wishingmary

I like nursing students and I like working with them. I have learned to set some ground rules up front so they don't get hurt or hurt their/my patient(s). Secondary to medication administration protocol, the big one is don't help patients get up alone unless the nurse has cleared a patient that day as an assist the nursing student can assist. The second big one is to come to an understanding as to what exactly they are to chart and have them use a scrap paper to write on first before the record or talk to the nurse first before writing in the patient's chart. I/O is incredibly important on a cardiovascular floor; sometimes they don't get charted. I remember how incredibly scared and sometimes brain dead I was when doing clinicals. I will always remember those nurses at which hospitals made my day. I work at the hospital I had the best clinicals with and I hope to see those nursing students again as real nurses so I can get some time off when I need it. As far as getting a BSN. If all you want is to be a floor nurse, then either is OK, an ADN or BSN. However, count yourself lucky if you don't get hurt so you can always be a floor nurse. BSN offers flexibility and job security, besides some upward mobility as a floor nurse or above; i.e. clinical ladder which offers incentive with higher pay.

" I'd really, really like to know more about how you've overcome your AD/HD in nursing. Do you find yourself prone to making mistakes? Or is that just me, not my diagnosis? Because if you can relate then you know I really am trying so hard. And if there's something that I am not doing that I could try, I would be extremely grateful to hear it. Besides it's nice just knowing I'm not the only one." Hey Bulk, If you want a penpal / e-mail pal, e-mail me off board at [email protected]. Try to have some fun on your vacation. :) Mary

Hi BulkyMonster. What you are describing is me on stimulants or when I didn't faithfully take my meds every day, not just the days I worked. Talk to your doctor and look at how you are taking your meds and whether a change in meds is in order. Are you seeing a doctor who specializes in adult ADHD? I have ADHD, I am an RN on a busy telemetry and cardiac stepdown unit, and everyone knows about my having ADHD. The self-fulfilling prophecy spiral of hell is hard to break out of. Thankfully, I have been through it growing up not knowing what was intrinsically wrong with me. Faith, and its' practice helped me beyond compare. Enough said about that here. I found out about the ADHD in nursing school when other students started making comments about the way I studied. I didn't study for a test by simply studing the material but I would bring in all kinds of things we learned previously because I'm not a linear thinker but a mosaic thinker. Still it wasn't until I finally got on Strattera that I had the most important tool possible for me to follow through in a linear fashion. I want you to know I believe you are doing your best to climb a steep climb. Why is it steep? Because it is other people's expectation of you - self fulfilling prophecy. I'll tell you this quickly and then tell you how I did it and continue to do it. What matters is what you think. Be very stingy about the power you give others over you. At first, I had to develop my routine, I learned I could not veer from it even if I felt confident I could. I also ask questions and seek double checks from nurses who are not quick to judge especially when hanging cardiac drips and heparin. I always thank others who remind me of something even though I may not have forgotten it; I just had other priorities first. Say, "Thanks, I never get mad or feel irritated with a good will reminder. Remember, everyone makes mistakes; everyone forgets. Attitude is everything. Yes I have ADHD and I'm OK with it. I love nursing. The compliments I get from my patients and their families give me a real high. I compliment my aide and work at making the environment I work in the environment I want to work in. I say to the float nurse and nurse aide, "Hi, I'm Mary and you are on the nice floor, ask away". I am always late because I care about how I give off my team. If I feel like my lateness is because of my ADHD, then I clock out manually with a time that is fair to my employer. I don't go back in patient rooms; however, unless it is OK with the nurse coming on and I'm still on the clock. When someone has the attitude of "I caught something you did wrong or forgot". Smile and say, thanks, you saved my skin! And do what is right, even if it means calling a doctor and telling him/her what you did if the patient COULD have a problem. Your person is OK if you did something wrong unintentionally. Not even God will judge you. Stand in the light and don't hide behind ADHD!! It is not an excuse for error. It is an excuse to be a real person. You might find your co-workers becoming less guarded too. Take full responsibility for your actions, wrong or right! Take pride in being a hard worker because we must work harder than someone without ADHD. Try to make yourself available to your aide when she needs you. Your job is first but having the willingness to help your aide is career saving to you. All this takes time. What nurses say on my floor is that the scariest nurses are those without questions, who don't build relationships with their co-workers by using them as spring boards if only to seek support in a decision you think is right but not quite sure. This builds trust and cohesion on the floor. I love my job and those I work with. In a crisis, I know I've got what I need and will be there when I am needed.

