icemanof92

Well the fact that you made a med error because of 2 cards next to each other clearly indicates that you work in an unsafe environment!

Where I work you can stay as long as you want to finish your charting and won't be written up. The catch is, unless you write in the OT book a valid reason for staying (charting does not count) you will not be paid for the extra time past your normal shift. You don't even have to punch out on time. If they see you stayed late, they check the OT book and if you didn't write anything in there, they just pay you for the normal shift and leave it at that. Why can't every facility do this?

This makes me so mad. I see soooooo many posts on this site about LTC nurses making med errors. Clearly it is not the fault of the nurse. While we all know that floor nursing is overwhelming, there is something extremely broken about the LTC system. I don't care what the acuity level, 20+ patients to one nurse is ridiculous and grossly unsafe. How the hell can they expect one human being to safely administer medications to two dozen people, more than half of whom are likely polypharmacy patients? I never have and never will work in LTC, but my god I can tell from the horror stories I read that there is something extremely wrong here. Does anyone know if California has established staffing ratios for LTC nurses?

I'll honestly tell you in my opinion that any of these errors could really be system related, especially #4. While you are correct in taking responsibility, think about what we are taught in school about new provisions being put in place to prevent errors. We seek to decrease reliance on memory and have safeguards in place to prevent errors. Let's be real here. Nurses are overworked and stretched to their absolute limits. An EMR system that updates orders in real time and that highlights in a bright color orders that are overdue is a great safeguard against errors. Perhaps this is my perspective because I'm young and this is all I've ever known, but I can not see how working without such a system can possibly be safe.

Forgive me if this is a stupid question. I'm a student in my final semester of a BSN program and doing my preceptorship on a cardiac stepdown unit. We routinely have pts s/p cabg who have temporary, external pacing wires, which I understand. However, most of them are not actually being paced. If a patient is not connected to an external pacemaker, then what is the big hub ub about handling wires with gloves (beyond infxn ctrl), wrapping and isolating? I don't understand how one can be shocked by something that is not hooked up to any electricity...Please enlighten me.

Your first fall is always traumatic. All patients are fall risks to some extent. One word of advice, while some may not agree, years of experience has taught me this: Do everything you can to stop a patient from falling, except catching them. You are going to get injured if you try to stop them mid fall. If they fall despite whatever fall prevention measures you have taken thus far, it is to late to safely stop them.

I am looking to receive some advice. I am in my final semester of a BSN program. Thus far, I have done well. While I have struggled here and there as everyone has, I have always been successful. I have never failed a class or had any significant issues at clinical rotations. My GPA is a 3.4 and I have received academic honors for my grades. This seems to all be changing now, as I am wrapping things up. For my senior practicum, I have to do over 300 hours of hospital time following the same preceptor as well as complete dozens of lengthy ATI tests where the passing grade is 80%. Additionally, I have numerous papers to write both for my practicum class as well as another online class I am required to take to graduate (plus I have to take this class to carry a full time credit load for financial aid). I work part time in a hospital and I am working the minimum amount (5 shifts every 2 weeks). What it comes down to is that I am drowning. I feel I'm doing very well in the clinical portion. I feel comfortable and I receive nothing but positive feedback from my preceptor and the professor who oversees me. But outside of the hospital, the rest of my semester is falling apart. I am completing assignments late, failing ATI tests despite studying, and having 10 hour panic attacks (literally) on a regular basis. Outside of school and work, I am dealing with family issues as my parents are both sick. I fear that I won't get my hospital hours done on time, but I find myself cancelling clinical shifts left and right and calling in sick at work just to keep my head above water with the rest of my school work and dealing with my parents. I recently went 8 days without a day off and that is taking a toll on me. I am always either at clinical, at work, or sleeping (I do clinicals overnight). What can I do to survive this semester? I just can't seem to balance everything. Should I cut back on my clinical hours? Working at my job less is not an option as I have no vacation time and I need the job (they will also likely hire me as an RN). Any advice would be appreciated. Sorry this was so long.

EMT training and experience are what got me through nursing school.

I have no certifications except EMT-B so what really got me in was having 3 years of undergraduate nursing education under my belt. Many hospitals will hire you as a PCT or NA after passing 1-2 clinical classes.

I would like to share this cautionary tale with all my fellow PCT/NA buddies because it is something I will forever wish I knew about before it happened to me. We all know the importance of body mechanics and lifting with our knees etc, but I suppose I took my back for granted for the first few years of my health care career. That all changed when I was doing a simple chair-bed transfer with a patient. He probably was a 2 person transfer, but I had been given grief about asking for help before, so I decided to do it myself. Within seconds of starting to help him stand, I felt the WORST pain of my entire life in my lower back and left leg. It was so bad that I had to sit the patient back in the chair, lay in his bed, and press the call bell. I was taken to the ER by stretcher because I could not sit up. An MRI revealed a herniated disk at L4L5, and I was out of work for over a month! Luckily, I have a great chiropractor and I took the doctor's advice to stay out of work for a month. I am now back on the job, but with one big change. I now ask for help for ALL transfers, boosts, repositions, and lifts. If the patient needs anything more than minimal assistance, I call for help. People sometimes get annoyed with me, but I tell them that my health is not worth risking. Never again will I take a chance of getting injured for the sake of the convenience of my coworkers, or even of my patients.

