tepbsmith

at the place i was working at the time, most of the charting was done by checking off boxes. i don't remember whether or not the fall precautions were specifically listed. what i do remember is when my 70ish pt faceplanted in the bathroom after i narrowly missed grabbing him, i charted like a crazy woman about neuro assessment, etc after the fall. the following morning the nurse mgr said "well, its good that you charted an assessment after he fell. but its more important that you chart what you did to prevent him from falling because thats really what risk mgmt is concerned about." so.. i don't recall specifically whether the boxes on the shift assessment had already been checked for the day. but since that particular incident, i always made a separate (even if it was redundant) note detailing the fall precautions, the pts actions, etc. --for pts that were very likely to get out of bed-- thankfully i never had another pt fall quite the way that guy did and in my present job, it isnt as big of a problem. i would think that people are going to chart in the way that feels most comfortable to them and maybe if there are concerns about a new charting system, it might be a good time to do an inservice on documentation and that might be very helpful to the staff.

there isn't going to be any way to write additional notes? i find that hard to believe. i would suggest asking your nurse manager how that will be handled. hannor- charting is not only for things we do for/to the pt. ex: you have a pt that is high risk for falls. as in, they are doing everything they can to get out of that bed and you can't restrain them (for whatever reason) you would need to chart every thing you did to prevent that pt from falling. sr up x2, bed alarm on, call light within reach etc. because if/when that pt falls that is what they are going to look at. also, there may be times when you need a doc to clarify a med order or something and the doc won't return your page, etc. if you are holding a med or some other ordered intervention because of an incomplete order then you would need to document that (nicely...no need to crucify the residents in your documentation). i bring these up as examples because they are both things that happened to me as a new floor nurse and although i did all the appropriate things, i did not think to document them.

its great that you are communicating with the docs so you'll know what to anticipate. i'm sorry about your coworkers that are unhelpful. i'm glad you mentioned it to the charge... since you are new there i'm not sure how you being direct about it with those coworkers would go for you. it will get easier to manage your time and it won't be so stressful.

1. pts placed in rooms. they should be telling you when they do, esp if its obvious you're in the middle of something and they should be writing atleast a note, if nothing else. also, as for your note i would suggest something like "initial contact w/pt at..." vs what you mentioned. 2. admissions. where i work, we call admissions and transfer after the bed mgr assigns a room and the accepting doc has written the orders. i'm honestly unclear as to how a pt could be admitted w/o the nurse knowing because of the consults, labs etc. a lot of ER nursing is being proactive and i think that getting used to staying on top of where a pt is in the admissions process is something you have to learn along the way. 3. teamwork is a problem everywhere, so i can't really address that. again, as you get used to ER nursing you will be able to better anticipate orders for your pts. as for the CNAs, i would imagine that if you need them to do an EKG or something else you would have to ask them. are they busy? hiding? 4. you know, ER nursing is very very different (imo) than floor nursing and one of the biggest challenges is getting used to the fact that you have to anticipate what kind of workup/interventions your pt needs and initiate that as soon as possible. then you have to stay on top of your labs, studies, etc to keep everything moving along. for example, you mentioned a CP protocol. so in my facility, our CP protocol is EKG & aspirin within 10 minutes and a chest xray. and these things are done in triage and of course, you always have to make sure they got the asa. from there they are either going to a room or back to the waiting area. in the room, if this is a garden variety chest pain (vs a STEMI or someone that looks like crap) and especially if they came to me from the waiting room, they are getting an IV, labs drawn and at the bedside -we dont have standing orders for lab- put on monitors, and re-assessing pain. if they are pain free, they get a repeat EKG. i may or may not put them on O2. they may or may not get nitro depending on the situation. that whole thing takes me less than 10 minutes- but it didn't always. point being, organization and time mgmt don't develop overnight in any setting that is new. and given the questions you're asking i'm really wondering how your orientation went. as you learn the workups, your time mgmt will improve. also, the book "Fast Facts for ER Nurses" is a great resource for nurses new to the ED. good luck to you!

i got fired for something lame. you should accept your part in your termination, be brief in your explanation. "the facility felt i mismanaged an unhappy family" and then say what you learned from it. (as in, end on something positive so they are not left dwelling on the negative)

idt i felt my coworkers were/are more helpful because we have kids. before i had kids, if i was off on a holiday (like christmas) i would usually switch w/someone that had kids they wanted to stay home with i personally feel that everyone should work either thanksgiving or christmas and it should alternate every year. and because my child is 3, heck yes i want christmas off and quite frankly i think i should be allowed to have it off, esp if i'm willing to work thanksgiving & new years. quite honestly, it irritates the crap out of me when ppl have said to me that i shouldn't expect christmas off or feel more entitled because i have a young child (vs their very important boyfriend). when its their turn to work on christmas morning and their baby is little and all jazzed about santa, then we'll see who is being unreasonable. as it is, i can't get my mgr at the LTC facility where i work to give me any days off after 5.5 months. my daughter starts her new school next monday. they will not be seeing me at work on sunday night.

