Certifiable

I can't do the basal temp measurment because of the shift work... If i'm racing around at work my body temp will be elevated regardless of my cycle. Cervical fluid is the next step. I just don't know if that is putting too much pressure on myself after 5 months...

I've been trying to conceive for 5 months. Now, i know that it's only "trouble" if it's been over a year. But nurses are not your average textbook patient! I do two nights and two days\evening shifts a week (8.5hours each) in a high stress BMT unit. I'm 32 yrs old. Major work stress, my age, shift work (fatigue, lack of sleep and weird sleeping hours), not much physical activity outside of work (not overweight though)... Just sounds textbook for infertility. How do all the nurses in my ward get pregnant?! It's really starting to get me down... after 3 months i've started bursting into tears every time i get my period...

I work 8 hours shifts and the monthly staff meeting is always scheduled at 13:00, everyone is expected to show up - but if the nurses from the previous night shift don't - no one says anything. They read the minutes printout that get sent along with their salary slip.

Exactly as written in "Cancer nursing: Principles and practice 7th edition" :)

I disagree. If I get a call from the lab about crazy electrolights or dangerous CBC, it's much quicker to intervene. I can immediately stop a drug that can be causing more harm, open fluids, check vitals and then... I call the doc and notify him of the problem. There is a lot that needs to be done before a doc makes a decision. Like in a hematology patient with PLT of 15K, he may not requite platelets if he's not actively bleeding. All that aside. This post describes my job to the T.

Very common.

When a senior doctor refused my request for a urinary catheter in a patient with Breast CA + mets to the brain (=every position change was painful) who was receiving mannitol and chemo (=lots of cytotoxic urine to come in contact with) and the new resident from India said to me "you'll get plenty of practice changing diapers!". ARE YOU F*&^$# KIDDING ME?! Never in my life have I wanted to punch someone more than in that moment...

Misery loves company: I totally get the loneliness behind this post! I'm more alone now than i've ever been in my 20+ yrs of life, curtesy of 8hr hospital shifts (i do them all-morn/noon/night). My close group of friends have broken up and moved to different cities, i live with roomates that are not my social cup of tea (but good and normal apts are rare and i am not moving), and the few friends that i still have can never hang out because of my crappy schedule. The nurses at work are great but have families of their own and are not exactly in my age group for sitting at a bar. Being single like this sucks. I'm halfheartedly inclined to take my patients up on their offers for blind dates of someone they know who will be ""perfect" for me. Very lonely.

Wow, that's a lot of people in one room. You have a pharmacist who draws the meds? cool. Our patient's rooms are so small (all for neutropenic isolation) that it gets extremely crowded as soon when the ventilator is plugged in. When a patient codes (Murphy's law it always happens at the start of a night shift) on my ward (4 RN's, 18 patients), two nurses from the shift are in the room with the code team (usually within 3 minutes they are there. anesthesia doc, icu doc and charge nurse of the hospital) and the other 2 cover the rest of the ward. Of the 2 codes that i've seen, both have been successful and patients extubated not long after a stay in the ICU. Codes are scary as hell. And that feeling after everything is done... sheesh.

It's been a few weeks since your post so I hope everything is alright. I'm a new RN, 9 months into the job. I vividly recall trouble sleeping, nightmares (based on true and false patients/situations) and sometimes a horrible, heavy anxiety. Once I couldn't sleep before a morning shift, i just walked around and around the dining room table until I somehow silenced my pounding heart. When I sleep badly because of nerves, I tell people at work - they're really nice about it and empathetic. Things have improved drastically, my nightmares have decreased - they only happen maybe MAYBE twice a month. I count that as a victory, that my subconscious shuts up. Working out helps me. Nothing like endorphins to perk you up. Life's natural uppers.

Thank you all for the great advice. A little update: i'm 6 months into working on the BMT unit, and my heart still pounds whenever the charge nurse writes the patient assignments on the whiteboard -gulp! the problem is, during my month-long orientation, i was so focused on learning all these new nursing skills that all the important info that was bmt focused flew straight over my head, so i'm still playing "catch up".... I do fine with patients post bmt, managing symptoms and juggling AB regimens, but pre-transplant i really dread- back to back chemo - I never get comfortable with that. Another problem is the day shift. My hospital works in 8hours shifts so the 7-15 shift is when most of the chemo and bloodwork is done- I HATE that shift! There is a ton of insanely pressurized work, worst pay--- in all i feel like i've been run over by a truck by the end of the shift. For some weird reason our unit is really low on transplant patients at the moment so our pt:rn ratio is waaaay off. So every so often our nurses are being floated elsewhere (mostly hem/onco)- tonight i was sent to hematology as a float nurse- I was super stressed all night! I almost missed the last bus home! And did i mention the kids? Our unit usually has 2 kids (5yrs and up) receiving a transplant- i really hate working with kids for a number of reasons, but the main thing is just the medicine safety issue- the doasages are different, less fluids going in- and when they crash- they do it in spectacular fashion. Oh, and not to mention that the language most spoken is arabic or russian- which i am not fluent in? (Arabic is easier to pick up than Russian though) I still don't know if this is the specialty i want to work in, at the moment what really keeps me going is the great staff that i work with- 100% willing to help even when they're super busy.

