whitecat5000

I find that the only times I want to find out how someone is doing after I have to upgrade them, or now that I work in the ER, after I admit them; is when I feel guilty. I truly might have given it my all, but sometimes I get those nagging questions of "what if." What if I noticed something faster, or called a doctor sooner, etc. So I try to keep reminding myself that I'm doing the best I can and that's all I can do. It also helps to tell myself that I will learn from the experience and that it won't happen again.

I'll say an amount. I owed $25,000 after four years at a university. I have a 20 year repayment plan. I would say as a side note to make sure and pay them because the do not go away, even with a bankruptcy.

Yeah, she was admitted because there was pain with urination and she kept passing quarter sized clots with much difficulty. Thanks for all the feedback everyone!

So back story. . . I had a 32 yr old female patient that was a direct admit around 2300 for hematuria. We call the doctor and get orders for a CT abd/pelvis w + w/o contrast, insert three-way and irrigate PRN, and CBC. So CT calls and says they need a pregnancy test and a CMP to check renal function. I am about to call the doctor when the nurse I'm working with says, "Oh don't call that doctor for things like that at midnight. Just put it in, he would order it anyways." Of course I don't, but she puts it in anyways (which I don't care to be honest because it has her name all over it, and the patient needed it anyways). The patient gets the CT done and the doctor comes in at 0530. The doctor said, "Thank you for just ordering those and not calling me. I hate to be woken up for stupid things." So ignoring everything else wrong with this scenario (and there's a lot), how do you all manage to figure out these idiosyncrasies? For instance, I have a doctor that if you do call him after 2200 for Cepacol he yells, and another one that will yell if you don't call him. I can't figure it out. But since prescribing is outside my scope, I just call always, get yelled at (or don't), get my orders and go about my business.

I'm not saying that the nurse caused sepsis. I'm saying the nurse didn't see the alert and transfer the patient to the appropriate level of care as she should of, and as it should have happened.

I don't know about that. I followed an experienced nurse with 32 years on-the-job who was not very proficient with computers and didn't see the Sepsis Alert notification form because she says she's "old school" and doesn't use the computer much. The patient ended up being transfered to ICU with a bp of 64/22 at shift change. Not saying that all experienced nurses are like that though. I think that we need to look at the individual for how well they are doing their job and not how much experience they have or how old they are. Experience and/or age don't necessarily correlate with competence.

I have a low tolerance for incompetence. That's why I like working night shift. Less people means less incompetence. "Oh. Did I just draw blood from a fistula?" "She's not responding; I think she's just tired" ::head desk::

You have a hard time checking if your patients are A/O X4 at 0200. "No sir it's not Tuesd... Oh wait, no, you're right." You can see in the dark better than most.

Thanks for the responses! I have my ECG, ACLS, BLS, and PALS. I can't take my med/surg cert or gerontology cert until August 2013. I've just become part of the SuperUser team, Skin/Wound team, and Shared Leadership team, and I'm taking steps to become a preceptor. I'm also going back to school to probably get a Bachelors of Science in Psychology. I volunteer to float a lot to other units. That way I can learn new things, and try and remember old things. I work nights, and I don't want to transfer to days. Even though I might see more and learn new things, I work best without constant supervision. I'm the type of person where if you give me direction and orders, I'll make sure it's all done, and done well. I guess I was worried that something was wrong with me because I've never had a job where I felt this bored. And I guess I feel a little disappointed, because I was hoping that I would never be bored in nursing. That there would be new thigns to learn and new things to do always. Ah well, I shouldn't complain so much. I have a job and I'm content. I guess that's better than most people.

