*4!#6

Could you have gotten a new IV site, I would not feel comfortable giving those two meds together? But I am always paranoid about those weird combinations.

I have had so many IV's infiltrate on me it is unbelievable. All of them I caught early, (so far). I always feel the site, ask about pain, and watch for any frequent alarming of the pump. If it's a lock, when I flush I always observe for pain or leaking, or difficulty flushing. If I have any question I will flush again and feel the site, I will also try to check for blood return although there isn't always blood return on a working IV. I think on obese patients it would be hard to see an infiltrate. Also it was only NS, so it was a good thing it wasn't a vesicant.

I am a new nurse and still trying to get my routine and time management down. On orientation, I did not get much of a chance to have admissions. Now that I am off orientation I have had a few. I feel like a train wreck when it happens. All my admissions have either at the very beginning of my shift or at the very end (within the last half an hour). I am just wondering how you handle an admission. First, what are your priorities? Lets say you have a patient in for a pancreatitis. The patient is in a lot of pain, requesting pain medication. What do you do first? I always get a set of vitals, do a quick assessment, check orders, and order supplies. Then address the patient's needs. While doing that, that orient them to their room. Then when I have time, do the admission paperwork. Does this seem correct? I just feel really overwhemled when I have a patient that is in acute distress being dropped off on me. And what about my other patients? How and when do I get a chance to see them? Sometimes admissions can be time-consuming. And what do I do if the admission comes at the very end of the shift? For example, a patient came to me very very late in my shift. I got her comfortable, took her vitals, and gave her some pain medicine. Then I had to give report. Could not act on any orders. Does that seem reasonable?

I agree, go in person. They can't ignore you if you're standing right there!

I am a new nurse just off of orientation too. Trust me, many of my days I feel like that. Especially with an admission or transfer -- that really throws a wrench into things for me. Just a few days ago I had a very difficult admission and I came home crying and was looking up jobs outside of nursing, wishing I could get out. I felt like I wasn't giving good care. The day shift nurses always grill me about my patients and sometimes I feel like an idiot. There are so many things that give me a lot of anxiety or cause me to panic. So I guess I don't have much to say except I can relate!

None of the people that I have cared for that are actively dying have spoken to me, but I have only cared for people on hospice care. I have cared for dementia patients who are declining and have heard them repeat bizarre phrases over again and again. I was turning one lady who hardly ever spoke, and when I turned her started yelling, "ORANGE! ORANGE! ORANGE!" I wonder if it has to do with the effect of hypoxia on the brain in your case?

Thank you for your awesome article CheesePotato. I actually read it when you originally posted it. It reminds me of what one of my residents said at my previous place of employment. She was in her 90's and liked to pass on wisdom to others. I asked her one day if she had one piece of advice for me about life and she said: "You will be okay." Today I decided to listen to my instinct. One patient was acting a little off and so I checked a quick pulse ox (seen confusion with hypoxia many times) and got in the high 70's! Also got some critical lab values back soon after that. Needless to say on-call was paged after I had her sats better.

Thanks for relating to me. I know this is common for new grads. I tend to be a very cautious and nervous person to begin with. I appreciate what your manager says. And sometimes it isn't our fault it they aren't doing well. I've had to transfer several patients out to a higher level of care. I have made some good observations and judgement calls in the past. I have a pretty good "sixth sense" and tend to get a little on edge when I feel something isn't quite right with a patient. I just wasn't sure what to do with this patient. Now that I look back, my sixth sense was screaming at me. I need to learn to listen to that "sixth sense" and not second guess myself anymore. For example, on another day, I had a patient in pain. I went to check her MAR to see what they had available and what they was receiving. I noticed that they had been getting a fairly high dose of an IV pain medication for someone their age and with their history. However, they had been recieving this dose for the past few shifts and their pain was fairly high. So instead of listening to that little nagging voice, I went ahead and gave the dose. Sure enough the patient was gorked out. Did not need Narcan but felt terrible. Alerted the MD and had the dose changed.

I am a new grad nurse and have been on my own for less then a month after about a month and a half of orientation on a busy medical-surgical unit. My first few weeks went okay, with a few bumps in the road. But today was horrible. I recieved a new admit and the patient was pretty unstable. I'm questioning how I managed the situation, and the nurse I gave report to also questioned some of my decisions. During the shift I have several "freezing up" moments. I asked for a lot of help. The patient was okay when I left my shift. But when I got home I finally broke down. Very upset and anxious. I am second-guessing myself as a nurse. I want to get out while I can, or find something different to do. I get this sick to my stomach feeling during report. I am thinking of holding out for a year and then moving to something different. But I don't know if I can make it for a year. My biggest fear is harming a patient.

