Kasandra

I have to give you kudos as well: At least you are stopping, thinking about your actions, and how they will impact the care that you give to your patients. Assessing is huge. Knowing patient baselines: really important. You are already thinking in the right direction! My pet peeve is following nurses who do not critically think the way that you do: who simply give meds (or hold without follwing up) without knowing what they are giving and why they are giving it. Patient baselines change so you have to know that it is still appropriate to give the meds in a patient's regimen. And to always follow up with the PCP if you hold/question something (like meds): You are keeping your patient safe and protecting your license. If you disagree with your preceptor's point of view, respectfully state to her why you view things the way that you do. Do not execute nursing actions at the bedside that you do not agree with: You are a RN and only you are responsible for your actions (even though you did not agree with your preceptor, you (not her) executed that action). Always ask questions as well. Nurses who think that they know everything are safety liabilities. Give me a humble, inquisitive nurse any day to work with. You are doing just fine. Hang in there! And keep being the critical thinker that you are! That is a strength!

Tokmom: I liked your description as well!

After reading everyone's posts, everyone has me thinking: Why don't all nurses accept eachother for who they are? A BSN RN can help ASNs with how all that extra theory applies at the bedside while ASN prepared nurses can help others with their experience. There is nothing wrong with nurses wanting to better the profession as a whole by advancing one's education. Any knowledge that adds to one's critical thinking skills at the bedside to help others is worth it. I am a BSN RN who is confident in both my theory and critical thinking skills. I am grateful for my education.

You can always invest in a portable b/p cuff that goes on the wrist. I would take the b/p before cardiac med passes to ensure that the patient's baseline has not changed (and trust me: It can, and does, change).

Keep it simple: Did you keep your patients alive? As long as they are safe and stable, you have done well at your job. Of course, in order to maintain stability, you have to give meds on time, F/U with the PCP as needed with concerns, etc. Basically, implement care in a timely manner. However, as a floor nurse, it is an environment of constant chaos although night shift can be really busy or okay. When you have multiple tasks, think about which is the most important: A STAT order? A medication that if not given could impact stability? Which patient is more unstable than the rest of the team and needs more frequent follow up? You have to pause and think. I use a sheet to organize my work and ESME12 has alot of sheets that can be used for the purpose of organizing your workflow. As far as your charting is concerned, make sure that if you did it, you chart it....Or you didn't do it (by a legal perspective anyway). Make sure that you are checking charts all day for new orders. Remember to sign those off (a huge safety and pt care issue is when charts are not being checked because it impacts the care that you give). Nursing is stressful. Your anxiety will never go away. That is why you have to have a life outside of work and be able to vent to your nursing buddies. Again, as long as you caused your patients no harm, and they are stable and alive, you have done your job. :hug:

Wow. I start FNP studies in the Fall online. I need to start looking into preceptors, appartently. I hope that you find a preceptor! If you do not mind, keep us posted on what worked for you! I will be looking into TakeTwoAspirin's advice for finding preceptors.

It sounds like you have alot going on. You have one little one with maybe another on the way soon. You are right out of school, and need work experience. I agree with mustlovepoodles: I would look into something part time so that you can get your family time. Even if the orientation was full time, that would not be a permanent thing. Good luck with everything!!

Between the two shifts, I prefer night shift. It does, however, mess up my sleep schedule! On my days off, as long as I have a couple in a row off, I "flip back" to a normal nocturnal sleep pattern so that I can spend time with my family (which includes a 2 and 4 year old who are all about their Mommy). Prior to going back for a night shift the next day, I will stay up as late as possible, still sleep all night, and get in a nap prior to my night shift. I then am back in nocturnal mode. With the way that I sleep, it is more like being a "rotating" sleep pattern (very much like what nurses must have to do when they have rotating shifts). What I dislike about nights is getting off of work and being totally wide awake. Unless I am dead tired, I want to watch T.V., eat some food, basically chill out for an hour or two before heading off to bed. I have had some mornings, though, where sleep will not come. Come to think of it, those rare mornings where I cannot go to sleep are when I have alot running through my mind (don't you hate that? I do!). Question: Does anyone have any input as to how to "slow" one's thinking down to go to sleep? What works for you? I also feel that my habits are not the best food wise: I love caffeine. I drink Mountain Dew (which does not work anymore) and coffee (which I love downing a big cup because I can feel the caffeine in my system!). I do not get in as much water as I should to adequately hydrate. I also eat whatever I want while watching portions although I do need to drop some pounds. However, a girl needs more than greens and rice cakes to have the calories for nursing! Another question: For night shifters: Do you have a workout regimen that works for you? Also: What foods do you eat at work that keeps your weight where you want it to be?

You cannot be serious. You never, ever date a patient. You are a nursing professional. You must carry yourself as one at all times. I would have to say the same about dating a fellow nurse. If they are above you in the chain of command, that is a big NO. If they are not, and things do not work out, you have to continue to see and work with this person. I have to say this because no one else is: You aren't wanting to be a nurse (or work in that environment) as a way of meeting people, are you? If so, you are pursuing nursing for a very wrong reason. Nursing is not at all like the television shows where nurses and doctors are having sex with eachother in supply closets, everyone hooking up with everyone. This makes for fine television but is not reality in any way.