So like the topic says, I feel like I'm in a rut. I've been a nurse for a year and a half and I've been a med/surg nurse that whole time. I feel bored. We don't get a variety of patients, and they ones we do get seem so predictable. Even when they go into afib in the night, or go septic, or c/o chest pain. I know what to do and get my patient's their tests and transferred safely. Oh, a cellulitis patient? Well lets give Vanco, dressing changes, and measure the area every shift. Oh, a back pain? How about some morphine q 4 hours and colace BID until the doctors diagnose you with something. COPD exacerbation? Have some Levaquin, Solumedrol, oxygen, and breathing treatments. UTI? Measure vital signs to check for sepsis q 4 hours and here's some Levaquin. Is this normal? I started as a new grad in a hospital that was like county. I did everything, learned a lot. Now I work at a big chain hospital and I do nothing! Dressing changes? Call the would care nurse. Breathing treatment? Call respiratory. Central line dressing? Call respiratory. Need a new IV? Call SWAT. Anyone have any ideas? I really love to learn, and I feel so stuck. Should I try a new specialty? Just look at things with a new attitude? I don't mean to sound snobby or condescending, I just can't figure out why I'm bored. I haven't even been at this for two years. I shouldn't be bored!!!

I'm the sepsis/declining patient queen! I can figure it out before the computer (though I wish the docs would believe me more.) I transfer a patient on average at least once a month (I work Med/Surg.)

I use Mint.com to help manage finances. I love it because I can list when my bills have to be paid, how much, and I can set a budget. It pulls charges from bank accounts and credit cards and automatically sorts them into proper accounts. I think the first step to money management, personally, is figuring our where all the money is going. I'm a single new grad with no kids, with new grad pay, with a house, car, and loans and I manage to save about 10-20% of my monthly income a week for emergencies without working overtime. Good luck!

Degree type: Bachelors Graduation month/year: 05/2011 Sex: Female Age range: 19-24 Job Setting: Hospital Geographical Location: Arizona Race/Ethnicity:Caucasian How long have you been looking for your first job before being hired? 3 months Did you do any volunteer work before your job? No Did you possess any additional certifications (i.e. ACLS) before you landed your first job? ACLS, PALS Did a family/friend/clinical instructor or other connection help you land your job? No Did you work in the health care setting at all before your job? If so, what field? Yes, Pharmacy technician Did you apply online, in person (at the facility), or other? Explain. Online Did you participate in any follow-up inquiries after resume submittal of your application or interview? If so, explain. Email, phone call? No How far away do you live from your job site? Include minutes/hours. My first job - 3.5 hours and 2 counties away; My second job 45 min away Did you hold a p/t or f/t job while enrolled in your nursing program. If yes, list whether it was p/t or f/t position: p/t Pharmacy Technician If you held a job during your nursing program that was not related to the health care field, please report the general field in which you worked (restaurant, retail, educational, business, etc.) Feel free to expand: Finance Manager at a Sales and Marketing office Did you receive any scholastic honors while in nursing school (Dean's List, Cum Laude, etc.?) Dean's List, Magna Cum Laude, Sigma Theta Tau, Nominee for Outstanding Graduate of May 2011

We have a facility policy regarding Heparin that explains when to check aPtt, when to bolus, etc. Did you check to see if your hospital has one? It could be different per hospital.

It's the same with the Accu-chek machine. You get a sugar of 482 and then recheck it and get 246. Both numbers will populate in the computer. But if you look it's obvious. "What?! 482?!. . . oh a recheck five seconds later with a 246." Just because you chart both sets of vitals doesn't mean you have to call the doctor on the crappy set. If the aide had charted both sets, it might have alerted me that this is someone that I need to keep my eye on more, or recheck their vitals myself. I guess my main pet peeve was that they set the patient all the way up to high Fowlers, then retook the blood pressure, and set the head of the bed back down. Wow, way to elevate those vital signs there.

I had a patient with a pH of 7.04. I didn't know that was possible.