These dementia stories are cracking me up and bringing back fond memories! I miss LTC and geriatrics so much!

I had someone who asked me for an phone charger too!! I'm not even sure what kind of phone! I had to ask them to clarify what they meant, because I can't believe someone would think that we carried all varities of phone chargers on the unit! I directed them to the visitor lounge phone in order to place any calls they needed.

I share nothing. I lie and say I am married to any patient that asks, and if they ask me where my rings are, I tell them I don't wear them at work for infection risk. I also tell them I live in "the city." I side-track the conversation if they ask me about religion or personal beliefs. For example, gay marriage was on the news the other day and my patient was asking me what I thought about it. I just said that there was a lot on the news about it etc etc etc. I will converse with patients but I don't feel comfortable telling them about myself or my personal life. When I am at work, the focus is on them and well-being. That patient asking you where you live is kind of creepy. I would have said "I don' feel comfortable sharing that information." and left it at that.

I am a new grad nurse, having worked for a couple of months, and only a short while on my own in a busy medical/surgical unit. I am a gentle soul, soft-spoken, and have manners ingrained in me from childhood. I strive to be respectful and professional, particularly at work. As a nurse, I am not surprised to be the "whipping boy." From HUCs sniping at me when I ask to a question, to PCAs rolling their eyes at me when asked to do something, to other nurses being blatantly rude to me if I have a question, to doctors chewing me out on the phone ... I knew this was coming and I know it is something that I need to get used to. My unit is not bad compared to what I have read here. But when working with people, each day, I know that some negative encounters are bound to happen. However I am very sensitive and it effects me. Mostly takes me aback and makes me upset. With the stress of the job, today I was almost in tears after a particularly rough afternoon. I do not want to be a blubbering mess at work. I can't seem to stand up for myself. What can I do to be more assertive in these kinds of situations? Some scenarios -- Ask HUC a question, didn't realize she was on the phone, HUC snaps at me and basically tells me to shut up. PCA tells me she is leaving a patient's tab alarm off because she feels he doesn't need it. I tell her I think it is still necessary and to put it back on, and she walks away rolling her eyes at me and avoids me the rest of the day. Patient's daughter is a zooligist and is ranting on the phone at me because she thinks the patient needs X, Y, and Z treatment. Doctor yells at me because I called and asked for an order that was already placed. (my fault, it was during a rapid response)

I do my best to be 100% honest with my charting. Even with the meds. With 4 patients on a busy unit, day shift, all who have fifty bajillion meds due at 8am, at least one of those patients may get their meds after 9 am. My assessments are always done before 9am. But I always chart the correct times for each med and for assessments/treatments. If I realized I forgot something such as examining that skin tear on patient A's right arm, I go back to look at it at another time before I chart on it.

I think the problem is that when you make healthcare a priviledge rather then a right, the health of people who cannot afford care suffers. Wealth and social class are the biggest factors that determine the health of a person in the United States. People should not be sick and dying simply because they are poor.

I take my name badge off multiple to scan into various rooms in the hospital. I try to check to make sure that my badge is facing the right way, but sometimes I'll look down to see that I've replaced it backwards on accident. I've gotten much better at remembering to have it face outwards. By the way ... I would never have my last name on my name badge! I've had computer savvy patients ask if I'm on Facebook or ask where I live. I like to keep my professional and personal life seperate.

Just wanted to say this post made me laugh! I have done the "I love you" thing to -- I just tried to pass it off as if it hadn't happened.

I had a patient like this up on the floor and we called a Rapid Response. The patient was taken to the ICU and then later on intubated.

As a new nurse, I have already seen this type of patient many times and would like to see if other nurses share my experiences or have any tips or information for me. This type of patient has diabetes and comes in for DKA. They are typically a frequent flier and what medicine calls "noncomplaint" with their treatment plan. They are usually younger then you'd expect and have multiple comorbidities that you would expect to see in a much older patient, such as ESRD, CAD - with CABG, neuropathy, etc. One of the biggest complaint with these patients is abdominal pain and nausea. Often this abdominal pain/nausea is intractable. Some are labeled "drug-seekers" and some are not, but all have similar symptoms. Does anyone know what this is, how do we successfully treat this, or why this pain happens? I have heard it explained as gastroperesis, but what exactly is this? And why is it so difficult to treat? I'm not really sold on the idea of gastroperesis.

