PediNurse3

Allergies to toradol, morphine, ultram, reglan, and zofran...and phenergan and dilaudid cause itching so please give them with IV benadryl as well?

If I were in LTC, I would be in pain, too. My experience with pain management in adults is limited to what I saw when I worked in the ER, and there was a lot of it. Was it chronic pain? Acute pain? Addiction? Drug seeking? Drug selling? Don't know. I gave what was ordered using my nursing judgment (there were some dilaudid orders for pancreatitis patients and sickle cell that made me very uncomfortable, and I could not bring myself to give it all at once), gave patient's their prescriptions, and left it at that. IMO, it is not our job to decide if someone is in true pain or not, but to report our observations, document what the patient reports and carry out orders as they were written safely, and report concerns of abuse, tolerance, etc to the ordering physician so that consults to psych, pain managment, palliative care, etc can be made if necessary. I have never witheld pain medication (even if I was rolling my eyes in disbelief that someone could have abdominal pain of 10/10 while eating Doritos, laughing and talking on their cell phone as I was getting it out of the pyxis) because I thought someone didn't need it, but have if I truely felt that it was unsafe to give (unarousable, decreased respiratory drive, periods of apnea ). In the PICU, most of my patients were on fentanyl and versed drips, and I was more than happy to give them all the PRN doses that they needed of whatever they had ordered. The last thing that I wanted was an unplanned extubation. We would get teenagers who'd had surgery that required an ICU stay that would be very push happy with their PCA's (had one patient that pressed it 140+ times in a 12 hour shift) and would still say that they needed extra PRN's for breakthrough pain...no big deal (again, as long as it was safe to do so). I often found that they might have been bored or lonely and pushing the Wii to the bedside or turning on a movie to serve as a distraction or entertainment was just as, if not more effective at times. But that population was very different than that in a LTC facility. IMO, pain is what the patient says it is - and if they insist that they are hurting after other nursing interventions or PRNs have failed, it's not my place to interpret what they report differently.

I have worked at two different facilities and they couldn't be more different. It's definitely more than a difference in hospitals though, the units/floors are very different within the same facility. Good luck with your decision!

I didn't really give a good report until I went to work in the PICU. I got to the point where I could give a report that included the following in about 5 minutes - Name -Age -ICU day -Vent day -Post op day -History -Diagnosis -Changes and events over the past 12 hours -Airway (ETT size, placement, vent settings, nasal canula, room air, etc), A(C,V) BG values -Breathing (Sats, sat goal, breath sounds, last chest xray respiratory meds) -Circulation (HR, BP, meds) -Neuro (pain, sedation , LOC, meds) -Electrolytes -Gastro (abdomen, last BM, meds, bowel sounds) -Hematology -Intake/output -Infection (isolation, WBC's, antibiotics) -Joints and skin -Lines -Nutrition (kcal/kg/day, NPO, feeds, bottle, diet) -Other/plan -Parents/family That's the bulk of it. I'm positive that there's more but I haven't given report in awhile. :) Once I got it down, it was a breeze!

What a stressful thing to have to be carrying around on your shoulders! Why can't it be resolved before Monday? 12 missing pills is a big deal...ot something that facilities usually wait until the next business day to resovle. Do they not do a narcotic count at the end of each shift? There would be no way that we could have gone home before that was resolved when I worked on the unit. Did nobody get into the drawer in the Pyxis after you? I understand that you know realize it was a huge mistake, but I really don't think that the fact that you joked about it with another nurse will really do much to work in your favor. It wasn't reported to the appropriate person in a timely manor- or at all- and that is really all that matters. I think at worst you will be written up. I really don't understand why it can't be resolved until Monday though.

I start by talking about how I got into nursing and take it from there. It works well for me because I didn't go into nursing right out of college and I feel like it gives the interviewer what they are looking for - information about me. I have only included personal information once and felt that it was appropriate because one of the reasons I wanted the position was because it would work better for me and my family. Just be personable and sincere. Good luck!

