ChicagoPeds

Hi. I am going to have to agree with another RN who was saying to just do it - over exposure to that particular task may eventually give you "immunity" to it...hehehe. When I was a nurse extern, I had to take care of 3 kiddos who were all on contact, all CP, & all trached...for a couple of shifts in a row. I no longer had any problems with the really, really poopy diapers, trachs were a breeze (could do the care & suctioning in my sleep), and turning those Pt's heavier than me & dead weight became an artform.... Oh yeah, and wearing a mask & breathing through your mouth helps as well. As others have also already said, everyone poops & it is actually part of what nurses do... assess all of our Pt's. Also, once you become a nurse & may have help taking care of Pts, you will also see that not every level of health care assistants worry about skin breakdown (read: Pt left in dirty/wet/soiled diaper for way too long...).

Checking out your place's EAP would not be a bad thing. You sound like you have a lot going on...and not just at work. Having a different perspective & someone to talk to who can direct you or help you would probably be beneficial. Starting out my first year, I went directly into the PICU (cuz I liked the challenge) & was frustrated & upset. I ended up transferring over to a peds floor with multi-specialty as well as gen peds cases & I have been extremely happy ever since. Just because you are now a nurse doesn't mean that you will be happy in any nursing position. You may want to talk to your managers/nurse educators (or other support people available to you) to see what other options you have. They want to have RNs who are good fits for the unit and the patients. Med-Surg does get a bad rap at times, but I have several friends who went into that right out of school & love it. I also know of several people who started out in a med-surg area & then after they get their own rhythm down, they move over to a more challenging unit. Good luck & take care of yourself!

fridayannelpn1974 - Firstly, I was not meaning to personally attack anyone. That was not my intention. Secondly, I have heard the craziness that nurses in the past 10 years (when the nurses on my floor were at the older hospital...before we transferred over to the nice new place) had to deal with...patient ratios, etc. They actually think that us newer nurses are sometimes goofy (for lack of a better word) for being concerned about having gone over our max ratio of 4:1 (some have been assigned 5 patients). I started nursing when nurses have to dual-check insulin....have been at a hospital where there have been issues with pt's getting too much insulin...& not even being diabetic patients or patients who need insulin...so yeah, I am going to double check & have someone double check with me. I play by the rules...cuz when I don't...that's when I have gotten burned. Also, as already previously stated on multiple comments prior to mine, LTC is different than hospital...there are not as many nurses...and a heck of a lot more patients...(& all of them probably have way too many meds to count). It seems that when "each person" starts in the nursing profession (different generations...), different societal/rules were in place. Different expectations were in place...and those shape us to be the nurses that we are today. (hence, insulin is a scary drug for me...because of what happened within that hospital).

At my facility, (acute childrens hospital), we are required to watch the RN draw up the insulin, check to make sure it's the correct insulin & dosage & watch them give it to the Pt. We also do dual verifications with PCA & epidural changes(initiation, changes, d/c), TPN, IL, all blood products, (Chemo for those chemo certified RNs...I am not) and dual signatures in the record. In fact, no dual signature = no place you can document you gave the med. If you want to get to the heart of the matter it is this: your license. If you don't want to protect yourself, your patient & your license, then that's your decision. I plan on keeping mine for awhile... Also, with all the distractions around us (call bell lights, alarms, phone calls from everyone about anything from "can you fix the tv" to MDs, child life, secretaries asking about your kiddos, etc) it is not unheard of that people make mistakes. After all, we are all human and therefore, it is possible to make mistakes (of course, unless you are super-nurse).

Thanks for the clarification 2bRN2010. Actually i have run across a few people in my masters program who are doing that...a very interesting breed there (a wee bit concerning...although I would hope that not all of those going from non-nursing bachelors to masters degree are like that). I am actually an accelerated BSN who has been working in the field for 3+ years....from what I have seen, I think that there are "scary" people from all types of degrees...& fields for that matter (some of our MDs can be quite interesting/scary).

Okay, I am going to claim complete ignorance here & say, huh? What is a direct entry BSN or higher???

I think the other important thing to note is that it is ultimately the individual nurse's responsibility to be aware of and remain updated on their hospital's/agency's policies & procedures. One of the biggest discussions I get into is that MDs need to write up how to give blood products in a certain way....all i's dotted & t's crossed....if it's not written that way then I can't give the blood. Period. Need to call them & have it fixed. Furthermore, we as educated & licensed nursing professionals have a duty to do no harm to the patient. When in doubt, ask. When you think that something doesn't seem right about orders, question. I have had to argue with residents, a pharmacist (whom the resident had them call me!)...and even the attending about the rate at which a solution of D5 0.45NS was being given to a toddler. They wanted to give a bolus...you NEVER EVER NEVER EVER give a bolus of anything except 0.9ns & LR...that's it. And all the MDs & pharmacist were saying it's okay. (Eventually I had a conversation with the attending who finally got it...). :-). So with the situation (as you explained it), there were only 2 lumens available to do a three--lumen job. Okay...ask the MD about the priorities...if the "carrier" was what is commonly referred to as maintenance fluid, then it's not a necessity or priority because you are already going to be giving a lot of volume through PRBCs. If they had said need all 3, then it's a great way to segway into asking about how to fix the original problem (TPA, new/additional line, etc). Forgot to say...there are medications that can be run/are compatible with TPN, you just need to talk to the pharmacist or look it up...since TPN has some elements to it that have not been "officiallly tested" My favorite quote in RN school was "Don't be a monkey nurse". 'Nuff said.

