AMarie85

If its an open wound then I use sterile technique.... If it's dry gauze over an incision then I place the sterile side of the gauze over the wound without touching it.... Yes I keep it as sterile as I possibly can.... When a patient comes back a week after surgery with a post op wound infection I'd like to think that I did everything I possibly could to prevent that from occurring.

I hate shift wars.... At night we have more patients. There is some quiet time from about 0000 until 0330 when lab comes in a wakes everyone up. And there are nights when I don't sit down. Last night I had a patient pull out his NG tube three times (the last time was while he was in restraints--the MD wouldn't allow me to leave it out--I HATE putting restraints on people) That's another thing if you call the MD at night they are angry and frustrated that you are waking them up. However I will say that day shift scares the heck out of me.... They have doctors and families to deal with on top of a heavier med pass and increased admits and discharges. The point is it's a 24 hour job.... If it doesn't get done on your shift it gets passed on the next shift... We're all busy. I had a friend tell me one time that each shift complains about the other because it's a damn hard job and we all are busting our butts to take care of our patients.

We have check boxes on our computer charting program so I usually check.. IV site check done; side rails up X2; bed locked and low; call light in reach; HOB flat (or up 30 degrees or whatever); Knee high PCDs on bilat; Activity: sleeping

Nursing school is incredibly tough. They make it this way in an attempt to prepare you for a tough job. While nursing is rewarding there are many times when our job is pretty hairy. I'm a new grad and I have to say at this point I'm finding my job a bit more stressful than school.... Except that when I leave I don't have to go home and study.... I think that getting through nursing school is a huge accomplishment no matter what the grade may be.... In fact one of my classmates (who I know will make an EXCELLENT nurse) didn't make it through school her first time... Tell her your friend not to give up. Nursing school is the way it is for a reason... Also.... I believe (although I've got less than a year's experience) that the type of nurse you are improves with experience. There are all types of nurses out there and they've all got different experiences. You just can't get that in school. You're friend's concerns are valid. I think that her drive to do well in school shows that she cares about what she is doing. It means more to her to do well than to just skate by. She will make a wonderful nurse.

Surgical patient with a fever??? Give them their IS and see if that works..... TCDB, OOB just as other posters have said.... These are the best nursing interventions before even having to give tylenol or call for an order for blood cultures..... (usually our orders state Tylenol PRN for fever greater than 38 or something like that depending on the MD) Once you learn that your nursing interventions work better than more invasive interventions you really start to feel more comfortable with common post op complications.... I'm a new nurse and I'm just figuring this out as well. For example if I have a pt who has difficulty voiding after surgery I have learned that getting the pt OOB works well rather than throwing a foley in.....

I had a wound care nurse tell me one time that wounds are already populated with bacteria found on the patient's skin and that research shows there is no need for sterile technique.... That being said I also agree with the previous poster who said that in the hospital sterile technique should be observed due to the overwhelming risk of hospital aquired infection. The doctor's order will tell you whether or not to dress a wound wet to dry....

Can someone tell me why our facility policy has now changed to IV site and tubing changes to every 96 hours???? Has research shown that this should be the new standard? It used to be 72..... I would think this is an infection risk.... (exceptions are TPN, LIPIDS, and intermittant infusions)

Hello, I'm Adrienne I'm a new grad and I work the night shift on a 26 bed surgical unit.... (I'll go to days in about 5 weeks) We get all surgeries in the hospital except orthopaedic surgeries.... our unit is a bariatric center of excellence and I'm credentialed in wound care for our hospital..... (we are the only floor to manage wound vacs) I hope to gain good experience there and maybe some support here;)

It's impossible to know everything about every drug.... especially uncommon drugs... That being said .... If a patient asks me about a medication I always print out a facts sheet and go over it with them.... Nurses aren't behind on their knowledge.... We're constantly learning and finding out more.... That's part of the art of nursing. I wouldn't worry about the concerns of one specialized doctor that ofcourse would only know about his area of care. Sometimes doctors rattle off orders to me that I'm unfamiliar with and I have no problem asking them to spell it or tell me what the medication is for.... If I didn't ask I wouldn't be practicing safely. Maybe you can remind the doc of that....

