Never_too_late

So how do you cope? Move on? I have lived such an experience lately. A short staffed night with a highly acute pt requiring one on one care and the other patients on the unit (palliative care unit -hospital setting) paying the price. So many things went wrong, not as important as how I felt: inadequate, helpless, ashamed of myself and the team for putting ourselves in this predicament (why do we take in such acute/unstable cases when we are short staffed and worn down), anger afterwards. I have been doing palliative nursing for 2 years ( I am 50) and this is the first time I have felt this bad about things. A few colleagues (doctors included) showed concern for the situation we lived through that night, others were in two camps, the 'get over it' gang (this is about you, suck it in and move on, we all have bad days) and the 'get used to it' gang (this is about the health system and its just the way it is). I don't ever want my definition of palliative care to be: well, it would have been worse on a med-surg floor or in emerg but am I too idealistic? Do we just have to accept that sometimes things will go horribly wrong (from a personal point-of-view) and divest ourselves of a situation over which we had little control? I am having trouble doing that, I am afraid that it will become 'just a job' because that will be the only way to overcome these difficult circumstances as Leslie pointed out: the more you give of yourself, the more it takes from you. Any thoughts? never_too_late

Change the catheter every 3 days???????????? That's bizarre. Ummmmm.. not where I work. The dressing gets changed by Pain Service when needed but the catheter stays in as long as it works or whatever is planned for. It sometimes takes a while to get it to work just right and with the right med and dose. I don't see them removing it. As Epocrates once said : ' if it ain't broke.. don't fix it.' Maybe he just needs the practice:lol2: N_T_L

I would guess that a 'typical day' differs from one institution to the next. Here is mine: unit has 14 pts daytime ratios: 3-4 pts / nurse + 1 PAB (4 nurses) evening/nights: 4-5 pts/nurse + 1 PAB for evening only (3 nurses) nights : 7 pts/nurse + 1 PAB (if short 1 nurse) admissions/discharges occur at frequency of: death, transfer to hospice, or return home (some pts come in for acute pain crisis then go back home when problem is resolved). sometimes we go a week w/o a death sometimes we have 3-4. same type of care as a med-surg floor, just less of it: baths, enteral feeding, trach care or colostomy care or wound care, meds, foleys, Picc lines/port-a-caths, IV meds, tranfusions, seringe drivers, antibiotics, CBI, etc... Some pts are level 3 (treat reversible conditions) some are level 4 (end of life comfort care) Some days can be very crazy and then some: opiod toxicity, delirium, family crisis, pt/family support, labs, surgery!(for spinal cord compression, for example), respiratory distress, gi occlusions, nausea/vomittting ad nauseum, last hours of life, admission still dealing with cancer diagnosis (some people consult late and wind up on our unit really fast) .. basically these are advanced cancer cases with all the symptom management that goes along with that.. Doctors are amazing. We have daily rounds where nurses and doctors sit down for 30 minutes to discuss cases on unit. Of course, discussions occur one on one throughout the day. There is a staff support meeting every wednesday morning to discuss how cases affect us personnally. Thursday's, there is the interdisciplinary meeting: nurses, doctors, OT, psychology, music therapist, death bereavment specialist, volunteer coordinator, pain service nurse, etc... We all make time for these meetings, they are very helpful. We have 8 and 12 hour shifts. Staff pick the length of their shifts and suggest work days for a 6 week rotation. When I leave late, it is because someone died at the end of my shift or the admission we were waiting for came in really late. That doesn't happen too often. Sometimes we are short staff (only 2 nurses) or pts are tough cases to manage.. I have gone with shorter breaks.. but we get overtime for that. I have accumulated 15 hours time owed since september so I haven't gone over my hours too often. The hospital setting is for the pts whose symptoms are not managed so they tend to be the most difficult cases. I am on a great team and the work with this clientele is very rewarding. Was this helpful?

Hey everyone, Living in Canada. Male. 47. Single parent with 2 teenagers. Graduated July 2006. Passed Boards in September 2006. Got a full-time position (permanent!) at an adult teaching hospital. Work in the oncology/palliative care unit (presently on the palliative side). Work 12 hour shifts: day/night. Work with an amazing team of co-workers. Learn something new everyday. Sometimes go home exhausted. Always go home proud of what I have accomplished. Can't imagine myself doing anything else. This work is sometimes humbling but always very rewarding. Just thought I would chime in on positive note. :-) B

