Rabid Response

Go for the tech job at the trauma hospital. The experience itself is probably not going to count for too much on a resume for RN positions, but you will have a foot in the door at an acute care facility. Never underestimate the power of networking. Also, you can work on basic nursing skills and become comfortable in a fast paced environment. In my opinion (I will get reamed for this) long term care is kind of a dead end/career killer. Good luck and congrats on having two job offers.

I've only attended one funeral for a patient, and I'm not sorry that I went. He was in our ICU for a long time, and I got to know his wife very well. I came to work the morning after he passed and did not realize he was gone. His wife was there to sign some paperwork, and I gave her a big cheery wave hello as I breezed past her on the way to my assignment. By the time I learned that he had died the night before, she had already left the unit. I felt terrible. I don't think I could have lived with myself unless I attended the funeral and was able to express my condolences to his wife. The amazing thing about that patient's funeral was that it gave me the opportunity to learn about the man he was before he became ill.

Ugh. This post brings back bad memories of my own student clinicals. So few of the nurses wanted anything to do with us, and the ones who were forced to work with us either ignored us or hid from us. Some of the blame must fall to your clinical instructor. Our clinicals improved (slightly) when we got a clinical instructor who worked at the hospital where our clinicals were held. Apparently it's a little harder to be rude and condescending to someone who you will have to work around in the future. Because of my own past experiences, I have gone out of my way to welcome students into our ICU and always offer to work with them when I can. I have rarely regretted agreeing to work with a student and only then because I had a really busy/crazy day and know that they didn't get to do much besides follow me around. Some nurses are going to be less than welcoming no matter what you do, but there may be a few things students can do to make themselves more welcome on the floor. One student automatically started changing my patient's bed linen right after we had gotten him out of the bed after extubation. I remembered that thoughtful gesture and asked specifically to work with that student again. Also, while I like answering questions, there is a time and place. If I look super busy and distracted (probably more often than I wish I did) maybe that's not the time to ask a very detailed question. Write down questions to ask later during lulls in the workload. One student did that, and it worked really well for both of us. While I understand that students are not placed in our unit to do scut work, my ICU has no nurses aids and so doing any of that sort of work for me (serving meals, helping to turn patients, toileting patients, emptying foleys) frees up time for me that I can spend helping them to learn some of the more interesting and challenging stuff. This too shall pass! I once got YELLED at by a CNA when I was a student and just trying to help. I left clinicals that day on the verge of tears. I now work in the same hospital where that happened and I see that CNA often during my rapid response rounding on the med-surg floors. Now that I've had a chance to get to know her, I realize that she yelled at me because she is incompetent and stupid, and I was the only person lower than her that she could take out her frustrations on. She is lucky that I'm not a vindictive person. Hang in there, students, and try to remember how crappy it felt not to be welcome so that you can change things when you are the nurses.

A few days ago, a patient's wife was irate with me because I hadn't brought HER any breakfast. "You didn't even bring me a coffee!" she shouted. I explained to her that I am not allowed to provide food or beverages to anyone who is not my patient. I told her that there was a cafeteria downstairs. "But then I will have to PAY for it!" was her response.

I work with one of those too. When I first started on the unit, I helped her a lot. It seemed that she didn't know how to set up/use the majority of our equipment and never had any idea where things were stocked. Also I was constantly running to answer her call lights and alarms. One day I asked one of the veteran nurses how long Wingnut, RN had worked on the unit, assuming that she had started a few days before I had. 15 YEARS!!! She has worked IN THAT UNIT for 15 years. It seems she gets by because her friends (and idiots like me) pick up just enough of her slack that she hasn't killed anyone. Needless to say, I no longer help her unless it is a matter of patient safety. I won't even double check meds with her because I don't trust her not to make a huge mistake later and have it traced back to me. In short--I feel your pain. Working near someone like that always increases the labor load and the stress.

