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  1. KalipsoRed

    Taking the ACLS. Some advice please.

    1) Don't panic. 2) Think of ACLS like you do Basic CPR certification. Yes you need to study for it and try to be prepared, but you go to the class so someone can teach it to you! You probably don't panic about BLS, right? I'll tell you this, I can't remember all the algorithms either and I just took ACLS a month ago. This is going to be one of those things were you go to the class to learn it and then you have to keep going every 2 years so that you can keep it fresh in your mind. Eventually, because you have to keep going over it, you'll pick it up. 3) Don't let the mass of information scare you. Remember what you can and if someone is a jerk because you forgot a step, forget them. You'll get it eventually. 4) Learn your cardiac rhythms by searching 'Six Second ECG (or EKG) Simulator'. That is an excellent little web site that is very helpful. 5) Really don't panic and if you happen to pass ACLS but still feel like you don't know it keep studying and identify a nurse that's had more experience with codes than you every time you go on shift. That way when the poo hits the fan you can grab her/him to help you.
  2. Thank you all for your responses, I have enjoyed reading everyone of them. I know that caring for people is something I've always done, ever since I was a kid, but I get more statisfaction doing it for free than I ever have being employed for a hospital. I also get sick from taking gratitude from my patients when in a lot of ways I feel their vist was not up to my expectations. Most of my work has been for non-profit institutions. I would say the majority of my patients are the blue collar workers of the USA, many of which have no insurance and are paying $50,000 and up for a 3 or 4 night stay. That is a huge sum of money for someone who maybe makes $40,000 a year and the patient couldn't even get to the bathroom in an acceptable amount of time because of staffing and stupid policies. I can't feel good about a complement given to me by a patient under those circumstances. I hope my feelings change...or that I can find a spot in nursing were I don't feel like we are just putting the screws to people. (I mean if you ever really take a good look at the actual cost of giving care, including paying staff and a hospital making a decent profit, and how much over that hospitals charge; I don't see how anyone can take pride in this profession. We basically fill the pockets of the business managers...even in non-profit situations. I'm not saying all hospitals, but the majority are this way.) I'm trying to learn more about nurse entrepreneurship maybe I'll find something I can feel respectable doing that way. Thanks again!
  3. KalipsoRed

    Full time vs. per diem

    I like the 'do both' idea, just realize that you won't see much of your family for another 6 to 12 months.
  4. KalipsoRed

    A reson why nursing is a bad career choice...

    I do believe I am burnt out on nursing, however I'm burnt out because the conditons are terrible. I mean I put this along the terms of slavery. What, because it was normal for black people to be slaves and mistreated they shouldn't have complained and continued to fight until fairer laws and treatment were made for them? What kind of nutzo thinking is that?! I trust my gut (guess what, it's more accurate as to telling me whats going on than papers and lip service. Shocking, no?) and the doctor knew the patient's condition just like the rest of us who were caring for her. I'm mad at ALL of us involved in the scenerio including myself. The patient shouldn't have to pay for falling through the cracks and that's why I said something. Believe me it was painful to sit there and have the patient ask why I didn't do more, because the patient did. (Little side note, I even defended the MD some in my OP.) And then some of you will want to turn my post around and say I'm feeling guilty and thus pointing the finger at others. And my honest to god issue is that our work environment fosters this sort of fallout. I pointed out some of the obvious problems with our work environment. When I say the majority of doctors are verbally abusive, I mean it. Why everyone is so focused on this issue and not something else I said like doctor/patient and nurse/patient ratios I have no clue. I've met some doctors who aren't, but by enlarge most of them are condescending, demeaning, and repeatdly talk down to nurses. What is sad is that a lot of older nurses think this is normal and don't see it as verbal abuse. Younger doctors are less likely to be this way...mostly because I think they were trained differently. I pointed this out because it is a factor of care because it is a confidence destroyer for nurses, especially new nurses. This whole 'your gonna have to get tough' talk is a bit silly because when a nurse finally 'gets tough' and stands up for him/her self he/she is likely to be reprimanded for it. (Little side note for those of you who wish to point out my 'attitude'. I've never been written up for bad behavior, 'spoken to' about it, OR any work/care related issues for that matter. This is what I've seen happen to to my friends, my co-workers who are very good, but newer nurses who haven't been educated properly because no one has the 'time' to make sure it happens. Or very good middle age nurses who finally have had enough and stand up for themselves, but it's usually worse for them, they get fired.) Nursing is like an abusive relationship where the tension builds and builds until he/she goes off. Then he/she gets reprimanded or fired, goes into a honeymoon period, and then the cycle starts again. I've seen it happen over and over again. My only saving grace has been I've known when I was about to blow and changed atmospheres before it came to a head. What some of you see as 'normal' post op complications, I know to be due to a damaged system that the patient should fight having to pay for. Yeah, health care is dying due to lack of payment. The pressure is building like puss in a pimple and eventually the whole thing is going to blow. People cannot pay for insurance when it is as costly as their house payment. Doctors and nurses don't want to work for free (rightly so) and insurance companies are making out like bandits and hurting both the medical staff buy tying our hands and the patient by dictating care. I frankly think we should get rid of insurance all together or make it something people shop for like car insurance. This way the insurance company would at least be more interested in provding service to the patient instead of the patient's company. I also think that hospitals should have a posted 'menu' of services with an estimated expected cost. In this manner patients can shop for their services more easily. My dad has no insurance and is a type II diabetic so I know after shopping with him how big the cost differnece can be for the same procedure at two different hospitals. For those of you who have posted about the horrendous care that was given to someone you know. I'm sorry, it shoudn't be that way.
  5. KalipsoRed

