fallrisk2008

Need me to turn the heat up in here? Looks like you must be cold.

So, the reason I asked this question is that the on-coming nurse bullied me into giving the insulin when I strongly felt I did not want to. I asked her to call the doctor to see if we could get a range to give IF the patient decided to eat. She refused and insisted I was in the wrong for not automatically giving it. As it turns out, when I went to work last night the patient ate poorly all day and was hypoglycemic most of mid-day with a CBG down to 54, 60, 70 etc. I don't know if he was symptomatic or not because when she gave report, she did not mention how his CBGs were. I saw them in his medical record. I learned a lesson from this, and it is to not let another nurse take away my critical thinking and decision making just because she wants to "stick to the policy" when in fact, there may not even be a policy.

I would like some feedback from other nurses regarding the following scenario. Your patient is an 80-year-old man with a diabetic foot ulcer. This is hospital day #2, his first morning after admit. He became mildly confused overnight. When you check his CBG it is 127. He is on a low insulin sliding scale and is also scheduled to receive 18 units of NPH insulin. The order says, give at 7am with food. When you assess him in the morning, he states he is not going to eat. You talk to him for several minutes and try to ascertain why he doesn't want to eat but he cannot give a reason. Further you explain that he will be getting insulin and needs to have breakfast. He is adamant that he will not eat it is now 7am and you will be giving report in a few minutes. Would you: a) ask the on-coming nurse to call the doctor to see if they will adjust the NPH dose b) give it because the hospital policy is that NPH is given by the off-going shift and NPH is an intermediate insulin C) ask the on-coming nurse to wait to see if the patient does eat breakfast and then give the full dose D) Other opinions? I would appreciate some feedback. Thanks

Venting: I'm so tired of the day shift nurses coming in and during report sneering or making demoralizing comments regarding the night shift nurses' actions. I oriented on day shift and I understand it's busy and demanding. I have never, ever, given a second thought to passing meds you didn't get to or cleaning up a patient's room. Nursing care is 24/7. And when I try to talk to you about it, you become defensive. I'm exhausted and sick of your attitudes! "Oh, so have you checked the 0530 labs?" Mind you I've been passing meds since routine lab draw and haven't had time to check. They didn't even get processed until 0630 and now it's 7. You have a computer too...check it. "Why didn't you [insert verb]?" Let's see, I didn't wake Ms. So and So at 2am and bladder scan her because the poor agitated lady was finally sleeping for the first time in days and besides it would interrupt my bon bon eating schedule. I'd hate to ruin your delusions about what night shift is like, but really we don't sit around all night. When I have four or five patients, three of which are total care I'm running to provide for them. So don't come in all bright eyed at 0700-or 0730 since you're late ALL THE TIME and think you have all the answers. And if you roll your eyes when I try to explain why something was done or not done, don't think we don't see it. Take the freaking chip off your shoulder, wipe the condescending look off your face, and try a night shift sometime so you know what it's like. Oh, you tried night shift and couldn't take it...I see.

I would say choose the job that allows you time with your family. Your kids will grow up and be out of the house faster than you can even imagine. That brand new baby needs to bond with you. Jobs come and go, but your family is your true foundation. Good luck in your decision.

I'm a nursing student too, and I was initially scared to talk to doctors. That fear is long gone. I keep certain things in mind when I'm talking to them: 1) I have the patient's best interests at heart. 2) I'm a student and they know it, so they don't expect much. (And they're impressed when I am spot on). 3) They were students once also. 4) I try to make sure I know what I'm talking about before I contact them. 5) They are people, not monsters. Anyone can be a jerk to you, even other nurses. So, if a doctor isn't nice or friendly, don't take it personally. Maybe they're having problems you're not aware of. 6) refer to #2 if you ever do say or do something that illuminates your inexperience. You're going to learn a lot even when you're a new RN and you're going to make mistakes. You're doing okay when you can let them go and not dwell on them. Never let anyone talk down to you, because you are a smart accomplished person (obviously, or you couldn't have gotten into nursing school).

:imbar I'm having a "duh" moment. But, when I'm checking those pedal pulses I'm assessing the lower extremities--so hopefully, I'd notice if there was a DVT. Thanks for setting me straight on the purpose of checking the pedal pulses. I wonder now why none of my instructors ever corrected me on that point (LOL!) I appreciate the comments thus far. I have two job options: hospice or a med-surg unit and need to pick one in the next couple of weeks. I wonder how differently my assessments will need to be depending upon which I choose...

I have been on a clinical rotation on a surgical unit for about eight weeks. I graduate from nursing school next week. So far the feedback from my preceptor and teacher has been positive--until last night. I'm caring for three patients and it took me until exactly change of shift to get everything done. My preceptor, a nurse for over twenty years, pulled me to the side and said: "I noticed that when you do assessments you are very thorough, even on the second assessment. I notice you spend a lot of time doing things like checking for pedal pulses which slows you down. I don't even bother checking for a pedal pulse. You will need to be a lot faster when you have up to five patients. Focus on the areas that are most important. If they've had an abdominal surgery, focus on the abdomen." Firstly, I disagree with her advice. Since surgery patients, especially ones confined to bed are more prone to DVT, I will continue to check pedal pulses and do a very thorough assessment. With time, I know will become faster. I'm also a triple-checker when it comes to medications because an error could be extremely detrimental. But, I do agree with her that I am slow and do need to be faster. My plan is to spend a few days creating a cheat sheet I can carry with me (until it becomes routine) to condense all of the nursing actions into less trips into the patients' rooms. For instance, flush lines, do assessment, pass meds, draw labs, etc. I would appreciate advice from experienced nurses about ways to be more efficient or to speed up. Thanks!

I feel like I could have written the above posts! I am graduating at the end of next month and I'm dreading starting a job. I'm dreading it so much in fact, that I make myself sick and am getting depressed. At my clinical site, my preceptor keeps telling me that I do a better job than most of the new nurses they hire. I hear the external motivation from patients, staff, and my teachers when they say, "you're going to be a great nurse!" I just can't believe it and at a time in my life where I should be excited, I'm just scared out of my mind. My biggest fear, besides the fears all new nurses have, is that I'm not fast enough to be a med/surg nurse. I'm already hired though, and will be working on a med/surg unit. If anyone out there reading this felt like they weren't fast enough when they first started and it somehow worked out, let me know. As it is, I am only caring for two patients at a time and it still takes me the entire 12 hour shift to get everything done. I'm a triple checker which makes me go slow...I'm so terrified of doing anything that could cause harm. Please, send advice!!!

I'm looking for EBP regarding the reuse of secondary tubing (piggy back tubing) for compatible drugs. If you know of any research that's been published I would greatly appreciate it. I've done 3 hours of lit search and found only one article (Hadaway) and unfortunately, it's not a research article. Thanks for your help in advance!!!

I am doing a project for my leadership class in which I am working with a unit-based practice committee to help them establish a method for disseminating unit info and education to all staff members. I am interested in how your unit accomplishes this. Please let me know what you like and dislike about how your unit disseminates information and any suggestions. Thank you!