miniangel729

I am 7 month into my job, I was asked by the unit manager to write a peer review for one of our charge nurse/team leader for her annual evaluation because they want to hear from a new grad's perspective. one of the questions they asked was "how is her leadership style?" Here's what I have for the review so far, this paragraph combines all the questions they had asked. But I'm not sure if I had answered the "leadership style" through it? ___________ is a helpful, supportive and knowledgeable Charge Nurse. She has great communication skill. As a new graduate, I find the way she gives clear explanation and instructions to be helpful when I have questions or encounter problems. She sets good examples in providing quality patient care by makes sure the patient and their family's needs and concerns are addressed of within a timely manner. She acts quickly but calmly when situations arise. Through working with her, she has helped me to become a more diligent nurse and taught me how to be a team player to the staff. ================================================================== Here's what I did not include in my review: She will see my review and my name. it won't be anonymous.. so it's kinda sensitive regarding what I can/should write.. She's generally helpful when you have questions/needs help, otherwise just leave you alone and let you do your job. Occasionally, she would make you feel uncomfortable when asking for help (eg. non-verbal behavior such as tone of voice sounds inpatient/slightly annoyed, or just seem too busy/overwhelmed herself to help you) When it comes to assignments - there are not much room of discussion, well, I never request to change assignments. but there were few occasion when I am overwhelmed and had told her but she would still give me an admission without offering help.. (when there are other nurses that are open for admission still)

new grad here, I recently had a pt with pulmonary fibrosis, not doing so well, and family just agreed for pt to go to hospice. He was going to transfer to hospice the next morning and not yet on comfort measure. Last ABG showed that he's hypoxic, he was on BiPAP 99% throughout the day until the afternoon they switched him to 100% non-rebreather to prepare him for transferring to hospice because hospice doesn't take BiPAP. At beginning of my shift (7pm), family and friends were all in the room, talking with him, saying goodbye, pt was still AAO x4.. 1 hour into the shift, just as I went in to the room again to made my round, I noticed he start to get restless, very confused, trying to take off his non-rebreather.. I know it's due to the lack of oxygen, but I can't really do anything such as putting him back on BiPAP or call an RRT, so what I did at the time was place the mask back on him, talked to him, was about to go get morphine IV asap for him that's what has been keeping him comfortable, and then call the doc. before I walked out, he had an episode 10 second seizure, body stiffening, tremor, staring to the left. I stayed in the room, had someone to call the charge, we gave him ativan x 1, morphine x1. called MD, gave another ativan x1. and started him on morphine drip and comfort measure. before the drip, his RR was 36, restless, seem uncomfortable. after on the drip, he's RR was 26 on 1mg, eyes closed/resting besides using accessory muscle to breath. He's non-responsive now. after one hour, I titrated to 1.5mg, and RR = 22-24, still using accessory muscle breathing. at this point, I talked to my charge, I don't know if up the dose would help more or would it depress his respiratory even more and cause him to have to work harder breathing? at the same time, I don't want to overdose him.. this is my first pt on comfort measure, I don't really what to expect.. I had also asked my other co-worker too, and asked if we should keep their breathing between 12-20? or as long as patient seem comfortable.. our conclusion, pt seems comfortable, family also think patient seems comfortable, so leave it as it. when giving report, morning RN came and saw the pt, she said - no no no, pt's not comfortable, when they are on morphine drip, you titrate it until they no longer using accessory muscle breathing, and appear as if they are just breathing normally.. I'm confused.. what should I have done here? also, throughout the care, I feel really bad because I don't know what to say to the family. I let them know that i was there for them if they had any questions or anything I can help. I explained everything I do with the family, made sure tissue, water, and blankets are available for those that are visiting/staying. kept the room quiet and neat, called the priest per family request to say the last word.. I left work that day feeling like I could have done better.. I guess the feeling of I didn't know what to say so I really didn't say much to comfort the family made me feel really bad.. I felt I did everything i could "tasks" wise but didn't offer them emotional support.. how can I do better next time?

oops.. nevermind.. I found the answer.. (don't know how to delete the question, thought might as well post the answer) Peak: 1.5 - 3hr Duration: 24hr Half-Life: 1.5 hr so it still works, just less effective...

our hospital has prevacid scheduled at 7am as prophylaxis for most patient. I had this one patient who doesn't wake up to eat her breakfast until 8:30 or 9am ish.. since Prevacid is normally recommend to take 30 minutes before breakfast.. is it still effective if it's given almost 1.5 - 2 hours earlier?

