kaufmlin

I feel for you. I am sad to say, the nurse patient ratio overload is occurring all over the USA. I am curious about the acuity level of the patients you were assigned and accountable for providing all the appropriate care and treatments ordered, constantly checking the charts for new orders written that might have been missed, if you had nurse aides available to help or if they were available but had an attitude problem which management should nip it in the bud immediately.Three years ago I took on a job as a telemetry nurse. I noticed that staff were transfering out like rats on a sinking ship and at that time I was in orientation so my case load was low. The hospital marketing did a wonderful job of tv commercials showing that we had bedside computers with all the necessary equipment in each room to do a complete set of vital signs, and O2 SAT check ,etc.this particular area of the state they had the only computer system where you read the bar code on the patients wrist band and checked it against the bar code on an individually packaged medication which allowed you to have made sure that you had the correct med for the correct patient at the right time. The computer checked bar code of the patients ID bracelet against the bar code on the individually packaged medication which you had carried into the room. If it was the right med, right patient, right dose, right time, you gave the medication and then documented each med you had to give into the computer. You had 1 hour to gewt this done, otherwise you were considered having given your medications late. REALITY CHECK: the unit only had at that time 6 working portable computers. Staff assignments were made out by the charge nurse at the beginning of the shift. The staff was kept at bare bones minimum and some were sent home, they were not on call,but yet needed to be available to come in if needed. On a good day you had a ratio of 6 patients to 1 nurse. ( I felt it was still a little excessive for a tele floor that received and required close monitoring of post angiogram/ cardiac cath patients straight from the cath lab. Many patients were older and needed total care. There were days were had no nurse assistants to help..and then on the days we did have some help ...it appeared that the more aggressive, in your face, nurses( few but they were present) always had the extra help and the Charge Nurdse and management played ostrich and chose to pick their battles carefully. They were still losing staff. One day I had 9 patients, all total care, no one going home, all were to be up and walking for their cardiac rehab, and I was to be receiving two cardiac caths back from the cath lab almost back to back in time. Let me tell you, the unit was each man or woman for themselves. No one helped each other. Nurses would pull the computers out of the rooms receiving cardiac caths....they needed them too.....the hospital mandated that we be documenting our caths on the computer. Lucky me, the cath lab came up and delivered a patient who had a clean cath and had been perclosed. They wheeled her into her new room. I began my head to toe assessment while hooking her up to our telemonitor and WOW WEE!!! The patient had a huge grapefruit sized hematoma to her right side, way above the cath site and her B/P was 60/ systolic. I started a fluid challenge, set the dinamap to take vitals every 4 minutes. The nurse from cath lab said, " Oh, that was not there in thecath lab, it must have happened when we moved her into this room." ( She had not yet been transferred off the cath lab cart...and had not been in the room a full minute when I saw this. I said there was no way that this occurred " just now", that she had to have had it in cath lab or it developed during their transport. I went and got a C-Clamp and put it on until I could speek to the cardiologist who had done the cath. I paged him over head, I called the Cath Lab and they were not answering their phone which meant they had started another procedure. I paged the Dr. on his pager. In runs my helpful Charge Nurse, best friends with the cath lab nurse. The patient was moaning dueto pain from the C-clamp. What does my great and helpful charge nurse say??? Why did I not call her. OOPS! So Sorry. " You did not post your number of the phone you were carrying today"...and I also thought the patient was my first priority and finding out the truth of the matter, and receive a full report from the cath lab RN. The other nurse with her kept her mouth shut and never said a word. My charge nurse then thought she would give some morphine for the pain without looking at the vital signs, asking what had been done so far, etc and did such a beautiful job of quickly pulling out of her pocket and pushing 10 of Morphine IV. Well great, now my Systolic B/P was 40/. The Charge nurse commanded to the nurse at the head of the bed, " Give her a fluid challenge!!! Run it wide open!!!" We took the C-Clamp off. The doc later came up and said the patient was going to have a nice sized bruise but would be fine. I continued to monitor her and check on all the other patients I was overseeing. LESSON #1. ALWAYS AND IMMEDIATELY FIND AND WRITE OUT AN INCIDENT REPORT.. IF THE PATIENT IS STABLE, RUN, DON'T WALK AND GET ONE QUICKLY!!!FILL IT OUT, STATING THE FACTS, NAMES OF THOSE INVOLVED, TIMES,ETC,WHO GAVE ANY MEDICATIONS,, VITAL SIGNS AT THE TIME,ETC. YOU GET THE PICTURE??? I am sorry to say that I was too busy taking care of my patient to think I was going to be set up. The next day the Department Director called me into an office on the unit. She had a Green Incident report form filled out by guess who??? The helpful Charge Nurse. I was blamed for the patient having the hematoma. It was documented that I gave the Morphine 10 mg IV that caused her B/P to bottom out more to 40/systolic. It was documented that I did not give a fluid challenge, and that I just stood their and watched making no efforts to help the poor suffering patient. I was told to sign the form..which I refused and I said that what was documented was no where close to what REALLY OCCURRED. I was told signing the incident report did not mean I agreed with what was written but that I had read it. I still refused to sign. I wasthen told that I was being placed on two months probation due to this incident. I was also told ( I had 7 patients on this day ) that I would be receiving two patients from the cath lab and that they would be coming back at pretty much the same time. I was furious inside. I have seen nurses set other nurses up before but I had never had it occur to me. You can bet your money I will never ever fully trust other nurses. There were motives by the Charge Nurse .. she would cover her Cath Lab friends butt and cover her own for pushing the morphine. It was documented that I had given the morphine. I asked the Director for a clean white sheet of paper. Several nurses had been allowed to go home early this particular morning. Sorry guys. Some one would be returning. I wrote on the whitesheet of paper that I was resigning my position on telemetry, effective immediately. I documented that what was written by the Charge Nurse on the incident,false statements, lies, and was not anywhere close to what had truly taken place. I documented that it was the Charge Nurse, not I who had given the Morphine ,nd she had bottomed out the patients blood pressure by running in the room and taking over on a patient that was being appropriately cared for and being observed. When you go look at new job possiblities in the future, notice the stability of the unit, just because they say staff? patient ratio is 1 nurse for 6 patients, plan on having a larger case load than this after you are done with your orientation. And always, always, be sure to carry your own malpractice insurance coverage. Do not expect that the hosapital is going to always be there to stand behind you and be your buddy. Healthcare is a cut throat business now, they look at profits and losses. If it helps them save money by sending some RNs home..even though its going to put added pressure and stress on the rest of the team, to bad. I know this all sounds very negative but I have been burned more than once. You learn your lessons quickly. Best of luck to you in your new role. Think about how the staff on the unit you are working on ... are they true team players and will help you. Is it I will help you only if you help me? Is it I am in overload sorry dear you are on your own? Keep your eyes and ears wide open.

