LauraMT

I don't feel dumped on by your comment, I actually appreciate it. That's the problem with the mellow ANM, no constructive criticism. And she also says, "Oh, that's just nurse's way. If you have a good shift summary he doesn't look for you". But shift summaries print 2 hours before end of shift and a LOT happens in that 2 hours. You are right. I was lucky! I don't want to be that kind of nurse! People have made fun of me before as I follow him down the hall trying to force him to listen to my updates, but until today I always ignored them. I wouldn't have done it with any other nurse. If it hadn't been a stable patient I wouldn't have let it go like that, and on our floor a stable patient doesn't mean crap. I can't even count how often I've come back the next night and said, "What happened to Mr Smith?" and find out he went into vtach or something and is now intubated in cicu or worse. Now hopefully this thread gets burried before everyone sees how dumb I was! I know I'll never be perfect but I ought to be able to avoid blatantly stupid mistakes!

I called. The ANM laughed at me and told me to go back to sleep. I'm such a dork. She said, "Nurse was late. Did you have anything to add?" and I said no so she said, "You're fine! Go back to sleep!" I could hear her eyes rolling from here. But I'll be reporting to anyone who will listen to me from now on!!

quick replies! See, that's what I thought. There is a written report on the kardex, but if no one HAS the kardex it's not going to do any good. Poop. OK, I guess I'll call. It was inadvertent, but of course still not ok on my part. At least I know I'll never let this happen again. I make new mistakes, but rarely make the same one twice.

I work the night shift and we have a nurse on days who does not care to take report. Let's call him nurse Anyway last night I had five patients and this morning I reported off on 4 of them. Then came nurse's patient, a person with an EF of 10% going for a new pacer/icd in a few days while waiting for their heart transplant workup. The only reason they are not at home is because our transplant team is the only one who will talk to them and they live 200 miles away. Nurse was not in the report room which is typical for him. If you have something to tell nurse you have to chase his butt down and tell him. You have to find out what rooms he has and have to wait for him to finish with the patient and then he'll come out and say, "I don't have any questions" and walk away and if it's really important you have to run after him and tell it to his back. So this morning I said to myself, "Self, nurse had this patient yesterday and knows him (i've abandoned gender non-specific language. HIPAA-schmipaa. I'm too tired) You've had this patient for 5 days and in that time you have gotten him tylenol for a headache once and gotten him a container of cranberry juice once and given him his spiriva 5x. Your carpool is going to leave you and you will have to ride the bus home and you know some crack-head will want to share your seat." So I left. But (this just registered in my brain) on the way out I saw a pile of kardexes and bridge worksheets on the table with a "nurse" sticky note on them. Maybe nurse was not there yet. Or maybe he knew all his patients and left his notes there. Anyway, did I break the law? The kardexes include the shift assessment as well as a narrative shift summary so if he shows up he'll know what's going on. The ANM in that shift is fabulous to new grads and mellow so I doubt I will get in trouble, but you know how things nag at your mind. I know in the future I'll be tracking his back down and telling it my reports so I don't have to be a worry wart. I guess if he really wasn't there the charge would have to hear report. Sorry to ramble so long (and sorry for the excessive use of parenthesis (it's an affectation)). Laura (parenthesis abuser/patient abandoner)

Oh, forgot to mention. Just call the hospital you're interested in and ask to speak to a nurse recruiter. If they dont take the time to call you back and answer your questions about orientation or any other questions you have they might not be a place you want to be.

I live in Eastern Washington (much different from Western Washington, I don't know where you want to go). We also have www.holy-family.org in this area which is also providence. Spokane also has Deaconess and Valley hospital, but they just got bought by a for profit company so I don't know how you feel about that. They actually pay about $4 less an hour too. Laura

My hospital would be in HUGE trouble if they demanded a BSN! On my shift I think I'm the only one with a BSN right now. Everyone else is an ADN, one person working on her BSN. Anyway, can you move? If you don't have a mortgage and a family you should go on an adventure! Go somewhere where you're appreciated and you like your job. I work telemetry in eastern washington. We have about 5 openings (even though there are better adventures elsewhere)!

I motivated myself by registering for a test date. I graduated on may 6th and took the nclex june 20th. I had a study buddy and here is what we did: First we did the kaplan strategy and saunders comprehensive alone. 1. The Kaplan strategy book--just worked all the way through it 2. The Saunders comprehensive review. We did the quizes first (I think this is pirated from Suzanne's plan that we never actually got around to signing up for so we just read the stickie) and if we did ok on the test we didn't read the chapter. We did read all the rationales though. We looked up things we didn't know the answers to. Then we got together with the saunders q&a and cds from other books and did at least 200 questions today. We would talk over why we were picking each answer and look them up if no one knew the answer and just teach each other. We really only studied for about 3 good weeks. the rest of the time we sort of studied. During that 3 weeks I quit my jobs and put my kid in full time daycare. The night before the nclex we made our husbands take us on dates. We were both in and out in 75 questions and under 30 minutes. Just practice and use those strategies!