There is no difference in pay unless you are on the "clinical ladder" which translates into more work (usually paper). You get merit raises on the clinical ladder based on degree, certifications, experience. But if you fail to accomplish a duty then you risk "falling off the ladder" which is costly of course since you lose all merit raises. They are revamping the "clinical ladder" so I am curious how it will change.

First, congratulations on deciding to get a pda. I can't imagine nursing without it. I'm new of course. As far as hardware is concerned, all you really need is memory. There are a lot of bells and whistles these days. I can't really stear you in what is the best; you have to do your research on line and decide what is important to you and how much you can afford. As far as software, it is getting easier to find good software. I recommend the 5-Minute Clinical Consult for frequent diagnosis/disease processes, a good drug book and a good IV drug book made for PDA's not a book on a PDA, a medical dictionary, and a regular dictionary. Stay away from books on tape/books on PDA. They are difficult to navigate and take forever to find what you want. There are a lot of free software that can be helpful like a drug calculations program. I like Skyscape but epocrates is available with some software free of charge I understand. If you are a member of AACN, you can get a member discount on anything you buy from them that are competitive in their prices. Do a search for medical software on PDA, and you will find lots of sites to choose from. Hope that helps.

In addition to what has been mentioned before, I recommend using your search engine on your computer for ACLS. There are some awesome sites that have quizzes and explanations too.

I think I'd be a good patient; try to assemble my requests at one time so as not to be on the call light much. If I had to go to the bathroom, I'm afraid I'd be bad because I do have a weak bladder - kids late in life. Would probably ask for a bedside cammode for safety issues. If I am in pain, I've decided I don't care what others think. Pain slows healing. I am a patient advocate when it comes to pain; especially those with chronic pain before their surgery since they are the ones in most need of advocasy. I just deleted a whole paragraph about pain control and nursing - off topic. I would want to know what meds I was taking and why. The rest of my questions would go to the doctor if he sees me; otherwise the nurses. If I am out of my head; well, I'm out of my head.

I am an ADN acute cardiac nurse. Out of school for 1 year. Live in Oklahoma. Yes I think we should wear a uniform; namely any scrub top alone or with a lab coat if we wish and other hospital employees should wear solid colored scrubs; ie. aides wear blue, housekeeping brown, orderlies green, labor and delivery purple - security issue. The problem is when patients and floaters can't tell who is who. Our hospital decided to go by a color code because you can't tell who is who but nurses are forced to wear white or maroon and no one gets to wear prints. Personally, I have always worn white pants but I like the prints that I have to give up.

Check out the CDC website. I recommend anyone in health care get it. Since I've become a nurse, I see so many people with Hep B/C. It is prevalent and I'll be first in line when Hep C vaccine can be found and offered. P. S. Got distracted during insulin administration a couple weeks ago, stuck myself right after giving it to a patient. She is low risk, but I milked that finger for all it was worth and washed it well in antibacterial soap. Results came back, I'm clean of hepatitis and Aids. I still have to be tested in 6 months. I am immune to Hep B thank God! The patient didn't have it or Hep C but certainly could have. Another little tid bit and I know it will get me in trouble here but tattoos are a big red flag. In my state it is illegal to run a tattoo shop so that may be why when I see a tattoo on a patient, I find EVERYTIME they have at least Hep C. This is just my experience.

20 years ago I was told by a career counselor I should go into research. Well I figured it was out of reach and required "brains". I'm just a very curious person who likes to play detective. I went back to school as an experiment, did well in nursing school, got my RN and am taking statistics now in preparation for the BSN program I'm starting next fall. I have never been so excited by any class outside of my honors physiology class as I am with this one. There is only one other stat class I can take- honors statistical analysis - sounds impressive, I'll see. Other than that one, the only other opportunity will be grad school. My question is how can I get into a position where I can still be at the bedside (I like to teach) and get more experience in the world of statistics/research. Heck I did something crazy, I bought SPSS base 13.0, and advanced module professional version at the student rate so I can figure out how to work it. But now the version is so new, the books about SPSS that I have found are outdated. Second question, can anyone steer me in the right direction regarding SPSS in the way of text? This thread is more of a teaser for references and ideas. I realize there is a lot of work a person can do with stat, that is why I've gotten bit with the bug; tell me what you do with stat that is very exciting to you.

