holdensjane

What do you do? Its just pulled out enough to see the cuff. Surgery recommended to come out but didn't seem firm as patient still needed treatment. Attending says okay to keep but don't know if its bc Dacron cuff is trivial or if they don't understand the implications. Surgery won. What is your standard of practice?

Hello all! Ive been a nurse for about 3 years now working in the same unit where I started as a new grad. I've recently taken an educator role, however, my concern is that clinically I'm not super confident. I've done well in all my pt assignments thus far but have had limited exposure to certain med/surg skills as I work in a specialized field. Whenever I've had to do perform such skills I've always had experienced nurses who have most likely worked with such pts to demonstrate for me first before I went on to take care of those patients the next couple of shifts, I.e. Trach care. unfortunately, as educator people will be coming to me for those things and I'm afraid I won't have the confident knowledge show them as others have shown me. ive already taken this job, and I think in the back of my mind I would have something valuable to bring into the role but I feel so incompetent right now. Is there any way I could obtain these skills or do you have advice for how I can still be effective in my role, now that I won't have the pt care opportunity to continue to learn them now that I'm away from the bedside?

Thanks for answering the question!

Thanks for the replies :)

not that i'm very beautiful to start with but I've noticed that my skin is constantly breaking out and I have huge dark eye circles that never go away. I never had this before doing nights. I get the same number of hours of sleep during the day and for the most part sleep right through the entire time so I don't know if i'm lacking sleep. so why the dark eye circles and acne. I would go back to days if i could financially afford. any other night shifters have this problem? any tips?

i will be applying for grad school in the next few months and am strongly considering nursing admin and leadership.. my question is, at my hospital we have nursing managers and above that is DON and i assume it is like this in all hospitals. what are the opportunities for a msn in admin in hospitals and outside of them other than being managers and DON because it seems that there aren't that many opening for positions.

sorry i should have mentioned that it was for grad school. i'm not really leaving.

when is an adequate amount of time that has past before I should ask my manager for a letter of recommendation. I work the night shift.

Thanks for all your responses. I'm greatful to have this place where i can seek the advice of experienced nurses since I hate to bring these things up in the workplace and became part of the gossip i've witnessed before. I have another question. Would it be unwise of me to bring this situation up with the manager and not name names specifically. I'm just so disturbed by this one experience. Also because I feel this nurse has something against me. I had an experienced where I took care of a patient once who was on pca dilaudid and ativan and was very lethargic one night. a week later I was called into the manager office and she told me she recieved a complaint about me going into a patients bedroom in the middle of the night sat down in the corner on the floor and read a book. She thought it was ridiculous and i wouldn't do such a thing but had to ask me because the nurse that took over my shift came to her with the concern. at the time the manager couldn't remember the name of the patient and i didn't press for the name of the nurse. but i only had one patient all week that was a man (i only get three patients) that was that lethargic and possibly hallucination (we all know what dilaudid on a pca pump and ativan can do). well the nurse i happened to give report was the same nurse that gave me a hard time in report recently. I thought nothing of it at first but everyone said that it was ridiculous of whatever nurse it was who brought it to the manager. and even then i thought, well no big deal she didn't mean it in harm. well after this experience, i think she might be harping on me and trying to get me because i'm new. Next time, if i have to give report to her again, I will tell her (if she continues to be rude) that she was rude to me once before in report and i won't have it to please not interrupt me until i am finished. I feel like she will keep doing this until i stand up for myself (I also look like i'm 18 which may make it easier for her). Though i have a feeling that she will only go to the manager and complain about my attitude. and since i'm new it will look bad. I want my manager to understand the situation from me first. btw, I want to ask my manager for a letter of rec for going to grad school. do you think this will ruin her image of me? or should I not bring this to the manager? is this too petty and insignifcant of an incident? thoughts are appreciated.

i make 60 a year base. I want to put in overtime but keep getting cancelled. we don't have a shortage of nursing in my hospital. btw, i'm a new grad at 7 months now and have recieved a raise of about 3,000 a year annually. goodluck it can happen. its a good question to ask btw. People who haven't been poor or struggled financially will most likely chastise you for being "just for the money". If you're only supporting yourself and money really isn't that much of an issue. but many people in life don't have that luxury and cannot afford to chose a career based solely on "because I love it". Its silly not think about it. I have friends that graduated from top schools and are jobless or make less than what their top tier education would suggest simply because there is no demand of history/anthropology/philosophy majors without a law/teaching degree. Now they're doing jobs that ppl who only graduated hs or has a GED can do, IF they have a job at all. Most the time these ppl don't have jobs because they won't settle for less (I'm a berkeley/ucla, etc grad I'm too good for that job). well guess what? no one is offering you more, so take it! most the time they just sit at home for months before finally taking the job or going back to school. what a waste. i didn't even mention today's economy, who can afford not to think about it.

what bothered me most was that even after I said "i'm just letting you know, if you don't think thats a problem then thats fine" she kept saying it "i don't know what you think its an issue, its not an issue, the bp did not drop". Like she made a point to purposefully make me feel dumb by harping on it. I took the blood pressures myself manually. I was concerned because I was giving blood products one after another. Hypotension is a reaction, no? I wasn't so much concerned with the actual bp than the trend.

its not so much the fact that she questioned my judgement but the way she said it was degrading as though it was SO outrageous that I was at all concerned about the bp. Next time will be out of line for me to document "informed oncoming day nurse of bp changes. Nurse aware, states "thats not a drop at all, we don't look at diastolic here". Pt stable no acute distress noted". I mean she said it, let her take responsibility for it right? haha. ok honest question, is it wrong for me to document that.

do you think my concern was valid, or am i just being paranoid?

