earned RN 2008

I think this is a great thread....and I'm wondering if people would include the size of their hospital and city. THANKS

It's a smaller hospital, less than 100 beds, in the midwest.

I should've added in my earlier reply that we allow LPN's & CNA's to take the vitals and there are parameters to follow regarding when to notify the RN.....if the RN isn't already checking them :-)

In the hospital I work at we have epidural checks that are every hour (epidural site, respirations, B/P, o2 sat, pain, pulse) and PCA checks that are every two hours with the same criteria except for the site. If they are a surgical pt we do vs Q15 min x4, Q30 min x4, Qhr x2 then Q4 hrs for the next 48hrs. Many times if a pt is getting a narcotic pain med for something like...a bowel obstruction the DR. will have written an order for vs Q4hr. To my knowledge we don't have a policy regarding required vs for giving IVP or oral narcotics...we are trained to consider recent vs, take respers, consider LOC prior to drug administration. I will research our policies & post again if I find something that might help.

Thanks for the input nurselori001...I'll keep in mind what you said. A recent shift went better....and I try to chart as I go but currently we have so many heavy care pts and/or unstable pts that I couldn't chart until after 0130. I guess that's the chance you take in nursing...I was just having a looooong stretch of bad shifts and still being somewhat new it did nothing for my self-esteem!! I like what you said about contacting congressmen & voting.....I'm not into politics but I think I need to be now! This might be a dumb question but what do you mean when you say you're mandation free?

Sorry this is long, but I would appreciate any input...........Please! :innerconf I work in a rural hospital on the general medical floor and there are nurses, mostly RN's, with differing years of experience from 20 years. The majority probably have an average of 1-7 years experience. I know I am a new nurse, just passsed my 1 yr anniversary, but I question my competency a lot. I work nights because I had trouble leaving on time doing 3-11 shifts and I occasionally still leave late when I do 12 hr night shifts. We do our staffing according to the census and not pt acuity. At times I feel the pt load is too much and/or the assignments are unsafe due to numbers &/or acuity. I am afraid to say something to the NM because I don't see others struggling like I sometimes do.....so it makes me think that it's just me & if I'm a 'squeeky wheel' I won't 'get the oil' but rather get replaced. I put my pt's needs first and usually have to finish charting after giving report. I still ask a lot of questions and ask for help when I'm falling behind, but I don't want to burden my co-workers. I DON'T like staying late or when people say "You're still here!" and the hospital is really watching overtime due to budget issues. I worry about the liability of being an RN, missing something in my assessment, not doing the right intervention, not calling the Dr. when needed or calling when it's not necessary (I had a Dr. get upset with me once for this) etc. and think my charting takes too long & is too detailed because of these worries.....how do you get past that? Does anyone staff according to the pt's acuity? And if so what kind of rating system do you use? I was told my facility used to staff by acuity, but that they found the nurses rating most of the pts high acuity so they could have smaller pt loads.

I can relate....when I was hired as a new RN on med/surg I did 3-11 & 7p-7a shifts. There were times when I would have 3-11's mon.-fri and I would only see my husband & kids for an hour in the morning, after two or three days it got very depressing. That on top of the stress of being a new RN made me feel like getting out of nursing! I was lucky enough to have a nurse manager that I could talk to. She wasn't able to give me different shifts right away, but she said she'd let me know when something opened up and in the mean time gave me suggestions to help with the transition from LPN to RN. About a month later, a position opened that was 3 - 12 hour night shifts a week. I love my night shifts, they are still busy, but in a different way than days or evenings. We have bigger pt loads, less staff to call on for help, one maybe two CNA's for all the pt's, a little different charting, double noting orders and paperwork to print & file in the AM. Throw in a confused pt &/or unstable pt and it becomes very interesting. The good side.....I get to see my family more, have more days off in the week and I think the night shift is more of a "close knit group" because we have to be there for each other when the going gets tough. I don't know if 7p-7a's would work with your school schedule, but I don't feel it would hurt to let your NM know that the 3-11's aren't working for you. They've seen how you work and since you became more of a regular instead of per deim, it seems like they must like your work. School can be depressing & stressful on it's own........I hope you can get something worked out with your NM.:hgu:

I'm also a med/surg RN and I never thought of it as dirty...sure we occasionally have MRSA, pneumonia, c-diff, , etc. but that's where standard, droplet, airborn & contact precautions come into play. And many of our pts are surgical, cva, dehydration, weakness, snf, etc, not people you think of as infectious/dirty. I like it because you see/learn something new almost every shift and get to use your skills (as mentioned by an earlier poster). What I don't care for is being staffed according to pt census not acuity of the pts, all the charting which takes me away from my pts, never knowing when you might get an admit or if you'll be lucky enough to get the same group of pts two or more shifts in a row. I'm "putting in my time" on med/surg and I'll never regret it.....but I'd like something a little more routine ....preferrably not LTC though.

When I entered healthcare cleaning up poop was my fear too. Sure you'll have some bad messes to clean up now & then but it's not so bad over all. At least we have gloves and disposable wipes to make it easier. As seen in earlier posts, use Vick's vapor rub under your nose if needed. I've heard of that being used in much worse situations than cleaning up poop! And just put yourself in your pt's shoes....it would be worse for them. You may find that it's not as bad as you thought. I've gotten over that fear and haven't found anything that grosses me out, yet.

This would be a great time to let them know of your vacation plans. Maybe explain that you had hoped to be working for them months ago and that you want to be up front and honest with them about your vacation plans to avoid conflicts with future scheduling. Your honesty would reflect well on your character.

Med errors are lessons to be learned, whether it is your error or someone else's. I agree with praying mantis......it could've been worse.

congratulations!!!! it's good to hear it does get easier, i can relate to the whole task orientated thing......i think i'm starting to make the transition......but many times i second guess my critical thinking. still trying to work on the self confidence issue, especially after making some mistakes. i've learned from the mistakes.....but it still makes me feel so bad when i think about them.

hey there....take it easy on yourself. i'm over half-way through my first year on a med/surg floor at our local hospital and i still have many shifts where i feel overwhelmed. when i trained for the rn position as a new grad i orientated with several different rn's that worked on the floor w/ varying years of experience. i could see how they prioritized their tasks, organized/recorded their notes and gave report........then i adopted their style and/or modified it (like underline notes or draw a box to write things that need to be discussed in report) so it works for me. as nervous as i was to be on my own after orientation....it was nice in a way because i didn't have someone asking if this or that was done. keep your preceptors "tips" and "helpful reminders" in the back of your head.......they're just trying to help......but when you're on your own you will create a routine that works for you.......and find out what doesn't work! just remember your routine will always change based on the acuity of your patients, admissions, discharges, etc. very rarely does a shift go as planned........i've learned in med/surg nursing that things are constantly changing & you have to adapt! learn to set goals......like have orders double noted before seeing your patients, if working 7p to 7a- have hs meds & treatments completed by 9pm and aim to do the first round of charting shortly after 9pm so you can start looking at the kardex's of the pt's you'll pick up at 11pm......if time allows get report early and start assessing the new pt's before the previous shift leaves so they can answer the call lights. (i don't think you said what unit or shift you work though.) also, make sure you are delegating tasks to the cna's if your facilitiy uses them. this was hard for me to learn, i didn't want them to think that i was bossy. i find quickly telling the cna what i need to do while they are doing the delegated task helps. then i make sure i thank them for their help at the end of the shift...or when ever appropriate. when time allows i try to help them with their tasks however, being a new rn doesn't allow for much extra time. our nurse manager encourages delegation to the cna's and made the point that they are the ones that (usually) clock out on time.....not left with the amount of charting the rn is responsible for. sorry this is long.......but i hope it helps