A lot of nurses where I work have dog tags (not military tags, actual tags like you would put on your puppy) zip tied to their stethoscopes. I don't because I don't want to be a copycat, but my stethoscope is engraved. Another nurse wanted to get his engraved and said the place he went to refused to do it because it would mess up the sound, but mine seems fine.

I got a patient up from ER with an IV in the artery once. I called IV therapy and they were not concerned. I dc'd it and started one (in a vein), documented and never heard anything else about it.

I just had a week off of my job on the nightshift on a very busy ACU because my husband was out of town and I had no childcare. Tonight was supposed to be my first night back but I called in because my Daughter and I have been sick with a really nasty cold and I felt like I needed one more day. Plus I hate to leave a sick baby. Also, my last scheduled day I scored an LCD and had just had a few days off. So I have weaseled out of work since the 5th. Anyway, I keep thinking--maybe I shouldn't go back. And of course I will, but I still wonder. I've been working since the end of June but I still feel like a big phony. I work on a busy ACU floor. We have lots of post-opens and a healthy sprinkling of mechanical hearts and transplants. I am terrible at reading EKGS--especially 12 leads, make sure I have it right side up if you ever see me trying to read one--and the emergency orders are a mess in my brain. Thank god for the monitor techs. If I'm ever the first one to a code I feel like that person will be as dead as a doornail before I figure out what the heck is going on. I passed the dysryhythmia test and the emergency procedure test, but that was while I was sitting minding my own business in the library. No one's life depended on me. And I'm starting to get MORE scared because almost all the nurses on my shift are pretty new and there is no one to run to for help. If the one nurse with experience is sick we are in trouble. Tomorrow I am supposed to precept someone too. And she's going to know more than me, so THAT should be pretty embarrassing. Well, poor sick baby just passed out (ok, she's 3, but she's my baby), so I'm going to crack open the EKG book so I can feel better. At least I'm TRYING to learn!

I'm not on the CICU but on the stepdown unit and often feel overwhelmed on my easier unit. So I can imagine how overwhelmed you must be! I have an organization sheet similar to WeeBabyRN's. I just made it on word. On the top I have names, room #, diagnoses, activity and diets. I have spots for vitals so I can see changes easily. The rest of the shift is divided into hours and I write the meds due and anything else that I need. There is also a spot for Is and Os and a little spot where I mark off everything I've charted. It feels really good to mark stuff off and it feels even bette to chuck it in the shred bucket at the end of the shift. It took me about 6 months of asking every nurse I saw about their brain sheets" before I came up with the one that worked for me. And if the unit is just too hard for you at this time take a little break on an easier unit and go back. They'll be glad to have you back I bet.

I've been working since June and at my hospital everyone orientates on days then switches to their shift for some more orientation. It was good to orientate on days because you do things on days that you rarely do on nights like discharges and certain procedures. I'm on nights now and I think my stint on days was helpful--and now I know I NEVER want to work days.

I just signed up for weigh watchers on line since I am getting all sorts of Chubby from working all the time, eating junk and not exercising. This morning my friend and I formed a plan and step one was to join WW online since the meetings in our town are made up of this one weird click of stay at home moms (that will never talk to me and my daughter) and octogenarians bussed from the local nursing home. Is this program working for anyone? And if anyone is doing this or any diet, when do you eat the biggish meal of the day? Step 2 is tomorrow. That's joining the local universities fitness center. For $110 a year you get to use the fitness center with the pool and weight room and raquet ball and everything. For an additional $95 a year you can use the circuit training and get an exercise physiology student to train you. I think that is probably cheaper than other gyms. Thanks for any input and is anyone interested in maybe starting a weight loss/healthy living thread?

Amidarone, Cardizem, Digoxin, lots of other antiarrhythmics. Lots of diuretics. We have heparin and insulin drips that get titrated on sliding scales. Tridil drips (nitro) for chest pain. Tons of potassium. Everyone has htn, diabetes and hyerlipidemia. I work nights so I don't give as many meds as a day or evening nurse but I still look up all the meds people are on so If something happens I know if a med they got earlier caused it.

I also hate Ambien. We had a rough patch where it seemed like evening shift was giving it to everyone (it's on our standard acu admit orders). Good for evenings. Bad for nights when they rip out their central line and run naked and bleeding out the fire door. Finally we got it across to (most of) the evening shift nurses that if they give out ambien we will hunt them down and kick their butts. I'll only give 5 mg and I won't give it to anyone who is over 70 unless they are really really with it and take a sleep aid at home. If they're 50-70 they might get one depending on my assessment. Ambien = Evil.

I had to switch preceptors and she really didn't care since she didn't like to precept me anyway. I give her report all the time and she's perfectly pleasant (on our floor we all start orientation on days and then move to other shifts). There is now a nurse on my shift who she precepted who thinks she is awesome and had a great orientation with her. She just wasn't a good fit for me and it didn't seem to bother her at all.