I'm a new grad, on my first job in a specialized unit. It's extremely stressful work (I dream about it quite often), the patients are really ill and we also get a lot of patients from other departments when they are full (which somehow happens during the night shift...) and we have a few empty beds. Morning shift is the craziest, the patient-staff ratio is the lowest but it's crazy because that's when most of the work is done. I'm very anxious when I'm at work, in 3 months of work, I can count on one hand the amount of times when I've had a relaxed feeling after work. Also, so often I dream of things that have happened or never happened that my sleep is never restful. If it wasn't for the staff and their constant encouragement - I'd probably have given up by now, but they keep me going. I'm not sure that I want to stay because of the nature of the nursing that I do, but until I make up my mind I know that I have the support of the staff - it makes all the difference in the world! But even the great staffing doesn't prevent me from being down and exhausted. It's really hard making plans with friends because of my schedule. My friends with "normal" jobs like to meet up but it's not their priority because they are not as stressed as I am -so when I can't meet people or plans get canceled it's really hard for me. These 3 months have flown by - i'm worried that i'll blink and time will have passed, but my "down" state of mind won't have changed.

ER will always have a place in my heart for the most well depicted nurses--- always overworked, fighting with management about staffing, dealing with idiot docs and knowing their stuff. People here keep talking about Grey's Anatomy--- the only time they had a nurse in the plot was when she had syphilis or he was horny and being unprofessional with dr. Baily or when they were striking.... common! Never seen nurse Jackie... maybe i'll give it a try....

Hi, I'm two months into my first job as an RN on a highly specialized unit. The patient to nurse ratio is fairly low due to the complexity of the work (mornings - 3 or 4, evenings 4 or 5, nights 6 patients). All shifts are 8 hours. The low ration was one reason why I wanted to work there - i couldn't imagine working a night shift and being in charge of 12 patients - that's just insane. I rarely get a night of uninterrupted sleep. My dreams vary from real patients, med mistakes and once I even invented a fictitious patient in my dream. I don't feel rested and as soon as I turn off the lights, thoughts about the day that was flick on in my head just like the flick of the light switch. I had orientation for a month alongside my instructor. I always felt very threatened by her (no idea why... maybe it was her knowledge? she was kinda intense) and that didn't help my confidence whenever I had her. To the credit of the staff, they're really supportive and encouraging (99%... there is that odd duck). I HATE morning shifts! They cause me unbelievable stress - once I couldn't eat what I brought because I was stressing out so badly about keeping my patients on schedule. (we deal with a lot of drugs given through PICC lines). I always pray that when we get the lab results at 8am that I don't have to order PC/FFP/PLT/SDP... that always makes me super nervous. (worse than when i'm giving chemotherapy- which can happen during any shift). The doctors are changing the orders often in the morning which is really hard when suddenly you have to give another 3 different IV meds that don't go together, that the TPN needs to be stopped because of it - basically anything that screws with the already crazy med schedule i've drafted. I like the evening shift the best, because it's a little more relaxed, there's more patient interaction and the staff are also a bit less stressed. I realise the best way for me to learn is to do morning shifts- because that's where and when everything happens... but the stress, oh my god, I can't take it. I wake at 5:15am, get home at 16:30 and am exhausted.... and of course I dont' sleep well after that, I can't stop going over what I did wrong etc' The head nurse keeps telling me that "the staff really like me", i can't be sure if he's being nice and honest or this is being said to me in a condescending manner. I have yet to cry, I process things really slowly, i regard myself as a meta-thinker (when it comes to my own emotions) and I don't discuss my innermost fears with anyone- who else could relate??? The nurses on my ward dismiss my anxiety as "first year nurse syndrome" and that it happens to everyone. That doesn't help me deal with the problem. My family have commented that I seem really on edge and cranky and tense - but at work i'm all smiles (that's just the way I roll, I smile a lot, even if i'm not happy). The more experienced nurses tell me that when the ward door closes, that my mind should close too about the workday- like a cork. leave my day in the hospital and not bring it home with me. Yeah, that didn't work. Because of the nature of my shiftwork, I don't see my close friends as often as I'd like and I'm feeling kinda down about it. I've stopped working out because I can't find the motivation even though i've signed up for a 10k (already missed another 10k because of bad scheduling). If you'd describe my current self to my nursing student self 6 months ago i'd probably say: all new grads are stressed, you need to do things that make you a happy, see friends, work out, speak to the nurse manager.... all things easier said than done. HELP!

Thank you, this was reassuring.

