RNbethy

I think you've completely missed the point with your sarcastic exaggerations. Team dynamics ARE important to saving lives. If they weren't important, ACLS courses wouldn't emphasize them so much. It takes as much time to calmly correct someone's compressions as it does to rudely take over his or her role... and I'd argue that it's more efficient. An empowering team dynamic will preserve brain tissue more effectively than a disempowering one.

I agree with Do-over. In ACLS, team dynamics are very important. We are taught to give instructions clearly and calmly and not to raise our voices. It might seem odd, but basic human courtesies also apply during an emergency because they MAKE THE TEAM MORE EFFECTIVE.... Imagine that! :) The code leader can instruct the new nurse to perform better in a calm, supportive manner in JUST as much time (maybe less) as it takes someone to take over. Compressions are NOT rocket science, and if someone is not doing them properly -- they can usually be coached quite easily.

I was already hired on a stroke unit and went through the interview process about a month ago, which was great. I felt prepared and confident during this interview! At this time, the manager only had part time work available, which I gladly accepted. More recently, a more full-time position came up, which I applied for. When I was called in for a second "interview," I assumed that this would be relatively informal and I didn't prepare much at all! I've had lots of other non-nursing jobs and have been promoted within the company and never required a second "formal" interview... When I got to the interview, there was a panel... and I felt my nerves kick into high drive... I tried the best I could, but it's hard for me to communicate clearly when I am unprepared and on edge. Now I'm second guessing a lot of my answers to the interview questions and the stress is eating me! I was extremely honest and forthright throughout the interview, but I could have given more details about why I am a great nurse. I found that it was difficult to find lots of examples when my nerves were on edge. I answered a few questions really well with great examples, but there were many vague answers as well! Any advise or words of encouragement would be greatly appreciated! I'm feeling pretty down in the dumps, and I'm hoping the company is not regretting hiring me in the first place.

Thank you for all of your comments. This advice was really helpful. I do value the practical experience thing because it is the only way one can actually make the theory useful.... Without practical skill, a nurse would not be a nurse. Thanks for all the great questions GrnTea! Some of them I didn't even think to ask, but they are actually quite interesting! I can't wait to ask some of them.

I've got a question about preceptorship... I've often heard that a preceptor prefers a preceptee who "does not act like he or she knows everything." But... how do I strike the right balance? Should I ever act like I know nothing about a topic just to make the preceptor feel good? I would like to be myself by simply discussing topics when I know about them and asking questions about topics when I don't.... However, I have studied many healthcare topics in depth (I am a science geek), which may be threatening to the preceptor... Still, I hate the idea that I have to pretend to know nothing about a topic... Won't "pretending" just make me look phony? I think I can balance this by acknowledging when I don't know something... Or trying to think of a question related to clinical practice that I do not know.... but I don't want to overdo this either!! Please help with some suggestions here! I messed up in a previous preceptorship (I think a lot of it had to do with a negative first impression), so further advice is needed :)

I feel so down about my preceptorship and need some motivation/guidance! How is it possible that I've done so well in all my clinicals, and now I'm told that I am at risk for failure? I'm so confused. When I started my preceptorship, I was motivated to learn and asked lots of questions. One of my preceptors held me back a lot from the very beginning. I told her that I needed to become fully responsible for my patients, and she told me that ICU was an advanced practice and that I would never be fully responsible. In spite of this, I continued to do whatever she allowed me to do and tried to have a good attitude about learning. There were many tasks that she wouldn't even give me the chance to do even though I felt I could learn them safely. (suctioning, taking blood from art lines). Now, my instructor is telling me that my preceptor thinks I do not take enough initiative, so I am suddenly trying to pick up the pace. After talking to my instructor, my preceptor is suddenly expecting me to take blood from the art line and do other skills that she didn't allow me to do previously. But it's all my fault because "I didn't take enough initiative." My preceptor told my instructor it took me 45 minutes to do a head to toe assessment, which is a huge exaggeration. It took me 40 minutes to set my alarm limits, do all my safety checks, record my hourly vital signs, do a head-to-toe assessment, talk to the patient about his concerns, and draw blood. I know that I am slow, but not that slow! I do not deny that I need to improve, but some of the comments seem unfair. My preceptor sometimes waits to give me feedback until days after the fact, and some of the facts, in my mind, seem twisted around. I am so worried about not succeeding in this course and do not know whether I should withdraw now to avoid a failure. Please help! Any motivation or guidance here would be greatly appreciated!

