abbysmom

I work the night shift and have been asked to figure out how to make our unit quieter at night. The staff seems resistant to small changes, such as dimming the lights and silencing alarms quickly. Also, many people use their free time as social hour right outside patients' rooms. It can get loud. Any ideas on how a new nurse (a year in) can change perceptions, behavior, and make a quieter place for healing?

RE: how to keep people from talking trash about you. (a few comments back): It seems to me that this is rampant throughout nursing. I hate it, and the only way I can combat it is to not join in. We are all way too hard on each other, and with the hospital administration putting more and more on our shoulders, I think the least we should do as a profession is to stop badmouthing each other and start supporting each other. SO, no hints as to how to stop it. Just ignore it, do the best job you can do, and never talk trash about another nurse. If you have a problem with a person's performance, talk to them--alone. The backbiting is just too much out there.

so funny that i would come across this tonight. i just read a nursing article about physician/nurse relations that started with an anecdote about a nursing professor addressing her new students. she described the nursing cap as one that marked knowledge, professionalism, and subservience to the knowledge and wisdom of doctors... and then she said "that is why we no longer use them". i never thought of them that way, but now i look back and think they could be construed as such. hats/caps/hairnets are a way of pulling back hair, implying less cleanliness, or at least a way to provide more cleanliness. i applaud the lack of caps in use--they are bothersome and symbolic at this point, and possible agents of disease transmission. good riddance.

I searched for "medical emergency airline" and found this string because it just happened to me. I took my family to Mexico to celebrate my first 6 months as a paid RN--it was a long haul through nursing school with 3 kids. So, I'm still a newbie, I work in Gyn/Onc, and emergency medicine scares the hell out of me. On the way from Cancun to Philly, the call comes out. I've been on many flights in my life, and I've never heard the "call". My stomach plummeted. The call was for a doctor. Not medical personnel. Not nurse. So, I said to myself that I would wait to see if someone jumped up. The call went out again (for a doctor), and I was reaching for my call bell (thinking, I hope they are having an ovarian cancer acute condition--which is just snide/sarcastic of me to say) because otherwise i will be useless. which i would have been. I was thinking there is no stethoscope, no BP cuff, no interventions available. What could I do? This thread has helped me to see that there is equipment on board that I could have used to establish at least some basic vitals. And oxygen, and defibs. I would have felt better had I known that before. Thankfully, some people got up and went with the f/a and came back pretty quickly looking calm. I surmised that all was well. (it was--the guy was more embarrassed than ill. He left the plane first with paramedics, at our normal landing time and place, and they cleared him.) Nevertheless it scared me. Now, as a nurse, I feel obligated to answer those calls wherever they arise, and I feel like such a newbie that I could do more harm than good. I don't really care what the laws are--it is more ethics to me--but I question my own ability to competently care for someone, so the urge to duck seemed a better medical decision for the patient than any other at the time. This thread has been immensely helpful for me and I thank all who responded. Now, I will never fly again. (just kidding. looking for another vacation spot already :) )

maybe Night of Care or Night on Call. not sure either. it means i'm up when most people are not, and i've had patients ask (at 5 am) if i've gotten enough sleep that night/ do they think i've been sleeping? my issue is that the day nurses coming on sometimes think the same thing--that my job is so easy that i've had time to nap. please--i have 7-8 post-surgical pts each night, or i get two admissions on top of my five pts at 3 am. it is a hard shift that seems to get less respect than others. i know that i run all night, hardly have a break, much less the time to sit and have 1/2 hour with my colleagues, usually have no clue as to what is happening on the unit as a whole (staff mtgs are during the day) and rarely enjoy a celebration of a unit goal (we are often recognized for excellence, but the celebrations are luncheons or dinners). It is a hard shift physically and mentally. I happen to love it for my family and me, but those are the things I give up--unit camaraderie, a feeling of belonging, accomplishment. as i've told my patient service manager, i feel like i am a stealth nurse. i keep the patients alive for the night (although i really do much more) and then hand them over to the day nurses for everything else. i'd like to see night nurses get more respect and honor for the hard work they do.

Hi--I enjoyed reading through all the posts--the outrage is mine as well about someone claiming to be a nurse who is not. I also hesitate to give any advice. Here is when I go completely off topic...sort of. I have an older friend who last year told me he had just stopped taking his cardiac/HTN meds. I was curious what he was on, and he said that he had just sort of stopped...I was horrified and concerned, and I began to nag. Now this wasn't medical advice, really, just take the prescribed meds b/c you have family hx, htn, blah blah. He didn't listen and ended up in the cath lab with a stent in Aug. Big old blockage, MI. Lucky guy, really. Now, he tells me he is taking lots of aspirin for headaches. (On top of the anticoags for the stent, etc.) I really just want to kill him to end the suspense of when he will die. What to do with people in your lives like this? Where is the pt education if it isn't with us out there in the community?

