kellyskitties

the rheumatism - rheumatoid arthritis reflex - acid reflux I've heard prostrate so many times I'm pretty sure I say it wrong half the time. Or I take "dilaudinum" - so is that dilaudid or laudinum? or demerdol... although those are not diagnosis they are kinda hard to interpret sometimes!

The nursing class that graduated before mine had a social security age great grandmother (I'm not sure of her age but they said she was probably the oldest nurse that had graduated ever). She said she did it as a goal. She was a great lady. Now, I too was a nontraditional nursing student. I thought it was a good thing. I don't think we lost as many older students as younger students. We seemed more serious overall, more there to learn and less there for socializing. I took learning a lot more seriously than I did when I was younger. I enjoyed going to class, and actually learning - not just showing up and memorizing. That was a significant difference for me. I actually enjoyed the process for the first time. When I was younger I didn't know what I wanted to be. I amassed a lot of college hours and dropped out sans degree. Then I had an AHA moment and went back for nursing - it was one of the best decisions I made. Advice to an older student: Set aside times just for u to work on homework - and set up those rules with only exceptions allowed if u are bleeding or can't breath. Then set aside times for just your family with only exceptions for u if u are bleeding or can't breath. Then streamline and relax everything else. Eggs for supper - fine. Cake for breakfast for the kids- OK if it's your test day. 4 year olds outfit doesn't match - cute, he picked his own clothes today. Dishes in the sink will be there tomorrow. Paperplates, papertowels, plasticware - the environment will survive if u use them short term. clothing can always be freshened in the dryer. It's ok to eat in the car, study in the car, carpool for study groups, etc. Now things u shouldn't do. Lose your sense of humor. When u can't do anything else - laugh. Lose your friends - keep in touch when u have a spare minute - use the cell, email or facebook to keep them up on your life. Lose too much sleep - don't study all at once - study some every day at your sacred study time in your sacred study spot. Lose yourself - set up a little me time too.

OK, first off, all you folks with extra unemployed nurses send 'em to southeast Missouri. We sure need them. Now, as for factory workers. Let's not turn folks away from nursing because of where they come from. I've oriented some previous factory workers at work as new LPN's. One tried my patience like u wouldn't believe because she was so insecure about every little thing. But I didn't eat my young. I kept trying. She's one of the best psych nurses now. Her down to earth personality has really paid off in psych. My BFF's DH just finished LPN school. He's an ex military ex factory worker - now think about that. He's obese, he's loud, and he's proud. Oh yes, he is. And he just found his calling in a nursing home. The residents can HEAR him - yep, and his military organization has paid off with so many residents to keep up with. His factory days created a nurse who doesn't show up late or ***** about hard work. Hmmmm, I think there's a place for lots of kinds of nurses, they just have to find it. There's lots of areas in nursing outside the hospital. Nursing homes, home health, dr's offices, health depts, schools, prisons, factories (yep, get out of the factory and go back as a nurse). I understand that nurses should look professional, and act professional, but that's like beauty - in the eye of the beholder. Give them a chance, and set a good example. They will learn and learn to be professional if they really want it.

First of all, congrats on becoming a nurse and enjoying your med/surg job. I love M/S myself. Second, a masters degree does not mean NP. You can get many different masters degrees. Third, take time to get your job completely down - go through many difficult patients (whether medically or personally difficult) and grow through this. Then see what interests you the most. I thought when I graduated I would be a wound nurse - no matter what - that was all I wanted. Then I learned how much I loved M/S, and how much I loved working with the new grads. Now I'm one of the ones they know as their go to nurse for help, even when they leave our facility they remember me and have told me later how I helped them (warm fuzzies anyone?). Now I am looking towards diabetic education - considering how I found I had an aptitude for it and a background for it. Don't feel you need to decide now - there's a lot more in nursing than expected - things will come along to draw your interest - then follow them.

