DudeNurseRN

You will see things in one day that most people don't see during their time on this planet. This will also include some pretty horrific and scary and sad stuff. Is it okay to cry... oh for sure, the more you get used to your environment the less it might affect you, and that's okay too. You might have a similar experience that you could relate; my 25+ year experience grizzled veteran preceptor in the ER never did blink an eye in trauma, but he could be there emotionally for the patients, he'd just seen it a lot before. But he told me how hard the first year was.

Hmm. So not the fear of making a mistake/scared to go to work everyday thing that most of us had. There really are plenty of other areas out there. I float to other units because my hospital has no float pool, and I can say for instance I was BORED TO TEARS in Rehab. Oh so not for me. And for me personally, I don't know if I would like just "staight onocology", I have medicine as well (but not really surgery). But the medicine helps to keep me going, seen some darn interesting stuff I must say. But I suppose you need to ask yourself what you were looking to get out of nursing and see if you are getting it.

Unfortuately med errors happen. We're people and we are going to make mistakes at one time or another. Statistically the more medications that you have to give, the higher the chance of having an error. 5 rights is great, but certainly not error proof. I think assess the pt was a great answer! And consulting with the charge RN (because you're new, and you WILL be doing this a lot trust me) would eventually get you access to the other parts that go along with it... e.g. notify physician, fill out incident report ect.. Regardless of what happens with the interview the answer that you gave was the right one.

It sounds like you already know which job is for you. From what I read it seems like you need support in telling your current workplace that you need to leave. The 3-11 place will be fine with you leaving. It's like leaving any other job. You're workplace and you have to have chemistry and it sounds like the 3-11 place and you just don't have that "spark". It will ideally be easier than you think, and once you've done it, you'll feel like a million dollars starting your new job.

I personally would use you influence to try to influence the other people. You don't necessarily have to go the whole nine yards and use "I" statements ("When you about your intimate lives at work, I feel uncomfortable."), but you could try manuevers like sticking your fingers in your ears and saying something like "LALALALALA, I don't want to hear this!". Sure it makes a scene, sure it might make some people laugh, but you'd be suprised at how many people think twice before they start talking like that again. Obviously you know these people better than anyone else, and you have an idea at the back of your mind on what you'd have to do to take an effect. I personally have seen people use overdramatics (with a HINT of shame, it's an art), and redirection with a fair amount of success. Things like: "WHAT in THE? What in the WORLD are you guys talking about?! Son of a... geez, do WE have THAT much time on our hands?" And then asking one of the nurses to help you with a boost in the other room, thereby redirecting to the work aspect of the job. But a difficult situation none the less. I hope that you are able to get the safe and comfortable work environment that you and everyone else deserves, and that this sitation resolves much easier than you thought it would.

Hmm. Thankfully I don't have anyone hitting me up for money, but then again most my family lives out of state and me being an only child probably has something to do with it. I don't advertise, but my wife drags me to her doctor's appointments and ALWAYS makes sure to tell everyone that I am an RN, because she gets treated differently. I just shake my head each time she does it. Ironically, when I go to the doctor's appointments, my MD's that I see are usually MD's I work with at the hospital and they know me, so it's kinda weird in a way, but at the same token it makes things easier when you both speak the same language and have good ideas on what will work for you and what won't for illness/ailments. Plenty of people hit me up for anxiety relief/talking about family members in the hospital, and ask me if I have heard of this or that before, and how are things typically treated.

I am in agreement with most of the people here. I am fine calling the doc's by their 1st names when they are getting SBARed for pt needs. I mean let's be honest, no need for formalities, we both know what our roles are. But when the MD's and RN's round together on the patients, I introduce my self as their nurse, and the MD introduces themself as doctor (In this case our particular roles could be confused by the patient otherwise).

