Michael_65

Same here. If a patient is getting narcs then there is a standing order for Narcan PRN. Protocol for RD is give Naran then call rapid response. House Doc is automatically there because s/he heads up the rapid response team. Another unit I worked on takes it a step further and instead of simply having Narcan available on the unit, has a dose of Narcan ready to be given in the patient room, usually taped to the IV pole.

From your description (smashed by 2PM, using a hip-flask to bring liquor onto the slope, afraid to carpool with her), it looks like what you are observing is the the tip of a much larger drinking iceberg. If you care about this individual, you would do well to ask her to do an honest assessment of her drinking and to get help if the result of that assessment indicates abuse. Alcoholics have all sorts of nifty ways to explain today's excessive round of boozing: "I'm on vacation, so it's OK", "I work night shift so it's OK to be plastered by X oclock", "2 servings a day isn't enough for me", and so on. By turning a blind eye to it, you join the ranks of her other enablers. Trust your senses and your observations. You're a nurse and you were trained to "call it like you see it". /soapbox

Go to your school's financial aid office, and see what's available. You should be able to fund the bulk of your education with grants and scholarships. Cover what's left with student loans. In any case do not give up on school.

So I am 3 months into my first job as a nurse. I'm on a med-surg unit in a inner-city community hospital. My biggest challenge at this point is "pulling it all together" so that I get everything I need to get done by the end of the end of the shift: Meds, patient assessment and care, charting, lab result reviews, physician calls, admitting, discharging, preparing patients for procedures, keeping track of new physician orders, dealing with whatever emergencies come up (and they always do...). How do you do it all SAFELY, and still report off on time? Nursing school only prepared me in a theoretical way. Real-life nursing is far more complicated than anything I encountered in clinicals. The veteran nurses on my unit make it look easy. I watch the vets and try to learn as much as I can from them, but I still feel as if I am running around like crazy and wasting a lot of time. I'd love to hear from some of the veteran nurses on this forum. You have no idea how much we rookies appreciate you. How do you manage your time?

I love this thread. I am a recent graduate (May, '08 - yeah!), and I oriented on 8-hr. days because that was when the best available preceptor worked, but then recently switched to 12-hr. nights, 7P-7A. I am still having trouble adapting to the schedule. Comfy shoes help. Also, I take 2 short breaks instead of 1 long break, and I eat 2 small meals instead of 1 big one. I also find that stretching helps. Once an hour, I try to take a minute to do some leg stretches, or a quick Yoga asana, like the "nataraja". Keep the suggestions coming!

Remember that patient autonomy trumps all. Unless the patient has been declared incompetent to make her own decisions, then it is her right to refuse any aspect of care that she wishes. To echo a few previous posters: 1. Hold the meds and notify the attending MD. Document your actions. 2. Push for a psych consult, and also for an ethics panel. 3. Continue to educate the patient on the benefits of taking her medications. 4. Do not, under any circumstances, lie to the patient about what is going into her NG tube, or try to "sneak" medications into the tube. 5. If the MD persists in ordering you to give the meds without the patient's consent, notify your manager. Your manager may want to report this to the Director of Medicine, who will then deal with the MD.

I don't know if this is an option for you, but at my hospital, nurses who need to get better at starting IVs are sent to ambulatory surgery for a day. Every patient in ambulatory surgery gets a new IV access started, so there are quite a few opportunities to start IV lines under the supervision of the experienced nurses on the unit. Another option is an "IV day", where you take a lighter patient load for the shift and start every single IV that is needed on your unit. Talk to your manager, either at your current or future place of employment about it.