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nynursey_ has 3 years experience and specializes in Med/Surg/ICU/Stepdown.

32. RPN-BC. Transitioning from MedSurg to Medical-Surgical ICU. Forever learning.

nynursey_'s Latest Activity

  1. nynursey_

    New RN having the worst time

    Like the others' have said ... it's been a month. I was never an RN in a NH, but let me tell you ... I am/have been a MedSurg RN, and > 80% of those patients are often NH patients in acute exacerbations of their illnesses. Should you ever choose to go into the hospital setting (and that's not to say you should--it's more of an IF you CHOOSE to), the skills you've gained working in that NH are going to be INVALUABLE and you are going to see your co-workers asking YOU for help. Keep on truckin', dear. A month is just a blip on the radar. Give it a year. Remember Patricia Brenner!
  2. nynursey_

    Horrible new boss

    I'm having this exact issue on my unit. Our new AN came in and she's an HCAHPS poster-child.
  3. nynursey_

    Throwing the Rubik's Cube at Nurse Burnout

    This article could not have been posted at a better time for me, both personally, and professionally. I am nearing the anniversary of my 3rd year as an RN and I often find myself swinging between two extremes: burned out, hysterical, and depressed versus passionate, over-the-top, perfectionist. These two extremes have haunted me since my very early days in nursing school; a result of 3+ years of bad habits I developed by criticizing myself for less an 90 points on exam, never allowing myself more than 4 hours of sleep the night before an exam, and many other similar self-defeating behaviors. I had always envied the nurses on my floor, who in the face of unspeakable stress in the nursing profession, seemed to be able to take it in stride; leaving the stress and the worry right at the time clock the minute they swiped out. I didn't understand at the time what drove these nurses to find love and passion in their career despite the challenges, but whatever it is, I wanted a piece of it. Your Rubik's Cube Theory is the epitome of self-care and balance; two things all satisfied RNs seem to have in common. It's sort of along the lines of "you can't pour from an empty cup" or "check your own pulse first." I have struggled for 3 years with crippling depression, anxiety, obsessions, compulsions, and physical illness; not as a result of my position as an RN per say, but as a result of my inability to balance work, life, and my own inner psychological issues (stemming from an extensive history of sexual trauma--just as yourself). So thank you for posting this. I feel more compelled than ever to focus on all sides of my cube, keeping in mind that neglect to one side only causes failure to the others. Fantastic article. Brava.
  4. nynursey_

    Trying to reduce supply waste

    I find one of the biggest supply wasters are improperly labeled equipment; graduates, bed pans, tube feeding supplies, syringes, IV tubing, IV fluids, etc. When these things are not properly labeled, they need to be thrown out as soon as the RN realizes the supplies may be out of date, and this leads to excess use of said supplies. It may be a menial cost, but over time, it definitely adds up. Do you have a materials coordinator? Someone that can help audit the most commonly used items in excess? That might be the first place to start.
  5. nynursey_

    Central Line safety

    I'd be interested to see if any best practice articles exist on this topic, but in the spirit that they don't ... Logically speaking, having an area on the lumen compressed for an extended period of time might promote kinking, which could then lead to small fibrin clots developing, loss of patency, and breakdown of the material (possibly leading to loss of access and/or infection). Part of ensuring patency in the line is making sure the clamps are in place, they release properly, the lumen flushes easily, and there is brisk blood return (in addition to assessing the site of course). I also agree with the previous poster that noted if PICC/CL clamps were required to be in fixed positions, they would be manufactured as such.
  6. nynursey_

    The worst.

    ​While I don't want to condone turning this into a night shift versus day shift post, I can say that I sympathize with those of you who hold it together on nights (for a point of reference, I work primarily day shift, with an odd 3p-11:30p thrown in for good measure). You're expected to be able to perform the same type of nursing assessments, procedures, and monitoring without 1/2 of the support (less depending on whether or not you work in an urban hospital with more than 1 on-call physician). Often times, the nurse acting as charge (or shift coordinator) has less experience than the least experienced shift on a day nurse and very little clinical support resources, if any. Many hospitals do not have evening/night ANMs (in fact, my organization is doing away with ANMs altogether) and thus the novice charge nurses are left trying to navigate patient care, bed assignments, and nurse assignments with little to no support, in addition to attempting to clarify orders once the ordering physicians have left for the day. It's a tough road to walk. We feel the squeeze on day shift, too. Believe me. One is not necessarily better than the other but each has unique struggles. I think across the board it's important to remember to be contentious to the oncoming shift's specific needs. It goes a long way towards making a difference and mending the us versus them mentality!
  7. nynursey_

    When to call a code

    My hospital does have a rapid response team, however an unresponsive person can go from bad to worse very quickly, so it wastes less time to call a code.
  8. nynursey_

