cardinalRN

Not always, but often...

ArtClassRN, you're kidding, right?

I hate being charge nurse. I feel like I'm baby-sitting the majority of the time. When I work as a floor nurse, I only have to worry about my patients...but when I charge, I have the whole floor to worry about. It seems like all I do is answer questions (that the nurses should already know the answer to), and put out fires. I have a lot of young nurses that lack the experience and assertiveness that is needed at times, so I just feel exhausted by the end of the shift. It's certainly not worth the $1/hour difference. I did it for the experience and to put it on my resume. The nurses love when I charge (or so they tell me), but it's not something I enjoy. Evidently I help out more than some of the other charge nurses do. I take patients, I start IV's, put in catheters, help clean-up patients, put in orders, call physicians, etc. I have always felt like the charge nurse sets the tone for the shift (either chaotic or calm), so I try hard to make it a calm shift.

Two nurses at my hospital were recently fired for saying we were under-staffed. They were at the nurses station, not speaking to a patient or family members, and were overheard by a member of administration. We had been told not to ever say that to a patient or family (which seems like common sense)...but really? Is this a fireable offense? Do they think the patients/families can't tell or don't already know that we are short-staffed? So....we've been warned. My hospital is so short-staffed/overcrowded, the nurses, doctors, and ancillary staff are all just burned out. Thoughts?

My hospital is about to start a new program that will place 2 hallway beds on each floor to help relieve the number of ER holds. The patients that are placed in these beds will have to be ambulatory since they will have to walk to the visitor bathrooms, as they will not have their own. They will simply be at the end of the hallway, with a curtain. The hospital recently opened a new floor which is supposed to be ICU step down, but because of the amount of patients holding in the ER, it is currently being used to house the ER hold patients...and is full every day. The opening of this floor for its intended purpose has already been delayed for 2 months because of this. There are days/nights when we are holding 30+ patients that are waiting for beds. They end up being held in PACU and essentially any "closet" administration can find to stick them in. Nurses are pulled from the floors to take care of them, which leaves the floors short-staffed. And this happens EVERY night (I'm a night-shifter). I've asked why we don't transfer patients to other facilities, and the answer I received was 1) there aren't any beds available within 200 miles, and 2) that would mean a higher level of care which the patient doesn't qualify for. I don't know if this is true or not. The hospital states that there have been studies done that show patient satisfaction is higher with the hallway beds. People feel they are getting better care on the floor, rather than being kept in the ER. I looked online...and sure enough, there are studies that show that. I'm just embarrassed, honestly. We already have hallway beds in the ER, but having them on the floor just seems crazy to me. A patient, a bed, and a curtain! I don't even know how we'll have room for a bedside table! And what about when family visits? Has anyone had experience with this? Does your hospital do this? I'd love to hear from others on this issue.

And remember that your manager "has" to encourage you to take a lunch for legal reasons. In case anything were to come up, she can say "oh, I always tell my nurses to take a lunch." Even when she knows it's not gonna happen...

I regulary have to report to several different nurses at shift change myself, so I understand what you are talking about. Do you use SBAR? This seems to make report much easier. Just be assertive with the "lollygaggers"! I simply walk in, get my blank SBAR sheets, look at my assignment and find the nurses I need report from. If they are busy giving report to someone else, then I look for the next nurse, etc. If everyone is busy, then I get on the computer and start reading H&P's or looking through my pt's charts. I don't sit around for too long though. If I feel like someone is taking too long, I will "hover", or just say something to them directly. There are some, that if given the chance, will stand around and gossip all day on the clock if allowed. Be assertive, but not rude. If a nurse is charting instead of giving me report, I will just tell her I need report and then she can finish her charting afterwards. You have a lot of control over this and they will soon learn what is expected when giving you report. You can get away with saying a lot when you do it jokingly, too. Bottom line: be assertive!

I am so sick of this "green" crap too. All of our emails at the hospital I work at have this stupid little footnote at the end: "Please consider the environment before printing this message." It's so ridiculous!!!! Do people not realize what a renuable source paper is???!!! My God! Paper comes from trees. The lumber industry creates a lot of jobs and tax revenue. Trees and cut down, replanted, grow, cut down and the cycle repeats itself. I don't get why people can't understand this! PLUS, paper is recycled, which creates another industry for jobs, revenue, etc. The whole "green movement" is just the continuation of the hippie ideals of the people who are now executives.

Most troubling in my opinion? HCAPS!!! Quality of care is no longer the focus...now it is all about the patient's perception of how they were treated. So, the people with dementia, the psych patients, and the a**holes who can never be pleased all have a say in how our facilities are reimbursed...which directly affects my employment. Yet another way the government (CMS) is trying to reduce payments to healthcare providers while putting the blame on someone else.

Go with your gut. I work nights in a telemetry unit. It's busy and stressful and the turnover is high, but it's great experience! If it's where you think you want to be, you'll be happier making the change.

Learn about heparin drips, Plavix, Coumadin and Pradaxa along with the other cardiac meds. Brush up on your electrolytes and how they can affect rhythms (especially K & Na). It's so important to recognize the rhythms on telemetry...SVT, Afib, Vtach, etc. Also, know about neuro checks and the NIH stroke scale. Hopefully, a lot of this will be covered in your orientation and you will have a good preceptor. But even if you don't, give yourself homework and research anything you don't understand. Good luck!

At the hospital I work at, the approximate time that the infusion would be done pops up on the EMAR in red, requiring us to chart a stop time. It never gets forgotten because it is always staring at you in bright red until you chart something and then it will disappear.

It will get easier as you become more confident. Just don't take anything they may say personally. Remember you are the pt's advocate and the Dr.'s eyes and ears. You may be yelled at even when you are doing the right thing. However, it's more important to err on the side of caution than to have something bad happen to your pt and wished you had called later!

There are a ton of nursing positions in SW MO where I live due to the recent tornado in Joplin.

That doesn't sound like a very good "nursing diagnosis". Ha ha ha! I guess some interventions could be listening to a weather radio, getting in a storm shelter, going to an interior room on the lowest level without windows, jumping in a ditch and covering your head if you're in your car, etc. Goal is knowing what to do in case of a tornado? But how do you measure that? We were always told that goals had to be measurable. Maybe this will give you somewhere to start though.

I'll give you 6 months in an ER and see if you don't feel the same. My husband is paralyzed, diabetic, deals with chronic pain and bladder infections...yet he is able to hold down a full-time job. Why? Because he takes pride in earning a living. Sure, there are some out there who need disability, but I find that the vast majority are just lazy, have a sense of entitlement, and are just taking advantage of the system. It makes me sick, too!