You have A LOT on your shoulders. You can quit nursing, it'd be okay. With the experience you have, plus your BSN, you could take that degree and ride it to do something else if you wanted to. Or if you wanted to stick with nursing there are a lot of options that are less stressful than nights in med surg, especially twelves. (I work that same shift, and staffing decided it would be funny to have be work 4 hrs on my floor and then float me for 8 hrs on another floor, thus doubling my workload.) Things like clinic nursing (which in most cases would be 9A-5P). From what I read in your note though, it sounds like you are kind of interested in nursing, and would like to possibly work somewhere else. But you'd have to get the depression by the horns first. Do I think that I am going out on a limb, by saying your depressed. Nah. Why? Cause a lot of us do depressing work. We work with sick and sometimes dying people all day long. That's the truth of nursing. MD's don't spend as much time with the sick people as we do. And yeah people can be sad and blue, but overwhelmingly the greatest telltale sign of depression is the lack of enjoyment/energy/motivation, which you definately mention in your letter. In my experience going and getting some medication, and talking with someone about the stressful type of work you do would be worthwhile. It's going to be hard getting though this, I'd be lying to you if I told you otherwise. But when you find the work that you truly love, and life and cats (per your letter) become enjoyable again, I have faith that you will find that your happiness was worth the effort.

It's going to be tough asking for a new preceptor, but being a new grad myself I have to say, that, this person probably is a good nurse, but doesn't appear to be a good teacher. There are people who are great nurses but not great teachers, and that's okay, but only if they aren't training in new staff. If you knew me you would know that I am a very understanding person who will always give people the benefit of the doubt, and give people multiple chances to redeem themselves, but. With regards to the "See I told you, you weren't ready for pt's." comment. That my friend is ABSOLUTELY INEXCUSEABLE. It is her job to train you, and it is her absolute FALIURE as a teacher/mentor IF you weren't ready for pt's. Please by ALL MEANS tell your manager about that comment, and the situation verbatim. It is not her job to grump, and scold you, but rather to teach and mold you. It won't be easy but it will be worth it, changing preceptors. I have had 2 wonderful preceptors, who taught me, one with 25+ years experience, and one with 30+ years experience, and I am thankful for, and am a product of, the wonderful job they did teaching me. AND I still am able to ask them questions, and they always make time for me. That's the kind of preceptor you can have and should have. Make sure to take time for yourself, and take a couple deep breaths. Once you get over this issue, the payoff of being a confident well trained RN will be great. Believe me. You can do it. I have to tell you, yeah, there is a difference between how things are done in the real world versus school with regards to sterile procedures, but central line dressing changes are not the exception to the rule. I deal with a TON of these things on my unit, and I think it would be fair to say if you were trying to keep sterile and had an "oops" moment that the patient would probably be okay. But deliberately not using sterile technique puts peoples health (and in rare cases lives)at risk. I have had lines go bad, and it SUCKS. I have had people get septic from it, but more often they have to get the lines pulled and have another one put in. Can you imagine? "I'm sorry Mrs. Jones we are going to have to take out that surgically implanted IV and put in another." That's the reality/risk of not following sterile technique in this situation. Foleys we want to try to stay sterile as well, but if we don't the risk is giving a person a UTI, and we pull the foley. Obviously, we don't want to cause disease in anyone, but a systemic infection vs. a bladder infection, to me are two VERY different things. Central lines vs. foleys, I have to say central lines take priority in making very certain that you keep as sterile a technique as you can.

I kinda go along with the concensus here. Personally if I am using an infusion pump, I won't in theory have to worry about air emboli. But per practice of my charge RN, I always setting the pump to make sure that the bag drains completely taking care of the overcompensation principle that seems to be the norm with IV bags/Pharmacy (If it's a 50ml PB then it likely has about 60-65ml in bag, 100ml has about 110ml and so on). For the amount that is left in the line... 4-5ml after the bag dries, don't sweat it because 99.5% got into the pt.

yuppers. it'll get easier, and you can't beat the learning curve no matter how hard you try. i know cause i tried too. but having this experience will benefit you down the road. what you chose to do is very, very hard and the work is worthwhile, you should remember to give yourself credit for how far you have already come, and all you've learned. way to go!

I had one tough nite. Dang. I had a person who was having problems with bone CA in her hips, and trying to get her on the bedpan, and I had a person with ulcerative colitis, who was getting blood and had a blood transfusion reaction, and I had to give her demerol, and tylenol, but she's fine now. And I had a guy with SOB, and colon CA, but no one knows how the two are connected, or if they even are. I had a guy with Gallbladder CA, and needed something for pain, I got him something, but dang. I tell ya. Shoot. Not a great night, and I am looking forward to some time off. I'll be honest... is this normal????

