mama2

I wish I could "turn it off"... that's part of my problem. I've been a nurse for 2 years now. Please tell me it will get better and that I will eventually feel more confident!

I know that we all make mistakes and that we are all human, but sometimes I am so hard on myself and let my confidence get so low that I start wondering if I should be a nurse at all. I love nursing. I love what I do. But, in the same breath, nursing totally stresses me out. Anyone else out there ever feel this way? What do you do to make yourself keep going?

obviously there is more to our protocol than I can write about here, but we have a very good success rate with keeping patients within their prescribed therapeutic range. A lot of patient teaching is done, and continuous monitoring. I think it's more of a headache when the RN's have to constantly ask the MD's what to do for every little INR change. If the patient is ambulatory, and cognizant, has been stable for X amount of time on a certain dose and has suddenly been eating a lot of cabbage/greens, and comes in w/ an INR of 1.8 I know I don't really need to freak out or ask an MD what to do. What works for one setting/patient doesn't work for all- but it helps when everyone is performing at the top of their licenses and can utilize critical thinking skills.

for those truly special patients, I say, (in my sweetest voice) "I understand how frustrating this must be for you, and I'm truly sorry that I am unable to get you what you are asking for. Let me transfer you to our practice manager, perhaps she can assist you further".

I've just accepted a position with hospice, and am excited and nervous all at once. Excited to begin a new career with an amazing team that I know is dedicated to compassionate care (they came in to my home to help my family while my father was dying), and nervous that I don't have the skills to be a great hospice nurse. I'm coming from ambulatory/community health center nursing, which seems like a totally different world. I want to be a great hospice nurse. Any of you veterans out there have any words of wisdom or advice for me? Books to read, or skills to brush up on? Anything? :) Thanks in advance....

I do a lot of telephone triage at my current job. Basically, you're answering patient phone calls and deciding whether they need to go to the ER, come in for an urgent visit, wait for next available apt. or try home care and follow up in a specified time frame. I bought a telephone triage book to make life easier, but eventually you get a feel for what questions are most important and which s/s warrant more immediate action.

We use a standard protocol for 5-10% increases or deductions depending on INR and therapeutic range. INR 5 or greater will warrant an MD notification (when 2- 3 is the range). If the range is 2-3 and the patient's INR is in the 4's, I will hold one dose or consider a 10% reduction in dose.

I've only been a nurse for 7 months now :)

I try to look at it this way- we are not losing skills, we are acquiring different skills. Acute care is completely different from ambulatory care- two different skill sets. I may not be using some clinical skills very often (straight caths) and some not at all (IV's). But, I have learned how to triage/prioritize large numbers of patients, have honed my assessment skills (it takes an entirely different kind of skill to be able to accurately assess someone over the phone!), have refined my teaching skills, learned the importance of family dynamics, referrals and follow ups, learned case management, and have learned to effectively communicate with other health care providers/ health care teams in our community. I LOVE my job in ambulatory care, and the best part is knowing that what we do on a daily basis helps keep our patients OUT of the hospitals, in their own homes, and helps them effectively manage their own health care. What could be better than that?! :)

Where I am in MA, we have prescription drug disposal drop-boxes at the local police stations. Call around- see if a program exists where you are, and if not, see about starting one! It's good for the environment, and keeps pills out of children's/teens hands!

Hi CarreBarreLPN, Typically, I was seeing about 16-20 clients per day in-office for "nursing visits", plus giving about 10-20 injections (immunizations) per day (to patients who were seeing Dr.'s), plus answering/triaging about 20-30 patient phone calls per day. I am scheduled 8 hrs. per day. Nurse visits are booked as 15 minutes each. I was the only RN, with 1 LPN. Thankfully, we just got another RN. We use an EMR system, and yes, I feel well trained on our system. If there were drop-down boxes for documenting nursing dx.'s and interventions, that would be extremely helpful. I have mentioned this before, but have recieved no feedback. And, no, I'm not the only one who is called out for not being able to leave on time, there is one MA who is also finding it difficult on a regular basis to complete all tasks on time. On top of what I mentioned above, there are also walk-ins, and "tasks" assigned by Dr.'s (mostly calling pt.'s about labwork, or calling to get more information about symptoms). I LOVE my job, but some days are just so overwhelming, it makes my head spin! :)

I love my job at a community health center! I have a ton of freedom, get to do a lot of patient teaching, dressing changes, suture removal, immunizations, coumadin clinic, routine sick visits like UTI's, flu swabs, and sore throats, etc. My favorite part is knowing that my assessment skills and patient teaching help keep our clients OUT of the hospital. :)

Someone clearly didn't see the DNR order...