I work the night shift, I had a patient that was admitted at 5, the nurse on days noted all the orders and told me he needed blood and plts. I look at the mar and noticed no premeds for plts. I asked the nurse about it and she said "yeah no pre-meds, I called pharmacy and they said no pre-meds too". after report I look at the original order, the premeds for plts were specifically crossed out and said "no premeds". but i noticed that the prbcs were right above the plt order. I concluded that the physician most likely meant no premeds for prbcs (usually theres no premeds anyway for prbcs) and accidentally crossed off the ones for plts. i asked the pt if he usually had premeds, he said yes and the one time he didn't, he had a reaction. well i called the oncall for premeds benadryl tylenol. bp was 119/62 on days and 121/67 for the beginning of my shift. I give him the benadryl and about half an hour later bp 98/60. that night he continued to be 92/50, 110/60, 90/55, 90/47. I asked the pt if he has ever had a bp drop with benadryl before, he said no. end of shift he was 105/55. well i give report to the day nurse and she says "what? thats no a drop in bp, I don't know why you're worried about that." I said "I didn't say it was a huge, prob i'm just saying its something that happened last night and its maybe something you should keep in mind" She said "his bp didn't go down! its fine". I said " at one point it was a 47 diastolic, so i kept an eye on it". Then responded "well, we don't look at that here, we only look at systolic". Its a bone marrow transplant floor. I finally said "you know i'm just letting you know, if you don't think its a problem then thats fine" and she rolled her eyes at me and said "so then his bp didn't really drop". I was soo mad, how rude! and this nurse interrupted my report with another nurse before her saying "are you guys giving report or fooling around, I hear giggling in here". I was telling the other nurse about my morphine cadd pump patient whose starting to get confused and saying weird things. the other nurse said "we're giving report about a confused patient, giggling doesn't mean anything". I'm a ng just off orientation about three months and this nurse knows i'm new. When I reviewed her noted orders, I had to fix so many things and you know, i understand things happen and its not a big deal, I fix it, I don't give her a hard time about it. I even gave HER blood that morning. How do you handle a situation when a nurse belittles you or trivializes your judgement in report? I came home and thought of all the things I could have said. Next time I will just ask her "are you trying to be rude or is this just how you are?" i'm not afraid of her! but then again, i'm new so i feel like its hard to stand up for myself because there is so much i don't know yet.

1. sure I can get your new tubing for the plts you just walked into the patient room with cause you're in isolation. you need something else just as i get up to get what you asked? sure, I'll get your dilaudid syringe too, just give me moment to check your MAR. Hmm? you need something else? oh no? okay....Oh, you need your plts PREMEDICATIONS too...of course, I will check your MAR and pull them up for you....but i just have one thing to say: I DON'T MIND GETTING ONE OR TWO THINGS FOR YOUR BECAUSE YOU'RE ALL GOWNED UP, BUT SERIOUSLY NOW. IF YOU FORGOT SO MANY THINGS YOU NEED TO UNDRESS GO BACK TO YOUR STATION FIGURE IT OUT AND DO IT YOURSELF! AT THIS POINT AM I HIS NURSE OR ARE YOU? AND HOW DID YOU MANAGE TO GO INTO THE ROOM READY TO GIVE PLTS AFTER DOUBLE VERIFICATION AND THEN REALIZE YOU HAVE NO SETUP NOR HAVE YOU PREMED-ED YOUR PATIENT! IT IS NOT OKAY TO ASK SOMEONE TO LOOK UP AND PULL YOUR MULTIPLE MEDS JUST BECAUSE ITS INCONVENIENT FOR YOU TO GOWN UP AGAIN. JUST BECAUSE I'M CHARTING DOESN'T MEAN I'M NOT BUSY. AND JUST BECAUSE I CAN HELP YOU OUT ONCE IN A WHILE DOESN'T MEAN ITS OKAY FOR YOU TO KEEP CALLING MULTIPLE TIMES FROM YOUR PATIENT ROOM FOR THINGS EVERYTIME YOU WORK A SHIFT. OTHER NURSES DON'T APPRECIATE THIS EITHER 2.stop gossiping. its not classy. I was there to witness the same insignificant probably unintentional actions/attitude/comments you witnessed and didn't give it a second thought until you brought it up again.