NancyNurse brings up a good point. Our team has a pharmacist too, lots of times they are on the floor and ready for any questions you may have. I remember more than one time I had to call them to have them save my butt when I had no idea about how to give a drug (and this particular drug wasn't listed on my PDA). Pharmacists are wonderful resources. augwest -- I know that I usually come in about 1/2 an hour early beforehand to look up the folks that I am going to be caring for that day, and also this usually gives me time to help to prepare for any weird meds that I might have to give. And believe you me, there are some weird ones out there. What do you do for prep?

I definately have experience when it comes to the day/night scenarios because that's what my shifts are. Nights is an interesting beast in the fact that they dump a whole bunch of pt's on you because of the theory that "well if pt's are sleeping then you can have double the amount and that shouldn't be a problem". Well that's sometimes true, but when somebody has a problem and puts on the call light or makes a whole bunch of noise it wakes more people up and then you realize that it's not as easy as it seems sometimes. But evenings tends to be more relaxed in general. Schedule takes some getting used to, and then comes the ultimate problem. To eat or not to eat, that is the question. Jury is still out in general, about 1/2 the RN's feel like eating and the other 1/2 won't and swear that you put on weight if you do. But you'll figure that out for yourself. You will have a support system of a Crosscover MD, in which case you will have to SBAR most of your pt's that have problems because this oncall MD will have no idea/information about the pt that you are taking care of otherwise. Those are the main things that I can think of off the top of my noggin.

My preceptor taught me, and I took it to heart, that you can't give a med not knowing what it's for. BUT... you need to make this easiest on yourself. What he taught me was to carry a PDA, with a drug database in it. This speeds up your ability to look things up considerably once you get the hang of how to use it. I am the only person on my floor who has one, but I can honestly say that I use it everyday, and lookup all the drugs that I am unfamiliar with, and I know how long to give them according to "the book". And once you get the hang of it, instead of 2 minutes fliping through a book, is cut down to about 30 seconds at most. Pretty nice way to build your knowledge base and confidence in giving medication if you ask me. That's my suggestion anyway.

Excellent question. They don't prepare you in school for the fact that chances are if you aren't currently working as an aide in the care facility where you want to work as an RN, then you are going to have a tougher time finding a job. Yeah there is a shortage, but it typically takes a month or two to get a job when you are a new grad. Glad you asked. Always are going to feel unprepared when you first start, but that's what your preceptor is there for, to help guide and mold you.

Tell me about it. No matter how hard you try, you can't beat the learning curve. You can't. There will always be something, but learning and accepting that you get paid the big bucks to be an RN because the job is DARN stressful at times is something that keeps me going. Not everyone can do what we do. Being new sucks! Will it get easier, yeah, will you feel comfortable down the road... yeah. But even my charge nurse who has worked on my same unit for 20 years still runs into new things that she has never seen before. That was a sobering experience for me, that you have a lot to learn when you are new, but you can never stop learning, there will always be something new to document and so on. But putting it into perspective... You got a hard pt admitted, and stable. So you missed a bruise, it'll get easier for see these things when you have experience in dealing with similar issues. It'll take time, but in the end it'll be worth it when you are training the next new nurse coming onto the unit, and you can make it a safe and exciting experience for them.

Being firm is definately something that you'll see, and need to have. When I went though school I had one of the best ED experiences and I have to say that you have to earn the respect of your collegues, and you will, but these folks will help each other out at a moment's notice. In a good and supportive environment someone is always willing to be your "wingman". Also you wouldn't think so, but accepting the fact that you can't have a good conversation with every pt that comes in without slowing things down in the department, very much the mentality of "gett'em in, gett'em out or send'em upstairs after they're stable".

Hey guys. I need some help. What is the best way to put in NG tubes that you know of. Easiest that is. Put in an NG tube and the pt's nose started bleeding and then they threw up and tried to do it again (RN that was helping said that the pt was trying to put his head forward when it was supposed to go back, coiled in mouth), but the pt said that they needed more time to catch breath ect.. Any tips? These things/putting these things in seems prehistoric. There has got to be a better way. Putting them in helps so much, but com'on, it's so hard to put them down without a lot of pt discomfort. My preceptor and I put some in, in the ER using Cepacol Spray, and Xylocaine gel in the nose, but had another RN (30+) years telling me that, that would make it hard for them to swallow, and not to do that. Need real world/done it a whole buncha times before advice. Thanks!

