Becca608

Time consuming, but this seems to be to model that everyone is switching to. What I do is give them the down and dirty at the nurses station and the sweet fluffy, 'This is so and so who had x surgery yesterday' in the room.

I eat my 'big meal' when I first get up before going on shift and take a couple of lean cuisines to get me through the shift. My meal before I go to bed is very light. I used to race through my shift and forget to eat so that when I got home, I was starving. That did nothing but pack on weight and gain me an ulcer.

Unfortunately, it all comes down to money. Experienced nurses are moving to less stressful jobs and the newer nurses are getting thrown out on the general wards. My first 2 years on a med-surg floor were horrible. I went' home and cried almost everyday and ended up on antidepressants. Finally I found a position doing the same thing at a smaller, not for profit hospital. It is much calmer there. Not everyone is meant to do floor nursing. You have to develop a really thick skin and fast response time to repriortize your entire POC for everyone based on what is happening at that moment. That's just something that comes with time. What concerns me is that I have only been a nurse for 5 years and I see newer nurses coming in that want to sit and 'think' about what to do. When your client with esophageal varices is bleeding out while the post-op patient is demanding pain meds, the confused person is climbing over the bedrails and the other confused person is yanking out her IV, you have to repriortize super fast. It gets easier as you gain more experience, but some shifts are just shifts from hell. There is no avoiding it.

Ultimately, none of us are perfect and no shift is ever the same. It is a 24 hour job and the client is the priority. I agree that the client suffers when we spend the first hour doing 'cleanup', but that is the nature of the beast with the understaffing these days. Peace.

This may sound like a cliche, but: FOLLOW YOUR HEART!!! Good luck with whatever you decide!

Thanks Tewdles, Neurontin is already use. Part of the issue is that no one is consistently medicating this guy across shifts. Some nurses are exclusively giving him IV pain meds and he isn't getting the PO as he should. I talked to the oncoming nurse about getting the po pain med to him around the clock and was told to essentially mind my own business and she will medicate as she sees fit. So much for implementing a plan of care . But when a client tells me that he can feel the pain down to the tips of his toes 5 days after an AKA, I would presume that phantom limb pain is setting in. (I hate the term 'phantom pain' it implies that the client is not experiencing real pain). I felt horrible when I told this man he could not have this IV med until he had the oral pain meds and had to wait an hour for the IV med. I don't even want to work with this charge anymore. She finds something to criticize me about constantly and I really resent her accusing me of trying to turn this man into an addict. Addiction should be the last thing that a nurse considers when medicating a patient in an acute med-surg setting given that so few people in genuine pain go on to develop an addiction. It makes wonder if she even understands the difference between physical tolerance and addiction. Thanks for letting me vent.

Hello all! I've got a question regarding pain management. Let me start by saying what I believe: 1. Pain is what the patient says it is. 2 My position is that patient's should medicated as ordered by MD and as requested by the patient. I am not an addiction specialist and it is not in my staff description to determine who is addicted and who isn't. 3. Yes, there are drug seekers out there. But they usually make themselves pretty obvious. So here's the question. Client is 5 days post op AKA on one leg. The other AKA done previously is a gross infected mess that we are doing wound care on. He is ordered oral meds q4h and IV pain medication q1h. He also has a large dose of IV pain med prior to dressing changes. Client has woken up after 4 hrs of sleep with a 10/10 pain rating and is moaning and begging Jesus. Oral meds take 1-2 hrs to reach maximum effect. Is it appropriate to medicate with both meds at the same time--the oral pain med for the long-term control of pain and the IV pain med to get control over the pain while waiting for the pills to work? I know this seems like a stupid question, but I was slammed at the time and asked my charge if she could medicate this patient. She claimed that he could only have his oral med and would have to wait a full hour before getting anything IV. She claimed it was hospital policy and I don't believe that. Thanks.

True story over several conversations with a patient: Mr. B., you are aware that you are on an 1800 calorie diet? --yes Mr. B., please don't have your family bring any more food from home. You are on an 1800 calorie diet and will get 3 meals and 1 snack everyday. I promise that you will not starve and we will get your blood sugar under control. --I'll eat whatever I want. Later, after housekeeping commiserated about the crawling things in his room... Mr. B., you know what I told you about not having someone from home bring you food? --uh-huh Well I think that bag of pork skins might have been bad. I killed two roaches and housekeeping killed three. Your family might have accidentally brought you a bad bag. --D@#%! I knew they were trying to kill me. Later response--he used the wall as a urinal. Uggh, nasty nasty man.:angryfire

Her books made me realize that I could be scared, afraid and totally human AND still be a NURSE! Read Echo Heron--she is heartfelt and practical! What I am less than impressed with are the ads promoting lesbianism while I try to post this. I am thinking that in between these and the censorship that I will leave ...and I am getting spyware alerts. That's it--allnurses.com is not where I want to be anymore.

