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Some things I've read in ER notes: The patient was recently diagnosed with "ear and double bowel syndrome." (Irritable bowel syndrome) The wound was urinated with normal saline. These always crack me up. Made me feel a little better when I found out the ER physicians use voice recognition software for their notes.

I know this is a question from school...but I love the idea of keeping a thread like this going with other possible scenarios. I love reading answers like this from experienced nurses because, as a new grad, I'm at the point where I'm able to tell when something's not right with my patient but the "now what" is what I'm trying to get the hang of. Thanks for posting this!

I was watching House a couple days ago and the doctor excused himself because he needed to go hang a new IV bag for a patient...it made me giggle :)

I graduated 3 months ago, and I was just wondering what sources you use to keep current on nursing issues. I'm mostly thinking new research, procedures, etc. rather than the political side of things. Now that I'm out of school and not doing the constant studying I'm seeing all the "real life" stuff but I miss getting the academic side of things.

Hi everyone, I'm a new nurse and I'm in the process of trying to fine tune my organizational sheets to save time throughout my shift. One thing that I'd like to make more efficient for myself is calling the physician for admission orders on a newly admitted patient. I'm trying to make a checklist of specific things I need to get orders on so nothing is forgotten. Some doctors are great at covering all the bases, but others will only give you what you ask for. I was hoping you could help me try to figure out if I'm missing anything. What I have so far: Home meds rec, IV fluids, pain/nausea meds if needed, DVT prophylaxis, diet, activity, labs/tests, chems/insulin for diabetic pts. Is there anything else that I should be asking about routinely on admission? I work on a general medical floor. Thanks.

I'm looking for scrubs that are made of stretchy material that are also available in petite sizes in pants. I found NuDimension which seem like the kind of material that I'm looking for but I can't see that they're available in petite pants. Does anyone have any recommendations? Thanks.

I just want to thank everyone who participates in making this site wonderful. I started coming here when taking my nursing prerequisites years ago and then started following the threads religiously when getting ready to start nursing clinicals as a way to relieve stress of the "unknown." I've learned so much about nursing from technical skills to politics from reading the discussions. I'll be graduating from nursing schol in 8 days and I absolutely cannot believe how quickly it has all gone by... despite the countless times that it seemed it would never end. I'll be starting my new job as a graduate nurse in the unit I did my externship in a few weeks, and while it's one more thing that I'm extremely nervous about, I'm so excited for what's to come. Thank you again!

I'm not a morning person at all either. I just love nighttime so night shift works a lot better for me that way as well as just more convenient for me since I have school-aged kids. However, I worked the day shift for about 6 months and was fine. I definitely had to go to bed earlier on the nights before I would work and it was no fun getting up that early, but once I was there I was there and so busy right from the get-go that it was never an issue.

It depends on the facility where you work. At my hospital we use computerized charting and the expectation is that each shift will complete care plans. This includes a problem list and whether the pt has met this goal and it is no longer applicable, whether it was met this shift, whther they are progressing, or whether the pt has not met this goal. If they have not met the goal we fill out a variance for that problem and state the problem, interventions, pt's response, and follow-up actions. It sounds tedious, but really it only takes a few minutes and I like them because they really makes you think about some things that you otherwise might not have time to stop and thing about, i.e. what ARE we doing about the patient's elevated BUN and creatinine?

1. When did you graduate? Will in Dec 2010 2. Do you have a BSN or ADN? ADN 3. Are you still looking for work? No 4. If not, how long did it take you to find a job? Applied to the unit that I did an externship on and currently work as an aide and was hired the day after I applied. 5. If you don't mind my asking, those who are working, what type of job or floor do you work on. Medical pulmonary

I thought the same thing, but once I realized that absolutely NO nurses on the floor that I was on use them I wanted to check. It's one thing for a few nurses here and there to take shortcuts but it really made me wonder when no one was doing it.

I'm about to graduate in 2 months and I know there are things that are different in the real world than "textbook." I see nurses on the floor do so many things differently than what I'm taught and lately I've been struggling with figuring out which things are okay to do a different way and which are just nurses taking unsafe shortcuts. One of my issues lately is the use of filter needles. I always use filter needles when administering meds from ampules. Nurses will kind of snicker and make comments about me using them because I'm a student. Do you use them? I was taught that shards of glass can be injected into the vein if the filter needles aren't used. Is this true or is this just in theory and the filter needles aren't actually necessary? Also, if you have time...can you mention some things off the top of your head that really are okay to do differently than what is taught textbook. Thanks.

I can't tell you enough how much I appreciate all the responses and explanations. It makes me feel better to know which way is correct and why.

Thank you all so much for your help. RNMeg-Yes, my hospital does have Micromedex. I use it for information on the drugs themselves, but I've never realized there was an IV compatibility tab. I will definitely be looking for that! P_RN-I agree about not going by what other co-workers tell me. I've realized that people have many ways of doing things and they aren't always considered the "correct" way. Since I'm just now forming my own ways of doing things I want to make sure that I'm not starting off by doing them incorrectly and I love to have references to back up my "why" of how to do them. Thanks. iluvivt-Thank you so much for the information. Yes, the rationale that you gave makes perfect sense.

