twarlik

I'll give PRN about 30 minutes early if needed. However, with pain meds I try to see if the patient's pain is really being controlled. If a pt is consistently needing pain meds early, then I'm on the phone to the doc to see if a change can be made.

I assume you don't have computers at the bedside? We have a computer in every pt room and just chart as we go. No need to write anything down; just chart what you do when you do it. Sounds like your hospital's system is a bit flawed.

I've done both and prefer computerized charting. I think it makes information much more readily available for everyone to access; our physicians are able to pull up vitals and assessments from their offices now. I can actually chart a full assessment in our system in about 5 minutes or less. Very easy to use. Doesn't sounds like a very good system if it's taking you 30-60 minutes per assessment. I think it's rather short sighted to say that computerized charting is the "worse thing to happen to patient care." If the system is well designed, it should improve patient care not take away from it. The problem is the design not the concept. Todd

Who are "they"? Yes, day shift is busier. You also have much more support and resources that new grads need.

Is the night shift job a 12 hour shift? I worked 12 hour nights for two years and loved it. I think the majority of people can adjust to nights with little difficulty. Remember that there are many other differences between working nights and days other than the sleeping schedule. I personally think new grads are better on days in the beginning since there is much more support available. This idea that new grads have to start out on nights is just crazy. Night shift is usually a skeleton crew with very few resources for the novice nurse. However, if you're a new grad with a good head on your shoulders than nights can often work out fine. Good luck with the NCLEX! Todd

I worked 20-30 hours/week while in nursing school. It if definitely doable. I second the opinion of one poster who suggested working in a hospital if possible. I worked as a nurse tech and got invaluable experience. Of course, having a 19 month year old at home is a different story and not something I had to contend with. I think at the end of the day, you do what you have to. If you want it bad enough it will happen. Good luck! Todd

What sort of things were you doing for her? Were they things like fluffing her pillow and filling her water pitcher, or more serious tasks? I've found that those "time consumers" often benefit from having me make strict hourly rounds. I tell them when I will be back and what I will be bringing with me when I return (pain meds, fresh coffee, etc). Once we develop trust, they stop calling so much and are no longer consuming my time. I put them on my schedule rather than the other way around. Good luck! Todd

I can certainly understand. I work 40 hour weeks as well and am usually hesitant to pick up overtime for the same reason. I just love my days off too much! Are you able to work half shifts? Sometimes I will stay for the first 4 hours of evening shift to help them out. That way, I get some overtime and I don't have to come in on my day off. If your hospital is anything like mine, they will be happy to get any sort of help they can get. Good luck paying off those loans! Todd

If you ever stop asking questions or get to the point that you think you know everything, that's when I would start to be concerned. You're going to have a huge learning curve this first year. Soak up as much information as you can. Find an experienced nurse who you look up to and make them your mentor. Watch them with their patients and see how they organize themselves. Above all, have confidence in yourself! You know far more than you think you do! Good luck! Todd

Good answers, TxPonyChic. I would add that for the 2nd question (low BP), I would first look at the patient and see how they're doing. Are they walking around and doing fine, or are they feeling faint? How does this blood pressure look when compared with their previous pressures? People walk around with pressures in the 90's, so I don't think it would be necessary to call a RRT for that. I frequently see patients with BP's in the 70's and 80's after dialysis who are doing fine, so it's always important to evaluate the information you have while looking at the whole picture. A BP doesn't tell you anything without looking at the patient first.

All excellent answers! Don't ever be afraid to tell a patient or family member that you don't have the answer to their question. Better to be honest with them than try to fake it and give them incorrect information. I think most people will appreciate your honesty. Todd

The Joint Commission no longer announces its visits. Hospitals are given a window of time in which they could be visited (usually several months). This is suppose to keep hospitals in a state of "continual readiness". Not sure how effective it will be. Todd

Have you done a literature search? There was a recent article in Nursing Management regarding a hospital which was able to drastically reduce the spread of MRSA through a new infection control program. I don't think that the use of disposable blood pressure cuffs was one of their interventions. I've heard that our local VA hospital uses individual cuffs for each patient and also swabs every patient for MRSA on admission. They have been able to almost eliminate the spread of MRSA (or so I've been told). Todd

As someone who is responsible for putting together my unit's schedule, I can certainly sympathize with the position your manager is in. I know at my hospital, it is quite a lengthy process even getting new positions posted, not to mention actually finding someone to hire. If you signed a contract saying you were available to work up to 72 hours in a pay period, then your manager should be allowed to schedule you for those hours. However, there needs to be some middle ground here since you're obviously unhappy and thinking of leaving. You should talk with your manager and try to come to an agreement. Lay it on the table and let her know your thoughts. Any smart manager will try to make a good employee happy. Perhaps you could work 3 days one week, and 4 the next. Good luck. I hope everything works out for you. Todd

I don't think you did anything wrong. Generally, we always hold medications prior to dialysis unless the MD states otherwise. This is especially true for blood pressure medications. I agree with the one poster who suggested calling the dialysis nurse for advice on what medications should be given/held. They are usually the experts in that area.