A lot of people who I graduated with in may with didn't take their nclex until August and they all got jobs even though they took their sweet time. If you are done with most of your nursing classes you could probably go ahead and interview with the rest of your class.

I had a CRAPPY night. It just started out on the wrong note and I never really did get my feet under me. Here's what I did to try to make it better, and I would like to hear what other people have done. 1) The charge nurse just happened to ask, "who want's a low census at 0300" and I said, "ooh me! me!" another nurse wanted it too and first we were going to arm wrestle but then decided flipping a coin was more civilized and I won! 2) Ran into a friend in the parking garage who also coincidentally got low census so we went to a diner and ate horrible french fries at 0330 in the morning. 3) Bought a box of hair dye on the way home so now I am a foxy brunette--not the same blonde nurse who got her ass kicked at work the other night. 4) Let my 2 year old help make her favorite breakfast, scrambled eggs--she likes to crack them--and have a leisurely morning instead of her dad rushing her off to daycare before I even get to see her and me crashing while she's gone. We read all our library books and put nail polish on our toes. I have the next 2 days off so I decided not to bother to sleep today. 5) Ditched the kid at daycare (hey. we had a fun morning and she likes it! Really!) and played Rayman on Wii and now I'm rotting my brain with an entire tivo'd season of reruns of Americas Next Top Model. 6) Stole all the chocolate out of Roxanne's trick-or-treat candy--she's 2 and likes the horrible gummy candies and suckers more than chocolate anyway and will never miss them. And when I go back to work on Friday I will be refreshed (hopefully) and ready to take on whatever the patient lottery throws at me. At least I will be if I get some sleep and eat something healthier than fries and chocolate! What are some of your strategies for dealing with rough days/nights? LCDs are a rarity on my floor and I'm not really that good of an arm wrestler and I can't dye my hair and eat candy every time! Laura

Thanks! That makes more sense. I know the dbp isn't 0 but that's how they have us put it in the computer with our charting system.

It's pretty common for our vads to only have sbp (that's the 78). Heart rate was 103). I don't know why this is. Our orientation was more technical than anything else--how to work the actual hardware and very lacking on assessment. As I understand it most of them never have a diastolic. So (78 + 0x2)/3=26--which is not right but is what our computer claimed it was. Our VADs are out of the CICU in 2 weeks and home as soon as their education is complete unless there are complications. It's overwhelming to me! Ive only been a nurse 4 months.

I would have called a code too. We have "Code 3" at our hospital where you just call one department (respiratory, anesthesia, whatever). We have a rapid response team too, but I don't know what they would have done with no history and no idea who the woman was. My nurse manager prefers that you call a full code because in the case of code 3 here is what you hear overhead "Code 3 respiratory" then respiratory decides they need intubation "code 3 anesthesia" then they need labs "code 3 lab" so by this time you could have called a dang full code anyway and not many more people would be there. You can always send away the ones you don't need and if they're going to be snippy about it they can get their butts off the code team.

I had my very first VAD last night. It was a Heartmate II. Anyway, her pressures were by doppler only. It was 78/doppler, which was normal for her. The nurses on my floor all say that THAT is what you use for the MAP for our vads too. I work on the ACU so we don't have the line like they do in the CICU. I know how to estimate MAP and it would be like 26 if you followed that rule, which is definitely not right. But is the way we did it right? We had an 8 hour VAD class and would you beleive they did not address this?? I can change a controller or battery with my eyes shut, but I can't figure out the MAP! The pt was very stable and just sleeping, but I was still incredibly stressed out. The charge asked for LCD volunteers and my hand shot up so I really only had a VAD for 4 hours. Next time will be better, especially if I can get a dang MAP! Our main transplant/VAD surgeon is terrifying so you don't want to screw anything up (of course mostly you want to provide excellent care above all else, but not being screamed at is good too). Once a year he apologizes for the abuse in a blanket statement, but he really should apologize daily. I work again Friday and we'll have 4 VADS on the floor so I'm getting at least one! PLease answer fast!!

I fainted in nursing school watching a PICC insertion. The next week I was in a bloody surgery and had no problems. Talk to some nurses--a large chunk of them will share their "I fainted when..." stories. I've seen picc insertions since then and all sorts of stuff and never felt faint again. You can do it!

I don't know if it's the drugs or the fact that the last couple of nights I won the patient lottery and had super easy patients, but I feel better. And a lot of it is probably because nice strangers listened to me. I think my brain will always be a little bit screwed up but I'm mostly intact. I've done talk therapy on and off and I actually don't get much out of it, probably because I'm not ready to do the work yet. Anyway, thanks for the kind words. I'm glad I found this board and I will keep checking back to see all the good advice you offer each other and maybe sometimes have some of my own to offer (like when you have a GI bleed put coffee grounds under the bed. It doesn't smell good but it smells a heck of a lot better--that's my good advice for the day).