MNRN2009

My absolute favorite....also known as "narcotic deficiency".

We use almost the same program at my facility. The only exceptions are PCA's are stopped the morning of POD1, and we still use CPM's on some patients but we are starting to get away from them. Some of the surgeons are resistant to that change. Our patients are very successful and we also have out-of-state and repeat patients.

I would like to know what current staffing ratios are and what the hospitals are proposing to raise staffing ratios to. For example, I work at a non-MNA hospital on a med/surg/ortho floor. Currently on day and evening shift, we care for up to 5 patients, on night shift, up to 6. I don't like having 5 on days, especially if half of them are fresh surgicals. 6 on nights is usually managable though it can get hectic. At least when you start with 6 you are not open for an admit.

I am also an RN at a non-MNA hospital. While I agree with the issues at hand (staffing levels, pensions, etc.), I don't know if I can get on board with a strike. I think it will compromise patient care way too much. I am hopeful that hospital management will see the light and come to their senses before it comes to that. But I just worry for the patients who will no doubt suffer because of a strike. And being a non-MNA hospital employee, I believe a strike will have an effect on our facility as well. The unit I work on is usually full to capacity through the week and empties out on the weekends. But it won't take patients long to figure out which hospitals to go to avoid the strike.

That reminds me of a story my preceptor told me back when I was on orientation. This happened quite a few years ago. She said that at change of shift, the nurse reporting off to her told her she had just pushed Phenergan for a patient. When my preceptor went in the room to check on the patient she was not breathing, she called a code and ended up riding on the bed doing chest compression while the patient was being wheeled to the ICU. When she called the previous nurse at home, she stated that she hadn't diluted the Phenergan and didn't remember how fast she pushed it. Shortly after that, the facility stopped using Phenergan all together.

I took all of my general classes before starting the nursing program. I did those part time in the evenings while I worked my Mon-Fri full time job. I was lucky enough to get accepted to a nursing program that had evening classes as well. So I was able to continue to work full time while going to school full time. It was hard and I wished I didn't have to work but I made it. It can be done.

Your friend and the new grad are two completely different people. It really isn't fair to compare one to the other. Your friend sounds threatened by the new grad for some reason. Just because she asks "stupid questions" doesn't mean she is a bad nurse. Maybe she didn't get an extensive education in the area in which she is working. And at least she is asking the questions instead of guessing. When I started on an ortho unit as a new grad, I started with 2 other new grads. I had 6 years of ortho experience in a clinic so I picked up on some things quicker then the other 2 did. It didn't mean that they were bad nurses. They just had different education backgrounds. Having orientation extended isn't a bad thing either. At least she still has a job.

Wow. The facility I work at allows light duty for pregnancy, work related injuries, and non-work related injuries. We have one nurse on a 25 pound lift limit, she is 34 weeks pregnant. She was given a lighter patient load as well as patients that were ambulatory. We have another nurse on zero productivity for a non-work related illness/injury. She is allowed to come in and do just paperwork (admits, discharges, pt education) and no direct patient care. I was out with a back injury a few months ago and was allowed to come back on a 25 pound lift limit for 2 weeks before returning to light duty. Neither myself or my co-workers have a problem with having nurses on restrictions. If anything, it means that our patient load will be lighter because the nurses on restrictions are often considered extra.

First of all, take a break from studying. You will drive yourself insane if you don't. I used 2 the Saunders books and the CD-ROM's that came with them. They worked really well for me. I have an aunt that is a professor of nursing and she recommends ATI to her students. But seriously, take a break first. Good luck to you!

Some facilities don't give straight day shifts. The two places I have worked give you either day/night or day/evening schedules. But if the facility you work for offers straight days, go ahead and ask. Maybe they can put you on a list of people that want days and you will get it when it comes to you.

Current, I am working 12 hour day/night shifts. My facility does not allow anyone "straight anything". But there are enough people that prefer one shift or another that most of the time switching shifts isn't a problem. That being said, I usually try to switch for mostly night shifts. When I work days, I have to get up at 0400. That's damn near impossible for me considering I NEVER make it to bed before 2400. My commute is also 1 hour each way so those 12 hour shifts turn into 16 by the time it's over and done with. Needless to say, I have figured out that 12 hour shifts are not for me. Sure I get 4 days off a week, but what good are they when I sleep half of them away? Fortunately, I've found a job at a hospital MUCH closer to home (by 45 minutes) and will be working 8 hour day/nights. Sure, I will have to work more days a week (most of the time 4), but I will be gaining about 6 hours per day on my work days. Before my 12 hour shift job, I was used to working 7-3:30 M-F so I'm actually looking forward to getting back to something similar. Never thought I would say that!

To clarify, it wasn't the radiologist that gave the "ok to use" order. He read the x-ray for placement and the ICU doctor gave the "ok to use" based on the radiologists read. The PICC team had also determined it was patent and had blood return. Thanks everyone for your replies!!!

I took care of a patient recently that had the tip of the PICC line in the right atrium for over 24 hours. The radiologist read the placement film as in the right atrium and "could be pulled back 6 cm to provide optimal placement" but the MD gave the "ok to use" order anyway without it being pulled back. This was from the ICU and patient was transferred to us the following day with PICC line in use. One of our nurses caught it and stopped use of the PICC until it was repositioned, confirmed on x-ray, and a new "ok to use" order was obtained. My question is, can a PICC line catheter tip being in the right atrium cause ECG changes? The patient had an ECG that showed minor ST changes after the PICC placement and before it was repositioned. Troponin was

Do you have an assigned resource nurse? My first 2 weeks off orientation I had another RN that was assigned as my resource. Of course all the nurses were available to help me if needed, but it was nice to know that I had a go-to person. No, you did nothing wrong. Chest pain over rules most things. BP of 80/50 is low and needs to be addressed, but pt was A&Ox3. I had someone with BP of 66/37 not too long ago and all the MD ordered was a fluid bolus that brought him up to 95/50 which was acceptable for this particular patient. This pt was also A&Ox3. As far as feeling bad, you will feel that way after almost every shift for awhile. That doesn't mean you did anything wrong, just that you are concerned and that's a good thing.

Took NCLEX less than a year ago and only used the Saunders book and CD-ROM. Kaplan and ATI did not appeal to me. I passed with 75 questions the first time less than a month after graduation.