SweetLemon

Never be afraid to ask questions... no matter how dumb and insignificant it might sound, its not. Personally I think the person unwilling to ask questions is a lot scarier then the nurse who asks the "dumb" ones. Good Luck & Best Wishes!

Thanks for all the great replies.... and I am so sorry to hear some of the more personal stories of family members who had to deal with HE it has to be so much harder when you are caring for your own loved ones!:redbeathe Something interesting I found with Alcohol induced encephalopathy benzodiazepines can often times make things worse (still working on figuring out the ins and outs of why... I will post it when I find it). But with that said when we get patients who are detoxing for alcohol and we are trying to avoid DTs what is often times the first medication we put them on... Lorazepam (benzodiazepine). I currently have a patient who I think may be suffering from some alcohol induced encephalopathy who is having lots of disorientation, confusion, and full blown hallucinations that he has trouble distinguishing from reality. We have seen this patient many times in the last few months. Each time he comes in his BAL is through the roof and to prevent DTs or seizures we quickly get him on frequent doses of ativan.... wondering if this may be causing some of his current disorientation. The doc ordered an ammonia level thurs and I will be really interested to see what it comes back at when I go back monday.... So say that is the case if we started putting him on barbiturates when he came in for alcohol withdrawal instead of benzos would it have the same effect for the HE?

To be completely honest I really do enjoy what I do. I graduated in may of 08 when finding a job (after being told time and time again about nursing shortages) was really difficult. I ended up applying for a psychiatric inpatient nursing position that I love!!!! I will not lie and say that every single day is all fun and that I don't run into discouraging days but overall I really love what I do. The small impact that I get to make with the people I get to serve makes it all worthwhile. Most days from the second my feet hit the floor to the time I walk out the door (which is usually a little later then my actual shift ends) I am incredibly busy; with little time to stop and relax but I love the rush. And to be honest with all the things that I learn and get to share with my patients I get back 10 fold. I can't tell you how many days I walk into work mentally exhausted feeling overwhelmed and that my life just sucks... only to come across someone who truly is having a bad day with "real" struggles (not that issues in my own life don't matter but it helps me have a little more perspective). In the end my job not only interests me but it also grounds me, and to be honest most days entertains me. I feel very blessed to get to do the work I do.

Another nurse that I work with and I have started an unofficial study group.... This week I am trying to learn more about hepatic encephalopathy and wondering if anyone has come across any interesting facts or tidbits, or just interesting first hand stories that pertain to this subject? I am also looking through articles and books but I thought pulling additional info from nurses here with first hand knowledge might be really helpful. Thanks in advance, sweetlemon :)

Never good to lie, of course the obvious reason would be dealing with getting caught but it is also a really poor way to start you career. At the end of the day you have to live with yourself and having that stress in the back of your mind that you could get caught is really not worth it. Also having to continue to lie down the road as coworkers get to know you to keep from getting caught is just another headache for you. I agree with the above posters, being out of nursing school for as long as you have probably is not you major factor holding you back but in fact your lack of experience. While putting together your resume try to focus on the positive things you have done between now and when you graduated. Their are so many brand new graduates having a hard time finding employment due to the economy, sorry you are struggling. Hope you find something very soon.

I work psych so the ratios typically run quite a bit different but staffing for us most days is really good; for 24 patients we typically have anywhere between 2-3 nurses as well as 5 techs and a unit clerk. Most days we also have another nurse whose primary job is admissions and so the majority of our admission paperwork is taken care of before the patient hits the floor. There are days when we have multiple patients looking to take "center stage" and it can get chaotic but for the most part I feel very blessed to have the staff I do.

thank you, very excellent advice....i am totally with you on the geek thing... probably part of why i miss school so much. :lol2:

I absolutely get what your saying and I really do agree with ya. It is important to be well rounded as individuals. I am not looking for this to take over my life but at the same time I really do enjoy nursing/pathophysiology/pharmacology... just science in general really. I also am very much an awe of the nurses who work in a certain facets of nursing but are able to carry with them a great deal of knowledge from other specialities. I currently work in psych and while the majority of issues that walk through my door are mental health related I also get combo patients such as the pregnant women who also happens to deal with schizophrenia or the bipolar patient who has some sort of compromised cardiac function. I'd like to know that in the back of my mind I am comfortable and knowledgeable in both areas of nursing. With being out of school now over 2 years I find its getting harder and harder keeping up with the different areas in nursing and want to work on being a well rounded nurse.