Yup it's tough. They don't teach you about the reality of things in nursing school. Your unit sounds kinda similar to mine in some aspects. My general suggestions: Shift start to 0745 * Assess pt's pain and nausea/vomiting (like 20 seconds with each person)1st and foremost so you can get the PRN pain/nausea meds out with the 1st scheduled batch, but don't bother with the lung or bowel assessments right away if there are no obvious problems. 0745-0900 *Give all "busy time" morning medications and perform focused assessments on those who are most in need, wait on the lungs and gut for those people who are obviously stable. 0900-1000 *NOW, sit down and chart all your "busy time medications" and the assessments that you were able to perform, and start your progress notes, but save them and realize that you can add a little bit more when you have time. Try do your acuities now. 3/4 of your documentation at this point can be finished/a work in progress. 1000-1100 *Reassess pain relief, and peform the assessments that you have been waiting on. After this, document your assessments, add to your progress notes and try and take a little breaky break around 1045. 1100-1200 *Change function to: grab scheduled/prn meds and document right away after giving them since there is a lot less of them at this point. Get your progress notes about 3/4 done to finished. 1200-1300 Grab your lunch for 30 minutes or whatever sometime in here. Checkup on your people, spend some time with them, and do dressing changes and whatnot. Grab meds and document as needed of course. REALIZE HERE THAT, if things are going to get busy/poo hit the fan, it's going to be in the last 2 hours of your shift, and that's why you need to have everything close to finished 1300-1400 Give report somewhere in here, realize that you can always add/ask someone if they have any questions when they come out of report. Finish up your progress notes. Attend to needs, help PCA/NA's if you can. 1400-1530 Do whatever you can for your patients, if you need to spend a little extra time with someone, try to put it here at this point in the day. Answer/update your relief nurses as they come to the floor (realize that, that is what these people are here for is to relieve you). Say your goodbye's and checkout. Easier said than done, takes practice, but definately doable. In general these suggestions from my charge RN, who has worked on my unit for 30 years, have helped me immensely to get home on time to see my family and have my day a little bit better planned out. Hope this helps some.

It's going to be stressful, and scary at times and exciting and fun as well. I won't lie to ya. It's a matter of coming to terms. You are going to feel like you don't know anything when you start, and that school didn't prepare you for what nursing really is. A profession of taking care of people, where the patient to nurse ratio could be much better, but that would cost the hospital too much money. So you are going to have to learn the skill to take care of many patients and not have a lot of time to talk with them. But in the 4-10 minutes that you have each shift to JUST talk and be with patients, you will learn to make a difference in their lives, and you will have to go home and realize that you did what you could, and you can't do everything, but that BEING and CARING is the difference that you will have made in this world. And then you'll go home and be with your family, go to bed and do it all over again tomorrow. We are what we are, not what we do.

You sound a little sad in your post. Sounds like life is stressful right now for you. Sounds to me like you aren't miserable like you were when you were teaching, but you were expecting something else out of the job, maybe a different feeling from the work that you do. I think that there is a lot of idealizing out there, that nurses need to be extremely passionate about what they do to be good nurses. I disagree. Yes, it is just a job. Just like any other. And you don't have to really be passionate about it, but it does help to pass the time if you happen to be. But it is important to be happy, and you don't sound very happy right now. If I were in your shoes I might take stock of the things that are going on in life (apart from the stress of starting a new profession) that are keeping you from feeling happy. Hope that things get easier.

Maggots can be benificial, but not all maggots are the same. It is true that some maggots eat only dead tissue, but some eat live tissue as well, and it's hard to tell the difference between the kinds of fly maggots.

Meh -- I liked the idea of working in the medical field and helping other folks out. Also, it's one of the few positions in the medical field that take the position of looking at a patient holistically. Money ain't bad, and having to put up with the usual "Have you seen MEET THE PARENTS?", by your close friends and family isn't too bad once you have your canned response all picked out.

Absolutely the more orientation days the better. Try and get as much out of it as you can, but if you think you are going to need more time, just ask for it. I know that all places love "fast learners", but you are being entrusted with someone's health and well being, so if you need a few more days, just go ahead and take'em.