Iheartadvice

I remember what its like! Here's a good one... You'll have to decide which type of ethical situation it is though... I work weekends, and I've noticed that so much stuff stays on hold over those two days. We get a lot of admissions who sit until Monday... usually doctors (that aren't working for the hospital) don't have even a report on the patient they are covering... Now throw in some consulted doctors covering for the md that has been following them over the following week days... The communication and continuum of care in these cases don't usually exist.. These doctors are rushing through so they can enjoy the rest of their day, only check vital signs and labs... no new orders. The progress notes are nearly unreadable and they never seek out the nurse for information. I had a patient that I had taken care of for three weeks, when I left her the weekend before we were preparing her for discharge. During that work week, something bad happened and noone could tell me what. She was now responsive only to pain and third spacing fluid... so swollen she was seeping from her skin. Full code with when I walked in, I was shocked at her change. I started early that saturday with inquiries/hunting down mds. Admitted with sepsis/pneumonia she had a lung specialist covering for her during my care... He keep with orders that were no longer relevant to her care... The consulted doctors that I knew would give me an order at a time... and ask me to call back the admitting.. By the end of the second day, that admitting doctor said I was going to make him retire early... but ordered some tests. Her body was in such advanced failure at this point (due to liver) that she was rushed to ICU. I notified the family and reported to the ICU nurse everything I knew. She died two days later as a DNR and on palliative/comfort care.... I felt so horrible that second 12-14 hour shift with her crashing that I wrote up a case study and have no idea what to do with it... Something has to change on weekends/nights/holidays... I think that these doctors should be more liable and accountable for the patients they are covering. I think that communication between physicians about the plan of care and status changes is an ethical dilemma. If hadn't known her, I would've never known how bad off she was... I exhausted myself between her and my other five patients that day... Good luck in school, enjoy this time to think about things like this... its what I will always remain the most passionate about... I also reviewed my state practice act that night to figure out what I could do to have a little more authority... I'm heading back to school! Nurse practitioners scopes are different in every state, and mine is not very good, but I have a feeling that will change soon because of situations like this!

21 beds, 5 RNs, 1 floating charge and we're supposed to have 3 but end up with usually just 2 techs... 1 on nights. Ratios with nurses stays pretty much the same between night and day shift. I also can't believe some of these ratios! When I'm just 5:1 I don't feel that I'm able to be the nurse I've been hired to do... We're a general medicine step down unit... A mix of everything, lots of needy patients who can't do much for themselves though and if you mix in one or two patients who are critically sick or admissions and discharges, even just 4 patients seems like a heavy load!

Noone ever suggested that we didn't know what you were going through... We're all in this together for the best interest of our patients...

Wow, that definitely puts things in perspective... I'm so sorry that happened to you. And it is very helpful here. I'll remember that story when I get into a position like that again. I called my manager today and had a conversation I never had the guts to have with her... She listened. We found some common ground of how to get things to change... for me... not the floor. It was very empowering and my negativity I've been carrying around was weighing me down so much I could scream. No burn out for this nurse... at least not yet.

I think that in hospitals, these nurses that are our managers are so detached from what we do now... Our educators are the same. I've read a lot of posts on all nurses about it.. thank goodness for this site. Seems like a lot of nurses like us quit - move on - go back to school - then when they return to management they are completely clueless about what I need in my stage of the game of being a nurse. I just want to never be that.. and work bedside with the elderly with a little more control of my work day. I love the high acuity, I love the hard work... I am one of the hardest workers I know... but after I work hard for a 15 hour shift, barely eat, and I'm sweating... I want to walk out without crying. The nurses I work with are the same... most know that I'm in the weeds but they say "leave...".. I think it depends what the floor is like when you leave... I reported to one of my favorite strong RNs on most of my patients, but realized that she had two new admissions that had arrived within minutes to the floor... And the other nurse she got report from left without finishing... I think there should be some teamwork with stuff. And with the elderly, after dinner is when everything happens... oh and lovely sundowners... gosh, last night was awful... two of them hadn't been fed after I asked my tech to take care of while I was with my "demon". He had just left... and to be honest, I don't blame him... I can't do it anymore..

I have known a change is in order for a while now... I'm a sh*t or get off the bucket sort of girl... but this has held me working under stressful circumstances... the last two months of changes has just about broken everyone. Not sure if addressing them with her would make it better or worse... I would've originally said that she would've sent me along with a recommendation letter... I think if I came at her like I wanted to, I'd probably be walking in with the demented/combative/biting/spiting patient that was my total all weekend and shut/lock the door behind me... Surely there's a professional way to tell her that her floor is unsafe and pitiful, and she'd assist me with moving somewhere else... I have a lot of contacts at the hospital now, but not anywhere that I'd want to work... I feel so trapped or stuck to just quit.

