AlabamaBelle

Some centers have the nice chairs with heat and vibration. I was in a Peds unit and even the 5 year olds hit those two buttons first!

I have worked for DaVita in Acutes. If you really like working on your own, it's great. It's also very feast/famine. You may to 5 hours one day and the next 20-24. And there's call. This part is very MD dependent. Personally, I am grateful for my experiences, but will not go back. I'm enjoyed nice, set clinic hours.

I'm more appalled at the pettiness of the nurse who reported Jonathan. This is a petty, vindictive individual. Everyone who works around this person should be wary. I don't do selfies and I don't list who I work for.

UGH! Ostomies. I will do any other task for any coworker if they will take care of my ostomy patient. I gag at the thought. Just no.

I've been doing dialysis for 4 years, part pediatric and part adult. Some days you got it and some days you don't. My 2 missed accesses were with the same doctor who does not like me. I actually call for changes in patient condition (patient bleeding profusely after 45 minutes of pressure, to the NP who told me to hold manual pressure, like my fingers weren't already cramping, took another 45 minutes to control enough to bandage. 30 minutes for the upper access. Though he might want to know about the patient who coded (DNR) while on treatment. There were other factors in play and another doctor is in hot water for a bleeder that he refused to come in and check. Be patient, you got what it takes. It's just like with IVs, you go through dry spells.

First, I want to say I am not asking for advice. I am an experienced Peds ICU RN, Peds Dialysis RN and Acute HD/CRRT RN. I only ask for some things to expect...not a fan of surprises. My husband was just diagnosed with dilated cardiomyopathy and aortic regurgitation. He has always kidded me about writing notes on paper towels...how ironic I find it that he wrote notes on a paper towel. His EF is 25% (he does not know I found it or know his EF, he is trying to protect me). There are ischemic areas in various areas. His cath is upcoming and, of course, we will know more. He is in denial, he's also a veterinarian, but this human stuff can get past him. He will be a patient in the hospital I work in and I know the staff in the SICU where he will spend some time afterward. I am comfortable with them and they know me well as I spend a good amount of time dialysing patients in their unit. I just need support, know what to expect as I am outside my comfort zone. I am fully aware of the seriousness. And please hope I behave myself and don't act like "one of those awful RN family members." And I will become the major source of income. Good thing I am well paid and have good benefits with one of the Big 2 that I work for. I'm not stressed, not stressed at all....

I make appointments very quickly after schedules are posted. I don't explain who the appointment is with, not their business. If the scheduler forgot to put me on, oh, well! I have had to learn the hard way to not let people push me around. Being nice only goes so far. I take care of me first, now. Especially since we found out my husband has some serious issues going on. Our time may be cut short, so us first, them second.

Dear youngling... Accept now that you WILL get yelled at or the MD will be extremely annoyed with you in the field of nursing. Grow a thicker skin. The Charge or Preceptor is just a cog in the wheel. You will chart that you notified your charge nurse. Then you will call the MD, as he is the only one who can give you orders. You will chart this also, as well as his orders (or lack thereof). You will carry out orders and note responses to interventions. Protect your license. Try to group questions to the MD, if at all possible. You can always ask if anyone else needs the particular doctor. This thread has given you valuable information. Use it.

Always, always, follow your gut. Don't listen to a charge nurse or anybody else. I'll take the chewing, which I had recently. The NP and MD (who has standing orders that we call the NP, not him) complained about my call, but my glutes were covered, just in case. And later, a couple hours after the treatment, there was a problem, not a big one, but my considerable hiney was covered as I had charted and filled out some paperwork on the problem with that particular treatment. It's your license, protect it. Nobody else will.

