OncNewbie

I just wanted to thank all of you that responded to my inquiry, your responses were very helpful.

What are your opinions on non-rebreather masks, acute respiratory distress, & comfort measure patients? I had a patient last night that was transferred to my unit. She initially presented to the ICU (days ago) w/ temp elevation, elevated WBC count, & was unresponsiveness, (which was accompanied by acid-base imbalance). She stayed in the ICU for three days, on the forth day she was transferred to my med-surg unit. This pt was on a bi-pap in ICU & then started on 100% non-rebreather mask before being trasferred to my med-surg floor (pt was unresponsive when she was transferred). Also, they made her a comfort measures pt prior to transferring her to my med surg unit. Isn't there some relationship between acid-base imbalances & non-rebreather masks, perhaps a contraindication? Let me know what you think, I value your input. I know there are risks w/ non-rebreathers like drying mucous membranes & possibly developing atelectasis, but let me know what all of you think. Thanks:specs:

My old preceptor went to my boss, I received a phone call at home later that week. I told my boss what had happened & nothing became of it. I'm glad my clinical leader called me because it gave me an opportunity to let her know how my old preceptor has been treating me. Thanks again for taking the time to listen & respond to my concerns. :) OncNewbie

Thank you all for responding to my inquiry. Alittle more information... The patient in question was a day one post-op ventral hernia repair w/ a 2 wk prior cholecystectomy. I was wondering myself why she wasn't on a PCA, the patient was wondering why she wasn't on a PCA. Anyhow, the nurse that bullied me was day shift charge nurse & I was coming onto a 7p to 7a shift. I told the 7P-11P charge nurse the situation and she listened to me w/ a sympathetic ear. The nurse I had issues w/ has a history of belittling and being rude to other staff members; she even does this to other experienced nurses. I did learn from this experience but there was no need for her behavior. I do need to be more careful & seek clarification. Why was this 4 hr post ventral hernia repair being given PO pain meds in the first place? This was the 7P to 11P charge nurse's first question. Anyhow thank you all for your support.:icon_roll OncNewbie:)

I was just starting to feel comfortable in my new job when another nurse, (who used to be my preceptor, until I asked for a new one) went into my patient's Pyxis med of removed meds. She called me into the med room and her and this other nurse cornered me. She told me I couldn't give my patient IV pain medication after she had been on PO. The patient had pain level of 9/10, excruicating pain which wasn't being managed by PO meds. I was going to give the patient PO Dilaudid until I thought about switching her back to IV, so I had not had not returned the PO Dilaudid yet. The nurse flipped her lid & started yelling at me, you need to return pain meds right away, you can't just keep them in your COW, (computer on wheels), you need to be more careful, you're nursing license is on the line. My stomach is upset, my weekend off has been consumed by this "confrontation". I talked to other experienced nurses on the unit and they said it's ok to switch a patient back to the IV form of a pain medication, if POs not cutting it. The confrontation has raised other questions for me, since I've been dwelling on it. For instance, say that the patient has two pain medications that they can have, i.e. Flexeril & MSIR, MSIR is not working on their back pain & another dose is not due for another hour, can I give the Flexeril or should I call the doctor & get a one time order? What are people's thoughts on this situation? The nurse that yelled @ me gave a fresh post-op ventral hernia repair Motrin for pain because she wasn't due for another PO pain medication, what do you think of this? Also, if I have a patient who is not due for another dose of PO dilaudid for another hour can I give them IV Dilaudid 1 mg which they can have every 2 hours? Is it possible to give a patient a dose of IV pain med to get their pain under control & switch them back to PO later. I realize they are two separate orders w/ different directions I feel that I should call the doctor to be on the safe side and say, "So and sos pain medication regimen is not cutting it..." Advice?

I'm a new nurse, about 1/2 year experience and... I had a hypotensive pt the other day BP dropped very low, I called rapid response. My charge nurse told me today that there are certain things I could have done in the moment. She gave a few suggestions but I was so preoccupied and nervous they just went in one ear and out the other. I got home today & started looking through my nursing books but couldn't find a clear answer. Should i have lowered the bed, other than calling rapid response, what could I have done?