I'll be graduating next summer. I'll be 47 when I graduate. I did a 2 year accelerated program at a college (I'm in Canada). Other than being told: 'Gee! Your older than my dad!' a few times too many :), the experience has been overwhelming in a very positive way. It has already been worthwhile for me.. and hopefully for my patients! I have never looked back. Its hard work but doable. I am a single parent family with two adolescents and have managed well. I interviewed for jobs in december 2005 and already have a job lined up in a pediatric ICU. I can say that being older doesn't play against me at all. In fact, it has probably helped. Should he stay put for another 15 years in a job he hates!!! Anything but that. By the time I left my management job, I hated getting up in the morning to go to work... it was awful. I hated the thought of going back to school also. How would I cope? How would I be accepted by my younger classmates? Would I fit in? Would I have the energy to make it through the program? At my age :), I only have a 4-5 neurones left, would they find each other every morning and managed to synapse all day and let me learn something LOL It all worked out well. Doing something you love gives you plenty of energy. Determination and focus help you to get through exams and clinicals. This is simply the most amazing gift I could have given myself... regardless of the fact many thought I had early dementia or a major mid-life crisis going on. My current success (fingers crossed) and comments from patients, fellow students and teachers let me know every day this IS what I should be doing. If this is what your husband wants to do, I say go for it.

Thanks VickyRN! It wasn't the exact same post but it gave me the acronym: SBAR. I was then able to find the thread again, it was tips for first year nursing.. Maybe the SBAR is of interest to others again so I repost it here from the original threads: >>>>>>>>> There is a well studied "cheat" sheet call the "SBAR" - follows is short version S=situation - your name, pt name & room #, problem calling about B=background - date of adm, adm. dx. pertinent medical hx, brief synopsis of the tx to date A=assessment- most recent VS, O2, pulse ox, changes in assessment R= recommendation - if the dr isn't ordering what you think the pt needs let him know, our DR.'s tell us they want to know our recommendations even if they don't always choose to follow them (tests you think need done - xray, ABG ---meds needed ----higher level of care --- dr needs to see patient, etc) >>>>>>>>> We recently implemented the SBAR tool at our hospital in an effort to help new nurses, or students in making sometimes dreaded phone calls to cranky physicians. If it helps, great . I have heard that it comes from other hospitals in the US, and some of you may be familiar with it. Our new grads (and some "old" ones) have found it helpful to organize the info you want to present. This part is the actual worksheet: SBAR report to physician about a critical situation S Situation I am calling about . The patient's code status is The problem I am calling about is ____________________________. I am afraid the patient is going to arrest. I have just assessed the patient personally: Vital signs are: Blood pressure _____/_____, Pulse ______, Respiration_____ and temperature ______ I am concerned about the: Blood pressure because it is over 200 or less than 100 or 30 mmHg below usual Pulse because it is over 140 or less than 50 Respiration because it is less than 5 or over 40. Temperature because it is less than 96 or over 104. B Background The patient's mental status is: Alert and oriented to person place and time. Confused and cooperative or non-cooperative Agitated or combative Lethargic but conversant and able to swallow Stuporous and not talking clearly and possibly not able to swallow Comatose. Eyes closed. Not responding to stimulation. The skin is: Warm and dry Pale Mottled Diaphoretic Extremities are cold Extremities are warm The patient is not or is on oxygen. The patient has been on ________ (l/min) or (%) oxygen for ______ minutes (hours) The oximeter is reading _______% The oximeter does not detect a good pulse and is giving erratic readings. A Assessment This is what I think the problem is: The problem seems to be cardiac infection neurologic respiratory _____ I am not sure what the problem is but the patient is deteriorating. The patient seems to be unstable and may get worse, we need to do something. R Recommendation I suggest or request that you . transfer the patient to critical care come to see the patient at this time. Talk to the patient or family about code status. Ask the on-call family practice resident to see the patient now. Ask for a consultant to see the patient now. Are any tests needed: Do you need any tests like CXR, ABG, EKG, CBC, or BMP? Others? If a change in treatment is ordered then ask: How often do you want vital signs? How long to you expect this problem will last? If the patient does not get better when would you want us to call again? Guidelines for Communicating with Physicians Using the SBAR Process 1. Use the following modalities according to physician preference, if known. Wait no longer than five minutes between attempts. Direct page (if known) Physician's Call Service During weekdays, the physician's office directly On weekends and after hours during the week, physician's home phone Cell phone Before assuming that the physician you are attempting to reach is not responding, utilize all modalities. For emergent situations, use appropriate resident service as needed to ensure safe patient care. 2. Prior to calling the physician, follow these steps: * Have I seen and assessed the patient myself before calling? * Has the situation been discussed with resource nurse or preceptor? * Review the chart for appropriate physician to call. * Know the admitting diagnosis and date of admission. * Have I read the most recent MD progress notes and notes from the nurse who worked the shift ahead of me? * Have available the following when speaking with the physician: * Patient's chart * List of current medications, allergies, IV fluids, and labs * Most recent vital signs * Reporting lab results: provide the date and time test was done and results of previous tests for comparison * Code status 3. When calling the physician, follow the SBAR process: (S) Situation: What is the situation you are calling about? * Identify self, unit, patient, room number. * Briefly state the problem, what is it, when it happened or started, and how severe. (B) Background: Pertinent background information related to the situation could include the following: * The admitting diagnosis and date of admission * List of current medications, allergies, IV fluids, and labs * Most recent vital signs * Lab results: provide the date and time test was done and results of previous tests for comparison * Other clinical information * Code status (A) Assessment: What is the nurse's assessment of the situation? ® Recommendation: What is the nurse's recommendation or what does he/she want? Examples: * Notification that patient has been admitted * Patient needs to be seen now * Order change 4. Document the change in the patient's condition and physician notification. Link on Google. http://www.ihi.org/.../PatientSafety/SafetyGeneral/Tools/SBARTechniqueforCommunicationASituationalBriefingM odel.htm N_T_L

