KaitRN

I transferred into RIC from Umass where I took prereq's. Almost all were accepted and I still graduated in 4 yrs. RIC is an AMAZING nursing school. I highly recommend it!!!

I agree BluegrassRN, Just a little too strange/ coincidental for me!

I'm not sure if the other pt's were on corticosteroids, but I wouldn't be surprised since they're mostly all respiratory patients! I'm glad that other people have noticed this.. I guess I'll just slow the infusion next time.. Very interesting though! Thanks!

Hey everyone! Just curious, maybe this is completely coincidental, but.. In the past few months, I've taken care of about 4 patients after receiving IV Avelox. 3 of them received the IV dose in the ER. According to ER documentation and per the pts account, they started getting a red line going up the arm where their IV site was almost immediately after the Avelox started infusing. The IV site was perfectly fine, no inflammation or infiltration and it didn't appear to be phlebitis. The ER nurse stopped the infusion, flushed with NS, and after a few minutes the red line diminished, IV site was patent and working beautifully. Pts were all fine afterwards and transferred up to my floor. ER documented this occurrence each time. The 4th pt was already on my floor- I hung the IV Avelox no differently than I always do, and the exact same s/s occurred again with this pt. I stopped the infusion, flushed w/ NS and the red line diminished... So I guess my question is: Has anyone else been finding this trend when hanging IV Avelox? Its only been in the past 2 months or so! I've never had an issue with Avelox prior to this. Is it possible the company made a bad batch? Just curious! My mind is wondering...

In the chart it said "flush ct with 10 cc sterile ns. don't remove fluid too quickly" (poorly written md order). and yes, the pleuravac was to suction -20 cm.... I have since been to work and no reprocussions occurred on my end. the pt was transferred to a medsurg unit so im guessing his condition improved... i was just curious! i guess next time ill just have to call the md and clarify/verify the order (gotta love calling a surgeon on 3rd shift. haha!)

Hi all. Okay so I worked last night and had a pt with 2 posterior chest tubes pigtailed to the pleurevac with the small catheters that have the stopcock mechanism. I was told in report that we "flush the chest tube and then aspirate slowly for output." I have heard of irrigating chest tubes but I just wasn't sure so I even had the day nurse show me before she left. Sure enough there was an order to "flush chest tubes with 10 cc sterile ns qs and record output". I used a 10 cc syringe with sterile ns and utilizing the stopcock i flushed then slowly aspirated contents. i got 2 cc return out on the left and 24 cc on the right (it just kept coming! eek!). pt was stable, no complaints, breathing at ease. so this AM after report, the nurse getting my report is like, "umm is there an order to ASPIRATE?! I've never heard of that. That's scary". I'm a new nurse to this floor. I've only been working on this unit for 6 months. The day nurses are not always the nicest people. So I started to get nervous thinking that I did the wrong thing! Maybe I was just supposed to irrigate and not "record output"? But the prior nurses to me were doing this procedure as well and recording it in their nurses notes.. I just don't want to get in trouble or reported and I'm doubting myself!!! Has anyone ever heard of this type of order? I've been searching everywhere and really can't find too much on this issue. I really hope I didn't screw up Thanks.

It's so funny that I'm reading this post- I just finished my 3rd 12 in a row, which always is really 13+ hours, and recently our hospital has been understaffing us (cutting costs? I have no idea...) so that on night shift, we end up getting 6 patients at a time, on a critical care cardiac unit. We're supposed to only have max of 5! I just woke up, and, like every other day I have off, there was a voicemail from my boss asking me to work extra tonight.. I rarely ever call back because I feel that my days off are for ME, and I need ME time!!! I feel guilty about not helping out because we have been so short lately, but I know it's not my problem- They need to staff appropriately! I need to keep myself mentally and physically healthy.. So I'm not calling them back, and this post made me feel better about that :)