    Med Surg or ER for New Grad

    I agree with you IMTHATGUY. Just trying to trying to go over some pros and cons. :)
  6. KalipsoRed

    Med Surg or ER for New Grad

    I worked ER as a nurses aid. I felt it was too steep a learning curve to try right after graduating. So I decided to do something 'slower' and went to a telemetry/step down unit. That learning curve nearly defeated me, but I understand a whole lot of what I saw in the ER much better after working tele. I think the hardest thing to understand about the ER apposed to working on a floor is that ER is what I call 'sloppy' nursing. Please do not misunderstand my wordage to mean that the ER nurses do a half - butt job. Far from it...but floor nurses are much more detailed oriented when it comes to a lot of things. Exampleish? Report from a floor nurse includes last pain medicine, a slew of labs, dressing change orders, activity orders, etc. A report from an ER nurse can pretty much go like their blood pressure is better, they're breathing with good oxygenation, and they'll be there in 10 minutes. In the ER you have to assess, stabilze, and ship them out because there's a whole crew of new ones waiting in the lobby. On the floor your planning what's going to happen to the patient on your shift and over the next couple of days. What I also noticed in the ER was that ER nurses usually get out on time....very rarely was a patient so critical that the nurse couldn't give report and leave. ER nursing reports are bare bones and you kinda figure out the rest on the way. Floor nurses will get miffed if you forgot to report the tinest thing. And for the floor nurse that is rightly so because missing tiny details can cause great delays in care on the floor. I don't know what is right for you. I'm glad I was an ER aid first, and I'm very satisfied that I decided to go to telemetry and I'd like to hit the ICU before I tried the ER as a nurse. What Nursedolphin says about ERs liking to hire new grads is somewhat true, but they also have a great preference for ICU and critical care experienced nurses. Some of that want to hire new grads over experience has nothing to do with 'molding' the new grad as you would think. In the 4 years I worked in a large teaching hospital I saw many rounds of new grads come through. They got very excellent teaching for a new grad, but there is no education that even comes close to experience. The hospital I worked for always had tons of new grads and very few experienced nurses. New grads get paid less and are willing to get 'molded' into doing more by management...if you get my drift. The constant turn over and the fact that tons of new grads always want to start somewhere exciting like the ER made the experienced nurses more dispensable which is really, really bad for new grads. You have no idea how bad you are going to want plenty of experienced (5 yrs or more) nurses around you in ANY hospital setting until you get out of preceptorship and are on your own.
  7. KalipsoRed

    Disappointed New Grad

    The show one, do one, teach one technique of learning is actually a very good way to learn. The military uses it all the time. The hectic feeling you have from an inability to keep up will aleveate in 6 to 12 months. You will still be staying over more often than not even as you become more capable in your nursing ability. Poor staffing is everywhere....more common than not. Give it a year and you'll feel better. It's okay to cry...even if you do it every single day you come home from work and before you go to work. That's what I did my first entire year of nurseing. Then I learned the whole, "you can only do what you can do" mentality and it got a little better. Good luck.
  8. KalipsoRed

    A reson why nursing is a bad career choice...

