Rachel2004RN

Hi all- Came across this old post and realized I never filled you in......(someone asked for info if I got it). They DID chalk this patient's symptoms up to the Reglan...all other tests came back normal and I guess they must have felt it was too cooincidental that this happened after her first dose. There's been talk a couple times since then about deciding on a med to give her whenever needed, and the 'Reglan incident' is always mentioned....they steer clear of this drug with her now. The patient is OK.....no residual effects from this incident, but it DID make me realize EVERY drug has it's potential dangers in different patients. Good lesson to learn......

My co-workers. I'm a new RN, been at the job just over 4 months & I'm just now starting to feel comfortable in my surroundings. For the most part I work with an awesome group of people who have been relentlessly patient and supportive throughout my terrified beginnings!! It was rough for a while there, but I was able to hang in there because of them making it a place I'd be sad to leave(and I've also grown very fond of a lot of patients). I also love the fact that it's a constant learning experience. Never a dull moment!!

Gosh....that's my essay! It made my night to know it touched you enough to want to pass it along. I wrote it a few years ago, while I was working as a CNA. I'm a new RN, but still feel the same about the work CNA's do. A good CNA is such a blessing to the health care team and to the patients we care for!!

Lousy leadership here......makes me wonder how common practices like you describe are in health care facilities. Sounds like your management team could write a book on "50 Ways to Lose Your Nursing Lisence".

Not only is this illegal but also dishonest and sneaky on the part of administration. Do not under any circumstances do this!!! Not only is it wrong from an ethical standpoint, it also compromises care and places the patients in jeapordy...if you clock in but aren't really there, who is??? Get out of there ASAP and report them to the BON.

Hi I took and passed the NCLEX-RN in August and personally I thought my questions most closely resembled the Kaplan practice questions. But I think it's good to practice using a few different resources. Helps the info stick better, and you might recognize something on the NCLEX that you may have reviewed. Best of luck!

Hi- I graduated from Quincy's full-time RN program this past May. Yes, you have to finish prereq's before applying (and take a not-so-easy entrance exam). One thing to consider is that applying as soon as your able and waiting until '06 to start the program might not be a bad idea. If you can afford to take all (or most) of your non-nursing classes prior to starting the nursing program I HIGHLY recommend it....although your tuition each semester during the nursing program will remain the same regardless of how many classes you take (one thing that stinks big time...my education ended up costing a small fortune because of this fact---they don't deduct anything from the set rate each semester, even if you've already taken all of the non-nursing classes, so essentially I paid for all my non-nursing classes twice for the luxury of not having to take them together with nursing). I went to school year-round for 3 years, finishing pre-reqs, doing nursing during the semesters and taking non-nursing classes in the summer and winter sessions. I was REALLY glad I did it that way because the nursing class and clinicals sucks the life out of you and demand a ton of time and energy. I was glad to be able to focus ONLY on nursing. Several people in my class had other classes to deal with along with nursing and it wasn't fun for them at all. So anyway this is just my two cents here, I realize not everybody is in a position to be able to do things the way I did them, but if you are able, I recommend it. Good luck whatever you decide! There are a lot of good programs out there...I was happy with the education I got at Quincy.

Run fast and far and don't look back......

Hi everyone- Thanks so much for all of your replies, I appreciate your input. I will let you know if I hear anything this week regarding the cause of the patient's symptoms. Have a good one! Rachel

Good grief :uhoh21: .......this post just singlehandedly ruled out anesthesia of any sort as a specialty for me and guaranteed I will avoid all physics classes like the plague.........LOL......Kudos to anyone who understands this stuff.....

Hi- Thanks for the response.... The Reglan was d/c'd immediately for this patient, too, and from listening to the PA & MD talk they suspected her symptoms were due to the med, but I left not knowing for sure. I'm just glad she bounced back. She's in a bad enough position health-wise, as it is, I can't imagine if she also had to live with the effects of a stroke or some other, new problem. I'll forever be a little cautious and aware when administering Reglan in the future, especially first doses. I did a web search on the drug and it returned many results for websites geared towards lawsuits surrounding ill effects of Reglan (!!!).

