Thedreamer

Just make sure you do your assessments after youve gotten report.

I had a lady being admitted for low H/H and Afib new onset, 88 y/o to my PCU. CRX/CT = r/o CHF + she had pleural effusions. All her sitter cared about? When is she getting a dinner tray? I was just floored. The lady is just got to my unit, shes confused, I havent even been IN to see the patient yet and her PDA/sitter is already making requests? I told her I hadnt even seen her orders or even if she was allowed to eat yet. The lady said, "Well she hasnt eaten all day." Seriously? Didnt you guys just come from home? You didnt feed her ALL day and its now 6pm? She came back 3 times within 5 minnutes wanting updates on that tray. Finally I got the orders, great a diet is there.. got it ordered and sent up. 10 min later guess whos eating dinner? It wasnt the patient thats for sure. Just makes me sick.

I think the gist of this was, "I like turtles."

Run. Its just a SNF. Its not worth your license.

I got lucky in that regard... 5-7 patients on PCU though is NOT fun!

I wrote that new nurses should try to find a unit that they sense an openness and teamwork atmosphere. Feeling alone on the floor and stressed is the fastest way to burnout city!

Done and done!

To be honest, on our unit we have a saying, Day shifters can do nights but night shifters cant do days. Day shift is a fast pace, procedures happen, Drs need to be called, family is there.. Theres just a LOT of action going on that needs to be managed. It teaches you routines and how to prioritize. Night shift is a LOT more relaxed. Things happen yes but its no where near as busy as a day shift. You are going to pick up a lot of good habits and management skills from day shift so that when you go to nights youll just be that much more prepared for anything thrown your way

Considering her age.. who cares? Its ONE freaking vicodin every 4 hours. I have patients with the Fent patch, Dilaudid q3 and Benadryl q3 that are young. Shes probably not even getting a "buzz" from the pill because shes actually feeling PAIN. When youre in pain it really just takes the edge off, thats how chronic pain works. The people getting the buzz are getting IV Dilaudid/Morphine5 days after thier acute sickle crisis Shes asking for it before its due because it HURTS and shes scared of the pain coming back. I wouldnt be so quick to call "Drug Seeker." You can usually tell who your drug seekers are going to be because they are frequent fliers on the unit or thier level of pain medication doesnt match the diagnosis or even the favorite, "Heres a list of things I cant take but I can take Dilauded 2mg" Lol?

Orientation should be you following the same nurse for a few weeks. Thats my solid opinion on the case. Being tossed around from nurse to nurse only confuses you since you arent seeing a consistent work flow. It also has the issue of comfort. A new face every time you come to learn something brings a lot of challenges, the worst being uncomfortable asking questions. I got 3 months orientation for PCU after being an LPN for years when I first got my RN. Thankfully I was given an amazing preceptor and paired with her schedule. I worked with her every day I was being oriented. I built a relationship professionally that let me ask any question without fear and because of that I was able to learn a great deal more than other newer employees to the unit who got shuffled around nurse to nurse. Those same nurses are still struggling and needed an additional 2 weeks/1month MORE orientation than I received. Yes it depends on the facility and all that jazz but I guess what I am trying to say is, never be scared to ask for help or more orientation. LTC has a large population of patients and acuity is just going up and up as the years progress. Hospitals are tossing patients out a lot sooner then they did years back and thats bringing the acuity up a lot in rehabs and LTC facilities.

From what the nurses on the floor are telling me, online is a LOT more writting, but I think all in all it equals out to the same effort.

Patients family "prayed" for the evil spirits to leave thier son (26 years old) so he wouldnt be diabetic. Guess who came in DKA?

We had a lady come in with persistent N+V, throwing Irregular rythyms, BP, the whole 9 yards. Once we got her to stop vomiting and got the stat labs back.. potassium was 2.5! Eek! Gave her some NS with K20meq and few days later had her outta there with all shiny and new!

Yea, treating that underlying should paint a better picture to work with. Maybe some Zofran IV to help with the N+V, see if the BP comes down, check out what the CBC looks like, maybe get a BMP or CMP. Hopefully after that the BP comes down, VS get to a better norm and you can start replacing those lost fluids and electrolytes.

So call and get the order changed. Nurses are problem solvers as one of our many hats. True we dont know the entire situation but I see lazy nursing every day on my unit. As a patient advocate sometimes we need to "suggest" to the Dr what might be best for the situation.