I have had not one but two patients with necrotizing facitis (sp?). I never realized that this was so common, or maybe I'm just "lucky" (if that's the word).

Thanks for all the tips. I like the idea of doing a quick round to introduce myself before grabbing meds and getting assessments done. On day shift CNA's do the first rounds and update boards and get vitals and BG. But evenings and night's RN's are responsible.

I feel that my delegation skills are okay, but go hand in hand with my time management. Sometimes I try to do too much and end up behind, but I can definitely tell when I am drowning and need help. For example, on nights where I was working with a reduced patient load, I got all of my own blood sugars. However another day, my patient needed his AM insulin and of course his blood sugar checked before, but I was dealing with a clogged tube as well as needing to give report (again envision me running around like a chicken with it's head cut off at 7am). So I asked the PCA to check the patient's blood sugar, and thankfully no insulin was needed (saves time as some of my other patient's needed 7am meds). It is also hard when they schedule a lot of treatments and meds half an hour before shift is over, and you also have blood draws, and to give report. I think I might start getting my labs and medications early.

You know, at another facility, I used to dislike bedside report, but now I really miss it for the reasons you mention. I like to know my patient is breathing and feel assured they are safe at the very beginning of the shift.

I am looking for an outline of how you organize your day, with times specifically, and particularly if you work in a hospital -- med/surg setting. I am new grad nurse and I want to get an idea of how you organize your day effectively. For example, here is my current routine: 7am: Nurses pick patients and assignments 7:15am: Look up patient's information in charts and recieve report. Decide who to see first based on acuity or needs such as insulin/other high priority medications 7:45am: Pull patient A's meds, take patient A's vitals, assess Patient A 8:05am: Pull patient B's meds, take patient B's vitals, assess Patient B and so on and so on. However, I end up getting interrupted by phone calls, new orders, changes in patient's conditions, and other things. I remember in nursing school that we learned we should at least lay eyes on all of our patients during the first hour of our shift. I also learned it is good practice to assess a patient before giving medications. I will peak in on people I haven't gotten to see. But it makes me nervous when I get behind, and I don't know how I can pass 8am medications on four patients all within a 30 minute timeframe

I am a new grad at a hospital med/surg floor and I work rotating shifts a month. I can manage a full assignment on most shifts and have been performing at a very rudimentary level. I am having trouble in a few areas though: 1- Time Management: When everything goes mostly as expected and is an uneventful or mostly uneventful shift, I can handle myself and feel confident. When something goes wrong or a patient's condition changes, I start to feel myself get anxious and panic, and run around like a headless chicken. When it's 7:15am and I'm coming off nights and I'm running around like crazy while trying to give report, I feel like a hot mess! One night I had to pass on a bunch of stuff to the next shift and I felt sooo bad, and like they will judge me as a bad nurse 2 - Being too task orientated: I am so scared about missing a medication, or being too late on vitals or assessments, or forgetting to chart this that I'm often more focused on checking off boxes on my report sheet rather then seeing the whole picture of the patient's condition. For example, my charge will ask for updates and I will have no idea what the patient's plan for discharge is. When we start shift, the nurses pick their patients, which takes up a lot of time (10-15 minutes). Once I get my assignment I need to look through charts and then get report, if I took all the time I needed, by the time I even see my first patient it would be an hour into the shift! So I often skim through the charts and miss minor things (like patient A needs a UA/UC collected). 3 - Prioritization: I know how to prioritize but in the real world it's so hard. For example, although I've got a new post-operative patient I need to assess, the patient in room 6's family keeps calling and calling for pain meds for the patient and getting angry at me. It makes me feel so stressed. Or, my patient is desatting into the low 70's-80's when simply speaking, is on CPAP, respiratory is on the way, but I can't leave the room. But the PCA tells me that my patient in room 8 has a blood pressure of 180/95. Or the patient in room 7 needs an antibiotic hung, 8 needs insulin ... 4 - Just being nervous in general: Nervous about an unsteady patient falling, nervous about making a medication error, nervous about missing something significant, not sure what to do when weird situation X happens ... I have a good brain sheet that has helped a lot, but I am often sick to my stomach and so nervous when I go home that I missed something or made a mistake. I try to avoid obsessing about it, and I can calm myself down soon after the shift is over. But I can't help but feel a lack of confidence and like I'm not sure this was a good career for me, or if I can really do it and be a safe nurse.