    6/11 WILTW Unsupervised Chalk Use

    I learned ... 1. I'm eligible to sit for the ANCC Medical-Surgical Nurse certification exam. I have 90 days to test. I may (or may not have) thrown up a little bit when I found out. 2. A patient can refuse medications, assessments, and other nursing interventions, but be deemed to lack capacity to sign themselves against medical advice. 3. 12 hours is my limit on how much screaming, yelling, verbal abuse, and nagging I can handle from one patient (and their family). At hour 13+, I started to lose my cool, and demanded that the Nurse Supervisor come to the unit to help reign this family in. What can I say? I'm only human. 4. Extending some empathy and compassion to a patient with advancing Alzheimer's disease really goes a long way towards making their loved ones feel as though their family member is more than their disease. It's hard to remember there was once a prideful person in that body: a person who had a profession, education, family, hobbies, and who was once a contributing member to society. It's hard to accept these behaviors as manifestations of the disease and not as a representation of the patient's true feelings. I have learned, however, if you put in the effort to see past these behaviors, you'll find much deeper rewards, and help the patient more than you know. 5. RNs on my unit are far under utilizing PRN medications (this includes for anxiety, agitation, pain, nausea, insomnia, etc). This causes them to feel more stress and anxiety over things they could control if they'd just help themselves!
  9. nynursey_

    When to call a code

    At my hospital, a Code Blue is initiated when a patient is unresponsive: with or without a pulse, or has an absence of spontaneous respirations. These interventions typically necessitate ACLS protocol initiation. I don't care what any physician says. They don't decide whether I utilize nursing judgement to call a Rapid Response, Code Blue, or initiate chest compressions on a pulseless patient.
  10. Urban/Metro Hospital in NY High Acuity Med/Surg = 1:4 (as it should be standard), 1:5 (when our ANM refuses to assist in taking an assignment), or 1:6 (when the ANM refuses an assignment, there are call outs, bed access increases the census, and there are no floats available). I can't speak for other units, unfortunately, because we have so many separate specialty units, it's hard to know what their census' are, and what their ratios are. I will say that our new CNO has since decided it should be standard on my unit to do a 1:5 assignment as a flat ratio. I disagree very much with that decision.
  11. nynursey_

    Should I SUE?

    I'm having a difficult time wrapping my head around this situation. You were academically dismissed from your program for ...? Failure to rescue? Failure to notify? Safety violation? Unprofessional conduct? The first place to start is in reviewing the materials given to you by your clinical instructors/nursing program regarding conduct at clinical. There should be a section addressing dismissal criteria and/or punitive action. If what your situation entails is addressed in the manual and they followed protocol, unfortunately you won't have a leg to stand on. The nursing program, while you pay to attend the college, is voluntary meaning you can withdraw at any time, and you can be dismissed at any time, so long as proper procedure is followed. It's been my experience that many nursing programs function autonomously in the college setting, especially community colleges, and very rarely do TPTB get involved in disagreements between students and instructors unless there truly is some sort of legal situation to be uncovered. Your best bet is to schedule a meeting with the Dean of Nursing and ascertain WHY you were dismissed. Ask for the specific policy you violated, their rationale for feeling it was worth a dismissal rather than corrective action, and if it still feels unwarranted, then pursue speaking to your Provost/Dean/VP. Best of luck to you.
  12. nynursey_

    Best way to avoid bedside care?

    You may be right. I more meant for insurance companies since much of it is policy based. But it would definitely require looking into more.
  13. nynursey_

    ANCC Medical Surgical Certification

    Let us know how the exam goes! I have been on/off studying for a few months in preparation for mine and I'd like to hear from someone who has experienced the madness!
  14. nynursey_

    General Rules for Med Surg

    I think what you're referring to as "general rules" are really simply essential parts of knowledge of a clinical skill. For example: it best practice to flush a PEG tube with 30mL of sterile water prior to and after accessing a tube for bolus feeds or medication (unless otherwise specified by the provider). Many policies and procedures are put together following best practices. But always check your facility.
  15. nynursey_

    Gracious Patients

    I love when this happens. It's rare but it's definitely a nice reminder of the fact that our work is essential and important. I have had patients (and families) thank me profusely for simply doing my job. I appreciate it more than I can say but I always remind them it's not a necessity to thank me.
  16. nynursey_

    Best way to avoid bedside care?

    If you're absolutely positive that you have zero interest in bedside nursing (hospitals, SNFs, LTACHs, LTC) then I don't think hospital experience is a must. It will hone your assessment skills and clinical skills but if your goal is to work in a clinic for the rest of your career then it's not particularly pertinent. Not every nurse desires to run the every day rat-race of floor nursing. And I don't blame them. As for career options, consider these: 1. Urgent Care 2. Clinic 3. Private Practice (Primary Care) 4. UR (Utilization Review)/CM (Case Management) 5. Public Health (Education Focused) I hope these suggestions help! Good luck in finding that right fit!