Lightning Bug RN

I just wish there was some way to fix it in my neck of the woods. We don't have what you in CA have, and night shift seems to really be pushed to the max every night. I wish I could understand the rational to keep us so bear bones at night. The pts do not sleep, are constantly on the bell because the floor I work on, an ortho floor, no one can do anything for themselves. Night shift is when we get slammed with admissions, it is when the confused pt will attempt to get OOB without assistance, pull out IVs and Foleys. If someone is going to go bad, it happens on night shift as well. Almost every night, someone is SOB, having CP, way Hypertensive, change in mental status, bradycardic, of a combination there of. It is getting to the point that I leave work an hour late on a consistent basis completely exhausted, and I just don't know what to do anymore. I think the most infuriating part is the fact that when we do have enough staff that we would not have a horrible night, they staff share them to another floor where the acuity is much less! Any other ortho nurses out there? What kind of staffing do you guys have at night? Any insight would be most whole heartedly appreciated!

Could not have said it better myself!

It is horrible how the hospital uses this method to staff floors. It is an injustice how floors with "walky talky" pts have more staff then floors where everyone on the floor needs complete assistance at all times. If anyone has a solution to this problem, I would absolutely love to hear it, my floor has been begging coordinators with no avail.:chair:

How did you do in the nclex review class? Did you take the end of the course test they normally give, how did you make out with it? The result of the test normally gives you a probability of you passing the nclex itself. I took the kaplan review, and then took time off from my job as a GN to study for the test using the saunders review book. Good luck with the test and your career.

I waited until my youngest was in school full time before I went back to school for m ASN. I do not regret waiting until this time. If you need the money for your families well being to go to school now for your degree, than as many people here have said it is doable, but if you can wait financialy until your youngest goes to school, I would suggest doing that way, it will be easier on you and the kids. Nursing school is alot of hard work, with alot of study and paperwork pre-clinical to do. I do not regret my decision to wait until my kids were older, it was difficult enough on them when they had to give me time on the weekends to study when I had a big test that Monday. One thing I will tell you is to make sure your husband is 100 percent behind you with this, because there will be plenty of times you will be turning to him for help and support. Good luck with whatever you decide.:wink2:

I was just wondering, how many 12 hour shifts do you guys do in a row? Is there a number of nights in a row that you would feel you would be too tired to take care of your pt's? Any input would be appreciated. Thanks

Wow, Tell me where you guys work so I can sign up! On my floor starting at 2300 we start the night running and we don't stop until we walk out the door, usually at 0800! None of us has time for a break, with call lights ablaze at all times, people attempting to get OOB by themselves, CP, SOB, PAIN, you blink your eyes and it's time to tape report. Then day shift comes in with three times the amount of staff, sitting on there behinds chit chatting until 0745 before they even start listening to report, Oh boy, I love my job!!

I work 7p to 7a and I have tell you that almost every night without fail we get a phone call at 10:50 from bed control and then two seconds later the nurse from the ER is on the phone demanding to give report that very second. You ask her to hold on for 2 minutes to print out any orders or labs that may have been done. and you hear "I can't wait for two minutes, don't you understand that it is time for me to go home?" The excuse that the ER has to wait for orders before they can send the pt is rediculous, many, at least 70 percent of the pts we receive from the ER do not have ANY orders for our floor before they are sent. I cannot tell you how frustrating it is to be short staffed on our shift on a constant basis, and to be constantly slammed with ERs at the beginning of a shift, and not being able to see the other multitude of pts on the floor that you just picked up. If someone is going to go bad, it is going to happen on night shift, if they are going to fall out of bed even though they they have been well behaved all day with no sign of attempting to ambulate by themselves, it will happen on night shift. The problem with the Er admits is the fact that often the report you receive from the Er is not complete, that is why I print out all the information I can about the pt before I take report (Potassium way high or way low as an example). There are often enough surprises once they arrive to the floor , like tachycardia uncontrolled, hypertension uncontrolled, of SOB and no pulse ox done or sky high blood sugar and no one even bothered to check it downstairs. So you spend the first hour trying to track down a dr who will take responsibility for this pt, which is often very difficult. I have had pts waiting for pain medications for almost two hours because of someone going bad as it is, the last thing my shift can handle is a ER dump at the beginning of the shift. Ifr you guys are gonna keep them down there, at the very least, please make sure the major issues are addressed, my favorite by far though is the pt who has been in the ER for almost 6 hours with a hip fx, and when I ask about a foley placement, the nurse practically laughs and says I don't have any orders for that. So I am supposed to a have time to address this by the time the pt gets to me and hour later? Please have some mercy for us poor med surg nurses!

