JustEnuff2BDangerous

While I was still in preceptorship on my floor, we had a man who was being discharged, all papers signed, IV had been taken out, street clothes on, stood up to get into the wheelchair to be taken out to his car and collapsed, immediately unresponsive (AKA, dead). We coded and coded and coded, 45 minutes long. Didn't get him back. Autopsy revealed PE.

I don't mind fulfilling simple, politely-worded-and-toned requests. Start treating me like I'm paid to take your order (and receive tips while doing it), or start acting like you automatically expect me to do such things for you, and that's where the ride ends. The sweet little old wife of one my patients who meekly asks me where the coffee machine is so she can get some to warm up? Guaranteed to hear me say, "It's out in the hallway, but tell me how you like it and I'll be glad to get it for you." I cater to niceness, not so much to those who act like I went to school for four years to fulfill their every desire. I had a confused patient one time, and brought his meal tray into his room and sat it on his table and told him the aide would be here shortly to help him eat. After I left out of the room, he called out loudly, "Waitress!" I'm used to confused patients hollering "Nurse!", never had one yell out for the waitress. I had to laugh.

You can make a huge mistake anywhere, not just med-surg. The good news is, there are not a whole lot of mistakes you will make that can't be reversed or mitigated - there's not a whole lot of mistakes that are going to outright kill someone. You become dangerous when you become complacent; that "on edge" feeling for the first year is your defense mechanism, it keeps you sharp and alert, and makes you stop before you doing something and double-check yourself. Everybody makes a mistake at some point, no matter their experience, no matter their chosen specialty. You WILL at some point make an error. It's the curse of being human. Doesn't matter if you have two patients or ten, doesn't matter if you work eight hours or twelve, doesn't matter if you've worked six months or six years. As another poster said, I have never gone home in tears. Sure, I've had some absolutely heinous shifts where nothing went right, I was on my feet literally ALL 12 hours, I had to give blood to 3 people, chemotherapy to 2 people, I had a double amputee fall out of bed and that caused his BKA wounds to split open... I mean I've had some doozies of some shifts. It all depends on your outlook, your coworkers, and your personality... and whether you WANT to be there or not. People who accept med-surg jobs knowing (or convincing themselves) they hate med-surg are just setting themselves and everyone else up for failure. There is a specialty in nursing for everyone, and for some people, med-surg is just not it. I hated med-surg clinicals in school, wound up stuck on a med-surg floor for my preceptorship, and here I am on that floor two years later, loving every minute of it (okay okay, almost every minute). People who go into med-surg floors already resigned to hating it will, well, hate it. People who think they hate med-surg but decide to view it as an opportunity for learning and knowledge growth may find themselves surprised to blossom on that floor and still be there 10, 20 years later. Sometimes you just have to think for yourself, and not take to heart all the howling you read. Every floor, every hospital, every shift, every nurse is different. It's all in how you approach the challenge, and that's with any specialty in nursing.

My "opening note" only consists of "Received report from ______, RN." But if your preceptor wants you to paint a brief picture of the patient, I'd stick with objective things. "Patient awake, alert, resting supine watching TV. No S/S of distress, denies pain or needs. Will monitor." That's usually what I chart when I'm doing hourly rounding. Their position (supine in bed), what the patient is doing (watching TV), how they look (no distress), and if they voiced any complaints or issues.

We require all patients on telemetry to have IV access, saline locked or otherwise. Most of our other patients do have IV access, but if the patient is stable, has no IV medications on their medication profile that they are receiving, does not have co-morbidities (if they are diabetic, I automatically keep an IV site, in the event I have to administer Dextrose IV), and not on tele, I will usually pull the IV site if it's over 96 hours old. Emergencies happen and there's no guarantee this stable, non-teled patient won't code or become unstable, but you also don't want to keep an invasive line in if there's no immediate need or use for it, as it is just another avenue for nosocomial infection.