I would just like to add, like the others, that most of the time death is imminent in the LTC facility. the pt has been put on hospice care, families have been talked to about changing pt's status to DNR, etc. Once pt's passed I would call the family and break it to them gently, see if they'd like to come view the body, if so do post mortem care, in the meantime call the MD and notify of estimated time of death then call their funeral home choice and the funeral home always picked them up from my LTC facility. I never had to deal with a full code situation at the LTC facility I worked at.. But I would assume if the pt looked like they had been dead for quite some time, you would not send them to the ER. As one Dr. said one time, "you can't treat rigormortis!" lol morbid but true

I work on a cardiac unit where BP's are all over the place. And it's true, especially in the geriatric population it can be very difficult to hear diastolic. We never have an issue when alerting the MD to a low or irregular BP and stating just the systolic, diastolic unable to hear. If you go very slow sometimes you are able to get a reading but if you can't I think at least verifying an SBP is better than nothing!! I may be wrong but I believe that sometimes you cannot hear the diastolic due to low perfusion? I think you did a very smart thing by documenting it that way. It does concern me that the ADON "fixed" your charting, but I also started out in LTC as a new grad and I totally understand how it works there. There's a lot of "fixing" that happens which is scary hence why I left as soon as I could land a hospital job! Good luck to you and I would support your documentation fully.

In the hospital I work for in Massachusetts, CNA's are able to insert foleys and straight catheterize, but I believe they need to be trained first. I think it just depends on the facility. I worked as a student nurse intern in R.I. during nursing school and the CNA's were able to insert IV's, which I was surprised about... So I think it depends on the training provided in the specific facility.

I worked in LTC for a year and did a few night shifts there. Now working at a hospital and am doing exclusively nights. I really enjoy nights. It can be crazy at times and there's not as many people there, but that can be a benefit as well. I find that most of the time, you are able to give yourself more time to assess your pts., etc. Sleep with an eye mask and ear plugs- it helps! As for med passing, in the hospital its not too bad, but I know from passing meds in LTC, it can take well over the alotted amt of time. I'm not saying that you should do this, its a big no-no BUT i know at my old LTC facility, most of the night nurses would pre-pour their 6am meds, write the room # on a seperate med cup and place that med cup on top of the pre poured meds, and hide them in their med carts. Also start right at 5 am passing meds. I was always nervous about pre-pouring my meds although the older nurses swore "everyone did it", so instead of pre pouring, I would arrange my meds in the med cart according to when you need to give them. If you use the big square med packs where you just pop out the meds, just arrange each pts meds in order in your cart. That way you can just go down the list in your MAR and pop each med out in order. Makes it a lot faster than filing through all the meds. (you'll have time to organize your med cart at night- a plus!) I hope this helps!! In regards to calling families at night, I would say wait until the end of your shift to call, if its not an emergency.. Good luck! I hope you like it! I find that people on night shift are more helpful than ppl during days sometimes!

I am a newer nurse as well so don't take my advice to heart, but I think you have the right idea to possibly get OR certified. This would enable you to expand your credentials in the OR nursing world.. If you want you could move out to the northeast! Most of the RN's that I work with are ASN graduates and I work in a small community hospital. I am a BSN and in the minority. Getting your MSN would be unneccesary if you want to continue working in patient care. If you go for your Master's I would not settle for just a general MSN and go for NP, if you want to go in that direction. But for the time being, get OR certified. It will make you more marketable :) Just my opinion though! Good luck

Sounds exactly like my unit! I'm still very new, just off orientation and I find that this is quite a hassle and most nurses on my floor will agree. The nurses are always held responsible, the MD's are not. It's a rather unfair standard...

