Nanz_B

Foolery - when something just doesn't make sense...staffing issues...md orders.....when something doesn't make sense it is plain foolery!

Can someone please explain the difference between sepsis and system infection?

I'll try not to make this post so long winded. I work at an LTAC and act as a charge nurse on an alternating basis. I enjoy being a resource to my fellow nurses. The issue that I have is with the CNAs...or some of them at least. Yesterday there was a situation at work with one of the other nurses. Her issue also has to do with the CNAs (with them being on cellphones and with some of them having attitude) I totally agree with all of her thoughts but am wondering...as charge nurse...what else can I do. Apparently, all of her concerns have been brought up to management already...and things are still the same. As charge nurse, what else is there for me to do? I admit, I am not as assertive as I should be when it comes to the charge nurse role. When I see a CNA on their cellphone, is it my job to tell them to get off of the cellphone? I mean, if I tell them once...ok...but if I keep seeing them on their cellphone...I'm not really in the mood to deal with the stress of aggravation of dealing with that. At what point, as charge nurse, do you pass it on to the nursing supervisor. I want to be assertive but not aggressive. Give me some charge nurse tips.

When studying for tests, I would set my timer for 30-45 minutes for each subject area. Sometimes, when we are studying, we get caught up in studying certain areas more and don't designate as much time to other areas. This allows all areas to be touched upon.

We have a group of students dong their clinical rotation on our floor. I'm curious. How do nursing instructors handle the student assignments on your floor? Does she assign the students to a particular patient? Does she assign the student to a nurse? I must say that as a student I loved the idea of shadowing a nurse but now that I am on the other side - not as much. On my floor, she does both...she works with one student and they do meds together. But, her expectation of the nurses are to allow the students to give meds with the nurse that they are following. What are your thoughts on this? I'm kind of a control freak and I like to move swiftly...I know that I am probably being a "B" but the student really slows me down.

Aye yay yay! I read pretty much every comment here and am so happy that a thread was started on this subject. I am having a tough time dealing with a recent "firing" from one of my patients. I actually "fired" myself before anyone else could. According to the nursing supervisor, the patients family (mother) did not have any specific complaints and according to the husband, the mother tends to "perceive" things the wrong way. I'm not sure what to make of that statement. What does that mean? I had a new admission last night. I think that I was in the room more than 10 times last night. We repositioned twice (I've decided that repositioning at least 3 times a shift should do it for an 8 hour shift) and I was also giving meds and just checking in to make sure things were ok. Unfortunately, that wasn't enough for the family. Obviously, I won't give any particulars about the case. But, just know that the pt is coming from an ICU to an LTAC. Generally, ICU nurses round hourly.....right? Well, I had 3 other patients....including 2 that I've never had before. Like I said...I was in the room like 10 times with my new admission. At any rate, this particular family/case is the talk of the floor. I mean it got to the point that the family snapped at the night nurse and asked about hiring a private duty nurse to take care of their child. I don't know. I'm just concerned. I'm a new nurse....been on my own since July 1st. I feel like every situation makes me stronger as a nurse and helps to build character. But, who wants to be "talked to" by the nurse manager. I'm pretty sure that the nurse manager is going to want to talk to on Monday. My question is if I should just beat her to the punch. I don't want to seem weak to my nurse manager but I also want to voice my concerns. I know this post is pretty vague. In the end, I guess the question is if you all voice your concerns to your nurse manager with any complicated patients. I mean....that is what they are there for....right?

I have a question for your all. How do you feel when a nurse from the previous shift passes something on to you? I work 3P-11P and there are times when something could not get done during the day shift....or maybe the nurse simply forgot to do it. I don't know if it is because I am a new nurse...but I am happy to do whatever it is that needs to be done. I find that the night nurses tend to get a little perturbed when something is passed to them. Is it because patients should be sleeping at night? It isn't like the nurse has to give meds every hour of the night and doesn't have time. I've reviewed the eMar for some of my patients and see that the nurse doesn't have to give meds until 0600 sometimes. I work at an LTAC and alot of our patients can't do for themselves and need incontinent care and turning...and all that jazz. But, I thought that we are all part of the same team. Why the rolled eyes and attitudes when something gets passed on?

So, I had an admission on Tuesday. 19 year old unresponsive with a right and left craniectomy..currently on a vent..scheduled to start weaning this past Wednesday. I forget what the mom and I were talking about...mom is really fragile btw (of course!)...the event happened early November. I said something like "I thought that I read in the chart that they removed one of her lobes". After I said it the mother freaked and started saying that the doctors didn't tell her that. She was pretty hysterical and I felt like an idiot. I really did think that I read it in the chart. I told her that I would double check...because I really hope that I wasn't telling her the wrong thing. Sure enough, I found the operative report and it said that a craniectomy was performed without lobectomy. What a douche I am! I went back to the mom and profusely apologized for saying what I said...the mother practically fell down in relief. I feel really bad. I've been thinking about this patient and her family since I left work on Tuesday. I am really nervous about going into work on tomorrow. I don't know if I will have her again. Should I stop beating myself over this? I am devastated. I am a first year nurse (5 months in) and I really do want to be great. I've really learned from this...learned to read more about my patients before blurting things out...

I agree. I've had NPH doses decreased because blood sugars were so low and I've been nervous about the pt bottoming out.