The patient was an admit about 30 minutes before change of shift. So the report from days was understandably lacking. They didn't even know where the IV was, let alone if the patient was on oxygen. So I go into the room and the patient is on oxygen. I think that the nurse did it and maybe forgot to mention (it happens) because I KNOW that CNA's can't do that legally. And even though those vital signs aren't great, they are still within normal limits. I don't remember what the temp was. I was thinking sepsis, but without ANY documentation of proof the doctors think I'm an idiot. My last sepsis, I called the doctor 16 hours before they caught it saying, "They just aren't right. Something is wrong, and I can't say what, but I think they need to go to PCU." Totally ignored. That's why vital signs are so important. And all the CNA's here (in Arizona) have to have a license (unless they got grandfathered in) and I would think that how to take correct vitals signs would be covered in class. I guess I'm just frustrated. It was a whole SNAFU and it didn't need to be. And the patient wasn't safe at all. I felt horrible for him.

So I have a question for everyone. The scenario: I had a patient the other day who was 88 RA and 78/49 with a HR of 92 at beginning of my shift. Came in for weakness and fever. The CNA put the patient on O2, sat the head of the bed up, and got a new set of vitals 92 on 2L, 102/68, HR 96 and only charted those last vitals and didn't tell me about the first set. When I assessed him after vitals were taken he was a little pale but had no s/s of anything, just tired. At midnight I take his vitals because the CNA was busy and see a patient whose pale, diaphoretic, nauseated with BP 79/48, 90 on 2L, and 102 HR. The blood cultures come back with gram+ cocci 5 min later. I call the doctor and we get a Lactic Acid and send to tele with dx of Sepsis. The CNA then tells me that they were told to only chart the good vitals and he didn't tell me what the first one's were because he got better ones and "it didn't matter." Here's the question. Has this happened to anyone else? I've had CNA's who take vital signs while the patient is on the bedside commode, while ambulating, getting temps just after drinking. Really?

I'm a "Sepsis Whisperer" on my floor. I can spot it within 12 hours of the official signs and symptoms. Queen of the transfers because of it (I'm Med/Surg)! Also I'm great at patient education. Give me a patient willing to learn and I'll educate the crap outta them!

Thanks all for your input. I'm just gathering feedback before my meeting with my financial adviser. I'm not completely financially retarded. I have a 401K, EE bonds, savings, etc. I do worry about having a financial security blanket. I had a family member admitted to the hospital in late December and he stayed until February. Two annual in network and out of network deductibles = financial ruin. $20,000 in bills in 30 days. That's a lot of money and I don't want that to ever happen to me. I just wanted some input from other sources before I meet with my adviser and to see if anyone had any unusual/different ideas that I hadn't thought of yet. :)

I have the ability to pay off my student loans completely now and be done with it. It would almost completely wipe out my savings, but I would be debt free. Also I would save about $8,000 in the 20 years if I paid it off in full now. Just asking for feedback. I hear three main theories from friends/family. 1. Keep paying the loans as is because it will show a good credit history, and it's very important to have savings in the bank. 2. Pay them off because you never know what will happen in the future and no debt is good debt. 3. Pay off extra each month. That way there's credit history and also savings on interest and in the bank. The hospital I work for does not offer loan repayment contracts. So that option is out. And I'm financially lucky enough where I don't qualify for almost all loan forgiveness/help from third parties. What do you all think? Any feedback?

1. Never let anyone hear you speaking bad about your patients. Never. That stuff gets around easily. 2. Hourly rounding, especially at night, is EXTREMELY important. 3. Don't take shortcuts. Do things right the first time. If you don't have time to do it right now, you probably won't have time to fix it later.

I think you should renew. Always. I renew my pharmacy technician license always, even though I don't plan on using it again. My father was a pharmacist, worked in corporate as a buyer for a grocery store for 20+ years, let his license lapse, and now that the economy tanked, he has to go through extra to reinstate it to work as a pharmacist again. My mother retired, kept her pharmacy license up to date, and when she went back into the workforce 4 years later, she could accept a job immediately. You never know. If you don't renew, will you regret it later?

I think that they will always have need in rural areas. I'm in Arizona and there are a significant number of new grad nursing jobs out here. You just have to know where/how to look. It's hard to get them because they are competitive. There's also plenty of experienced positions available.

I drive 3.5 hours to work. 200 miles. So personally I don't think 45 minutes is a big deal! :-)