Hello all! So I just finished my orientation on a busy cardiac critical care floor yesterday at 7:30 am I got a great review from my supervisor and the director of nursing so I am very excited, just had to put that out there! YAY! haha. Anyways- I did most of my orientation on days then switched to nights 7p-7a about 2 weeks ago and will remain on nights. I actually don't mind it at all. My body has adjusted fairly well to the sleeping schedule and I try to stay within that sleeping schedule even if I'm not working (it just helps my body to stay in sync). However- I'm wondering for all those night nurses out there- how do you find time to schedule dr.'s appts, hair appt's, food shopping, all those "day activities"? I find that I sleep until 4pm and most of those places are 9-5 schedules! I'm especially wondering because I just moved to a new area for this job this summer and have yet to find a new dr., dentist, etc. so I'd like to get it out of the way. I'm thinking probably an early morning appt would be better.. Just wondering what other night people do! Thanks

I took the Kaplan course and thought it was well worth the money! The questions teach you HOW to THINK.. It's all about reading into the question and finding the best answer, which is the same strategy that the NCLEX uses. Kaplan taught me an entirely new way to think and read into a question... It's not so much about facts and diseases and such on the NCLEX- they know we know that, we've been through years of nursing school!- It's all about APPLYING that knowledge and prioritization techniques.. Kaplan definitely showed me how to do that. Even if you can't take the class, buy the book!

Thank you! I appreciate the feedback. I completely agree- I'm excited that I will have the time to read the Dr's charting and have a more in depth look into my patients' tx and care. Having a different perspective with a new preceptor will also show me different styles of how nurses do things also.. I know I'm not getting worse- I do feel as if I'm progressing.. and it will take time to get to that point.. So thanks for the encouragement guys :)

Hi all. So I started in August on a very busy cardiac step down/tele/critical care unit at a community hospital in an inner city. I had been working for the past year in a long term care/ rehab facility. Needless to say, it's been a big transition!! I'm so excited to finally be working in a hospital, on such a complex unit but at times, I find that I doubt myself. My preceptor has been very nice and she's a great educator but lately I've been feeling like she's becoming impatient with me. She basically lets me do everything on my own now that she has assessed my abilities, but we've been having some very sick, very needy patients lately, with multiple issues and at times like these, I still need to look to her for guidance. On Monday, it seemed like she was getting frustrated with me, but I was trying my best! We just had a very trying assignment. Also with family teaching especially, they throw me for a loop and I still need help! Maybe I'm just doubting myself but I feel like I'm getting worse as my orientation progresses! I am officially on my own starting in late October and I just hope I'm ready by then. I don't know if its just me that needs a little push to reassess my abilities or maybe my preceptor is getting overwhelmed.. I'm looking forward to switching to nights in the next few weeks (I have been training on days- my supervisor thought it would be good for me to see the day process of admissions, special procedures, discharges, etc. that occur during the day before switching me to nights.) . I think nights will be beneficial because I will not only have a different preceptor (exposure to a different mind, a different way of doing things) but also I think less interruptions will benefit me. Coming from LTC, I know that I can manage my time efficiently, but I don't do well with tons and tons of interruptions. That's what drives me crazy during the day shift! My brain is in all different directions and so are my patients! I know nights will still be extremely challenging but I think nights will give me a better perspective. Did anyone else feel like this when they first started? I'm sorry this is so long- just got home from work and it's been bothering me. I had to get it off my chest! Thanks :)

That is an excellent opportunity as a first job!!!!! I would have loved to do that! It will teach you excellent sterile technique, OR, how to work with the surgeon and techs... And I'm not positive but I think you could go anywhere from there (If you should decide to leave). Any OR in a hospital I would think would take that as experience.. Seems pretty ideal, and probably no weekends or holidays (JACKPOT!!!!)

Thanks so much for ll the words of encouragement. I do think everyday will get better and I do feel like I'm learning more and more each day. It's just nice to know that this is a normal feeling that other people have to! Nursing is not easy so I know it will never be "comfortable" but I do have faith that I will become comfortable with MY skills as a nurse the longer I practice. Thanks guys :)

WOW! How inspiring!!!! That hard work pays off when you least expect it! Kudos to you!