[COLOR=#660000]thanks esme12 for your encouragement and brainsheet! I am modifying my current brains and yours examples are really helpful. I know this coming year won't be easy, sometimes I wish I can skip the first year learning curve and download even just one year of experience from the experienced nurses.. ha.. I will keep reminding myself that I'm not alone and I will make it.. :) thanks again

I'm recently hired on a medsurg floor, from hospital statistic, near 45% of of hospital's RRT calls comes from our floor.. I'm terrified just thinking about when I am off orientation. I can feel my brain freeze just thinking about - eg. What if my patient suddenly become more lethargic? What should I do next? What if his RR suddenly increased? (check temp., listen to lung sound, elevate HOB if pt have trouble breathing...etc but what to do next?) I realize I am no longer a nursing student and can't just go "get the nurse".. I am the nurse now! AH! The last thing I want is "freeze" when I see my patient has a change in condition, or hesitate what to do.. it really helps me when I hear other people's story or experience, what situations they encounter and how they respond/take action to solve it... So I was wondering if you could share some of your experience on what are some of the change in patient condition that you have encountered on the floor and what did you do? eg. what did you do when pt had BP dropping, increase in respiratory rate, decrease HR, ALOC change.. besides to just call the doctor; and what are the things we can do/trouble shoot before calling the doctor? eg. per CNA pt had drop in BP --> double check BP, temp., lower HOB, trendalenburt position, check for any bleeding if post op/wound.. anything else? *I am aware every patient/situation is different; therefore the way to respond varies. But still appreciate to hear other people's experience =)

I am a new nurse working on a med/surg floor We have dialysis pt every now and then. Just want to hear from the experience or dialysis nurses - 1. what are some important things and tips to know/monitor/be mindful of when caring for dialysis patient? 2. what are some important things to report to dialysis nurse prior to patient start getting dialysis? - eg. BP? My preceptor told me when change shift, its important to let next shift nurse know if the patient is new on dialysis, but didn't explain why. 3. What are some important things or signs and symptoms to monitor for new dialysis patient? and after receiving dialysis? 4. up till how long is the patient consider a "new dialysis" patient? eg. 3 days? 1 week? I know low blood pressure is one thing to monitor for. but how low is consider too low? we had a patient whos baseline SBP was in the 100/90s, but just prior to getting dialysis, last BP was 87/46. Throughout dialysis, his BP was 70-80/30-40s .. honestly i was really worried! but my preceptor/dialysis said it's ok. even after pt's BP was still low like that. so how low should I start worry about pt's BP? is it +/- 20 to patient's baseline? eg. baseline 120/80 and if pt's BP become 100/60..?

