pers

It's not a situation I would find myself in at my current facility, but the OP was asking what people thought about the situation as it is one she faces so I offered my opinion.

Fired? No. Prepared to protect my license? Damn skippy. We all take risks and that's one I'm not willing to accept. I refuse to accept any assignment I consider unsafe and being the sole nurse on my unit is not safe. There may be some who are happy to take that on and they can have it. If my employer tried to fire me for refusing such an assignment I'd happily take the unemployment and get another job. Patients on my unit can go bad quickly and having help is essential. Sure, folks will be there within 3 or 4 minutes to help if my patient codes but I'm more concerned about all the other things that can go wrong. Like when they are circling the drain and as the only person on the floor I'd have to make a choice between being with the patient and being at the phone to deal with the doctor/supervisor/lab/pharmacy/whoever. Or dealing with a confused and combative patient by myself without a reliable way to get help quickly. Or getting slammed with multiple admissions. We don't have a secretary at night so as the only person on the unit I would really be the only person on the unit. That's not happening. Ever. Fortunately, my employers also think that sort of staffing is beyond stupid and not safe so it's not a situation I'd find myself in. Our core staffing level requires two nurses at all times regardless of the number of patients. It doesn't have to be two RNs but it does have to be two nurses.

I got a waterproof mattress pad after getting an expensive white mattress because stains void the warranty. I don't remember the name of the brand but the mattress store where I bought it had cut a piece of the pad and placed it over a jar filled with blue liquid so you could feel the pad and also see that it didn't leak. I started with a typical plastic pad that may be waterproof but caused me to sweat like you wouldn't believe, even with a thick fabric pad over it! The new one I bought is really nice and very comfy, it feels like fabric and I don't sweat at all. It was pricey, just shy of $100 for a queen size, but worth it to me to provide the comfort I need to sleep but still protect the mattress.

You are in orientation and expected to precept two new grads? I'd refuse that!

I would refuse to staff a unit as the only licensed person. Even if there was only 1 patient on the floor, I wouldn't accept the assignment unless there was a second nurse with me. You never know what will happen with that patient, or on my unit, how many admissions you are going to end up with.

I wear earplugs most days and still hear my alarm just fine. I currently have a dark and heavy curtain in the window because I found it blocked more light than the room darkening curtain I'd been using! I tried a sleeping mask but I'd take it off when I slept and then when I'd do the groggy roll over where I'm just awake enough to register it's daylight, I'd suddenly be wide awake. I think with my next move I'm going to make some styrofoam window blocks that I can pop in and out of the windows based on my schedule. The current set-up is great for when I'm working but in the evenings when I'm home and in the bedroom, I find myself wishing for more light without having to leave the curtains open.

I have never heard of a jurisdiction where good samaritan laws cover on the job conduct. Even if they did, good luck finding a medical professional willing to testify in court that a 92% O2 sat justified your action.

Putting myself in your shoes, I would have helped him by telling him I notified his nurse and she'd be in shortly. In a few minutes, I'd check on the patient and remind the nurse again. If I was really concerned, I'd let the nurse know if she doesn't have time to assess the patient I'd be happy to get someone else to look at him. You can bet your bottom dollar though, I'd call 911 before I gave him a breathing treatment! You not only do not have a duty to administer breathing treatments to patients no matter how much you believe they need them, you don't have the authority to do so either. How do you even know the patient was allowed a breathing treatment? What if they had been discontinued? Or if he'd just had one earlier and it wasn't time for one? You not only don't have the skills to determine if the patient needed a breathing treatment, you don't have the information necessary before providing one. I'm a nurse but I can't give a breathing treatment because I think a patient needs it, I have to have an order for it. If the order is for a treatment every 8 hours, I can't give one every 4 just because I think he needs it, I have to call and get an order for that extra treatment. If you worked at my facility, you'd not only be fired for that stunt, they'd most likely turn you in and try to get your certification pulled.

Another vote for all 3 in a row. If you hadn't said you were a night person I'd have suggested 2 on, 2 off and back for the final shift as dayshift people often struggle a lot on that 3rd night. One night off is not a night off when you work nights--you come home and are either a zombie till bedtime that night (maybe or maybe not after having a quick nap) or you sleep the day away and stay up in preparation for going back to work the next night. If you really want to feel like you had a day off while working nights, you need at least two scheduled nights off to really accomplish it.

"If you didn't chart it, you didn't do it." That was drilled into us repeatedly before we even started clinicals. I follow that today and hold other nurses to it as well. It's not just CYA either, documentation is also communication between staff. If I need info about something that happened on a previous shift (even a previous day) that wasn't passed on in report, I look to the documention to find an answer (particularly when I'm being asked about an order that was written).