Sometimes you learn more about the meaning of life from your patients than your own life experiences. Also, there's nothing like going home & saying to yourself, I really helped that patient & that family. I've felt this many of a time on the oncology/med-surg unit I work on. I enjoy working w/ hospice patients, I like being there for the patient and his/her family. This is one reason why I thought I might leave floor nursing (after my one year experience in the hospital) and go into hospice nursing. I want to learn more about hospice nursing before I go into it. I also thought I might enjoy psych nursing. I like comforting people emotionally, I enjoy listening to people, & sometimes the best thing you can do is listen. I've learned a lot in Oncology. I access ports and discontinue PICC lines. I've learned so much and it's only been six months; I think this and the patients keep me there. When I first graduated nursing school this past May, I wanted to become an Onc nurse & get chemo therapy certified. That has changed. I think the dynamics between staff members & mgt has been a little overwhelming for me. My preceptor was burnt out and hated her job. My boss is constantly calling people into her office, (including me) to find why this happened...ect. I recently found myself in a rather overwhelming situation last week. Yesterday I was called into the office regarding the situation. Here's the skinny... The patient's primary doctor complained that stat labs were not reported to him like they should have been. I told my two boss' that this piece of information was not passed a long in report. Another thing they asked me is why I didn't bladder scan the patient when it was initally suggested to do so. I admitted that I got immediately preoccupied, (I had a patient that was trying to climb out of bed naked). They then asked if anyone offered to help me. I said, no not until everything started to go down hill. My boss' told me that they were impressed with my charting of the event & were surprised that I was able to indentify crackles as a new grad. They also told me that anytime a doc orders IM or IV lasix that the patient needs to be seen, I nodded my head. My boss' said they are going to treat this as a learning experience and talk to everyone involved. Then we are all going to meet to discuss the matter. I feel that the CRF & chronic liver failure patient was very acute and not an appropriate pt. for a new grad. I also feel that having all new nurses on, (w/ one experienced, LPN & thank god for the experienced LPN) was not good. Also, having a doctor that was yelling at me because I wanted to call report to the ICU even though it was shift change, was not helpful. I called ICU anyway and got my patient up there as fast as I could. I was honest and only hope that I'm not going to make enemies because I told the truth. I'm trying to get my mind off of the situation but it's very difficult. Questions like, "Do you feel comfortable working w/ OncNewbie" were asked and I just wonder what does it all mean? Maybe I feel this way because it's my first time getting called into the office like this. Anyhow, I don't like feeling like I'm walking on thin ice all the time. I requested to work on days because I feel I have a lot more to learn & I honestly feel like I'll have more support on days. But I don't know if another job is in the works because this is all a little too much. I have a scholarship w/ the hospital and don't want to have to pay it back; which I will have to if I don't give them a full year. But money is not everything and my husband says but honey you're making so much money and it's true but money is not everything. What about getting back to why I went into nursing in the first place, to make a difference in people's lives.

I don't know if floor nsg is for me. Anyone out there doing hospice nursing, mental health nursing at a retreat, home health nsg, or just something different that want to share? What is an average day like for you? What do you like or dislike about your job? What are everyone's opinions about floor nursing? Especially those of you who have been floor nurses for a long time? I'd appreciate your input. Related Topic (added by staff) You may be interested in reading Beyond the Bedside: 10 Nurse Opportunities Outside of the Hospital for in-depth opportunities.

I have been an working in an oncology/med-surg floor for a little less than six months. I'm already thinking about going into a different area of nursing. Most of the staff members on my unit are stressed to the max & miserable. I can kind of see why they are unhappy because their actions are always being criticized. Is this common place? Mgt comes in early & checks on random patients. I understand people's lives are @ stake. How do you not take your job home w/ you?

I HAD A HORRIBLE NIGHT... When you can count the years of nsg experience of your current night staff on one hand, we're in for a rough one if something goes wrong! I get onto my shfit & my patient is somewhat somnolent after 4 mg Dilaudid, serum ammonia of 93, liver & renal disease. Lactulose q 2 hours, ok. Lungs starting to sound very junky, I think I'll call the hospitalist & let the charge nurse know I don't have a good feeling. 40 mg Lasix IM, 2 liters of oxygen, HOB up 30 degrees, no void; no void in over eight hours, bladder scanned for 524ccs... Lungs get junkier, oxygen up to 4 liters; hospitalist livid because he has to come down & see the patient, why didn't I ask him to see the patient sooner... Treatment: IV, IV lasix 40 mg, insert foley, stat ABGs, & ship him to the ICU. Wife of patient comes up to the unit & tells me she wishes I was a better advocate for her husband, I cry. I hate being a new grad. Why didn't I have the balls to tell this prick doctor, (who should already know by what I've told him that he should see the patient) "PLEEASSSEE come down to see my patient, I think he's getting worse..." until **** hits the bucket. The patient is stable, he's being treated as we speak in the ICU somewhere in America... But I feel like I should have stuck up to this prick of a doctor & said he's going bad, something needs to be done, instead of waiting for **** to hit the fan. Also, I went to my charge nurse who wasn't very helpful; she was basically indifferent, I don't think she knew what to do & the hospitalist didn't want to stop surfing the internet... What's wrong w/ this picture.:angryfire