Our hospital also began AIDET and hourly rounding. As many things go, it fell away and was lost by the nurses eventually - sacrificed necessarily by our desires to actually take care of the patient medically (with our usual pt load of 8). Then they decided to have the CNA's do the rounding. The CNA's resisted, some do it, some don't. I have patients who made fun of AIDET - those frequent flyers who not only know me by name, but name my pets, tell me which floor has the best coffee and fix their own telemetry stickers. Other patients appreciate some of it being done. I limit it to what fits them - not the entire customer service rote memorization speech. Do I want to seem real or seem like your waiter reciting the soup of the day and my dish recommendations? The worst thing I think we came up with is a call light log. Every time you answer the call light we are supposed to write it down in a log - who, what, when, where. WHAT? I can't just go fix the beeping pump, now I need to note it first? The CNA's even resist this one. I said we just need a note pad by the light - so if you can't run fix it right this sec - make a note for the nurse they belong to and leave it posted in the open or hand it to them as you pass them.

I agree, even the 1 hour before and after is a rat race with as many patients as a nursing home med nurse has to medicate. I work med/surg and they just determined we have had too long to pass our meds (TOO LONG!). CMS apparently has a 30 before and after standard and we have lost an hour of our med pass time. That doesn't sound undoable - except we all know how short staffed med/surg is, and I understand from nurses from other areas we have some very demanding patients in our area. So you always start out behind, try to catch up and can't. I suggested moving the BID's to 10 and 10 instead of 9 and 9 and was told that it was JAHCO (sp?) But I know other hospitals I have heard mentioned at a conference did make that change. I don't know who they were or I would call and ask them myself. Anybody know anything about this that could help me at our hospital?

I have a confession to make. I am an RN. I care for patients on telemetry. I am terrible at cardiac and telemetry. HOWEVER, when the phone rings and they tell me about a rhythm change and I do not know what they are talking about - I just say, "OK, what does that mean." I'm not afraid to look stupid. I just ask. Heck, everyday there's some new surprise on the job when one of us says "What's that mean." Isn't that how it works? I certainly wouldn't ignore it. I can say if one of our nurses did ignore it and it was bad enough an ICU nurse (our telemetries are montiored in ICU) would be standing on our floor or at the patient's bedside shortly. I have seen them try to call us, get no answer and out of concern come to the bedside - to find us at the bedside where utilizing our med-surg skills we had already realized there was a problem. At which time we welcome the extra brain to the problem solving. Don't be too insulting. I orient new nurses. On occassion I find one who knows a lot. One who knows more than I do about something. I don't get insulted. However, if the new nurse thinks they know more than I do about everything they will quickly hang themselves. There's a lot of variety in my med-surg world and you're going to need this RN eventually. Of course, I'll be sure the patient is cared for, but I won't necessarily care about your ego in the process. Be careful. We can't all know it all and neither do you. I do agree the nurses shouldn't ignore the calls, but that is for managemant to deal with. You can't fix them, just report it up the chain of command. If your concience isn't satisfied, find another job.

OK, first I got to get this off my chest. Most of the fields of nursing you listed are bedside nurses. Unless you are in community health, home health, legal nurse consultant, doctor's office etc you ARE a bedside nurse. I believe in med surg and I don't think we are "stereotypical." Now, that being said, on my med surg floor when things are bad nurses float. We get psych nurses, OB nurses, ICU nurses etc. They come to us to help out and we go to their departments to help them out. We usually baby them when they come our way so they will want to come back. But they need a little knowledge about the other floors even if it's just to recognize what's going on around them so they can be more helpful. Second, on med-surg I have had overflow from every other floor. I have taken care of a miscarrying OB patient that was passing a fetal demise. I have had psych patients on suicide watch that are waiting on a bed in psych. I have had a patient waiting to transfer to ICU who we started ICU meds on to save their life even though they were not in ICU. Diabetics may also be pregnant or schizophrenic. Pregnant women may have gall bladder disease or could fracture their leg. No floor is exclusive. We see it all everywhere eventually. Thirdly, I have come to believe the broad spectrum of education given to nursing students gets them into uncomfortable zones and makes them reason. Even if you never again have to locate a fundus (and I can say I have had to since we have had a fetal demise patient a few times to care for) you had to learn the process. Get out of your comfort zone. Stick to it. It's worth it. In the end you'll see you needed more knowledge. Unless you manage to land a private duty job with a kid with one oddly uncomplicated disease and that job holds you until retirement - the broader spectrum will serve you best.

