OlivetheRN

I've regularly wrestled kids who are waking up from anesthesia. Not boring. Especially when the toddler is half my weight.... It will really be facility dependent on how "boring" it is. Are you looking at a surgical center or a hospital? If it's a hospital, is it a smaller community hospital or a large trauma center? PACU nurses are responsible for recovering patients from anesthesia. We give a lot of pain medication but are also responsible for being alert for changes in breathing, cardiac status, mental status, etc. A lot of patients are routine and recover and go on to to post-op or the floor no problem, but they can change on you at the drop of a hat.

Agreed. I used to work OR and the music variations where interesting. Probably my favorite was the vascular surgeon listens to things like Drowning Pool while doing amputations. It was perfect timing when "Let the Bodies Hit the Floor" was BLARING as he was handing off some guy's leg that he had just cut off.

I am great at doing a kids' first IV when they're in the 5 and up age range. I always let them see what an IV looks like and I retract the needle so they can hear the noise and see what's actually going to be in their arm and feel and touch it, etc. Everytime I've had the time to do that, the kid may cry while I've been prepping their arm and while I've actually done it, but they 9 times out of 10 don't move and definitely don't thrash around. Don't get me wrong, I still have someone else there lightly holding their arm just in case, but it's usually not needed at all. I'm also great at attracting behavioral patients when I work in that area. But hey, makes for an interesting shift lol

Last night I was in our behavioral area. I had 7 patients who were not going to be going anywhere anytime soon. I did my assessments, my room checks for the shift, pulled what seemed like 100 pills for my patients, had two patients refuse their meds, wasted said meds, had to give IM haldol to my little lady in the hall (who about got her leg up around my neck because we were all focused on holding her hands). We tried and failed to shuffle my patients around to make room for three more behavioral patients that showed up in the lobby in and amongst all that stuff that happened in my first 4 hours. After that it was cruising...checks, documenting hourly rounds, redirecting people back to their rooms, their was a straight cath on my hall lady when a room briefly opened up that we could do it in and change her in, then another IM injection, then just a lot of helping my coworkers with minor stuff (IVs, getting EMS patients settled, etc).

What will be challenging to one person may not be challenging to another based on a variety of factors, i.e. their strengths, their weaknesses, their background (have they worked in the medical field before and if so, as a CNA, an EMT, etc), personality factors (my slightly ADD type personality LOVES the ED and HATED a medsurg environment, so medsurg is "challenging" for me), and also what interests you. Your initial question does not have a one size fits all answer in my opinion, because there are a lot of areas of nursing that can be as challenging as you make it. In the ER I work in they are always asking for volunteers from various shifts to learn how to use a new piece of equipment such as our CHF vest we have and things like that. Your job and your area of nursing is what you make it beyond the required con ed you HAVE to do for the BON and your job.

I think that will depend on the type of acute care area you work in. Working in the ER, yes, I give a TON of IV meds, but if I'm working in our fast track area (or depending on how the night is going in our behavioral med area...) I will give a TON of IM meds. Tetorifice, toradol, sometimes dilaudid or morphine, I've given IM solu-medrol over there, muscle relaxers, and good Lord if we have to give the first Rabies vaccine, it's like a jigsaw puzzle figuring out where to put them all if the patient is on the heavier side (we will literally draw a diagram of where all their injections are going bahahaha).

Working in the ER we get patients and family members who are in high stress situations or, more often, are just impolite people who don't understand that their ingrown toenail does not take priority over the person we are doing CPR on in the next room or the person who is doing their best to die on us. Honestly, I treat them as I do the psych patients I work with. Establish boundaries, give them consequences for their actions, and follow through with the consequences. Im fortunate enough that there is one particular doctor that I work with who if he finds out that a patient or visitor is being abusive towards a staff member will go in the room a set things straight in a hot minute. "This is Olive. She is your nurse, not your verbal or physical punching bag. You will treat her with respect. Is there any part of that that you do not understand or that I need to clarify?" I love that man. Great, great guy to work with.

