained placenta. The doctors I've worked with would have standing orders about catherizations and pitocin. If this doesn't correct the situation, call the Dr. It's normal that when the patient first gets up, the pooled blood in the lady parts will pass and be a large amount, but it doesn't continue. Keep a check on the vital signs, but moms can lose a good bit of blood before vitals will change. We had a doctor that collected cord blood after deliveries, heparinized it, and then used it in an inservice. Measured out in ML.s what 50ml, 100ml, 200ml, and 250 ml would look like on a pad. If you have baby scales available, you can weigh the pads also when you are concerned. You can also describe the amount in sizes of softball, cantaloupe, basketball....especially when it's "congealed" and you don't have individual clots. I hope this helps.

I've posted this before, but it has and will always remain one of my best thank you's. Got a call and the woman was asking me "what do I need to do to be able to do what you do"..(education wise that is). So I spoke with her about her options. She told me that I didn't remember her but that she would never forget me. I took care of her through her labor and delivery. I had made such an impact on her life, she was wanting to follow in my footsteps and make an impact on someone else and become a nurse....wow.

I've been a nurse for 24 years. The insurance the nursing school carried on the students wouldn't allow for the students to do IV's. Even though our instuctors didn't agree with this, we wouldn't have been covered if something were to happen.

Wow...talk about a common thread woven throughout. Sounds like you already know your answer. You have been through so much already. There are many opportunities out there. Wait until you have a fit for you and your injury if you can. Hang in there.

The main reason that WHITE isn't in....the people wearing it didn't like it. NOW...the POWER....it is in the WHITE = NURSE. In the hospital...you don't see the "ice cream man". Patients can SEE the white long before they experience the what the nurse offers. The reason for getting away from the nursing caps, with all the advances the caps became a hindrance. I don't look good in white, but I do know that patients, families, even hospital personnel responded to me differently all for the better. It just looks more professional and CLEAN...as long as it is cleaned! Just as a judge wears a black robe, you KNOW who he is when he enters the courtroom. You KNOW who the nurse is when she entered in her white uniform. We have taken this away from ourselves.

Many people don't really know what all we DO. When I worked labor and delivery, many NURSES would say "what is there to having a baby", " you don't know what real nursing is all about". We had a unit secretary that worked on the post partum floor that had such an attitude about helping us in labor and delivery we just would do it ourselves rather than listen to her or wait forever for her to do anything. WELL....she became a labor and delivery nurse...HAHAHAHA She did say that "IF she'd known how much we did....she'd have been checking on us much more frequently"!!!! If someone that is actually in our profession or someone that is as close to the scene as a secretary is...how in the world do we expect lay people to get what we are actually doing.

HOOOORAY for you!!! I can understand a poor student struggling and needing support. What I do not understand, NO practice. I see students that want to be "spoonfed" and then there are others that want to be "perfect". The ones that are serious about learning, it is easy to spot them. They may not have the right answers, but you can tell they have put forth the effort. NO effort to practice....not serious. Now...is there a possibilty that he has a job that may have conflicted with his practice lab time? Did he take the time to speak with anyone about his lack of practice time prior to being checked off? Sounds like he thought it was going to be a breeze and blew it off. Hopefully he will come to see what it takes and step up to the plate.

When you are about to hang the blood, this is when it's most important to confirm the information and done at the bedside. The RN is the one that will be held accountable if something is amiss. When it is checked out from the lab they are checking to make sure the blood matches in their log book. At the bedside, you are checking to make sure it matches the PATIENT. 2 NURSES are required at our facility. The supervisor will do this if another nurse isn't available.

I have a bit of a question. The nurse that was left in ICU to care for 4 patients...did she ACCEPT the assignment or did she write it up and send it through the channels? If she didn't write it up, then she put herself in jeopardy.

The Dr.s and nurses are very busy, not an excuse but a fact. Before I give a medication, I've made it a habit to ask every time..."are you allergic to anything". I've gotten made fun of at times...but once...a patient was telling me NO...the patients mom said yes...YOU are allergic to Penicillin...I was about to give it IV.....said it made her stop breathing as a child. The patient had never received it since until almost now! The patient said she was never told about this!!!!...she was 24 yo SO all the documentation and pt response was NKA...

We all make our own decisions. I've seen cardiologist that smoke like a freight train, nurtitionist that are obese, hypertensive nurses not take their medication...and the list goes on. AS long as these decisions don't cross the line and impact our patients, we give our patients the correct information, then they will have to make their own choices. Whenever you have an IMPAIRED nurse or DR....it does cross that line.

I am a nurse that is working in telemetry. We have 4 RNs and 3 LPN's. We don't have direct patient contact. The cardiac floor has a duplicate monitor. They run their own strips but we runs strips on their patients too. (double charting). We watch the telemetry from the rest of the hospital also. We can now monitor almost 50 patients at one time....ONLY 1...repeat 1 person working telemetry at a time. Does anyone know if there are limits to how many patients one person should be monitoring at one time?

I sure am wanting to think that with your work experience, your preceptor is assuming you know more than you do. Either that or why in the world would they place you with someone that obviously doesn't want to TEACH. I would encourage you to make a list, have a meeting with your preceptor first and make sure she understands what you are dealing with. If you are still feeling that you are lacking the guidance you need, you both could meet with the nurse manager. Feeling overwhelmed is normal. As you gain in experience, then you should be more confident and independent. Does the unit have a list of competency skills or how do they document that the staff is competent. This could be a starting place.

Confidence and knowledge are great assets. Give your co-workers time to LEARN you too. Many new nurses don't have a clue as to what all they DON"T know, and are in deep trouble before they know it. Labor and delivery is a very quick paced area. Most units will not place new nurses in this highly litigious area. I have taught some really wonderful new nurses. What stands out to me with the "good ones". - Always seek out learning experiences. (One of my best teachers when I was learning was a scrub tech. She taught me how to watch for the "signs" of what was going on with patients.) -Never say "I already know how to do that" when someone is wanting to teach you something. You very well may know how to do it, but you never know when someone is going to ADD a pearl of wisdom. Then afterward, you can say "you do that the same was as my mentor showed me , or thanks for showing me another way to do it". This works well for the early learning stages. -Never do ANYTHING you aren't sure you are doing correctly. -Take time at the end of EVERY shift and ask your mentor, What went well, what could you improve upon. As you gain experience, transition to becoming more independent by taking over the patient and your mentor "watching". I had to get pretty rough with my mentor, she kept wanting to fill in the spots I missed. You don't know what you need to work on if someone does this. These are not impossible things to do, but they have always made me take notice of new people that do this.