Buckeye.nurse

That's crazy Emergent!! I can't believe the medical staff doesn't have the various codes covered during their orientation. Code blue seems universal, but some of the other codes vary from state to state. For instance, Code grey was also used for a violent person in North Carolina, but means "weather alert" in Ohio. And Jedrnurse, we have a Code Brown in Ohio--it means "missing adult". Maybe someone forgot to check the bathrooms before panicking?? :)

The "Q" word is right up there with bored. Neither are allowed to be spoken during a shift!

I agree with Klone. The place you worked doesn't sound typical (or safe) TexasLVN. My employer has a policy/procedure database with a clear link on our intranet. You can view the policies from the default settings, or log in and save your most used/favorite policies to a separate tab. I love this feature for frequently used policies that I want to show to my preceptees. For many aspects of nursing care (PEG care, trach care, central line care, etc.) our policy is to use Mosby's nursing skills. We have a link to that as well and can search for titles or look up subjects by alphabetical letter. Finally, we have clinical practice guidelines with algorithms to guide us in situations such as suspected sepsis, neutropenic fever, acute chest pain, suspected stroke, etc. The guidelines have tools that include printable ACLS pocket cards, ISBAR guides for calling providers, and time sensitive best practice advice (ie. medication timelines for ACS, antibiotic grid/timeline for neutropenic fever).

Thank you so much for the article link, Neats. "How Doctors Die" is a truly eye opening essay.

There has already been some great advice given. I'd just like to add that, at least in my line of nursing--hematology, often times patients are grumpy, gruff, upset, or anxious because of underlying fear. They're scared out of their minds and have lost all sense of control. Sometimes what can help more than anything is to sit down and listen to them for 5-10 minutes. If there are misconceptions, I try to clarify them...or get someone who can. If they don't understand something, I educate them. But often, they just want someone to talk to. Stress management services can help a TON. Options available to our patients are aromatherapy, music therapy, art therapy, chaplain services, and mental health CNS. Above all, I try to meet my patients where they are at. At the end of the day I am walking out of the hospital while they are still there dealing with a very serious blood cancer. It's not my place to judge their mood.

I don't think that the 2 week notice has gone out of practice at all. Like a few previous posters, I've only left a handful of jobs (I've resigned a total of 2 times in my career). The first was my CNA job at a nursing home. They knew, months before my graduation, that I was leaving to work at a hospital as an RN when I passed boards. There were no issues, and I continued to work there until the week before I started my job as an RN. I gave a 4 week resignation the second time because I was a charge nurse. Again, there were no issues, and I continued to work (and train a new charge nurse) until I moved out of state. Giving notice always makes you look better, and nursing is a small world. As Annie said, don't burn bridges!

I agree with all of the previous posters about monetary donations. One unit that I worked on had a significant number of homeless patients on a regular basis. We noticed that social work generally would drop off scrubs and flip-flops if clothing was needed so we brought up the perceived need in unit council. After much discussion involving management, case workers, etc. we decided to start a homeless closet funded through unit council/sunshine fund money and donations. We stocked it with warm socks, sneakers, sweat pants/sweat shirts, gloves, and hats. Maybe a version of that would work on your unit.

Is there a nurse educator who manages your orientation? Do you meet with a manager to discuss your progress at set points during orientation? I'm a bit worried that you are at week 4 of 6 and only taking half an assignment. Do you work 12 hour or 8 hour shifts, and how many shifts do you have left before your orientation is set to end? I would strongly suggest that you ask to take 4 patients for your next shift. If you meet push back from your preceptor, then it is time to talk to your educator or manager. If you work 12 hour shifts, and have 6 shifts of orientation left, then set a tentative goal to take 4 patients for your next shift, then 5 patients for 2 shifts, and the entire assignment of 6 patients for 3 shifts (so that you can get a feel for what the workload feels like with the help of your preceptor). At my current job, a typical orientation for experienced nurses is 6-8 weeks depending nurse comfort, so speak up if you feel like you need another week!