I really wanted to love clogs. I never felt quiet right in Danskos or Sanitas. Although I don't ever really run while at work, I don't like the feeling that I couldn't if I wanted to. I wore Crocs for a while but I would bump the toe of my foot on the floor every once in a while and pitch forward--ugh. Then one day, while transporting a critical patient by gurney, I did the toe bump thing, my croc flew off and got run over by the gurney while I hopped on one foot after my co-workers trying to retrieve my shoe and catch up in time to get the elevator. So awkward! After that I started wearing shoes that would stay on my feet, that let me feel the floor, that I could run up stairs in if I had to--Adidas Sambas and Converse Chucks. My shoes have no arch support and no padding. Other nurses think I am crazy, but my feet feel better than ever, and I never trip anymore. I save my squishy, comfy shoes for when I get home.

I have a 2.0 GPA, a criminal record, and I'm pregnant. What are my chances of getting into nursing school? Should I wait to apply until after the baby is born? Should I wait until I'm paroled? Also--do these pants make me look fat?

Our Pyxis always prompts us with a message like--"Are you going to give the whole 4 mg?" to which you must answer yes or no. If you answer no, it will not let you continue without a witness. If your patient is still on the unit, you can go back in the Pyxis under that patient's name and see what exactly you pulled out.

I would get my CRNA license and then work with an organization like Doctors without Borders. I would also get a Masters or higher in Disaster Management or some such degree so that I could be a useful volunteer at large disaster sites. Teaching nursing school would also be fun. I would not ever want to leave nursing completely but would enjoy more flexibility and excitement (and less charting and red tape).

I'm reading this while recuperating from a surgery I had three days ago, in which I did have part of an organ removed. Really the thought that some silly nursing students and (I'm sorry but it must be said) a callous OR nurse would think it was amusing to post with my removed body part for a photo on freaking Facebook has brought tears to my eyes. My God, HIPAA aside, where was the sense of common decency for a fellow HUMAN being??? Really a nightmare for anyone who has been a surgical patient. Those students and the nurse got at least what they deserved. Why would you think otherwise?

I had a similar nightmare recently. In the dream I was in attendance at some bizarre educational post-mortem the attending MDs were holding for the new residents. There were three bodies laid out on gurneys. The one closest to me was the body of a young woman who still had an ET tube in. At one point during the presentation, the young woman opened her eyes and started moving her hands. I yelled for the doctors to do something, that she was still alive, that we needed to start bagging her or remove the tube or SOMETHING. But the attendings just said, "Oh we declared TOD an hour ago, we can't revive her now." Everyone was just standing around watching. I was so frantic and horrified that I woke up with my heart racing. Then I went back to sleep and swear I had the same freaking dream two more times that night with no resolution. Ugh.

Horrible.

We usually have one or two notices posted on the back of our bathroom door. Often they are announcements of the time and date of the next unit meeting. My favorite was the flyer advertising free pap smears offered to hospital employees that week during breaks. I can't think of anything I'd less like to do on a break than have a freaking pap smear. Nothing like holding your pee for six hours and then getting socked with that message when you finally get a moment to relieve yourself.

Great work on the resume and cover letter. I'm in the process of revamping mine for a CRNA program application, and you have given me the inspiration I need to finish that tedious job. Thanks for posting, and congratulations on your new and well-deserved position.

We got an overdose patient in the ICU once. His medical history contained a diagnosis of known etoh abuse going back decades. His roommate brought the guy's home meds to us in a paper lunch sack. Among the contents of that sack were three bottles of benzos, a bottle of Ambien, and a bottle of Viagra--all prescribed by the same doctor. That little brown bag told a sad story.

It's very telling that their only testimonial is from someone who has NOT yet received his RN. All the program has done for him is to make him feel better about dropping all of his prereq classes. I think it is criminal to take advantage of people like this.

