roxie144

Thanks for the tips, once I sat down and drug out the caliper, third degree blocks started to click in my head.

If you are taking care of a patient who is non-compliant, when giving education stares out the window, paying no attention, throws a fit at every meal because they are on a fluid restriction/diabetic diet, tells you he is going to eat, you give the insulin, he takes a bit then says it's **** and stops eating, who refuses to clean up then yells at you later for not being cleaned up, who curses at you all day, they are AOX3, ambulatory, and actually told me during my shift after throwing a fit over sugar free syrup tells you, and I quote, "i'm going to **** on the floor so you have to clean it!" So my question is do you document his statements word for word including all the foul language?

So I can explain heart blocks but, my problem is knowing it when I see it. First degree PR > 0.20, second degree type 1 lengthing PR with dropped QRS, second degree type 2 regular PR with QRS's dropped, third degree atria and ventricles beat independtly of one another but when I see it, it just doesn't hit me that it's third degree. Any suggestions/tips to help me out

Thanks for your input, I appreciate it.

I have asked aroung at work and can't seem to get a straight answer. If a patient has lasix ordered and BUN/cr are elevated at what number(s) do you call the Dr. to see if they want to hold it. Do any of Dr's have a standard order. Also, is it because if the kidneys are in trouble and you give Lasix are you doing more damage because they just arn't going to kick in?

How is it at your hospital? We are short staffed and nurses are more and more flexing up with six patients on a step down unit. We often find ourselves with one aid for 24 patients and then getting reminded about how important it is to answer call lights and do hourly rounding so our patient satisfaction scores are high. You are only one person who can do only so much. The moral at our hospital is low and anymore people walk in to work and we have so many poor attitudes because everyone is so fed up. Not to mention some of the assignments are just unsafe, for example, a nurse with approx. 2 years experience with a new grad and a nurse with 6months experience coming on at 7p with three heart caths, two of which that had problems with bleeding and a fresh cva coming to the floor and 8 other patients on top of it. I can't tell you how many times I've heard the comment "every time I come here I feel like my license is on the line." Just wondering is the grass greener or is it like this everywhere. We are expected to do more with less and are told all the time about patient satisfaction and budget but it seems like we never hear about patient or nurse safety!

I have no CM experience and the company is aware of that. Case management is something I have had my eye on but don't possess the experience most companies require. I do see where you are coming from that feeling you may not feel as if your acting as a patient advocate.

I have an interview with a workers comp managed care organization next week and am looking for some advice.

I work in a SDU and recently I was forced to flex up with an LPN and cover twelve patients. Our normal ratio is 4-1.

I have been a nurse for almost a year and have worked only nights and currently a position is open for days. I have not adjusted well to nights and feel like a piece of me is taken away everyday. I'm just worried about going to days, my husband keeps reminding me it's the same job and that I'll be fine. I'm just wondering if some of you out their who have done both what the major differences are and any hurdles. Thanks

Sounds like a famliar story. I graduated in May and for the first 2.5 months I felt the same way you did. Time has passed and although not much I'm getting into a groove. Don't get me wrong, just a week ago I had a real bad night, a hospice patient, a pt having a seizure and a pt go into asystole for a few beats while at CT, I also had 3 other patients. Once the tornado calmed down, I cried, got a few hugs from coworkers, thank you from family members, excused myself from the floor to clear my head and went back at it. I was so much like you when I started the tears, the dreaded car ride to work, not being able to enjoy my time off thinking about going back was all that was on my mind. Like some of the other posters I called my Dr. got some much needed meds for anxiety and now I can say for the most part I love my job. You say you have great co-workers as do I and that really is a golden ticket. Give yourself time and it will play out, your not alone, so many of us new nurses feel the way do. You'll get into a routine and learn how to manage time better to give you that extra few minutes with your patients and you'll see you will make a difference. Hang in their RN, you got through nursing school you'll get through this....meds do help.:)

Sorry to hear about your experience. I graduated in May and work in SDU with a ratio of 1:6. We have a lot of new grads on the night shift but it's balanced with experienced RN's. They have been so helpful to all of us and are so willing to teach and answer questions. I can understand where the exp. RN's are coming from but one of the great things or hospital does on night shift is having a Mentor on. The Mentor usually comes in for a few hours when there are more than 2-3 new grads on. This RN has no patients and is there to answer questions and help where needed. It's a wonderful resource for everyone. I can appreciate how tough it can be when your trying to get your work done and you have 3-4 new grads asking quesitons all night.

After reading these posts I don't feel so alone. I graduated in May 09 and started working in the ICU about 5 weeks ago. I just started night shift and have about 5 more weeks of orientation left. I don't think there has been a day where I don't feel completly overwhelmed and clueless. The patients I've been taking care of are a mess. I'm not even used to dealing with numerous IV's going and here I am with two patients titrating multiple drips on each and if that's not enough we ended up intubating one of them. The hours that I've spent there have been chaos and my preceptor is constanly saying I'm sorry, I feel like I didn't teach you anthing because things are moving so fast. I recently went to my educator and told her I just don't feel ready and she agreed to switch me to MCU. I'm just feeling totally inadequate and that I made the wrong decision in my career, what if this isn't for me. The other issue for me is watching all these people die, being in the ICU and going to codes with the I-team nurse is leaving me with a heavy heart. I'm not sure if it's because the people are so young or if it's because I recently lost my father-in-law or a combination but it sucks. I too like so many of new grads find myself coming home in tears and dreading my next shift. I'm just putting hope in the comments made by so many of you that it does get easier