Andrew, RN

When was the last time one of your med-surg patients ran off of the unit, into the kitchen and began wielding a knife? When was the last time one of your patients bit you and bent your fingers backwards? I have 30 patients and there isn't anything easy about it right now.

Tips that helped me as a new grad: Transcribe orders in a quiet place. Focus on completing one task at a time and don't let things like a phone ringing or a call light distract you. Finish what you were doing and then tackle something else. I still have to remind myself of this from time to time, that way I don't have to be like "Wait... what is it I was going to do?" after I got interrupted. Hopefully your facility does not look down upon self-reporting and is not focused on punishing for errors. They should look at the problem, not the person, and figure out why it happened. This is not your fault, it is a failure of a system. Do not blame yourself. Look up the "Swiss Cheese" model for errors/sentinel events. There are many people and many events that have to happen for an error to occur. I take phone orders all the time because I work weekends when there is not a doctor around. I repeat back to them what I think I heard them say and then they say yes or they clarify it. Then I write it down immediately on a blank order sheet I have in front of me, write the patient's name on it, then fax it to the pharmacy. Once you get a routine down and avoid certain pitfalls like distractions, things will go more smoothly. I hope this helps.

It depends on the cost of living in your area too. It isn't just what you make, it is what you spend that also really counts.

I've spent many nights sleeping in my car or in the lounge on the couch because I was either too tired to drive home and had to be back in the morning anyway, or because I was on call. Ya gotta do what you gotta do.

Want something completely different from any kind of nursing? Work in psych. :)

I graduated two years ago. No way would we bath each other. You do not need training in how to bath someone. It's soap, water, and a washcloth. Seriously. The most invasive contact nursing students/instructors should have with each other should be vital signs/basic assessment. We have mannequins and Sim-Man for the other stuff. Doctors don't do pelvic exams on each other. Their medical school pays someone to come in and let them practice of them. It's time nursing comes out of the dark ages and joins the year 2010.

I'm jealous. Depending on where you live in the country and what the cost of living is.....

I'm making $18.75/hr. I was making $21.50/hr at a hospital. However, I get "Baylor Pay" which is 8 hours of pay per week extra. So that helps it even out.

Mood, affect, facial expressions, body language, posture, what the patient says, how they say it. Their behaviors. etc....

Lots of people are in your shoes. You are not alone. You may have to relocate to find a job. Try the help of some staffing agencies that will give you permanent placement. I know TX and NM are hurting for RNs right now. They will take anyone. Good luck.

How do they figure it is "low stress?" lol

What's inappropriate to some is not by others. It depends on the situation. Generally, you are not supposed to cuss around/to patients, even if they are cussing. That is the rule I go by. Sucks that they got fired but there was probably good reason. Usually someone like that has a track record and many complaints against them.

We have "Black Out Boundaries" The pt can not interact w/ someone they are on BOBs with. They have to be at least 3 feet away from them as well. One male pt is on BOBs w/ all female peers. It is confusing whom is on BOBs with whom and is not evenly enforced by the staff.

Thanks everyone for the support and helpful words. I am waiting on Letters of Recommendation from my previous employer and a date to get my physical.

Hey everyone. I'm talking with a recruiter right now about joining the Army Reserves. He is a Captain that specializes only with medical people. Basically, they are offering me a commission as a 2nd Lieutenant. I will be going to school for my BSN, be non-deployable for two years while I'm doing this, not have to do the "one weekend a month" drill (unless I want to for extra money) and I'll be getting $1,600 a month. The program this falls under is called the STRAP program. After I get my BSN, then I will have to drill and I will be eligible for deployment. Has anyone else done something similar to this? What are your experiences with recruiters and the military? What questions should I ask him?

Your friend needs to get professional help for their addiction. They can get treatment that is confidential and it will save their life. They have a problem and they need help. Relay this to them, this is very serious. You may end up saving their life if you can talk them into getting help.

I wouldn't divulge any extra information about yourself other than what you have to. This is my policy for any job. I don't tell them I'm in school or I'm joining the Army or anything like that. I only tell them what days I need off when they need to make the schedule. Anything extra that you give them can only hurt you. It's best to keep things like that to yourself, at least until after you're hired. If you say "Oh, I'm expecting a baby soon!" or something like that in a job interview, they could decide not to hire you because you'll be gone on maternity leave relatively soon. This isn't ethical but this is the world of "Employment at will" that we live in. As long as they are not discriminating against age, religion, disability, etc... they can do whatever the hell they want.

Pay is an issue. I have to be compensated for what I do and am responsible for, and since I have graduated I have never felt like it's enough. I'd rather do something I like for less pay but I feel like I have to use my degree to make a living.

They cannot discriminate for age and saying you "Look young" does this. This is illegal. Got an attorney you feel like calling to hear what they say?

My boss tried adding me on Facebook before.... DENIED! hahahaha

Hey, Great post! Pain management varies from person to person. It's about finding what drugs and doses works. We're all snowflakes. =) This is something I've been very passionate about and interested in. I've been a PACU RN for just a short period of time but I hope my input helps! 1. What drugs are preferred? You'll find your own favorites as you practice. The best CRNAs/MDs I've seen give something longer acting during the middle/end of the case in combination with their fentanyl, which works fast but doesn't last very long. 1mg hydromorphone or 5-10mg of morphine intra-op for an average adult is a pretty safe bet. It all depends on the patient, what meds they take, and the type of surgery. 2. What drugs do you like anesthesia to use? And why? I'd like them to have their pain controled and not be puking. So, add ondansetron/promethazine/metoclopramide to the above list. Scope patch pre-op for the extra queezy ones. 2. What drugs do you not like? And why? Darvocet. Surgeons order it all the time. It's a lamesauce drug for treating pain. Too much acetaminophen to boot. 3. Do you notice a difference in recovery time in those who are properly narcotized? Everytime the PACU RN has to re-dose the pain med, that adds about 10-15 minutes (depending on facility policy) to the time they have to be in PACU for monitoring. Definitely shorter stays are noticed if pain is managed effectively. I try to pre-emptively treat someone's pain so that at the last minute before they go to their room they don't start hurting. Asking them to hold their incision (if its abd) and cough or adjust themselves in bed slightly is a good way to see how they feel. They could be 100% pain free laying completely still but then have 7/10 pain once they move a little. On the floor, they are going to be up and walking around, it's good to make sure they're at least at a tolerable level for that. 4. Do you believe that too little/too much pain medication is generally being used? Depends on the facility. Depends on the anesthesia provider. One CRNA would give me people not breathing more frequently than their colleagues would. They gave too much. The very old and the very young get significantly less narcotics than any other demographics. You want your patients to be pain free after surgery, but you also want them to be awake and breathing too =) 5. What do you think anesthesia does/could do different to assist you with post-op pain management? Most of the anesthesia providers I have worked with are fine with giving you more/different drugs if things aren't working. Hope this helps! I'm a new RN but I love PACU!

Thanks!

Hey. I'm a RN with 1 year of experience in need of a job. I have BLS/ACLS and an unrestricted license. I am interested in PACU, OR, ICU, or Med/Surg. I'm willing to relocate. I'm very flexible with my schedule/pay. PM me and I can provide a resume.

Short answer: Not enough.

Google "Rule of Nines" That's the general guideline to base your lacted ringers fluid resus for the patient. There is one for adults and peds.