Are you saying that the nurses decide what the patient needs to be on and the dosage and has the doctor ok it at the end of the day? We are given physican delegation in our clinic so we are able to authorize refills without consulting the physican if they meet certain criteria, and use our nursing judgment/discretion. We also send new prescriptions (the dr may say order this, change that, etc) and order labs and imaging studies. We would never just put a patient on a medication because we (as nurses) thought that they needed it.

A flu vaccine and antibiotic are hardly the same thing. Antibiotics, beta blockers, diuretics, etc may be a necessary part of treatment. The flu shot isn't part of a patient's treatment plan, and it certainally is not medically necessary. We offer the flu shot at our clinic. We are a specialty clinic so we probably administer a fraction of what a primary care office would, but it is available. The consent is filled out and signed and the parent/guardian is given the VIS before we give the shot, and the consent is later scanned into the patient's electronic chart. I have always had to sign a consent before my children get their immunizations.

I was hired two months before graduation. I started my first job about two weeks after graduating, worked as a GN about a week, took NCLEX, worked some more, and had results a couple days later. I guess that it varies by state, but it was pretty much unheard of (to me) to wait until after boards to look for a job. Most of those that I graduated with had jobs weeks to months prior to graduation.

My drive is fairly short now. When I drove 45 min to an hour, I would listen to books that I downloaded from iTunes.

An incident report should be written. That is how we learn from mistakes and make changes to (hopefuly) keep them from happening again. And if you haven't, you should write one yourself so that when the incident is reviewed, whoever reviews them at your facility is able to understand how things happened from your point of view as well. You didn't say how much time passed between when the order was written and when night shift arrived, but I am assuming it was more than an hour or night shift wouldn't have been upset about it. Being busy when something is written does not relieve you of the responsiblity of checking orders, ESPECIALLY when you already know that you have given warfarin to someone with an INR of 5.5 and has just had an ischemic stroke. Physicians should not have to tell you that they wrote an order. You didn't mention having asked anyone for help...in these situations, if you're too busy to review labs and check for/carry out new orders, ask for help. You might get sighs and eye rolling but I can't imagine that a (good) charge nurse wouldn't be willing to jump in and at least help you out. And I am sorry, but you have got really horrible attitude. You screwed up. Everyone has made a mistake at one point or another. Lose the attitude, learn from it, and move on.

I wanted to work in the PICU when I went into nursing school. When the time rolled around to start applying for jobs (last semester of nursing school), it just was not an option. I was already working as a tech in the ER, and a lot of other people were having difficulty finding jobs so I applied for their intership and was hired. When I was offered a position in PICU at a children's hospital, I was sooo excited to be working my "dream job". The excitement was short lived though, because as it turned out, I pretty much hated it. A lot of my nurse friends found their "dream job" wasn't as dreamy as they thought it would be. Thankfully there are many different areas in nursing to persue!

My new grad internship in the ER was 12 weeks. There were tons of classes on top of the scheduled shifts.

When I worked in adult ER, pain medication was given IV push, and it was really nurse discretion if it was diluted in NS or not and how quickly they wanted to give it. In the PICU, depending on the situation and the age of the child, it was given on a syringe pump. I have never put pain medication into a 50 ml bag of NS.

Ours was a 'Capstone'...I did mine in an ER. I also worked as a tech in a different ER, and already had a job in the ER internship where I was working. I thought that it would be good for me to get a head start on the nurse role. I don't know that I would have done anything different but I would NOT recommend it to anyone else. IMO, the ER is not a good place for a fresh mind that's developing habits that will stick with them throughout their practice. Looking back, I feel like I missed out on a lot of the important pieces of being a nurse by working there straight out of school, but I digress. Where do you want to work when you graduate? If you have a good idea, try to get into one of those units. There were only 3 new grads in our internship program- myself and two other girls who had done their capstone/role transition/ precepting/whatever there. A lot of my classmates were given job offers from the managers on the units that they had done theirs in...so it could work in your favor if you go to an area that you want to work in. I don't really know that doing it in the ICU will maximize the experience, as it is so different from most other areas in the hospital and doesn't really paint a very realistic picture, unless you think you're going to work in an ICU. Good luck with your decision!