gilf7243

At my hospital it works like this ICU=vitals every 1 hour, I&0's every 8 hrs (6a,2p,10p)unless very critical then every 2 hrs. Step-down ICU=vitals every 4 hrs, I&0's every 8 hrs (6a,2p,10p) Tele=vitals every 8hrs unless they are on a drip or have been admitted less than 24hrs. (Drip like cardizem, heparin, nitro, dopamine, dobutamine, etc) Med surg=vitals every shift or every 8 hours-not sure b/c I work the critical care block. I&0's every 8 hours (6a,2p,10p) Hope this helps gilf7243

I work at an hospital who is cutting costs the same way. The ratio is the same as you have given. In ICU it is 2 patients=1 Nurse, unless they have a doctors order to be 1:1. On step-down we have 3-4 patients per nurse. Many times without a nurse tech. Our secretary has to cover the whole critical care block so you can't always get his or her help putting in orders. And always, tele patients are 4 patients=1 nurse. Many nights my back hurts, I am lucky to take my lunch break, and lucky if I can urinate when I need to. It really sucks but such is my chose profession. No, I don't agree but this is the way it is almost everywhere. Many hospitals are cutting back b/c of not receiving enough medicaid/medicare funding and other economic issues based on the current economy right now. Plus, all our nurses are taking turns getting called off. Some of our units have closed down for 5 weeks at a time. Some of our nurses have prn nursing jobs on the side to make up for the lack of hours. This all after they layed off all our LPN nurses.

I've taken care of one prisoner for a few hours before he transfered out of the facility to a bigger hospital. He was hand-cuffed to the bed rails and had 2 guards. I never specifically asked what he was in jail for. Didn't want to know in fear it would affect my care to him. He was very polite. More polite than half the patients I take care of. I also took care of another patient that had been in jail for several years but was no longer in jail. He was weird but a nice patient to take care of. He told me why he went to jail. He acted like he had nothing to hide. He said he killed the man his wife was sleeping with. The only thing that bothered me was that he said didnt' regret doing it and that if he had to do it all over again he wouldn't have changed his actions. Scary thought. I have to say it was a little uncomfortable for me to continue caring for him the remainder of the shift. I was off a few days after that and he was discharged home before I came back.

Legally you can not copy any nurse note record from the chart. You can keep track of dates, times, and actions on your own in a calander or on a report sheet so you can remember or recall if ever called into a court hearing. Just as you can not take the nurse notes neither can your employer or DON. What they have done is illegal and unethical. I would report this to the State Board of Nursing and would take a second look at staying on there staff. Remember, you have to protect your own license. Good luck to you.

I went to school and got my LPN then went back much later to get my RN. I am not sure that either school set out to wean out students. However, there are so many students that are on a waiting list to attend nursing school in my area. If they find that you don't take it seriously and are wasting you and there time they will not have a problem kicking you out so someone else who may be more commited will get there turn and succeed. As far as one being less strict than the other. Didn't happen for me. Both schools equally adhered to their policies and had no problem kicking you out if you didn't comply. In there defense if you aren't there to give it all you have then why are you even there? Hope this helps answer your question. Good luck in RN school.

I was an LPN for 12 years before going back for my RN through the LPN to RN program. I did not attend this school for my LPN either. They didn't even have an LPN program back then. Anyway, the classes you take will go through all of the body systems. It should all be a review for you since you just went through LPN school. Some of it might be more indepth then your LPN school. Clinicals might be more of a struggle for you. It was for me. I had always worked in a nursing home as an LPN. When I did my clinicals we only did 3 semesters. I had never had IV experience as an LPN. I had practiced in the lab but wasn't very skilled. It all worked out well in the end. I have been an RN now for 2 years and work on ICU step down. Good luck with school, I'm sure you'll do great.

