gvernz

Years and years ago.... I did a precordial thump on a 36 years old woman who was having a unstable V-tach ; I was passing by her bedside when I saw her eyes rolled, loss consciousness to do precordial thump and her monitor promptly showed V tach.,I had no defibrillator beside me .Just had my ACLS class then so it was really fresh in my mind. Did the precordial thump and started cardiac massage at the same time calling a code. Our team was fast enough and we were able to revive the patient. That was one experience I won't ever forget- that was the one time I did precordial thump and it saved a life. The woman was very thankful when she was discharged from ICU.

Morning shift can be very busy. The culture of the unit as a whole also play a big factor in creating the "Team spirit". It takes only 1-2 person in the group to show inconsideration for others and "un-team attitude" to rub off on everybody in the whole group. I worked12 hour days and there are times that I get so busy with taking care of my patients that I don't even have time to void and much less, time to chat with other nurses during my shift.You have to be your "own man" because you cannot expect other staff to do your job for you and besides the other staff are probably having a time coping with their load as well. The only time I could claim my own during am shift is my lunch break and "pee" break.

When I first started my carreer as a nurse, I worked in a hospital where our shift is rotation...3 day shift-3 evening shift and 3 night shift and 1 day off before you start the rotation again. My sleeping time was really out of whack! My Circadian rythm is off and I did it for 7 years. I was younger then and enjoyed acytivities after work hours; bedise that , I was flexible. Then I migrated to another country and worked pm shift for a couple of years. That was the best shift for me because I am not a morning person and I liked sleeping in the morning and waking up fresh in the afternoon. When I get home after 11pm, I am able to watch TV til the wee hours of the morning and not worry about waking up early in the morning. Then I tried morning shift . Getting up early in the morning is not exactly my cup of tea esp if I had to wake up extra early during winter time to clean my car because of the snow that accumulated and nearly buried my car. Not good at all!! 11p-7a shift at a psychiatric hospital was bliss! Most of the patients at the Geropsyche ward are asleep by then because of the meds given during the day to prevent sundowning...Chart checking is more accurate. I loved doing it even though we have to do rounds every 15 minutes. 7a-7p shift in the hospital is really busy, most admissions and discharges always happen during the day; procedures, consults, Dr's rounds andof course, bosses are always around. The bulk of medication are given during the day. The advantage of am shift is that , there is a lot of help and you are able to communicate your needs to the administration. :nurse:7p-7a shift is more sedate and calmer, provided the "Sundowners" are not acting up. It takes only 1 very confused patient to act out or just one patient to have a "code" to make the night shift really crazy and draining. Add to that , is the fight against sleepiness.

I understand how you feel. A few of my family members often commented that when I'm on my days off, "my mind switches off" too. I guess subconsciously, for self preservation, my mind don't really want to deal with complex things when I am not working. I love my days off whenever I get them. When I am working , I am very focused and I problem solve all the time. Work takes a lot out of me. Like Mazy, my first day off is often fuzzy :singing:and all I want to do is sleep..

I am going back monday after 3weeks on medical leave. This is the first time since 2008 that I had a long vacation. It feels so good...! I was able to organize things at home and spend quality time with family. Shopping with cousins. Enjoying the flowers as they bloom. Perfection. I normally worked 12hr shifts 3-4 days/week and on my days off I pick up shifts from my part time job. And yes, I did not have time to stop and "smell the roses".

There was a time when I was working in ICU way back when ...that we had family members who can't afford to pay for mechanical ventilators and they were willing to take turns ambubagging while the nurses are taking turns doing CPR until a loved one arrives or until patient's heart rate showed asystole and the doctor would pronounce the patient dead. I am not kidding!!!! That is probably why I had back issues now, 14-15 years later. Cultural diversity also plays a significant part in these situations. In some cultures, DNR and ending life sustaining measures are frowned upon. Dying with dignity vs. dying a painful death. In some cultures, a family member who decides to end artificial life sustaining measures is considered disrespectful and will be judged by elders and other people.