I've been at my hospital over ten years and in that time the only department that has never closed is the ED. Telemetry closed once for 3 days when they did some cleaning/renovation work (usually they close part of the floor down while they do the work and leave the rest of it open, working in stages till it's complete). At my facility the unit that closes most often is pediatrics or OB followed by ortho, neuro, progressive care and then med-surg. Of course patients are shifted from one unit to another to accomodate the closed department, if they have 4 patient's on neuro and 10 on med-surg then they'll close neuro and move those patients to med-surg. The MICU, ICU and CVICU close in rotation as well, when census is down they often combine to one or two units being open rather than all three.

We no longer use pressure dressings either but if I had one I'd definitely feel underneath! We check the site and compare groins, check VS and pedal pulses q 15 min x 4, q 30 min x 4, q 1 hr x 4 and then q 4 hr x 4.

The market is more competitive now than it has been for a while so I'd be prepared to sell yourself not just as a nurse but as a tele nurse. Why do you want to work tele? And remember, they aren't just interviewing you, this is your chance to interview them too! Ask about their turn over and ratios. How many new grads do they have? There are plenty of horror stories of the most "experienced" nurses being those with barely a year experience, that's not a floor you want to work on! My unit is tough for new grads, if you were interviewing here I'd strongly suggest you ask how many new grads hired in the last year are still here (or how many hired in the last two years remained after a year). What about your work schedule? Will you be expected to work weekends? Will you have 12 or 8 hour shifts? Work nights or days? Will they alter those things without asking you first? Nightshift has a crew of "weekenders" so I only work the occassional weekend but I can be scheduled as often as every other weekend because that's the policy. Our policy also says nightshift workers only have to work nights but dayshift workers can be scheduled days or nights (and that tends to fall to new hires). Telemetry nurses should be ACLS certified, is that something they will provide? How soon should you expect that training? What about the length of your orientation? Will the NM meet with you regularly to check your progress? If you don't feel ready at the end of orientation, is an extension possible? Will you have one preceptor or multiple preceptors? In the event you and your preceptor aren't a good fit, are there other options? Really think about what you want to know about the unit you are interviewing for, this is your opportunity to find out! Ask if you can speak with a new grad or two. There's no guarantees of course, but the more questions you ask the better decisions you can make about what kind of work environment you are entering.

Like a couple of others, it was an easy adjustment for me. I spent a year on dayshift and never did get used to it. I couldn't fall asleep early enough and was far from my "best" (both in personality and function) for the first several hours of my shift. For those I've seen struggle with sleeping during the day, melatonin and herbal teas can help. Making the room very dark and developing a strict bedtime routine generally helps the most though. To stay awake at night, some swear by coffee, others by energy drinks but most of us are so busy you don't have much time to think about being tired though!

I would never actually do this but the mental picture of a nurse enthusiastically agreeing with all of a patient's complaints has me in tears I'm laughing so hard!

For the record, I'm not of the belief that "a nurse is a nurse is a nurse." I'm a believer in advancing education in general (and I think continuing education requirements for nurses in general is laughable at best but that's another thread). That's not to say those with less education are lesser nurses! Just because I believe in education doesn't mean I don't also believe in experience or recognize that some people are simply naturally better suited to certain skills/professions than others. Each of those attributes can give one person the advantage over another but natural abilities can't be taught and everyone gets experience with time while education is a choice we all get to make. My facility is phasing out LPNs. They have eliminated them from the ED and ICU already and are no longer hiring LPNs hospital wide. The next step is to diminish their scope to that of a CNA who can pass oral meds only. As new RNs are hired, the LPNs will be rassigned to other non-nursing positions (primarily CNA/tech and secretary jobs) with adjustments in pay that are appropriate to the new positions. Some of the LPNs at my facility are upset because they don't want to be relegated to only being able to pass pills, particularly since it's only temporary until they are phased out completely and new RNs are hired to replace them. Some of the LPNs however, are elated as their job is about to get a lot easier as they won't have to do anything but pass pills. The difference in that mindset makes a big difference in how I view their plight. For the LPNs who value their roles as nurses, I hurt for their loss and will miss what they bring to the table. These are team players who work with me to make sure our patients are cared for as safely and effectively as we can. For the ones who actually want to be little more than CNAs that pass pills? They can't phase them out fast enough for me! These are the folks who hand me a list of things they can't do (or worse, expect me to magically know on my own) and always have a ready excuse for why they can't do something for my patients when I'm busy with theirs.

There are fans of each. Personally, I liked Kaplan. I waited ten years to take the NCLEX and basically decided to take it before investing a lot of time studying so that I would know what I needed to work on most. I posted everything I did on these forums way back then but basically I did the question trainers and the pre/readiness tests then reviewed the rationales as the bulk of my studying. I passed my first attempt in 75 questions. I'm smart and I got a great education but I really didn't expect that after a ten year gap and so little prep.

