blinks14

I also never learned how to do a venipuncture or IV in nursing school. All we learned in school was the theory behind placing an IV. But the school I went to was affiliated with a hospital that had an IV team (they don't anymore) so they didn't teach us and the lab techs came and drew the blood for you. About 7 months ago I started working at a different facility where the nurses do lab draws and place IV's so I had to learn. Sometimes I feel like I was done somewhat of a disservice by not having to perform those skills in my first 2 years in the profession.

I work per diem at an outpatient surgery center. They're only open 4 days a week, no weekends and no holidays so I don't have to worry about those requirements. Sometimes it gets a little tiring and it's not something I'm gonna do forever but for now it makes the pursestrings a little less tight.

We do not have Pyxis per se at my hospital but we do have something similar, it's called Omnicell. Anyways not every single med is stored in our Omnicell. We keep IV fluids, all narcs, additional emergency meds and other various things in the Omnicell. When a new pt comes to the floor pharmacy sends the required meds to the floor and they are placed in the Omnicell for us to get out. Also new daily meds are brought up between 2100 and 2200 and placed in the Omnicell for us to get out and distribute into locked drawers in each pt's room. We also have a computerized med administration system. We have had it for almost 10 years, a LONG time. The computerized system that we have does not require you to scan the patient and then each med, you scan all the meds you are giving at that time then you scan the patient at which time you can administer the meds. It's actually a very nice system. I really like it to be honest. We also require a cosignature from another RN on various meds, IV heparin, cardizem and other various meds. The other RN has to type in their SSN when the med is given. I do understand your frustration with the new changes but there is always frustration with any new change and there's always a learning curve. Various kinks will need to be worked out as well.

I don't think it is a law but I worked in ambulatory surgery where anyone who received general or MAC anesthesia was discharged by wheelchair. Noone really ever made a big deal about it. Local cases could walk out. Now I work on a cardiac unit (in the same hospital) and we offer all discharges a wheelchair but they can walk out if they liked. I just chart whether they were ambulatory or discharged via wheelchair.

We don't have a wage freeze as of yet but NO overtime, no agency, no per diems. We also have a hiring freeze and transfer freeze (I'm not sure how that helps) but our unit is short because there were 4 full-time RN positions open and noone was hired for them and now they can't. And then they claim no OT and all around we get the shaft. But then they call me in at least once a week. I also feel bad for the new grads, we have a hospital-based RN program and they won't be able to hire anyone. All those new grads not able to get jobs. It certainly won't be that a grad can go anywhere they want, they'll have to take what they can get.

I had heard that our Infectious Disease department had once picked a nursing unit to swab to see what the incidence of MRSA was and it turned out they never released the results presumably because so many actually carried it.

I just started 12 hour shifts and I LOVE them. The day goes pretty fast for me. I start at 3p and work til 3a so when I get in at 3 in the afternoon it's always busy. The first 8 fly by. Then the second 4 I reassess everyone, do meds, chart checks, med checks, and all that administrative stuff I didn't do on evening shift and then before I know it's time to go home. :) Working multiple 12's in a row is difficult though because I work, go home, go to bed, get up and go to work. Because I only work 3-4 days a week I usually only do 3 in a row if I do. Although my weekends are a little weird because of the way the schedule is made (it overlaps 2 schedules, we work 1 weekend a month) I sometimes end up scheduled for 4 or 5 in a row because of that. That's gonna be a little difficult.

We use Alaris pumps with the Guardrails system for blood administration. Initially the rate is set at 120/hr for the first 15 minutes. After we do a set of vitals to check for transfusion reaction we can increase the rate to infuse the blood with 4 hours. I usually bump it up to 160/hr to infuse the blood in about 2 hours (since it's usually about 300ml/unit). However we are a certified Heart Failure unit so if it is a HF patient I leave the rate at 120 for the remaining infusion. And to the person who asked about liking the Alaris pumps I really like the Guardrails system. All the reminders are built in to the system like using filters with certain meds, infusion time, appropriate rates. I am familiar with the Baxter pumps from another system and I liked the feature that could sense when an occlusion was not occluded (i.e. a positional site) and restart the pump automatically.

We are required to get to work on time if we are scheduled. I never think about it, I just go, I adjust my departure time accordingly. I honestly get quite peeved at people who think that snow is an excuse not to come to work, if I can manage to get to work in my car (I don't have 4 wheel drive), and you know that snow is coming you should make the necessary arrangements to get to work to relieve your coworkers. It's a team effort and everyone has their part.

At our facility we do not hang blood, nurses on our IV team do we just do a double-check with them, but I've watched it done both ways. To me it seems easier to prime with saline first. For me the problem is always switching over the saline in time to flush the blood in. I never seem to catch it in time no matter what I do.