Thank you so much for your advice.... I'm doing much better now.... I'll be graduating next friday and I'm really excited about that.... I am also assured that wherever I work I will get a good six to twelve weeks of training so it will be like starting from the beginning again which will help me alot.... I tend to learn by repeating things over and over.... My next concern..... Passing NCLEX

I'm also on the job search.... I have to say I get discouraged everytime I read these posts..... I will graduate May 8, 2009...... I've applied to all the hospitals in my area.... (there are alot of them... I'm in the heart of Florida where everyone spends their golden years) No call backs..... A few rejection letters.... All I can say is to keep applying.... I have a friend who just got her teaching liscense..... She's a waitress at steak n shake where she's been for years.... I think we're all in the same boat.... Hopefully this won't last too much longer

I'm just about to graduate and I've been doing my nursing practicum.... I've learned this..... Everything that goes wrong is the nurse's fault.... I've already gotten used to that idea.... We do the best we can in situations like these....

I am about to finish my last day of nursing practicum and I'm realizing how difficult this job is and I don't know what to think about some of the things that I have experienced. I just want some guidance or advice or maybe just some understanding of what I'm feeling..... I can't seem to get that from my parents or my fiance because they just don't understand.... I know all of you will. First of all I have found that no matter what everything is the nurses fault..... I had a patient who had a fixation of the femur and she was not to have any ROM of the affected knee (she was supposed to have a knee immobilizer on but I guess she got poop on it so the previous nurse threw it away.. she was ok as long as she stayed in bed but if she got up she was to have another one put back on).... PT got the patient up and sat her in the chair with her knee at 90 degrees..... Great.... and of course the PA walks in and sees it and almost has a heart attack..... NOW.... she said that it was ok and that it wasn't my fault..... but I totally felt responsible because I should have told the physical therapist about the order... X rays showed no changes and everything was fine but I still feel like I should have know better than to have allowed that to happen.... Second..... Other nurses get mad when you don't pick up the slack.... I've experienced this with a dialysis nurse and a pre op nurse... I didn't know I was supposed to do a pre op check list until my preceptor said did you do the check list..... Right before my patient went to surgery.... so I scrambled to get it done as much as possible and called the pre op nurse and was like I'm really sorry but I didn't get it done.... Then she was like ok well does she have an 18 G Iv site or larger.... No she has a 22..... SO she was mad about that..... Not too mad but I could tell she was aggrevated..... There was also a form I had to send down to dialysis with my patient stating what meds were held that day and if there were any meds to be given during dialysis and that kind of thing.... well I ended up getting that done at the last minute because the dialysis nurse asked me where it was and I was like Uh... what form? So I did it while I was down there.... It was ok but I felt like I should have been more prepared for that than I was. This one is bothering me the most..... When I ask for advice I feel like I'm either being bothersome or like the answer I'm getting isn't the one I'm looking for (or something).... I had a patient that was ordered CPM.... The order was completely unclear.... Know one could read what degree of flexion was ordered..... SO PT called the doctor three times..... still no call back.... So PT says to leave her off CPM and chart that there was no call back.... So I did.... Now I'm thinking that we should have at least put her in at 60 degrees which was the lowest number we thought the order might say.... Everyone knows the doctor is going to be mad about that even though his order was unclear..... The next shift asked me if my preceptor knew about it..... She did but I still feel like I'm responsible.... Another thing with this same patient..... She had VERY low output for the day (150 in 12 hours).... I asked my preceptor if I should call the doctor (she has a foley already; no kinks in the tubing) but she told me that I should push fluids because she didn't really eat or drink much all day..... Which is completely true.... I had a hard time to getting her to eat or drink anything.... So the patient's daughter told me she likes oj and I got her 8 ounces of oj and she drank it right up..... She was working on the next cup when I left.... I'm still not sure if my action was correct.... Maybe I should have called the doctor.... I was working on the advice of a very experienced nurse (who was also responsible for this patient) so I think I'm alright... I just keep going over it in my head.... we have learned in nursing school that if there is less than 30 an hour we call the MD.... Anyway I'd really like some thoughts on this if you could help me please.....

The good thing about being a nurse is that we all know the benefits of breastfeeding babies...I think it's great because our coworkers are probably the most supportive of breast pump breaks...I couldn't imaging working in an office or something and having the same kind of understanding of how important it is to pump breast milk both for the baby and for your supply.

That's one of the reasons I work nights... Semiprivate rooms are crowded with beds and chairs anyway...Add four visitors per patient and it's chaos...Visiting hours are over after my shift begins and boy am I glad when they anounce that visitors have to leave in fifteen minutes... And I find that visitors that stay overnight ask for water and juice and snacks also...This doesn't bother me so much unless they want me to act like their waitress instead of their family member's nurse...