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Was taking report the other night. Every patient on the team had just been admitted within the last couple of hours so there were still loose ends that needed tying up. Then, just when assessments and 9 PM meds were finished, and I thought I saw the light at the end of the tunnel, I was told I'd be getting another admit... a falls risk, 2-person assist patient who was being treated with lasix every few hours. Ugh...what a night! Except for meds, I wasn't able to get to any other charting until after shift change in the AM. And even though I work on a unit where everyone is very team-spirited, every other RN had a rough team, also, so no one was available to help anyone else. I didn't even take a sip of coffee all night. There was just so much action, there was no need for caffeine!

Hi All Am trying to get info from CNSs regarding the type of work they're involved with? The CNSs on my unit have office jobs, M-F, 8-5. Are there CNSs still working on the floor directly involved with patient care working the typical 12-1/2 hour shifts that staff nurses work? If you're a CNS, please tell me about your position, what your specialty is, what your days are typically like, etc. Would love to hear from you

I also tell them that it's easier to clean up soiled linens than to fix broken bones AND, with a smile, I also tell them that no patient has ever fallen on my shift and "I'd hate for you to be the first!" That gets a chuckle from everyone. Thanks for your reply

I usually do just offer toileting to those who are awake and I agree that waking people is neither fair to them or productive for the nurse.

You hit it on the head by asking about the acuity and nurse/patient ratios. We have 5 pts per night. One night recently, of my 5 pts, 2 were total care and on contact isolation, 2 others were receiving blood transfusions, and the 5th patient was on seizure precautions. This last one was down a different hallway, but fortunately had a sitter in the room. The other nurses are helpful, but they are also busy and I hate to keep asking for help. I ask a lot anyway cause I'm new and have questions, but I try not to ask people to do parts of my job for me such as rounding or sitting with patients when a new bag of blood is just hung. I'm thinking the unit needs a nurse to just float around esp for the first few hours of the shift to help out with those sorts of things.

Thank you. we do have bed alarms and I plan on using them more often.

Thanks for you response! I'm on a medical oncology unit. People have been reporting after the fall that no one has been in to help them go to the bathroom, so that is what prompted the nurse manager to request hourly rounding whereby we tell the patient, "I'm taking you to the bathroom now." I usually ask my patients if they want to be interrupted at night. Some do, but most want to sleep! It's the most frequently heard request from my patients. Honestly, i do round / peak my head in to their doors as much as i can, but I'd be lying if I said I do it or could do it every 2 hours on every shift! Some of my patients are not sleeping, and they are up with other issues that require a lot of my time and I just don't have the ability to check on those who are less needy or who are sleeping. Thanks again for you input. I'll be looking at meds more carefully now, and I'll check more conscientiously on those who have UTIs, also.

Hey There, Not sure if you still need suggestions, but what worked for me was using a multitude of sources for practice questions. I used Saunders, Evolve, ATI, and also NCSBN. NCSBN, if you don't know about it, is put out by the same folks who write the NCLEX exam. The questions were ridiculously hard and maybe even unrealistic, but the review material was good. You can purchase a 3 week access to the course for $50 or longer for additional money. I only used it for about 2-1/2 weeks. I didn't get to all of it, but I still felt I got my $50 worth out of it. Another thing that's worth trying is a review of test taking strategies. There were questions I didn't know anything about, but was able to use strategies to help answer questions. For example, if you get a question that puzzles you, look at the answer choices. Let's say they give you a bunch of lab results that you might be watching out for with a particular condition or medication, just pick the lab that's the most abnormal. Also, leadership principles & delegation helped me rule out poor answers with several questions that focused on prioritization of care. I came on here to help a friend in a similar boat as you. She's so bummed. Try not to overanalyze...just get back to studying and start all over! It looks like you were so close. A couple of my friends from school didn't pass 1st time either, but they did much better 2nd time around. I think you should just do as many questions as possible... I spent about 2-1/2 weeks reviewing material, then spent 10 days doing about 200 questions/day. I truly believe the practice questions helped more. Good luck!