I'm certain I read a thread about this over the holidays: Giving report about a patient over the phone to a doctor. I don't know how old the thread was and can't find it again. It mentionned the details that should be transmitted to the doctor and it had a name, an acronym. If this rings a bell for anyone I would like to read it again. I have searched for it and have not been successful but I know its here somewhere.. Hope this rings a bell. Thanks. :) N_T_L

OK, I miss having time to develop and nurture a new relationship. My wife and I split 6 years ago. My new girlfriend made a run for it after 3 years once I had made up my mind (or lost it, she would say) and left my high paid job to go back to school full-time. None of this makes me sad..anymore. But what I wouldn't give for evenings spent with a significant other.... sigh.. N_T_L

Teachers may go off on sick leave, for example. Not much you can do about that. So, yes, changes can occur. Aren't you happy to get a new teacher if the ousted one was not providing you with good teaching? When you talk about failing, you mean this one clinical, right? If this new teacher is great and cares about you, he/she will work hard to make you pass. I think the school was not trying to scare you but to justify their decision to fire the other teacher. In my school, as of this year, all clinical groups are supervised by two teachers during the semester. Each cover a set number of weeks of clinicals and each is involved in final grading.. it should be to a student's advantage because personality issues or other grey zones are minimized because two teachers are involved... All I am saying is this can be a good thing...and if I was in your shoes I would be happy the school decided this matter was important enough to be taken care of now rather than make you waste your time during an entire semester with inadequate training... N_T_L

What you need.. every minute: determination: its not always easy but its worth it. hourly: a reality check..'I am not losing my mind, i am just in nursing school'. daily:a hug and a smile from someone who cares. weekly: a review of your planning and work-in-progress to make certain that you are not falling behind. monthly: a look back in awe at all that you have accomplished. yearly: a party to celebrate how far you have come. Never_too_late

Well.. I cover ALL my books. Don't we pay enough for these books? I want mine to stay clean and last a long time. Another plus is when textbooks circulate in the class because so many fellow students didn't bother bringing theirs, mine sticks out like a sore thumb. Its easy to spot.... so yeah... I think I am the only one...and people mock me....and I don't care. N_T_L PS I guess its funny because the only person covering his books is a grey-haired 40-something guy

This is my particular problem: a central auditory processing loss. I have been checked out by an ENT and an audiologist. I have borderline hearing but do not yet need hearing aids. The quickest way to describe it is that my brain receives all sounds at the same level and therefore can't pick one out to focus on. At lunch in the cafeteria, if several of us are talking, with all the background noise, I have a great deal of trouble following the conversation. So, I have adapted by getting an electronic stethoscope to take the stress out of evaluating VS. As well, the people who know me well in school (profs and students), make certain I haven't missed someting important. And in my work as a part-time Patient Care Attendant, when I pick up a call from Hematology, Microbiology, Blood gas whatever and they are transmitting results, I ALWAYS repeat the information..and nobody has ever been annoyed by this. That being said, for most of my daily activities, it isn't a problem...and I have done well and this shouldn't make things difficult for you in school. Good luck! Hope this helps.

Nylon belt and belt bag that carries stethoscope, scissors, tape, gloves, pen... Not too big. Would be perfect but haven`t seen anyone fashionably wearing one of those in a hospital uniform... N_T_L

Over the last week or so, I have consulted my school lab techs, various manufacturers and suppliers of electronic scopes, and you here at allnurses. Last week, on loan from the store, I took a Littman Cardio III home. Higher end acoustic scopes provide clearer sound (in some instances) but do not make the sound louder. So, that didn't work for me. So this week, I went back to the store and picked up a Littman 4000. First impressions are very good. It is not too heavy. I have no trouble discriminating among the various sounds I hear. As I test it more in noisy environments, the verdict will become clearer and final..but if this doesn't work... It provides an additional 20db of amplification. It has a visual readout of pulse which can be useful. It is capable of recording and therefore data can be visualized on a computer. This latter feature is way beyond my current (and future?) needs..all I want is to hear better. For me, this Littman 4000 may be overkill because of some of the 'bells and whistles' it includes but the pickins are small in Canada. Not too many models available from suppliers in Montreal(Canada) anyway. Littman 4000 and Andromed I-Stethos are all I could find. Buying from a local supplier was important in case the need for servicing comes up... If you have some form of hearing impairment (not enough to require prescribed hearing aids), the options are rather limited where I live. At least, that is my experience. I will be glad to put this little adventure behind me. N_T_L

Never_Too_late .. to start over again: For me Nursing is a major mid-life career change.

