roosmom

First, I want to say that you're already on the road if you're asking the questions that you asked. I think you just need some time and experience. In my opinion, critical thinking is partially based on a skill we all possess to some degree and partially based on experience. It's truly a learning curve. I think to be a good critical thinker you have to a good base in pathophysiology while at the same time understand that every patient is an individual and reacts and responds differently. For me, I never fully grasped a disease process just by reading about it and taking a test on it. Until I encountered a patient with a certain condition it was very difficult for me to put the whole picture together. I've been a nurse for 10 years, and I feel very confident in most of my nursing skills and decision making, but not a days go by that I don't question myself about something I encounter. I guess what I'm saying is that lifelong learning and continuously adding to your knowledge base will lead you to that critical thinking and decision making process. You're doing great - it just takes time!

I'm about two weeks into my online RN-BSN program. We don't really have a specific forum that I know of. It would be great to see if there's enough interest to get one started.

changeofpace, I'm not a new grad - I've been in nursing for 10 years now. Reading your post made me really stop and think, though. You made alot of really wonderful points and I sure hope that many of our site's newer graduates take the time to read it. I've noticed a trend in the last few years in my local area. To back up, when I graduated with my RN, there was talk of the nursing shortage even then, but I think most of my classmates took all that with a grain of salt. We knew going in that nursing was going to be hard work, and that nursing is a 24 hour a day profession. There were much fewer opportunities in my area at that time to find positions that were great shifts, and we all knew that. My first job was night shift, 7p-7a, as were most of my fellow classmates. Day shifts and clinical jobs were just very scarce at the time and we were all grateful to be working at all. Many of the last few years of graduates around here seem to be coming out of the local nursing program believing they can demand any position/rotation/shift that they want. Note: I said many not all! Many do end up starting on night shift because those are simply the available positions in this area. They don't want to work weekends, they don't want nights, they complain if scheduled on a holiday. I have seen a real disparity in the number of sick calls between the newer grads and the "seasoned" nursing staff. I live in a fairly rural area, so it's not unusual to hear about one of the nurses that called in showing up at a local bar or party. I don't know if this is related to the talk of the nursing shortage students are hearing of in school, or if it's a generational/societal thing. It's odd, because alot of the newer graduates are "older" students themselves. There does seem to be a difference in work ethic though and it would be interesting to see a study or some statistics on the subject. I hope I haven't offended anyone. I was not trying to generalize - we have a several new grads that work their butts off and are very greatly appreciated. They're enthusiastic and very eager to learn and I love working with them. I also know of few older nurses who tend to kind of skate through their shifts. I think that some of us older nurses should take more opportunities to precept new grads - it can be a real chance to instill in them a pride in the job, and see where they're coming from too.

Erin, Have you read any of Echo Heron's books? I thought they were all great - written from a nurse's perspective, humorous and light with an occasional moment of heartbreak.

It's funny you should post this today - there was an article in our paper today about a 6 bed adult family/LTC home that a local RN and LPN are opening. Not sure how they got financing or how much red tape it took though. But really who knows better how to operate a facility than nurses?

Nebrgirl, We must work at the same facility. I had a very depressing shift Saturday, and I'm sitting here thinking about it still. And like you I live in a community where everyone knows everyone. I'm sorry for what you're going through, but just posting this post is helping me a bit. It's sometimes hard in this profession when we can't get together with good friends and talk about our days - good or bad. I wonder about MrBill's post - does anyone know of rules regarding speaking about these tough things with other professional "debriefers"? Anyway, sure hope your week gets better.

I think what it comes down to is that there are only 24 hours in a day. You're going to have to figure out how many hours a day you'll be taking care of your child, how many hours in class/clinicals, how many hours studying, attending sorority functions, cleaning your house, doing your laundry, showering, grocery shopping, etc, etc, etc. You're the one who has to figure out how much you can fit in and where you're going to cut corners. I do have to warn you though, that while babies can be very adaptable they also need routine. He may do very well for you. On the other hand you may end up with a very fussy boy if you end up hauling him all over town to social engagements after trying to spend several hours a day studying with him. Doesn't sound like alot of fun for a baby to me.