When I was working in PACU and would occasionally do days in post-op, there was one urologist in particular who wanted us to tell EVERY patient who was going home with a foley how to cut the port in the event that the Foley catheter got yanked on but not totally pulled out. Then there was another one who argued that that should be done for males but not females. When I moved to the OR if the two of them worked together on a case they would get on that topic occasionally and oh my gracious they would drive each other batty hah

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Girl (okay, I'm assuming here, forgive me if I'm wrong), it's been like 4 days! You gotta give yourself some credit where credit is due! The number of patients that you're juggling at one time is a lot, and as a new grad it's a steep learning curve with a quarter of that amount. As a PP said, focus on one task at a time until it's completed, unless of course an emergent situation comes up, then move on to the next. I don't use these for myself because I work in the ER, but you might benefit from something like a brain sheet to help organize your day and tasks. I did like them for when I was still in school and doing clinicals on med/surg floors. They helped me have a visual of what needed to be done all in one place without having to go into everyone's separate chart to see specific orders, med times, etc,and this may be particularly helpful for you given that you guys do papercharting. It also let me quickly do a loose plan of my shift (that usually went to $&*% quickly, but the thought was nice lol)

We have the same system of when we clock out we're asked did we take a 30 minute uninterrupted lunch break. My typical policy is to say yes if I did or if I didn't but had the opportunity to and didn't for whatever reason by my own choice and no if I didn't because I legitimately couldn't for reasons outside of my control. Luckily our management does not punish us when we answer honestly because our numbers for those shifts will generally reflect that we couldn't realistically take a lunch, even if staffing was appropriate because EMS was hammering us or we had 2 CPR in progresses come in at the same time, etc. I will admit I do miss working on a unit that would give us 45 minute lunches because "since we can't really do 15 minute breaks we just put it in with your lunch" and on busy days "sorry, we may have to cut your lunch down to 35 or 40 minutes cause it's a crazy day ya know" Those were the days man

I have yet to come across one

Pt had came in with complaints of constipation and abd pain. Had taken Epsom salts at home the night before and that morning. Wadled over to in room toilet with my assistance and had explosive diarrhea all over toilet and surrounding floor. Splattered up wall and up to my thighs. I had poo squishing between my toes....

Dude. I need to move. Most nights I'm lucky if I get 15 minutes to stand in the break room an inhale something. The other night my lunch was me eating a Tupperware container of strawberries and pineapple spread out over like 3 hours of my shift ducking behind the monitor of my computer at the desk and I drank half a can of diet Mt. Dew.

Our in and out kits don't have bags. Our female kits go into a tube and our male kits have a sterile urine cup in them. Everything in an in and out kit is sterile. As posters above have said, urine bags are typically not considered sterile which is why it's much better practice to get a urine sample from the port.

UNC Chapel Hill is on campus

Fortunately the number of IVs I have to do on kids is limited, because we don't have a peds ED associated with our ED. With that being said, I have had a run lately of about one shift a week I have to stick a kid and/or in and out them and then sometimes transfer them out to one of the other hospitals to be admitted. It's not easy, but you get better and you get help from your team. On days I knew who the kid IV masters were, and I know who they are on nights. Great teamwork is what makes or breaks an ED job for me.

Per terms of service we can't give medical advice. I would look at your discharge papers and see who they told you to follow up with, or go to your primary care doctor for further care if they didn't give a doctor to follow up with.

I'll agree with a PP about flipping back and forth wrecking havoc on your body. I understand how much it sucks to be on an opposite schedule from your husband, so on your off days you want to have a day time schedule. I did that for years. But I had to stop. Now I pretty much maintain a night shift schedule all the time, unless I'm getting ready to go on a vacation or something like that. I may go to bed a tad earlier and get up a tad earlier, but my body is a looot happier than it was when I was flopping back and forth. I also found that I all of a sudden stopped sleeping well aka woke up after a few hours when I had underlying stress that was getting to me. It was my PCP who figured that out and suggested several different things such as exercise, journaling, etc, but after a few months of that not working, what did work for me was an established bedtime routine and a prescription from my doc. The routine gets me to sleep pretty much immediately, med helps keep me asleep.

Obs units can be different from facility to facility. I have had the same PITA patient more than one shift in the same week either because they came in more than once or because they were still there waiting on placement (psych). At my previous workplace I came back to work the next night during a horribly high census time (flu season) and got the same patient assignment and had the same little old lady who was waiting on a bed assignment. Thank heavens she was nice and understanding. What makes sense and what actually happens aren't always the same thing.

