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sleepdeprived1's Latest Activity

  1. sleepdeprived1

    struggling with med surg expectations

    Thanks Esme..if given another chance I will use these..I was sent home today and told that this unit was not the right fit for me and that I wasnt making enough progress yesterday i had 4 patients and struggled some and then got an admission which i still struggle thru the computer admission process.and trying to remember my other pts. i still have my preceptor had me go to first patient room in morning administer all meds for time do am assessment and do all am charting on these in room then go to pt. 2 and do same and so on...well by the time i get to patient 4 its a little late and then expected to go to patient discharge meeting which im forever late for or miss..sounds easy but maybe still a bit slow with charting entire am shift assessment...thought itd be better just administering meds doing am assessment noting abnormals to chart..after all meds in on time then going back to chart but then id prob. be behind too ..oh well..in the process of finding right fit for me..obviously 15days med surg training wasnt enough or too chaotic for me
  2. I could really use some urgent career advice. I graduated winter 2011 from nursing school. My first nursing job was inpatient psych (I loved mental health and still do). I worked there for a year before deciding to look for something in the medical field (I wanted to branch out and develop my medical skills). After interviewing and obtaining position on med-surg unit in hospital I gave notice to employer and thought how much happier I would be working med surg acute care and developing more critical thinking/acute medical skills. I have been working on busy med surg floor (what med surg floor isn't busy?) and yesterday was my 15th day training on the unit. I have been struggling with prioritization, and time management and also development of skills (I am terrible at starting ivs..) Yesterday i worked 12 and half hours straight with no break at all-im really trying..theres just so much charting and soo much to do and keep up with. I dont want to quit and want to keep trying BUT My manager talked to me 2weeks ago and warned me I wasn't making enough progress and that I needed to be able to care for 4 patients + to get me up to speed. This past week I have been trying my hardest but I struggle still with more than 3 patients. Yesterday I had 4 plus an admission which put me behind and required my preceptor to jump in to provide the cares to my other pts. Anyways...this morning I went in and after getting report my manager told me this wasn't the right fit for me and that I wasn't making enough progress to keep me on unit-she sent me home and told me she would assist me in finding another position within organization. The problem I am having is this: If med surg isn't for me, what is? What would be a step down from med surg? I am basically interested in ALL areas of nursing (I love interacting with my patients). There are some positions open: ENT clinic (what would I be doing?), urgent care clinic, family practice clinic, GI clinic, Internal Medicine clinic, Procedural derm clinic, pain mgmt clinic....IDK what one would be the best fit and if im struggling with more than 3 patients on med surg with multiple things going on and admits which one of these areas would suit me...any nurses in these areas or with prior experience please advise me...I don't want to make the wrong career choice. Any advice would be greatly appreciated!
  3. sleepdeprived1

    struggling with med surg expectations

    Well tomorrow will determine the fate of my future with this company..meeting with the NM after/during work to see what she thinks of my progress thus far..I am a firm believer of strong orientation process to the unit-I think its safer for the patients too. my #1 priority is patient safety and should be theirs too..im not a turtle but im not gonna hustle and bustle through skills ive never done...without making sure safe practice first..i think im getting there..my patients seem to like me and really enjoy providing bedside care..from the time i get on the floor to the time i leave i am 100% focused on my patients and keeping busy,not much for gossip at the nursing station...but it doesnt matter what anyone thinks..my NM will tell me my fate tomorrow so far she has acted like im invisible maybe thats good?
  4. sleepdeprived1

    struggling with med surg expectations

    Thanks for the words of encouragement and feedback! Hopefully the hospital will continue to work with me to develop my skills/training because I know with my time I can be successful as all of us newbies can especially transferring into a new department. I know the hospital needs to stay within a budget, but I would think it would be cheaper for them to fully train their already retained staff, then to have higher turnover and to have to continuously start over with new employees.
  5. sleepdeprived1