well, if men dominated nursing then women could dominate medicine. all that said, i prefer to work w/men and working momstly w/women is one thing i strongly dislike about nursing

i thought they were pretty similar (HESI and NCLEX) but HESI had a lot of delegation questions on it. seemed like half the test but thats just the lvn-idk about RN

thats hysterical! i seriously would be all kinds of irritated if a charge nurse came up to me and asked me to go clean her pt and she just went and sat down or finished her med pass, etc. i work in a nursing home and i don't *have* to do any of that because the CNAs kind of look crazy at you for helping w/pts but i do it anyway because if i act like its beneath me, that sends the wrong message to the CNAs. they (in a LTC setting) see those ppl more than the nurses do and when i was new, thats who helped me figure out how to manage those residents. besides, you do so much poo-wiping in nursing school thats its nbd later. although i will say i wish we had gloves that went past my wrist. i'm with the other ppl on trachs. those are far more revolting than poo. period.

this late, i'm assuming you got into the RN am i also correct in assuming you are military and thus closer to CTC? i just finished the TC LVN program in 07. i will tell you unequivocally that TC is the better school and i have been paying out of district tuition for 3 years and driving all the way up there just because i hate CTC so much. TC has this incredible lab that the med students from A&M use and we do sme stuff in there, also. i think the clinicals at TC are better. S&W, VA, Kings Daughters. CTC does do some at S&W, some at darnall, some at local LTC and also at CMH in gatesville. speaking in terms of your education, TC is so much better. the college has super duper wonderful facilities and the ppl in the offices are actually *helpful* and you don't have to be herded like cattle just to get some help. its completely unlike CTC in that regard. the flipside, if time is an issue, CTC is closer (its hella cheaper in tuition AND gas) which is nice when you have to be at clinicals at 545 til 4 and i'm assuming you already know how great the traffic is around 4-6pm:madface:. they also have a daycare there. actually, scratch that about clinicals. RN students have much less grueling clinical hours. either way, its a drive to TC. TC also has a better pass rate on their boards than CTC, although i hear CTC is improving. TC has the HESI, which is different than the end of semester exam type formats they have at CTC. but they will flunk you out of the program for failing HESI. fyi: over half my class failed it the first time. (i passed :wink)

well, at first i rejected EC on the basis of cost. but its a lot cheaper now that i have more core stuff out of the way. i would really prefer a distance learning course, because i HATED clinicals and i prefer my online courses. i don't have to stay in school to defer my loans, but i'd certainly rather defer them if possible. i'm not a brand new grad, although my experience is limited. the floor i started on had so many different serves and served as a step-down unit. i really feel i got an extraordinary amount of experience there that i'm def not getting at my current job. i have to be honest w/you though, given the enormous cost (vs. free) i am concerned i would start and not finish. but i also now that i will be re-applying to the bridging program in a year and if i can complete my RN through excelsior in that time, thats the smartest choice. thx to everyone for their input- i appreciate it

my mom started doing a lot of it once she went back to work because its closer to her job than my house. the daycare is 17miles away...so there aren't many in my town that send their kids there after 18mos of that commute, she is starting at a new school around the corner next month (and its cheaper! and private! whoo-hoo!)

things i have said to my patients. (but in nursing school- whoops!) upon entering the room of my annoying, nasty, genitals out everywhere 40yr old post BKA pt i find mcdonalds in the trash and a snickers on the bedside table. "what is that for?" i ask, referring to the snickers "in case of emergency?" answers patient "emergency?" i am genuinely puzzled "in case my sugars get low" he smugly replies "oh. well jic it escaped your attention, your blood sugars are consistently in the 400s and you just got your leg cut off and if you keep eating like that both of your legs are gonna match" ....my teachers weren't real happy about that. but i stand behind my statement

to "exorcist lady" have you always been this crazy? why do you think its acceptable to point at the water and expect me to know what you want w/o speaking because i know you are capable of speaking when every single time another resident comes within 20 feet of you and you start shouting expletives and swiping at them w/your dirty crusty talons that need a dremel. why do you insist on sitting at my desk, shaking the sh1t out of it and letting your perpetually snotty nose drain on my desk? i can't stand you! you make me crazy!

after seeing the title, i was definitely drawn to this topic, although my take on it is dif than the OP's experience. the RN on my shift (nights at a LTC) is 60 and she is very, very nice and she'd help you if you asked her to but she cannot hear and she can barely walk. coming from a busy med-surg floor at a large hospital, when i was new i turned to her for advice. i was trying to figure out what a certain medication was (hydroxyzine) so i asked her by the generic name because our only med books did not have it listed. she looked it up on her PDA (she's very tech saavy, as it happens) and helpfully announced the drug was aka phenergan. now, i'm only aware of two names for that drug, neither of which is even remotely close to hydroxyzine so i politely asked if she was sure and she showed me her pda, which confirmed that i had not gone stupid. i asked her a few more questions and thanked her. after several other conversations w/her, it is very clear that she cannot hear to the point of not even understanding what you are asking. how on earth does she talk to the residents? as for walking, one time the med cart got away from her and she actually fell. another time, a full-code arrested and it was on her hall, and by the time she got to the resident's room, EMS was already there. ack! now i realize her health problems have a lot to do w/that. but i seriously have to question the safety of her continuing to work. but she is needed since she is the token RN for the shift. there is no polite or good way to say "your health issues negatively impact your patients and put them at risk and therefore you should retire"