I feel that it is simply about respecting all individuals on the team and helping eachother out. I have encountered some CNAs that have been on the floor doing patient care longer than I have been a RN (this month makes 2 years for me). I verbalize the respect that I have for them, and tell them that I will learn from them just like they may learn from me. They seem to really like that. I also do not abandon my patients in times of need. For example, if you have someone who needs to use the bathroom, and your CNA is busy with another patient, put the patient onto the toilet. If they are a major fall risk, stay with the patient, of course. If not, tell the CNA that the patient is on the toilet and to take them off whenever they get the chance. Patient care and safety is always the priority. One must be able to delegate though. It is all about reaching a happy medium. A RN is a supervisor of sorts: You do not want to come off to hard (too strict) or too soft (which can be interpreted for weakness). Your goal is to achieve a happy medium of both so that you are approachable yet firm with your work expectations. Praise all of your peers for their accomplishments, especially the CNAs. I have met alot of hard working CNAs. Let's face it: They work hard for what little money that they do get. They can be knowledgeable and caring professionals, and should be treated as such. For those CNAs who absolutely insist on giving you a hard time, hold them accountable. Pull them aside and assess what the issue may be. Verbalize your expectations for behavior. Also verbalize that if certain behaviors do not change, you will pursue a written method of holding them accountable, following up with the charge nurse and/or maybe the nurse manager. It is true: Whenever you start anywhere as a nurse, you will be tested: Your fellow nurses watch your nursing practice while determining if they can trust you; the CNAs are doing the same thing. Some of the CNAs also see how much work they may be able to avoid as well. As long as a nurse is respectful yet firm, things should be a fine as they can be in what I affectionately call the "Controlled Chaos" of the floor in the hospital.

@redhead: I loved Bad Teacher! It was so funny!

Most, if not all, nurses have experienced passive aggressiveness because we work in a predominant female oriented specialty. Most women do not like any confrontation. Instead, they gossip, are passive aggressive, etc. Yes, I myself have had people simply not like me. I have had a few decide that I wasn't a "good" nurse which caused their clique to adopt the same opinion of me. I was a new grad out of school when I had to endure being asked what my normal lab values were in report (which I was on my own at the time), had people condemn me to my peers and management for not being able to stage a wound (although I could describe it well, and did so in report), etc. Real quick, I had to grow a thick skin. I used to get mad about how certain people treated me at work. There were a couple of times that I pulled people aside to ask what I could do better, some of the same people who did talk behind my back, who would say nothing to me. I was given no constructive feedback. The majority of the nurses, if not all, that I worked alongside with enjoyed working with me. I have always been safe with my patient care..and detailed. The conflict that I had at my first job was with some of the nurses on the opposite shift as me. They just did not like me and never did me the service or kindness of being any sort of mentor or supporter of myself. So, yes, I have endured passive aggressive nurses. However, I have always went to work knowing that my patients are the priority. If I am not popular, per se, or liked by everyone (almost impossible in most cases), I can deal with that. Why or How? Those passive aggressive nurses made me just that much stronger. I hold my own as a nurse much better than I did in the beginning. I directly speak my mind regardless of whether someone will like what I have to say (although I have decided to be much wiser in choosing my battles). I know that I am a very good nurse and have a safe, effective nursing practice: I have seen so many of my patients get better, have received many hugs and compliments from them and even my nursing colleagues. Essentially, you take a negative and turn it into a positive.

I am not sure what to think about this. On one hand: you know your vitals and if they need to be followed up on. There have been instances in the past where the NA did not tell me if a b/p was too high (although they always told me when someone was too low...strange, huh?). You could always slap on the AUTO b/p cuff in the room while you are doing a quick assessment. This is much easier, of course, if you have equipement readily available. However, if there are a limited number of vitals machines....... Then it will not be efficient and work well. With limited vitals machines, a CNA would be most efficient at going from room to room to take vitals. You see how equipment availability plays a role in this. One lesson that I have learned: Choose your battles. After a certain amount of time, if you and your nursing colleagues feel that this is not working, bring it up as a group at the next meeting. Change may or may not happen. Either way, continue to deliver the best care that you can at the patient's bedside.

@Commuter: You did the right thing, not doubt about it. With a patient who was that "out of it" after having been given multiple pain meds, it would not have been wise to give addition pain medication. As far as upper management is concerned, I realize that these scores are the equivalent of money which the hospital receives. It also determines if the patients will return to the hospital for care. Yes, money is important or hospitals would be closing down from being in the negative. Thankfully, as nurses, we simply deliver care at the bedside: we are not accountants. The two jobs are different: The "higher management" look at numbers, figures, etc. and nursing strives to deliver exceptional care despite the patient's means (no matter if they are insured or not because it would be unethical to do otherwise). No one can fault you for good, solid nursing judgement. However, if patient harm is caused from a lack of good nursing judgement, you know as well as I do that nurses are held accountable. Bottomline: I would say to take care of your patients with both you knowledge and gut instinct. Your management cannot fault you for looking out for the best interest of your patients, keeping them safe.

If you feel like your younger colleague treats you differently, simply pull her aside and ask why you perceive tension between the two of you. There may very well be an issue that exists. You will not know until you do her the courtesy, and pay her the respect as a nursing colleague, to ask what is bothering her. After assessing the situation for what it is, you may or may not be able to fix it. It could be that your personalities clash which cannot be fixed. However, you are expected to behave as a health professional at work. You must execute your nursing duties in the most objective way possible because the care that you give at the bedside depends on it. One last thing: Out of all respect for you as a human being, I have not seen you own up to anything in all of these posts...still. Despite how other people give you advice meant to empower you, you still want to play the role of the "victim", casting fault on everyone around you but yourself. All that I am saying is to assess yourself, make changes to yourself, because that is what you have control over. Take responsibility for yourself and your actions. It is only then that you will be truly empowered.