medicrn13

Our visiting hours aren't technically open, but they're technically not not open either...get it? On paper our hours are from 11am - 2pm and from 4pm to 8:30pm, but we aren't very strict on when people come in and when they don't. We usually take it case by case, family by family.

We have the "3 way's" at work and usually if someone is short on space we will attach those and hook an infusion up to each clave. Have seen it where people have hooked up pressors to the Y port on their IV lines, makes no sense to me, so I'll go in and change it to the 3 way connector when I take over, easier to track everything.

Where I lwork LPNs are being "phased out". Not to say that they're firing the LPNs that work here, they just aren't hiring anymore. I guess it depends on what you want to do with your degree. Do you want to do hospital work? Work in a clinic? Do you aspire to teach or go into a managerial position? These are questions you should ask yourself. As far as pay differences, it again depends on what you would like to do. I believe you would see more pay if you worked as a nurse (at any level) in a hospital versus in a clinic or education. LPNs are really beholden to RNs, at least in New York state, it depends on how their scope of practice is defined by your state board of nursing.

Your learning does not end with orientation. Just because orientation has ended, does not mean that your education ends. Always attempt to learn and see new things. If a person comes into your unit with an illness/device/surgery you've never seen, taken part in or heard of, jump at the chance to assist the primary nurse in whatever way you can. Subscribe to a nursing journal, attend conferences, go to continuing education seminars if your hospital offers them. Nursing is a living, breathing profession and is continually evolving and changing. It is your responsibility to evolve and change with it! Best of luck!

My first instinct about this position, even with the way the economy is going, would have been to leave. They set you up for failure there, fortunately for you you thrived. I'm moving to the ICU in August and I will have a 3 MONTH orientation program, with a preceptor the entire time. When I started on Telemetry/Med-Surg I had a 3 MONTH orientation, with a preceptor the entire time. Never was I left on my own to "work things out for myself..." I'd start looking somewhere else...my opinion only though.

To the poster who was complaining about not making enough money when having poop thrown at her from a Hep B/HIV infected patient... Try making $12/hr as a Paramedic for 3 1/2 years. Try working in cramped conditions with little to no resources, living with the very real threat of being shot by a patient (happened to a friend of mine last year) being infected with dangerous diseases, traveling out into horrid weather conditions when no one else will, picking up that HIV/Hep B infected patient and NOT KNOWING THEY'RE INFECTED, stocking an ambulance, keeping up with training, long distance transports at least every day...all the while being called an ambulance driver... MEANWHILE....not being able to adequately provide for your family because EMS is still viewed, in some parts of the country, as the bastard offspring of the Fire Department... You do all that...THEN come talk to me about not getting enough money for the job you do...

I find that if you simply view them as a person, and not someone who holds something over you (which by the way, doctors hold nothing over you, they are not your boss nor are they to be feared...) reporting to them becomes much easier. Remember, we are all part of a TEAM. The doctor may be responsible for prescribing therapies with which to make the patient better, but ultimately it is the nurses/techs that carry out those therapies, and report back to the physician. If a doctor begins to yell, I would simply say something to the effect of "Well, if you want something done your way, I suggest you do it yourself..." We are no longer living in the 19th century, doctors no longer "lord it over" nurses.

I empathize with the OP. I'm making the jump from telemetry/Med-Surg to the ICU in August. I've wanted to do ICU since I was in nursing school and did a rotation in the ICU. A position on nights came up and even though I love the floor where I work, after talking to my wife and several co-workers I decided to jump. Everyone told me, "If it's what you really want, you'll kick yourself if you don't do it..." As for worrying about the change, my wife said it best to me..."You're not going to be good at first...you'll be new again...but you'll get good..."

I had many problems with field intubation, poor view etc. Then I started placing a rolled towel or a pillow underneath my patient's shoulders, view improved dramatically and I've had no problem since.

Like Eric, I too have some experience in the EMS field. It was always impressed upon me that these patients could be experiencing other medical problems, vis a vis DKA/Stroke/hypoglycemia...etc etc.... The situation gets muddled even further when the patient has been involved in a fight and has a head injury...had that happen numerous times. However, I as an EMS provider have had multiple occasions where I've called the doc and said something to the extent of: "Pt does not want to go to the hospital...we have a sober party here who says they will take responsibility for the patient....can we sign them off?" Nine times out of ten the doctor has said yes when all vitals are stable and the assessment was benign.