Obs is probably not for boarders, it's probably for observation patients that can, as you said, do self care. In the ED, depending on the facility, it's not unusual to have patients waiting for a rather long period of time for a bed to open up on the floor once admission orders have been put in. One facility I worked in, it wasn't unusual to have admitted chest pain patients discharged from the ER after serial troponins came back negative, they had an echo and a stress test or some other combination of tests and cardiology cleared them. Where I currently work, during our peak census times, we will sometimes have patients waiting for beds for half a shift or more.

That is really, really very odd. I've never gotten a verbal job offer from HR without getting the pay details at the same time. Heck, when I was going BACK to a hospital system from another hospital system, and was doing my initial talk with recruiting, we talked pay during that phone call (granted that was a more unusual situation and she was feeling out how much more I was getting paid at the other hospital and how much negotiating she was going to have to do with her higher ups lol). I would definitely try and find out BEFORE orientation what your pay rate and any differentials are going to be. Not that there's much you can do about it, given that new grads are paid the same across the board, generally speaking, but still. It would be a pretty big downer to go into orientation and find out the pay rate is much lower than what other hospitals are paying new grads. Makes one wonder if that's why they hold off on telling you..

We do the same as PPs. All belongings are taken in triage and bagged, and they are changed into hospital provided clothing all the way down to their underwear. They get mesh underwear, paper scrubs, and non-skid socks. We draw blood and get urine to clear them medically and do a UDS. SI/HI patients automatically get a 1:1 order and it's up to the RN and MD discretion whether or not that's d/c'd once they're in a room and get a 15 minute safety rounds order instead. In our ED all the behavioral med patients are in one area (till they start overflowing into regular medical rooms) so we typically will d/c a 1:1 and do 15 minute checks like everyone else gets, which is really more frequent because there's a tech who sits back by those rooms and has eyes on pretty much everyone and there's also an officer there as well. We will use 1:1s for our SI patients who are actively trying to harm themselves in the room or SI patients who aren't back in that area in a stripped down behavioral room until we can get them moved. Then we have other policies like no silverware (even plastic spoons), no straws, no pens or pencils unless they're writing something down under supervision, no plastic med cups, no cup lids, no hot drinks, no hard fruits like apples, and no caffeinated drinks. No outside food. When visitors visit they have to leave bags and purses with the officer. We have certain visiting hours and certain hours they can use the phone which are posted. For some patients its overkill, yes, but when we explain the why behind it, "Yes, Ms. Smith, I understand you are not planning on hurting yourself, but for the safety of you, the staff, and other patients, we can't have personal patient belongings in your room with you" they understand, at least those who are A&Ox4 and aren't out in left field somewhere. Exceptions and modifications have been made before. A young adult came in c/o depression and triage didn't think that anything would come of it so they didn't dress her out or draw blood, but did take her belongings from her and leave them with me at the desk and sat her in a hall bed since she wasn't dressed out. She ended up leaving an hour later. Another time a patient came in manic...after being discharged from the inpatient that morning. She was going to be going right back to an inpatient bed. The day shift nurse had tried evvverything to get her into some paper scrubs short of bribing her with cash but she wasn't having it. Since they get direct admits in street clothes all the time and those were the clothes she left in, I wasn't about to push the issue and get her riled up and sent her to the unit in what she came in. Sorry, I started to ramble, but I work in the psych area generally at least one shift a week, and had recently worked at a facility with horrible, meaning no, policies for their SI/HI patients, so I'm glad you're stepping up!

We had a particular patient who was in the locked area of our ED where the rooms are camera monitored (including the bathrooms but the toilet area is blocked out) and he was being a particular moron and lost linen priveleges. He got a pillow with no pillow case, a bare mattress, and no blanket since he insisted on taking his linens off the bed and defecating and peeing on them. When he didn't have them he would use the bathroom. But we also limit them two a max of two blankets in that area and that are camera monitored by security 24/7 (which they are told as soon as they go into that area). In the main ED some younger patients will end up on a stretcher mattress on the floor if they insist on throwing themselves on the floor from the stretcher (rather than restraining them) or there was a guy who was looking for parts to pick off the stretcher to use as a weapon (we always take the IV poles off, but he had found some spring in between 15 minute checks).