I am a new grad - on week 3 out of 6 of my orientation on a very busy/heavy resp/tele unit. I am orienting on day shift, but will eventually switch to night. There's a chance they might keep my on days, but I am so scared because I know I will need to go to rounds and doctors will be there more often. One of my biggest fears right now is how and when to talk to the doctors I've worked 7 shifts already, only called the doctor once. 99% of the time my preceptor just go ahead and talk to them then let me know what happened, often time I am not there when he speak to the MD or I didn't even know he was planning on calling them - because he think talking to doctor is the "easy thing" I should focus on not being behind d/t charting or giving med. My preceptor tell me, whenever you see doctor - go listen to them talking to your patient, or if you see them on the floor, just go talk to them about your patient. He made it seem so easy, and kept on saying "it's not scary, you just talk to them." But 1. "Just talk to them" - talk about what exactly and how? How do you initiate the conversation about your patient after "Hi Doc, how are you?" 2. If I want to find out what's the plan for the patient - how do I ask the doctor? or how to find out what's on their mind after they speak to the patient.. I feel simply walking up to them and say "Hi doctor, so what is your plan for Ms. _________?" sounds.. just awkward, yet I am not sure how to break the ice or make it flow better. Would they think -- why don't you go read the chart after I put in the order? 3. I often see a doctor in the room but I don't know their name, what their specialty is, if they are the primary, or specialist? I really want to find out but I also don't know exactly how? I mean I introduce myself all the time to people on the floor, PT/OT/RT, but when I know it is a doctor it's like I lost all social skills all the sudden somehow... what do you do in situation like that? What exactly do you say and introduce yourself and find out who the doctor is? I feel I will sound stupid if I go, "Hi Doctor, my name is ____, I am the nurse for _____ -- what if your name? and what is your specialty?" I feel I should know!! 4. When doctor come into the room they ask "how is the patient?" what do they want to hear? I often don't know what to say, I feel it's either I'm caught off guard sometime or I just gave them useless information that they don't seem to care at all from their look. L Sorry if this is a stupid question, but I really am frustrated with myself about this problem, I feel speaking with doctors is something I should know how to, since it's big part of nursing, but it's really scary for me. asking my nurse with the answer "just talk to them, they don't bite" didn't help me much.. I know each doctor has different personality and preference to be talked to, but I really appreciate if you could help me with more specific information such as give me examples on exactly how you would speak to the doctor? like a sample conversation of when you see the doctor on the floor, or what you say when you see a new doctor, how to ask about what's their plan after they see the patient? Because sometimes I don't always get to stay in the room to listen or sometimes I simply didn't catch what they were saying...

I'm a new grad recently started working in a busy respiratory/tele step down unit. My preceptor is very type A and is following me 24/7 - even when I chart! He stand right behind me and watches me. He takes over things - eg. dressing change, ileostomy dressing change before asking if I would like to do it. rushes me when giving medications.. etc. It seems He just can't stand being behind sometime. Our last shift, he would pull out medication and get it ready for me to just have me hand to the patient. Or go ahead give the medication I prepared when I had to go grab something from med room real quick - I mean can't you wait just 2 minutes?!?! I feel like I am not doing/finishing anything by myself. He often going into patient's room without letting me know, start doing things without informing me first. and often time I would walked by and caught him in there already speaking to family member, etc.. I feel like I'm intruding his patient care, sometimes I feel like a 1st semester nursing student all over again. I feel very incompetent and low confidence because of it. I know I can do it, I just need to be given the opportunity. I know I am not the fastest - but I am learning and trying to be safe. This is my 3rd day working. I guess he's just not use to having a newbie slow his daily routine down. This is his first time precepting new nurses. When I work with him I feel so bad as if I am slowing his day down. I feel I don't have room to breath when he's constantly behind my back. I am more laid back and prefer the preceptor to give me time to figure things on my own and be there for me if I have question. If he's there ALL THE TIME, I feel like I am constantly being feed information - I don't even have the chance to know when there's something I don't know, before I even have time to think over something he's already there to tell me what to do next step - it really doesn't fit my learning style. So I asked a few of my friend, they all say I need to talk to my preceptor first before I bring it up to the nurse educator/manager. This I agree, but I am not sure how exactly to say it nicely. I mean it's nothing personal, I just don't feel we are a good fit. But I don't want him to take it personally and feel like I am criticizing/confronting him... How can I communicate these concerns I have in a skillful way? I thought of one way - making a list with specific example that worked really well for me when I use to work with my other preceptor during last semester of nursing school. The list would appear as if it's a thank you list for my old preceptor. I am thinking to tell my current preceptor that - this is a list my old preceptor told me to made for her, so she knows what works well for me. So though it sounds like this list is for my old preceptor, but it's really like a subtle hint for my current preceptor.. for example: my current preceptor rush me when giving medication such as doing 3 check, and take over things for me instead of explaining to me first and let me try it. so on the list I said... Thank you for... -Not rushing me when we are preparing and giving medication. Making sure I do all my checks in giving medication, read up how to give a medication or how long to run it over if it's a medication I am not familiar with. - Giving me as many opportunity as possible to do hands on practice, always checking with me "have you done this before?" and "would you like to try it or would you like to show you first?" If you feel it's something I might not have done before. (Eg. drawing blood from the PICC line) what do you think about this method? or should I be more straight forward? - if so, how should I say it?

