Deseosa

I'll just add that you need to decide how important this issue vs. your job is to you before you become too vocal, ie. if you are willing to be fired. Legally, they can't fire you for "whistle-blowing", but if they want you gone, they will find a way. I worked at a major hospital that was switching to computerized MARs. If the pharmacy entered something wrong, they wanted us to rewrite the order on a physicians' order sheet and send it to the pharmacy. I said I wasn't a doctor, and I wasn't rewriting orders that were written correctly the first time just for the convieniece of the pharmacy. At first they ignored me, but I got other nurses behind me and we took it to the head of the committee and explained why it was unsafe and that we wouldn't do it. I told some of those nurses I would consult the BON or JCAHO to see what they thought about nurses being forced to rewrite physician orders. Magically, they changed their mind, and changed the policy to what I suggested to them in the first place. Two weeks later, I was searched by security, drug tested, and told there were "performance issues" (I worked there 10 years without one single complaint or write up). Everything came back negative, but from then on it was a constant battle with them, so I quit.

Absolutely not. The only thing you would chart would be any interventions for possible adverse reactions, but you still wouldn't say that was why you were doing it. Same for missed meds or omission. Chart only what's neccessary in a matter of fact, concise, nonjugemental, nonaccusitory way. Since you are an apprentice and it sounds like you are getting some questionable advice, let me also add some other charting pointers in this vain. Many nurses will write alot of unneccessary or inappropriate documentation in nursing notes. Never chart opinions, assumptions, errors, omissions, feuds between you and another nurse/doctor/patient. It doesn't belong in the patients' charts. If you have to call a doctor 65 billion times to get a reply or whatever, you chart: 2100 MD paged re: xyz. 2130 No return page. MD repaged. pt stable, etc. 2200 Clinical administrator paged (or whoever is next in your chain of command.) The nurse charting is ultimately responsible for what she/he charts. If you have to go to court one day and explain why you have this hostile note in your charting, or lots of charting but no intervention, you are going to be up s*** creek without a paddle. Things I have seen charted in a patient's chart that are unacceptable: Meds are behind because Suzy Q RN left me with a pile of undone work. Suzy Q RN said this, but its' not true. I did it because Suzy Q didn't. Pt. was obviously faking. Pt. is drug seeking. Pt. does nothing but whine and cannot be satisfied. Called Dr. Q 50 billion times and he won't answer. MD won't give me... MD yelled and screemed at me. MD said don't call me again. Family member is a PIA. Familiy members are enabling... Most of these are obvious why they shouldn't be charted, but you will see it done. If a doctor yells at you, won't call you back, or tells you not to call him again, you write him/her up. You don't put it in the patient's chart because it has nothing to do with the patient. What the court is going to want to know is, why did you let this patient suffer and/or deteriorate while you were arguing with this doctor? If you can't get what you feel your patient needs by your professional nursing judgment, then you go up the chain of command. If you are in a smaller hospital where you call attendings, then you can still go up your nursing chain of command. Trust me, if an attending gets enough calls from the OA/CA or NM something will happen. Never let a situation go without intervention if the patient is at risk. I had a patient that would fake seizures if she didn't get what she wanted. I mean she would ring the call bell, and say she was seizing. Do I chart "patient faking seizure"? NO! How do you know she's faking? You chart the objective and subjective facts. Called to room by patient initiated call bell. Pt. found with limbs jerking. Pt. eyes open, responds to touch with withdrawl, moaning etc... Pt VSS. Episode lasts 60 seconds. Pt. then states: "can I have my Ativan now." You would intervene appropriately per your unit protocols and nursing judgement and chart that. Always chart according to your specific unit policy.

I work at Duke University Hospital in Durham, North Carolina. Our CT step-down takes up to three on days (four if the staffing is really bad), up to four on nights (five for bad staffing). Our telemetry step-down, that also does all the drips you mentioned, takes 5 on days and nights regardless of status. Tele step-down at night only has one tech which means you rotate your vitals and i/o's every other. However, our surgical step down floors are 3:1 if you have 1 or more stepdown status patients and 4:1 if all your patients are intermediate care status. I will say though, that we have much more ancillary support 24/7 than it sounds like you do. Since we are a teaching hospital, we have 24/7 MD support a text page away, CPOE, and MDs are required to do many of the things the nurses had to do at the community hospital at which I used to work. I'm surprised your floor management is pushing for higher ratios while, ours are begging for FTEs for lower ratios. If you ever feel like it's becoming an unsafe situation either leave or contact your state nursing board for help. It's not worth your license. When they can't staff their floor and have to resort to travelers and agency nurses, they will realize there is a problem.