Just my 2 cents on delegation of vital signs. The PCA (patient care assistant/associate) is responsible for the *work* delegated. IE. they were checked off in central orientation on the actual task, then checked off again during orientation on the floor. False documentation is a fir-able offense, and I have seen it happen during my career. As someone else mentioned, obtaining vital signs (along with accurate daily weights and I & O's) is some of the most important work that PCAs do. Trends can't be measured if vital signs aren't timely and accurate. As for the RN, we are responsible for the *results*, and any actions that need to be taken. We can't use "the PCA didn't notify me!" as an excuse for failing to manage a documented HR of 140, temp of 101.8, or B/P of 74/44 for example.

I know nurses who have taken both the AMSN and the ANCC med-surg certification exams. From what I've heard, the AMSN focuses more on body systems and disease processes, while the ANCC has questions related to delegation, collaboration, ethics, patient management, etc. in addition to disease questions. There is a *huge* body of potential questions that your exam can come from though, so results may vary. I personally took the ANCC exam from a purely financial perspective. My employer is part of the Success Pays program with ANCC, where we get two attempts, and only pay for the exam once we pass. Like Sammi, my employer gives us a raise for being certified (3.5%!) which is nothing to sneeze at, and it also ties into our clinical ladder program. For me at least, the actual studying for the exam reinforced my knowledge base more than the exam itself. I do feel like studying was an excellent refresher, and the CE requirements for certification renewal force me to continue to stay up to date with articles, classes, etc. Hope some of this rambling helps you, and best of luck! :)

Many years ago when I worked on a general med-surg unit, we had a psych patient on our floor who was a medical hold until a bed opened up at the psych care facility. He was convinced that he was a rapper, and was furious at us for keeping him from his concert in Chicago. He pressed the call light, and promised to give us each a Grey Hound bus if we would let him go. All I can think about is the Oprah Winfrey meme.."You get a bus, and you get a bus, and YOU get a bus!!"

Thank you for sharing your story Ruby Vee! I too was in an abusive relationship in my younger years. I went to the same ER 3 times for injuries (twice for a severely bleeding nose that I thought was broken, and once for a broken hand). I was never questioned further after giving suspicious reasons for the injuries, and was never offered help. Luckily, I eventually left my abuser, but I wonder if I might have left sooner if a medical professional had questioned my stories more thoroughly (and then offered help and resources!). One of the reasons I stayed so long is that I didn't have a clue as to where I might go. Now, as a medical professional, I take the safety at home questions very seriously. I've only had a patient answer no once--and when it did it took me by surprise--but the "No" answer ended up involving social work (who, by the way, are freakin' amazing), case management, our manager, and security.

Many (think hundreds) of potentially serious or life threatening medication errors occur at hospitals across the country yearly. They are often related to IV pump programming. Most of us would question giving 100 pills...and would call the pharmacist! However, accidentally programming in a 0 instead of a decimal point is not outside the realm of possibility, and results in an insulin gtt dose of 205 units/hr instead of 2.5 units/hr. Many situations just like this have been reported to the Joint Commission as sentinel events. Root cause analysis has resulted in best practice advisories such as independent double checks, smart pumps with guard rails, and pumps that program themselves from the computer MAR. Here are a few articles that go into more depth. (Hopefully they link correctly!) camh_2012_update2_24_sepdf.pdf SEA_11pdf.pdf

I'm so glad you made it through your illness alright. Yes, everyone should get the flu vaccine!! In addition to the Leukemia and Lymphoma website, cancer.net also offers excellent advice to cancer patients regarding the flu and vaccination-- How to Protect Yourself From the Flu During Cancer Treatment | Cancer.Net One caveat...get the flu vaccine *injection*. The nasal mist is a LIVE VACCINE and is not appropriate for anyone who is immunocompromised.

I work in the hematology-oncology world. Most of our patients have central lines, but occasionally they have PIV's. We use the peripheral IV as much as we possibly can for blood draws, especially since many of our patients are difficult to access, are prone to bleeding/bruising, and have labs Q 6 hours. Edited to add that, as another poster mentioned, our policy states that blood cultures can never be obtained from a PIV.