haha thanks for the RELAX katinme!! :) lol I will make sure to not rush my answer!! and can you elaborate a bit more on what you mean by "you need to address everyone in the interview"? do you mean I should prepare a question for each of the manager? or when I answer to make eye contact with each interviewer..? or..?

I have a panel interview coming up with 5 people: managers from 4 different unit (Cardiac telemetry, Respiratory, Med-Surg & Pre-Op.) and the recruiter. I've been wondering, how to prepare answering the questions - such as why do you want to work at our unit? Because I have no idea which unit I will be working for.. I also don't want to sound like I prefer one unit more than another ruining the chance of getting into any one of them. (btw, what is respiratory unit? is that part of med-surg..) what other questions should I expect? I don't have any experience with the Pre-op unit, not even during nursing school, what questions should I prepare/info. to study? another question I've been wondering, what questions should I ask at the end of the interview? I found many great question on the forum. but I don't know how to ask them in a panel interview - since I'm being interviewed for 4 separate units, who do I look at and ask? for example: - What is the typical nurse to patient ratio? - What qualifications are you looking for this position? - What challenges are there for this position? - How often do you offer in-services and other education? - How is orientation structured? How many weeks? - How long have most of the nurses worked on this unit? (turn over rate?) Since it is 4 different units, I don't know what to do. Do I just pick a random manager and ask? Do I ask the recruiter? or do I phrase questions in a way that covers all units - such as how long have most nurses work on each of the units? (hmm that sounds weird..) what are some good questions to ask at panel interview for multiple unit? I've never been to a panel interview, especially not one for multiple units. Feeling a bit overwhelmed, any specific things I should prepare for/study ahead for these units? any suggestions/tips/comments are welcome :) thanks in advance!

To make sure the message get to the recruiter in time, I sent an email. Thanked her, very briefly touched on why I declined the interview in a sentence, expressed my goal/desire units & interest for the hospital, asked for another chance. Ended with thanking her again. kept it short and to the point. She replied "Thank you." ha.. well I did my part! pray and hope for the best, if not.. it's not the end of the world.. lol :) thank u all again~

nope, I didn't, because I didn't want to apply for OB.

haha no and yes. No, because I am thankful for all the honest opinion. Does it sucks to repeatedly hearing how bad I've messed up? Yes. Feeling even more stupid and like an idiot especially after all these comments. Thank you all, you guys really helped "reinforced" this costly lesson.. I like the idea of sending a note to the recruiter & assistant suggested by Tina, RN. Any suggestions - handwritten note? or email? Even if I'm already on the blacklist for the hospital, I still would like to be polite and I really do appreciate they called me. I know it is a privileged and I am really grateful that I even got a call. OB is a very unique specialty, I have high respect for the nurses. However, I also know it is the one specialty I know that it's not for me. I'd feel sorry for my patients to have a nurse lacking the passion for the specialty. Prior to nursing school, I volunteered 80+ hours at an 40 bed mother/baby floor. I did well, even got recognize for it, but never liked it. During nursing school, despite doing well in the OB clinical, the rotation just confirmed that OB isn't for me. I loved learning all the new information, but not once felt the excitement and passion. Yup, I should've gone to the interview for the sake of practice... very good point. That's what I'll be doing from now on! hopefully I will get more call.

ya.. I thought about that too... but too late now =( I think call the recruiter back request for the interview would make me look even worse at the moment.. right? anyway, on the bright side, now I won't make the mistake again!