We are 2:1 in our dialysis unit. We have no techs. If we have an unknown Hep B status, that patient has his/her own nurse. Hep B, does of course, complicate staffing. We also do portables 1:1 in our ICUs. We often have more than one patient in a particular ICU, so we load up as much as possible and go from room to room. Our larger sister units in the largest city in the state have techs. Their ratio is 4:1 and there are at least 4 techs at any given time. The techs get all the fistula/grafts on (and these techs are awesome). The RN must put on any PermCaths.

parolang, if I were in a clinic, I would love to work with you! I work in acutes. Our program doesn't routinely have a PCT, just occasionally. We feel pampered when she is there. We have a four bed space in our unit, with 2 patients per RN, Hepatitis status permitting. We do a lot of mobiles and are adding CRRT to our program. I have a different schedule. I do 4p-12a, no weekend, no call. I do treatments that are left from the day, trying to get the on call person out and resting, just in case. I set up paperwork, machines for the next day. The portable ROs are stocked with extra equipment. I initiate all PD treatments. We just all pitch in and do our jobs to best benefit the patients. Acutes is definitely a different animal from chronics (did that, too). Some days are beastly, some days are little or nothing.

I've always been known as "The Pen Queen." My collection is embarrassingly large. I have found some pens that are very distinct and I will retrieve my pen from your hand. I have pens that I don't care if you take. I have sharpies in different colors. I have learned to have several dry erase board markers handy because there is rarely a marker handy.

He certainly was! His parents were Southern, as well. They didn't have a much in the way of formal education, but they could read, write, and reason. They passed that on down.

I'm just wondering how many people had to look up Edgar Cayce. We're giving away ages! Somethings you just can't engage me in during work hours. I leave religion and politics at the front door and any "hot button" topics of the moment. I'm good at playing dumb, and the moment passes. I will stubbornly persist in silence. The hair may be blond (or least the part that isn't gray), but it's really dark, and only my colorist and I know really what color it is. My daddy always said to "sit back and enjoy the show, 'cause if you give some folks enough rope, they WILL hang themselves."

Our school started preparing us at the end of our next to last semester. We were ready with all documentation at the beginning of the final semester. They even brought a company to do fingerprints. We were given a list of places if we couldn't make the time this company was there. Disturbed that your school has not given you this information or resources.

We have a few "frequent flyers," but for some of them it's a function of ESRD and the co-morbidities. I do know of a large acutes program that acts as the chronic for several patients. They have been dismissed from their respective clinics. For the type patient you are addressing, we just do the acute dialysis and know that it won't be long before we'll see them. I think Chisca brings up a great point of mental health issues. I think mental health should be addressed more aggressively than it is. In all areas of chronic issues, mental health should be given a higher priority than what I currently observe.

The break room or the med room would be the most appropriate place to vent if you are going to use profanity. I worked with one nurse who had to be repeatedly counseled for her inappropriate language (f-bombs were her favorite), but other expressions could be equally offensive. This was in a Peds ICU. I've worked with a great nurse with the worst potty mouth ever and did not possess an inside voice. As the OP, she realized she was guest on the unit and did act appropriately. Nothing will destroy a relationship between school and unit like a "tattle tell." Or a know it all student. I've see both, neither was a pretty sight to behold. I was in nursing school at 45, with a mix of ages. My upbringing and personal convictions were/are no cursing. It's my choice. I did utter a bad word during my chemical stress test and was appalled. People who have worked with me in the past and to this day know I don't curse and I don't raise my voice. The one time I raised my voice scared the pants off my coworkers. I yelled the name of the last nurse I saw (patient's BP was tanking and I'm cranking up the dopamine). He heard me, along with the Assistant Nurse Manager. I had worked with them for years and it was the first time they'd heard my voice raised. "She doesn't yell....must be bad!" Do I engage in comments about patients? Yes, but only in a safe space. And if you're in nursing any length of time you will, too. You'll have frequent flyers, noncompliant patients, whiners, swindlers, etc. You will do your best for a patient/family only to find out that they complained about you. They will curse at you, throw things and threaten. Honestly, we have spent more time discussing some doctors in not so great fashion......