By the time our first year was done, we were all clones of eachother as well. Short nails, bobbed haircuts or up in ponytails, identical nurse totes that had been give to us by various hospitals, backpacks. You could spot a nursing student a mile off!

50 ml/hr and 12.5 gtts/min which rounds up to 13 gtts/min since you can't administer 1/2 a drop.

Amen! This is why I am here. Right now I'm a new grad working on a med-surg floor. My goal is to learn priortization and time management. I still do not know what I want to be when I grow up (I'm 40), but I do know that I want to be a nurse!

There isn't anything wrong with you. Your concerns tell me that you will be a better nurse than I will be...even as my preceptors and nurse managers tell me how impressed they are with me. Never doubt yourself My Friend!

Writing someone up for something so silly is usually the writing on the wall. She might want to start jobhunting--this is the nit-picky stuff that happens in ALL FIELDS when someone wants you gone.

I would like to point out that it may not be the coworker with a drug 'problem'. She may be trying to obtain them for a 'loved' one or a dealer. Regardless, she needs to be reported. Truthfully, I have empathy for the addicts that are in pain. I have ZERO tolerance for the providers that introduce the 'solution' without warnings. I hate street pushers and I especially hate pushers that hide behind an MD. It broke my heart to see my mom being accused of being a drug-seeker and coming off the opiates after just trying to do what she had always been told--do what the doctor tells you to do.

I stopped by to make a an appt about regular chest pains. The receptionist refused to make an appt and told me I had to go to the ER. I went to the ER where I was left sitting for hours. When the ER nurse updated vital signs (after I had been there for 3 hours with tears running down my face because it hurt so much), she decided to not update mine. At that point I left and went to another ER a mile away where I was seen immediately. Not a heart attack, its probably an ulcer--but I am waiting on getting a new doc now that I have health insurance. My former primary provider was great until I no longer had insurance, and then my aches and pains simple had to do with stress. Just griping about crappy docs I guess. Many offices are unprepared for emergencies. I think I would be safer coding in my VET'S office.

"He needed money." I am glad this is working out for you, but the whole concept of 'he needed money' is wrong. You are his wife and and money needs should go through his partner (you), not his mom. Make him take you for a massage and have him rub your tootsies this weekend. Demand that he take the morning/day off work to be with you. If he won't do those simple things, then go to Mom/Dad or a sibling/best friend for the weekend. What hubby won't do to care for you, your family of origin or friends will.

I am not ashamed to say that I own 2 Ped-Eggs (available at WalGreen's for $9.99 each). One is for my feet and my hands, the other is for the rest of my body. Got dry skin? Get a Ped-Egg. It is totally gently where you need it to be and rough on the feet and hands. I have come to the conclusion that my hands are far dirtier than my feet will ever be.

Report her now. Report the veiled threats. She is not safe to work with patients. If anyone ever asked for drugs, I would tell them that they have lost thier mind and go looking for my charge nurse. Period.

I would do 1 full assessment during the shift, but make one more focused. For example, when you start your shift and have meds to do as well, then I would use the info on the Kardex and from report to quickly prioritize the order of assessments. Since you already have a good idea about each client, do a focused assessment pertinent to the presenting complaints. Once meds are done and things settle down, then go back to each and do a thorough assessment. Remember--its your license and your means.

Agreed. One thousand and one percent. :nurse:However, there is a time to advise and a time to comfort. There is a time for some hard 'sister talk' and a time for unconditional support. :rolleyes:This is a time to offer comfort and for unconditional support. peace, bec

AngelFire, Just do what you need to do to get through this experience. Again, I would reach out to supportive family and friends. I don't have kids, so if a friend called me needing some support then I would gladly 'call out' to do what I can to help. People can't support you if they do not know that you need some help and TLC. And sometimes, the most unlikely people may help you. praying for you, peace bec

I actually had to 'ignore' someone because I was reading a thread and it was so abusive toward the OP. As near as I could figure it was someone that claimed to be a retired nurse. It was horrible.

There is a difference between 'running a warrant' which is what police/security should do and a 'nurse' reporting someone to a security officer based on 'impressions' that are seemingly unfounded or based on personal dislike.

{{{{AngelFire}}}}