midnightRN

I prefer to stay home when sick; I think most of us do. However, a lot of us are limited by unrealistic work policies. At my place of employment, we are allowed five days a year before diciplinary action commences. Not very realistic when you consider that we work with sick patients daily. I wash my hands a bazzillion times a day. All it takes is that one patient who sneezes in your face, the co-worker who coughs on the phone, or for me, my kids coming home sick form school and wanting to cuddle with mommy. i can't count the number of times i've been sneezed on, coughed on, thrown up on, etc. I'd say it's true of ANY of us. I have come to work sick becuse it meant my job if I stayed home. Believe me, I very carefully consider when to call in, and when not to.

On the med/surg floors we have up to 6 on days and pms, then up to eight or nine (rare, but possible) on nights. In the ER we have 12 rooms and typically 2 RNS, a tech, and a triage nurse if it's really busy. ICU will have 1 or 2 ICU patients, or up to four telemetry beds; they can mix and match ICU and tele, but if they have a high acuity pt., they can over-ride for more staff. OB has thier own staffing grid based on labors and mom-baby. I still need the grid to figure out it out. I work at a small rural hospital in Wisconsin.

It is scary, realizing you are responsible for several patients. I started on the night shift and had 8 to myself within a month. Did I make mistakes? Yep. Fortunately, they were minor and easily corrected. On days at my workplace we generally have 5 on the med/surg floors. It take some practice and confidence, but I'm certain you can do it. The nice thing about the place you spoke of is that the staff there are supportive and friendly. If they have a positive learning environment and atmosphere on the floor, I'd recommend heading in that direction. I'd also recommend you take all of the orientation time you are offered. It helps build skills and confidence! Good luck!

I do know the union in question has a long history of representing nurses. They have represented another local hospital for quite a few years. The other hospital's nurses are very satisfied, from the few nurses I know that work there. I'm interested, but worried I might get fired for "signing up".

Hey all. I have a question about unions. What are the pros and cons of a nursing union? I'm not familiar with them at all.

I've got to agree with everyone else. This doc's behavior was wrong. I've never has to refuse a procedure (would have refused this one), but I've had to politely state "Dr. I think the patient needs something for pain," during a chest tube insertion. He wasn't thrilled, but did numb the area more. The doctor shoud by reprimanded. I'd contact the nursing supervisor, and ask that an incident report be filed, and that the medical director review it.

I'll let you know when I get there! Most days I leave work and think about what I should have done, and will do next time if...I can say I always do my best. I've been a nurse a little over a year. Some misguided knucklehead nominated me for a "nurse excellence" award; I just found out last week. I work with some truly gifted nurses, I'm still not sure why they nominated me! To answer your question, I think all truly wonderful nurses know there is always something new to learn, or an area of knowledge to develop. There is ALWAYS more to learn. It's still suprising to me when I talk to family members and think, "Whoa, I knew the answer... where'd that come from?" You know much more than you think you do, I'm sure of it.

Don't be discouraged! I'm planning on going into psych when my contract is up. Truth is... psych issues are everywhere, in almost every patient! Just last night I took care of a guy going through DT's in ICU. I get the same kind of feedback, but I like what I like. Hang in there!

I read the post and thought I'd reply. I have been an RN for a year. Like you I LOVED psych in school, and was also told I did really well there (they offered me a job). Because the facility was 50 minutes from my home, I started in a local hospital in med/surg. I'm okay with med/surg, but lately feel a bit burned out. I'm here at this forum because I'm thinking about driving the distance for a job I hope I love. It's hard to make the right decisions, but the beauty of nursing is it's diversity and opportunity. My only limits are location!

Isn't it the truth about that darn toilet! I had a patient who stopped breathing while on the toilet. We carried her back to bed, and a sternal rub later, she "pinked up" and resumed breathing before the code team got to the room. The first death is probably the hardest. Not long ago I posted about another horrible experience. I felt like qutting too, and as though I wasn't cut out for nursing...hang in there, it gets better.