I prefer my droid but agree that smartphones offer great resources! We do have a policy that they can't be used in patient areas or the nurses desk but I work nights so I tend to bend that rule. I don't do it in front of patient's but only because of the rule, not because I don't think it's worth explaining. There are meds we give that aren't always in our medbooks and while the pharmacy is a great resource they rely on the same resources we do for info on new meds! I wish we had internet access on our work computers, even if it was only to medical info sites the hospital approved.

I've worked with a couple of different systems but currently I make $2 more an hour for working nights. It's a nice bonus that adds up but if I didn't prefer nights, it's not enough pay difference that I would make the switch just for that. Would love to be working somewhere that offered 50%! I'd be all over that!

We all do twelve hour shifts on my unit but are still required to have an assessment done every 8 hours, this results in day shift doing two (0700 and 1500) while nights does one (2300). Most of the night shift nurses do their assessment closer to 2000, just before their 2100 med pass. Then do notes later in the shift to address problems and a "mini" assessment about 8 hours in to go over everything again. Some nurses prefer doing a mini assessment at the start of shift and then doing a full assessment closer to 0000 and then following up with notes later. I do my assessments first because I want to have a baseline so four hours later I know if something has changed. If I pick up patients at 2300, I do a complete assessment on them then and a mini assessment later.

WV offers a 6 month temporary license. I'm not aware of any facilities in my area (that are in WV) that don't hire graduates with only a temp license. I can't say how it impacts the odds you'll get a job but I know of 2 and possibly a 3rd new grad at my facility who are working under a temp license.

Interesting. I wouldn't think this was a good idea, based soley on my previous experience with a lawsuit. Did she say it could actually become evidence? That would be my fear. I can see why having additional notes might be nice, I do remember saying "I don't recall" a few times in my interview! However, I would worry about something being misconstrued if anyone but me was able to read it.

Personally, I only refer to a piggyback as a med that is piggybacked onto a primary line and uses the same pump. If a med requires a seperate pump from the primary fluid, I consider it to be Y'd in (and chart it as such). This is the quickest pic of our setup I could find. The piggybacked med temporarily stops the primary infusion (which is why it is hanging higher) and our pumps allow us to set up a seperate rate/volume infusion for piggybacks that once complete, will automatically switch back to the primary rate/volume. You can't see it in the pic, but on our pumps the piggyback (using secondary tubing, it's much shorter tubing than primary lines and can't be run through a pump on its own) is Y'd in to a port just prior to where the tubing is inserted on the pump. There are more ports below the pump on primary tubing for medications that are Y'd in and have their own pump. We put all medications on a pump, even antibiotics. I have heard some nurses refer to any intermittent infusion as a piggyback. So if a patient is getting an antibiotic, they'll call it a piggyback even though there is no maintenance fluid. Since it's hung as a primary line without maintenance fluid, I don't consider it a piggyback. Our policies refer to piggybacks the same way I do but when talking with other nurses it would be arguing semantics since it's clear they are referring to an intermittent infusion if no maitenance fluids are present.

I started keeping a journal this past year and I do include quite a bit of job related info in there but primarily as it pertains to me, not to the patients. When I do refer to patient's it's by initials or room number, never their actual name. However, I will say that I once was deposed for court when a patient sued my hospital after falling and the hospital attorney did ask me if I kept a journal or diary where I would have written any information about the incident. He also asked if I had told anyone outside of work details about it and that if I had, they could be questioned about what I'd told them. At the time, I was able to truthfully answer no regarding the journal, but if I had I'm not sure what the impact would have been if I'd had one. I do know that the hospital forbade me from looking at the incident report from the fall as it wasn't part of the patient's chart and the attorney said if I viewed it they would have to turn it over to the patient's attorney as well. I would hope they couldn't force me to turn over a private journal but I don't know what the law actually says about it.

We had a new hire like this a few months ago on our unit. She was an experienced LPN who was due to graduate from an RN program in less than a year. When it came to doing anything though, she would want to "watch" rather than actually do. Since she rotated through several different orienting nurses, the majority of her orientation was watching rather than doing. Sure enough, when she got off orientation, she would hunt down other staff to help her with everything because she didn't "do" that on orientation. There was even an incident where she didn't give any IV medications to one of her patients because she didn't know she was supposed to! Thankfully she did have multiple nurses orienting her so when she claimed she wasn't taught and multiple nurses insisted that she was, the nurse manager held her responsible. I'd politely but firmly insist that she needs to do everything for the patients. You need to know she can handle things before her orientation ends and while she may be an experienced nurse, every unit is different. Things that were (or weren't) acceptable at her old job may or may not be acceptable at her new job. If she's still resistant, I'd bring it up to the nurse manager and make it clear she's getting a poor orientation not because you aren't providing opportunities but rather because she's refusing to participate.