Dear Pilynurse, I graduated from Stormont-Vail School of Nursing in Topeka, Kansas years ago. It is now Baker University School of Nursing. Baker University's main campus is in Baldwin, Kansas. You would be taking your classes in Topeka. Baker is a very good school of nursing. I am a school nurse and I have Baker student nurses spend time with me for a day to see what school nursing is all about. The students are wonderful and enthusiastic to learn. Yes, there are mothers with children going to nursing school. I know that Stormont-Vail Nursing School Alumni Association offers scholarships to students. I had received years ago a scholarship from The March Of Dimes for nursing school. If you call up Baker School of Nursing, they can put you in touch with someone who has knowledge of all the scholarships and grants that are just waiting for some one like you. You can go to school and still be a mom. It will take some flexability on your part as well as keeping an organized schedule. I started nursing school when my son was 5 months old. I was fortunate to have family close by to help watch my children. If you do not have family here to help care for your children while you are in school, mention this to the person you talk to at the school of nursing. They shoulds be able to give you suggestions on where to find information on childcare. ( You did not mention how old your children are and I just assumed they were not in school yet.) If you have more questions or concerns, e-mail me at [email protected]. I will try to help you.

Hi. My name is Linda and I have been an RN for 27 years. I have worked in a wide variety of nursing specialties over the years and this has made my career quite interesting and fun. In response at to whether Nursing Education is a specialty, I believe it is. Each person has their own talents. Some, like my husband, love to get up in front of large and small groups and educate on various topics. These individuals are prepared, allow the group to ask questions and respond to their questions, they don't drone on and on but keep the subject moving fluently, have visual aids,etc. They know their topic well. There are good nurse educators and some who are not so good, but they try.....just like in each nurse specialty, you have some nurses who are very competent and others who still are learning and not as sharp as others in their area of work. Some nurses would feel uncomfortable being a nurse educator due to fear of speaking in front of groups, and not having developed this area of nursing for themselves. Some just flatout do not want to teach nursing groups and prefer to be educated by someone else. Being a nurse educator is a special gift. Yes, I believe it is a specialty!