nurseladybug12

Shes a passive aggressive bully. I dealt with one and I left. Please research bullying in nursing, there are so many articles on it. I would look for a different unit to work on, I left the first one I was on and I am soooo happy I did because all of my co-workers now are nice, teamplayers, professional, and respectful. I would not even bother bringing it up to anyone, I would just get a Plan B and C and move on. Dont even give 2 weeks when you do find another job, tell them you are being bullied and leave and dont feel bad about it. Honestly, she's probably fat, ugly, older, and is jealous of the great qualities you have and the bright prospective future you will have since you are so nice and helpful and therefore you must pay!

P.S. What nurses get paid is far from fair for the work and the bs we put up with.

Do the lab then. If it is hard for you to relay empathy, it is going to be very , VERY difficult to feel empathy for pts that are literally driving you crazy and you will lose your patience. Many pts are non-compliant, drug seekers,and just plain rude, it definitely is not all sunshine and roses. These people are usually chronically ill and that tends to make them depressed, crabby, and non-compliant , which is very frustrating to deal with when you are trying to help them. So if you just want to be left alone to work and are not much of a people person, work in a lab. You only really know yourself.

It's a pretty wide known fact that nurses work holidays and weekends, maybe you shouldve considered that before you went into the profession...hospitals dont care about you celebrating whatever they need to be staffed. Sorry if thats rude, blunt, whatever, but I am sick of hearing about people needing this day and that day off , let's get real.

Actually, it is the nurse to patient ratio rather than the experience and knowledge of the nurses that affects pt safety more.

psh yeah right

I think it is hostile of the on-coming nurse to keep you in a room to assess a pt beyond checking their safety, IV, and ID because it is saying, "I dont trust you", it is saying " oh, you're not leaving just yet, I have to find some more work for you to do so that I dont have to do it" Nurses that usually do this always find something to nitpick about. We all know the other shift wants to just go home at the end of the night, why would you prolong it? Because they are being mean. when they question you about every. little. thing during report, things they could easily look in the computer about is part of this " i dont trust you, i want you to make my job easier on me so I will put you through the wringer". It is hostile. We have older night nurses doing it to the younger nurses on day shift and Ive had many nurses discuss it with me, it happens.

Well, when the ED calls us at 5 with report on a new pt and the pt doesnt hit our floor until 6:45, it sure seems like they held onto them as long as they could. And it does happen all the time. I would ask that the nurse please do a quick safety check of the room with you as part of report but you dont have time to do her assessment with her thats her job on her time they dont pay both of you to do it! And say it before you start report. We had a travel nurse do this to us, she would drag everyone in the rooms and fully assess the pts! It held us up an hour. She was gone before the week was over.

There's bullies too. I think nurses are more abused by their patients than by anyone else and it is not right either. I am verbally abused every shift. I have been physically assaulted a few times. I dont know if it's my floor or what, but I am starting to think there are more nutty people in the world than normal people, based on my clientele! The hospital definitely gets their money's worth out of me and plenty more. Florida nurses are not paid enough, and dont tell me the cost of living is lower here because it is not, Ive lived in CT all of my life and gas, milk, bread, electricity costs the same. Depending where you live in FL rent is the same too. I am still living pay check to pay check. I made more money waitressing. I honestly would rather live on a secluded tropical island with nothing but a hammock and just lay there, do nothing and have nothing and have no one bothering me. I feel like crying now thinking about going back tomorrow!

I document on fall risk scores as required, when pts leave the floor and when they return, because you never know what can happen when they are not on the floor, and sometimes the dr hasnt allowed them to leave but they choose to do so anyways, ie when they are on bleeding precautions and they choose to drag their hep gtt with them! ugh. So I always chart on things pts do that is against the better judgment of healthcare personnel and make sure to include that they were educated on this and that, verbalize understanding, but do x,y and z instead.

I think that since you work PRN and you do not have to deal with this pt on a daily basis, you should really reserve judgment and not call your coworkers lazy. I would look into whether or not this over-sedation is new or not, since you just noticed it yourself. If so, maybe his kidney function needs to be looked at.

Famous introverts: Bill Gates Abraham Lincoln Julia Roberts Tom Hanks Stephen Spielberg Steve martin Angelina jolie Gwyneth Paltrow Meryl Streep Diane Keaton Michelle Pfeiffer Kristen Stewart J.K. Rowling Barbara Walters David Letterman Johnny Depp Michael Jordan Al Gore Clint Eastwood Harrison Ford Barbara Streisand All these wildly successful actors are shy and yet they are successful, hmmmm , I dont think you should let it hold you back.

