snowfreeze

I worked at a facility that did simular, often the admitting doc for the nursing home was the one who wrote the discharge instructions from the hospital. We would call doc to let them know patient arrived and repeat discharge/admit orders along with usually asking a few questions about labs, diet etc that might have been missed. Admissions to nursing homes are much more work for the nurse than those to a hospital in my opinion.

Do you like finding out first hand what stupid human trick was attempted (work ER) or do you like fixing the problem after the labs and tests have confirmed the trick was successful(work ICU)?

In general as a nurse in the USA I am respected by patients, families and doctors.

Yes you may be fired for sleeping on the job. Making personal calls during work hours is not usually acceptable, you are working not socializing. What type of license do you have? Not giving medications because you were too tired isn't acceptable, if you are that tired tell your charge person or supervisor and sign yourself out of work. How many hours were you expected to work and did you know that you were going to be working that many hours 24 hours prior to that work time? Sounds like you need to get a different job, no orientation for what you are working is not fair to you.

Make sure you filled out the application correctly and had references with phone numbers. A nice resume also helps a lot. 1 to 2 weeks after submitting application and resume, call to see if it was received. If you don't hear from them in another week call again and inquire. If no return calls from human resources in another 3 or 4 days, call the unit or department you are interested in and ask to talk to the manager. Ask the manager if there is a position available and if they are in need of a qualified person. Possibly ask for an interview at this time depending on the response. If and when you show up for a tour of the unit/department make sure you have a resume with you. In all phone conversations, have a written outline and facts sheet in front of you so you stay on course and sound very professional. Any interview or tour, have a resume with you and all your contact reference names and phone numbers with you.

SBP less than 90 does not mean poor perfusion, look at the Mean Arterial Pressure. Assess your patient. If this was an automatic pressure, check a manual one. Ask your patient if they are light headed, do they have a headache, do they feel dizzy or are they nauseated. Check what their previous pressures were in the last 12 or 24 hours. Are they a fresh post op, are they bleeding, is this a cardiac patient, what does their EKG show? Do they look in distress? What did they look like during a prior assessment? What medications where they given in the past 2 hours? Lots of critical thinking to be done in a minute or two prior to calling a rapid response team in. I am assuming you checked all critical possiblities of a slightly low SBP and nothing to warrant a RRT. Document your assessment and leave knowing you did what you are supposed to do.

Travel RN, on 3rd contract with this awesome facility in Maryland. Type of Hospital: Community Type of Unit: med/surg/cardiac telemetry Number of beds: 24 Number of patients each RN has: 1:3 or 1:4 only 3 patients if you have a ventilator patient. Do you have a nurse's aides and/or at what census level do you downstaff an aide: daylight 3 or 4 nurse aids, nights 2. I think we downstaff at around 14 patients. Do you have a unit secretary and/or at what census level do you downstaff the sec'y: unit secretary on daylight and evening, share one secretary with the rest of the facility for nights.

The average person who is basically healthy will have 3 to 7 days/year when they are sick. Most of those are stress related not actual infectious related. If your work environment also adds to the sickness level with extra stress and exposure to infectious diseases then maybe you should either have a less stressful work environment with less tasks or be given a lot more sick days.

There are two routes, take the small hospital and semi specialize in everything for a rewarding career at the low level or work really hard for a while (teaching facility environments can be stressful) and work in some specialty units and get some awesome experience then as you slow down toward retirement, work in a small town facility and have enough experience to be comfortable with just about anything that arrives. Also be aware that there is a new direction for improving work environments. Doctors won't be allowed to belittle you and co-workers wont be allowed to do that either. What do you expect to achieve as a nurse? Do you want to teach new nurses, or be the most awesome nurse manager of all time. You sound like you would like some experence in many aspects. I wanted to be a flight nurse so I got a job in one of the toughest facilities with a low nurse patient ratio just so I could get my time in for a position in the future because that facility had just been purchased by a facility that had an awesome critical care flight team. My plan worked, I loved it and learned a lot. I am now a travel nurse. Good luck with what ever you choose. Do some research about your local facilities.