I have been out of school now for a little over 2 years now and find that part of me really does miss it. As intense as nursing school can be it really does force you to learn a lot of really interesting things in a fairly short amount of time. So I make it a habit of learning new things everyday and try to push myself but I feel like as time passes the things I am not using on a regular basis... such as L&D or pediatrics I am loosing. :eek: Anyone have any good tips or tricks of how they continue to keep up? I have been reading old textbooks and journals and while that is helpful I can't help but miss the structure of having study packets, quizzes, and study groups that really push you to absorb the material....

Thanks everyone for all the good advice and ideas.... wherehastimegone... I can't help but crack up at sending meds telepathically:yeah: but in the best interest of your patient I could totally see how that would work. You sound very creative in your approach and I think I am going to need to focus on becoming more so. Working with the patient rather then against them, thanks much! ~Sweetlemon

Recently I came across the sweetest older women who became one of my patient's in an acute care psych hospital. She is a paranoid schizophrenic who insists that she is healed mentally and physically. I have run into this many times with patient who are prescribed only psychiatric medications. While I always encourage medication compliance I never try to argue their beliefs or bully them into taking meds (Until they are court committed with IMBUs it is their choice to take meds or not). So my lil lady with paranoid schizophrenia also came in with a UTI and was prescribed antibiotics.... each time she came to the window she insisted that she had no UTI she had been healed by God.... and even though we wanted her to take meds she told us she loved us anyways.:heartbeat a total sweetie! I again highly encouraged medication compliance and kept the medical doc informed of the situation but still was not able to get her to take meds. Anyone run into this problem? I would be really curious of what one does if the medication was medically necessary??? I am specifically interested in ways to encourage compliance before appropriate measures have to be implemented to "force" compliance (deeming the patient mentally incompetent to make their health care decisions and putting them in restraints to allow medication administration). Within my own hospital I have heard stories of nurses telling the patient that "God has told them (the nurse) that the patient should take their medicine" :eek::eek:. I have also heard of sneaking meds into coffee without the patient being aware (without guardian consent). Both practices I find incredibly unethical and something I would be unwilling to participate in. Any other ideas?????

I have to agree with a lot of the posts mentioned above regarding it all has to do with the person who they feel they have the best rapport with. When it comes to Alcohol consumption especially when a pt. is placed on ETOH withdrawal protocol I find stories can often change to best facilitate the pt. scoring additional doses of Lorazepam (or whatever benzo they are being given for sx). I work in psych so this puts a spin on things but often times we see people with no deisre to quit drinking and with the knowledge that no alcohol will be available to them for at least 24 hours they want the next best thing and will say what they need to to get it. Just a thought...

I agree, their is no benefit in your supervisor "seeing" that you are actually sick... if you call and say your ill they should be able to trust that your telling the truth. Leaving the unit short a staff member with no time to find a replacement buts both your supervisor and your coworkers in a bind.

This is exactly what I was thinking, not sure how hard these positions are to come by but something you may what to look into. Good Luck, hope you find something you can feel passionate about!

~Exactly my thought:yeah:

I really do understand what everyone is saying and as a patient advocate I agree it would be very appropriate to get the women's permission before you start examining her lady bits not to mention bringing other people to do so. But playing devils advocate, until you have an oppertunity to see and experience the examination process it is really difficult to learn. As much as I personally do not like the idea of additional people looking at me while I am so indisposed on the flip side having a doctor exmaining me that does not know what he/she is looking at is even more disconcerning. And as we all know most med students do eventually go up and become doctors. Advocating for our patients is important but also setting the tone of a professional teaching atmosphere where everyone is respectful and appropriate can also help put a patient at ease. I think a lot of it rests in how you present it.

When I was about to start my associates program I was told that with the exception of working as a school nurse or being in nursing administration I would have no trouble getting hired. Not exactly what I came across. While many of the hospitals in my area hire both ADN & RNs they are going hire the RNs first. 10 years ago I am sure this was no issue with so many jobs to go around. With the current job shortage (see all posts with new grad in it if you don't believe me) its become a lot harder for ADNs to get hired. In my current facility we hire both and they allow almost equal advancement of both degrees. Almost being that they wont allow a ADN take on the DON or ADON postions, but here both our DON and ADON have masters anyways. The good news is the economy does look as though it is slowly getting a little better so hopefully we will see more positions opening up all over.