Sometimes it is guilt and selfishness that motivates family members to act the way they do. Guilt, because they think that by trying to sustain a dying mother's life makes them feel better about themselves, absolves them from " not doing anything for their mother." I'd say we see it happen a lot. Selfishness because the intent is to show everybody that she is doing everything for her mother or in another tangent, it could be that the daughter is not willing to let go so she could still have her mother by her side. It is just sad, sad situation.

In the previous facility I worked with, we clean our nebulizer Face masks / hand held neb tubings with mouthpiece with 2:1 solution of warm water and vinegar. Rinse well and dry them in paper towel. Machines are just wiped clean with clean towels. Please don't use disinfecting agents as it is harmful to the patients when they use the tubings /machine for inhalation.

I ,too, had my fair share of being burnt out. There a time when I was having multiplejob assignments. Worked as woundcare nurse , 3-11 supervisor and doing the audits for psychtropic meds documentation such as behavior charting fora 180 bed capacity LTC. It was tough. Then the administrator quit and then almost 50% of the r RNs who worked for the facility for a long while up and left the facility. Then A few months after the DON left too . I was stuck because I had a 3 yeArs contract and I was barely a year in that facility when everything happened. Itwas no fun at all. We had agency nurses filling the gaps. No continuity. It was hard for everybody . Talk about hurting between the scapular area d/t tension. Dragging yourself out of bed to be at work on time. Unable to sleep at night because you are trying to think how to get everything organized at work or thinking about what it would be like inthe morning. Being so busy at work your energy is spent and all you want to do on your day off is sleep.

I beg to disagree about my country's student nurses being not intelligent enough to be in nursing school. Each university that has a nursing program in the Philippines has rigid rules in accepting nursing students into the program . We have this NCEE (National College Entrance Examination) which is equivalent to US' GED and most nursing schools ( during my time in 1991) , if I am not mistaken, would only accept 80 and above percentile rank. Aside from that , after a year in prep nursing school , nsg students have to go through nursing aptitude test which will determine whether they are eligible to continue in the nursing program. Competition is also fierce in the nursing school because most nursing students are the cream of the crop from their individual provinces. We have a lot of nursing graduates because having the degree as a BSN-RN gives us opportunity to go abroad and it is not only USA who benefit from FILIPINO nurses, China, Japan, British countries, Saudi, Singapore , to name a few. These nurses who work abroad had to go through a lot of tests too, to get qualified for their position. I know for a fact, because I had to go through the same experience when I started as a nurse. I passed my board exams in 1995 3 months after graduating from college, 1996 my CGFNS ( commision on graduates of foreign nursing schools) and then the ball dropped. US hiring was frozen. During my time, we had a lot of nursing graduates and everybody was vying for on the job trainings at various hospitals. I got lucky. I worked at a hospital for almost 7 long years before i was able to migrate to US after TOEFL, TSE AND TWE and a lot of US money spent on job application- my parents spent more than $3-4,000.00 to pay for my tests and job processing fees just to get to the coveted US job. I think there was a miscommunication somewhere regarding spending so much time about learning info in nursing schools and that majority don't pass. In the Philippine nsg curricullum, it takes 4 years to be BSN and be qualified to take the RN licensure. We do have the associates degree on the second year right after capping ceremony and it be somewhat equivalent to a nurses' aide or midwife( im not sure). The reason why this new nurse mentioned herself being a clinical lecturer/ instructor in a review class was because, it is one of the lucartive business in the philippines because there are a lot of nsg graduates hoping to get the chance of working abroad and they had to undergo a series of tests to qualify for a workers immigrant visa (EB3 for US and theres one also for UK). Filipino parents work hard with the intent to give their children a good future, Education-- this is their LEGACY. It is matter of family pride for a typical self-sacrificing Filipino parent to send off their children to college even to the point of selling their last piece of land or their only water buffalo (carabao) so they would be able to pay for their childrens tuition fees. In the Philippines, you have to have a college degree in order to land a decent job and even then...so much competition also....I guess the government is trying their best to better the system as with every other government. Unfortunately, Philippines is a third world country and still trying to improve the economy as much as help the Education system as much as they can. For a fact, I am proud to say that I know of a lot of nursing leaders in big hospitals and long term care who are FILIPINO nurses and I am pretty sure that their education has prepared them enough to be the nurse they are right now. I just have to say that because I strongly believe that whatever my mentors and my clinical instructors taught me at school, I am using it right now.

