bth44

Is it customary for people to receive HIV test results in person only, even if the results are negative? I got paperwork back from the doctor's office, reporting all my pregnancy, pap smear, and STD tests as negative, but saying that the results of the HIV test have to be received in person. I was hoping some one here would know if this is just done for everyone because of confidentiality and legal reasons, or if I could have possibly had a positive result.

Ever since I graduated nursing school, I've worked at a reasonably-sized hospital, and the nurses only work with attendings there. Our hospital is considered a rural rotation. I only time I've ever met a med student was when one came in to shadow a family practice doc for a day, and I think I remember a student touring the hospital with a GP a while ago. So, the big change for me this month is that I've accepted a position at a very large university hospital in a big city. LOTS of students. A minor concern of mine is what to expect with all the residents and interns running around. I have no idea of the succession of medical student, intern, resident...is it even in that order? What's within each's scope of practice? Do I have to wait for an attending to give a looksee over orders before I act on them? How's their demeanor compared to attendings? Oh...are the attendings cocky because they have students under them? I'm sure that residents and interns are different from attendings. Can anyone give me any information on what to expect?

HAAAH! I thought I was the only one who noticed!!

I'm finishing up my resume, and I thought it was appropriate to include clinical opportunities that not everyone in my program was able to do. For instance, I listed, under my education of course, that I assisted school nurses with wellness checks, and worked with nurses in the state health department. Would including that be a bad idea?

I think I'm ready to leave my hometown and move to the next largest city. I've been a nurse for, hmm, a little over a year and half. When I got my job here, it was really easy, because I worked at the hospital as a CNA for over a year, so I pretty much just started working as a nurse after I got my RN license. And, I got the CNA job because I was a student nurse there. So, I'm a little ignorant at job search etiquette. Portland is about four hours away by car. I've made plans with my friend, whom I'll be living with, to go up there and look for apartments next month. I've looked at hospital websites and I see postings that would be a good fit for me, but I'm unsure of how to act. Here's my thoughts: Should I apply online at the hospital websites, and hope for calls back to set up interviews before I leave? Should I go on my trip without applying online, and then just visit the hospital recruiters and human resources offices, hoping that they'll have time to talk with me whenever I just show up? Should I apply online, and then visit without an invitation, and tell them, "Yes, I've applied online, I was just checking up on it"? Oh, and about online applications anyway: Is applying online better or worse than printing up applications and sending them off? Is it absolutely critical to have a resume? I know I could just call recruiters and human resources offices for more information. But what do I say when they answer the phone? How can I not sound like an idiot? I really don't expect anyone to answer all of these questions I have in my mind, but I'd love any kind of input anyone has to offer. Thanks in advance!

The hospital I work at uses summary charting. I find it's not working for me because I'm too wordy and I go on and on and do a lot of double charting. I'm trying to meet up with a supervisor every so often who's teaching me focused charting, specifically using the D A R method. I believe it stands for Data, Action, and Resolve (?). I feel I'd do better with it if I could read some examples in a book, or at least hear the basics from more than one nurse. This supervisor doesn't have the time to really sit down with me and chart with me at times. Does anyone else here use focused charting? Any websites I can turn to for help? Any examples of what will be good focused charting? I really want to become proficient at this type of charting, but I can't rely entirely on this one supervisor who has their own job to do.

That's a great idea too. Thank you!

I've developed a bad habit that's totally bit me in the you-know-where. I work on a med/surg unit that has 16 beds, my usual patient load is six to seven patients, and I get pretty busy most of the time. When I receive report at the beginning of the shift, I write down the assessments of the previous shift on my report sheet (lung sounds, bowel tones, colors of any drainage, etc.). I go do my assessments, then, if I assess something different in that patient from what I heard in report, I'll make a note of the new finding on that sheet by writing it down. If nothing has changed, I'll just circle the note I made during report, and then document what I circled as my finding. Then when I give a verbal report to the charge nurse in the middle of the shift, I just go by the report sheet. This has saved me time, but it's cost me a few things. What's happened as a result of doing this is that sometimes, I'll mistakenly circle "decreased lungs" when I heard them to be clear, then I'll relay the wrong information to the charge nurse. Sometimes, I'll say something like, "The stoma is pink...no wait, I'm sorry, it's really beefy red" when I've read the incorrect assessment note and corrected myself. This either results in my getting lectured for appearing to second guess myself, or what's worse, getting accused of not doing my assessments and just telling the charge what was going last shift and saying that that was MY assessment. The charge nurse assumes this because I'm reading from my report sheet. I can't really explain myself, because this certain nurse yells at me for making excuses, so I've just learned to say, "You're right, I'm sorry." Ugh. So, I've decided that instead of fighting her, I'll just improve myself and what I need to do. What I'm asking is, is there something online that I can use as a resource, or does some have a template that they use at work that they helps them make notes from their assessments? I'd like a "cheat sheet" that allows me to quickly (and accurately) make note of what I've assessed, and maybe even lets me fill in the blank of what IV fluid and rate the patient is getting, diet order, etc. I thought that my usual way of just circling each finding would save me time. It does, but it's not 100% reliable for me. I've learned that to do a good job, I need more structure and preparation. If no one has a template to offer, can anyone suggest anything else that's helped them that might help me succeed? I really want to make this change.