I'm a 6 mo. new nurse and look to the experienced ones to help with this. I work on a post-surgical gyn/onc floor and feel comfortable now dealing with my pt population. However, we get people from all services who have some coincidental issues. I am a night nurse, and have just come home from taking care of a lady with several yrs of GI issues. She is 42 yrs old, ulcerative colitis, many surgeries to do bowel work. Just now she had a benign ovarian mass removed as well as an ileostomy redirection--she seems to have had a few different stomas in different places depending on the problem at hand. She also has arthritis, occular problems, depression, carpal tunnel, a knee arthroscopy, etc. Every system seems to have some issue. My problem is that I could never get her comfortable--either nausea, pain, both, or a cough that she thought needed a CXR for, or an IV that she thought needed replacing. Her bed needed changing, her ostomy wasn't putting out enough, then it was too much, then her Foley burned. After taking out the foley, she couldn't pee so back it went. I spent more time with her than all of my other 6 pts combined. I really started to doubt her complaints and her motivation, and my judgment of her complaints was compromised. I thought she may have Munchhausen's (sp?) because everything needed a new intervention for her. Now that I am home, and she has stopped ringing her call light, I worry that my judgment was clouded. I'm not used to taking care of pts with such chronic illnesses who have different needs than your typical post-surgical ones. Did I ignore valid concerns? How do others handle such frustrations? I kept the docs aware of her complaints, but they too could find nothing to substantiate or explain them, so I was not alone in being befuddled and irritated by her needs. Help!

this morning at 2 am a woman walked on to our floor in street clothes, asked for some help, and looked like she was going down. i got up to try to catch her but she hit the deck -- though i couldnt see her head and if it hit. then she started seizing. i'm brand new, all i could think was to call loudly for the charge nurse (there were only three nurses on the unit) and find out if she had a pulse and was breathing. she had a good pulse but erratic breathing. the charge nurse came running, took in the situation, and said call a code. i said she's breathing and has a pulse, but i really liked the idea of lots of people coming to help because i had no idea what to do about this very large lady seizing on our hall. instantly 25 people were there, and they took over. she had good vitals, wasn't responsive, but was deemed stable and was moved to her bed (oh, she was a pt who had recently been admitted but went MIA for several hours so i didn't know she was one of ours) --turns out we probably should have called a different team--the "rapid response" call--because she was breathing and had a pulse, and i think the code people were either irritated or disappointed that they weren't crucially needed. perhaps that is a harsh judgement on my part because they were very helpful and not derogatory at all. anyway, i just share this because i've had classes on codes, and my biggest fear has been that i wouldn't know when or when not to call one. i wonder if others have had situations that they weren't sure. it seems so cut and dry in class--when the pt isn't breathing or has no pulse--but on a night shift with 3 nurses and 2 patient care associates, and a whole bunch of crazy stuff happening anyway with our patients, anything else seems a catastrophe at 2 am.

hello--i'm a new nurse--off orientation end of september, working nights. i am on a busy post-surgical/oncology floor with overflow from other services. i usually have 7 patients overnight, and as you night nurses know, someone always spikes a fever, gets a little loopy, cannot sleep because of pain, or needs narcan because they aren't handling the anesthesia well. whatever. people think and say that nights are easy because the pts are just sleeping--which is just not true. anyway, i'm doing well dealing with all the unknowns, giving meds, keeping people comfortable, getting the piles of documentation done, labs drawn, etc. all night--i do not sit down for 12 hours. then i get into report and get a barrage of questions about a patient's long term history, why is the medical plan for this and not that, what is the discharge plan for the patient, etc. i know i should know all of this, and sometimes i do, but sometimes i've just been focused on handling the pts immediate concerns like pain or nausea or fever or respiratory status or urine output for the 12 hours (with six other pts). i don't get this information at report when i come on, so am i supposed to read everyone's entire charts when i come on so i can get their entire history? anyway, then i leave report feeling like a bad nurse. i know i'll get better at knowing my pts' total histories (which usually you can only do by reading a 100 pages of notes in the chart, because no patient wants to tell you their whole story at 11 pm) but my questions are these: 1) does anyone else feel utterly stupid when it is time to give report even though you did a good job taking care of the pt for your shift? 2) if any experienced nurses are reading this, how long before i should expect to get better at this? i'm tired of leaving work feeling defeated and stupid, even though i took care of a lot of patients and got them through the night more comfortable, safer, and handled all complications that arose. 3) when do the bad dreams that i have when i go home and sleep stop? i dream of iv pumps beeping, people going septic, forgetting patients altogether and leaving them in their own xxxx. thanks for any input.