Maybe offer the option of elastic waist with drawstring front (little lower on the waist) or just elastic waist (sitting higher on the more traditional woman) - both with mega pockets and same trendy trims so a person can pick what works for them and still get something fashionable. More stuff for guys. I hear them grouch a lot about not getting many choices without looking - um, er, well, since it was said by a gay man I will just say it "too gay." Not PC, but came from the "horse's mouth." I hear them complain about the lack of cool scrubs - just tan, navy, black... Also, pockets everywhere. As somebody else mentioned - vneck that won't pull down from the ID tag being clipped onto it. I don't wear a lanyard - always falling into stuff, and on med-surg that's saying something extra gross. Tops that are a little less square. I'm a plus sized girl - but I don't necessarily want to look like a box. Also, make the cute stuff in a big size range so we can all be cute. Plus sized doesn't mean I want to dress like an old loving granny nurse (in cutesy gingham patch with teddy bear tops). Fat doesn't mean old or cutesy. Somebody mentioned ink resistant - AMEN. I clean ink off scrubs every week. Pocket organizers aren't practical - can't get in and out of them fast enough. I carry a lot of stuff in my pockets. I have said "I have a supply closet in my pants." With long halls and never knowing what I need I just load up before going to see patients. I get made fun of by new nurses for carrying so much stuff but then they'll say "Hey, you got a flush." and BAM I give 'em one. Or tubing. Or IV caps. Or IV drop hooks. I think stain and wrinkle resistent is a must. I don't iron. period. Hate it. Lousy at it. No time for it. Stains - just a fact of life at my job. Mystery stains are worse. If I know it's poop or vomit I can accept it and go on but if I don't know - it's grosser! Matching jackets. My floor is alternately a sauna or a new polar cap. Little cell phone pocket? That would be handy. I like the trendy solid colors with neat trims because they still look professional, not like nursery wall paper, and modern. Good luck, it's a great idea. Hey, while you're at it, make me look 20 lbs thinner and 10 years younger!!! and smarter too!! teeth whiter?? haha.

You are correct, you can't always turn around the patients and make them better. But sometimes you can. I distinctly recall moments I have really made a connection or caught an illness going terribly wrong and saved a life. I also enjoy interacting with all the personalities I run into, even the negative ones. I feel good if I handle a negative person with a good outcome. They don't have to turn into a positive person, but I am often told how much they appreciate my kindness or time I gave them. Yep, if you get your act together, sometimes you can find that time even on med surg. Right now I have a lot of new nurses - some nights it's just me and 3 new grads on my floor. WOW. What a chance to influence their attitudes! Thank you all for the suggestions and keep them coming.

I thought 3 12's sounded great when I started. Then I found out it's not 4 days off. Oh no. I work nights. 7p-7a. It was 3 days, then one day totally exhausted that I just slept away - plus slept that night away. Then the remaining 3 days off. Well, I could deal with that. Turns out now it's 4 nights, one day lost to sleep then 2 days off. Heck, that's just a weekend - 2 days. No different than working 5 8 hr days. Plus, the workdays - I can't do anything those days but get my butt home, get ready to go back and go to sleep. No time for anyone or anything else. I kind of wish for 8 hr shifts now. 12 hr days might feel better - since at least you're not converting nights to days all the time.