Chloe, I'm so sorry to hear what happened to you. It's every new nurse's fear to be blackballed like that; I still fear it in fact. But you know what... Would you really want to work on a floor where the people that are willing to help you are scarce? Nursing is such a unique profession unto itself. Can you really think of a profession like it? No. Many times we're faced w/ hypercritical people who are not supportive of one another. This is not true of all nursing or hospitals, etc, but it's a reoccuring theme & the U.S. could really use a paradigm shift in regards to this. When you go for your next job interview; interview them. What is the nurse to patient ratio? Talk to other people that work in the department? Find out what management's like? Are they accepting of new grads? Ask your old professors who might know of new grads that went to work there, maybe they can give you some feed back. A good book you might want to check out is The Everything New Nurse Book by Kathy Quan, excellent read. Good luck my friend & keep your chin up.

I definitely can sympathize. My initial preceptor would treat me like a retard & refuse to teach me essential parts of my job. She hates her job & is basically ready to retire, go figure. Anyhow, when my three month review arrived, "surprise, you're on probation", my immediate response was, "I want a new preceptor". My probationary period extension wasn't all her fault; I was new & being an RN was and still is new to me" but how can you learn if someone treats you like a retard and isn't willing to help you. Good for you for putting up w/ her. Not all seasoned nurses are like that, thank god. It's good that you're seeking out the helpful experiences nurses that are not treating you like a retard. If you had a longer time to go, I'd suggest switching preceptors. What you're going through is all too common. Also, some hospitals in my area give more money per hour as well as give away cruises to nurses who choose to precept, hmmm.... Good luck to you. Be weary of her making you so nervous you make a mistake, with her rush, rush, attitude. My old preceptor used to do that to me and she got my nerves going.

I know exactly how you feel. In fact, when I didn't know something they thought I should know, they would go tell my boss. Then all senior nurses came to the conclusion that nurses schools are just different then they used to be. Anyhow, hang in there. It gets better. I've been a new nurse for 6 months & trust me it gets better. How else are you going to learn unless you ask questions. The older nurses are just going to have to suck it up and answer your questions, like they should. I think sometimes older nurses forget what it's like to be a new nurse. :)

I work w/ this nurse w/ 2 yrs of experience, not too far out of nsg school to remember what it's like to be a newbie, right? So here's the skinny, I have been helping this nurse when emergencies arise, (like N-G tube stat) & when she's had an admission. She never says thank you & criticizes the way I do things. Why did I help her in the first place? We should all help each other out, right? My boss, strongly emphasizes helping your fellow co-worker, it's part of our review, in fact. But I do not want to help this woman because she's unappreciative. Another nurse, (1+ yrs of experience) says the last time she helped this nurse, she bit her head off, so she's through helping her out. This oldie but newbie obviously has some issues: 1) she gets a lot of pressure from senior nurses because they think she's still a novice nurse, (technically, you still are at two yrs) 2) she's the youngest nurse on the floor 3) she doesn't seem to really like our boss 4) she works night shift & is not a night person My dilemma: By not helping her, I risk not being a "team player" and if I tell her how I really feel, I'm afraid she's going to flip out on me, because she did so on the prior nurse who was helping her. I'm sick of being treated like an imbecile by this lady, any advice?

It's really not ok to be doing opposite shifts like that so close together. I can speak from experience... because I've done it very recently. You could stick to your guns and absolutely refuse to do the shift but then it will make the nsg mgt have a negative view of you and your ability; they may think "she's not a team player". The real question is, "Do you plan on working their after you get your RN?" If you do, do the night shift but make sure you sleep in as late as you can the morning of your 11p -7A stretch. Stay up late the night before too. NCLEX flash cards are the best because you can do them in between tasks; I used to use them @ work when i was studying for the boards. Also, if you're not planning to work there after RN school, you don't have to kiss their butts! Anyhow, in Nsg homes they are more apt to use their nsgs but you don't owe them anything, you have to take care of yourself too. :) OncNewbie Good luck in whatever decision you make but set boundaries, I am willing to do... but I feel uncomfortable doing... It sounds like you already did this, so you're on the right track.