Only issues here with showering are the IV site getting wet and the potential for the patient to fall (you could be in a world of hurt if the patient on heparin falls and hits their head!). As long as you safeguard against these two things (wrap the IV site up well with saran wrap, use a shower chair, and have someone stay very close by to watch the patient as he/she gets in and out of the shower), there's not reason why the patient shouldn't be able to shower.

Never worked in an OR but I've worked on a Med-Surg/Oncology unit for as long as I've been a nurse (a measly 2 years ), and I feel I have learned more in these 2 years than some of my peers (who went into "specialized" areas) have in 5 years. I have many more immediate paths open to me than someone who went directly to OR, OB, etc. because I know a lot about a lot of different things. I used to scoff at my teachers when they pleaded with us to do a year of med-surg (I hated med-surg before I did an actual preceptorship in it - what you are calling capstone I believe), but I am a firm believer in its experience now.

Eventually, going into ANY profession (especially one as physically, mentally, and emotionally demanding as nursing) solely or mostly for money will only cause you to burnout. There have been many studies done on what motivates a person and what keeps a person in a job, position, or profession, and money actually ranks quite low on the totem pole. Bills need to be paid, of course, so money is somewhat of a motivator, but while you see no problem in people who are in nursing for the money as long as they do a good job, if you are in nursing long enough you will be able to quickly pick out the people who are just there for a paycheck and nothing else. Nursing requires heart, and you can't buy that.

There's absolutely no reason why you can't perform Heimlich on a patient who is choking, after all at that point it's all about clearing the airway so a choking situation doesn't turn into a code situation. Also, in the hospital setting we have the advantage of something we don't have "in the field"... suction!

I had a 5-day regimen of inpatient IV chemotherapy delayed by a day because there is apparently a shortage of Taxol as well (patient's Day 1 was Taxol only; Days 2-5 were Ifex and Cisplatin). So it's not only potentially affecting outcomes, it's lengthening hospital stays as well.

I typically have 12 patients assigned to me, and an LPN (to give meds to the 12 patients) and sometimes a CNA (to do patient care on the 12 patients). Not only do I trust my LPN -and- my CNA to "watch" my patients for me, I usually depend on them to do so, as I cannot be in 12 places at once for 12 hours. Your LPNs (LVNs) have received enough schooling and almost always have enough experience (most of my LPNs are more experienced than me) to be able to safely help you monitor your patients, and know the signs and symptoms of a patient going into some kind of distress. Unless one of them gives you a reason not to, trust them!

These are probably just surly people who need something to be surly about - its nothing against you personally. :) I am always thankful for my sitters, especially if them being there means that my staff will not be pulled to sit, thus making us shorthanded. You can't worry about what others think, do what you have to do to the best of your ability and don't worry about anyone else!

I complain about this too, but (much to my annoyance), someone in the non-medical field always has some version of a comparison to "regular" work clothes and it really comes out to be about the same (if not cheaper) than every other profession. I usually try to buy basic colors of pants (black and navy blue seem to be my favorite) and coordinate them with a wide range of different print tops. Scrubs online can be cheaper, but you usually have to shop around a bit, and it can be a hassle if you have to return them because they don't fit properly or you don't like them.

One of the first posts I ever read here, I remember a quote from it, as plain as day: "Do I love my job? What day is it?" I love nursing. Some days I love my specific job on my specific floor, and some days I don't. Some days things go mostly as planned (never entirely as planned!), some days I can't even remember what I was supposed to be doing because on the way to doing it I have to stop and do 10 other things. Some days its like floating down a quiet, gentle river, some days its like trying to keep your boat afloat in rushing rapids. I do not regret my career choice, but some days I just don't like my job very much; I'm stressed out and feel overworked and don't have enough resources or proper resources or enough help and everyone is yelling at you and everything is going wrong. But I am not a special case; everyone feels like this sometimes, and it is not unique to nursing either. However I am under the impression that if you are consistently miserable, never happy, and are making others miserable or are just generally not a good ambassador for the career, you should either find another job or find another career. Who wants to be miserable all the time anyway? The important thing is that you do not allow it to sully your disposition; misery is a poison and it will infect you if you let it. You WILL learn a lot, but make sure you are learning the right attitude about things as well. If you find yourself miserable just like everyone else on the floor, get out (of the unit) before you burn out. There are plenty of places to "learn a lot". :)