    struggling with med surg expectations

    I recently transitioned from psych inpatient nursing to med surg. I quit my job in psych - working there for a year as a new nurse. I didn't want to lose my nursing skills and wanted to be involved in more acute medical care nursing. I applied and got hired on a busy medical surgical unit of hospital and although this is my fifth week of orientation, I have only had 10 days on the actual unit. The other days were for trainining,equipment,and computer classes... I feel that I am doing my best to improve and catch on quickly (it does take me a little longer to learn things , im not a "see one, do one, teach one" type of person and I don't feel that is safe practice anyways. Well, my last week of 3 days training were kind of "rough" and did review at home iv pumps, computer charting, etc..this week when I came back to work I felt my confidence was up more at ease, although I guess I still appear nervous to others. I have been given 3 patients to care for and I am still falling behind. It seems like multiple issues keep me distracted and have been late on administering medications today. My NM called me in her office and spoke to me about how she feels that maybe this is not the right fit for me..etc..bottom line is it sounds like I am going to be fired UNLESS i can prove that I can take care of 4 patients next week without issue. I just feel that 10 days into orientation is so short with such high expectations. I am NOT one to give up and I continuously strive to manage my time better and prioritze. I am scared for next week. I need to be able to take care of 4 patients without issues or late med administration. I understand NM perspective but really had to hold back tears and choke it up to finish my shift. I was hurt to hear that other staff had "concerns" on if I would make it. I don't feel like I am getting enough feedback until now -that it seems too late. I was also given a "checklist" for orientation with weekly reports on my progress. I have yet to see a written eval or check off on anything. It is basically sink or swim. and I have been sinking. I feel that they think I am "sinking" because I ask a lot of questions. If I have not done a skill since clinical and/or only read in textbook I want to ensure safe practice and barely feel like 10 days is sufficient for me to practice as RN on unit. While I am hurt that others (not only nurses supposedly) are saying im less than adequate I am also saddened that I quit my previous job and will probably be fired next week unless i can care for 4 patients on my own without any issues. I just don't understand how healthcare is safe anymore with this mentality/demand on nurses. It is expected that I will be off orientation in 2 more weeks. (6more days, which would give me a total of 16 days orientation on a busy med surg floor-is this typical???-in psych i had 30+ days...)
  6. sleepdeprived1

    Safe staffing levels

    Census on adult/gero unit "full" is 18-22 and if we have 16 or less patients only get 1 tech with myself. Sometimes its a busy week with high acuity patients and census over 18+ and supposed to get 2 techs but it doesn't always happen. Mgmt. doesn't lose any sleep over me running around like chicken little like the sky is falling they don't seem too bothered if there are high acuity patients, falls, agitated patients, 1:1 monitoring orders, gero's confused, fragile, admissions with just me and 1 cna...well maybe they do care but they don't show it or show appreciation to their employees.
  7. Okay. So for the past year I have been working as a psychiatric nurse at private psych hospital (new grad, first RN job). I recently decided I needed to get out of psych to keep up my skills as RN including critical thinking skills ..and current employment has VERY limited medical treatment (no IV's, caths, ports, transfusions, ...) so I applied for medical hospital on oncology unit And I got hired!!!!! I am excited but now I am getting TERRIFIED!! I want to know what are the 3 most important areas to review for oncology nursing. I feel I have the compassion, patience, hardworking-always willing to help out other staff members going for me, (and some basic level of nursing knowledge) BUT I am worried I will look like an idiot my first day, since @my psych nursing job I didn't need to perform hardly any medical skills. I want to know SPECIFIC areas to focus on before my first day of training on the unit so no one thinks I am an idiot! Any oncology nurses-maybe who have acted as preceptors to new RN's to unit and found areas you expect them to know? Please let me know.
  8. sleepdeprived1

    doctors repeated rudeness..trouble coping

    RECENT UPDATE: This Doc who gives me a hard time had another nurse speak to me and tell me I was "calling him too much" I could NOT believe it! I NEVER page for meaningless crap. EVER I am VERY mindful for what I page for..and since I last posted this he was on call and covering all patients and my patient had a change in status (abnormal vitals,etc....)so I was paging him for over 3 hours before I got a return call but during those 3 hours I documented/charted in computer every time I paged him and the time and update on patient condition..charted notified supervisor,....until he finally returned page..WELL he told this nurse to ask me to NOT chart when I page that he didnt call back or return page.......SERIOUSLY?? Is he kidding?? now if something DID happen to patient is he gonna take the fall if I dont document how many times I contacted him...I dont think so!! iM SOO ****** off about this...Im thinking of looking for a new job
  9. sleepdeprived1

    doctors repeated rudeness..trouble coping

    HouTx, Thank you soo much for this!! I was looking on the Internet for exactly this and could not find it! I knew there had to be standards/expectations...I have printed out a copy for my own reference and I am thinking about hanging up a copy at work for staff. I have since put the issue of rude doc behind me but in the future I will not be passive and stand up for myself(really my patients) and do an incident report. All of us nurses have to stick together. Thanks again for the info!
  10. sleepdeprived1

    Dangerous New Grad Co-worker

    I understand where you are coming from. I see many orders unchecked and I work the graveyard shift..Im talking med orders from 9am sometimes that never get faxed to pharmacy to be entered/ordered and patient doesnt receive med. I see order where doc forgot to order the freq. just wrote the drug name, dose and signed his name...well pharm. entered it as one time order but noone reported charted this med change or anything..i was livid..not like im gonna page this doc at 1am for clarification so waited until am...I could go on and on ..but I wont..Im no genius myself I have ALOT to LEARN but I do really hate stupidity and laziness. I can say that when I first started my preceptor prob. didnt think I would make it. I took me month or so to get anywhere close being comfortable but now I am VERY comfortable..and many of the other nurses dont even know im a new nurse. Maybe if you have ANY down time on shift go over crash cart meds supplies with him/her and encourage her to write notes on everything or can make cheat sheets for her i know i needed them for awhile.. It can be scary if it is first nursing job too I know i was terrified I would look dumb or do something wrong..praise him/her when does a good job or for effort...that can go a long way and help build confidence..let us know how it goes
  11. sleepdeprived1

    doctors repeated rudeness..trouble coping

    Our facility does post the on call schedule for the week on the unit and on the intranet. I always check it before calling (usually check like 3 times just to be sure)and they also post who is on vacation and covering... One example where this did not help me was a past incident where my patient on detox started having multiple seizures and decline and paged the on call (i had no standing orders to give med to stop seizure if didnt stop on own....)so on call called back and of course it was this particular rude doc who did not give me any orders for patient and did listen to part of story on patient he told me to call the attending so I call the attending who gave med. orders and told me to page the on call to have patient sent out to med. hospital. Attending said on call should handle that since he was on call that night. so I paged the on call back and when he called back and I told him attending wanted him sent out to hospital he was like WHY ARE U CALLING ME? I told him per attending ...he refused to told me call back attending to take care of transfer to med hospital (do doc to doc report) so i called attending back who was ****** at this doc..but took care of patient... Also the 3 nurses I consulted 1-was the other rn that i switch units with every week (we have two units in our dept) and this rn KNOWS WHO to call and has never been snapped at like I have..maybe because he is a male?? other rn works on my unit pool rn, and other rn doesnt work on unit but has in past.. As far as asking the charge nurse who to call -one time in past we had an escalating patient code situation violent so she told me page this doc (he was either the on call or attending cannot remember) but i do remember being hesitant cuz this doc has gone off on me before but she was firm -"You call him, that is his patient, he needs to deal with this" (or something like that) so I did and of course he didnt handle the situation and got ******..
  12. sleepdeprived1