    I want us to be able to say we are sorry to the patient, Lineartlinker. I'll go in on the blame with everyone, I'm alright with taking my share of responsibility for something that fell through the cracks. No one 'saved the day' in this situation and that's what I'm tired of. This happens all to frequently. The other things unrelated to this particular incident (the verbal abuse, poor pt ratios, etc.) are just icing on the cake and things that make situations like the one I described possible. What I don't understand is why we let ourselves get craped on over and over again? Not only do we do that, but we tell new nurses that are less willing to play by these rules that it is part of their job to put up with this crap. I want a rally. I want to feel like things are improving instead of getting worse. I'm looking into lobbying and such because these conditions have to change.
  9. KalipsoRed

    A reson why nursing is a bad career choice...

    I did not call the MD because I knew he was aware of the dehiscense. Like I said in my post this was a wound that was closed for 4 days then gradually began to open over 5 days prior to the patient being sent home. This is not a case where in the period of one shift the wound went from closed to dehisced. Of course I would have called for that. Yes, I and all the other nurses were documenting the changing amounts of dressing needing to be used for the wound. The problem with calling is that I had nothing to call about. There was no visual change between the beginning of my shift to the beginning of another. It was over a period of 5 days that this occured. I don't know what was said to the doctor on days, I do feel from what I've heard from the day and evening nurses that the doctor was aware. I also know from the patient that while the MD didn't look at the wound himself everyday he did look at it before the patient left. I'll call a doctor at whatever time I think it needs to be done in this particular instance the I felt that the A) the change to the patient wasn't something that warrented me calling the MD and more of a concered to pass on to day shift B) From the progress notes I feel that the doctor was aware the wound was getting bigger c) I'm a traveling nurse and could give a rats butt if any of the MDs likes me. I made reference to doctors being verbally abuseive because it happens ALL THE TIME and NONE OF US DESERVE TO BE TREATED THAT WAY. And yes, this 'profession' is still crappy and not professional at all. I wanted to care for people so much when I got out of school. I was misinformed that nurses and doctors actually did some form of caring.
  10. KalipsoRed

    A reson why nursing is a bad career choice...

