dankimal

Heya! i can empathize with you. Accept that for the short term, your eyes are not going to pick up on subtleties an nuances. Therefore, I would do your assessment as near you can, report what you think you seeing, and then ask your preceptor what they’re thinking and seeing. when you’re first starting out, it will be difficult to hone in on the cluster of signs that are really important. the fear of ‘missing something’ may cause you to OVER-assess inconsequential details. Keep it simple, keep it safe. best of luck!!

Hey all, I’m investigating care giver response in the acute phase of high stress situations, specifically, the observed “freeze” response. Imagine, if you will, a nurse walks into the room of a just bedded patient in a busy ER and finds the patient apneic and blue. The chief complaint was benign, and triage gave no indication that the patient had a critical illness. The immediate emotional response of shock and surprise gives way quickly to action... the nurse yells for help, activates the code and begins assessing... but in her head, although she’s seasoned and trained, it’s a frozen jumble. Do you know this nurse? ARE you this nurse? I want to hear all about it. thanks!

Hey All! The nurses union that represents my hospital has called for a strike. Without getting into the gory and messy details, I was just wondering what people’s experiences with strikes have been? Thanks in advance!

I believe that a fluid restriction of that nature would require a physicians order.

Hello all: In my practice I have encountered several instances of objectively addicted pts being prescribed massive amounts of narcotic medications. May I make it clear that these are not pts with low pain tolerances, these are confessed addicts with telltale signs and symptoms of narcotic addiction. They will manipulate, exaggerate symptoms, fabricate symptoms, and will go to great lengths to have more meds. My question/comment is this: After all physical causes of pain are ruled out, isn't it simply enabling to allow this population to remain admitted with increasing amounts of pain meds to satisfy ever increasing self reports of pain? Perhaps our mantra of "pain is whatever the pt says it is" should be modified to "pain is whatever the pt says it is until objective signs prove pt reports of pain to be unreasonable."?

Are you perchance a Humboldt State Grad? HSU represent!

While I don't feel like a licensed drug pusher, I do sometimes feel that all I do is run around throwing rx at people.

I must admit, I love the computer throwing emoticon.

Hello All: I've been flexed off the past few shifts, so I've had a great deal of time to browse the discussion forums on this sight. The discourse has often been heated and I've noticed that so much of the space is taken by posters who are angry, frustrated, disillusioned... "burnt out." So my aim and question is this: What problems do you see in the health care delivery systems you practice in? What can be changed? How can we change the environment and culture so that quality health care is accessible to all? How can we as nurses ensure that our working hours are uplifting to our patients as well as to our co-workers and ourselves? May we have civil, thoughtful discussion that avoids over-simplification. Happy posting. Daniel

In my neck of the woods we get a ton and a half of cocci pneumonia.

Not sure if anyone has seen this, but I read in AJN a few years back (I believe in 2008) that a OH hospital was piloting a system that allowed for RN working nights to sleep in the on call room prn using a similar "buddy system" already mentioned.

I have though about ICU, and I have seriously considered it. But part of me (perhaps the "grass is greener syndrome") is looking outside of acute care altogether and leaning more towards primary care. My nursing program kinda shortchanged me a bit in that arena, but we were in a rural area with little clinical space, so I am looking at shadowing opportunities at local clinics and seeing if that's a better fit. Regarding home care, it sounds like a dream come true, but before I am eligible for most positions I would need a few more years in the hospital. So we'll see. My year review is coming up and my DON is fantastic. I feel completely comfortable bringing this up with her.

Thanks, everyone. I know it will get better, and relative to my first few months (see my previous posts) I am doing much better on the floor. And I have no regrets regarding the invaluable experience med/surg had given me, and to missladyrn, I have often wondered how anyone could handle more than five! My hat's off to you! Cheers to you all!

Hello All: I am a relatively new nurse (practicing 8 months). At the time I started my first job, I entered with the excitement and enthusiasm that accompanies most new endeavors. Although nervous and extremely stressed, I persevered through my first few months with few incidents. But I find myself consistently plagued by a sense of dread. This feeling that I am missing something. During my shift, the tasks seem overwhelming. Tasks.... Even with CA fantastic 5 pt ratio, the needs of my patients can be too much for me to hold. I wish I could pull up a chair, converse with my clients... be in an environment that isn't wound up so tight at the hilt... anyone get my drift? Perhaps Med/Surg just isn't my niche. I have considered searching out opportunities outside the hospital. Perhaps home health, primary care, or even pursuing an advanced practice degree. I know this post is a bit dis-jointed. And maybe it's just the rain outside talking. But I'm desperately afraid that someday, all the little things that I've missed because I've felt so under the gun are going to come crashing down. I don't want to be that nurse. Anyway, any thoughts are appreciated. It's good therapy for us all. Cheers.