Good luck, I did some time in LTC and understand your frustration. You never see someone get better, it can be depressing. You do have time management skills that could be sold on E-Bay, lol. I am sure any unit hiring you will be blessed with your wound care and behavior management skills.

Debriefing helps a lot, talk to someone about this. The chat after a traumatic event is a defusing, a few days after is a debriefing. These are helpful to most people, going over the details with someone else who was there and seeing their view helps you to release the event. Having follow up information also helps a lot. In acute situations you are there in the middle of it then suddenly you are not even involved, that doesn't work well with our reasoning. You need some more information so that you can have a closing of this event.

As far as passing boards, I suggest test questions by yourself or with a group which ever you have access to. As far as being an orientee nurse, listen to your preceptor. Your orientation is very generic so ask questions and make suggestions as to what you feel you need to achieve and what your weaknesses are. Your weaknesses are the things that scare the crap out of you even thinking about them. Discuss these scary issues with your preceptor. Your preceptor wants to help you and have you as a future competent co-worker. The rest of the staff on the unit would like to socialize with you but you are so overwhelmed right now so they are just helping when needed,,,,,they do appreciate you and what you are going through.

htrn has good advice, talk to the manager. Suggest giving the complainers the job of finding a solution. Staff that complains about a problem needs the opportunity to be on a committee to fix the issue that is bothering them and others. Allowing the staff on a problem unit the power to fix the problems usually corrects many of the issues.

I was pregnant during my first year of nursing school and had to take time off due to a c-section mid August. I returned the following year and completed nursing school and passed boards the first time. My daughter will turn 18 this coming week!!! It can be done, I worked a 24 hour shift every Saturday as a paramedic to pay for day care for that daughter while I finished nursing school.

Injecting through anything could cause an abcess, a small piece of fiber could be embedded in the flesh and this could cause a nasty infection.

Humm, a facility that has you caring for vent patients and has not oriented you to that yet? Sounds liike a place that runs on a shoestring. If you like the job (place, hours etc) then maybe you could get involved in fixing some of the problems you are seeing right now. Sounds like there is not proper orientation of new employees. I also suspect that no one is held accountable for things not getting done. A few places I worked at in the past had these issues and they closed eventually. All the problems seem to trickle down from the top, bad adminstration breeds bad management and hires and allows bad nursing etc. Do some research if this is a problem only on your unit or is it facility wide too?

I worked at UPMC in Pittsburgh for 2 years.

Try working all your night requirements in a row, that way you can sleep daytime and work nights. Yes your social life will be non-existant but you will get your hours in and be back to normal for the next week. I could never do the switch back and forth with days and nights like you are trying to do.

My first experience with a not so nice doc was with a pulmonologist who had a reputation for being verbal. I was orienting in ICU at the time and this was my first assist with a swan placement. I was methodically getting my things together and getting the flushes etc. He asked for the flushes, I didnt have them quick enough and he made a rude statement of how he could have easily done this himself. I responded with "if you dont speak to me in a more polite manner you will be doing this yourself". He appologized, I accepted and gave him a quick outline of my nursing career goals. We got along fine after that. Sometimes the docs don't actually realize how rude they are. Some will never change.

When you stop having nightmares about work stuff that is simple like meds given, forgetting patients etc. Your mind will tell you when you are there. Oh geeze, I had a dream about med passes two nights ago. I have 16 years experience and am now a travel nurse. My facility just asked for a new sign in requirement for contract and agency nurses. My mind trying to make sense of this I guess. Forget the first statement. When you wake up and look forward to work. Yup thats it...humm, when I get bored I move on to another area so that isnt quite it either. Oh well, a couple indicators offered. Welcome to nursing, hope I work with you sometime!!!!

