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.

@Esme12: No worries. I apologize if I came off snippity. I realize that what I have written in inappropriate, really, for this thread. However, I was stating my position on nursing which does differ somewhat from CapeCodMermaid's. I did not know what LTAC was until I read this thread. I am glad to have stumbled across it. I did not know that such places existed outside of the hospital. Ok: Now I will stop posting on this thread! I did not want to leave you hanging, Esme12!

I have learned the hard way, through experience, that it is a mistake to move between one job to the next related to common issues in nursing: unreasonable ratios, not enough clinical support, etc. The common problems found in all nursing jobs will not change from job to job. Instead of leaving your current job, verbalize your concerns to your preceptor and, if need be, your nurse manager. They may have good advice, and support, to give you. I can pretty much tell you that the grass is not greener on the other side. There is no such thing as the perfect nursing job. Make the most out of the job that you currently have, doing the best you can with time management and patient care. In your daily tasks, always put safety first. Slow down when passing your meds, know why you are giving them and if they are still appropriate to the patient's condition. Do nursing procedures right the first time. Round on your patients the best that you can, checking in with your NAs to ensure that they have seen nothing out of the ordinary. Hospital nursing on the floor is really a team effort. No one really accomplishes anything on their own. With the stress of your work environment, give praise to the nurses and nurse assistants around you who help make the day go a bit better, who really make a difference in patient care. Ultimately, take care of eachother. Of the jobs that I have had, the one thing that I value most is the camraderie and support of my nursing peers. Work becomes like a second home. Your fellow nurses are your family. When you need to vent, do so with a nursing buddy (a close friend). Have a life outside of work. I hope that this helps. Give your current job more time. There is alot of change going on for you at work. Make the best out of what you have to work with. That is all that you can do.

Do you have additional work experience on your resume? I have read some articles that say not to bother putting down a place of employment of short duration. If you were to leave it off of your official resume, I would definitely be honest with HR and the nurse manager who you would be interviewing with. This is why: They do thorough background checks and confirm prior places of employment. When they look into your history, prior jobs do show up. If you were not to mention your short employment, it would give the hiring people cause to wonder why you would withheld this informaiton--they would wonder if you had something to hide, would contemplate what happened. As someone who has had a couple of jobs in the past couple of years, I always mention prior places of employment so that any trust is maintained between myself and those interviewing me.

I have read over your posts. What I am about to say is to help you, not hurt you. Quit thinking like a victim. You are in control of how you respond to your environment. I agree with everyone else who said that you should not be concerned with receiving birthday presents or having your name put up on a bulletin board. When you are at work, you are there to care for the patients. If you make a friend, that is great. However, you are there to care for people, not socialize. Yes, people do socialize at the nurse's station. There are cliques. This is with any job. I also agree that I would by pretty annoyed to have to explain myself to a charge nurse about why I did not see "so and so" a birthday present or put a kudo up on a bulletin board about her. This took her away from running the floor or from patient care. Yes, that would be annoying. I would be willing to bet that you did not even pull this individual aside to tell her your concerns/thoughts. Instead, you went over her head to management. That is not going to win anyone over. I believe in karma. My intent is not to being negative or mean. You became a nurse to help people, right? Well, quit worrying about the presents that you do not get or the recognition that you also fail to get. It is not about that. Your goal is to help make your patients better, to keep them safe. That, in itself, is your reward. The way I look at it, I want my patients to confirm that the care that I am giving them meets their standards. That is when you know that you are doing your job well.

@Esme12: I was responding to a post from CapeCodMermaid. I realized a couple posts back that LTAC is totally different from LTC. I even said this as well a couple posts back. I do not see you "scolding" CapeCodMermaid about posting about LTC. I do not plan on posting anything else on this thread.

I acknowledge that passive aggressive personalities exist in nursing. In contrast, I pull people aside, communicate, and determine if a compromise can be made. People respect directness that is respectful in tone and approach.