We are not completely computerized at my facility yet but physicians have the ability to put in computerized orders wherever they can access a computer so if you call them for something they just put the order in and you get it. Which sometimes has it's benefit, don't have to worry about miswriting the order or mishearing the order. But on the other hand if they're in the hospital they don't come see the patient either. Although sometimes they're so busy they wouldn't be able to come see the patient anyway because they are stuck in the ER.

Nursing is everything I expected it to be and more. I LOVE it. I love it when it's hectic, I love running around, I love solving problems or being part of the solution. I thrive on all of it. The only thing that I had a hard time wrapping my head around was the fact that I am responsible for what happens to my patients, I mean I knew I would be but it's different then I imagined it to be. But I still like it, I like all it's challenges and learning experiences.

If we want to apply for another position in our hospital we have to have our manager sign our transfer request before we can interview.

I work on a Surgical Tele unit and our ratio is 4-5:1. We also may cover an LPN and their ratio is the same. We may or may not have an aide, the ratio for them might be up to 1:16. We also have at least one unit clerk, and our tele is centralized, the monitor tech is not on the floor.

I'm not surprised to hear this at all. I've never heard of a contract with nothing in it for the employee but it is a way for the hospital to get their money's worth out of you. By that I mean the money they invest to train you once you are an employee. On average it costs a hospital about $60,000 for every nurse they hire and orient. That's a lot of money when you think about the large numbers of people a hospital hires, especially new grads. They are simply protecting their investment. But what I would like to know is if they are not offering anything in return for completing the contract what would stop you from breaking it. I mean at my hospital they offer a sign-on bonus and if you break your contract you must pay it back. But if they don't give you anything there's nothing to really force you to stay.

I had my first Code on one of my patients this evening. Unfortunately the patient did not make it. I know I did everything I could, there was no indication that the patient was going to code until it happened, the Doc thought it was a PE. I cried when it was over, I knew I would as soon as I got out of the room. The patient was in isolation and I was so flustered that I couldn't even get the stupid gown off. I know I did everything I could and there was nothing that could be done that wasn't, I just felt like I was stupid. When the code first started I was functioning but couldn't answer simple questions. But then after a few minutes I was able to function better and answer questions about the patient's condition. I guess all that is normal, I just needed to vent a little to people who will actually understand. My coworkers were very understanding and supportive. And the attending was wonderful, he reassured me as well that I did a good job. It's just very overwhelming. I know it'll get easier but I don't think you could ever be fully prepared for your first code. Thanks for listening!

As a first responder I responded to an MVA one time and didn't realize it was a friend of mine (he didn't make it either) for several hours until his girlfriend came down to the scene (the accident was only around the corner from her house). It was a terrible terrible feeling and that was just a friend of mine. My dad is a firefighter and was badly injured in a fire years ago and good friends of the family had to come and tell my mom what happened after they flew him to the hospital.

We follow the protocol word for word, but our insulin gtts are open heart patients and it's important to follow the protocol on those patients. Plus the drip gets documented on a special flowsheet with the BS and the drip rate and all that stuff.

I think the practice questions available in that review are very helpful. I encountered many questions on the actual NCLEX similar to the ones in the NCSBN review.

While I do strongly believe in adequate pain control for patients I ask my patients frequently if they are having pain and need to be medicated. I wouldn't give a pain med that is ordered PRN as a scheduled med. What if the patient does not want the medication for whatever reason? That won't really increase patient satisfaction either if pain meds are being forced upon them. And if I go to reassess pain after meds are given I don't wake them if they are sleeping, I chart that I cannot assess because the patient was sleeping and reassess them after they wake up. Seems like another ridiculous idea from someone who is not involved in direct patient care.

In the critical care units at our hospital nurses routinely mix their own meds, including insulin gtt's. Anytime I get a pt on an insulin gtt from the ICU the med was mixed by them. When I need another bag on my floor though the pharmacy does it for me. One of my best friends works in an ICU at another hospital in the area and they also mix their own drips.

Our hospital is full to the brim. Practically overflowing. I work on a surgical cardiac unit and someone always needs a cath or open heart surgery or is in CHF, because we are the overflow for that unit as well.

We have a bunch of people who must be contacted in the case of a death and it takes almost an hour for them to come to the floor to see the pt. But we start post-mortem care as soon as those various people have seen the pt. And we take the body down to the morgue as soon as possible. We do allow family as much or as little time to say their goodbyes as they need. I've never seen them take that long though at that time either.

I can't even begin to count how many times I have forgotten to bring a flush along before starting an infusion or disconnecting one. But I guess as a student you need to make sure you have all the proper equipment, although I don't think it's necessary to fail a student for that.

In PA an LPN can hang an IV abx through a peripheral line only.