natsfanrn

I'm at Fair Oaks...ratios for nights are now 1:6, with a 7th patient on a really bad night; days are 1:5

I LOVE SmartScrubs cargos...they're all I wear now. Yeah they're pricey, but they are so soft and comfortable, long-lasting and they come in tall sizes (I'm only 5'6", but a lot of the other cargos only come to my ankles). You can even wear them to the store and stuff without feeling like you just came from work. Lots of colors, too. Try them, you'll love them

On a similar note, I spent the better half of one morning a few weeks ago trying to convince a post-op patient to let me administer SSI. She takes metformin at home, and couldn't understand, no matter how much I tried to explain, that we hold metformin 48 hours post NPO. She just kept saying, "but I don't take insulin at home." Never did let me give her insulin; just documented the h$%& out of that conversation!

I do this each and every time I give a med or do a procedure...it's mandatory at our hospital and grounds for immediate firing if you don't do it (managers do rounds on our patients and ask if the staff have been properly using identifiers). Everyone in our hospital system is required to do this, including dietary (when bringing up trays), physical and occupational therapy, CAs/CTs when doing vitals and such, and, of course, the nurses. (Hmmm...come to think of it, the docs DON'T do it!!!) Yes, I sometimes feel like an idiot doing it, especially when I've had the patient for a long period of time and I was just in their room chatting on a first-name basis with them a few minutes ago, but I explain to the patients that we are doing it for their own safety. I joke with the patients about it (I like to ask them for their credit card number after their name and birthdate), and I've had more than a few give me fake names just to keep me on my toes, but they always understand and seem to appreciate the effort to keep them safe. We've even gotten quite a few comments on our discharge surveys to this effect. I might add that this policy was initiated several years ago when there was a fatality at another hospital d/t an identification mixup. When you have 5 or 6 patients (or more), there is always the potential for giving the wrong meds (or doing the wrong procedure) to the wrong patient.... no matter how familiar you are with the person. Never hurts to do an extra check at the bedside.

I made a cranberry vodka drink and put it in an empty 1L NS IV bag (it was a "practice" bag that came with our lab kit), then used the IV tubing to deliver individual shots into medicine cups (hubby built a make-shift IV pole). Also put raisinets in a bedpan. Did the Foley thing, too, which was a big hit.

We had a debate about this where I work. I have no problem giving one Vicodin 2 hours later if the patient rec'd one and the order was for 1-2 Q4...sometimes the one just didn't help and others just seem to have their pain controlled better if they rec'd one Q2 instead of two Q4. Others said I couldn't do this. Finally called pharmacy and they said there was no problem giving one every two, as long as the patient didn't receive more than 2 in a 4-hour period. I've never had an MD object to this practice, either. On a related note, I had a patient complain that her nurse wouldn't give her half of a Percocet when she didn't want to take a whole one, saying that she couldn't because the order was written as one to two tabs

Okay doc...just to clarify the order so we don't disturb you unnecessarily... Is that when Hell freezes over solid, when there's just patches of ice, or if it's just sleeting? Can you leave a number so Satan can page you directly if that occurs?

Because to be honest it doesn't matter much once he gets to the floor, especially when time is of the essence. When you call and say you're bringing a patient up and I have less than a minute b/w my other patients' demands to listen to report so that I can be in the room to greet you (as required by our dept), I become selective in what I need to know. It's a given that the pt has rec'd some potent narcs in the OR/PACU, and my assessment will tell me if he's rec'd too much. If he starts zoning out, I'm going to give narcan and take away the PCA button no matter when/how much fentanyl he's received (especially since some can receive enough to knock out a horse and still be A&O while others may have rec'd a tiny dose hours ago and still be barely coherent -- it's how they're recovering that I'm concerned about, not how much med put them in that position). I'd much rather know when the pt's preop antibiotic was given so I can make sure pharmacy times the next dose appropriately; when the pt last rec'd antiemetics or pain meds that I can give on the floor so I know when I can give him another dose; whether his VS are stable; whether he has any drains or such; if he's coming up in a bed or stretcher and whether he has a need for any suction equipment, etc, so I can get the room ready; and so on. This is all stuff, BTW, that has been left out of some reports I've received in lieu of a blow-by-blow rundown of all the anesthesia meds given intraop... I hope this makes sense...it's not that I don't think it's important, it's just that there are certain assumptions I can make in any post-op patient, and in the interest of time, I just need an edited report...

