francine79

I will have been a nurse for a year in May and I must say that it has gone very well for me. I never experienced the horror stories that I have heard about a person's first year in nursing. However, the last 6 months of my personal life have been extremely stressful. A five and a half year relationship ended with the person I thought I was going to marry(now I thank God that I never did) that left me paying all the bills with one less income. I had this image that once I graduated from nursing school life was going to be awesome and nonstressful. Well, I was wrong. I love my job, I love what I do but I have definitely realized the truth that "you can't give to others if you aren't giving to yourself." The thing I loved about my job was knowing I was helping others and sharing that with my former boyfriend. Now that my life has become so much of what I never wanted I have become so irritable at work and I see that I am not "giving" to my patients what I need to. I'm merely going through the motions. Not to mention I have had some very trying patients and family as of late. I hate this feeling. I dread going to work because I just don't have the energy to give to my patients. I feel drained all the time. For those of you who have experienced being burned out, what have you done to help?

I probably saved a patient's life by taking the steps necessary to getting them transferred to the unit when they should have been transferred several hours before, probably even on admit. The patient's condition was completely ignored on the previous shift. I felt pretty good about myself and I felt more confident in my ability to care for my patients as a new grad. This is a good thread. It's hard to brag about yourself as a new nurse because many will assume that you think you know everything. Although we need to brag about ourselves in order to build our confidence!

I have only been a nurse for a little over a month. And I know one of the biggest fears is having to call the Doctor. So far I have had great success in not having a doctor yell at me (even the one's the other nurses have said aren't very nice) or treat me like I'm stupid. I don't know if it is luck but here are a few tips that have helped me out. - Always make a list of the things you need to mention. - If calling labs or test results I always look up what the previous one's were in case they ask. - If I'm told I have a return call from a doctor I always grab the chart and take it with me in case I need to look something up (& so I can write the order) -I try to anticipate what they will order so I can provide them with the right info needed for them to decide what orders they need to make - When working nights I always go through all my patient's charts to make sure they have some type of pain medicine ordered or assess if pain is an issue with the patient so that If I need to get an order I can do it at a decent time of night. I have had several patients admitted with chest pain yet not a single pain med was ordered. I also work on a floor with tons of different doctors, all of which none of their signature's look like their names. I have started to make a little book with a photocopy of each of the physician's signature and their name for easy reference. Hope these tips help!

Here are several that I have found: Effective breastfeeding Ineffective breastfeeding Interrupted breastfeeding Disorganized infant behavior or risk for Readiness for enhanced organized infant behavior Ineffective infant feeding pattern Disturbed sleep pattern Knowledge deficient--- this is a BIG one because mom/baby is mostly about teaching Risk for impaired infant attachment Caregiver role strain Readiness for enhanced parenting Impaired or risk for impaired parenting Risk for infection (related to childbirth trauma to tissues or others) Risk for consitpation Acute pain Risk for injury Interrupted family processes Impaired verbal communication Anxiety Risk for situational low-self esteem Risk for ineffective airway clearance (newborn) Risk for imbalanced body temperature (newborn) You can also use alot of your normal physiological diagnoses. During our OB class we were taught to really emphasize the teaching and we should be using a lot of knowledge deficient diagnoses. This should help you get a good idea.

It is getting to be the time when I have to decide where I want to do my preceptorship. I really want to do it in the ER or in an ICU. However, I am worried because I know to be a nurse in the ER you really need to know your stuff and since I am a student I am worried that I won't meet expectations. I have people tell me I should do it on a med/surg floor so that I can get more experience, but the way I see the preceptorship is to try something you are interested in and do something you may not get a chance to do right out of school. I want it to be more of a learning experience rather than just getting me used to doing med/surg. I will have plenty of that when I graduate.I take my critical care class next semester, so I don't have much of a good idea about providing care for a critical patient. I was just wondering from the perspective of a nurse who works in the ER, what are your expectations from someone who preceptors there and do you think it is an appropriate spot for a student? Thanks for your advice.

Vistaril is not allowed to be given IV, however it is apparently given that way at times

Ok, I figured it out the tubing size by working backwards. For #1: Your tubing is microtubing (60gtt/ml). You need to first find out the rate that your solution is going at. To do that you need to convert your 20 gtt/min to ml/hr. Since you are using microtubing: you would divide 60 gtt/ml by 60 min to come up with 1 as your drop factor. Then to convert to ml per hour your would multiply 20 gtt/min by your drop factor (1). This results in 20 ml/hr. Next, you need to find out how many mg/ml of dopamine there is in the 250 ml bag of D5W. To do that: 400 mg / 250ml = 1.6 mg/ml Next, you need to find out how many mg of dopamine is being infused each hour: Your solution is running at 20 ml/hr so multiply that by 1.6 mg/ml = 32 mg/hr. Then to find out how many mg/min: 32mg/hr / 60 min = 0.533 mg/ min. then convert 0.533 mg/min to mcg: 0.533 x 1000 = 533.3 mcg/min #2 First you need to find out how many mcg/hr the doctor has order: 4 mcg/min x 60 = 240 mcg/hr Then you need to find out how many mcg/ml there are in the solution: There are 1000 mcg/mg so the solution contains 1000 mcg/250 ml. To find out mcg/ml divide 1000mcg / 250 ml = 4 mcg/ml. Then to find out the amount of mcg you need to deliver per hour: 60 min x 4 mcg/ml = 240 mcg/hr To find out the rate you need to set the solution you need to divide 240 mcg/hr by 4 mcg/ml = 60 ml/hr. Again the tubing is microtubing since the problem doesn't say. So to convert 60 ml/hr to gtt/min you need to come up with your drop factor constant by dividing the microtubing value (60) by 60 min = 1. Multiply the 60 ml/hr x 1 = 60 gtt/min. I know it's kind of confusing. Yes, 15 gtt does equal 1 ml. But when it comes to IV calcluations you need to know your tubing size because that will affect the amount of solution that is given to the patient.

What size is the tubing you are using to infuse the solution. The amount of medication received depends on the size of the tubing that is being used.

I work with a couple of nurses who went to Indian Hills. I haven't heard much about what they thought about their program. The only thing they have said is they wished they would have been able to have experience in bigger hospitals, like Des Moines, rather than just Ottumwa. They feel that they really missed out on what other nursing students get to experience.

The policy at our hospital is the patient has to come up with a password upon admission. Then they are told that they need to tell family members, friend's, etc. the password if they want us to give them information about them. Then when a person calls we simply ask for the password. It seems to have been working very well at our hospital, although we have had a few people complain. However, some patients are relieved that they get to control who gets information about them. I'm not sure how it's implemented at other institutions.

jemb, Obviously the patient has to agree to the disclosure of information, but what I was trying to emphasize is the fact that these family member's were nurses at other institutions and when told there must be a Dr. order for them to read the chart, they were absolutely furious and told me that is not true.

When taking tests always remember, that if your patient is not breathing, NOTHING else matters. That one can help you answer several questions. Also, when learning about disease processes and interventions, don't just try to memorize it. Always ask yourself "Why?" It really helps you learn the information.

when your patient's family member is a nurse and they act like you are completely stupid and think their family member is getting horrible care because they are the best nurse in the world!

Within the past week I have been yelled at by 2 different patient's family members that happened to be nurses. They wanted to look at the patient's chart and I stated that to comply with HIPAA there must be a doctor's order for them to view it. They were absolutely furious and stated that is not true. And I am floored that they reacted that way. Is this a policy at your hospital? Or are we one of the few that follows the rules?