Things I wish I knew as a new PCT: 1. Orientation will probably not teach you everything you need to know and you have to develop your own style, routine, and tricks. You will be overwhelmed at first but you will adapt 2. A great PCT is one who stays moving, works hard, and doesn't get complacent or lazy (too often) 3. Give yourself A LOT of time towards the end of your shift to make sure your patients are all clean and dry. For an average NA/PCT load of about 10 patients, I like to give myself at least 2 hours to make sure everyone is changed/washed. 4. VERY VERY IMPORTANT. DO NOT NOT NOT lift/boost/transfer ANY patients who needs anything more than minimal assistance without a second person helping you. This is for their safety and moreso yours. I injured my back transferring a pt chair-bed and was out of work for more than a month! Do not let this happen to you. Your health is not worth risking for any reason. GOOD LUCK and LEARN!!

Working in cardiac expect to do a lot of lead placement and adjustment, 12 lead ekgs, weighing patients, fluid restrictions etc. A great PCT is one who works hard, stays moving, and doesn't get lazy (too often). When you first come off orientation and are on your own chances are you will feel overwhelmed. You will, after a few weeks of working on your own, develop your own routine, time management skills and tricks, and way of doing things that works for you. Just a hint, give yourself AMPLE time at the end of your shift to make sure everyone is clean and dry. For a load of 11 patients, I would give myself at least 2-2.5 hours of time to get through everyone that needs to be changed/washed. There may be times you will need less time, but at least while you're new, try to set aside that much time to make sure you do not get behind. GOOD LUCK :) I hope you find it to be an educational, valuable experience. It will be hard and frustrating at times, but you will be successful if you can LEARN from the experience you have!

In my PCT orientation classroom wise as the other posters said it is a general overview of hospital policies and in my case a lot of customer service/AIDET training. Then there were a few days of PCT specific classroom instruction on various skills such as emptying foleys, hemovacs, JPs, assisting pt with assistive devices, finger sticks, etc. We were tested on our ability to manually take VS. Then the on the job training started where I had ten 8 hour shifts working with experienced PCTs on various floors. This honestly taught me next to nothing and was especially lacking in time management skills. I really learned how to do my job when I was on my own and it was swim or sink. Good luck!

From speaking to many many new nurses who have gone through orientation at their first jobs, I can tell you that nursing school really doesn't teach you much about how to be a nurse. It's just a foundation on which you can learn from your preceptor. What you have already learned from your experience working as a CNA plus the hands on experience you will get during orientation as a new nurse will be the things that really prepare you to practice independently.

verizon/construction worker. PS with all due respect, any nurse married to or dating a paramedic is going to be the one paying for everything. I'm allowed to say this because I'm an EMT and ALMOST a nurse!

I had a nursing professor who said the thing that separates nursing from other health professions is that we take care of "the whole patient". I couldn't disagree more. I think it's every health professional's responsibility to address more than just the physical needs of their patients. I think what does make nursing unique is that we are "care coordinators" in that we not only provide direct assessment and care but we also assess for the need for, and provide for, and coordinate, and bridge the gaps BETWEEN various disciplines of care ie PT, respiratory, psych, SW, nutrition, radiology, MDs, and ourselves. We as nurses not only care for patients in our own right but also juggle all those and many more aspects of a patient's care both in and out of the hospital. Therefore I would say what nurses' jobs really are: Care Coordinators. Almost sounds like a better name for us...

I have been a PCT on a med surg floor for almost 6 months now. I am going into my senior year of a BSN program in the fall and I have been an EMT for 3 years. I am pretty confident in my skills and ability to work with patients. My big challenge has come in recently because I switched from nights to days. The last day shift I worked, I did not even get to my section and start my VS until 30 minutes into my shift because numerous nurses from another section asked for my help. In one case I was unable to do what the nurse asked me and I told her this, but she just gave me a blank look and said 'I know know' (I went straight to the ANM on that one). Don't get me wrong, I am not the "not my patient, not my section" type of tech AT ALL. I am happy to help where needed, but not at the expense of my own patients who need me. There were 3 techs on the floor but the others were nowhere to be found. Another problem I had was when I was in my section a patient returned back from a test. I needed help to move him back to bed because he was a fall risk and very unsteady on his feet but able to walk with assistance. I had to keep apologizing to the man because his RN was literally standing talking to a coworker for 15 minutes and kept saying "I'll be right there". Again, every other tech was mysteriously "invisible" at this time. I have never had this problem on nights as it seems the entire night crew works well together and people take care of their own sections, only asking for help when really needed. I feel like I am "too nice" and not pushy enough to get the help I need and say no when I really can not help. I guess I just need to learn to say NO more often...any advice?

This question is based partly on my wanting to give advice to a not-so-new grad I know...as well as on my fear of ending up like her as I prepare to take my boards in less than a year. One of the ER techs I have gotten to know over the years as an EMT informed me that she graduated from an ADN program and has taken her NCLEX 5 times over the course of more than 2 years without success. She says she has taken all the kaplan classes and read the davis books to no avail. I know some people are bad test takers, but how could she have graduated from a program, obviously haven passed many hard tests in that time, and now be unable to pass the boards? What last ditch measures could I suggest to her to try as she has told me she intends on retaking it yet again...and how can I avoid this situation? Not that I think I would have such trouble but I almost think it could be one of those "there but by the grace of god go I" things...

I have a couple of questions regarding blood pressures. I am a nursing student, and also an EMT student. I normally feel comfortable checking bp's and I am usually confident in my reading, but occasionally I will have a patient who doesn't quite fit the mold of textbook korotkoff sounds, and it throws me. On the systolic, sometimes a few mmhg above where I start hearing an actual beat, I hear a whoosh type sound. Is the systolic going to be the start of the whoosh, or the sound of the beat? Sometimes with the diastolic, the sound changes from a beat back to a whoosh. I have been taught that the point where it changes is the diastolic, as opposed to the point at which all sounds stop (unless the beat stops and there is no more sound). Is this correct? Thanks for your help!