    Just a little addendum. 10 months ago I got an award for catching an almost deadly medical error at a hospital I worked at. Shortly after I had to go to the ER my self and since there were posters everywhere with my face on them and what had happened, the MD caring for me made mention of it. He said he had recently read that if air traffic control had the same amount of deadly error that medicine did there would be four plane crashes a day. Really? How many people are we going to let DIE because ratios are to high and communication is poor?!
  11. first of all sorry i didn't spell reason right in my title. to make a long story short, i had a patient who needed abdominal surgery. the patient did and because of other reasons ended up staying for a good length of time. after 4 days the abdominal incision came open a very tiny amount...not much to worry. unless you consider that the wound had been closed for 4 days and the patient had been up and down out of her beed several times a day. then it came open more and more. over the period of 5 days the wound went from approximated to 2 inches wide and tunneling 1.5 inches deep. at discharge no granulation tissue had formed...in fact slough had in some areas, and the wound was still continuing to get bigger. the patient had no underlying diagnosis as to why she would have dehisced in the first place. i work nights so i don't know what the doctor was aware of. i do know i told the shift after me and documented. i knew that when i would give or get report the nurse would say something along the lines of, "they need to quit messing around with this wet to dry dressing change and take her back to surgery and see what is wrong!" i also know that it is the mds responsibility to look at the wound every day. i knew when this patient got discharged that the patient would be back very soon. a few days later the patient was. the patient had to have surgery to repair a bowel that got nicked in the first surgery. the patient is again having complications in a stay that should have never occured had the proper action been taken before the patient was discharged. i told the patient that i did not believe that the patient should agree to pay for the second stay. i'm sooooooooooooo angry about this! do not missunderstand. mds make mistakes and a nicked bowel is a potential of abdominal surgery. i'm mad because to me it was obvious that something was not right and the md should have taken her back to surgery to find the problem before she left. now i'm going to have some of you chastise me for saying anything to the patient, but when do we stand up for the patient? i'm not saying that the patient should sue, i'm just saying that the hospital personnel didn't catch something that should have been caught and thus the patient should not have to pay for the second visit. all we do is cover the hospital's butts for providing patients with sub standard care through poor doctor to patient and nurse to patient ratios. (hospitalists work for the hospital...surgerons and other mds are different i know.) how can anyone feel good about doing this job? the definition of a nurse is: a person who cares for the sick or infirm; specifically : a licensed health-care professional who practices independently or is supervised by a physician, surgeon, or dentist and who is skilled in promoting and maintaining health according, to the merriem-webster dictionary. we don't give care, we tick off tasks and allow doctors to intimidate us and/or talk down to us in a manner that damages our confidence in our skills. this is the worst profession anyone one could choose to go in to mostly because you are damned in most any course of action you take. you stick up for the patient you get a bad wrap for being hired at hospitals. you tell a doctor who is being a piece of poo to you or your co-worker to back off and you get told by management that you need to work better with people. not to mention that patients can just walk all over you if they feel like it because we are there to provide them with "customer service". i also love all the stories that i read in my nursing board bulletin where a hospital gets sued and suprise, suprise it's the nurses' fault and not only is she/he getting fired but their license is also on probation or revoked. and when i read these stories i clearly see where the nurse is being held responsible for something that i would assume is the doctor's responsibility or that the hospital was making the nurse do some sort of stupid hospital activity that interfeared with the care he/she was giving....not to mention the ones that just sounds like the nurse had too many patients but was probably afraid to say anything because then she could a) get fired b) get accused of patient abandonment or c) be reprimanded for not being a 'team player'. futhermore something like 80% of the stories i read that are not about nurse drug abuse make me feel this way. nursing is not a profession, it's bullying made legal.
  12. KalipsoRed

    Support Hose?

    I didn't use them for the first 2 years I was a nurse and I've already started to get spider veins! USE THEM! I also felt my legs were a lot less 'heavy' after work than when I didn't use them. I don't particularly like hose, I like compression knee-high socks. My favorites are from TravelSmith.com the cushion travel socks that are about $30 a pair. Most excellet!
  13. This has been my issue with nursing since I became a nurse. Drives me bonkers! I'm done....I've set my self up enought that if they feel like firing me for doing what needs to be done then so be it. I think patient surveys are good, I like feed back on my care and really I didn't mind the customer service classes either. I think they helped me dissolve some issues before they started BUT I draw the line at ignorant disrespect and giving good patient care. I've made people do the things that were good for them and had my manager tell me I could have been nicer to them to get them to do it.....uh, hello, if that were the case the patient would have done what I asked the 1st time I explained why we had to do it now. One day I'd had it and I went off on a woman who had been cursing me out all day....I don't know why, I've had people say the same things to me before, but for some reason that day I'd had it and I went off on the patient. I didn't curse or be petty back, but I did tell her that she was impatient, a waste of my time, and that I had sicker patients that actually needed my help. I shoved the chart into my Charge RN's hands and told her I wasn't stepping into that room again for any reason. Later I hear my Charge RN trying to do 'patient satisfaction recovery' with this patient and she told the patient that I went off on her because I'm "kinda crazy". Oh yeah that was great, don't let the patient know that she was at least some of the issue AND then indicate to the patient that our hospital hires incompetent, crazy nurses. That sure recovered the patients satisfaction, huh? Eh, I'm done. I've been actively looking for work out of nursing for 2 years and I've only been a nurse for 3! I'm going to massage school and have a part time job serving coffee at a book store. I love caring for people and I think some customer service is really called for in the hospital setting (more along the lines of the education we give and the time it takes for us to answer a call light), but I refuse to be 'nice nurse' when a patient really needs to do something for their health but doesn't because it's 'uncomfortable'. I won't let them do that. I get in trouble for doing the good thing for the patient and the wrong thing for the patient so I might as well make the patient do whats best for them and get b*t*ch*d at about it later.
  14. KalipsoRed