One time I was doing a female catheter validation in front of an instructor and I was very nervous, she rudely pointed out that my face was flushed and said " it's getting redder by the second!" I think some people are just purposely evil. I am a shy person also, I did not socialize much in nursing school and I got a few comments from teachers about how that would hold me back and it was also discouraging. After a year on the job, I can say that I dont feel all that shy anymore and your patients will appreciate a gentler approach to communication that a "shy" nurse can provide. Sometimes people are better with one on one interaction. Do not let those jerks discourage you.

I would say output of 23 ml in an hour would be priority over hepatic issue if this is a deviation from baseline. When output is this low perfusion is compromised and this leads to shock and death. If they are chronic renal failure than not priority. Hepatic encephalopathy pts can be confused for days on end and it takes awhile to correct, from safety stand pt you may want to check on them first see that they are safe then deal with low output.

The money is not that good. Most people live beyond their means no matter how much money they make. Nursing is not a guaranteed job anywhere you want to live. Nursing school was challenging, but the day to day tasks that we are ordered to do makes me feel like a robot with not as much autonomy as I thought I would have. If you want to interact with people, volunteer, pick up some hobbies. I am planning on going to PA school so that I may have an opportunity to be respected more, think more critically and independently and really problem solve for my pts, not just follow orders all day.

I took a human development class online a few yrs ago and I was also accused of plagiarizing a short paper. I was shocked because I had always been a straight A student and would never jeopardize my future edu/career with that especially after I already earned oneuseless degree and was doing pre reqs for nursing school. So I emailed the teacher and I politely asked on what grounds do you feel I have plagiarized I would like to see and she responded with a highlighted portion of a sentence out of a whole 5 pg paper that had come up in her program as "plagiarized". I responded and said I honestly feel highly insulted to be accused of plagiarism I am a straight A student I have another degree I was in an honor society blah blah I hae gotten As on all of your other assignments I would like you to give me the points I earned and deserve for my paper accordingly thank you. I definitely came off as stunned and aggressive but I was in the right so I didn't feel bad about it,too much was at stake to be messed with.

New recommendations from CDC that my hospital just implemented are that family members/visitors do not need to gown up in contact rooms, just wash hands in and out. This is because these bugs are out in the community. Staff needs to gown up because they are going from sick patient to sick patient. If you think about it, once these patients are discharged they are going to be touching the elevator buttons, using the restroom in the lobby, going to your local grocery store etc all without wearing gloves and a gown. You also dont "catch" MRSA and all of a sudden get a horrible life threatening disease from it. You get colonized with it, everyone has staph on their skin and some people have staph that is methicillin resistant. The only time that it may be a problem is if you somehow develop a staph infection on your skin sometime down the line and there happens to be MRSA in it.

"but this is a first offense and there is no pattern of malicious behavior at any facility I have ever been to in almost 3 years of clinical experience, administering many units of insulin within that time frame" -OP You say this was your first offense and you dont have a pattern of making mistakes- I think your thinking this way is an unsafe approach to administering medications because as "safe" as you think you are or have been, you still need to do your due diligence and do your 3 checks because everyone makes mistakes and all it takes is 1 to hurt someone. Don't be lulled into a false sense of security just because you haven't made a mistake yet. If you make a mistake that hurts someone, do you think they are going to say "but Nurse X is perfect she has never made a mistake before! All must be forgiven! " - no. If the syringe looked unfamiliar, why didnt you check out the scale on it to make sure you were pulling the correct amount? Either way, 3 units is usually a very minute amount compared to 30...My nursing school had and I am sure yours has a policy about near misses/ med errors and the consequences. 30 units of insulin is a fatal error, I gave 2 units of insulin to a pt once based on an incorrect BG and I felt sick to my stomach afterwards because those 2 units could have also had dire consequences. The mistake was caught but I think there was a lack of attention and critical thinking that lead to the error, and also with your apparent lack of preparation- you should have gotten report on your 2nd pt, not knowing the pt's meds-regardless if you were administering them or not, if that was your assigned pt you should have known them. To the RN you precepted with, you were unsafe. Why she let you continue the 12 hrs, I dont know, but I would have went to my CN or mgr and told them my concerns because it is unsafe and a liability to my license. Having almost given a harmful dose of insulin to a pt, you should feel humbled and accept that you need to repeat the semester and learn from your mistakes, stop dwelling on the HIPAA violation, you could have seriously hurt someone.

To preceptee:" Don't worry,you'll grow a thick skin in no time."