I love this discussion! This has been happening to me since I first went into nursing. My favorite was when a patient asked me if I "worked at the hospital after school as a part time job"! She thought I was still in high school! As others have commented, I try to appreciate that fact that at 31 I can still pass for a high school student!

Thank you all for your input. I met with my manager last week and we are working to find a way to make my position a better fit for me. She thinks I'm doing a good job and wants to try and keep me in my current role. For the time being, I have decided to stick it out and see how things go. Thanks again for your replies. Todd

After two years at the bedside, I accepted a management position. I was sure it was what I wanted to do, but after 6 months I am feeling the desire to go back to the bedside. I'm a little concerned about how my manager will react when I tell her this and was wondering how you other managers would feel. Have any of you had an experience like this? Is 6 months too soon to leave my current position? I appreciate any advice you can all give me. Todd

I moved from Florida as a new grad back in 2005. I had a very difficult time getting anyone to talk to me. There are several nursing programs in Portland that are putting out more and more new grads every year. At Providence where I work, we draw heavily from the University of Portland, but it's certainly not impossible for someone from another school or even out of state to get a job. My advice: Make personal contact! All the hospitals have online applications. Fill those out, but also make some phone calls and talk with recruiters or nurse managers if possible. Plan a visit to Portland and let people know when you'll be here so you can set up interviews and meetings. I did this and went home with two job offers. Portland can be a tough market for new grads, but it's not impossible to find a job. Let me know if you have any questions. Good luck with school! Todd

We have no such rule at our hospital. She actually had Thanksgiving off, so even if this rule were in effect she would need to work Christmas. This all actually worked out well for everyone. I was able to get a nurse on light duty to work as secretary on Christmas Eve so that the regular secretary could have it off. She is still scheduled to work Christmas day. HR was no help; they have no policy governing this sort of thing. How the days are decided is left up to each individual unit. Thank you all for your input and suggestions! Since you asked, I am working Christmas Eve, Christmas Day, and New Years Eve. I always work my fair share holidays. Todd

We have two secretaries; one is usually day shift and the other is for evening shift. They both normally work M-F on their respective shifts. They share holidays, in that on holidays one of them works 8-5; covering most of day shift and the beginning of evening shift. The secretary in question is working Christmas Eve and Christmas day. She has Thanksgiving, New Years Eve, and New Years Day off. Thanks again for all the input. I will probably be speaking to her tomorrow about this.

Thanks for your response. I plan on speaking with my manager first. Our system for determining holiday schedules involves a few factors. First, all staff sign up for the holidays they want off by ranking them (1 being their first choice, 2 being the second, etc.). Second, we look at what holidays the person had last year in the event there is a problem with giving someone their first choices. In other words, if you didn't get Christmas off last year and you want it this year, you're more likely to get it than someone who had it off last year. This system is well known by all the staff. We currently have two unit secretaries who typically split the holidays. The other secretary worked Christmas last year and was wanting it off this year (she does not have children). I personally think this is fair and don't believe that holiday requests should be based upon the fact that someone has children and someone else doesn't.

I am an assistant head nurse on my unit, and as such am responsible for putting together staff schedules. I recently posted the holiday schedules and am having a big issue with my unit secretary. She had requested Thanksgiving, Christmas Eve, and Christmas off this year. All my records indicate that she had these days off last year (this is my first year in this job). This year, I am unable to give her all of these days so have scheduled her to work Christmas Eve and Christmas. She is now "refusing" to work those days and tells me that it is an unreasonable thing to ask since she is a single mother. I am planning on speaking with her Monday, but would like some input from some of you experienced managers. How would you handle this situation? Todd

Wow, that is just crazy! I can not believe that you are responsible for making calls and staffing your unit. At my hospital we have a separate staffing office that handles all of this. If someone calls in sick, they make all the calls. If no one agrees to come in, we can stay extra for overtime plus incentive pay. We are NEVER obligated to stay past our shift. I agree with those who suggested you get your resume and take a walk! ~Todd

No. I had applied for my Oregon license and was scheduled for the NCLEX when I interviewed. ~Todd