Hi all- I had a scary experience with one of my patients yesterday. She was given a new order for Reglan 5mg via GT to try to ease her never-ending GI problems. (daily upset stomach, frequent constipation issues despite bowel meds). She is vented and on continuous tube feeding. Anyway, she was "herself" in the morning, alert and oriented as always. I gave the first dose of Reglan around 9am. I popped in on her a few times throughout the morning. The last time I saw her alert and oriented was at 11:20am, when I went in to check on her tube feed. When I went back 20 minutes later at 11:40, to get her VS before her noon meds, she was unresponsive. (vital signs were stable). I called another nurse into the room, who also tried to get a response. She opened her eyes half-mast with a sternal rub and her pupils were the size of a pin head and barely reactive. The right side of her face looked a little droopy to me, as well. She was examined by the PA, who immediately called in the MD. All kinds of labs were ordered in the meantime. While she was being examined by the MD, about 20 minutes into this episode, she "came around" and returned to baseline. She was sent out for a CT scan which came back OK. She was placed on telemetry and oximetry and an EKG was ordered, she seems fine. My drug book says that Reglan can cause nuero reactions (also listed--extrapyrimidal effects, lassitude, lethargy...). This patient also has 'small vessels' and there was a question as to whether she had a TIA, or maybe some kind of seizure activity. I think it's awfully cooincidental that this happened on the same day she took her first dose of Reglan. This was an unusual occurance for this patient. A nurse I work with seems to think this patient had taken this drug in the past without any problems. Has anyone else heard of a reaction like this caused by this drug? Or do you think it was more likely a TIA of some kind? (her face is fine now, no drooping.....no residual effects, mentally, either). I was shocked and thrilled when she finally opened her eyes but I'd love to know what that was all about. I left yesterday before getting the full story and won't be back til Monday....the suspense is killing me, LOL....

I just wanted to thank everyone who has posted input on this thread. It really helps to know I am not alone in the way I am feeling, and that others can relate. I'd worry if I WERE the only one feeling this way.......at least I know the problems and issues I'm perceiving are widespread and are not accepted by my fellow nurses as "OK". What is it going to take to change things? It seems like a problem with such a simple solution.....better staffing.....but how many different ways can we explain our working situations to those in a position of changing things before things get better??? What's it going to take?? You know, I worked as a nursing assistant alongside LPN's and RN's for 8 years before deciding to go to school. Part of the reason I waited so long to go to school was because every nurse I ever worked with HATED nursing with a raging passion and urged me not to pursue the career. From the outside looking in, I didn't and couldn't see what they were so unhappy about and I thought they just had attitudes or they didn't like nursing in general and should have chosen a different career. It took me 3 days on the floor, working as an RN, to see what they were talking about. I love nursing.....I love caring for patients, I love the skills, I love nursing in general but I do NOT like the current atmosphere and work environment in which apparently so many nurses are finding themselves. It's now more understandable to me what those nurses were talking about. And it's also clear to me WHY there is a nursing shortage nationwide. The burnout rates couldn't be anything BUT astronomical considering the conditions nurses are expected to function in these days. I don't mean to sound negative or whiny and I definitely don't want to be discouraging to current and prospective nursing students. Nursing itself is an awesome profession with so many different positive aspects to it. I am proud to be an RN and I do not regret my decision to follow this career path. I am, however, very disappointed in what I've seen and learned in a very short time related to the REALITY of our roles on a day to day basis. I imagine that a good percentage of nurses who leave the profession did so due to the same disillusionment I am already feeling. This is not what I bargained for. While in school, I was so excited and so determined to provide exceptional, high quality care for my patients. Excrutiatingly thorough physical assessments, interpeting labs daily, therapeutic communication, etc.....these are all things I recognize as being integral parts of quality, competent nursing care and I am more than a little upset that I am not able to do half of what I SHOULD be doing because I don't have the time. The thing that aggrevates me the most about this fact is that the solution is as simple as staffing the floor with another 1 or 2 CNA's to free up the lisenced staff to do their job properly. Sorry for the rant. I'm feeling at a bit of a crossroads here. It's clear to me I won't be happy at my current job, but I am afraid if I move on I'll find myself in the same situation (or worse). Thanks for listening.

I haven't had a morning break in weeks.....it's impossible because by the time I actually get my 8am meds out they run into the 10's and it starts all over again....by the time I get through the 10's I have to wash up my 2 patients in between answering call lights and everything else that has to be done....then the lunch truck arrives and the rush starts once again...trying to pass trays while getting noon meds out and worrying about patients who need to be fed. It's never-ending. I hate to even take a bathroom break because I don't have the time...I'm perpetually behind as it is. I think I am pretty good at prioritizing and managing time and I go like a madwoman but it's never enough. Not enough hours in the day.

You just hit the nail on the head.

I believe this is EXACTLY what is happening in my hospital. I believe that upper management is reasoning we don't need more CNA's because we each have "only" 5 patients. Well let me tell you, I worked this past weekend and had 6 patients both days, BUT we had 2 CNA's in the hallway. I had a MUCH better, less stressful day with 6 patients and 2 CNA's than I have on the days I only have 4 patients and 1 CNA. That is saying something. Oh my gosh we LOVE to see the student nurses coming!!! I don't know HOW I'd get through some days without them there...and the days they are there I always think to myself "how do we do this when they aren't here?" And YES, my thoughts exactly.......as lisenced staff our focus SHOULD be on "providing safe nursing care, completing assessments, and critical thinking, and if we have time, basic nursing care.".....I feel in my current position it is impossible to do my job. You mentioned "standards of care".......wouldn't it be nice to have the TIME to do everything the way it was meant to be done?? It's like we're set up to fail or something.

I have gone to management about this. I'm always told "well there are some floors that don't have any CNA's" (THAT would be a floor I'd never ever work on in a million years) or I'm shown the census and how the numbers work out and hear "you only have 5 patients and have to wash up 2". What they don't realize is if THAT was all we had to do, it would likely be a little less challenging.....BUT you know how it goes. Since there's only 1 CNA in the hallway....the CNA needs SOMEONE to help her turn the heavy patients, needs someone to help her hoyer up the heavy patients into chairs. With 1 CNA in the hall and 2 feeds....a nurse always has to feed the second patient....ALWAYS at the same time when meds need to be passed. Not to mention the fact that while I am actually passing meds I get sucked into the black hole of certain rooms.....often my patient's roomate won't even be my patient but since I'm standing there I get called over and given a list 20 minutes long to take care of. (can't delegate to CNA's and passing it off to the patients nurse will earn you a reputation of being not a team player). And the call lights never stop. In the short time I have been working there, there's been at least 1 fall caused by a patient on 11-7 who had her call light on for a long time waiting to go to the bathroom and no one ever came so she got up herself. They are real big on "safety" on my floor....be sure patients are in low beds and a sign on the door, etc......what good does it do if the safety gap occurs because of not enough eyes, ears and hands to tend to needs??? As for finding a niche, I agree with you for sure on that one. I refuse to believe that my current job represents the entire world of nursing. I'll keep looking and hoping I find the right place. I have been so bummed out and disappointed lately as I've been realizing my current job isn't going to work out, because I truly like the floor and I like my co-workers (for the most part). It's an excellent learning experience, and it has the potential to be an awesome unit.....all it needs is 2 CNA's in each hallway every day instead of 2 for the entire floor......but I have a sinking feeling I shouldn't hold my breath.

Wow---do you work in my hospital?? My gripe exactly. As a new grad RN I am finding it infuriating and exhausting to be doing the job of RN AND CNA on a daily basis. It's unrealistic and unfair to the nursing staff and the patients. I'd love to have the time to do all of the RN things I learned about in school.....things you mentioned like therapeutic communication etc.......but, sorry, I am too busy putting someone on a bedpan and running for another glass of water for my patient. Sure, we have enough lisenced staff members on the floor to keep our patient assignments around 5 each....but what good does it do if you only have 1 or 2 nursing assistants to help with the basic care needs of the patients?? I think it's wonderful we have so many LPN's and RN's to care for the patients on our floor.....but it's assinine to lack support staff to assist with the care. I literally feel like a nursing assistant who passes meds and has the daunting task of getting through each day PRAYING I'm able to work my RN duties and responsibilities around the never-ending call lights and performing ADL's that COULD be delegated, if there were someone to delegate to. They teach us as nurses to prioritize...yet don't give us the means to do so. This is my first taste of lisenced nursing (was a CNA for 8 years) and I'm thinking long and hard on where to go from here because I'm not content providing 'minimum', rushed care and I refuse to jeapordize the safety of my patients, not to mention my lisence.

Hi-- Thanks for your response. Something in my gut tells me you're right. I keep hoping maybe things will get better here....but the staff that's been there for a while say they've all complained and nothing ever changes. I think I'd do good in an environment where I have fewer patients to care for with more support staff. A friend I graduated with just started at a hospital on an ICU/oncology/transplant unit and she says she has 3 patients to care for and every nurse has her own CNA to help out. That sounds to me like a more realistic environment to work in. I'm feeling kind of bummed out right now and really hoping hard that I find something that I enjoy and feel I'm able to do well with. I'm disappointed this job isn't looking like it's going to work out because it really is a great learning experience, skills-wise.

Hi- Thanks so much for your reply. I realize that it probably will take a while for me to feel effective. Being a new RN, I'm sure it takes me twice as long to do anything than those who have been at it for a while. But even the ones who have been at it a while complain and feel stressed out. (why they've stayed is beyond me....do they know something I don't know?). I have spoken to my nurse manager who is a super nice person and has tried her best to be supportive and helpful. SHE is actually the reason I have not run screaming from the place already. There have been days when I have approached her, completely overwhelmed at my list of things that had to be done RIGHT NOW, and she has gone as far as to call in a nurse from another floor to help the hallway play catch up....and she's even gowned up herself and done patient care. One day in particular, I had about 5 things that needed to be done immediately....4 of which could have been and should have been done by a CNA......switching a patient into a new bed because his was broken (head wouldn't raise so couldn't eat or drink), getting 2 other patients onto stretchers to go downstairs for X-rays, things like this, all while trying to get my meds passed out and hanging IV's and tube feeds. My complaint has been since day one that there are not enough CNA's on the floor. There are 2 hallways on the unit, currently there are 30 patients total. We typically have either 5 or 6 lisences (either 3 on each side or 2 on each side with a 3rd splitting between hallways) and 2 or 3 CNA's (1 in each hallway or 1 in each hall with the third splitting). Looking at the numbers, you'd THINK we would have enough staff--the numbers look great on paper but don't take into account the acuity and needs of the patients....we NEVER HAVE ENOUGH HANDS. In the hallway I've been in recently, the patients are very sick, physically demanding and on the call lights continuously. It's a respiratory floor so we do a ton of suctioning. The CNA is assigned 6 patients to wash up, leaving the rest for the lisenced staff....I typically wash up 2 or 3 of my 5 patients......in addition to passing a HUGE amount of meds at 8, 10, 12 and 2, not to mention taking off orders constantly throughout the day, faxing the pharmacy and running downstairs for missing meds, tube feeds, IV's, assessments, suctioning, treatments and God forbid we get an admission, that is such a time consuming experience............despite all my other nursing duties, I spend the MOST time each day giving bedpans and toileting people. I can't tell you how many times each and every day I feel completely exasperated, thinking of all the non-delegatable, RN duties I have left to do but CAN'T GET AROUND TO because I am too busy playing CNA. It's insane. There is no support staff to delegate anything to, EVER.....so the nurses on this floor are technically functioning as RN/CNA or LPN/CNA. I am most definitely not above doing patient care or ADL's....I worked for 8 years as a CNA before going to nursing school.......I am just finding it completely maddening trying to get my job done without help. There are 2 CNA's on the floor in particular who try their hardest to be as minimally helpful as possible (you can't delegate anything to either of them.....and they actually will chase me down to tell me my patient needs the bedpan or needs to go to the bathroom.....as a CNA I would have NEVER dreamt of passing off ADL's to an RN standing at the med cart.) I told my nurse manager that my job would be a whole lot less challenging if I could focus on just my assignment but the call lights never stop. (one of the above mentioned CNA's actually resentfully told me the other day she put one of my patients on the bedpan and followed with "if they aren't my patients I don't touch them".........uhhhh, if we all did that none of the patients would recieve attention). It takes me over 2 hours to do my 8am meds for only 5 patients because of all the interruptions. I'm at the med cart continuously to do what should take a short time every day but I can't get through it.......too busy bringing people to the bathroom or any one of 1,000 other things that a CNA could handle if we had more. It's ridiculous, really. I never ever have time to sit and look up labs and I feel like I barely get through each day....with only a vague picture of what's happening with my patients because I don't have a second to stop and read through charts and I always feel like my assessments are half-assed and rushed. I feel like a CNA who passes meds and I feel like I'm not giving good care....not because I don't want to or because I'm not capable of it, but because the staffing situation makes it impossible. I could go on and on but I'll spare you, LOL. I will definitely keep you posted. I've told everyone at work, including my manager that I'm leaving due to staffing issues, but haven't given my notice yet because I don't have a clue where to go from here.

