vashtee

I should add that the patient was experiencing heart pauses throughout the day, 2-3 seconds long.

I am wondering if anyone can offer guidance about how to choose which PRN blood pressure medication to give when there have been multiple types ordered. For example, when might you choose a calcium channel blocker over a beta blocker? Patient (in the 80s) has had a hemorrhagic stroke and now comatose and DNR, SBP in the 160s, A-Fib/A-flutter with a HR to 110, RR irregular (20-40 throughout the day). A hospice eval was already done, but I still felt bad when the patient passed, and wonder if I chose the wrong medication to treat her HTN with. Thanks in advance for your advice.

I hope your patients are low acuity! 6 neuro patients can be a lot if they are all stroke patients!

I hadn't worked (for money) in many years when I applied for my current position, so I listed all my volunteer work on my resume so they wouldn't think I did nothing during all that time. It seems to have worked for me...

I couldn't possibly care less if someone calls in sick. We have patient ratios, and my workload is the same, regardless of who else shows up.

I hate those surveys, too. Our nurse manager insists on having meetings to go over them as a group (this after 12.5 hour days), and they really only ever cover the complaints. It's so demoralizing. Also, based on these stupid surveys, they are actually giving us a SCRIPT about how to speak to patients (thanks to one or two surly nurses), and they intend to shadow us on rounds to see how well we do. It's so insulting. I wish management would just grow some testicles and speak directly to the one or two nurses with attitude issues.

I work in a community hospital, and we definitely treat tons of these. In fact, I work on a floor that takes all the stroke patients. We get lots of "ordinary" diagnoses where I work. The thing we DON'T get are *unusual* chronic diagnoses or pediatrics. When we get these kinds of patients, we stabilize them, and transfer them out. We also transfer out when insurance (or lack thereof) require it, but only after the patients are stable.

I made up a day planning grid when I was in nursing school, and I still use it every day. There is a column for each patient, and each hour of the day is listed in rows. Before I start working, I just list all the tasks I need to do throughout the shift for each patient in their column, and then cross them off as they are done (or add things in as needed). I write abnormal labs and procedures at the bottom, as well as anything else I might want to mention to the doctor. It's VERY effective, and very helpful in getting yourself organized, and I share it with all the students who pass my way. I tried to attach a copy of it, but it didn't work, but it's sort of like this (imagine there being multiple columns): _______pt #1____________ pt#2_____________ _______Room 100A________Room 101B________ dx_____GI bleed___________ PNA_____________ 8-9_____________________ IV abx/turn pt_____ 9-10__med_______________med______________ 10-11____________________turn pt___________ 11-12_ blood sugars_________RT tx_____________ 12-13_IV abx______________IV abx/turn pt______ 13-14_____________________________________ 14-15_med________________turn pt___________ 15-16_____________________________________ 16-17_____________________IV abx/turn pt____ 17-18__blood sugar__________coumadin________ 18-19___IV abx_____________turn pt__________ IVF ____HL________________D5NS @100_______ tele____SR________________A-fib_____________ diet____CCU/CCD___________low Na+__________ .......... wound care [_].............. high fall risk ........... PT [_] OT [_]...............soc svc consult [_] .......... 2D echo [_]..................CXR [_] .......... WBC ^ 16.1................ INR 3.1 ......... Hgb 8.8.......................crush meds ......... constipated..................stage 1 coccyx

edited - just in case it could be construed as a privacy violation. Too bad, too. It's a great story.

I think if this happens again, you should simply hand a pair of gloves to the phlebotomist and say, "trust me: you should wear these".

Leslie - Thanks for clarifying! Also, I wanna work with wooh! :)

I just wanted to thank you for noticing the difference between days and nights. I agree that day shifts (at least on MY floor) are crazy, but I could never stay awake all night. To each their own...