Have you heard about the street nurse Cathy Crowe? She's a Canadian nurse who has advocated for social justice and who is very inspirational. Check out cathycrowe.ca if interested :)

I feel so down about my preceptorship and need some motivation/guidance! How is it possible that I've done so well in all my clinicals, and now I'm told that I am at risk for failure? I'm so confused. When I started my preceptorship, I was motivated to learn and asked lots of questions. One of my preceptors held me back a lot from the very beginning. I told her that I needed to become fully responsible for my patients, and she told me that ICU was an advanced practice and that I would never be fully responsible. In spite of this, I continued to do whatever she allowed me to do and tried to have a good attitude about learning. There were many tasks that she wouldn't even give me the chance to do even though I felt I could learn them safely. (suctioning, taking blood from art lines). Now, my instructor is telling me that my preceptor thinks I do not take enough initiative, so I am suddenly trying to pick up the pace. After talking to my instructor, my preceptor is suddenly expecting me to take blood from the art line and do other skills that she didn't allow me to do previously. But it's all my fault because "I didn't take enough initiative." My preceptor told my instructor it took me 45 minutes to do a head to toe assessment, which is a huge exaggeration. It took me 40 minutes to set my alarm limits, do all my safety checks, record my hourly vital signs, do a head-to-toe assessment, talk to the patient about his concerns, and draw blood. I know that I am slow, but not that slow! I do not deny that I need to improve, but some of the comments seem unfair. My preceptor sometimes waits to give me feedback until days after the fact, and some of the facts, in my mind, seem twisted around. I am so worried about not succeeding in this course and do not know whether I should withdraw now to avoid a failure. Please help! Any motivation or guidance here would be greatly appreciated!

How do you manage thirst? I've been swabbing the patient's mouth with ice water and then suctioning. Can you ever swab without suctioning? For example if the mucosal glands are extremely dry and the patient has a CASS tube? How do you balance the need to moisturize the mouth and the risk of aspiration? I've heard that some intubated patients can have ice chips, so I am confused about this issue. Please help!

Thanks for the feedback... While I agree that all nurses should work nights, sometimes the short turn arounds are unhealthy. I will have to wake up at 2 am on Friday to make it to the conference on time (due to commitments at home). By the time I get home from the conference, I will be exhausted and the only way I will be able to stay up really late is if I take extra caffeine. Yes, I will do it... but nurses are undermining their own health by doing these short changes and it unfortunately does take a toll on quality care.

Is this something that I should be able to do? - Go to a critical care conference from 7am to 1630 on a Friday in another city with 3 hours total commute time - Then go to clinical for the night shift on Saturday night from 1930 to Sunday morning at 0745? I'm finding it so hard to switch my natural rhythms from days to nights, and need at least 24 hours when changing schedules. (this is also an important consideration for the patient!) However, are most students expected to be able to adjust to these kinds of schedules with ease? My clinical instructor told me I needed to "toughen up" when I mentioned that I might need to change this schedule to ensure adequate rest.

My patient is supposed to be extubated today, and I was looking for nursing research or review articles on how to best care for the extubated patient (I'm on night shift). I haven't found any info on this topic and was wondering if anyone could give some insight on what the extubated patient might need -- both physically and psychologically. This might seem like a stupid question, but in nursing you never know... there seems to be important theory behind everything. Thanks for the advice!

Thanks for the advice. This has been helpful, and I will try to look at the bigger picture here. It can be confusing when, in all my other clinicals, I have been responsible for documentation and communicating on some level to the doctor... And now to be held back here... I'm not saying it's wrong, but I'm not sure I'm meeting our course expectations... We are required to take on the RN's role in our preceptorship. However, I am also on a more intense unit (ICU), so I also understand why a preceptor might be more cautious... I'll avoid getting involved in the discussion between the 2 RNs.... I was only asking preceptor #2 about 'breath sounds' - #1 used a term I have never used before...I also asked #1 about the term, but there was no further explanation when I went to research it.... (which is why I asked #2 to clarify the next day). I have a feeling that this may cause conflict as I saw #2 questioning another nurse about this term, and the other nurse appeared offended. I just hope that this doesn't cause any ill feelings between us. P.s. Thanks for those summary sheets - they look like they will be quite useful :):)

I'm concerned about the 2 very different approaches that my preceptors have. By the 2nd day, my first preceptor wanted me to do almost all of the patient care and documentation, as well as multidisciplinary rounds. I was overwhelmed but also very excited! The second preceptor was a little more cautious, and held me back more (no documentation, no multidisciplinary rounds, no ventilatory suctioning, etc...). I like both preceptors, but I'm scared that the 2 different styles are going to conflict... How do I hold back with one and then put all the gears on with the other? Also, they have some different expectations, which seem minor... but may cause conflict. For example, one wants me to reposition the patient q2h while the other wants me to reposition q3h. One wants me to avoid double documenting, the other encourages me to overdocument to avoid legal ramifications... Today, I asked preceptor #2 to clarify something... and I think I ended up pointing out something that preceptor #1 was not doing correctly (this was not intended at all!) Now preceptor #2 wants to talk to #1..... and I am really worried about the conflict this may cause. So there are a number of issues here... I don't know what I should do. Should I work it out with the preceptors, contact my instructor.... or what? Any input would be greatly appreciated!!

Is this mainly for metablic acidosis? Or also for respiratory acidosis? Or both? My drug guide says metabolic acidosis, which makes sense since bicarb levels are lowered in metabolic acidosis. As for respiratory acidosis, in which bicarb levels are either normal or slightly elevated (compensated acidosis), adding bicarb would cause more side effects and would not be useful?? What's the correct way to look at this problem? Thanks