Always possible they could have been laughing at something completely non-related but all the same confidential. If they are laughing at you then they are unprofessional and seriously immature. It sounded as though the charge was unaware of the procedure involved in switching out the water, so why laugh at you.

I have only been a nurse for a little over a year and can remember some intense days in the begining. I think this post really reminded me of the importance of taking care of your new nurses. While it is important to teach it is also important to encourage. Sometimes we get so use to the normal routine or the task at hand we forget how overwhelming it can all be in the begining. Please hang in there, it will be worth it and eventually it will all come together and not feel so intense. Good Luck, we are here to cheer you on!

Sometimes it also helps to try to address the issue less directly. I have found with a lot of patients its not so much they have problem doing what you want them to do, they just don't like being told what to do period. On the one hand I can understand that being an adult and having someone else dictate how you are going to structure your morning is irritating but on the other hand its just part of being ill and in the hospital. Reminding people of the benefits of whatever you need them to do sometimes helps, and every once and a while I simply level with people. Explaining that while they might not feel a shower/ambulating early in the morning is important I as well as the doctor have a schedule and would really appreciate the cooperation.

So for the past week I have been training for relief supervisor. It was not something I asked for but was excited for the opportunity to try something new. The plan is to train intensively for a few weeks so at the end of the month I can cover to the regular sup while he is on vacation. So in my mind I am just trying out something new and learning some new skills. So my question, why do people have to be SO mean!?!?! :hdvwl: In the two days that I have been training I have gotten an earful from numerous coworkers (many of which are friends or at least I thought they were) and find myself trying to convince other people to take me seriously. I am not completely naive and I am aware training for this kind of thing is not going to win me extra friends but I was really disheartened to see my current support system totally bottom out on me. One of my closest friends and coworkers gave me an earful this morning about how understaffed she was (which she wasn't I double checked) and how I needed to question the person training me to make sure staffing was more appropriately allocated!?!?!?! She called me 2x last night for additional staff and both times she did I sent people, not to mention she already had good numbers to begin with. So my issue, I really want to tell people to knock it off. I am the same person I was on the floor and just because I am TRAINING to work in the admin office does not give you the license to be so nasty to me!?! But on the other hand I have always had an amazing rapport with most of my coworkers (we go to dinner at least once a month just because we like to hang out) and I don't want to loose that. :spbox:

Yeah I hear you, I remember struggling with that a lot while going through nursing school. The other thing I ran into frequently is when you have a really emotionally draining case that is sad.... As much as family and friends want to support you their are only so many sad nursing stories they will want to hear and can handle... i.e. mistreated kids in peds or end of life complications in the icu. I found a LOT of support with my fellow classmates and found that we quickly became a very supportive psudofamily for each other. It's nice to be able to share what's going on in your work life with your friends and family but their are just times when like you mentioned above.... unless you have worked in the field you just don't get it. Now that I am working I have a few nurses that i work with who I can share with and will listen and understand.... Hang in there:redpinkhe

The Dictator.... Wants to demanding the care their family member recieves but wants nothing to do with the patient. Usually found calling and giving orders over the phone but never seen during visiting hours (and lives right up the street). These ones burn me a lot.

It's really not that bad... I mean don't get me wrong it has its days (but what job doesn't). My theory is you notice a lot more bad then good because people are more likely to seek out support when things are going poorly as opposed to when things are going well. The job market is tough but that seems to be across the board in most all professions. You will also put up with a moderate amount of verbal (more depending on your specialty :smackingf) abuse. This will probably shock you a little at first but eventually it will make you laugh. Nursing is a tough but very rewarding profession. In my humble still somwhat new opinion. . To those of you about to graduate. Good Luck we look forward to working with you

As you mentioned about everyone HAS been through this at one point or another... Including your coworkers on the floor. They will be there to keep you on the straight and narrow. Being a little bit anxious is a good thing, it will keep you on your toes and keep your patients safe. The nurses who think they have it all under control right out of the shoot are the ones that scare me!!! :stone I am sure you will do amazing. You deserve to be there and the fact that they are letting you off orientation means that whoever is overseeing you thinks so too. Have a wonderul first day and know all your buddies here are cheering for you. :anpom::anpom::anpom::anpom::anpom: