kmmRN,BSN

I also try to ask general questions first, checking orientation, pain assessment, nausea, etc. It helps me to know where to focus my assessment, and then if I forget anything, I will ask at the end of the assessment

I understand your POV, however, I still stand by my belief that the patient is the customer. They are a person that we are doing work for, regardless of how they pay, insurance, selfpay, etc. I never ever let a patient tell me what to do, however, as I am the nurse and ultimately know the correct way of doing nursing care (just as I wouldn't tell my repairman how to fix my wash machine). I do, however, welcome patients to question the care that I and my coworkers perform, and I fully explain all tasks, and give choices to the patient (when options are acceptable)

I feel that the patient is definitely a "customer" of the hospital, they are paying the hospital to provide medical service. With that being said, there are also rules that must be followed, no matter what. When you are a customer in a store or restaurant, it is just the same. You can't order something not on the menu, you can't smoke somewhere that is a no smoking establishment, you can't tell a cashier that you only want to pay $2 for milk when it costs $3, that is because every establishment has rules that must be followed or they would ultimately end up going under for some reason or another. The patient is still a customer! We are working for them! I tell my patients when I admit them, that we are there working for them to get them well again, and with that they have the right to question any treatment or plan of care that they are concerned about. Yeah, it might just set us up for a billion questions, but, after reading a different post about some of the horrendous things nurses and docs have done to patients, I don't think it hurts for our patients, or customers, to question things we do.

Head-to-toe: start at the top and work your way down; makes doing your assessment quick and easy. :)

Nursing school is definitely time consuming and demanding, however, make sure that you make time for yourself. I went to a very competitive BSN program at my state university, and I still managed to work at the hospital 3-11 as a tech, I was very active in my social sorority, belonged to the nursing organization on campus, and still found time to spend with my boyfriend who went to college in a different town 3 hours away. I may not have been at the very top of my class, however, I still worked hard and graduated with a 3.6 and honors. I also got a great job that I had lined up before graduation. I guess it is all how you prioritize. Yes, I probably could have graduated with a 4.0, as some of my classmates, however, when I look back on it, I'm happy I did things the way that I did. I would rather be able to relax and spend time with friends and family, rather then all of my time studying and my head buried in a nursing book, like most of my classmates. I'm glad that I didn't let nursing school ruin my college experience. I have been working as an RN for about 16 months now, and I definitely feel confident in my abilities, and if I don't know something I ask. You are not gonna learn everything that you need to know in nursing school. A LOT will be learned when you are in the field. I hope this helps :)

I wouldn't look for a new job at this point, however, I would definitely sit down with your manager and discuss some major issues that seem to be occuring on the floor. Ask your manager what exactly the charge nurse is expected to do on your floor. I work night shift on a busy med surg floor, and without the charge nurse, I would be drowning most nights as well. On our floor, the charge nurse does not take patients, and her role is to complete all of the admissions and take care of the post-ops when they first get to the floor. She is also expected to help out the nurses as much as possible. Not having to do the admissions is a huge life saver for me, as they can take a huge chunk of time out of your shift. If I am really busy, I will ask the charge to do a med pass for me, hang more IV fluids, start a new IV, etc. However, when you do utilize the charge, remember that she is there to help everyone, not just you, so do as much as you can, but when you need help, be certain to ask! I think you also need to discuss with your manager the obvious safety/infection issues going on. A nurses using the same flush on all her patient?! Not assessing patient properly? You need to tell your manager about these things! I know that you probably don't want to get any of your coworkers in trouble, however, as a nurse, you are the patient advocate, and if you know that there are things going on that could be harmful to the patient, you can't just ignore the fact, it has to be brought to the attention of the manager, so this can be resolved. To help with your time management, there are a few things -Most definitely give report as soon as possible, and then finish up your loose ends. And get rid of that phone/pager ASAP! haha, if you don't have it then you can't be interrupted when you are trying to finish charting. If i still have some charting to do at the end of my shift, I give report to the nurse coming on shift (don't be afraid to bug them about starting report, they need to be there and ready to work at a certain time, and once that time hits, report should begin. some of our nurses like to look everything up before you give report, drives me crazy), and then as soon as I give report I get rid of my phone, and go into a quiet area and finish my charting. I don't know if you guys use computer charting and charting by exception, but that is what we do. With charting by exception, you can mark WDL(within defined, or normal, limits) for each system, and only do detailed charting on those that are not. Some of the nurses I work with do a detailed documentation on every body system! I don't know how they can get everything done this way, but I guess they manage. This might seem like it is cutting corners in documenting, but its not, its simply charting by exception. Then, when we reassess, we simply mark no change, if everything is the same, or document on those systems that have improved or worsened. -Marking times down for when meds and tasks are due is also important, that way you can see the big picture from the start of your shift, and can try to clump things together as much as possible when you are in the room. -We also do bedside report at our facility, which is actually super helpful, bc you can meet all your patients right away, and do a quick assessment when you are in the room -I also try to go over the plan for the shift with each patient at the beginning after I have all my times marked down, that way they know what to expect for the next 12 hours. I can answer questions at that time, and do some quick education if needed. This cuts down a lot on questions throughout the shift from my patient. -Make sure to utilize your tech. Our techs do vitals, I&Os, remove foleys/IVs, and do other basic patient care. If these are the same tasks for your techs, then ask them to do these things, that is what they are there for -I would definitely try to chart as you go as much as possible, and be sure to write down everything that you are planning on charting later so you dont forget anything, or have to try to remember things later Sounds like you are doing as best you can for the situation you are in, 7 patients on day shift, wow! I work nights, and we max out at 6 per nurse! Good luck with everything!

I have been working as an RN for a couple years now and I plan to go back to NP school in the next couple years, however, before I even began nursing school, I had the same plans as you, not stop until I reach the end. After my first semester of nursing school my plans quickly changed. Nursing school can be very time consuming, and by the time I completed my BSN program and got my RN liscense, I welcomed to opportunity to take a break and work in the "real world" for a few years. There is so much more that you will learn once you are working as an RN, and to be able to apply so much more of what you learned in the classroom will definitely make confusing concepts much more understandable. There just simply isnt enough clinical time in nursing school. Im so happy I decided to wait it out, rather than try to go all the way through. There is so much more that I have learned since nursing school that I probably never would have fully grasped unless I worked for a few years.

It's the same at my hospital, we have a group of hospitalists, however, they are not working in the hospital 24/7. Our group of hospitalists work for the hospital, meaning they are always there during the daytime and care for patients who do not have a physician, as well as the patient's whose doctors choose to sign their patients over to the hospitalist to care for when admitted to the hospital. It seems that hospitalists can function in many different roles, depending on the facility in which you work. It is probably best for you to talk to your nurse manager to get a clear understanding of the hospitalist role where you work.

I would have done the exact same thing. I don't know why any nurse would try to give a medication through an IV site that has gone bad (which is what this clearly sounds like) just to get the medication passed. And, It wasn't like you didn't take care of the problem, as you had already rescheduled the antibiotics and the patient was in the process of getting a PICC line. You did what you could with the situation. Especially if the patient was symptomatic from the low hemoglobin, giving the blood would have been my priority too. It almost sounds as if this nurse was upset that you were "passing on" some of your work to her/him. Our manager always stresses to us that there is only so much you can get completed in your shift, and there will be times that you will have to pass on some of the work to the next shift, as there are bound to be times when others will have to pass on some work to you. Yes, it can add a little stress, however, this is what teamwork is about, and if you can't be a team player, then I don't know how you can survive in nursing. I think you did exactly what you should have done in this situation. And shame on that other nurse for questioning you about why you didn't give the medication through a bad IV