Hi, I'm about to start my first nursing job as a nurse on the bone marrow transplant unit. I know what a lot of you are thinking- not a good place to work straight out of school- but I really like oncology and this was the only job available. Now, i'm set to start working in a few days and I'm TERRIFIED- of making a mistake, of being out of my depth... you name it. I'm so used to being in control I feel like i'm jumping out of a plane with no chute. I just got back from a surfing vacation and I feel like I left half my brain cells in the Atlantic ocean... I'd appreciate any advice... especially from someone who works with BM transplant patients or hem-oncology.. Sincerely, A nervous wreck

Hi, I'm happy to post this in the RN forum after finally finishing my BSN a few months ago and passing my exam. However, i'm TERRIFIED of starting my new job in a few days. I feel that all the stuff I learned has been knocked out of my brain (I went on a surfing vacation so I might have killed off some essential brain cells from head blows and hypoxia ). I'm terrified of making a mistake... especially in meds. Everything was always far away, dreamlike- the degree, employment... now that it's all here, I feel like taking the next flight and postponing my first day for 6 months... Sounds like I'm off to a great start huh? Thanks for reading, sincerely, a nervous wreck.

Thank you.

Can TB start off as full blown TB or does it have to have a Latent phase first? my common sense says that it starts off active then switches to latent... but for some reason I can't find and answer.

I used to say that my favourite quote was from Legally Blonde "exercise gives you endorphins, endorphins make you happy, happy people don't kill other people"----- BUT, only after seeing Patch Adams as a nursing student (the other 5 times it never registered) I now say my favourite quote is the same as yours ‎"You treat a disease: You win, you lose. You treat a person, I guarantee you win. No matter the outcome."

It's that time. I'm 3 months away from my national licensing exam (eek!) and every 2nd person I meet or that hasn't spoken to me in a while asks "so where do you want to work?" (where=what kind of nurse)... it's really starting to get on my nerves--- because I want to shout at them "I DON'T KNOW"! I'm very sure as to what I DON'T want: pediatrics, ER, Cardiac, neuro, OR, dialysis, hematology. I'm most inclined towards oncology. But i'm afraid of starting in such a specialized field... I don't want to go to a general ward, for example- internal medicine, because I just finished 38 shifts on that ward and never felt comfortable (constantly stressed)- the nurses says it takes a year and a half for a new nurse to finally feel comfortable there. I couldn't hack that, even if it's "the best thing a new nurse can do" according to my preceptor. I want a "field" that has a root cause for the patient being hospitalized, not a smorgasbord of illnesses that I saw in internal medicine. This is starting to stress me out. End of rant.

People here talk about the great and amazing nurses they encountered--- I'm the opposite. My grandmother was hospitalized in a geriatric rehabilitation ward, had a tracheostomy and a colostomy. A bunch of nurses came in (I think they were rounding or doing something with the head nurse) and one of them blurted out "Is Dr. X crazy? she doesn't belong here, she's in rehabilitation?!" I was dumbfounded that someone could be so callous with another persons life. All she saw was the frail elderly patient, hooked up to machines. She did not notice that I was next to her (one of 5 grandchildren), nor did she know that my grandmother survived Auschwitz and other murderous camps of the Nazi regime. She did not know of her courageous and victorious battle with breast cancer, her daily battle with Ulcerative colitis and other medical conditions. Nor did she know of her amazing daughter, my mother, who being an RN herself, would nurse her back to health so that she danced at my sister's wedding a few months later. That moment, along with other forms of substandard care in that facility--- I felt the pull of being a nurse as a calling, that other people's family members receive the care and respect they deserve in their time of need.

I was just being nostalgic and thought about that moment with a patient that really made me realize that I can make a difference. I was in my 2nd year of my BSN, and I was on the Oncology ward. I was caring for a patient with end stage pancreatic cancer in addition to being paralyzed from contracting polio at a young age (mets to the rest of his body, Jaundice, ascities.. you name it, he suffered from it) and I was just fumbling along. The first few days with him, were really awkward on my part, he was just in so much pain and I was a pretty clueless student back then. One day, after I had finished brushing his teeth and after a painful bed bath (his morphine didn't help the 15 separate parts of his body causing him pain), I jokingly said something about how he can rest now (everything knocked the wind out of him), because I'm all done with the annoying things that cause him discomfort and I'll leave him to rest... and he then said something that hit me like a ton of bricks: "Please stay... can you just sit with me?". The whole time I thought that I was annoying the hell out of him with my questions and not so confident caring... but that was the very first time that I really understood the word "vulnerability".... it was almost tangible in the air of his room. I felt humbled, that my mere presence could be a comfort to a complete stranger in pain. I feel that that moment has shaped who I am today, and for me the psychosocial aspect of nursing is far more important than the medicine. BEING THERE made more of a difference to the patient than endless treatments.

Nothing helped me. My first year sucked.... I got the hang of it in my 3rd year of my BSN.

Yes, thank you.