    Want to be a competent travel RN

    Hi, I've just started travel nursing. My first position was way up north and I'm not really digging the freezing cold. However I have found the people I'm working with very wonderful, luckly. I'm in the 8th week of my assignment and I have some concerns with my performance. No one has said anything to me, it's just what I'm feeling. This place is still using MIS or FAMIS as their base computer system...if you know what that is you know how bad it sucks. Most of the charting is paper. The issue with FAMIS is that it gives you a print out each shift of what the patient needs, MD to RN communications, Labs to be done, etc. You would think that is great except once an action is completed by an MD, RN, RTT, and so on that person is suppose to go through a pretty lengthy process to take it off the print out so the next person doesn't think it needs to be done. Well as you can imagine most people do not take off an action once it's complete and thus it leaves a lot of guess work for someone who isn't familiar with the work procedures and policies. Also these nurses still do taped reporting...which I also think is sucky and doesn't really allow the on coming RN to ask good questions. And I'm working 8 hr shifts, which is new because I've only ever worked 12s. So with all these changes I feel like I'm missing to much stuff. I haven't missed anything really important yet. But I did miss a patient scrub (I work nights and his surgery was scheduled for 17:00, so it was more like something nice I could have done but not really my responsibility....and that's even if they didn't have a standard policy for how close to a surgery a scrub should be done. My last hosptial required that the scrub be completed no more than 4 hours from or less than 2 hours until the surgery.) I'm not so disturbed that I didn't do it as I never even noticed it was something that needed to be done. I've missed bits about dressing changes like applying creams around edges or things like that. It's just that all this information is scattered throughout the profile and not really something that is reported in report so I can write it down for myself. As I have 7 to 10 pts without an aid, I don't really have time to spend 30 minutes scowering the profile to find everything I'm missing. I've made it a habit (really this is what I always thought people did anyway) of reading the last 12 hours of orders before I start, but some orders that I've missed were written before that period of time. I guess what I'd like to know from some experienced nurses is how you guys figure out polices and procedures at every new place (because most places don't give you a book anymore, its somewhere online)? I've done the whole asking gig, but I kinda feel that these people are annoyed that I'm still asking so many questions and I've been there 8 weeks. Are ya'll able to pick up every new hospital floor's groove in 8 weeks? I'd also like to know if it is common for hospitals to ask nurses to take 8 patients without any assistance. This is post surgical floor, a lot of GI, hips, knees, and some thoracotomies and pacemakers. Most of these people are in their 60s, 70s, and beyond. While 60 and 70 year olds can be very active, it has been my observation that ALL people post hip and knee surgery need help out of bed even if it has been 3 or 4 days since surgery. Furthermore, GI surgeries are the same....it's just hard for people to sit up to get out of bed. If you are a nurse that has been able to successfully care for 8 people, keep track of it all, get to them so they don't have to wait 20 + minutes to pee, and do your paper work in an 8 hour shift AND leave within 45 minutes of then end of your shift, I'd really like to hear how you do it. Thank you!
  15. KalipsoRed

    Is nursing "care" a thing of the past?

    Huh, I came to read this because there was a heated discussion about bed changes and baths that I was posting on. As a 3 year old nurse I can safely say that nursing is not the loving, caring, and compassionate career that I had believed it to be. I got in it for all the right reasons and I can say that I hate everything about it other than the few times I've actually gotten to do good things for the people & families I've cared for. I'm tired of hearing one nurse say to the other that their complaints about how hard they are having to work show their lack of care. We DO have to work to hard to take poor care of our patients. I never would want my family to be in the position the OP was in. I try to make sure that doesn't happen to my patients...but there have been those who feel like I took to long or didn't do enough. There are those who thought my care was so great that they sent me personally flowers to my floor. The second is very far in between and the prior is much more frequent. I've struggled for the last 3 years thinking that if I just kept going this career was going to get better. That I'd eventually figure out the magical time management skills and nursing secrets to getting things done on time, documenting, and giving excellent personal care while still being able to go home at a resonable time and enjoy my life. I've changed nursing venues 3 times and yet I still feel like this career is a lie. The longer I'm in it the more callous I've become. What I have learned is that I no longer trust medical personnel. I will be at the hospital with anyone I care about and that death is not a bad thing.