Its been a very trying two weeks at work. For some backstory: I work on a 36-bed medical-surgical/oncology floor that dabbles in a little bit of everything (telemetry and such). We do team nursing. On a typical day we will have 3 RNs, 3 LPNs, and 3 CNAs, 12 patients for each team of RN-LPN-CNA. RNs are the "team leader" and do shift assessments, troubleshooting, admissions, etc. LPNs pass medications and do discharges. CNAs do vital signs and patient care (baths, feeding, etc). Obviously we are not static in our roles and help each other out when and where possible. We do not have a charge nurse; each RN "charges" their own set of patients. We are the busiest floor in the hospital, and that is not me being biased; every person, regardless of title, who gets floated to our floor to help out always ends up saying that breathlessly at some point during the day. Yesterday, our house supervisor/staffing coordinator floated all three of our aides to a different floor. So we had 3 RNs and 4 LPNs left to do what we normally do, plus total patient care on our patients. I did not get to eat lunch until 4 pm (I work 7a-7p) and that was literally the first time I got to sit down all day. All of us on the floor were exhausted, frustrated, and pretty much at our wits' end by the end of the day; we knew we were not providing good care and attention to our patients because we just couldn't. We complained to the evening house supervisor who told us, "Its like this at every hospital." I KNOW that's a lie. But just for the sake of my sanity (and the sake of comparison), I'd like to ask: What is staffing like at your hospital? What is the typical nurse to patient ratio? Do you do team nursing or primary nursing?

It depends, really, on how long the IV has just been sitting there with nothing running through it. Most hospitals have a "flush IVs not in use every ____ hours" but nobody really abides by it. If the IV has only been sitting a few hours and has a "clot", chances are the "clot" is not big enough to do any damage to the patient (usually its just a teeny tiny "clot" on the very end of the catheter, only big enough to clog the hole).

That's why we have Google. :)

I don't think you can sit for a med-surg certification exam (like the ANCC - if that is what you mean) without having worked so many hours on a medical-surgical floor over the past year or two. I would focus instead on obtaining other certifications that would assist you on a med-surg floor (ACLS for example). Happy to see someone who enjoys med-surg :)

Some hospitals/organizations will only hire BSN RNs for positions, especially if it is a "leadership" role (charge nurse, supervisor, etc). It could be argued that BSN RNs have more upward mobility because of this, and this is the only time there would be a disparity in pay between an ADN RN and a BSN RN. As staff/floor nurses, there is no difference in pay between an ADN or a BSN RN unless it is compensation for years worked; a RN is a RN. ADNs and BSNs hold the same license, and it does not specify on your license whether you are ADN or BSN. Also, you must have a Bachelor's Degree if you wish to go for a MSN; so, if you are seeking a supervisory position or you will eventually want to further your education, a BSN would be a necessity for you. In most cases (from what I understand), a BSN would be chosen over a ADN for a charge nurse position because the main difference between the degrees is that a BSN RN has received curriculum specializing in leadership.

As a nurse, my small talk has a dual purpose... It helps me bond with my patients, and it also helps me uncover any underlying issues/frustrations/ailments that I might not have known about. If I ask the patient, "How did you sleep last night?" and they say not well, I ask why. If they say its because they were hurting, then there's a pain med dosage/scheduling issue we need to deal with. If they say its because the bed is uncomfortable, I can see about getting them an air mattress to help with discomfort. Etc. There's always going to be people who sneer at you if you ask how they're doing and say, "Not good, I'm in this place!" but there will also be the patients who tell you, "I'm actually feeling a little better today." To the patients who sneer, I try to give them a little extra TLC, to the patients who tell me they are feeling better, I use that as an opportunity to suggest an increase in activity or diet (if permitted): "That's great! Do you feel like getting in the shower today?" Most patients in the hospital are bored/lonely for most of their day, and will appreciate any effort on your behalf to small talk. Don't be afraid of asking the wrong thing, you can always use their answer to bring a little humor or a little compassion into their day.