This post may be kind of long. I am having SOME KIND OF week this week and I really feel the need to vent. Luckily, today is a real Friday and I am off for 3 days. I'm a new nurse. I got my license in March and my first nursing job in May at an LTAC. Orientation went well and I learned alot...and am continuing to learn lots. The only thing that bothered me about orientation was the fact that I didn't have just one preceptor - which was a challenge for me - just feeling like I didn't get the opportunity to develop a relationship with someone during this time of my transition from student nurse to newly licensed nurse. I can't really dwell on that now though - the nurses I work with are great and are really great about providing help when I need it. OK - now to the real story. Yesterday I had my first textbook spinal injury patient and from the start of the shift I felt really inadequate. He was a pretty heavy patient and during the start of the shift it was up to me if I wanted to keep him or give him to a more experienced nurse and take another patient (one who will be getting blood). I chose to keep him because I never turn down a challenge. In retrospect, he was heavy but not that heavy at all. My problem was letting the nurse who was giving report get into my head about how this patient was going to be alot of work - blah blah blah. At the start of the shift, the pt was getting a PICC line and the MD was going to put in an NG tube. I had to assist with that and kind of drew a blank when it came time to put the tape on and set up suction. The patient was vented to was already connected to one of the suction tanks in the room. So, we had to get a portable suction machine that would be used for the vent suction and the wall suction was to be used for the NG tube suction. My nurse manager helped me out in getting the additional suction device that I needed and showed me how to use it - and that was fine. In the end, it all turned worked out. The PICC line was placed and ready to be used, the NG tube was in its proper location and ready to be used. The patient turned out not to be that bad. There was just alot going on at the start of the shift. I almost had a break down when the charge nurse kept checking in to make sure that I was OK. I thought that it was nice of her and she is a great charge nurse (I would have loved to have her as my sole preceptor). I know this post is all over the place - it's basically a new nurse vent. So, that was that patient. I followed the doctors orders and although long - my night finally ended - way past 11:30. Then, it was time to give report. This was one patient that I had trouble giving report on. It was hard for me to give report for this particular patient that I had for the first time and didn't get a chance to read his chart to get the backstory. I only had time to read the full page of new orders that I the MD gladly left for me - one which includes a straight cath q4h. At any rate, I had to give report to a nurse that never had him before. So, she was as ubberly confused as I was at the start of my shift. I felt so inadequate. She said that it wasn't me - but the full page of MD orders that were left during the day. As I sit here and think about the orders, they all make sense now. I don't know why they just didn't keep a foley cath in the pt (I get that it is a breeding ground for bacteria). But, isn't straight cathing a pt q4h just as bad? Hopefully strict sterile procedure is used by each nurse who does it. I't's basically ordered to be done at least twice a shift. To be honest, I really hope that I get the patient tonight because it is an opportunity for me to practice my skills as a new nurse. I have a feeling though that the charge nurse tonight will try to take the patient and give me someone easier. Another vent of mine is that I feel like the nurse manager doesn't like me. I've already had two situations when she talked to me based on some information from some incident reports that were filed. The first was because the patient of a family accused me of basically be negligent and not paying enough attention to her father and the other was one that I filed mentioning that I told the family of a pt that I would file an incident report to report that an iPod shuffle was missing. I guess I didn't take the proper steps when filing the report. I was told that I should have called the laundry department to inform them of a missing device and also that I should not have mentioned to the family that I was filing an incident report. The only thing about this situation is that I wished that my nurse manager would have spoken to me in her office instead of reprimanding me in the hallway for all to see - with other people being in earshot. I felt like it was low blow and I was embarrassed. I think that part of my feeling inadequate with my nurse manager is the fact that I think I remember her saying that she hired another student from my school (I got my ADN from a community college) who didn't work out well. My goal in this life is to be a great nurse! I love nursing and all that it has offer. I'm not in it for a paycheck. I could have heard her wrong. Come to think of it, she may not have said that because there are three people on my floor along who went to the same community college as me. Another vent of mine is some of the CNA's that was have on the floor. I don't want to call them lazy. But, sometimes they march to the beat of their own drum! I have learned alot from the CNA's though. I didn't work as a CNA during my time in nursing school. My only hands on practice came from clinical and lab. All in all, my first nursing job is good. I am learning loads. There are alot of things that I get to do as a nurse because we don't have specialized departments to do them for us (i.e putting in IVs, drawing blood, etc). Sometimes I just feel inadequate because the pts on my floor are really sick and I know that my knowledge base is lacking. The family's are alot to deal with and I hope that I answer their questions to their liking. If not, they go right to administration and then administration comes to me...you get the idea! Another reason that I feel inadequate are because my orientation checklist is not all checked off. There are some things that I can't do on my own until after they are checked off. It is really hard to get those things done when everyone has their own set of patients and are extremely busy. I know that the orientation checklist is my responsibility - I feel like I really dropped the ball on it. I know this post is all over the place. I just needed to get some of what I've been holding in - OUT!

Evening program here I come! I am soo excited!! I'll see you at orientation on the 23rd. 8:30 sharp!

Hi. I've finished all of my prereqs for the evening program and am finishing up micro. Micro is the last class that I need to complete prereqs for the day program. I actually called them today and they told me that letters were mailed. She didn't say what day they mailed...but they were mailed this week. Good luck to you! Keep me posted. I am beyond nervous!

Hi Olga, I applied for Spring 2011 and haven't received a letter yet. Have you received a letter yet? Nanz_B