I'm a new nurse, 6 months on the job so far and have made two, count 'em two med errors. Both were relatively minor, and I will spare all the grusome details, but what I have learned is this: 1.) Always check your orders 2.) Always check IV rates What has saved me in both instances is the fact that I did not try to cover anything up. Once the error is discovered, instantly report it to all necessary parties. It really is the difference between mercy and wrath. People will forgive an honest mistake that is honestly rectified... people will not forgive one who tries to cover up an error, and nor should they. We are human. We will make mistakes. But we own up to it and prevent as best we can any harm from befalling those in our care who have given us their trust. Luckily for me, my institution has installed mobile computers on wheels with attached scanners which prevent a lot of errors from happening provided that one always scans, which I do, religiously. In addition, I am always checking orders, checking the unit dosage, the route, time, patient and rx. Keep it up!

where I work, the pharmacy has specialized tubing for platelets with a nifty one way vent on the collection chamber that makes priming quick and easy.

Fortunately, so far I have been spared the grossest of the gross, so I will offer the best I have and tell a tale from nursing school: I was taking my Human Anatomy class as a pre-requisite for entering the BSN program at my school. I was in the lab studying overtime for the upcoming lab practical. My lab partner and I were working our way through the cadaver, locating and identifying various nerves, vessels, muscles, etc., making good progress. Now, for those of you who don't know, our cadavers were stored in a contraption that resembled a stainless steel pit barbecue filled with a formaldehyde and formalin "soup." You would crank the handle on the outside of the tank, open the top, and the cadaver would emerge from the preservative. The "soup" was this purplish, red-cabbage color that smelled like latex and something awful, and had a fine colloid of proteins and other dissolved body tissues. So as I was working away, I lifted off the thoracic organs to expose the anterior portion of the thoracic spine so we could locate the sympathetic chain ganglion. "Soup" had collected at the bottom of the cadavers chest cavity in a neat little puddle. In the middle of that puddle, was a red piece of yarn that was tied around a structure we were to identify. Without thinking, I took my gloved hand to move the yarn, flicked it out of the way of the nerve we were examining, and saw, in seeming slow motion, a splash and splatter of soup arc through the air towards my face. Before I could react, I felt a distinct moisture on my mouth and lips... I froze... My lab partner asked what was wrong... I replied in a panic, "I think I just drank some of the soup!" It tasted awful. Like latex and poo.

Had a 40 yo male admitted to the ED after having just been side swiped by a car going 60mph. The dude had a L wrist fx, L open tib-fib fx and of course several bumps and bruises, but otherwise looked pretty good for having just been hit by a car. Anyway, after we got him really stoned on morphine, I was asking him how he was feeling, doing an assessment when he with a thick morphine-drawl slurrs, "Oh man... I don't think I'm going to make it to church tomorrow... shoot... oh well... I guess they'll understand..."

I graduated nursing school 5/16/2010, began my first job on 6/21/2010

My time management skills are poor, but after re-reading "From Novice to Expert" by Benner, I think what is more the issue for me is my prioritization. I found this quote yesterday from the above mentioned book which describes perfectly what's going on: "New Nurse: In nursing school, you have very few patients. And then I come on here and I still have few patients, but I didn't realize all the lifting and time it took because I'd want to get... I don't know... I'd come here and I'd get all my sheets out and go pass them around and then somebody would want a glass of water and I used to just run, jump anytime a patient said anything. And that would totally disorganize me... If you saw me in the beginning, you would see me making a hundred trips up and down he hall with a very frustrated look on my face, almost in tears and never really accomplishing much of anything. You would probably have to give me a lot of help. You would be watching somebody give me a lot of help..." I know it will get better, and I have been granted a lot of grace, I go back to work this weekend, and I only hope to do better this time. From what I have been told, almost every nurse experiences this phenomenon at first, and my directors are confident that I will succeed. I just pray that all will be well for my patients.

Hello all, I'm a new graduate nurse, RN BSN, graduated in May, hired in June, working Med/Surg up until now. To be frank, I feel like a failure. My senior year preceptorship went great, and I had thought that I would be up to the challenge of working that I knew was coming. But like I heard a Army private say upon his first deployment to Iraq, [despite all the training and preparation] "there is really nothing that can prepare you for this." I feel like I am fumbling, bumbling, and one move away from disaster all day long. Everyone on my floor has been supportive and helpful, but their frustration is growing, and I right now just can't do it all. May the Lord help me, because I am breaking.