ckc6977

There should be formal meetings to determine the student's goals/objectives, what the expectations are, what the student is allowed to do (with & without your supervision), etc. The offer should just have been the 1st step. Their main purpose in doing this is to help the student transform into an actual practitioner. In the meetings they should also discuss strengths, weaknesses, etc. My advice if she's already made arrangements to follow your schedule is: to get more input and have the instructor answer ALL of your questions before you agree to anything. I just completed a similiar situation. My student's goals were mainly task-oriented (better knowledge of meds/charting), so I tried to focus on that for her. Along the way, she saw some "cool stuff" and learned to prioritize, perform some great assessment & time management skills. Good luck. I will say that precepting a student is much harder than precepting a nurse (new or otherwise).

When I precept, I always "make" the orientee watch me the 1st clinical day. (with assessment, asking questions, educating pts, give meds, etc etc etc) On subsequent days, I am attached to their hip. I watch them start iv's, give meds, chart, perform assessments, use equipment, etc. (not to mention if the pts have any questions that the orientee cannot answer). Once I've "checked you off" on giving sq/im/iv shots, injections, perform tasks, etc). I give you space because I don't want the orientee to feel like he/she is back in nursing school. Our hospital's outlook on precepting is: let the orientee and the preceptor take care of all the patients together (not you get 2, I get 2). For example: we do all of the work together, then you do 65% to my 35% (together), then 75% to 25%, etc unless the preceptor feels the orientee is beginning to "sink". I work nights, so I do have extra time to make sure the orientee understands things that are pertinent to our floor (what specific cardiac meds actions are, the purpose of the medication, CP protocols, iv titration gtt protocols, interpreting telemetry, etc.) As far as suggestions: I would speak to your preceptor first. Because if you go to your NM without having said anything to your preceptor, your NM will probably revert you back to him/her first. I'm sorry you having to deal with this. I know it is hard enough trying to "fit in" to your new role and floor without having any additional stress. GL and keep your head up!

I concur! We have the same process and it's such a pain, especially if you only have to give 1 unit of SSI!!!

HIPPA HIPPA HIPPA. This is the scenario you see as an orientation example that is so over the top that the "crowd" laughs thinking what idiot would do this?? I'm not about tattle telling but this is noteworthy! There is a hotline where "the powers at be" can be notified of HIPPA violations. You don't have to leave your name, etc and they must investigate every complaint. Give the details, specifics, etc. Since everyone in the office knows about the incident, no one would know "you" initiated this! This is the CMA's fault, not yours! I feel bad for the family. I'm sure their anger about this is misdirected to just keep their mind off of the dx at hand! GL and keep us informed on your decision!

We have disposable trays, tableware for all pts that are anything but standard/universal precautions. We just began the procedure where dietary brings the meal tray cart on our floor to those that are contact, airborne, droplet precautions and it is the nurses/aides jobs to disseminate the trays into the pts rooms accordingly.

At our hospital we have computerized charting. We have to perform a shift assessment by mostly "clicking boxes" etc. on every body system. We also have to write a "generic" nursing note at the beginning of our shift. This is something typical I would write. Pt lying in bed, awake. A&Ox3. Skin warm, dry, intact. D-stat patch to R groin c/d/i. Site soft, no hematoma present, slightly tender upon palpation per pt's grimace and verbalization. Respirations even & unlabored on RA c O2 sats: 98%. Tele: SR in the 60's. IVAD: #20g to LFA dated 12/2/07, c/d/i c no s/sx of infiltration, currently infusing Integrilin at 5.3ml/hr; pt tolerating well. Denies pain, CP, SOB, dizziness, n/v at this time. VSS. NAD noted. Defer further to this RN's shift assessment. Will continue to monitor. Hope this helps.