I commend your enthusiasm :) You can start by calling the schools in your area. Find out what the curriculums are, and who the people are in charge of developing/implementing them. Lots of school nurses work with school social workers and teachers in developing curriculums for total health. Start by finding out what is being taught in your local district- contact the local boards of education, principals, school nurses, etc. See what exists and can be built upon. Just my two cents.... :) Good luck!!!

I need advice on how to handle a situation. My immediate supervisor- the practice manager at an ambulatory care clinic (who has NO medical experience whatsoever) has told me that she feels that I spend too much time charting/documenting. Honestly, I feel that I chart only the basics, and document only what needs to be documented. Most days, I have so much to do, I don't even get a chance to document the basics that I really should be documenting. If I stay even 1 minute past when my shift ends, she yells at me. I'm not sure what to say or how to say it. Any suggestions?

I'm right in the same boat with you- working 40 hrs a week, taking full-time classes to bridge from my ADN to BSN. I spend ALL of my free time studying and doing assignments that have so far, been only mildly useful to my worklife. My only hope is that once my BSN is complete, I might actually be CONSIDERED for a job at a hospital instead of LTC or clinic nursing, and nurses at the hospital here make almost twice what LTC or clinic nurses do...

JZ_RN, Thank you so much for sharing! Sounds exactly like what I deal with- at least I know now that I'm not alone!

I agree that triage is a different world- especially triage over the phone! I have only been doing this for a little while now, but it always stresses me out when after triaging, I determine that a pt. needs to be seen, and the next available appointment is like 3 months away! uggh. Then I have to go beg (a.k.a. advocate) for a Dr. to double book (or triple book) in order to get the pt. what they need.

We do bill for this! We use 99211 for all nursing visits. All nursing services are billed. We do simple visits like possible strep, possible UTI, BP checks, coumadin clinic, vaccinations/immunizations, etc.

I'm the only RN at the clinic/health center I work at, and if you are a pt. with acute pharyngitis symptoms, you will be seen by ME, not a Dr. or NP. I will assess, swab and do a rapid strep, and send out a culture. I can't believe they would make you be seen by a MD- that's crazy! I do the same for dysuria symptoms- assess, do a urine dip, send out for c&s.

Alright, I've been working in the clinic setting for a while now, but what still drives me absolutely insane is how many patients walk-in to the Dr.'s office demanding to be seen because they are experiencing chest pain. Really?! Why not walk-in to the EMERGENCY ROOM that happens to be about 2 blocks away?! I can't believe how many people every week are showing up in our office this way. Because we are a FQHC, we can't turn anyone away (that includes calling 911 to get them to the hospital) without seeing them. So, they get put into the NURSE's schedule. Then, I get to assess them, perform an EKG, administer O2, etc. until an ambulance arrives. Thankfully, only 1 person so far has actually had a cardiac issue going on. But, SHEESH! Anyone else experience this at their place of work? It's terrifying!

I felt this way at first, too! I went and bought myself a telephone triage book, and started compiling my own rolodex of phone numbers. You will get better with time :) I promise.

This drives me crazy where I work now...I tried correcting people in the beginning, but realized quickly that it was a losing battle. No one in the office wears their name badge except for me. *shrug* I guess I'm going to have to learn to get over it.

I say just go for the ADN! From what I understand, the difference in pay between ADN and BSN nurses is negligible, and you already hold advanced degrees, so the ADN would be enough I would think. Also, since you haven't started the nursing courses yet, you have no way of knowing if the field is "for you"- ADN programs are usually much cheaper, and you can bridge to BSN later, if you decide nursing is absolutely for you! :) I have my ADN, am in a RN to BSN program now, have 2 small children, and work as an RN. I had no problem finding a job with "just" my ADN. Just my 2 cents Good luck!