Nurses have a unique perspective on end of life matters because we get the full picture, thanks to our access to information about the patient that the family may or may not have and we have the knowledge and experience of how to apply that information to come to a reasonable and expected outcome. Being an outsider looking in, we KNOW when a situation is hopeless, we KNOW when a patient's quality of life is a bit on the negative side of the column. But for some/most people, when faced with that critical moment of making a critical decision, there are many reasons they hope against hope: they do not want to be the one to "pull the plug" for fear it is not what the patient wanted (guilt that they "didn't fight" for mom/dad/sister/brother/etc); they do not want to be the one to "pull the plug" for fear they will be demonized by the rest of the family; they believe the patient will miraculously make a turnaround if they just hold on a little longer. As a previous poster said there is usually a very strange and sometimes vindictive family dynamic at play when it comes to arguing over DNR/no DNR. You have to realize that people who insist everything be done for their family member who clearly wants to be let go often do not care about the big picture, they do not consider suffering of the patient, they can only see their own intense despair at being without mom/dad/sister/brother/etc and cling relentlessly to the patient; they would rather have the patient physically there, even if comatose, than let go. Sometimes they come to peace with this and finally allow us and them to let the patient go. Sometimes they don't.

- Visitors shall abide by the usage of the call light ONLY for summoning nursing staff; visitors shall not come out of the room and interrupt an occupied nurse for the purpose of fulfilling needs for a patient, nor shall a visitor stand in the doorway of the patient's room and stare expectantly at every nurse that walks by. - Visitors shall let the patient speak for himself/herself on all matters unless the patient is incapable of communicating, in which case the visitor should notify the nurse of patient behaviors that may or may not indicate a patient requires something (such as pain or anti-anxiety medicine); in all cases the nurse's judgment will be final based on what is the anticipated best decision for the patient. - Visitors shall be respectful of the patient's needs as well as other patients' needs; if you are cackling or talking loud enough to violate the city's noise ordinance, you will be asked to leave - Visitors shall move when asked by hospital staff in order to allow them to perform their duties. - Visitors causing undue stress to the patient, other visitors, or staff members due to an oppressive, angry, or argumentative nature will be asked to leave and/or escorted off premises immediately.

I'm also an introvert, and do not feel that it has hindered me at all in my profession; in fact I think being a nurse has actually helped me be more outgoing and "openly" friendly, because you deal with strangers on a daily basis. It has forced me outside of my box and, while I'm still an introvert, I feel I can deal with people comfortably where before I would have been anxious about new things. I'm also terribly awful in math. I struggled through college algebra (a prereq) with the help of my now-husband, and kind of flapped my way through probability and statistics (also a prereq). The only math in actual nursing school is dosage calculation and I, surprisingly, consistently rocked this.. I had the highest test average in dosage calc of my class. Can't do geometry or trig to save my life, but I can do dosage calc to save yours, and that's all that matters as a nurse. No patient is going to come in with a diagnosis that is dependent on your ability to solve for 3x(42-y) - 59z. I wish you the best of luck on your journey and remember you can always come here for some moral support. :)

Pt has the right to refuse any and all treatment prescribed for them, period. Forcing them to take a medication (and putting it in their coffee is, in fact, forcing them) violates their rights as a patient. The only way to encourage compliance is to encourage compliance, without stepping over the boundaries of their rights as individuals. Your duty as the nurse is to provide the medication and to advocate for the pt regarding medication administration. Putting it in their coffee or something similar means you are not being an advocate for the pt.