At the hospital I work, they tried to make us go all white and one floor actually did but because of the nursing shortage and the outcry against all white, the other floors put it on a shelf. The hospital says that research proves that patients and the public like to see the all white for nurses because everyone wears the print scrub top; patients can't tell who is who anymore. I found this to be true as an aide floating to another floor. I had to ask staff members if they were an aide or not so I could get some help. Now that I'm a nurse, I voluntarily wear white pants with a solid shirt and a button-down print short-sleeved scrub top that I wear like a jacket. One look at the pants and the little RN pin that holds my name badge, no one has to ask who I am. I think the jacket look over the white pants looks very professional. I hope they go to that than the all white.

Thanks to everyone for their support. I thought that patient care ended when you sign out on the time clock and gave report. I know now that if giving report is the sign off, then I won't accept the verbal report until my before-the-shift paperwork is done or 0650 so I don't get caught with prns. The idea of dumping on people is hard to swallow. What I mean is stopping patient care once I give report when I know I haven't been able to pass my 1800's, leaving an IV bag that is about to empty, onclogging an NG tube that just quit, or dressing a wound that is currently draining even though I may have already done it once before. This isn't a common occurrence but I don't want nurses following me feeling like my inexperience is going to make their job harder. I guess the problem is just letting go even though I know things need to be done. Changes I have made is I try to tape report at 1700, just before passing meds and then giving the on-coming nurse a quick catch up verbal. I do most of my charting between 1400 and 1600 or at least half of it. I was told that I have to chart on both shifts not just day shift. Other nurses said I don't. Usually when I clock out on time but don't it is for paperwork but not always. Thanks for reminding me about the legal issues of giving direct patient care off the clock. I also write on my "brain" the odd med times I need to pass meds. Off the subject, I feel good about a decision I made regarding a patient I had Monday. He became tachy up to 144 bpm. The patient was only tired and didn't know his heart was running fast. He had just gone for a 4-day post CABG walk. He said he could feel a gentle squeeze over his sternal area for a few minutes. Got him back to bed. Pulse Ox 94%. BP nml. He was very calm and just watched TV with his wife. I put 2L O2 NC on him. I was reminded we have standing orders for Verapamil for sustained tachycardia but I was afraid to give it because only two days previously we had problems with him being bradycardic (40's & 50's). QRS complexes were narrow and he was in sinus rhythm. Called the surgeon. He didn't return my call because he was in surgery and I didn't press the issue since he was OK except for the tachycardia. No more walking. After ranging in 130's to 140 for a few hours. I called again and reached him in surgery. I told him my fear of giving him Verapamil so he gave orders for loading dose of digoxin. Again patient in no distress. It wasn't slowing things down. Another doctor came to see him and ordered 60mg Cardizem IV. I got the order changed to 15mg IV for same reason. Continued to give the po digoxin q 6 hours and I heard it finally slowed it down the next day. This slowed my whole day down and why I was so late getting out Monday. His surgeon did see him when I was still his nurse at the end of the day and told me to just leave him alone. He wasn't in distress. That made me feel good that I did the right thing for him. :) Still, his tachycardia took up 9 hours of my day and why I was so late getting my patient care and charting done - 2100 .