Perhaps just letting them know that once the pre-req's are done doesn't mean that you just got through the hardest part & the rest is a breeze. Nursing school isn't easy...you really have to want it...and back that up with studying. (I recently found out that one nursing school had over 50% of their students fail Med-Surg I....most students were having difficulty taking nursing school seriously). Nursing is my second degree....my first one was in Recreation, Parks & Tourism Administration....and during junior & senior year, I was always questioning whether or not I was doing the right degree for me. But, I didn't want to be seen as a "failure" for changing degrees & not completing what I had started. 3 years after graduation & I was headed to nursing school, loving it and have never looked back. One thing though is that I think you really have to enjoy what you do (no matter what your vocation/occupation), so that you keep wanting to go back. Nursing (and the healthcare field in general) is especially taxing on its members...think about it - where else do you deal with the sickest of sick people, dysfunctional families that need to be included in patient care (for pediatric patients), incredible demands (emotional & physical), just to name a few (I am sure you can think of more...). How often do you go home wondering about how your kiddo/patient/etc is doing...because that last 12 hours you spent with them was crazy busy b/c the pt was going bad on you. (Not saying that you take your work home with you, I just mean that you are human and you are hoping for the best for your person). It's not easy, but we do it b/c we love it. :-)

I agree with all of the previous posts.... I started working on my Masters after having about 6 months of experience as an RN. I will be graduating in mid-2011. My thought was that in 3 years from when I originally made the decision to go back to school, I could either have my masters or not. Hmmmm...hard choice. It was also easier for me to jump back into school instead of waiting a few years (I was worried that once I was out in the field, I would not want to bother with all the studying/papers/etc). The program I am in has me taking 1 to 2 classes for 2/3's of the program...not bad. Plus all the info you are getting during your grad program helps your to become an even better/well-rounded nurse. The other reason was that I eventually do want to teach as well...so this is my back-up plan. By the time I get to the place where I am tired of doing bedside nursing, I will have another door waiting for me to open... Not bad. Good luck with your program! Im sure you will do well...

There are many times that we joke among ourselves about that one.....hehehe. Should give Mom some valium or ativan...would make the day so much better

Agreed...I look at it as a rolling 24hrs...and would dose accordingly. No second full dose within the 4 hours of getting the rest of the first dose. If the pt was still in pain & wanted meds after the full 10 was given, I would start chatting with the MD. (I, too, work in Peds...and that's a heck of a lot of morphine :D

It is hypocritical to talk to a patient about smoking cessation when you 1. reek of smoke or 2. the patient saw you smoking outside prior to going into the hospital/clinic/etc. How can you expect a patient to stop smoking when you aren't practicing what you preach? Hmmm....

My sister-in-law lives in the Philippines so I thought I would just read through some posts to see how the conditions are for you guys...and my :redbeathe goes out to you all. I am amazed that you are in the position where you need to "volunteer" and pay to work in order to get experience. That is incredibly ridiculous, sad and disheartening!!! You have all earned your degrees and your nursing license...(and from what I have heard, your programs are pretty intense!). You have earned the right to be paid for the knowledge and skill that you possess....not volunteer & pay for the experience. I hope that this will be changed....(especially reading about your nurse:patient ratios as well....not safe.). On the flip side, (just like others have posted) hiring in the U.S. for nursing positions is slower right now (although you will NEVER see a stateside nurse paying to work as a nurse)....the positions are not as plentiful as they were prior to this economic mess we are in currently. For new grads it is also difficult b/c more and more hospitals are looking for experienced nurses (so they are in the same position you are in...education but no experience). Also, nurses who may be at an age to retire are deciding not to because of the economic situation. Nursing programs in the U.S. are also very competitive...there are many people who have applied multiple times to nursing school before they are admitted to the program. The nursing school I am currently at (for my masters degree) has decided to get rid of their nursing bachelor's degree programs....so there are even less openings.

Teeniebert - I think that most nurses can recall a "New Grad" experience when they first started nursing...(or else they purposefully put it in the back recesses of their mind so that they don't have to relive that particular experience or they are lying). The great thing is that eventually you will be able to laugh at yourself for those fun "new grad" experiences. As for the original situation...WOW...I am surprised that the HCP just said to check on the patient & then bailed!!! Very supportive...hmmm.

I take the flu vaccine every year & have had no problems with them. That being said, I do not feel comfortable taking a vaccine that the government is wanting to make mandatory & also protects the liability of the vaccination makers. That is like giving those companies free reign to do what they want without consequences of their actions. Without the consequences of causing harm, would the companies still feel responsible for their actions?