My d/c note looks something like this. D/C instructions as follows. Advised pt of no added salt diet c examples of foods to eat/avoid. Explained to pt he may begin driving in 4 days. Discussed and reviewed medications. Rx given for Metoprolol, Colace, Percocet. Discussed side effects and written information of aforementioned medications. Advised f/u c Dr. White in 7-10 days. Pt verbalized understanding c all questions answered. Pt's wife present during time of d/c teaching. D/c'ed telemetry per MD orders, turned in to "me", MCT. D/c'ed IVAD, catheter appears intact. Applied gauze & tape to control bleeding. Advised pt if bleeding occurs to hold pressure and elevate extremity. I usually write another note stating how the pt left, for example. Pt left floor via w/c c me, NCA and pt's wife. Pt left in stable condition. Hope this helps!

I'm sorry this horrible incident occurred to you. BUT we are human. It's happened to EVERY nurse at some point in her career! Learn from it. Realize that you DID NOT kill anyone (even though that could have been the case as you pointed out). Think about how many times this happens to other nurses like yourself. Be proactive in fixing the problem. For example: At our hospital we have computerized charting (to include the MD's entering in computerized orders). We also have a computerized method for our medications. When an admission comes in, the admitting nurse verifies all of the MD's orders/meds. We verify those orders by making sure that pharmD's have entered what the MD ordered. We have a "home screen" in the nurse's station that tells us when new orders arrive (via RT, MD, Diabetes NP, etc). We verify those PRN and again verify that what the MD ordered is what the pharmD typed in.On our system, you also scan the bracelet, so you know it's the right pt. From hearing what a lot of the other posters have said, most people are still using the MAR's, paper, which can be very tricky and a lot easier to make a med error. Try not to beat yourself up too much. GL!

I'm sorry this horrible incident occurred to you. BUT we are human. It's happened to EVERY nurse at some point in her career! Learn from it. Realize that you DID NOT kill anyone (even though that could have been the case as you pointed out). Think about how many times this happens to other nurses like yourself. Be proactive in fixing the problem. For example: At our hospital we have computerized charting (to include the MD's entering in computerized orders). We also have a computerized method for our medications. When an admission comes in, the admitting nurse verifies all of the MD's orders/meds. We verify those orders by making sure that pharmD's have entered what the MD ordered. We have a "home screen" in the nurse's station that tells us when new orders arrive (via RT, MD, Diabetes NP, etc). We verify those PRN and again verify that what the MD ordered is what the pharmD typed in.On our system, you also scan the bracelet, so you know it's the right pt. From hearing what a lot of the other posters have said, most people are still using the MAR's, paper, which can be very tricky and a lot easier to make a med error. Try not to beat yourself up too much. GL!

IV Digoxin, Metoprolol = I hate the fuss off putting up to the bedside monitor. IV Adenosine = it always scares me when the flat line for those few seconds Narcan = I hate watch the shake; it looks like they are convulsing sometimes. Kayexolate, enemas = obvious reasons.

I hope my reply was clear. I was a nursing school student and our parent hospital agreed to pay me back. My school tuition was ~20,000. The hospital will pay me ~21,000 over a 3 year contract that I have agreed to work for them in exchange for them paying my school's tuition.

Good Luck - and great choice on choosing tele as your 1st RN job!!! Cynthia

I concur with the other previous posts. At our facility we begin the pt on NS (usually c K+ supplements added also of course c the insulin gtt). Once the BG levels are = 250, we'll switch the IVF to D5NS, D51/2NS.

I agree c the previous poster. Pts should not have + troponis s/p CABG. I've have several pts s/p CABG who have re-infarted. Was there anyone else you could have gone to for further eval of your pt?

My Nursing School actually advertised the tuition reimbursement as an agreement to work for 1 of 3 local area hospitals over a 3-year span. My tuition was $4,875 x4 = 19,500. The alliance between my school and the hospital agreed to pay me $7,500 over 3 years = 22,500. So far, I've collected (1) check and received approximately $4,000 after taxes, etc. GL in your search!!