I work 7p-7a shift in Ohio on an ICU step-down floor and our hospital just layed off all the LPN's and a few RN's plus many from other ancillary departments. They also just decided to change our Matrix. Our Nurse staff ratio has never been based on acuity but rather by numbers. However, now if we are no longer full with every bed filled on our unit we will have to either lose the tech or techs depending on the number or lose one or more nurses depending on our numbers. The techs are usually responsible for 10-15 patients. We will be responsible for 3-4 patients a piece depending on wheter we lose a nurse or not. Here lately we have had 4 a piece. Sometimes we get patients who should stay a few more days in ICU but are forced to leave b/c of an incoming trauma. These patients don't deserve less care but we can't give them as much attention as they can in ICU. We have one secretary for the entire critical care block. It is rare to actually have the privilige of utilizing her unless you get an admission. We don't have any other extra help on our floor. We read our own tele strips every 2 hours. Here lately, nurses have been called off losing hours or sent home early losing hours because our census is down. This is happening more and more. Half of our staff have other jobs to make up for the lack of hours. I am also thinking of looking for something else as well. Nursing jobs aren't in much demand in my area. There are too many nursing schools in this area. Plus, our hospital keeps pumping into us that we need to have a high patient care satisfactory level. Its all about customer service. The demands just keep getting more and more and more. Just wanted to know if this is true in other states as well.

I work at a level 2 Trauma Center in Ohio. Recently they layed off all of the LPN"s. They offered them a few options to cross train for another position for less pay such as a nurse tech or Unit Secretary. However, this would be fairly big pay cut. I heard some had the option to go back for there RN. Not sure if hospital was paying or not. Some of the nurses have been there for years and have more on the job experience in their pinky than I have in my whole body. Some have opted to stay b/c they are so close to retirement. The severence pay wasn't good from what I hear. Just a few weeks worth. I feel terrible that this has happened to them and my heart goes out to them all. :heartbeat My question is: Is this the new trend? Are your hospitals doing the samething? What does this mean for LPN's out there if so????

Don't be too hard on yourself. I have been a RN for two years now and before this had worked as an LPN in a long-term care facility. I didn't know anything about the hospital at all. I started working in ICU step-down and some of the patients should have probably been in ICU. Anyway, it was hard for me to catch on. It is unreasonable to expect that you will know everything or be perfect from the start. All nurses have been there. Some just forget. It took me a good 6 months to feel comfortable at work and to not agonize or have panic attacks before work. Don't give up on yourself. Just learn from your mistakes. I assure you after you do them once, you don't usually do them again. You'll do fine. Trust me, if I can make it then you can make it. Good Luck!

Sounds like you work with a bunch of hulligans. This is about the stupidest thing I have ever heard. How mature is your CMA or Administrative staff? I'm glad I work in a hospital where things like this don't happen. We have a machine called a Deibold machine that dispenses almost all of our narcs. You take and you record your waste with another nurse via this machine that dispenses the med. It is kind of works like a bank machine. You swipe your badge and enter your password to dispense. Then you do the same to return a med if you don't need it. If you need to show your waste for a half dose administered then you log on and your witness has to log on entering her password. You can never be 100% sure that someone may not waste but rather use it and replace the drug with water. You just have to know your staff, co-workers, and do random drug screening when problems arise. As far as I am concerned there is no room for games like the one your facility has performed. Wish you luck.

The hospital I work for offered a 4,000 sign on bonus but you had to sign for 2 years. It hasn't been bad working there. Definitely have to check out your hospital before signing.

I personally feel these two nurses are not acting professional at all if they are kissing at work and extending their breaks. As far as I am concerned the two should not be working on the same floor or shift if they cannot act in a professional manner while at work. Patient care has to take first priority. However, on the other hand. If the couple is merely taking breaks and working together because they are a couple I don't see a problem as long as they are acting professional and put their patients needs first. I have a similiar issue where I work. I just have to place my focus on my patient assignment and worry about my license and my professionalism. It does get on my nerves and it is very annoying at times. I try to schedule myself when they are not working so it limits my awareness of the issue. Eventually, if they keep up this behavior they will get caught or a patient will complain or they will neglect some aspect of their job and it will get ugly for them.