Hi Judith, Do you know if it was the HP-Stethos model you borrowed? Do you have a specific model number? What specifically 'blew you away'? Thanks :) N_T_L

Hi Judith, Do you know if it was the HP-Stethos model you borrowed? Do you have a specific model number? What specifically 'blew you away'? Thanks :) N_T_L

I guess it depends on you for the most part, how outgoing you are, whether you actively seek out new friends. That being said, I too have noticed the context isn't always on my side. In my school, nursing classes are organized into smaller groups (15) that are (after the first semester) made up of even smaller sub-groups. These sub-groups are people who have worked together before and have geled together nicely into a study group or something and are not particularly open to newcomers later on. Some people are just plain on a mission and don't have time or any inclination to make friends. Those that have a natural tendency to panic, find each other and encourage each other to do so.. Same for the really smart ones, who stick together. It is always interesting to look at the dynamics of people in these groups. Anyway, so much for my armchair psychology... :) I seem to always come across new friendly faces in my classes. Its a matter of slowing down and taking time to look around. My 0.02 N_T_L

>>> Chillywill, Thanks. I would really appreciate that. I may not be able to afford the 4000 but the 2000 is comparable minus the software and storage capability. Get back to me when you can. N_T_L

>>> Judith, Thanks. I guess you decided that the electronic scope provided better accoustics and you went for that. DRG, HP, ... that's what I worry about= Oh look at this new neat model.. but I guess I have to start somewhere. Are you worried it is more fragile than a regular scope? I noticed the warranties on the electronic models are 1 year against 5 for the traditional models. N_T_L

An electronic scope with a portable amp on wheels! :chuckle Would the electronic (read expensive) scope be overkill? I just don't want to walk on to the ward the first day wondering if I will ever be able to take a full set of VS..sigh... I guess, you're right, trying them out is the only way to find out what works for me. I was just hoping to 'run into someone on this board with the same problem. I can already see myself at the store: "Excuse me, could I see this stethoscope please and while you're at it, please extend you arm and make a lot of noise while I take it for a 'test drive' " Thanks N_T_L

Its funny because our teachers tell us that we will barely have time to put down our pens when writing our last exam before hospitals grab us. That is what the situation is like..we are told. I am in Montreal, Quebec and english and french hospitals work differently. In the french sector, you apply for A position and live with that until you have enough seniority but you will find work. So you might work the night shift for 10 years. In the english sector, you are on rotation all through your career (N-D-E), shifts are 12 hours so you get lots of days off. I think this is good for me. I am a part-time patient care attendant while I study and when I went to HR to sign my hiring papers they said: "..and when you are a nurse your pay will become x$ an hour and..."". For them, it is a given I will hang around and work there. Finally, for years, positions required university degrees. Now, with the shortages, most jobs require a university degree OR a DEC with experience OR just a DEC. I think this is also indicative of the shortages and the 'compromises' hospitals are willing to make to get nurses. Anyway, my 0.02. N_T_L

I don't know if this is the best place to post this but here goes. I am a first year student and have been practicing vital signs. BP is a real problem for me. Usually, in a quiet room, I make out the sounds fairly well. In a lab where there is plenty of background noise, I can no longer make out what I hear in the stethoscope. I have been diagnosed with a Central Auditory Processing Disorder. It is apparently a processing issue where my brain has trouble focusing on one sound when many are competing for its attention. In a crowded (noisy) room, I have trouble following a conversation though apparently everyone else can. Does anyone else have this type of problem? What I am looking for specifically are suggestions as to the best model of stethoscope to manage this problem without breaking the bank..unless I have to. For instance, a Littman Cardio III or their entry level electronic model or something else. I was told by ENT that 'boosting the volume' would help me to better distinguish the sounds coming from the stethoscope from the other sounds in the room. Any takers? Thanks N_T_L

We sometimes forget that Pediatrics is not just another specialty like Cardiology, Surgery, Oncology and so on. 'One size does not fit all' as the saying goes. Within Pediatric Medecine, and a Pediatric Hospital, you will find departmenst for each of these: Cardiology, Surgery, Oncology and more. In other words, you can do Med-Surg in a children's hospital. So, if you like pediatrics that where I would go, if that is possible in your area. Then, within the Pediatric Hospital pick a specialty: oncology, cardiology, orthopedics, whatever. Hope this helps.