At my place of employment, you tend to get guilted into coming in. I'm nights, and we're understaffed and we get called in as extra staff on top of who's already there, too. In the past, when I'd get a call, I was empathetic towards the nurses scheduled and I play the karma card on myself and think, "Boy, I'd sure want another nurse to agree to come in on their day off and help me out the next time I'm sinking." The guilt trip I'd let the supervisor play on me, as well as the time and a half, was enough of an incentive to have me once work up to six nights in a row, have a night off (which all of us night nurses agree isn't like a day off at all) and then work another six. I'm exhausted, my performance sucked those days and I'm waiting impatiently for my first two nights off in a row since last month. Blegh. I feel so burnt out. From now on, I'll just say, when they call me at 9:30pm to ask if I'll come in at 11; "I'm sorry, I haven't slept today, I wouldn't be safe." :l

"distinct personality difference"? What differences do you see between the staff on the shifts?

I work in a 200-bed rural hospital. It's the only hospital I've worked in since graduating nursing a couple years ago, so it's the only thing I know. :) As time goes on, it's becoming more apparent to me that the staff on certain shifts are nastier than others. My shift (night) and the evening shift staff get along well and socialize a bit at shift change. But day shift on our unit aren't as chummy, they only talk amongst themselves when they arrive, despite attempts by my shift to make small talk with them. I've come to realize that this has always been the case, but recently, it's been getting worse. Some of them only say good morning to our shift after we tell them good morning first, but they rarely say anything to us. Actually 98% of the time, the only times that day shift says anything to us is to tell us what we did wrong the day before. When they say nothing to me except to tell me what I did wrong or what I should have done, it makes me feel like they think I'm incompetent. It's getting to the point that they don't even talk to us, and we just approach them if there's a change in a patient's condition while they were in hearing report. I know it shouldn't bother me, but they're so unfriendly that I can't help but to take it personally and feel bad. Everyone on night shift went to the manager in hopes that they can fix this problems between the shifts, so I hope the situation resolves or at least go back to the way it was when they'd at least say hi first. The question I have for all of you is this: I'm going to move to a larger city later next year and hope to work at one of the major hospitals. I worry if what's currently going on on my unit is the case at all hospitals. At my future new job, I really hope to work with friendly, helpful people who'll make me feel like I fit in, or at least give me positive feedback. Or should I just get used to other nurses (and shifts as a whole) being snobby to others like this?

Yep, I agree on that one. The 6th and 7th MUST be rationale and documentation.

Expiration date can be considered a right. I learned it as P-DART-E. Patient Drug Amount of drug Route Time and Expiration. I don't know of a seventh one, but if I can take a wild guess, I'd say Patients' birthdate? It helps ensure that the patient is who they say they are. I'm going to keep a lookout on this thread, because I'm really curious about the extra rights. :)

Your flushes sound like ours. They do say "0.9% Sodium Chloride" on them. And I thought about the morphine or other drug in the syringe, but then I thought about how the patient didn't have IV push meds ordered. I do know who wrote me up. On the incident report, the person who's reporting has to sign it.

I got written up for leaving a saline flush in a patient's room. I had went in the room with it already having the plastic cannula on it, ready to use, but the previous shift didn't tell me that the patient was getting an IV at TKO, so turns out I didn't need it. I didn't throw it in the sharps container. I think I left it on the IV pump. So, the next night, I received a med error report in my mailbox, saying I left a "syringe with an unknown medication in it in a patient's room". The patient didn't even have IV push meds ordered, and the syringe already had "NORMAL SALINE" printed on it, so it couldn't have been an unknown med. So, on paper, it just looks bad, when in reality, it's something that every nurse has probably done on accident without discipline. I'm starting to think that if the next shift has time to write up reports like this on me, then they're probably over-staffed or is out to get me. Has anyone been written up for something like this? Or have you written someone up for this kind of thing? I realize what I did was wrong, but filling out a report with "unknown medication" on it seems petty to me. This could have easily been resolved with a quick, "Oh, by the way, here's something to remember..." Any thoughts? And how can I defend myself well on this? It just doesn't look good when the only thing I can think of to say in defense was that I was ditzy at that moment.