KulRN

I have been working as an RN in a 40 bed Med-Surg unit, though it's been 3 years, I still feel like I'm still one of the new ones....recently, I got my evaluation and I was asked by my DON to start orienting to charge (day shift). I didn't accept it right away coz I feel like I'm not deserving yet. I made a deal with my DON that I will give it a try and just be in charge as needed...relief/back-up CN. So she accepted. I have started orienting ( 2 days now), my dilemma is, I don't think I'm that assertive yet when it comes to dealing with issues with family, staff, and other issues besides checking and noting off orders. There are other nurses on the floor that I feel are more deserving, more experience and have more leadership skills than I do. I have a very good working relationship with my co-workers and other departments, I'm afraid that with me having a new role, I might step on other people's toes unintentionally... And I also noticed during the 2 days of my orientation, it's hard to address questions from Doctors, families, other dept about patients since I only know them by paper (report sheet)...I miss interaction with patients....I am coming to realize that really bedside nursing is what I enjoy the most...it's really different.

This always gets me everytime I call transport when a patient has been given discharge instructions and ready to go...." Hi, I'm calling from ___, I have a discharge"....sounds awful huh???:imbar:uhoh21:

One question........I was scheduld to work 4 days in a row (weekend and then x-mas eve and x-mas day)....2 days prior to my weekend shift, I developed gastric symptoms (stomach flu like and sinusitis), come weekend I wasn't feeling well so I called in sick (Sat/Sun). I couldn't get myself out of bed because I wasn't feeling well. Monday I almost called in sick again coz I was still not in great shape, but I had to force myself to come to work ( I made a commitment with my DON that I'm willing to work eve and day)..so I did and thank God my run wasn't bad and I was only given 4 patients. Today I was called off due to low census and overstaffing. My question is do you think I will be in trouble or a warning is waiting for me since I called in sick the weekend before x-mas? I have never miss work unless I am really sick or one of my kids are not feeling well. This year I only called in sick 4 times. I'm just worried.

This is actually what I was thinking of doing..Maybe the first day I'll let her shadow me so that she can see how I start and end my day.... She called me last night and she said she has a guideline on what she needs to get done during this winter break clinical...so that's good! No, I will never leave a student on her own, even when I precept new grad, I still check on them ( not neck to neck though). After all I'm still the primary nurse for these patients and my license is on the line..I hope she'll learn something from me.

Hi, I just want to get an input on anyone who has precepted a nursing student before. I have been asked by one of the RN instructors at my work if I can let an incoming 4th semster RN student follow me on my shift during this winter break ( 5 days ). Of course I said "I'll be happy to" since I have been working with these students during their clinicals ( I have instructed/guided them) but with their clinical instructor around to check them off and explain things to them. I guess my question is, HOW DO I DO IT ALONE? What specifics do I need to take into consideration? What should my and my student's expectations should be? Can someone give me a note sort of like a syllabus to get me through the 5 days I have to work with this student (only one)? I just don't want the student to get confused or overwhelm when we start. Thank you!~

Informed Consent has to be done by the physician who will be performing the procedure/surgery. Authorization for surgery is done after the Informed Consent has been signed or at least after the physician talks to the patient...patient signs the authorization then a licensed nurse has to sign as a witness.I always check the patients chart if an informed consent has been signed by the doctor or at least it's written in the Doctor's progress note that MD has already spoken to pt or family regarding the procedure..if I don't see this then I call the Doctor and remind him/her that an inform consent has to be completed and sign by him/her. Sometimes, I actually ask MD's to talk to the patient on the phone (example if a patient needs a blood transfusion) then I document it on my note that MD and patient spoke on the phone and what has ben agreed.

DOU? DOU is a Direct Observational Unit....the same thing as PCU (some hospital calls ICU step down either PCU or DOU. ) Like where I work, we call it PCU (progressive care unit).Can someone tell me where I can get a reading material about algoryhtms ( the ones that we have in our unit is soooooo confusing, I want something easier to read and understand).Thanks!

I work on a busy Med-Surg floor and we also get floated to Telemetry once in a while. For me I get really nervous when I float because I am not exposed to reading strips or the tele monitor, I only have the basic knowledge but I know how to do cardiac assessment, the only problem is not quite sure what to do if I detect something wrong...But I do ask questions and help from the regular nurses and Charge Nurse on the unit...As a med-surg nurse I have transferred quite a few patients to either PCU or Tele because of my thorough assesment. Given the proper orientation, I am 100% sure that I can become a good PCU/Telemtry Nurse. I'd love to know more about cardiac drips. Just my two cents.....Oh, and one more thing, I really think that if a floater is assigned to a tele or PCU, the charge nurse needs to take into consideration what this floaters are capable of (competencies) and check acuity of the patients assigned to them (us).