While I can completely understand the need to socialize and occasionally blow off steam with friends while in nursing school, I don't know that you are setting realistic goals for yourself. Everyone has different priorities, and mine definitely are mine alone. But when I was in school, after taking care of my children and home along with schoolwork, clinicals and an actual job to afford all of the above, the last thing I had time or energy for would have been a sorority. I'm not trying to judge you, but when do you plan to spend time with your child between school and social obligations? Nursing school is no walk in the park, it really requires hard work and dedication, as does being a parent. Just my 2 cents, FWIW.

Snoring respirations can be signs of brain injury or oversedation - people that are impaired are sometimes unable to maintain an open airway, their tongue can fall back causing soft tissue obstruction. In this instance, if you have evidence of desatting, altered LOC, ineffective respiratory effort, the airway needs to physically maintained by positioning (head-tilt chin-lift) until a definitive ariway can be placed. I think in the instance of a snoring pt in acute care setting, there may be an element of oversedation, but if sats, rr, and LOC (easily arousable) are WNL it may just be normal for the patient. I know I haven't liked taking care of patients in Med-Surg that snored, because it can be unnerving if you've seen this emergently before. I guess this is where more investigation comes in - pt history of snoring, on sedating medications, etc. I know alot of people with sleep apnea are snorers too.

I'm trying to imagine what my next shift's going to be like - maybe we'll hang out the "No Dilaudid" and see what happens!

We got a memo from our pharmacy last week about a worldwide Dilaudid shortage and the effect it is having on our hospital. Apparently there's a problem with the manufacturing of the carpujects. I can't find a whole lot online about this yet. Is anyone else seeing this in your facility yet? When I left my ED last night we had 8 1mg Dilaudid's and 12 2mg left in our pyxis. The rest of our facility's almost out, too apparently. They were able to order 2mg ampules, but they don't know when the shipment will come in because I guess these are going fast now. We've already had to deal with patient's coming to the ED for pain control issues when they couldn't fill their oxycodone, and now this? My departments choices are going to be Morphine and maybe Fentanyl I guess - we don't have Demerol anymore. Just wondering if this is effecting anyone else out there yet?

I'd like to hear more about this tubing being recycled - I have a pt in my ED that is coming in daily for outpatient antibiotics via PICC. She was on vacation last month and told me that the hospital that she went to would wind up her tubing every day after her abx were infused so that they could re-use it. I thought surely she was wrong, that maybe they were saving the tubing for some other non-medical purpose, or that they had a special waste bin for it. She still insisted that she thinks she used the same tubing the whole week she was there. How can this in any way be considered good nursing practice? Am I missing a piece of the picture somewhere?

We use lido 1% plain - 1ml for 500mg Rocephin and 2.1ml for 1 gram Rocephin. And then of course figure the amount in ml's from there. Our bottles state this, but I can't remember what brand our ED carries.

I'm not seeing how a "behavior" can be illegal. Sure, there are more than a handful of my ED's frequent visitors that I wouldn't mind seeing less often, but I certainly can't imagine ever calling the police because I don't believe a pt's complaints. Is this behavior a pain in the neck? Yes. Is this taking my time away from pt's that may need me more? Absolutely. Do I tend to occasioanlly get frustrated and want to call 911 on a PITA drug seeker? YES! But I can't do it. It is not illegal to come to my ED umpteem times in one week and request pain medications. It is not illegal to make up symptoms - how do we truly know how anyone else feels? Until we have a BS detector that we can place on a finger like an oximeter we are pretty much out of luck. This is certainly not to say we have to give narcs to anyone who requests them. Stealing narcs or forging scripts will by you a trip to jail. But I just can't figure out what law these folks may be breaking otherwise.

You're right, there are watches where the second hand smoothly glides by instead of ticking, but I can't see how that could be of increased help in taking a pulse. If your school requires it though, you probably ought to get one, but I had trouble finding one on a google search that wasn't really expensive. I did see one at Nurses Station for $59.95 - kind of silly looking, but here's the link. http://www.nursesdirect.com/product.html?t_q=RJ771