I'm a new nurse and, fortunately, have never had a patient fall on my shift. Falls prevention is an issue on my unit where there is usually a fall very one to three days. Sometimes longer, but very rarely. Our nurse manager wants us all (techs and RNs) to go into every patient's room each hour and say "I am taking you to the bathroom!" in order to prevent falls which are usually occurring when patients are taking themselves to the bathroom. It sounds like an ideal solution, however I'm trying to figure out to fit that into my shift. I have 5 patients, so if I do rounding Q2 (and my tech does them on the alternate hours), it seems it would take 5-10 minutes to get into each patient's room, wake them up, take them to the potty, wait while they eliminate and wash up, and then get them tucked back into bed. Multiply that by 5 patients and that takes up quite a bit of time that I already don't feel I have. Most of us don't get out on time as it is. My question is - even though purposeful rounding every hour seems like the safest thing to do - is it also very realistic or necessary for nurses and techs to be waking up every patient that often? Are there some other strategies that have worked? I'm not asking for falls identification like falls bracelets and Morse Fall scales. We have all that. What our unit needs is a realistic and practical approach to keep patients safe. Typically what I do is let the patients know that even though it's embarrassing to soil yourself in bed, a fall-related injury would be a lot more difficult to fix. I also let them know that I haven't had a patient fall yet, "and I would hate for you to break that record!" I don't know if that's really efficient, or if I've just been lucky - but I'm looking for some additional simple strategies that are truly effective. Thanks in advance :heartbeat

I totally agree. I'm in a somewhat similar situation, too. The difference with me is that I'd be turning down a job offer that I'm expecting to get this week. The hospital has hinted that they'd have a different position available in about 3 months that I'd much rather get. I'd rather wait for what I really want.

Excellent response :-)

Tweetums... I don't think you were cheating by asking how someone would handle a situation. I do it all the time, and no one would ever question my integrity. In fact, newer nurses and students are expected to ask for help from those with more experience. After a while, you will be able to act more independently (they say it takes about 5 yrs to become "an expert"), though you probably will never act completely independent. Even experienced nurses encounter new situations and will find themselves in need of asking others for help. By the way, while on this subject, you will also find a plethora of websites on how to handle your first job interview as a nurse. Many popular questions asked by nursing interviewers will be found on these sites. Some even offer examples of responses that would make you look bad or good. So, if new grads are looking around for help w/ interviews, I don't see why prospective nursing students can't ask for help, either. :-) All the best to you! I'll be looking for your good news about the interview!

Thank you all for your tips and suggestions. Am a day person and am just about to start my nursing career as a night nurse. This will all be helpful to me.

Let the officer know you are only a student, that you will look in on the patient, and would need to get help from someone else (your clinical instructor or a staff nurse after checking the patient. When checking on the "patient", get a few details ... is he breathing, is he arousable (in a strong voice say, "Sir, can you hear me?"), what is his general appearance (is he disheveled, does he look nourished). You can also get some info from the officer such as where was the man found, or is this a man with a history of being found by police? While it's true that no one expects you to provide nursing care at this point, I think it's important to look at the patient first because the staff nurse or your clinical instructor might ask you a few questions. You want to demonstrate that you've taken the initiative and that you've gathered some info on your own before seeking help.

Depending on how old you are, you might be able to look into AARP. They offer scholarships for women over 40 - though I'm not sure if it's for grad school. I just graduated from a BSN program with tons of debt now to Sallie Mae. Am not sure of interest rates, but I believe student load debt is still tax-deductible. I spent hours and days looking for scholarships. Got some small ones through my school, but mostly found that I wouldn't qualify for most of the ones I found through other searches. Also, are you in a western state? If so, look into WICHE which offers scholarships and loan reimbursements to students in 11 western states especially if they're interested in health care. Good luck, Gerridib