I hated nursing school, but really admired how smart my fellow classmates were (after the 2nd semester, anyway). I was very happy to graduate. The best thing about being a nurse is that you are never bored, though honestly, I think it would be very hard for a young person to understand exactly HOW boring a job can be unless they have worked one. I also happen to love and respect the people I work on the floor with... And of course, though I like most of my patients, every now and then, you get someone special...

Lack of moralities? I don't know what kind of people you work with, but none of the nurses or CNAs I work with are "immoral". They are just really busy.

I truly wish there was some way to diplomatically tell family members they should be participating in their loved one's care if they want them to be shaved or have their hair fixed if they are a patient anywhere besides ICU, and that I have as many as seven other patients who believe they are more deserving of my attention than your parent. Of course, the hospital would fire me if I gave the impression that we are understaffed. :/ I don't mean this to be sarcastic... I wish this with genuine concern for my patients. My own child was a brain surgery patient, and there is no way I would rely on overburdened hospital staff to take care of her basic needs... because I have no idea what her nurse's other patients needed. Caring for the sick should be a collaborative effort between staff and family members.

HAH! We document about our patient's cardiac activity every four hours, but we have to do hourly rounding. Looks like Wisegeek (website) isn't so wise.

I work on a DOU floor that also takes *all* CVA patients. There is a very high patient turnover rate, and the majority of our patients are total care, or close to it. People hate floating to our floor because of the pace. I would LOVE to take 2 patients (even total care) and not have any CNA at all. Then yes, I might have time to brush their hair, but for now, I am more worried that my patients are eating, because we have a LOT of feeders (and CVA patients take a LONG time to eat because of impaired swallow and high aspiration risk), and turned q2 so they don't get bedsores, and not sitting in their own excrement or urine. Is grooming important? Yes, but not as important as other things, and you will see that at times, you too, will have to learn to prioritize. Most nurses *I* know want to provide high quality care, but are limited by high patient loads and poor staffing. You'll see.

Oh, lord. Come back after you get a job on an understaffed floor where 85% of your patients are total care, and tell us all about how we should manage our time better. Until then, you *honestly* don't know what you don't know.

We have Definitive Observation Unit/DOU separate from the telemetry floor, although all DOU patients are also on telemetry. DOU patients are higher acuity than the tele patients, so the nurse:patient ratio is different.

I - for one - would LOVE someone to come in and teach me how to get better at time management. Maybe then, I would have time for at least one of the 15 minute breaks I am legally entitled to, or maybe I could have a lunch break before 2:30 or 3:00. I honestly feel I do a heroic amount of work during a day in the hospital, and I don't think many people could do more. We are ALL limited by time, the quality and quantity of our CNAs, and the number of total care patients we are assigned.

I generally hope for the best on days when I have a team of 6-8 total care patients on a floor with 2 CNAs for 18 patients. Yes, the CNAs know they are supposed to do it, and I do it myself when I can, but seriously: since I KNOW what it's like to work in a hospital, I wouldn't leave it up to the nursing staff to handle if my family member were the patient. I know there just aren't enough people around to give the kind of care I would want them to have.

I had a patient "fire" me before. I felt awful until the doctor asked me how I did it so he could be fired, too. Sometimes people are just irrational jerks.

The phrase I get sick of hearing on this site is "lateral violence".

Our consent forms say something to the effect that "Dr. So-and-so has explained the risks, benefits, and alternatives", so as far as I can tell, I am only witnessing the patient's signing. One thing I won't do is have the patient sign consent forms for anesthesiology, because I have never in my life seen an anesthesiologist come to my floor - Never - so I know very well that it hasn't been discussed.

The hospital I work in says they will be starting bedside report soon, and I am also dreading it. Our floor is chronically short on CNAs, and most of my patients need stuff done the second I walk in the room (bathroom, water, turning, changing). Are we supposed to ignore the 90 year olds who have to go to the bathroom (and take forever to do it) when we are standing right there? Also, we have shared rooms... no privacy. Honestly, I will probably end up doing most of my report in the hallway, and then just introduce the next shift's nurse to the patient at bedside.