    doctors repeated rudeness..trouble coping

    So, I have been an RN for little more than 9 months. I remember the talks in nursing school from our professors regarding expectations of doctors yelling at us, cussing us out once we became an RN..I always thought 'I dont care,it won't bother me' I am typically not one to allow others attitudes affect me this way-and know its many times not personal. So, during my orientation period/training other RN who trained me NEVER got chewed out by Doc or was NEVER rude to her..and while she was there I never had any issues with rude docs...but..soon I was on my own..only RN for unit..I learned quickly and have grown in critical thinking skills and grown in ability to anticipate what will be needed for the patients care..I do get frustrated when I see other nurses doing stupid things like missed orders, not following mds orders, ordering duplicate excess meds..soo What I am tring to say is that although I am NOT perfect I feel my competency is not the issue for Docs lashing out/rudeness to me.. and I am very selective in what I am paging the Doc about I have seen other RNS page for EVERYTHING -that is NOT me-I try to respect docs esp. since i work nights.and know they are prob. sleep/ If not crucially imp. will leave note for doc on chart and tell patient. Well we have protocol on who to call and for what and maybe I need clarification on this? We have the on call Docs who are on call other times you only call the attending for things and we have one doc who takes calls on his patients all days of the week no matter what, and weekend on call Docs,so yeah it can be confusing. so this one doc has been getting super snappy with me and this past weekend was prob. the 6-7th time he refused to listen what i was calling about and interrupted me and very rudely raised his voice in rude tone said "why are you calling me-you need to call this doc" I have called this doc for important issues like prolonged dudrug induced seizures, violent patients attacking staff and psychosis becomeing danger to themselves others altered consciousness in patients decline in condition abnormal critical vitals and many times doesnt give me chance to even say what im calling for how would this not worry him-what if one of his pts. were dying woudldnt he care sso this past wkend when i called for something he cut me off short and went off ..after call i started crying and needed to leave the unit..i felt hurt that i am trying to do my job but he doesnt care..i told my manager in morning (i never told her about doc before) she said she would talk to him-but "in a way so he doesnt know i told so he wont take out his "wrath" on me" next night another doc ive never had issue about i paged cuz on call doc.didnt return page and after consulting with 3 other rns i trust on other units (I was scared to page cuz of this other doc always goin off on me) they recommend/said they would page attending so i page attending-he returned call fast in like 5min. i stated im calling on his patient (name),,he stopped and cut me off right there (just like other doc has been doing to me) in rude tone said WHY ARE YOU PAGING ME AT 3 AM I DONT PAGE YOU AT 3AM " I was soo upset that he insinuated i was doing something wrong..i was like well "Dr. so and so last night informed me ...page attending..he was like no dr. on call covers for wkend..i stated well no order written in chart for transfer of care ..was told to call you..he didnt even know what i was calling on..repaged other on call and did return page and deal with patient issue(which could have been serious-decline alter patient condition) ok sorry for rambling my issue now is i dont know how to get over this and not allow this to affect me personally i have been upset the past two days crying excessively, and feeling extremely sad and anxious scared for when i have to page the docs in future..im sooo distraught because i care so much for my patients but these docs that cut me off make it hard for me to do my job and provide good care-arent these docs even worried that maybe i am calling for something serious (thats typically only time i do call) i plan to get written protocol from my mgr. for who to call when and if dr. doesnt call back who to call next......so I know EXACTLY ..i am upset with myself for not being direct with docs and passive and i think this is why i am crying so much and feeling so down..anyone got any other advice on how to move forward?? how to let these past incidents go?? I think its too late to directly address these past issues and that is what is upsetting me soo much. *Also just to clarify the doc who has gone off on me 6-7 times was either the doctor on call for the night or the patients attending doctor
  13. sleepdeprived1

    pregnant psych patients?

