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!!

Just to clarify: my generalizations about diploma, ADN, and BSN programs were all based on my experience here (in the RTP area of NC). After re-reading my post, I only prefaced "in my area" once and I can see how my post can be misleading to other readers.

Personally, I think it depends on the area in which you live. In my area, my DIPLOMA based program is well-known and would probably beat out a ADN or BSN new grad easily. Also, Diploma and ADN programs have more clinical hour-credits because they are more clinically based programs. Sometimes this can also appeal to certain hospitals. If I had it to do all over again, I would choose to obtain my BSN. When I was searching for the right school for me, my Diploma program told me that you only needed your BSN if you wanted to become part of management (nurse manager, etc). Little did I know that couldn't be further from the truth! You can't teach, perform research, etc. It's much more than not being able to direct others! GL in your search!

When I was oriented: Preceptor and I had 2 pts x1 week, then 3, then 4-5. The first week: basic manuering around the floor (clean/soiled hold, where to find "x", how to use MAC system and computer system, etc. The 2-9 weeks were about fine tuning skills, protocols (CP, arrythmias, titration, etc) Now orientation is like: preceptor and orientee immediately start out at 4-5 pts and work as a team to complete all assessment, meds, etc. My suggestion: ask questions. If you don't get what you are looking for (rationale, etc.), perhaps a different preceptor would benefit you also. GL! Cynthia

I can appreciate the situation you are in. My situation (briefly): took NCLEX in January, started working in February, baby born in September of same year. I CHOSE to tell my potential NM that I was pregnant. I felt comfortable with him, I wanted to be up front (to prevent further trust issues down the road). I was geniunely interested in my nursing position (cardiac telemetry stepdown). Needless to say, I got the job. Working was difficult. I was tired all the time (did I mention my children are 13 1/2 months apart - - 2 and 1). Orientation was okay but I was crabby at times. I got through it; got off orientation, went on maternity leave, came back and did fine. I was worried I would have to go back on orientation for fear of forgetting everything but I did fine. My only concern for you other than the effects of stress while being pregnant is be careful with your health insurance. Because I wasn't a full-time employee for 1 year, I didn't have any time PTO so I didn't get a paycheck. Which in itself isn't that bad BUT if you do not "work" the full-time hours you were paid for then ALL of your benefits are held - - - AKA your health insurance, which could be mean you pay full price for certain things. So make sure DH/SO covers you. GL! Cynthia

We've had a RRT also for +/- 1 year. We do not involve the pt or family member in our process. Some of the criteria that meet a RR is: sustained O2 sats What type of RR's do you respond to?

We start, titrate and d/c our Cardizem gtts as well. The MD's typically place computerized orders to tell us when to titrate. For example: titrate to HR 110, SBP >/= 100. We usually titrate the gtt by 5mg/hr (5ml/hr). Our maximum rate for Cardizem on our floor is 15mg/hr. If they need to be titrated higher than that, we have to send them to CCU. Typically, that does not happen. The MD's will try another medication instead. My personal fave: Digoxin. We have monitor techs that monitor the pt's HR/rhythm and advise us of any notable changes. We monitor VS typically q2H or if we ever need to increase the gtt.

We just switched back to angioseal. It no intervention, pt is on BR for ~2H (max). No sandbags or ice. If increased risk of bleeding then we may increase BR or place a "Femstop" on pt.

IMO, tele is a good place to start. You have a little critical care and a little surgical c CABG pts and a little medical (unfortunately). Suggestions: remain engaged in learning. Become proficient in reading tele strips and intepreting dysrhythmias, continue your ceu's as they pertain to tele. Read your policies. TEACH something to all of your pts and by doing this you have to know what 'x' is. Unfortunately, it's typical for the staff to be good-great and mangement not so much. Remember that the people you work c can help you - - A LOT! Stay focused, driven and you'll be able to survive at least a year (my recommendation) before looking for another job! GL! Cynthia

On our floor we are able to titrate: NTG, Insulin, Dopamine, Cardizem, Amiodarone gtts. Also, do you care about Integrillin, ReoPro, Heparin gtts? (If so, we do those too).

Our hospital only uses Lovenox via SC. I find it very interesting it may be given as an IV bolus and will inquire about this c our cardiologists.