By far my favorite population is the pleasantly confused, 80 - 90 yo... I know crazy. Especially because I work on a med-surg tele unit. The old ladies are always the sweetest... I can usually connect with them quickly and they are so cooperative after they trust you. We have plenty of combative patients too... I walked on to a patient that was called "the demon" all week... I worked fine with him, some issues, but it was due to understaffing r/t our now budget issues and low census. This is my issue... My favorites.. these old crazies are always the most frustrating when you're understaffed, bc they require so much! Many are not made DNRs when they should be... Almost all require two people to get them up or to pull them up... all are incontinent.. Since our staffing has been changed... so many are neglected or left for hours soiled/new bed sores... mouths crusty /dry... I had a patient I was told was blind until I walked in to assess him and realized that this nurse just didn't clean the drainage off from an eye infection that noone looked into... even the ones that are the "lighter" load... as in cooperative, are so sick that they can't even lift their water without assistance... I know the obvious is to report it, but its become so frequent, even with the good nurses I follow. I know how our floor can be, its crazy somedays... today being the worst I had in some time. Nothing changes... seems to me that its either manageable or horrible... but one thing is steadfast... I am still very passionate about this population of patients. I enjoy being that one nurse that broke through with them.. And knowing when I walked away leaving them A LOT better off than when I found them... I usually don't even tell anyone all the stuff I do... I know that I just care more about this group than most.. so I want to do something with that, but I'm about to burn out on this.. This weekend I walked into five patients, all of them total care/elderly/two were combative or confused and one was so unbearably sick with a chronic condition... oh and one FTT with family in denial and crisis... that's the hardest, when you do so much, but really there's not much you can do and the family lets their anger out on someone.... And lastly one that was snowed from night shift... I can tell none of them have been bathed in days... or they're incontinent with bed sores... just people leave them bc they can't do anything for themselves. This is also while we only had 14pts on the floor so our staff was cut down to 3 nurses and 1 tech who was just getting vitals and accuchecks. I walked into the worst couple of days I've had in a while. I'm ready to go in and quit tomorrow... I really thought I'd be on my floor for a couple more years while I went back to school (ADN - BSN - MSN/NP)... But feeling like this, I just can't do it anymore. I don't want to lose this passion.. and its the environment, not my patients... That is one of the few things of why I still walk out of work feeling rewarded about something... I find it an honor to take care of them.. I don't care how nasty they are, that could be my granddad and with our staffing so low.. They are being neglected to a point that's almost unbearable for me to watch now... So, I need a new change of plan... I've stayed on our unit because of the diversity of conditions, we see everything.. and of course, that I love the age group so much... Being that I haven't really been thought out a change too well, what do I do from here... Eventually I'd love to be an adult outpatient NP... But without even having my ADN loans paid off... It seems so out of reach right now. The economy is scary out there for us... I'm not sure what to do and feel pretty trapped to be honest. Its sad because everyone's lost all trust in our manager in the last several months... her agenda is very different than ours and she's lost touch with her staff... staffing to census is now the priority.. our sister unit always causes us to be overbudget.. we're the more acute unit and always over budget that makes it more frustrating. I've tried reporting things that were really bad... Nothing done... I've worked on our floor for so long, the few that were there when I started have all given up... Some of the other nurses I work with I wonder if they've even turned that patient during the previous shift... I've tried being proactive... I advocate with families, doctors, our manager for small changes... sometimes it works, sometimes it doesn't... I've been on our leadership group... fall prevention team... clinical coach... I'm the acuity documentation monitor. in hopes to improve our staffing through showing the true needs of our patient population bc noone's ever been educated on how our charting affects our staffing ratios... Nothing's done or changed... I still had hope... I lost all of that this weekend... Right after I walked in and saw what I was dealing with, I emailed my manager on the weekend about staffing.. first time I've ever emailed her about something related to staffing (and as charge nurse weekend nights for almost two years... my manager never questioned my judgement on staffing decisions and we were able to keep that extra tech/nurse based on judgement of acuity, I was trusted to make those decisions). Now with our staffing matrix... there's no variations/no supervisor involvement really... We have what we have... and we have way too little... So I emailed her, simple request now looking back, could've saved me from where I am now actually and that's what makes me more angry... Asked to keep our 2nd tech... (she usually emails back in minutes and its bc I don't do it unless its important... but she never responded... not even worth a response??)... I have really just gotten to the point of just finished.. There have been other things lately with her that all of the staff has become distrusting of her. I'd like to go in tomorrow am and tell her where to shove it.. Honestly, money is not why I'm working there, I don't need this job like some of my coworkers and I won't just sit and let this happen anymore... If that means I'm not a part of it, then so be it, its obviously affected my mental stability... Hence my rant here?! And I try to explain it to my husband, I love being a nurse. I don't want to quit... I just want to provide the standards of care that I'm expected to provide. And its been two months like this... I'm done.. Another assertive, hard working and loyal nurse down... so sad it happens like this... So, all that being said... being as dumb as I was to how this was going to be... and literally at my breaking point... what do I do? I have been just unprepared for the whirlwind of career change.. nursing school... then developing myself as a nurse... I thought it would be smart to focus on my education and experience... I got married.. and Now I'm not ready to quit but I swear I have to or I'm going to end up giving up this profession forever. I have not updated my resume in almost six years.. Would hate more than anything to go to another place I think will be great and ends up like this... I worked in PR with a business degree for many years and had management experience... and I had planned to start back for BSN and eventually NP... and here I am, this far along, disgruntled and still with a lot of student loans to pay back from just my ADN! I love working... I worked outpatient gen med while I was in nursing school... but don't even know where to start. I'd like to tell my manager how awful she is and where to shove it, but I work for the best hospital group in town... sadly after this rant! I'm totally type A... controlled for the most part since adjusting to autonomy as a new nurse... I've adjusted to the different personalities at work and how to work with them... my coworkers are some of my closest friends... But I've learn that I thrive much more in a pampering/extras sort of environment... Guess it was my PR experience... but I had accepted that standards of care are what I shot for... And it shocks me what happens at the hospital. Tell me, there are so many good nurses here... how can you walk away when someone who can't do anything for themselves?? How can anyone clock out from this job and not feel like I do? Should I try to stay at the same hospital? I really don't think my manager is looking out for anyone but herself... and I don't know how it would go down if I told her how I want to quit like yesterday...