Our hospital sets a max goal of 8 pts per nurse. Due to short staffing this winter there was one night I had 13 - just one night and our manager did stay almost the entire night to help us get through that. It wasn't as bad as it sounds like. At times we have 10 and at others we may have 3 or 4 - during the summer and currently we are running at about 6 per nurse. I've learned the trick to the heavier loads is to work smarter not harder. I make a note on my assessment lap at the beginning of my night next to each pt what they ask for - then a take those things as I pass my meds or I delegate a few items to a CNA if possible. A lot of times the pt is just glad you didn't forget the blanket or snack they asked for. A lot of the time everything doesn't have to be right now. That's helped me be more efficient. I also try to make a list of what I need to do that night and what time I expect to do it. Helps me organize and plan my night a little. Even when I get off plan - I have a clear list. That helps when I know I need to follow up on pain for a pt at say 0200, but I also know from this list they asked for blanket and they are due an Iv antibiotic at 0300 - well, one trip at 0230 will suffice for all three and save some running. I just thought maybe I could help a few folks frustrated with med surg with my tips for how I'm doing it. Keep the input coming. I enjoy the responses and read every one of them.

To clarify my "walking in you" - obese with acute generalized edema. She was both. Weeping all over - arms, legs, face, abdomen - everywhere. And since my last post I nearly had a urinal poured over my head by a mentally ill patient that was mad at me. That could have been a top 10 except I was quicker than he was.

Many times I have a pt in pain that requires more than one pain med. I usually give PO meds 45 mins to 1 hour (if pt not appearing to be a true 10/10 pain pt - otherwise start with dilauded). Then assess pain - and give dilauded if pt pain goal not met. Then another 20 mins roughly and reassess - not meeting pain goal - call dr. We have a frequent flier that is a drug addict - but has a real need for pain meds when he is at hospital - has a chronic condition that obviously requires pain meds - takes enough to get him pain managed to put me on a ventilator.

Walked into extremely obese (like u see on tv folks) pts room and realized I was standing in something that went "splat splat splat" when I walked. Looked down - lots of clear liquid? Water? Oh no, she was seeping all over - it had ran off bed into floor. Splat splat - oops - sorry, was I standing in you? And the runner up - necrotizing fasciatis wound about 12 inches across open with loose skin I could have put my hold hand under - on a back. I dressed up like hazmat to do dressing changes so I missed a lot of the smell.

For hand lotion might I suggest carrying anything that's not alcohol based with you in your pocket - small tube of course - and then here's my big suggestion. Your hands will still get dried out - so every night at bedtime I suggest you use working hands - available at workinghandscream.com. I have used it awhile with great results. I will warn you it doesn't work with alcohol based hand cleaners - thus the suggestion you carry some other brand in your pocket. In fact, carry something "aromatherapic" in your pocket - you'll need the pick me up, but the working hands will heal your hands the rest of the time!

We use one for TPN, one for IVF/Meds and one for blood draws. Unfortunately, everyone thinks blue is blood or no maybe white - no no blue is TPN... It's always mixed up anyway. I try to take it mose seriously if I actually have a pt on TPN (we have one that gets intermittent TPN and IVF - alternating) - I try to get it right for her.

We had similar suspicions about a nurse I worked with. We have a "no gift worth more than $10 rule." She didn't get in trouble where I worked for it that I know of. She did however get her comuppence (sp?) down the road. Took advantage of a homecare pt. Lost her license. :)

Come to Missouri - we'll hire you!!! She was upset over handwashing! Was she also a nursing instructor? How long does she wash her hands? I don't see many nurses in reality take that long to wash their hands unless they just did something gross. We use the alcohol handwash, when it's dry - you're done. Sounds like a not too friendly environment. No jobs for new nurses? Plenty here in Missouri.

I got turned around just trying to read your post! We have terrible nights sometimes. I'm told we can fill out an occurence report for such instances to demonstrate the nurse was overwhelmed just in case something bad comes of it. You can always ask the higher ups to help out and should - that's not wrong - even if it upsets them. Your pts welfare is 1st - not their mood or lashing out at you. What kind of unit are you on? We take care of sepsis and trachs on my med surg - but no vents! We don't do vents. Medical staff on rare occasions do clean rooms. We try not to, but HE&& night happens sometimes.