I've been a nurse for about a year, and am pursuing a NP degree, though I won't attain it until at least 2009. I work on a med/surg floor, and would suggest it as a place to start. The reason I do is because here you see a wide variety of the conditions you'd see as an NP. Diabetes complications, CHF, MI, wound care, pneumonia, influenza, etc., etc. I suppose the bigger question is- Do you know what kind of NP to be? Another thought is to work someplace that allows you to cross-train on other floors. It's be easier to find out what you love, and what you are best at that way. Above all, pick a place you'd like to be at for at least a year. You have to like what you're doing. Best wishes! Anna

I'm on night shift, and wake up my patients do an assessment. The question is when. I work 12 hr. shifts and if I have not seen them at 7pm, then I wake them at 2330-0000, to make sure everything is as it should be. I do a an assessment focused on the admitting problem, but assess everything. We team up with the techs and get VS at the same time, so we don't have to wake them more often then needed. If they're stable, I'll wait until lab or the morning med pass to assess them again. If needed, if there are changes from an earlier assessment, or if they are unstable, they get woken up. If they get cranky, I try to explain that this is the service they pay for in the hospital, and yes it stinks to be woken up, but it's necessary. Most are okay with that. On nights we usually have 8-10 pts per RN. Neuro checks and detox pts. are woken more frequently. Of course, we let them know they will be woken frequently and why before bedtime, so it's not a surprise. Sincerely, Anna

Thanks. I don't trust my instincts enough. I also charted everything. I wish I'd been a better pt. advocate. I can promise I will be next time. Sincerely, Anna

Here's the story... At 2330 I picked up 2 pts. on my m/s floor giving me 8 total. My pt. b. after assessment showed these abnormals: BP 60/30, R 28, P 89 apical and irregular, peripheral pulses weak but palpable. Pt. denied any s/s of hypotension, pain, discomfort, nausea. His mentation was normal for him; he's only ever been oriented to self, but will respond appropriately to most other questions. He was repeatedly trying to get oob without assist. Pt skin turgor was poor, he had mottling at the knees, abdominal sounds were very hypoactive. I reviewed the chart and noted that the bp was the only change in pt. condition since the 13th. I called the MD who increased iv fluids, and at that time i asked to provide the pt. with 1:1 supervision because I did not want restraints and we had an extra cna that night. This pt. repeatedly was climbing out of bed and pulling on lines. He said ok. So I completed the orders. I reassessed the pt. again at 0200- he was the same, and at 0430. At 0430, he was noted to have no output, and his lung sounds were becoming coorifice at expiration. I had and experienced Rn come in to assess him, to be certain I was not missing anything and to verify my assessment accuracy, as I was concerned. I'm a new grad as of Dec. I tought I'd call the MD. I asked the experienced nurse If I should call the Md with these changes, and because the pt. condition had not improved. She asked me what I thought the doc would do. I replied that the only thing left was to transfer him, but I'd feel better. She sid to try and wait until 0500. The pt. was responsive at this time. He is 84 years old and a full code, by the way. The doc walked in at 0500, and quickly walked in a pt. room to see a new admit. I had to see my other pts. , so I wrote a note with my concerns and put it on top of the pt. chart, and put the chart on top of the new admit chart, and went to see the other pts. About a half hour later, the cna who had been with the pt. runs in the room I was in and states the MD wants to see me now. I go into b.'s room, and he's on the verge of a code. His color is gray, and he's agonal breathing. I start bolusing him and transfer him to ICU where he codes within 30 minutes of transfer. Now the Md is pissed. I am upset. What should I have done differently? Please be kind, I cried the whole way home. I should have called the doctor at 0430. Thanks, Anna

Wow, what an orientation. As a new grad I was oriented to the medical floor for about 2 months, took a full load on day 2, with my preceptor taking a smoking break every 2 hours. This is on the night shift, so the patient load is usually 8-9. This is without a HUC as well, which translates into the RN doing all the paperwork and assembling the charts for new admits. When going off of orientation, I asked if I'd have help if I needed it, and was assured I would. Half the time there is no in house supervisor. My goodness, was I gullible. I don't mind the medical floor, but do get frustrated with the patient load. If you get just a couple who take a turn for the worse, we all suffer (patients and nurse). I've signed an agreement to work here for 3 years, at this point I'm not sure I'll stay. Every area of nursing has it's problems. Hard to know if the grass is greener until you actually get to the other side of the fence, then it's too late. It's nice to here about a fantastic start to nursing in a facility that promotes it! Sincerely, Anna