You can also shadow a nurse for a half shift or shift, call HR at a local hospital.

libran1984, are you a LPN or MA? I'm going to be blunt and offensive in my comment, sorry. I went to school with a lot of idiots taking prereq math, chemistry, and anatomy and phys who were repeating these classes for failing, some were repeating them for the third time, still hoping to apply to nursing school. I thought to myself , oh god if they cant even pass a basic algebra class or anatomy and phys, or take the time to study for these classes in order to pass or get some extra tutoring to make it happen, I pray they do not ever become a nurse. When classmates of mine failed nursing school exams in the first semester and would argue for points in the exam reviews and sound like complete morons because they lack critical thinking skills, I thought good riddance when I finally noticed these same people never came back to class again because they had to drop out because they couldnt hack it. Nursing programs are competitive and weed people out who are not dedicated and who dont show some form of intelligence needed to do the job. Nursing school is intense and life consuming and if you dont have the dedication to study, make hard sacrifices, and deal with writing careplans, which require critical thinking, at all hours of the night just before you have to wake up at 5 am for clinicals, then you just are not cut out for it because real nursing is much harder than all of this. I dont know what MA school entails but MAs dont know what nursing school entails either and I hate when people- PCAs CNAs LPNs who have not been through the rigors of nursing school presume to think they can do our job. Yes anyone can learn the hands on nursing skills, but do you have the brains to make it to and through nursing school, and pass the boards to be licensed to take responsibility for the lives of pts when crap hits the fan? It's insulting after all of my hard work and dedication to hear this.

1/3 of people are "shy". It is a natural part of human nature, so to say it is negative is wrong. In different cultures besides ours it is not looked down upon at all. I am shy but I have confidence when speaking to pts because I feel that I know what I am doing. Many of my pts have expressed appreciation at the fact that I approach them with a gentler tone and they say it is calming, soothing and have said that I dont give off a sense of being flustered or rushing them. I personally dislike when people are phoney baloney with fake smiles on their faces, I dont think it's therapeutic to approach pts as if you are taking their order at Applebees and need to blow sunshine up their butts to get a good tip. If you are genuine and caring in your nonverbal and verbal communication I think that is most important. As far as interacting with other professionals, if you are licensed and keeping your license is part of your daily motivation on the job, I dont think most people have a problem communicating what needs to get done for the pt.

It is important to know baselines when dealing with pts with so many comorbidities. With CKD, pts will have baseline H/H around 8/24 , blood transfusion protocol at my hospital is to transfuse at 7/21 and under. Pts with chronically low H/H have bodies that are accustomed to living with this and they will not be symptomatic. There is a problem when they are symptomatic- lightheaded, dizzy. The blood pressure 92/49 is not low-look at the MAP. If it deviates from the baseline, then yes it is low. With BP meds, Drs set parameters for when to give and not give. HR, SBP. I have seen orders that say do not give if SBP is less than 90. Ok, well if its not under 90, give it, their body can handle it and if you dont give it, their BP will not be maintained. There were times Ive given beta blockers to pts with bradycardia HR in the 40's, I had to ask the Dr about his rationale and also read the cardiologist note- giving the beta blocker in that case was intended to increase the contractility of the heart and to also convert his heart rhythm. As for blood loss-they will always report Estimated blood loss in the report after surgery, you will also get it in report from the RN in the OR before the pt returns to the floor. They knew how much blood loss there was and if it was a concern and there was a need to replace it, it was already addressed right after her surgeries. 300 ml blood loss from a chest tube is also not that concerning of a number over a shift especially if it is a new chest tube. I would say 500 ml is concerning. Hopefully the pulmonary specialist is coming in shortly after the pt returns to the floor to assess the chest tube and output himself, or comes in at least before shift change. If output was trending downward each shift, changing to serous color then all of a sudden the output is more and its sanguineous, then that is a problem. If her BP is lower than baseline and she is symptomatic, call the MD, they may order IVFs, they may order orthostatic VS, they may adjust doses of her BP meds-who knows maybe the night before she was very hypertensive and the Dr. increased her daily dose of a BP med and it just wasnt right for her. Also, the kidneys regulate BP, so with pts with CKD, you can see a wide variety of BPs in a shift from the same pt, high to low-I've seen 210's/150s to 70/30's in the same shift in in the same pt with CKD. She had a gastrectomy-how much of her stomach was removed? How much is her PO intake? That could play a factor in her fluid volume as well. Ca of 7.4 is not WNL, but for CKD, this is often a number you will see and they do not aggressively treat a Ca like this, they give daily medications to balance phosphorus and ca, usually around mealtimes-renvela is one that lowers phosphorus, ca/phos have inverse relationship in the body.

It is also ok on my floor to hang a bag of 500 ml or 250 ml NS with abx, we use it to back prime the line and set it for KVO with VTBI 20ml which will flush the line when it is done so no air enters the line when it is finished, it will also give you time to disconnect it so you dont have to run in the room right at 30 minutes when the pump beeps. I always charge the pt for the NS.

Your classmates will wish they were back in nursing school after they get out into the real world of nursing!