Hey guys! have been working as an RN for a year now, but in LTC. Just switched to a Cardiac Critical Care/ Tele/ IMC unit in a community based hospital. I had a month of orientation classes and now it's my third day on the floor. My preceptor is great and I feel like I'm progressing each day. First day I just shadowed, 2nd day I took our 4 patients but preceptor was in room while I did assessments, gave meds, etc., today I felt like I took a little more charge and did more things on my own, though my preceptor was always available and checking, which is great. I'm just wondering- how long did it take you guys to finally feel comfortable at your job and confident in your skills? Maybe its just personal but I feel like I doubt myself! I also get very intimidated by certain nurses (today one of my patients went south very quickly and everything happened soo fast, I ended up transferring him down to ICU but the nurse was so snippy, I got intimidated giving her verbal report!) and also with MD's. Maybe it's just that I'm not confident enough in my skills yet to really feel comfortable... I know it takes time, just like with any job! I just really want to make a good impression. This is a place I would like to stay for a long time! Just wondering how other nurses felt starting a new job... Thanks!

thank you so much! that was an excellent article. i appreciate it !

Hi all.. So I just started last week getting precepted on an IMC/ Cardiac Tele Critical Care Unit.. My preceptor says I'm doing well, asking good questions, and have great motivation but she did give me some things to work on.. I started working after becoming an RN last year in LTC so I haven't had much experience with IV medications. She said that we will work more on that, including IVP times. Also she says I should get more familiar with cardiac meds and the different effects they have on the pt... I'm just wondering, is there an easy way to remember some of the common meds and their side effects? I've made lists, studied, etc but it just doesn't stick that well! Also, remembering which IV drugs to push slowly over time? Pharmacology is not my strong point! I tried some of the "Helpful links" at the top of the cardiac nursing thread and some are helpful, but I'm looking for a more specific list... Any help, advice, studyguides, etc would be greatly appreciated! I just want to excel on this unit!!!

Hello! Just started my unit orientation on a very busy cardiac telemetry/ critical care floor. Coming from LTC, I felt very underprepared lol! I'm going to go out and get a new penlight, scissors, tape, clipboard with calculator attached, etc. to make the transition easier. However, we have these little handheld computer devices that we are supposed to carry on us so we can do bedside documentation. An amazing and convenient concept, BUT I feel like once I'm on my own and in the chaos of everything, I am going to forget where I put it!!! Even today I noticed seasoned nurses on the floor walking around in circles going, "Where did I put my handheld? Have you seen it?!". Such a time waster!!! .. I am wondering if anyone has suggestions of how to keep this close to me at all times. It's big, the size of one of those oldschool walkie talkies lol, but it does have a velcro snap on the back, so I'm thinking if I got some type of belt I could hang it from there..... Any suggestions?!

Not a dumb question at all! I had no idea what it was until I starting working LTC too! (btw: ask as many questions to your preceptor as you can, regardless if you think its dumb! It's probably not as dumb as you think!!:) ) Anyways- you will most likely have a "treatment book" aka the TAR. Similar to the MAR (medication administration record). Both are basically a binder (again, this may be different if your facility is computerized), which has tabs for each patient. Within the seperated tabs, it will have a paper that looks like grid or graphing paper. It has 31 spaces across for the 31 days in a month. on the left side it will list either the medications (for MAR) or in your TAR it will list treatments. You sign off when you give that medication or treatment... Kind of confusing to explain until you see it, as I'm sure each facility is different. But let me give you a few examples of treatments that are likely: Check pulse ox q shift: you would sign your initals in the TAR and prob have a space to write what the pulse ox was Change g tube dsg qd and prn if soiled: you would initial in the TAR Apply dimethicone cream to reddened left buttocks q shift and prn: you would initial (i would usually check with my cna's for this one, as this cream is usually applied with brief changes and will be in the patients basin) Cleanse stg II pressure ulcer with NS f/b solosite gel f/b clean dry dsg q shift and prn: sign your initials in the TAR and also intital and date your dressing. these are simply examples but were very common treatments in my facility.. Basically you just start at the beginning of the binder and read, gather all supplies and treat the patient, sign off in the binder, then turn the page and continue in that fashion. I hope that helps!!! :)