I work at a med surg/tele unit. We use portable "tabs" monitors and bed alarms on anyone that's confused or doesn't follow instructions (75%+ of our patient census right now) and the bed alarms are mandated at night. If there's a fall, that's the first question that's asked... was the bed alarm on? Honestly, I don't like them, but I do think they can be useful, when used correctly. We also do hourly rounding, both were mandated after our unit had almost a year of no falls then had 10 in two months.. I can tell you, it wasn't anyone I was around or knew, but I hear a lot of falls weren't reported during this time... That's just sad.. Then when they are reported, bed alarms are mandated... and I think our fall rate has actually gone up this year. I find bed alarms useful with the elderly (as long as you explain clearly why you're doing it) and for patients with weakness that think they can make it to the bathroom on their own...Oh and bed alarms are great if you have a delirious patient that you can't sit with all day/night and you warn your coworkers about them in case they're near... that's when they can be a life saver. I became a part of the fall prevention team on our unit, to be proactive after I had two falls from alert/oriented patients who I would've never guessed would fall... It made me want to become more proactive about this... I know that from our research, all of our falls happen at change of shift and when staff is low. It really didn't matter at all in our stats if the bed alarms were on or not. Tabs monitors are a little different... we never saw a patient fall with a tabs monitor on from our two years of pulled data... I've seen a lot of almost falls thanks to them. Some patients that are fall risks but are oriented can be very irritated if you don't explain that this is a mandated policy on our floor... After all the research we found too... nothing was done... Best fall prevention in my book, good team work and making sure all my patients needs are met... Having good nurses and techs around you who are looking out for you and you're looking out for them.. Unfortunately its hard to find that when people are all for themselves on a busy med surg unit. Bed alarms are just ignored during busy hours, understaffed shifts, and report anyways.. its one of the most aggravating hours of any med surg nurse's day... change of shift. I'm always the one that runs bc noone else does during these hours... Hopefully you won't have to get to a computer every hour to point of care chart that the bed alarm is on like we do... First thing that's pulled by our manager.

I took ACLS about six months after I graduated... I wish I would've done it sooner... The things that I took from that class are not the drugs, etc but more that I knew what I could do as a new nurse as soon as things started turning bad... I felt so much more prepared after getting the certification. Its two days of intense fast paced material, followed by a test/mock code the second day... we worked ourselves up pretty good before the mock code, but it wasn't bad... everyone passed and I heard ACLS has become a lot easier with their grading... I think you should take it. Just plan on getting a good nights rest in between classes and definitely review everything in the acls book before class. Might be a little harder for you since you haven't had too much telemetry experience. I work on a telemetry floor, so that made that part of the mock code/testing much easier. Good luck!