    1. We request records from ob/gyn to determine current health of unborn baby (if pt. signs consent), and we also have transport. many times so that preg. patients can still attend their ob appts. 2. Yes. 3. Protocols in place... psych docs request info from ob doc on meds, patient signs waiver/consent for meds including pregnancy category a, b, or c .(never seen less than c given to preg.?) including educating and consent to potential risk/vs./benefit..-if i admit preg. patient. i dont admit them with nothing but prenatal and leave ordering/continuing/standing order meds for the doc.to review since i dont feel comfortable including standing orders if preg. 4. the pregnant patient receives a prenatal vitamin daily other than that it depends on her situation and what types of meds are needed ..and what is safe during trimester of pregnancy..
  14. Ok. So I have been a nurse (first RN job) little more than 6months. At first my job was a honeymoon-ie: never any complaints, always willing to pitch in and help other shifts, very tolerant of others mistakes on previous shifts that I need to clean/patch up/fix. Many other employees would constantly complain and I thought it was terrible and tacky-I loved my job and realize no shift is perfect and all have busy days BUT I have become increasingly stressed and unhappy at work..it is affecting my ability to unwind after shift I continue to be angry and stressed and have a hard time relaxing-like now- I am very upset and stressed out with multiple work issues-very minimal staffing on night shift and last night had to train a cna (and this was the ONLY cna on the floor) first time cna was on my unit and had or acted no idea what to do with new admit that came in..very unsafe for myself patients and not fair to anyone, patient room not clean or bed made guess who had to do that?? barely ANY cna staff for nights, ALWAYS cleaning up after 2nd shift and throwing away their half full beverages, emptying the overflow garbages that reeks of their dinner (usually strong onion odor), secretary that leaves important patient chart info on desk for (who else) me to file away, and of course I get to check all the orders for the day and verify medications prescribed and entered by pharm. against orders,apparently 3rd shift is the only shift required to check and verify orders, if admission comes i am a secretary as well as the nurse i do all my own faxing, filing, ....I am so fed up with being treated like crap or that I don't do anything when I work hard every day I am there. It is finally getting to me. I am ready to find a new job where I am not the only nurse on the entire unit and one cna..
  15. sleepdeprived1

    Safety Concern

    I KNOW I am not safe at work. No security and MINIMAL staffing on my shift so all hell breaks loose I am screwed until 911 police show up! Let's just fill EVERY available bed we can though! Doctors arent on my shift either to deal with these severely agitated patients..but they will be happy to give me a telephone order for something PO that will take effect hours after this psychotic patient has beaten the crap out of me!-Still love my job though..DEFINATELY SOMETHING needs to be done about these unsafe environments..mgmt/admin. doesnt seem too concerned..(at all) maybe all us nurses can sign a petition or something??
  16. sleepdeprived1

    Increase abuse of Bath Salts

    Okay, can ANYONE tell me if they think this sounds like bath salts. Younger middle aged male admit Emergency Detention-medical clearance at hospital .Drug results negative except for opiates ..CT scan normal labs WNL for most part nothing critical .so he was at the ER being cleared for 12hours??? so when comes to psych unit..WAY WAY more psychotic than i have EVER seen before EVER! .. severely psychotic and actively hallucinating-talking and laughing to self ..hypermotor agitation while sitting in chair rocking back and forth.or almost constant body movements. talking nonsensical..refused to get up and follow directions to do anything...not able to comprehend. Not oriented to person, place or time (could not even tell me his name). later calmed some and took a psych med ordered by mouth ..(little effect)...went in seclusion but open room ..did not sleep for more than 10minutes came out of room increased agitation and psychotic able to answer few questions very disoriented still . not able to say date of birth wihtout checking his armband from hospital ER and given a benzo PO (little effect) attempted to elope and jump over nursing station .police called and arrived. no decrease in agitation assisted staff with secure hold ..IM's given geodon and benadryl...did calm some but was kept in secluded room too...so does this sound like bath salts?? just wondering what else it could be??? ive seen my share of AVH patients but this seems like soo much more! I CANNOT imagine if this is bath salts dealing with these patients on a regular basis! especially without security and staffing