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!

I had a death the other night, and despite performing post-mortem care countless times, I still print out my hospital's procedure for care. It tells us to gown the patient. Basic dignity. If the morgue needs to disrobe the patient, they will. The funeral home should have no problem unsnapping a gown when performing their care on the individual.

I had a female patient come onto the floor with a Dx of constipation. Admitting/overnight hospitalist came up to attempt to do a manual disimpaction of the patient, I was there at the bedside. MD is doing his best, but Pt. is confused and in pain. She starts saying "No, NO! Stop it, no! You can do that to a man, but you can't do that to a woman!" I was trying so hard to not LMAO at the bedside.

I've been through quite a few codes in my short time on a medical floor. We have had one frequent flyer who has coded at least 3-4 times on our floor. I remember she was a transfer from SICU at the beginning of my shift (my patient). I had already reported off on her to the day shift, went to the back room to get my things, walked slowly by her room and poked in as I was leaving... and yeah, she was bluish and agonally breathing. That was a quick successful code, she was off the floor within a half hour. Another time (of course at change of shift again) we coded a woman for about a half hour... I had never been so happy to see day shift workers come in for support. That was a nice smooth code as well. Patient went to heaven. Only a few times have I seen out of control codes with something like 20 people just hanging around in the way. Most of the time at night they are well-controlled at night. I must say, I love when a specific doc runs the codes, he stays so calm and is very clear in his orders. Love Dr. G.

A rant, and a call for advice from my fellow Med-Surg'ers. I have been working 12 hour nights at my hospital for a year and a half. Over the past year we have had a MAJOR turnover of staff. We've lost about 4-6 excellent nurses who were able to be charge. Somewhere around 8 months into my time on my floor, I took on the role of charge RN overnight. I would still take a full patient assignment (5 patients at most). Life was good. I began to take steps to be a better me and a better nurse. I felt positive about being in charge, as I worked with more than competent staff. Everyone could manage themselves pretty well. Shortly after, I was given the role of preceptor. This generally went okay, but it was a big stress to precept/act as charge/take my own patient assignment. On a positive note, I was only in charge maybe one night a week while precepting, and luckily I had a wonderful new grad who grabbed the job by the balls and took every opportunity to learn and not drown in her work. Lately, things have changed drastically. There are currently four nurses who can be in charge - one of these nurses does one night a week only, the other does weekend nights (Friday and Saturday), there is one FT nurse, and me. The weekend nurse is going on maternity leave in February. This will leave me and the other FT nurse do be in charge EVERY shift we work. My manager is aware of our staffing issues. I was hoping she would hire an experienced night nurse who, following orientation, would be able to take on the charge role to help lighten the load. No. She hired yet another new grad. According to my manager I will begin precepting her in February. I feel so burnt out. As soon as things finally start to smooth out with the latest new nurses it all begins again. The girl who is "next in line" to be charge can't possibly take on that role anytime in the near future. Not ready. The other new grads are there to get their year experience and then "move on." In a nutshell I am being forced to be in charge while precepting again, still managing the newbies, with the added bonus of our census increasing next month. The nurse going on maternity leave is taking four months off. *sigh* I am about ready to look for a new job, or at least a new floor. Has anyone had similar experiences, and if so, how did you cope? I am thinking Tele might be a nice change if a position ever opens up. I am not going to work with an experienced floor nurse for the next four months. That seems like some sick form of torture.

COPD exacerbation, acute renal failure, sepsis, UTI, pneumonia, syncope, anemia, intractable back pain, intractable abdominal pain, etc. etc.

At my facility we attatch the blue caps to IV tubing not in use. We keep plenty of these in stock and I usually pull out between five and ten for my 12 hour shift. A lot of nurses will use the tops from saline flushes instead of the blue caps, which I find irritating because half the time I find a "naked" IV tubing with the white cap on the floor. I also want to strangle the nurses who keep using wrappers from alcohol preps to cover the end of the IV tubing. Ugh!

My facility instructs us to flush with 10cc saline and 1cc heparin Q8 hrs. We document on this in our MAR. I always double check my order, as some MDs will order without the heparin based on the Pt's current issues/past medical history. I still flush with 10cc saline before med admin, and 10cc saline/1cc heparin following med admin based on flush orders.

Good for you for sticking up for yourself, and more importantly- your patient! Is the open area truly a pressure area, or could it be a partial thickness injury? I learned this from my current hospital, that if moisture is a factor in the skin breakdown, it may not actually be a stage 2... just food for thought. If the patient is incontinent frequently, I would probably try something like a mepilex border or zinc oxide (Balmex) to the area. Sounds like it is an open deep tissue injury at this point though... Best of luck!

I work with the same 3-5 doctors at night on my floor. After working with them for almost a year, I am on a first name basis with most all of them except one. I could NEVER bring myself to call him by his first name. When I call the doc on the phone or address him/her in front of a patient, I always use "Dr." If he/she is hanging out at the nursing station taking their time doing an admission or just shooting the **** I will refer to them by their first name. I have never had an issue with this. I think it's safe to say there is a "feeling out" period of time when you get to know someone. I feel that it's similar as to when you finally get to call a friend's mother "Jane" instead of "Mrs. Smith."

I am casually seeing someone from work. I like this person a lot, but I only get to see 'em once every month or so because of our schedules. It's fun, but there is no pressure on either end. This person will be moving next summer to start fellowship. We both keep it on the low just in case of repercussions from co-workers. If something blooms, and it doesn't interfere with patient care, I don't see the harm.