One good thing about nursing is it is versital. Maybe it is just the area of nursing you are working in. Would you be more comfortable in any other area of nursing at the bedside? There is med surg, pediatrics, OB, ER, ICU, CCU. At my hospital some of the nurses prefer the sicker patients in ICU b/c they are the ones on concious sedation b/c of their injuries. There are doctors offices but the pay isn't as good. Some nurses travel so they don't get caught up in the politics of hospitals. I am not sure you will ever be able to get away from confused patients at the bedside completely. It is bound to happen at some point. Have you considered working in a supervisor position. You wouldn't necesary work the floor but advise the RN's that do. You will soon have your BSN. Colleges look for clinical instructors all the time. Would that interest you? Whatever you decide, I wish you luck.

At my hospital we take pressures every 15 minutes on someone with a pressor.

Most of the doctors at our hospital are nice but there are a few that we fear to call at night. I work ICU step-down unit. I usually try to wait until morning since I work at night but if the patient has a significant change of condition for example low blood pressure, high blood pressure, new hear irregularities, or repiratory issues that are of new onset you really need to speak to a doctor immediately. Sometimes you have to page the doctor 3 times before they return the page. Sometimes they don't call back at all. Sometimes they disagree with the nurses judgement and say, "This could have waited til the morning!" and hang up on you. Sometimes they won't even let you finish your sentence and talk over you and miss out hearing important details before they hang up. I have had a situation one time that I had to call the hospitalist for the patient and call a rapid response b/c the doctor never called back. Then that same doctor gave us crap for using the hospitalist. What else could we do?? The patient couldn't wait for the doctor. It was a dire situation. That only happened one time though. I believe this doctor was disciplined for that incident. Hope this helps.

I have had 15 years experience as a nurse. 13 as a LPN and 2 as an RN. I don't hate my job. I like the profession very much and find it very rewarding. The problem is not liking or disliking the profession as much as the stress and demands placed on many hospital staff these days. Many times I have felt as though I was placed in unsafe situations for my patients only to be more productive for the hospital. Many hospitals have lost funding from the state and to compensate for the loss they cut staff and take short-cuts. It has a negative affect on staff and often nurses feel invaluable, unjustified in their feelings, and stressed that they don't have the time they would like to spend enjoying the profession they chose. In my years as a nurse things have changed alot. Not always for the best either. I think it is a shame these nurses targeted you like this. However, I think they are just releasing some of the anguish they have over the current trend in healthcare off to you. If nursing is what you want to do. Go for it. Make the decision yours and don't be influenced by burned out nurses.

This has happened at my hospital before. Someone is on a K+ depleting drip and no one thinks about the K+ level. I think it should be protocal to check a K+ level daily when on a drug like lasix or bumex. I work night shift so it irritates me when the day nurses don't think about these things when the docs round and you come on night shift and by the time you have a chance to fully examine the patients labs, tests, etc it is too late to call the doctor and you get an on-call doctor that doesn't know anything about the patient. Especially, if they start having arrhythmias. Normally a lab order is given when asked but in general it just irritates me when day shift doesn't catch things. Happens a lot at my hospital.

Sounds like moving this patient was the right thing to do. This patient is sick. She probably is septic or in shock from her colostomy surgery since her pressure is low. It's difficult to say for sure with such little information. She definately needed cardizem or amiodorone to get her heart rate under ctrl. Also, she may need Dopamine or something to get her pressure up. She needs the doctor to start checking her labs and figuring out what is going on?? Maybe her H and H is low from surgery, maybe she is bleeding, maybe they nicked the bowel in surgery. Who knows? Moving her was a smart move. Let me know if you can how this patient does?