I worked with some refresher nurse students last month. This program took them through the whole facility. I worked with one student for 8 hours in a telemetry unit and she was very much into doing hands on so we worked as a team through my shift. They say its like riding a bike, you just have to get up there and do it again. After 8 years out of ICU nursing I got pulled to ICU from telemetry and had a nice assignment until 2am when I had to transfer one patient and recover an OR patient intubated and on diprovan. Had not done that for a while but it came back quickly and I had a lot of support staff too. Find a program that fits what you want to do as a re-entry nurse.

Humm, what a refreshing idea. I would love to be backed by the administration for this. Screen play for JACHO training film. Doc sits down and starts softly cussing and tossing charts. nurse "Hey doc, might we discuss this in the report room?" Cussing gets louder and charts fly nurse "this is unacceptable, please stop" Cussing gets even louder and more charts fly along with a few nurses clip boards. nurse " OK now we are heading to the medical directors office and we are inviting the DON" ( nurse tugs doc along by his hand which is trying to flail along with his other hand) nurse ;as she is slowly walking down the hall, offending doc in hand..."Everyone please give me a signed statement of this event and get one from every patient and family member who witnessed this and fax it to #### medical directors office ASAP." Whew, wiping brow....I liked that one!! LOL

We all fear the unknown. You will do fine, you care. The more you learn and experience the less you will worry. Except during nursing school when you seem to develop the symptoms of every disease you learn about at the same time you learn about the disease. The human mind is complex and we all have to live with it.

#1 if you are in charge of your unit then there are some things you can change. Big units with hopelessly long med passes, split the med pass up between two halfs of the unit. 7am and 9am or 8am and 10am that way you will have your meds in the patients on time nearly all of the time. Work this out with pharmacy and the DON of course but you can make that change without their input if necessary. #2 Make your decisions based on patient advocacy, you won't go wrong with that direction and make sure the basis for your decision is documented. (ie patient behavior, patient complaints, family complaints, family behavior etc) #3 Utilize ancillary staff, nutritionist, social worker, case manager, respiratory therapist, physical therapist....any problems you have are probably their problems too. Send e-mails and hand notes often and always keep copies in your own file that you keep in a locked locker or file case you take home. Occasionally things are misunderstood so you will have the original document to show for clarification. #4 organize your shift so you will get your work done and charting done, learn to prioritize when something out of the ordinary happens. What meds can be given 2 or 3 hours later and have no problems, what treatments can be delayed also. #5 an irate patient or family member can be quickly calmed by writing down information and telling them that this issue will be addressed to the charge nurse, DON, medical director, administrator or whom ever they think needs to know about it. Have the shift supervisor also chat with them so they know the issue is being recognized. These are the big ones I can think of, I worked as a supervisor in a large facility with LTC, sub-acute and dementia for 5 years, I also worked all 9 units as needed. I had 8 years of acute care prior to this so going from 2 patients to 28 or 36 was a big change. Good Luck!!!

Last week was one of my toughest weeks ever. My oldest daughters best friend died suddenly from a brain aneurysm, she was only 28. There were many questions about what had happened and how it could have been prevented. My past experience in neuro helped me reassure everyone that the possibility of seeing the aneurysm prior to rupture was slim plus it being in an inoperable site was also a probable issue. She had gone to the ER a few weeks prior with a raging headache but the pills they gave her made the headache go away. It came back intermittently during the next few weeks and she never went for a follow up appointment with her primary doc. We got a call from her mom early one morning saying that she was basically brain dead. The questions continued about if she was dead why was she still in the hospital in ICU? She was a potential organ donor which is something she would have wanted. The time frame of declaring brain death and the tests were explained to those concerned. The viewing added more questions, why doesn't she look like herself she is so bloated. The organ donor nursing necessitiy of keeping adequate blood pressure required lots of IV fluids so she was just carrying that with her. Understanding the grievinig process and assuring those who cared about her made me glad I had experience to help them along.