Starting in my area is $28.40/hour (no experience and new grad)...With at least 2 years experience, I would say that fair start should be at least $35.00/hour.

I agree with llg.......something is missing....your post and title are conflicting...Maybe she's helping you more since you're the newcomer and she knows that the other ER experienced nurses are much capable of handling things. Give her a chance....But don't get me wrong though, coz I know some Charge Nurses are really lazy and will try their best to relieve themselves from their responsibilties by "passing the bucks".......maybe you should talk to your CN in a nice way of course! Good luck!

and what about those patients who suffer from SICKLE CELL CRISIS???? In the hospital where I work at, we do see a lot of these patients suffering from sickle cell crisis and are frequent flyers. They come in almost lethargic due to unbearable pain, joints swelling, hypoapneic and showing signs of dehydration. I have seen a lot of nurses and even Docs just shrug their shoulders because they think these patients only comes to the hospital "to get their drugs" and even heard a comment saying "these people knows how to work the system in order to get free drugs". I don't exactly know how these patients feels when they're on crisis but I can't imagine the pain they're going through ( just by reading literature about sickle cell). I, personally don't judge these people right away...I look at the whole picture, their symptoms and labs. I know that majority of the point of care of these patients needs to begin from them. They need to be EDUCATED. I don't deny my patients their pain meds when they tell me that they're in pain....of course the only time I "hold off" is I see that they look too sedated and if their blood pressure calls for their meds to be held off. I mean we can see amongst them who's faking or who's sincere. Docs needs to be notified and sometimes educated as well...as we NURSES are the primary care taker of these patients and we spend a whole lot of time with them to know if something needs attention....WE ALL NEED TO THINK OUTSIDE THE BOX and not to judge too quick!

If a patient only has a heplock without any primary IVF running through, I always hang 100 ml of NS at TKO rate with my IVPB's, this way I am assured that I will not clog off the patient's IV access. I also think that it's ok to hang antibiotics/IVPB's without NS as long as you set it up on a pump....at least this way when the antibiotic has finished, the machine will go off letting you know that it's time to flush the line and shut it off.

I've only been in practice for a little over 2 years and believe me I still struggle with time management at times...but I still somehow get out in time...Here's how I do my day (7A-7P shift): 0653 I get my assignment (normally I have 8 patients with an LVN and a Tech), I look at all my patient's labs in the computer ( I religiously do this before I get my report) 0700 I get report from the night shift ( I like to do bedside report so I can see my patients...mini assesment.. and point out anything questionable to the night RN) 0730 I go to the patients bedside chart to check their meds and the ones I have to give ( LVN gives PO meds) and patients vitals signs and previous I/O's 0745-1730 From my mini assesment, I now go do my assesment on the ones I feel needs to be seen first (priority)..FYI: when I perform my assesment I don't do head to toe unless it's called for. I focus on what they're in for...I do my assesment all day long without having to spend a whole lot of time...even when I'm hanging an antibiotic or just handing pen and pencil to my patient...we call it "eyeballing" a patient. I chart as I go..at least the flow sheet... In between I give meds (IV) scheduled at this time, make calls (MD, lab etc) if necessary, checking/following up orders, prepping patients for tests/procedures, patient teaching....2- 15 minute break and 1- 30 minute lunch, reassesing patients, finishing charting. 1730 I total my I/O's, PCA pump..clearing pumps (IV, PCA) 1800 double checking orders/charting, making sure patients questions and concerns were addressed 1830 reviewing my report for the next shift 1850-1920 Giving report to the next shift 1923- clock out

ha-ha-ha-ha...that's a good one....

First of all your friend who made a statement that post-op floor is easy compared to tele, is flat out WRONG! I work on a med-surg floor that cares mostly on patients who just had surgery....These patients will stay in the recovery room for 1-2 hours then they send them to us. The pace is fast, you also need to have good understanding on the type of surgery they had, the complications, and the post op assesment and teaching. Mind you there were times when I've gotten report from the PACU nurse telling me that the patient is stable...as soon as I receive the patient, guess what??? Patient lethargic and respiration shallow at 8-10 bpm ( anesthesia, oversadation....) sometimes we get post-op patients back to back....even when you tell the recovery room to give you time to receive and assess..they will still send these patients if not at the same time, only 5 minutes apart.....NOT SAFE! Sometimes you come on shift having 5 patients but 3 out of those patients are for discharge, which means you will have 3 admissions. I hate comparing specialty because I've also floated to other units in my hospital...NO FLOOR IS EVER EASY! I like med-surg and taking care of post op patients...this way I'm learning a lot and I'm exposed to different procedures...