I work in the Acute setting and recently had a PD patient who had several other problems. His wife was at bedside and he was sleeping. She revealed that she felt like she had not been educated well enough prior to the placement of the catheter. She said she would not have done it because she felt uncomfortable with any "nurse" like thing. She was terrified! I let her e press her feelings and suggested she speak with his clinic nurse. Never felt so helpless. I've also picked up patients from other teammate. One of the patients had a UF goal that could have killed him. He's compliant, not big gainer. Immediately I decreased his goal, which was close to where he was. A few minutes later he complained of cramps, so UF turned off. Cramps quickly resolved. We are generally ordered "max fluid removal." Sometimes some teammates get a litte aggressive, even with BPs not high, so the BP is not the best barometer. I try to teach any newly diagnosed patients about what HD means for the rest of their lives, and also try to include the spouse/significant other. Teaching family can be tricky since families aren't supposed to be present during the treatment. I had always worked with family present at my former dialysis job and as a Peds ICU RN. ON occasion, I will confess to forgetting to clamp the saline line. As for the stethoscope, it is on record that I am hard of hearing and must use my electronic stethoscope. For isolation patients, I put it in a clean garbage bag. I can hear nothing with those cheap things. If my hearing aids are out, a bomb could explode behind me and I wouldn't hear it, only feel the vibrations.

I'm not sure about those areas. I hold an Associate's degree. Many hospitals offer tuition reimbursement if you want to pursue the BSN. Many people go this route, as it does make some good economic sense. I'm in the South and ADNs don't seem to have problems getting jobs, nor do LPNs.

It takes repetition to learn to string the machine. One day, you'll see you've done it without thinking about it. No way you'll get in the very short time frame you mentioned. I'd also suggest you read the machine's manual. We have Fresenius 2008K and I decided to ready the manual. Some of the biomed/tech stuff was difficult, but the actual set up and what does what was very informative. I also got to spend some time with an excellent BioMed tech. As others have said, breathe. Don't forget to breathe. Everyone will get on and everyone will get off the machine. Some days will always be better than others. Be gentle with yourself during this learning time. You will get there!

The patient's MAP was 50, propped up by a SBP of 118/11. Wide pulse pressure, much? Patient was on pressors. She was sick and her heart was a wreck. Patient passed after about a week and a half of daily dialysis. BellaGeorge, what is interesting is when you have a patient with a low BP and as you pull fluid off, BP actually rises.

Nothing I have seen or been around in nursing has taken my appetite (unfortunately). Ostomies may make me ill, but I can still eat.

My babies/children were grown when I became an RN. I'm also an non-smoker. I have covered for nurses that needed to pump. More often than not, I got left with some sort of "mess" to clean up or found the patient needed interventions. Getting same nurses to cover my lunch breaks (or even a potty break)I l was useless and often met with the excuse of having pump again. l learned to make myself unavailable. Smoking Supervisor....you have got to be kidding! I'm with Ruby Vee ... Crusty Old Bat

Like Chisca said, renal patients are truly surprised when you remind them that when ice melts, it's water! Who knew?

This is a touchy subject. I've dealt with some pretty rude and thoughtless remarks about my daughter's congenital heart defect. She's nearly 30 now, which is nothing short of miracle, since she was not expected to live out her first year. The absolute worst was "You've got your own little Frankenstein." This was said in front of other mothers....the mom who uttered this remark quickly realized she had put her foot in the poop pile. We never spoke again, my daughter did not associate with her or her daughter and many of the other children avoided her. Usually, I take the opportunity to educate on her particular defect. Sometimes they just get my "you're too stupid/unfeeling to live" look. Sometimes, what is even more hurtful, is people avoiding you. They don't know what to say or what to do. When I am given the opportunity, I educate folks in the nicest way I know without punching them. She also has to deal with the sequelae of 5 years without adequate oxygen to her brain. I can usually get people to understand she is a bit different, but she is more loving, loyal and forgiving than anyone else I know. I have responded not so nicely to people who have made derogatory remarks about her less than perfect mentation. Educate as best as possible. Don't forget to breathe. Take care of yourself as you are taking care of your family. My parents both died of cancer, so I feel your pain. (((hugs)))