Good luck, make allies as soon as your start with students as focused as you are... they'll get you through the tough times when you're neck deep in clinical worksheets and tests! Just remember, it will be over before you know it...

Ok, quick follow up about my super nurse, "large and in charge"... She was admitted to the hospital with TIA symptoms! Should be out tomorrow and she's ok, but man, I feel bad. Looks like she's been at the other end of burn out that I would never like to see. I'm going to try to pick up a good exercise routine. Geez. As much as I dislike her sometimes, I feel bad for trashing her all the time now.

Haha, be careful, all the class I graduated with started getting crazy this time last year when the results were coming in, and hearing of smart people failing/ or so in so passing, it was so much unnecessary worry... Me and my nursing school buddy were anxious and pessimistic checking and rechecking and texting... she texted that she passed and I didn't get my results for another five hours or so.. OMG, worst five hours of my life. Seriously, best advice for those waiting waiting on your results, relax... watch tv... get your mind on anything but the nclex. Good luck and for those who don't pass the first time, register again quick for as soon as you can take it... that's what I hear is the best way to beat the nerves and really to buckle down because you knowledge is fresh and you have less time to worry about it, and plenty of time to study while its all fresh.

This is long... but its so nice to be here with other nurses of all experience levels getting value from this site like me... I've been on the tele step down med/surg floor as an RN for almost a year now... about to hit my anniversary and I still have those nights, rest/take care of yourself. I work weekend nights with increased differential, which was offered to me because I had worked part time/prn on the floor as a PCA/Student Extern my second year in school. I remember I felt so confident on orientation and was doing well because my preceptor was there if I needed her... I really felt like I was thrown to the wolves when my first night off orientation was my second night after orienting on day shift. Oh and 5 patients, all unstable and all getting really scary drugs. I've come so far now... I've always had notes from patients and caring stuff... but the best thing I did to build my confidence were the classes offered through each hospital's education department. We have core module classes of each system... It was the best experience for me, for example the renal class, the dialysis manager for our hospital also came and talked to us. I learned we had been doing stuff we didn't need to for prep, I learned what meds to give prior... and which one not to, which the sheet is in my locker and accessed daily by someone. Its a good refresher and its a lot more practical to the patient care. It also helps you explain chronic illness/PURPOSE of procedures to patients who are scared and start to trust you know what you're doing, then your work is easy... I love when I've had the time my first shift to build trust and talk to them about what all was going on... Telling them what the night will be like, "ill be in every hour to check in on you, every other hour while asleep, and addressing pain/getting up the bathroom/wound care/iv sticks... they are so much easier when the patient is working towards helping you. My best and most satisfying nights are when I'm done early because I didn't take that extra 20 min to ***** about our manager or that demanding patient, I can be proud of that, then help the nurse who's behind or my tech taking vitals, always go in with the tech and offer yourself, give them a brief report of what they need to know right after you get report, and be respectful... I bring my PCAs my notes from school, since a couple are starting... I ask them to help me with a foley or what not so they can see it... or if a patient is turning bad, you're catching it bc youre not falling asleep over the chart or caught up in some story... Your doing what you're there to do. Patients can turn quick, always have a routine with getting report... instead of asking the off coming nurse, I'm done earlier and know what I should get as data anyways... labs, tests, etc. I never not look at labs/vitals for a diabetic, cardiac/chf patient, copd pat or dialysis patient... scan the chart, labs, orders, heart rhythm/changes and plan of care... I've seen so many nurses not do this, and it really makes a difference to have a clear understanding of what we're doing for them tonight before you go in... and definitely do focused on assessments, which will come with experience... even just a little and you're asking the right questions. Then at 4a when the patient's sugar is 500 OR they are sob with chest pain you'll be organized... everyone appreciates it! We've had several preventable codes the team talked to us about on our floor. Chart right when stuff happens and get your charting done early... I try to get it all done before midnight then I can defluff and focus on details/learning about the patho/dx... Patients first, that's why I'm here, but second for me is lifetime learning. I am certified in tele which was a requirement and I think if you can, at about six months get into an Advanced Cardiac Life Support Certification class. Its an intense two days, but that class made me stop hyperventilating about if I was going to correctly do chest compressions! I wasn't required to get my ACLS, but I think we should be, it will make you able to see the signs of "impending doom"... the other nurses laughed at me when I got all worked up about a patient's swollen leg that was not there last night.... or yelled at by a doctor when I call with info on a patient's status changing, then call again when they keep deteriorating... I'm annoying and persistent, but very polite and thorough... I always say I've been working with them for multiple nights if I have, and tell them, yeah, now their lungs are full of fluid... oh.. had a bout of v-tach... hm. why. And I'll ask the person I know who is the strongest on our floor w/ tele or surgical or experience or skin care... each have their strengths... watch a good nurse start an IV asking them how they were so good.. then answer a patient's bell and get their patient something instead of telling them that so-in-so's pump is beeping, now you got a good RN to go to for an IV for future... I have my patho/sx rn who wants to be an MD that I'm good at helping him catch up bc he's slower with care... i barter a lot haha, but it works. I agree with quick head to toe but also add a room check mentioned earlier... ok, alert/oriented, heart/lungs/belly, pulses/swelling. o2 on/cough, eat today/hungry/thirsty/last bm, foley draining, pain, IV fluids/need anything? I still miss some stuff but these are easy checks to do while you're doing first walking in... Do that as soon as someone is admitted and you'll be proactive not reactive. Don't bother your coworkers with labs and simple med questions/orders... the pharmacists don't mind at all when i ask them...I used to just ask the closest person I knew for whatever I needed in our computer system/supply/assessment abnorm/order/etc... bad mistake to make at first and looking back I'm sure I was so irritating my first few weeks off orientation I never feel like a pest when I actually think through the best person to ask this question to. I know my resources and I'm always polite/professional/thankful/helpful with them. Some coworkers I ask nothing of... they are the ones complaining, etc... negative attitudes will spread quickly... I've utilized the RRT nurses more for status changes instead of calling mds at 0300 with half of my ducks in a row. RRT loves that I'm utilizing them... they like to teach and feel valued. I tell them they made my night... and you know what, they're offering to come back in an hour and see how we're doing... And that same RRT nurse has also taught me some of my most invaluable info during a patient transfer... and I save them a lot of work. That gut feeling surprised me the first time I felt it... you see one little thing, then next thing you've got is a clot and stroke that you caught.. being able to tell them that data you collected early on, or atleast knowing their name and last vitals and dx... its better than the average nurse I think. They a lot of times get left alone with no background. Team work and planning... it will come, and I've learned every bit of this stuff by trial and error. I've had a few horrible nights recently, but I talked to my best friend on the floor after leaving... and you'd be surprised at how quickly you'll start to think, hey I did that, and I'm a good nurse. I love writing, and obviously rambling on and on... about how passionate I am about patient care and being their advocate. I'm really proud that I had three emergency ICU transfers in two months... preventable codes. Med surg floor is full of them... Be careful and always ask for help. I'm hoping that I'll just get it all soon, haha, but I feel so stupid some days when I am mispronouncing a disease or drug... but always laugh at yourself! Something that really helps with my most stressful nights when we're all busting tail to get that patient's BP up that hadn't been checked on by their nurse!!! We can all sigh together sometimes with just one person smiling or goofy face, everyone's spirits are lifted that I would ask for help. :) I just wish everyone felt this way... and I really appreciate this thread too... I've read over these blogs, especially of seasoned advice since nursing school... it doesn't really click until 6 months, then read it again, and this has been so helpful, so thanks a ton!! I think we all have to freak out and worry we're going to kill someone... otherwise we wouldn't be conscientious nurses. Expect at a year you'll still have to double check that simple procedure and you'll still miss an IV every now and then..