Congratulations on your new job. I'm sure you'll do great. I would suggest that you start studying materials for the CCRN exam right away. For me, that extra study really helped with my day to day functioning during my orientation and my first year in ICU. By the time I had enough bedside hours to take the exam I hardly needed to study much at all. Your hospital sounds really supportive. However, try not to mention your CRNA ambitions to (m)any co-workers until you are fairly well established on your unit. It tends to rub some ICU nurses the wrong way, and you will have enough to deal with at the start of your nursing career without inciting enmity. Yay! I am excited for you!

Your thick skin will develop in time. Those (horrible) PCTs who predicted your failure in school are of the type who can only feel good about their own meager lives at the expense of other people. They don't think you will fail so much as fear that you will succeed. So you are not a perfect PCT right off the bat--big whoopdedoo. That is hardly a predictor of how you will perform as a nurse. And in my experience, people who stay PCTs for too long often make substandard nurses as they can't break out of a merely task-oriented mindset and into the realm of critical thinking. Keep your chin up, take some deep breaths and carry on. In a few years you will be a nurse and having to listen to these harpies or their ilk go on about some other poor newbie. Remember how it felt to be the focus of that kind of negative and gloating scrutiny and do your bit to make new trainees feel welcome and supported. Good luck, and don't let them get you down.

Hang in there! I hate hate hate nights, and working them makes me sick as a dog. When I was hired, my manager told me I'd have to do 6 months on nights and then could transfer to days. Four years later I was still waiting for that day shift haha since the economy had tanked and my hospital closed all open positions indefinitely. I wanted so badly to quit, but I knew there were no day shift jobs for me at any other hospital in the area. Keep reminding your manager that you want night shift. Talk to the nurses on nights and get the unhappy ones (very few people like nights) to remind the manager that they would love to switch to days the moment he/she thinks they are ready. Don't make any rash decisions or threats to management. I am sure that you won't have to wait long for a night shift--in general, that is not a very popular shift. Be grateful as you can that you are not having to alternate nights and days in the meantime.

I work for a union hospital, and I am grateful for the benefits that has brought me. That said, I have come to believe that unions are merely a necessary evil. I am not naive enough to think that management really gives a hoot about anything but the bottom line, but I am also not naive enough to believe that the union cares about nurses any more than it needs to in order to perpetuate its own powerful position. I like the security of knowing that I cannot be fired for some made up offense so management can balance their budget. On the flip side of that, I have to work with several nurses who are so incompetent that they have no right to be working any area of healthcare, much less nursing, and these nincompoops are protected time and time again by the union. Also, I have to say that despite our fantastic working conditions, excellent pay, etc... our morale is kind of crummy. Nurses complain about every little thing. While nurses other places complain that they are going 12 hours without a break, my coworkers (whose breaks are guaranteed and whose patients are always covered by the break nurse during that time) will complain that they are not allowed to go on break at exactly the time they requested. They get 15 minutes, then 1/2 hour, then 15 minutes. The ones that Always come back late from their breaks are the ones who complain loudest when the break nurse is late giving them their last 15 minutes. No one seems grateful for what we have! My friend has a union job in another field and tells me it is pretty much the same--everyone's a big whiner, and the longer you stay there, the more likely you are do adopt the prevailing attitude. It's a shame. So I guess I'm grateful for what the union has brought in the way of benefits, but I wish that I didn't so often feel that it was now mostly benefitting the incompetents, the lazy, and the whiners.

The same thing happened to me when I worked nights. Because I have a family and other obligations I could not keep to a regular schedule of being awake nights and sleeping days; I was always short a few hours of sleep. When I did finally get to sleep for an uninterrupted period, it was not unusual for me to sleep 18 hours at a stretch. After I switched to day shift I was amazed to find that I only needed 6-7 hours of sleep each night to feel rested. Multiple doctor visits and tests showed nothing wrong. I cured myself by switching to days. I feel so good that I don't miss the pay differential. It's worth it to feel human again. Maybe you should cut out the daytime OT?

