smartin13

In my facility all of the units are a specialty. Even the med/surg units, for instance we have a Neuro/Neurosurg unit, HemOnc, Ortho/Trauma, Cardiac, General Surgery, GI/Transplant all as individual units. There is no area in my facility where a new grad could start that isn't a "specialty". To say that new grads shouldn't be in the ED seems absurd to me as I know ED nurses who could not make it on some of these med/surg units. Would it be a good fit for all new grads, absolutely not, but some of these other units wouldn't either. New grads need support and someone willing to educate and train them. More and more schools are focusing on Nursing Theory and less on actual nursing skills through no fault of the students, which unfortunately leaves it up to their employer to teach them how to actually be a nurse.

Sometimes I am taking report from the ED in the middle of the hallway, or in a patients room while they are toileting and do not have easy access to a computer to check so I ask. I am sorry if that is inconvenient for you, however I am no longer allowed to ask if I can call you back when I have a free second as my hospital now says we must take report from the ED and PACU when they call, no exceptions, to help with patient "flow". If we do ask if we can call back incident reports are written, so you get asked all kinds of questions that I could easily look up if I had the time. Also I realize report in the ED is different then how things are done on the floor, however so are the goals. The goal in the ED is to stabilize and then transfer out or send home. On the floor our focus is a little different. We have different expectations placed on us such as charting requirements that the ED does not have. Not that one area is tougher or better they are just different.

Any IV not started in my facility has to be changed out within 24 hours. Our IV's expire after 4 days (old policy was 72 hours) and have to be changed unless we have an order from the MD. Some units do not stick to this policy, however our manager believes in this policy and audits our IV's several times a week.

Yes we had a simulation lab where we "started" IV's on a computer program. After we showed we were competent with that we were able to start IV's in the clinical setting when ever we had a chance. No hospitals in my area have "IV" teams and starting IV's is not something that is taught in orientation. It is expected that you know how to do it upon graduation.

Working in an acute neuro department and with the recent focus on removing foley's I have extensive experience with condom catheters, and most of the time they stay on and don't leek. Ensure you have the correct size so that it is snug, use your skin prep prior to placing the condom and then again around the edges, we then place an attends or breif on the patient to help secure it in place and catch anything that may leek. Perhaps it is just the brand my facility uses but 98% of the time they stay on our patients including the confused ones.

At my facility intermittent tubing is changed every 4 days along with continuous tubing, this was recently changed from daily. Nothing in our policy states anything about the amount of times you connect/disconnect the tubing from the patient. Unfortunately not all of our pumps are attached to rolling polls, some are attached to the beds so in order for our patient to be able to ambulate anywhere they have to be disconnected.

I have three jobs currently, all part time. My primary job is working two 12 hour night shifts a week and receive benefits there. I then work agency for another hospital where I may get called three times a week to work or not at all. There I make 10$ more an hour then my "normal" job and do not have benefits. The third job is a nurse consultant where I review patient charts for class action lawsuits. I do that from home in my PJ's for as many hours as I want. I still have enough time in between all of this to go to graduate school for my FNP.

Not a solution to the problem of the lack in care necessarily however when I see that one of my patients needs oral care and isn't receiving it consistently I get an order for nystatin swish and swallow/spit or biotene scheduled. It is amazing to see the difference in oral care after that. Also on my floor (Neuro/Neurosurgery) many of our patients are total care or require mouth care. With recent cuts in staffing oral care seems to be falling to the wayside for more "important" tasks.

In my facility most new positions are "flex" or rotating as you say. Half of the flex staff like nights (I fall in this category), the other half like days. We self schedule and I haven't had to work a day shift since last year because we switch shifts with each other, meaning if I get assigned a day shift I find someone who doesn't want to work nights and switch. Our manager got so tired of doing 40+ switch forms a week that most people get the shifts they want with the knowledge that we may be flexed if the floor needs it.

I currently attend MU and am in the FNP program. Like every program there are problems. My class has a FB page and that has been amazing as the instructors are not allowed to "teach". Some instructors do reviews, others do nothing so the FB page has been great for us to get together and share what we can. Group work has been a large part of the first two semesters so far, with group assignments being done every week. Hopefully you get lucky and have a good group to work with. Some people have not been so lucky and had to have meetings with instructors due to fighting and other issues. Just be prepared to do this on your own with minimal help from the school. If you can get your classmates together do it so that you can support and utilize each other. Also start looking for your preceptors as soon as possible, it isn't as easy as you would think.

The insurance provided by my hospital only pays if we deliver in our hospital so there isn't much of a choice. If I had a choice I would not deliver there just because there are better facilities in my area to deliver. I do know that if I were to be admitted to the hospital I would want it to be on the floor in which I work because I trust my coworkers to give me the best care.

At my PRN job they call and ask if I can work, I say yes or no depending on what I want. I have no obligation to holidays, weekends, or the amount of shifts I take. It does not interfere with my full time job as I get to decide when I work.

Tell the union reps. If retaliation occurs report it to the union. There really isn't much else that can be done if your co-workers don't want to use the avenue they have available to them.

I work in a union facility and this does not happen. There are rules that have to be followed when a position opens up as to how long it has to be posted on the floor, in house, and then to anyone. While posted on the floor or in house the position goes to the most senior nurse. If there were any issues we would bring it up with our union rep.

We use it all the time in our post-op patients who have a hard time going after several days regardless of if they are female or male.