I am pretty good at placing IVs most of the time. The one problem that I seem to be having at times is I place the IV in, get a great blood return, then when I retract the needle and attempt to thread the catheter into the vein, it blows. Any advice would be greatly appreciatied. Thanks;)

I am currentyl working on a med surg pre and post floor, and I am thinking about going to ICU. Has anyone else done this? How hard is it to make the transition ? Would it be better to go to telemetry first? My floor does have telemetry monitors but we have to transfer pts if our limited meds allowed to be given do not help with tachycardia/afib. or if their troponins are above a certain range. Thank you for your thoughts :smilecoffeecup:

I only mentioned to save things like sociology or psych with nursing because of two reasons: 1. Many schools, such as the one I attended, require you to carry full time credits 2. If you do decide to go with a school that does not require this, it will take you that much longer to get your degree. I know when I was in school, my goal was to get in and then get out as quickly as possible, but again that is up for you to decide what is a priority for you. :monkeydance: One thing to keep in mind that all schools are not alike. Make sure you research where you are going to go and make sure it is a school with a good reputation. These schools may be more difficult to get into, but are worth it. Also many of the schools offer tuition reductions if you have a GPA of 3.5 or greater. The school I attended gave me half off. Good luck whatever you decide.

I too did things backwards, having children first, then I went to nursing school. I waited until my children were in school full time before I started. I started out slow doing summer classes at the local community college to build a good GPA before I applied to nursing school. Some advice I would give you is: take all the sciences prior to going to nursing school, save things like sociolgy and psych to take with nursing, if you decide to have children first, make sure your husband is like mine and is willing to run the houselhold or at least do the majority of running the house (nursing school is all encompassing), and make sure you and your husband have a strong marriage because this will test it, and try to have a good support network around you (friends and family). Nursing is a wonderful profession, but it is very physically and mentally draining. Make sure this is something you truly feel a calling for because it is not a job that I would recommend soley for the money, or flexability. Often the job is not as flexible as you would like, and if you decide to work in a hospital such as I do, you will work many holidays, and many times not what you place as your preference, as well as working weekends. Good luck with whatever you decide.

As a nurse who works the "rotten shift" 7p to 7a, I have to tell you that if you work night shift, you most certainly will be very busy. There is a large misconception that during the night, the pts sleep, I have to tell you that for the most part that is far from the truth. Also, there is less staff, so each nurse has double the amount of direct pts that a day shift nurse has. Time management skills are well learned on this shift, due to necessity. The call bells are constantly lit, and there is only on nurses aid on, so for the most part we are running all night. Another thing is that there are PLENTY of learning opportunities on this shift. If a pt is going to go to experience Afib, chest pain, Low or Hight Blood pressure, a fall out of bed with or without a change in mental status, or become SOB, this is usually the shift that this occurs. The one thing I would make sure about if you do take a night shift postion, is to make sure that there are experienced nurses working that shift to assist you when someone indeed goes south. One thing I must say to recommend this shift is the fact that you are home during the day to be with family, and not miss alot of the things that I used to miss when I used to work evening shift.

I love my dansko clogs, they keep my feet comfortable all night through my 12 hr shift. Lightning Bug RN

I just wanted to ask everyone, what do you guys do to leave work at work? I have been a nurse for over 2 years now, but especially when I have a bad night, when I wake up from my nap, I just keep going over the night, what I might have forgotten to do, and how my fellow co workers are driving me crazy, complaining how slots are asigned or whatever :trout: . I would love to leave it all behind once I walk out the hospital door, but especially lateley, with short staffing becoming the norm :angryfire and feeling stressed , I am having a hard time letting things go. Is anyone else having this problem, or has had this problem in the past, and found a way to leave it behind you until you have to come back? Thanks for the input. Lightning Bug RN

I used the green saunders book with cd to study for the nclex. I was working as a gn at that time, and I took a week off from work to prepare for the test. I went through the book chapter by chapter taking the test after each and if I did not get something correct I read that section to find out the rationale for why my answer was wrong. After I got through all of the book, I started with the cd, just doing question after question, and again looked at what I answered incorrectly, and went back in the book, to understand why my answer was wrong, and the rationale on why their answer was right. After I got through all of that, I did the end of the book test. I had taken the kaplan review as well right after I was finished with school, but I think the saunders book is what got me through the first time. I wish you lots of luck, I know plenty of excellent nurses who did not pass the first time. I' m sure you'll get there. Just remember to try to understand why something is right or wrong. Lightning Bug RN

I would be careful anchoring the vein above the site, you might wind up sticking yourself if you do this. I anchor, but only below the vein and if the pt is able to follow directions, I ask them to hold their hand in a fist position if it is going in the hand, this helps keep the vein nice and taught. If I am placing it in the inner arm, I sometimes place a pillow underneath to keep the arm nice and straight. However, we do not us lidocaine or ns wheals with our iv insertions. Lightning Bug RN

I am the first born, both my mother and father are alcoholics.