i'm in my last semester of nursing school and i'm still a bit unsure about iv piggybacks even though i've asked questions from all the nurses i possibly can. it seems that i get different answers from everyone and i can't seem to locate a clear cut answer in any of my textbooks. i just want to make sure that i'm doing things the right way and have at least a solid understanding before i graduate. i know how to look up which continuous iv solutions are compatible with which medications, but what i'm unclear about is how to find out which medications are compatible with each other. for instance, most of my patients are on multiple iv piggybacks throughout the day. ns will be running with a piggyback of vanco, then merrem, and later on flagyl. i see most nurses just backprime the "old" line with ns for a few seconds, unattach the old piggyback bag, and then reattach the new bag and run it. this just doesn't seem completely safe to me. how am i to know that (just as an example) merrem and flagyl are compatible, and if they're not is this quick flushing of the line adequate to clear it all? if not, what is a better practice? is it better to use a different line for each antibiotic and just hook up that line whenever it is changed? or is this unnecessary and extra work? i guess i'm asking what the right way is to do this. i know there can be multiple ways to do it the "right" way and i just want to make sure that i'm not doing something in a way that is inadvertently cutting corners. i've heard people say that you can call pharmacy to check about the medications but i'd like to know if there's a place i can look this up on my own rather than calling pharmacy each time, which seems almost impossible taking into consideration how many times in a shift this has to be done. anyway, sorry for being so wordy. thanks in advance for any help you can give me.

The best advice I can give you for all nursing math is to look at whatever answer you get and ask yourself, "Does this make sense?" Usually it's obvious if it does or not and you can tell right away whether you're close or whether you need to change the way you're doing the problem. For example, if you have 100 ml of medication and it needs to be infused over 45 minutes, you know right away without calculating anything that it will be more than 100 ml/hr since you have to give it in LESS than an hour. Therefore, your answer of infusing 2.2 ml/hr would take over 45 HOURS! If you look at it critically you could tell right away that you need to look at it again. Nursing math is definitely something that takes time to get used to if you're not a "math person." Good luck!

Where did you hear the term "vesicular dementia?" As far as I'm aware it doesn't exist. Could it be a misspelling of vascular?

Have you applied for an externship? That's an excellent way to get experience as well as your foot in the door at the facility that you'd like to work...not to mention that it looks very good on a resume :)

I'm a nursing student graduating with my RN in December. I worked as a nurse extern during the summer and now that that has ended I applied as an CNA on the same floor. I'll be starting my new position tomorrow and am really nervous about this. Honestly, I see how hard the CNAs work, how many patients they have, and how much they get done and I just can't even imagine how they do it. I will now be one of them and I want to do just as good of a job. The downside is that since I externed on this floor I don't get the same "orientation" as someone who would be starting brand new and I know more is going to be expected of me since I've already been working there, and I worry that I won't be able to live up to that. The problem is that I have never seen the entire picture of what the CNAs do so I was hoping for some insight. I'm thankful to have gotten this position though, because I never wanted to be on of those RNs who didn't understand the other side of things and how much work the CNAs really do and what they have to put up with. Anyway, I was hoping you could give me some tips/pointers or anything to keep in mind to be a good CNA. I work on a busy med/surg floor with each CNA usually having 10-12 pts each and quite a few of the pts on this floor are actually total care. I wondered if you could tell me what your priorities for your shift are, how you ensure that everything gets done (like if you have 3 total care patients and all need to be fed at the same time...what do you do???), how you stay organized, etc. Thanks so much for the help.

I'm still a student, but I just completed an externship on a med-surg floor and am doing my leadership on a different med-surg floor. I requested both of them because I know how overwhelming and super busy they can be and I feel like I would much rather start out there, get used to that, and then if I move anywhere else I can carry those skills with me to cope better. I'd much rather go that route than the opposite: I see nurses pulled to my floor from other areas all the time who have never worked med-surg and they say how they could never do it every day. They're used to seeing basically the same kind of patient with the same kind of problem, which is definitely not how it is on med-surg. I think med-surg a wonderful way to build a foundation right out of school, and even though it may be terrifying at first, the experience you have will be priceless. Our team of patients almost always have completely different admitting diagnoses, different needs, and true, the ratios can be high and it can be very busy, but eventually you will get more efficient and more confident and it won't be such paralyzing fear anymore. Whatever decision you make, good luck to you

At the hospital where I work everyone is color coded based on their jobs. While it's not the most fun to have no say in what color you where, I definitely think it simplifies things for all staff since you can tell at a glance what anyone's role is. The colors are: RN: Light blue and/or white LPN: Royal blue CNA: Burgundy Lab: Black/red Transport: Green HUC: Beige Nurse Extern: Burgundy bottoms/white tops

When I applied for a nurse extern position a few months ago I received a message that said almost exactly the same thing. I was devastated. Then I got a call a few weeks later calling me in for an interview. When I asked about the message, they told me that it was automated and everyone who applied for that position received the same one. It made absolutely no sense to me and caused a lot of unnecessary stress. I ended up getting the position.

I agree about the TV. I didn't watch much to begin with but there were a few shows that I just "couldn't miss" and those hours really added up over the course of a week. I stopped watching them and instead caught up on DVD during breaks from school. I also took a step back from other obligations (leading church groups, teaching Sunday school, parenting groups, big volunteer responsibilities at kids' school, etc.) I don't know if you have kids or anything, but babysitting was a big deal. I made sure to line up multiple babysitters who could be called on short notice if my husband was working, my mother wasn't available, and if something out of the normal schedule came up. Overall, I just looked at my life and got rid of anything that wasn't necessary. Some of them were difficult to do but it's only a couple years, not the end of the world, and I can go back to them when life gets back to "normal" after graduation.

I've searched JCAHO's website and unless I'm completely missing something I haven't been able to find information about restraints. I'm specifically looking for what documentation is required to meet JCAHO's standards for restraints. Thanks for any help you can give me.