:yeah:

I guess you did what you think was right at that moment. I admire your passion and for standing for what is true and what is right. Unfortunately, your decision to stand for your beliefs gave the wrong impression to your superiors and instead of having a positive outcome, it went sour. Go back to that incident and in your mind's eye ask yourself this question? Did the patients benefit from what happened? Our patients always comes first, specially if it is a medication such as insulin and coumadin- they are high risk medications. For example, that specific patient could have had a high blood sugar result and needed the insulin right away, otherwise, the patient would be hyperglycemic and would have reactions if left unmedicated. Waiting for pharmacy to bring the medication would be a long wait and the patients should not have to wait that long. It is the responsibility of medication nurses to call pharmacy and fax them the RX number of the said unavailable medication. The facility must provide inservice /education to the nurses regarding following protocols in medication administration.

Tell you what, if you report it to the STATE would it do you any good? Try talking to your supervisor por DON. There is a chain of command, let your supervisors fix the problem internally , give them a chance to discover where they went wrong and try to find ways to fix the problem. Maybe the nurses that you worked with were told the same thing during their orientation. Maybe it has been a common practice among nursing staff and the DON was not even aware of it. Maybe there is a purpose why you are there in that facility. Maybe you will raise the bar on the nursing practice among your peers by being a good example; setting the new standard- BEST PRACTICE!. Remember, you are just starting in that facility, it doesn't make a good impression to be the "bad guy". Believe me, in my previous job we had a disgruntled employee who called STATE on the facility just to get back at the management for being fired and I don't know how the bosses discovered but they knew who it was when the surveyor walked in the building. You don't really want to earn the reputation of being a "tattle tale", DONS have their network among themselves and they asks for references on hiring new staff. Be smart, do not be impulsive and try to think things through before doing something drastic. Be cautious.

Working in Nursing homes /LTC have the pros and cons. I did work in a skilled nursing home/LTC for quite a number of years and currently , I am both an employee in a LTC ( as part-time)and hospital. My skills and time management has improved because I first started with long term care, managing different patients with a higher RN-PT ratio. Learning is subjective and is not limited to where you are situated whether you are in a hospital or in a long term care. It is how much you are determined to learn and how much initiative as well as enthusiasm you are willing to put into it. Yup! you are prone to mistakes because of the ratio but that makes you more aware that you need to raise your standards and there is zero tolerance for medication error / or judgement mistakes. There are always your managers and DONs and ADONs who will help you. All you need to do is ask for help when you need it. Yeah, Hospitals also provides us opportunities for education and I agree that there are more stringent rules in the hospital than in a LTC. I would say, whatever I learned from my LTC experience has helped me in a lot of ways working in a fast paced setting in a hospital.

Well, 15 years ago , I got myself into the Intensive Care Unit as a starting nurse and did not know much...hated psychiatric nursing, Endocrine, Respi and Cardio as my subjects at school. All I really wanted was to be a maternal-peds nurse, I thought I would make it my mission. For 7 years , I worked in a very stressful environment where you get "code blues" all the time, mastered CPR , suctioning and caring for stroke and intubated patients , at times severe traumas. For all it was worth, I loved what I did. Then I migrated here in US and worked in Long term care- worked as staff nurse then worked as wound care nurse and did part time psychiatric nurse. I loved doing it all for all my 6 years of crazy , busy schedule.In the last 2 years of my stint at that LTC, I was assigned as a nurse supervisor/ rac/ mds nurse. I loved it too. Then again , due to family reasons, I had to move to another state and became a Inpatient Rehab nurse, still loving what I was doing. I get to see patients come in my unit with severe one sided weakness or severely debilitated and unable to move and as the days go by improve their outcomes and see the wonder in their eyes when they start standing with a walker and take baby steps. In short, it is not the specialty, it is the sense of accomplishment knowing that you are a part of certain individual's progress; having a mission to help people get better and learn ways to improve your technique in giving care.