I hate floating. That being said, it's an occurence that happens all too often and will most likely occur depending on your facility' staffing levels. THAT being said...I do believe that it's dangerous to float nurses to areas where they have no clinical experience. It would be akin to tossing a fresh GN out on the floor on their first day with a full patient load. My hospital floats nurses...but we do not float Med/Surg nurses to the ER/ICU or other specialty areas such as L&D or surgery. We will float aides though. I would suggest filing a complaint with your state board of nursing, or maybe the Dept. of Health...see where taht takes you. Good luck.

A heart monitor should never be a substitute for an actual physical pulse rate for all of the reasons mentioned above. Electrical activity does not necessarily equate to mechanical activity.

Ok....are you talking about mixing Lovenox with another drug in order to give it? Was the person you talked to a pharmacist? What is the other shot you're giving? Personally, I wouldn't do it, but that's just me. If you feel comfortable doing it and you've been told by a pharmacist that you can...Sure....

He is still here, alive and kickin. A very nice gentleman and a very good 90+ year old.

Had an issue similar to this the other night. Had a patient come in, 91 years old. The doctor approached his daughter, his HCP, about signing a DNR order for him. The daughter agreed, the paperwork was filled out, but when we went to place a DNR bracelet on him, she freaked out, saying that her other sisters would be upset if they found out she had made him a DNR. She threatened to rescind the DNR if the bracelet was placed, so it wasn't. When I got report, the evening nurse said to me, "So technically he's a DNR but what they'll do is slow code him and take the family outside and explain that he's DNR." I looked at her and simply said, "No..." That is a totally uncomfortably, unethical situation that you DO NOT want to be in. At the end of the day, it's your license, and more importantly, your conscience. You did the right thing.

I meant in regards to his abdomen, what was the diagnosis of his abdominal pain.

The next time you notice them text messaging during your presentation, call them on it. It's rude and unprofessional and they should, as someone else stated, know better. These are the type of people who know everything, just ask them, and feel they are above everyone else. Unfortunately, these are also the ones who end up being the crappiest nurses around. Feel better in knowing that you will be a much better nurse on your own than they could ever accomplish in their little clique.

Was it a regular, formed bowel movement? Was it diarrhea? Color? Any frank blood noted? How bad was the pain? Why didn't you assess the abdomen when he began complaining of abdominal pain? Any change in patient condition requires further assessment, something you'll learn later I'm sure, but that is something VERY IMPORTANT to know. What other medications is this patient on? Agree with others, we need more information before we can help you. Also, curious as to the diagnosis, what did the pt actually have going on?

http://www.webmd.com/a-to-z-guides/lactic-acid Some information on lactic acid. Also if her white count decreased that much without the use of anti-microbials, that may have lead them to believe that it was a stress reaction as well. She doesn't really present with all the classic signs/symptoms of sepsis (fever or low temp, tachycardia, tachypnea...) Really just that pesky blood pressure, white count and lactic acid level.

Not uncommon for a pt in severe heart failure to not produce alot of urine, even with the use of lasix. I'm interested to know what the Ejection Fraction of the patient was. Agree, maybe Dobutamine, Milrinone or Natrecor for a little inotropic backup.

Sometimes doing nothing, and gathering more support/research/money, is better than doing something.

Complete bollocks. If you do get to a place that's understaffed and/or has coworkers who won't help you...RUN...FAST...IN THE OPPOSITE DIRECTION! That place is definitely not somewhere you want to start out as a nurse, sure you may learn independence, but at what cost to your physical and mental well-being? After all, there's a reason they're understaffed. In my opinion it's a sign of weakness not to ask for help. On my floor, no one is ever too busy to help with a boost or turning a patient.

Love: my co-workers and patients who actually appreciate all we do for them. Hate: Incompetence.

hmm...

The biggest piece of advice I can give you comes down to one word: Relax. Apparently caring exclusively for the geriatric population isn't for you, if that's the case, I'd recommend finding another job, if that is feasible for you. It seems that most of your anxiety comes from the actual patient care aspect of nursing, and that you have a firm grasp on theory. What makes you so nervous about going into the clinical setting? If it's fear of embarassment, we were all students once, and the best place to make a mistake is in clinical, where you can learn and grow from it. Once you're out of school, you're nearly on your own, and mistakes can be much more costly in terms of your career and peer relationships. If you really need to, speak to your doctor about your anxiety, and perhaps even see a therapist. Do you have underlying anxiety issues? or is it just the thought of the nursing profession that gets to you?