I remember your anxiety and dread of telling everyone I had failed! I had already prepared my speech... but of course I passed, I worked my tail off for two years in school! I think I did buy the test results for that extra money and checked the state nursing license page of listed current licenses which actually had it posted the same day as what I paid for from pearsonvue. I have never heard of a single nurse or any student I graduated with getting less than 100 questions and failing if that's any help... that means in 75 q's they were able to tell if you were a "basic skills level beginning nurse". Relax, enjoy this summer and your time now... rest up, because you've got a whole other school waiting here for ya! :) Good luck!

TTC's nursing program was tougher than my BA - double major. I cried when I studied for a week and got a B... accept it that they are have no GPA or acceptance requirements besides those pre-reqs and passing the classes. They are tough, you'll learn a lot really fast, but you are a prepared nurse when you graduate. You'll start seeing the slackers and people who aren't ready for an intense program and profession start to shed off with each class. We started out with more than 200 students and I think we graduated with less than 50. Go to their website, go to the pre-admit meeting where they explain all of this stuff... lots has changed. I graduated in two years, but it flew by, the classes are intense with clinicals that take all day. You could work but not take more than one NUR class at once, unless that's changed, go to pre-admit meeting, its where you get your answers. I truly believe this was the best education I could've gotten. I worked two part time jobs and took out loans... To be honest, I'd recommend this over MUSC, its a lot less expensive with more clinical experience. Good luck!