As a surg floor nurse, I truly try to understand the pressures the PACU nurses are under and be ready for PACU admits. but please, a few thoughts from our side... 1. If you call and say you're bringing a patient up in 10 minutes, please bring that patient up in 10 minutes. If something has delayed you, please let me know so that I can grab a quick lunch, do a procedure with one of my other patients, or do one of the many other low-priority things that I've put on hold while awaiting a PACU pt. Can't tell you how many times 10 minutes has turned into 45 minutes or an hour or more. 2. When you give report, we really don't need to know how many mics of fentanyl the pt rec'd and when he rec'd it. If it's something we can't give on the floor, we honestly don't care...and it takes forever to wade through that to get to the part that we DO need to know (we tape report here, so prob not as applicable for face-to-face reports). 3. Please premedicate the pt as much as possible for pain/nausea; even if the pt hasn't had much of either in the PACU. More often than not, the transport will make even the most comfy pt hurt/nauseous, and when they get to the floor, we have to wait 15-20 minutes or more for pharmacy to get the floor orders and get them into the system. 4. Do understand that it's difficult to provide a safe transfer of care at shift change and/or when we get multiple admits at once. We want (and are required) to be in the room when a post-op arrives, and we can't if we're still getting report on our other 5-6 patients. Even the most stable patients can take a bad turn after transport, and we need to be able to give them our full attention when they arrive. As someone else said, we're all on the same team. Now let us floor nurses know what else we can do to help make your lives easier....

The tuition reimbursement is fairly common (at hospitals in my area, at least) and can be worthwhile IF it's a facility you're willing to commit to after graduation. Before signing, find out what the penalty is if you decide not to work there upon graduation, and also find out whether you'll have your choice upon graduation of which dept to work in (pending availability, of course) or whether they'll just stick you in a unit where they have the greatest staffing needs... Also find out how many hours/week you'll have to work as a CNA -- it will be great experience, but not if you're working close to f/t hours and trying to handle the demands of school as well. Don't know what state you're in, but like vamedic said, check your state's BON website for details of state-sponsored scholarships. Sometimes the reimbursement is contingent on working in a rural part of the state upon graduation. Also check with your nursing school -- they should have a full list of scholarships/tuition reimbursement programs available. At our school, the instructors told us that many of the scholarships went unawarded d/t lack of applicants. Have never heard of students being locked out of clinical hours altogether. In our program, you may not have gotten your first (or even second) choice of location/time, but there were clinical slots for every student. If the school you're looking at truly doesn't have slots for every student, I would definitely look at alternatives... Good luck!

And remember, a person with critical H/H values can have O2 sats of 100 percent yet still be hypoxic...

I've been asked to sit on the employee satisfaction committee at the hospital where I work, and I'd just like to get an idea of some of the measures taken by other facilities around the country re: ways of improving employee morale. Not the obvious (more money, better benefits, better ratios), but other things your hospital/LTC/etc does (or that you wish it did) to make you happier at work. TIA!

In my "past life" I wrote (on staff, then freelance) about veterinary issues for horse owners as well as human health for the layperson, and did editing work for nursing journals. Now, as an RN, I've occasionally thought about doing freelance work for some of the nursing mags, but to be honest I'm so worn out by the end of the shift -- and tired of writing progress notes -- that the thought of writing one more word exhausts me! There are a lot of opportunities for the nurse/writer, though, not only for the nursing journals (which I don't think pay very well) but also in the mainstream media. One of the best-paying clients I had was a trade magazine that always had a health-related topic in each issue. Good luck in both school and your writing/nursing career!

Reality shock is setting in. Give yourself time to feel more comfortable with what you're doing and see if you can get over this "hump." As a new grad, I was miserable with my job until the 5th or 6th month mark, then I finally started enjoying what I was doing. Meanwhile, I saw a lot of my friends quit jobs and start over in other departments, only to find they were facing the same feeling. I really think it takes half a year, at the very least, to get over that "dread going to work" feeling. Good luck

Forgive if a dumb question, but do the arch supports fit okay into the Crocs? Wasn't sure if they would hold an insert since they're so wide and they're a clog. I have a very high arch, so the lack of support is the only drawback I've found with the Crocs.