As far as this nurse walking in and seeing first admit next to her name, the only time this happens is when the other nurses that will be staying until 7AM have gotten an admission with the last few hours. As far as being all caught up since we have been there since 7P, that is not true at all, I wish it was. Most of the time we from 7-11 we are slammed with ERs Post ops and transfers, while attempting to give blood, calling Drs with off labs that have been off all day but no one called on. We strive to get all the problems resolved before 11P because the Drs that are on call after that will only address things if it is a dire emergency. We are often far from caught up when 11P comes around . As far as not being fair for the 8 hour shift nurse to have to float after the 7P nurse was already floated to the same floor, I believe it is fair for the following reasons: the slot will change almost completely almost all of the time, when someone has to be floated in the 3-11 slot, the 7-11 people are the ones to go first, so we are floated much more often the the 11-7 nurses, and the floors we are sent to know at 3P that they are getting a float from 7-11 and save all the open beds for when the float comes, and then slam the living daylights out of that nurse. I have worked both 8 and 12hr shifts as well, and I do believe that this is the fari way to do things, if one of my fellow 12 hr shift nurses was floated from 7-11 and I was next one to be floated, I would gladly take my turn because I know what heck she has put up with for 7-11. Lightning Bug RN;)

I personally have never had an order to give blood while a pt was on a herpain drip. If I did receive an order to do so, I would contact the nurse coordinator/nurse manager for our policy and procedures. If you are not sure if something that is being given to a patient is correct, it is always better to double check with, in your case, your nursing instructor, on why something is held/not held, and speak with the nurse who is directly caring for the pt. on what follow up the pt needs. Good luck in school. Lightning Bug RN

Thank you for the welcome,and I appreciate all your advice. I just wanted to explain a few things about what is happening. As for the floating, we do have a book which keeps a record of who floated last, the problem is that this nurse feels that if you are a 12 hour person (this nurse works 8 hours) and you are floated for the first four (7-11) let's say to the first floor, and then at 11:00 the first floor calls for a float nurse from your home floor, this nurse feels you should stay up there and wants to refuse to go if it is her turn. I attempted to explain to her that they always change your slot so like you are starting from scratch, but she insists she is right. I have spoken with my manager regarding this issue, and he says it's our call. As far as when we have admissions, when I make the slots out for 11-7, I always put who is first admission next to that persons name, the problems occur when this nurse walks in and sees first admission, she usually feels it is unfair, or if we get another admission after this I attempt to be fair and ask her how her slot is going, and can she handle an admission, and the answer is always no, or if it is someone else's turn and I ask her to take it because they are drowning with someone going south, she refuses, and I end up taking it if I have any room in my slot. I am usually charge nurse when we work together. In regard to being charge nurse, the one thing that has me nervous looking at the schedule for December, that maybe they were trying to give me a break, they have this nurse in charge the majority of the time, which has never occurred before. I am nervous about this because I don't believe she can be objective aand fair . As far as getting into verbal arguments, I agree that it is unprofessional. I do not raise my voice back at her, I speak in a calm way, attempting to resolve the situation without alot of fuss, because this is occurring at change of shift, when everyone is trying to get through report and out on the floor before 1:00 AM. I just find her yelling at me very upsetting, and then I am upset for the rest of the night, while it seems she feels herself justified in all she says and does, and does not seem to be flustered at all by all the tension she creates. Thank you all again for all your advice. Sincerely Lightening Bug RN

Hello. I just wanted to get opinions and/or advice on how to handle working with a fellow nurse without butting heads all the time. This nurse and I get along very well as long as everything is going her way, but if an admission has to be assigned, there is always some reason she feels it is not her turn to take it, and only will take it with hostility. Also, there is alot of tension because this nurse works 8 hour shifts, and the majority of the nurses on my shift work 12's. This nurse feels that the 12 hour shift nurses if they are floated to another floor for the first 4 hours of their shift, and this floor calls for a nurse from our floor for the next 8 hr shift, that the same nurse should have to stay this shift as well, even though these floors always change your slot. There always seems to be a battle of wills. The arguments are always in front of coworkers with her raising her voice at me. I in turn attempt to be professional and try to explain my thinking but I am just so tired of the arguments. I always try to bend over backwards to accomodate this nurse, and for the most part we get along well, and she if very knowledgable and is more then willing to help you with procedures when asked, and I want to maintain a good working relationship, but these arguments are happening more and more. Any advice would be greatly appreciated. Thank you Lightning Bug RN

Hello, This is my first time posting. I just wanted to ask you guys your opinion about being staff shared during a 12 hour shift. If a nurse is staff shared to a different floor for the first 4 hours, and then staffing calls for a staff share on that same floor from your home floor, and they will be changing your slot where you will be having different pts, don't you think it is fair for another nurse to take a turn that is just coming in for 11-7? Thank you for your thoughts Lightning Bug RN