I have never heard that pushing Dilauded and Ativan was unsafe uless the wrong dose is given. I was never taught to use the most distal y port. I always have used the closest to the patient. Of course I make sure first that it is compatable with the current fluids running and I don't push it fast but steadily over 1-2 minutes letting it mix with the maintance fluid as it goes in. Not sure how else to answer your question. Hope this helps.

In my hospital we have such a thing that is a standard form to replace potassium called "Potassium protocal" When it is ordered we print the form and fill it out and fax to pharmacy. The dose is based on the patients weight and most recent potassium level. If it is under 3.5 and if they get lasix and some other meds that deplete potassium you mark it on the form. The nurse decides how it would be best administered. Oral, Liquid, IV. We always try oral unless contraindicated. Then we re-check the level after two hours if the original level was under 3.5 otherwise, we wait until morning and re-check it then. As far as wheter IV is better than oral I cannot say. I know it is probably given a lot faster if oral b/c it takes longer for the iv's to get infused. I have never heard of potassium being given any other way then 10meq at a time IV. It is very irritating to the tissues. I hope if given this way it is through a PICC line not peripherally. Hope this helps.

I just took ACLS and if pulseless, yes it is a shockable rhythm. Of course CPR and meds must be given before and after til a pulse is felt. Epinephrine 1mg every 5 minutes time 3 doses. Hope this helps

I think you may work at my hospital. This all sounds very familiar to me. I feel burned out too. Good for you for going back to school. If we don't work at the same hospital then it must be the same company that owns it. Is your hospital a catholic one that just added a tower called the K tower? That would give me a good indication if we are at the same place. Good luck!

I have a form that is very informative for report use that I can get my hands on at work. I don't go back until tomorrow. Sun July 27th. If you still need let me know. I am not sure how to get it to you. Can you attach things on these forums? I am new?

I work for a Catholic Hospital too!! It makes me wonder what would happen to me if the situation was mine? I have never had cancer and cannot begin to understand all that you have been through. I cannot believe you where fired!! I will include you in my prayers. I am so glad you have some insurance benefits now. I work with a nurse who travels an hour from where she lives b/c she had a similiar situation as yours. She worked for the hospital in her home town for several years and she claims she loved that job. She said one of the doctors begged her to leave the hospital to work in her office. She kept passing it up b/c she didn't want to give up her benefits. Finally, after much convincing she left the hospital to work for the doctor. Not long after she found out she had breast cancer. She said, "when the doctor found out she was more worried about her practice than her and what it would cost her to pay for her new employee to continue her benefits while off on leaver for chemo and so on. Needless to say, she is fine and cancer free now but does not wish to see the doctor who she left a job at the hospital that she loved to work for who wasn't there for her in her desperate time of need. So she travels an hour to work with us. She is such a good nurse too! I was speechless when she told us this story. I didn't even know what to say after she told us. I was the one who asked her, "Why dont' you work in your towns hospital since you loved it so much? When she came out and told us why??" I felt like sticking my foot in my mouth! May God continue to heal you and your family and bring many more blessings your way.

Something else struck me about your situation with this co-worker. How can she get away with leaving early so much???? This should be a red flag to the DON?? I used to work in long-term care but now I work at a nearby hospital. To the best of my knowledge "NO ONE" could leave their shift til the next nurse came on. At the hospital they are very strict about attendance. You get docked if you leave your shift early and they have a point system. After you reach a certain point you are fired. She is obligated to her patients and to her employer. My hospital just layed nurses off. She should be glad she has a job!! It is easy to see how you could get so irritated with her. The only solution for you is to go to your DON and explain how this is getting to you and how it is affecting your work relationship with this nurse and in turn I'm sure it is spilling over onto the patients you are obligated to care for. Can you work alterate days then this nurse so you don't have to be the one deal with this? If the DON doesn't already see a problem with this nurse than possibly she needs some classes on her role as leader. I am so glad I work at the hospital. We do self scheduling aside of our weekend. So if there is someone I don't particually want to work with I can just schedule myself on opposite days. Good Luck!!