@CapeCodMermaid: I understand why what I wrote must have put you in a "defensive" mode. What I wrote was not meant to be hurtful towards any of the nurses that do LTC. It is, however, my objective experience. Although I apologize for offending you, or any other proud LTC nurses, it is my experience. As far as what you said: "And there wasn't much need for most nurses there (at the hospital) to think at all since the place was crawling with doctors. In LTC, it's you and your fellow nurses, and most of us have highly developed critical thinking skills." If you had invested any significant amount of time in a hospital on the floor, you would realize that it is the bedside nurse, not so much the doctors, that know about the patients. The nurse is asked by the physician specific questions about the patients under her care in order for the best care to be given. Doctors are simply not there enough. They may spend a couple minutes (if that) with the patient while the nurse is there the whole 12 hours. Hospital nurses deal with unstable patients: that is why they are in the hospital in the first place: for both monitoring and treatment. If they were not predisposed to a decline in health status, they would not be inpatients in the first place. The hospital nurse collaborates with the physicians to address any aspect of the patient's care. In a nutshell, hospital nurses always "have a need to think" because people's lives can depend on it. In contrast, LTC nurses can help or harm with their nursing practice as well. However, as we both know, LTC is not at all like the hospital. I already summed up most of my thoughts on my experience in LTC. I still stand by my position that a new grad needs to develop critical thinking which is achieved by learning what "normals" and "abnormals" are regarding their assessments. Yes, in LTC, a nurse cares for more people. This is the residents' home. They are stable. However, when their health status changes for the worse, it is the nurse's job to assess, and inform, the PCP of these changes. This was not happening at that facility. I cared for all of the residents under my charge with the standards of care learned in the hospital setting. Also: They do not orient in the LTC like they do in the hospital. A new grad gets two weeks. An experienced nurse may get a day up to one week of orientation. In the hospital, a new grad gets up to 3 months training on the floor in addition to class training. An experienced nurse orients for a month. I can only speak according to my experience. It was quite the eye opener. I shall leave it at that in an effort to keep what I am writing classy and not disrespectful. What you said in your post was not objective: it was (is) your subjective opinion on hospital nurses. In contrast, my post was an objective post about LTC nursing. I did not even delve into half of what I saw (or heard) which was incongruent with safe nursing practice. With unsafe nursing practices, I stopped care at the bedside to protect the resident. With those many instances that were brought to my attention by another nurse, I told them to follow up first with the nurse and then management if necessary; otherwise, they would be just as guilty as the nurse who put their residents at risk by not following established nursing protocols (example: a nurse suctioning a trach with a dirty suction kit which had been stored in the resident's night stand or allowing the new grad to open the red container with sputum from the lower respiratory tract (from suctioning), emptying it at a sink or commode, because another LTC nurse told her that this was acceptable: putting herself and other people at risk of inhaling the contents). I can keep going but believe that I have made my point. Like you, I am entitled to my opinion. I have respectfully stated it. I stand by my position. I respect your opinion even though I may not agree with you.

I would say that you should remain at your job. A little background: I am a RN who had both children while in school. I had my daughter halfway through school (two years into my BSN) and my son a week before graduation (my senior year). Having children is an expensive endeavor. You will need the extra income for formula, diapers, wipes, clothes, baby accessories, etc (the list goes on). The only exception to this is: If you feel that your significant other's income is more than adequate to keep you and your family comfortable, you can afford to postpone work for a bit until you feel the time is right. There are many nurses who choose to have children, and continue to work all the way up to just prior to the baby's delivery. You must follow up with your OB/GYN on a regular basis to monitor your health as well as that of your baby's. I can attest that I did this. I worked while pregnant, and took breaks to hydrate and eat. It can be done. I wish you the best of luck! Congrats on the baby and new job! :w00t:

@Brandon: Thanks for the clarification! I totally thought this post was about LTC. Oh well. Anyone who was wondering about LTC: Maybe my post will be of some help to them. Who knows!

In my experience, that is how call is done: You are cancelled for the first 8 and on call for the last 4 hours of what was your scheduled shift. There is no financial compensation unless you use your ETO. You are also given a choice as well: you do not have to accept the cancellation. If you answer no, the charge nurse calls another nurse on a list that they go by. The nurses that I used to work with called the charge nurse the Cancel Fairy, a warm term of endearment. Many people, including myself, enjoyed getting those calls. I had ETO to burn so I would just substitute those for my hours. Sad to say: with two little ones, I have not been out of town on a real vacay in like 6 years! I am overdue, I know! Anyway, I hope that this helps!