evilolive

I would have done the same thing as the OP. How would it make the resident feel if the nurse dropped what she was doing for patient care for a pain med that could wait 10 minutes or so? If I were a resident receiving incontinent care, or having a dressing change done, I'd be royally P.O.'d. To me, this isn't just nursing prioritization, it's common courtesy.

Diagnosis, pertinent history, ambulation, treatment plan, and discharge plan are my necessities. It's a bonus if you tell me what fluids they're on, and how they take meds (I take a lot of medical overflow, and it would be nice to know if I need to bring an applesauce into the isolation room with me). Sometimes the family issues during report are overkill. I don't need the whole story, just a "heads up."

Electrolytes, Mag, Phos, CBC are the ones I see regularly on a telemetry floor. If you use a computerized system it may give your facility's lab value range when results come back, which makes reading them easier. Always know your facility's high/low ranges and you'll be good. It definitely varies from place to place.

I work on a stepdown unit now, and started with med/surg prior to transferring. The telemetry experience can only benefit you in looking for positions down the road! We have a lot of med/surg overflow, and patients who really have a lot of co-morbidities that translate into "med-tele." Rotating shifts must be misery... I've only worked overnights for the past three years in my current hospital. I work with a lot of Moms who do this shift and seem to enjoy it. Good luck! :)

You know, I never thought about that D-Ring until you brought it up! Maybe if you had a few items on a carabiner (like scissors or hemostat) it would come in handy. I never liked that much stuff banging against my leg all night though!

Very infrequently do I have to use filter straws, but on the rare occasion when I have to draw up phenergan, I always use one. I remember when I did a L+D rotation in college we used them frequently to draw up Vitamin K. For some reason, there are always MILLIONS of them stocked on my floor. Someone must like them a lot!

Being threatened with physical abuse. I am generally the "nice" nurse, but if you make a fist at me, get ready to hear me get very serious.

One thing I thought about when I heard about the reimbursement issue: I only fill out surveys when I feel as if I have had sub-par service. I know this is only my personal opinion, but I feel the need to vent and complain about things I don't like. It's sad, but very rarely do I make the effort to fill out the customer surveys unless I felt slighted by the establishment in some way. I think this method of reimbursement is setting up our facilities for disaster. Oh, and what about all the deceased "discharged" patients who I provided extraordinary care to? Do they get a say?!? Can you send some surveys to heaven?

Never stop asking questions

I think you'd succeed in critical care by starting in med-surg. With med-surg, you'll learn a lot of the basics, and a ton of skills over the course of a year or two. If you have the basics under your belt, my thought would be that you'd transition easier into critical care. Remember, if you start in critical care, you'll have to learn the basics AND everything that comes with critical care nursing. Just my two cents, as a med-surg nurse :)

Oh god no, that is just a mistake waiting to happen for the both of you. I have precepted two new grads in the past year, and we have shared the same patient assignment of 5 each time. You are responsible for teaching the new grad the ropes, and although he/she is licensed, I would probably venture to say you're responsible for the patient assignment at the end of the day. If your immediate manager does not listen, go up the chain. Not safe. Who cares if they get angry. I say you should get angrier!! :)

For the first 16 months or so of my current job, we had this glorious, convenient way of communicating with whatever in-house hospitalist was covering our unit - The Text Page. With The Text Page you could send a nifty little message to Dr. to get a short and sweet message across. It especially worked well for when patients refused a medication - this way Dr. can get the heads up that LOL refused her Senna at 9pm, and you don't have to slow his roll if he's in the middle of an admit. Not like he really cares that granny refused her med, unless she's constipated. Hey doc, can you please put in CVAD verification for Pt. XYZ? Five minutes later you can "officially" use the PICC that day shift began using anyway. We could even request pain medication, let them know a DNR/I had to be signed, etc. etc. Of course we would call if something emergent requiring their help was needed, or if the situation was too long to be explained via text, or if the MD was taking too long to enter orders/reply to the text. Some MDs made damn well sure that the night nurses communicated this way. It made life simple, sweet, and easy for everyone involved. Can you see where this is going? Of course all good things must come to an end. From what I understand, a Cardiologist at my facility made a HUGE stink, calling The Text Page a HIPPA violation. Per my manager, we are no longer allowed to use this method of communication at night. Because of this, I have truly had to DRILL into my nurses' heads what does/does not warrant a physician call overnight. DO NOT call to d/c orders like blood glucose tests that you did anyway, and aren't due until the morning. DO NOT call because your patient is refusing to drink contrast (per day nurse) and you haven't attempted to resolve the issue yet. My question to all of you is, have you ever used a form of communication this way at your facility, and was it ever shot down by someone higher up the food chain? I say if text paging your unit, room number, and initials of the patient are a HIPPA violation, then the Bedboard/Transport beepers who use the patient's full name, MR#, attending physician and diagnosis are even more of a HIPPA violation. At the end of the day, all of these beepers are for In-House use. What is the problem here?

1) IV tubing that has an alcohol wipe wrapper covering the end instead of a sterile cap 2) Overflowing linen/trash cans 3) When the new lady in material services reports our night staff for "refusing" to use a program we haven't been able to log in to for ordering supplies. Lady, you are the first one giving me a problem about this. Cut it out. 4) When my manager emails the ENTIRE UNIT regarding the refusal to use the program. Why must you make my shift appear lazy to everyone else. That one I did not tolerate. 5) Seeing all the new grads leave my unit before I do. 6) I run 90% of the way to the bed alarm before someone finally yells "Got it!"' 7) Hospitalists that don't seem that motivated to try to work with you overnight and will ALWAYS have an attitude (or at least it comes off that way) 8) The endless questions like, "this patient has blood sugars BID but isn't diabetic, and it's midnight, so I should call the hospitalist to d/c that order right?" NO NO NO! 9) "Courtesy bags" of fluid that are the completely wrong fluid. Now that patient's been charge umpteen hundreds of dollars, and I can't return the bag because it's an isolation room. 10) When you "hold" the tube feeding, please flush the darn line so it doesn't clog. Kthx. Ten is enough for now :)

In three years of working nights I've never taken a nap. I believe there was one night when I laid my head down on the nurses' station for about 4 minutes, but then couldn't even think of closing my eyes. I don't get a "paid" lunch break, but I usually try to get off the floor for about 15 minutes once a 12-hour shift. I've been so exhausted at times, but there is always something to do at night to keep you busy. Whether it's rounding on patient rooms to make sure they all have a suction setup, folding isolation gowns for floor stock, or stocking the computers on wheels, it's mindless work that can keep you going when it's a slow night. Note that this mindless work happens infrequently for me the charge nurse, who is usually dealing with my own poopy assignment and everyone else's poopier assignment.

I work in CT on a medical floor. 5 patients per nurse at night max for my floor (we have 15 patients). The acuity ranges from "walkie talkie" ready to be discharged to ICU transfer who still looks like they're going to require a ton of care. It really varies on my floor. The most patients I ever had at one time was probably 7, when a nurse had to go home sick in the middle of her shift. Even the five patients can be a handful. I should stop talking though, I'm lucky enough not to have 7-12 patients!