That was the gist of my argument with the intern. He was claiming that the patient's code status disallowed us from using a non-rebreather. On admission, during their code status discussion, the patient and his wife had expressed a wish that he not be intubated nor (supposedly) be placed on bipap. At the bedside, however, the wife was requesting that we give him more oxygen, as he was barely rousable (not his baseline). The wife (who spoke little English) did not seem to understand what exactly she and her husband had agreed to when they worked out his code status with the ED doctor the day before. She didn't understand what bipap was, so how could she have known that her husband wouldn't have wanted it? In any case, I could not see that his status should preclude us from placing at least a NRB on him, and I was having a ridiculous argument about it with the intern. We placed the NRB, his O2 sats went from low 80's to high 90's, and he perked up considerably. Time for a meeting with the palliative care team WITH AN INTERPRETER. I also always get my own vitals on my patients. I did not realize that the problem of CNAs fudging vitals was so prevalent. I'm slightly horrified. On my next RRT shift, I am going to talk to the manager of the m/s floor on which this incident occurred and relay my concerns to her. I like to give people the benefit of the doubt because, lord knows, I have made my share of charting errors, but something about the situation just doesn't feel right. I really appreciate everybody's input on this situation. Your stories are unsettling. The scales have fallen from mine eyes!

Are you not changing the biopatch along with the tegaderm? It is my understanding that the biopatch is supposed to pull off along with the tegaderm when the old dressing is removed. This is why we are taught not to tuck the biopatch under the line.

Today, as part of my rapid response rounding, I spent an hour at the bedside of a patient who was having respiratory issues secondary to TB and exacerbated by CHF. The whole time I was there, the patient's O2 sat never exceeded 89% despite his being on Hi Flo NC at 100% FIO2 and 30L/min. I had a lovely argument via telephone with the brand new intern who claimed that putting patient on NRB would violate the patient's wife's wishes that he be a partial code and basically disallowed everything except for pressors in the event of a code. (The patient and his wife had no idea that they had apparently signed away their rights to an O2 mask!). In any case, the doc at one point said, "I just checked his chart, and he looks like he's doing okay.". HUH??? I walked to the nearest computer cart and opened the patient's chart. Sure enough someone had charted the patient's vital signs as O2 sat of 94% on 50% FIO2--ten minutes ago! Up and down the halls I roamed searching for the person who had charted these vitals. The hour I spent in that room, not one other person had come in to take vitals or assess the patient. Apparently it was the CNA. CNAs are responsible for getting vitals on the patients on our med-surg floors. Unfortunately this is not the first time I have found the charted vitals to be completely divorced from reality. Every med-surg patient has a respiratory rate of 18 or 20 for some reason, and nobody's O2 sat is ever below 90 unless the patient is busy for some other reason (diarrhea for instance) and the floor nurses want her/him transferred to a higher level of care. I have noticed that assessments and vitals are especially fictional if the patient, like this one, is on isolation precautions. I could not find the CNA, but the RN for the patient assured me that the charting must have been a mistake. She thought that the CNA must have charted another patient's vital signs in this patient's chart. I decided not to make a stink about it so as to maintain good relations with the staff on that med-surg floor, but the more I think about it the more I feel that the CNA made up those vital signs just so he wouldn't have to enter the room; the values were much too similar to what the vitals had been 4 hours previously. What do you think? What would you do? Find the CNA and question him (he pretty much disappeared after that!)? Fill out an incident report. Contact the manager for that floor? I did put a note in the chart stating that I had been at bedside during the time the vitals signs were alleged to have been taken and charted the actual O2 sats and FIO2 on top of the erroneous values.

I never know what day it is and have been forgetting what year it was since I was just a kid. I told my daughter that if I'm ever hospitalized, she needs to tell the nurses that this is my baseline so I don't get diagnosed with delirium and get written for Haldol by the intern covering night shift.