Don't beat yourself up. In the real world there are sometimes shortcuts. I myself have left meds with an oriented pt and come back later to find them on the bed table. I ask pt why? One pt didn't tell me she refused her reglan PO until I entered room with the next dose. I just charted it. I don't feel it's my responsibility to check oriented people for "cheeking pills" or hiding them. Had an oriented little old man who would "palm" them to avoid taking so much pain medication. I told him he should just refuse the dose and we would get dose adjusted. He thought he "HAD" to take them and he didn't want to. I don't babysit every pt to be sure pills go down. I do usually make sure pills get from cup to mouth and that they have water to drink - then I move on to the next 9 pts. Usually I make a 2200 round anyway after passing 2100 meds and I check and pitch the empty med cups as I tidy on the run. It's not a huge deal unless pt missed a med for something serious or is "pocketing" narcs. Shortcuts aren't the way you are taught in school. Just be sure you don't take short cuts you are uncomfortable with. You are ultimately responsible.

I am a charge nurse and have been in similar situations. However, that BP is borderline for our facilities call the doctor guidelines, and since it was already being treated and had been noted in the progress notes I wouldn't have taken it too seriously. Some BP meds take more than 30-60 mins to work. I would have not worried - maybe look up the onset time for the specific med you gave - some are quite a long time to onset. As far as the charge nurse thing - the charge nurse at my facility is NUMBER ONE above all else - responsible for pt welfare. I am not responsible for the action of others - just the welfare of my pts. I don't see that BP as being that high risk to pt welfare. I'd say let it go, she probably felt she was being more "safe than sorry." It never hurts, when in doubt, to call the Dr. Even if it Pi@@es them off. She probably was going on that assumption. Maybe she has had a bad experience with that doc or with a similar situation or maybe she lacks some experience. I can say I have less than some RN's I charge over - and have had fits sometimes getting some of them to call the Dr - over much more serious things. Sometimes I just do the calling. Then they get upset because I "over road them." Pt welfare first - making friends last. If she was that concerned she could have just asked you for a quick pt report for more info and done her own calling.

If you have anxiety, medical nursing may be very hard for you. Harder than normal. Cause people will yell at you once in awhile. You have to be calm when others lose control. There's often a very fast pace (especially early in my shifts - if I'm lucky they slow enough at the end to catch up). I've observed other nurses running down the hall crying. I've heard of one sitting in the break room crying. Had one explode at me over something not even logical she thought I did. One was found in the med room sitting in floor crying. You may need to handle the anxiety first. What triggers your anxiety? Maybe you could consider another area of nursing - there's a lot more than LTC and med/surg.

The nursing class before mine wore the "bell" shirts - tapered princess seamed white long top with puff sleeves. Flared at the bottom. It had little inverted pleats at the shoulders so as they moved around the pleats would end up popped out looking like little wings. The shirts were trimmed in navy to accentuate the bell shape - haha. They eliminated them when I started. For all those upset about their uniforms just look at what they used to wear. White dress, white hose and the CAP (dum da dum dum). Dress perfectly starched and ironed and white. White orthopedic shoes only. We've come a long way - even if you're stuck in dumb smock. I'm sure the fellers looked funny in the caps and hose (haha).

I always include the part of our admission assessment about "are you pregnant" even for the men. Always gets a laugh. I sometimes leave in the question about "gynecological problems" but for most of my clientel I rephrase it as "female problems." One male pt stated "no, not since the divorce." I sometimes tell a pt with a difficult IV start "Next time you come in, please don't forget to bring your veins." When they say "I hate needles" I just say "ME TOO" When I do anything painful (don't use this with violent pt) I say "Now if this hurts you hit _______" Insert name of whoever is helping you or with pt. When a pt says "man, I hope I go home in the morning" I say "man I hope I do too." When pt won't/can't urinate I tell them "If you don't go soon I've got a 300 lb male nurse with a garden hose he'll put in to help you out" Gets a UDS sample fast! When on says "I pay your salary" say "can I get a raise"