fab4fan

We have a "shortage" because: 1. Nurses are leaving d/t deteriorating working condtions. 2. There are not enough nursing educators; nursing educators are paid poorly. Build all the schools you want, but if there aren't any teachers... 3. Many hospitals "claim" to have openings, but routinely turn away qualified applicants. It makes the hospital appear to be trying to get staff, without ever really having to follow through. 4. Research has shown that many nurses leave due to abuse from physicians and patients.

And I can counter every one of those stories with stories about nurses being assualted by patients, doctors, etc. Patients these days have a serious problem with "entitlement," and admin. just goes along with it and coddles them. It's more important for admin. to have a "happy" customer, even if it is at the expense of the nursing staff. Admin. tries all sorts of new and inventive ways to chip away at benefits for staff. Just worked an 8h shift and the next shift is short? Look out, you may be mandated! Neither profession is perfect. Job shadowing would be a very good idea.

I really loved my English and Spanish classes (I became pretty fluent in Spanish just from what I learned in high school). I loved writing and studying literature, so I had a lot of encouragement from both my English and Spanish teachers to go the teaching route. My high school Spanish teacher actually let me teach a couple of the freshman classes, just to get a feel for it, and my English teacher used to let me help her with grading papers, lesson planning, etc. I enjoy working with kids, particularly teens, and watching what happens when they're learning. I guess I just have that teaching desire in me; I've done a lot of staff education, precepting in my job as a nurse, and that has helped a little. I guess after 20y of nursing, I'm just tired of it all. Nursing is not kind to the body, and when you get to be my age, it's downright unforgiving at times. I've just gotten to a point that, looking back, I think I would have been better suited to teaching (secondary ed.). And before anyone accuses me of having an idealized vision of teaching, rest assured, I don't. I know how much time good teachers put in after-hours, and the problems students and parents can cause. None of the teachers who encouraged me to go that route whitewashed the profession. As fas as having summers off, most of the teachers I knew had jobs over the summer. Finally, it was because of my one English teacher that I stopped being a slacker; she believed I was capable of more and got through my thick skull somehow. Had it not been for her, who knows what I would have ended up doing. Thanks, "Mrs. M."

If I had the means, I'd go back to school to be a teacher. It was a toss-up when I was in high school; ultimately, I chose nursing. And believe me, tencat, nurses get blamed for boatloads of stuff that is totally out of their control. Teaching doesn't have the corner market on that problem.

It kind of bothers me when people rec. home health as some sort of "easier" option. Home health is very stressful, in a different way. You're out driving around, sometimes in terrible weather. Pts. don't always live in nice, neat homes. I've been in many places that were out and out disgusting. Expect to put a lot of wear and tear on your car, and not get compensated adequately for it. HH agencies are notorious for paying as little for mileage and wear and tear as they can get away with. Your car becomes your office. Trunk space? Prepare to have it filled to the brim with supplies (God love you if you ever get a flat and have to get the spare out!) Pts. come home very sick, and you'd be surprised what you're expected to deal with in a home. And there's not another nurse "just down the hall" to ask for a second opinion...you need to do a lot of problem solving on your own. The paperwork...think it's bad in a hospital? It's a thousand times worse in home care. Plus you usually have to take on call, so you could have put in a difficult 8-10h day, then have to get up at 0200 and go see a pt. No cakewalk, that's for sure.

If you're aware that this is going on at the ECF, you still have a duty to report it. You can always make an anonymous report to the Office of Aging. And you can still tell them what happened at your facility. As you stated, it's happened more than once at your own facility, so the likelihood that it's going on at the ECF is pretty high.

Some of it is just getting familiar with the venous structures, good old A&P. I also palpate the vein as far as I can feel it. Sometimes I will stick just a little below where I first feel the vein, advance a little, and then when I get a flash, then thread it. But I would suggest that you first get comfortable with starting IVs on veins you can see and palpate; then start trying to tackle the ones where you have to go by feel only. If you have an IV team, ask if you can spend the day with an IV nurse. Or see if you can spend the day in day-surgery; they start lots of IVs there. If you can't do that, then ask your NM to have you do any IVs that need to be started, and ask your co-workers to do the same. It's hard to get comfortable with starting them if you only get to do one here and there. It takes practice, practice, practice. And patience, patience, patience.

Notice how she hasn't been back to update, either?

One other thing I forgot...ask the pt. if he's had IVs before, and if so, if one arm was better for "sticking" than the other. And if the pt says, "My left arm is better than the right," BELIEVE him! I can't tell you how many times I've seen nurses ignore this, go ahead and stick someone several times on the "bad' arm, then have to ask someone else to try, and that person gets it on the first stick...on the arm the pt said was best. I don't care if you see pipelines...if the pt says it's a bad arm, better to believe him than stick several times and repent later. I just had this exp. a few weeks ago; I told the nurse my R was better than the L, and that usually L arm IVs blow right away, if she even get one in at all. Of course, she was just sure she saw something on the L, stuck me, and you guessed it...nada. So she wound up looking for another spot on the L arm, and I finally said, "Look, I don't want you to try again on that arm. Use my R arm." Will wonders never cease...that IV was fine. Make sure you select the appropriate gauge IV; don't try to put an 18/20 in a vein that won't support an IV that big. If you need a larger bore IV, then make sure the vein is big enough...don't try to put it in the smaller hand veins. Try having the pt take some slow, deep breaths while you're starting the IV; guided imagery works well for some, too.

I guess he needs more nurses because he's run out of butts to kick.

I'm one of those annoying people who just has a knack for starting IVs; I'm not sure what it is or why it happens, it just does. One thing I have noticed is that new nurses or nurses who have trouble starting IVs don't take their time...they tend to go for the first thing they see. I'll often put on the tourniquet and then take some time to just look, tap around on a few areas, etc. Also, if I don't get an immediate flash, I don't pull the cathlon out right away; sometimes just taking a minute and repositioning is all it takes. But I would say the one thing that has really helped is to just take your time. It doesn't take any longer to look around for a bit than it does to just stick the first thing you see and then have to stick the pt. again...and at least in my case, I often save my pts another IV start.

How are you an SRNA if you're only 20y? In any event, this site is not for giving out medical advice. And if you have an MI or a stroke, that's gonna cost you a whole lot more than a trip to the ED.

NO! NO! NO! Never, under any circumstances leave meds at a patient's bedside. It doesn't matter what the med is. Any nurse who does this is setting herself/himself up for major league trouble.

My understanding was it usually meant "status post incision and drainage," usually done with a wound that may have closed but has underlying infection.

Talk about perpetuating the myth of the nurse as a sainted, angelic figure.