As night shift nurses you are sometimes forgotten, but I had one patient who made me remember why I was in nursing. I cared for a man in his late 60's with a Koch pouch that, over time, had gotten increasingly hard to cath. He was so sweet and patient with what had become a very painful procedure. So much so, the urologist ordered an indwelling foley to be placed through the stoma for straight drain. The first night I had him, I got report from a nurse who "hadn't gotten around to" irrigating his indwelling cathetor all day. This had to be done, or it would occlude with intestinal mucous. I check his I & O's. He was given 60 of lasix at 2100. It's now almost 12 MN, and he has had 240ml out since 3pm! The first thing I do is go in to check the cath, and, of course, it was occluded. Not just occluded, but pushed completely out from the pressure. His abdomen is so distended, he looks like he's 6 months pregnant. I used a bladder scanner over his Koch pouch just to see if it would pick up, hey, it's kind-of a bladder right? Well, it reads >999ml which is as high as it will go. I try for 15-20 minutes with four different types of caths to cath him. I even call his wife (who caths him at home) for some possible tips. 15 more minutes, I call back and she agrees to come in with their special caths and try. She tries for 15 minutes before I say to H*** with it, I'm calling the urologist. By the time he comes in from home, we've been trying to cath this man for about an hour and a half. Of course, the doctor has much more freedom as to how hard to push and what he can do, cause if something perf's, it's on him not the nurse. Well, he tries for 15 minutes until he finally ends up sticking his whole fist down this man's stoma before he can get him cath'd. We empty 2.5 liters of urine. The urologist hands it over to me and says: "find a way to secure it, 'cuz I ain't coming back," and leaves. After some thought, I use suture and an ECG lead to rig this thing from backing out. We have to completely bath and change linens because urine is everywhere. Not until 3am did his lights go out for sleep. I didn't get him again before he discharged home. Weeks go by, and one night I get a call from another floor. I happened to be charge. It's the charge nurse from the floor to which this patient was re-admitted. It's the same patient, and they can't get him cath'd. How did they know to call me? The patient told them my name, what floor I worked on, the shift I worked, and to please call and see if I was working. When I get to his room, he's got tears in his eyes; it has obviously been very painful enduring multiple cath attempts. He grabs my hand in both his big beefy hands and kisses it. He says: "I can't tell you how glad I am to see you. You are my Angel." Using the same technique the doctor showed me, I cath'd him on my first try. He thanked me profusely and repeatedly and talked about how the doctor had been impressed with how I had secured his cath that first night. He talked to me with pride- like I was his daughter. I never saw him again, but weeks later, I received a full two page letter from my manager. It was from him, thanking me for being his "Guardian Angel." Are you kidding? I cried like a baby, and I don't cry. lol

very well said. it's about the patient, not you. you either suck it up and do it, or find a different line of work.

Be careful of Crocs with holes in the toe box. OSHA says this is a violation of toe protection. Many places have banned them. Check your facility's policy on them. Ask safety/ infection management, not Suzi nurse from down the hall, because most people don't know they aren't allowed. Even my unit manager didn't know they were banned at our facility.

"Dusty's" by Klogs. I work 12 hours, go shopping after work, am pregnant, currently weigh 250 pounds, and my feet still feel the same as when I put them on. I'm breaking in a pair of "Caitlins" by Dansko. They are more cushioned and flexible than the original "Professionals" and have elastic gussets to make pulling them on easier and releive pressure on the top of the foot.

Definately NO. Even if they did, 9 times out of 10, the facility you work for would pay to put you through a bridgeover program just like they did with the LPNs. Here is the real low down on what you nead to be considering. 1. Money: Because you get ADNs through 2 year colleges (and tutuion is cheaper at two year colleges than at four year colleges) it is usually much cheaper. If money is an issue, look in your area. Many hospitals, especially if they are affiliated with a nursing school, will pay for you to go back to school to get your BSN and MSN after you have worked there a certain time period. 2. Time: ADNs are only theoretically two year programs. At most schools, you apply for the nursing program, and you get put on a wait list. You take prerequisite classes until you have a place in the actual nursing program. This can take one or two semesters depending on your grades and how many applicants there are. Once you enter the actual nursing program (ie. clinical rotations) you have two more years to go. At most schools, you are only able to finish in two years because of mandatory summer sessions. In other words, they are cramming 6 semesters into two years. At a four college, 6 semesters would be 3 years. So, by the time you finish your "two year" degree, most people have done 7 to 8 semesters, or the equivalent of four years, but you get "credit" for "two". In a four year school, you take your prerequisite classes for the first two years and the last two years are the clinical rotations. Sound familiar? ADNs are four year degrees compacted into 2 1/2 or three calendar years, not "semester years". This can make them even harder than four year schools, but can also make better nurses because it can weed out the weak and lazy. Most ADN programs start with 100+ in a class, but end up with less than 30. Check the school's NCLEX pass rates. Many times, ADN programs have higher pass rates. 3. Nursing school patient care and being on your own on the floor are two WAY different things. It takes an adjustment period beyond even the new grad orientation. You have to learn how to do it on your own without a preceptor looking over your shoulder and keeping you on time. ADN programs focus on nursing practice. BSN programs focus on theory. In my experience, it is easier for ADNs to transition to the "real world". BSNs take longer to catch up, but do. 4. ADNs in no way keep you from going to specialized nursing or even management, it just depends on your area and the hospital. Going straight into a specialized area is never recommend for a new grad anyway. Even if you are the validictorian of your school with a 8.0 GPA , you still need to get a solid Med/Surg foundation for at least 6 months to a year after initial new grad orientation. Due to the nursing shortage, you see more and more new grad internships to EDs or ICUs, but without a firm foundation in Med/Surg you will: 1. not have any experience off which to draw; 2. will not have found your "rhythm" as a nurse yet; 3. will probably be overwhelmed learning advanced practice teqhniques before you've mastered the fundamentals. And, my own personal hint for an easy tranition from school to practice: try to get your first job at the hospital where you did your clinicals. It will be a much easier transition if you are already familiar/ comfortable with that hospital's policies and equipment. Every hospital, even different hospitals within the same system, can have different policies and equipment. Every floor within a hospital may have it's own policies and procedures, so apply to floors you are familiar with and liked from clinical rotations. Me: ADN Degree RN III CMSRN 6 years experience Duke University Hospital