Hi all- I've only been working on the floor as an RN for a month and a half and I am already at the point of feeling stressed out, burnt out and disappointed.... Note: I had a big long rambling post here describing all the reasons I'm feeling frustrated with my job, but since 33 people have read it and noone has responded, I assume noone can relate and it's just me. *sigh*....Here's hoping I find my niche......if what I've experienced so far (lack of support staff to allow lisenced staff to properly do their job) is true of nursing everywhere I'm going to have a very short career.

I am a new RN working on a floor that takes patients like your MIL. We get lots of admits from ICU's, many come to us to be weaned off the vent as they become more stable respiratory-wise. Weaning is a gradual process and isn't always successful. There are patients who have been on this floor for a very long time who have failed to wean repeatedly. There are others who wean without difficulty, and still others who are able to wean eventually but may experience setbacks along the way. I agree with the other posters who suggested a family meeting with the case manager and the rest of the health care team, including respiratory therapy, to find out the plan and the progress. Since she is alert and oriented definitely get her input on her desires for her care---and get it in writing. Also, depending on her progress, part of the discussions may include where to go after the vent-weaning hospital, if she is indeed able to be weaned off the vent. A different floor within the hospital? The same floor? Long term care? Home with visiting nurse services? Home with 24 hour care? Was she healthy before this surgery (relatively)? It's hard to tell you what exactly to expect, since I don't know her and it's hard to predict how people will come along, but I wish you well and hope for the best for her.

Hi- I strongly suggest you avoid taking an online CNA course. Find a hands on course that will provide you with patient care practice if possible. Keep in mind that wherever you take your training classes, you will need to take a state certification exam to become certified. You will recieve a written test and a practical skills test. Many nursing homes offer free nursing assistant training upon hire. (some require a commitment). Also, see if there is a Red Cross in your area--as they offer CNA classes in some locations. Community Colleges do, too. $650 seems like an awful lot to pay. I have run a nursing assistant website for quite a while and you may find some useful information there: www.NursingAssistantCentral.com Good luck!

Hi- I am so sorry to hear this, I know you must be so disappointed....but on the positive side, you know the areas you need to work on and you can retake it again. It's not an easy exam, that's for sure. Like you, the prioritization questions I got on my exam weren't what I expected. They were tricky and you really couldn't answer them using the ABC's and up Maslows. What helped me was to be aware of chronic vs. acute medical conditions, possible serious complications of each patient's situation, (how stable they are) and also early vs. late stages of diseases. Of course, the ABC's and Maslows when possible. And it might help to review disaster triage, because the prioritization of patients is different in that situation. As for medications, it might help to review the most common meds, also the different classes and their use and action. It's impossible to know ALL meds! You asked about Kaplan. I personally thought the questions on my Kaplan practice CD (and book---I got them on Amazon.com I think) most closely resembled my NCLEX exam. I used a few different books to study. I also used the www.ncsbn.com learning extension website. You can go through each section and focus on whichever areas you're having the most trouble. (Just don't freak out if you score low on the practice exams---you're not alone!). I wish you the very best of luck on your next attempt & I'm hoping for your success!

What a sweet thing to say! Yes, I started work a couple weeks ago---it happened fast. Talked to the nurse manager Thursday, interviewed Friday, started orientation Monday! A friend I graduated with had told me a day spot opened up and I went for it. It's on a busy pulmonary floor in a hospital. It's a mix of rehab and long term care, which I love because I enjoy learning new things with the more acute patients but I also love becoming comfortable and familiar with the more chronic patients. The majority of patients are on mechanical ventilation....some are weaning. We get a lot of ICU patients who are still too sick to go anywhere else. It's an excellent learning experience, there is sooooooo much to see on this floor and so many nursing skills to practice. I had a clinical rotation on this floor in school and I liked it but found the vents a bit intimidating. I'm OK with them now....including the suctioning end of things....and the respiratory therapists on this floor are amazingly knowledgable and helpful. THANK GOD everyone has been really supportive and helpful so far. I'm up to 4 patients now. (Goal by the end of orientation is 6 patients....typically I'll have 5 patients but they want you to be able to take 6 if needed). Yesterday was not a good one at all----started off bad and just got worse---and I came home and cried, telling my husband I refused to go back---he talked me into going back today and it was a better day. Time will tell if this is the right fit for me....but if it's not, I have been told by multiple people familiar with the floor that future employers will value the experience I'm gaining here. I do hope I catch on. Wow---the real world is nothing like school, huh? Quite the reality slap.