Because this is a long post, my real question is at the bottom. I am 6 months post NCLEX/RN so I've been on the cardiac step-down floor for that length of time but I just can't get everything done before the end of my shift due to paperwork. Granted it seams most RN's leave on time or 30 minutes later; I don't go home until 1-2 hours after I give report. I have many times contemplated what it is that I'm doing besides running non-stop from the moment I hit the floor and wolfing down lunch in 10 minutes if I eat at all during my 12-hr shifts. I have an aide and thank God my manager limits me to 5 patients. This is suppose to be sweet. I feel guilty because other nurses have to take 6 - 7 patients. I get to work at 0600 so I can get my before-shift paperwork done before night shift leaves at 0630 - I come in 30 minutes early because night shift that is suppose to be there until 0700 don't so I end up losing time with prn's. This is a gripe I have and not why I'm writing. To get to the point... I can't say "No" to my patients. I find I'm doing work that should be delegated because it takes too much time to explain why I'm too busy, go find the aide, and hope they meet my patients' needs. It takes less time to just do it. At least I'm not routinely walking my patients like I was at first. Second big time engulfer is I teach. I do a lot of teaching to my patients and families. It seems that CABG patients don't get pre-hospital teaching as most are emergency or done in short order. In fact the post-surgical patients I see (NEURO & Cardiac mostly) have had little teaching. This in a way makes sense if they had their surgery on Thursday or Friday as I work Sat-Monday and it isn't until M-W-F that there is formal education presented in the floor classroom. I also believe that patients act like they haven't received any teaching just so they can hear different nurses explanations of things - the detective thing. Third big time engulfer is calling doctors. They want you at the phone when they call you back so I try to use this time to chart. Problem is time is a fragmented thing. I chart a lot too. My manager says there is no doubt what happens on my shift with my patients. A typical entry for the day is 1/4 page. When I sit to chart I like to write not only what is happening but what I'm doing about it, some things are just drawn out a bit because I'm doing things in all rooms. My goal is to work in critical care but I have to prove myself on the floor before they will hire me since I'm a new grad even though I worked there as an aide. New grads haven't worked out in the ICU with few exceptions from years ago. I need to prove myself on the floor so how about just clocking out on time and then finishing my paperwork?

I work on a cardiac/neuro step-down unit. I'm in orientation as an RN. Just graduated in December 2003. I'm seeing 5-7 but 5 is the target. From what I'm hearing the places offering the big sign-on bonuses are not good places to work. I don't know about West Brighton, but your caution is prudent. As far as Tulsa is concerned, we have metropolitan amenities. The arts, 3 Universities, many technical educational opportunities, 2 medical colleges, award winning museums, an aquarium, zoo, an international airport, many health care venus, parks, award winning floodwater containment system that bring in people from all over the world (I feel sorry for those downstream in Bixby though), a civic center, pavilion, TV break-in weather information right down to the city block if need be (tornados). Good Lord, we have a lot to offer. We are a mid-sized city, lower than average crime rate outside north Tulsa and strangers smile at each other in passing. You don't find that in NY or Chicago or Los Angeles or anywhere outside the midwest. If you have your own plane or want to fly one once you have your license you can go over to Riverfield Airport in West Tulsa. Oh, I can't forget all the shopping MALLS and of course specialty shops & services. If your kids like horsebackriding, ice or roller skating, hockey, soccer, gymnastics (Tulsa World of Gymnastics is the best), school sports, world class golf, and tennis... we got it all. You don't have to drive far to get to anywhere, maybe 20 to 30 minutes in rush hour from one end to the other. Cost of living is a lot less than many other places in the US. Yes, we have quite a few large homes and older smaller homes. Tulsa Public Schools aren't as well funded as the private schools. My kids go to a Catholic school; homework every night; parents are expected to volunteer and be involved in their children's education. I keep up the H&P's and Immunization files for the school and help transport my children's classmates on fieldtrips. Life can get hectic. Mary

If you have a computer, I'd recommend the CD BASIC DYSRHYTHMIAS INTERACTIVE! by MosbyJems ISBN 0-323-01478-X http://www.elsevierhealth.com This is an awesome CD. You pick your own skill level. Even teaches about axis deviations, old MI, non-Qwave MIs in a down to earth fashion. It's even fun. If you want a CD that you can match on one screen one rhythm to another like the blocks, junctionals etc, I recommend LEARNING ARRHYTHMIA RECOGNITION (The Arrhythmia Teaching System) Catalog number: 717-9010 Cardionics, Inc. 910 Bay Star Blvd Webster, TX 77598 USA 1-800-364-5901 or email: [email protected] http://www.cardionics.com (This CD is pricey and not as exciting as the BASIC DYSRHYTHMIAS CD but is more simplified). Both go into the basics and have quizes. For books, I like ECGs MADE EASY by Barbara Aehlert and published by Mosby. ISBN #999762788-1. She also authored ACLS Quick Review Study Guide. ISBN 0-323-00892-5 If you want practice reading strips, I recommend ECG WORKOUT Exercises in Arrhythmia Interpretation by Jane Huff, RN, CCRN and published by Lippincott. ISBN # 0-7817-3192-5 Hope this helps. By the way, where is your home town? Mary