This reminds me of a book on my to read list : "Small Great Things" by Jodi Picoult. It's quite sad that a situation such as this is still happening outside of fiction. Small Great Things by Jodi Picoult

I believe almost all of the NPs at my facility were RNs in oncology before finishing school. At least a few of them worked in the outpatient clinic though, so I think either outpatient or inpatient RN jobs are viable for the experience you seek. I work at a large teaching hospital on a hematology floor. Inpatient side, 3 of our 4 heme services utilize NPs (although there is often also a fellow). The other heme service is traditional teaching with interns, residents, fellows, and the attending. During the week the NPs work 7am-7pm shifts. They manage medical care on their patients (the attending makes most decisions on whether or not to administer chemo), and do procedures such as LPs, bone marrow biopsies, placing short term CVC's, and giving chemo via an ommaya reservoir. We absolutely love our NPs! Outpatient side, Nps see patients on routine clinic visits in partnership with the hematologist. Many of my patients have developed close relationships with their outpatient NPs, and those NPs will come up to visit their patients when they are inpatient at times, especially when goals of care come up, or treatment decisions may be changing in a major way. There are definitely many career options for you at large cancer hospitals--from working on a hematology or oncology team to specializing as a NP on a service such as infectious disease or palliative medicine. Best of luck to you in your career!

I second everything Sour Lemon said. At my current facility, there is a visitor/staff/non-patient ERT we can call for any non-patient who needs medical attention. We can then begin first aid, v/s check, blood glucose check (there is an emergency visitor code we can enter into the glucometer), etc. until the ERT team arrives. The team stabilizes the ill person if needed, fills out all necessary paperwork, and then transports them to the ER if deemed necessary and the ill person agrees.

This post is a few months old, but I just got the nicest compliment from a patient this past week. She's been a nurse at another large hospital for many years. She told me that when she is well, she wants to apply for a position on our floor because "everyone who has cared for me has been skilled, compassionate, and seems to truly love their job. I've never seen that before."

The above tips are great. Know the experience and background of your orientee. The expected orientation schedule of a new grad is much different than that of an experienced nurse (16 weeks vs. 8 weeks at my employer). There's also a difference between a new grad who was a PCA in the hospital (knows much of the charting and some policies) vs. a new grad from a different background. Your approach will also vary greatly based on your practice area. The guidelines in med-surg will vary greatly from an ICU, ER, or specialty area such as bone marrow transplant for example. I personally work on a hematology floor. Most of our patients are fairly stable, but we do have intermediate care patients, and sometimes have 1:1 patients who are getting stage 1 clinical trials. I closely follow my orientee during the first 1-2 weeks. I give them 1 stable, non-complex patient the first day, and then slowly adjust from there based on their performance, time management, and comfort level. I try to find a balance where they feel somewhat challenged every day as their skills grow, but I also strive to avoid setting them up for failure. There will be times where you think your orientee can handle an assignment but things head south. In those cases I jump in quickly, help them prioritize, get caught up, and then review together at the end of the day. Even towards the end when the orientee is almost independent, I review orders/labs/meds/charting frequently, round on the patients we are assigned to make sure they are alright, and check in with the orientee at set points. Being available and approachable is very important. Orientees (especially new grad ones) are generally very task oriented. This is expected. I do try to help them see the big picture as time allows, and constantly look for learning opportunities. Finally, see if you can find online CEs for adult learning or assertive communication/constructive feedback type articles or videos. I try very hard to phrase all my feedback in the "I" format. So saying something like "I would probably do..." vs. "You should do..." or "You should have done...."is generally perceived better by the learner. Best of luck!!!

This is identical to our hypoglycemia protocol. We also have a prn accu-check order that is entered with the admission order set on all of our diabetic patients. This lets the nurse obtain an accu-check whenever and however often she/he feels is necessary.

We have yearly peer to peer evaluations as part of our performance evaluation. There's a few key differences from the format currently being suggested on your unit that are worth pointing out. 1) Our reviews are not anonymous. As many others have pointed out, negative feedback quickly grows out of hand when it can be done anonymously. Why do you think there is so much cyber bullying? When people can hide behind an online handle the gloves come off. 2) The feedback is structured into a survey monkey. Our administrative assistant randomly chooses 3 peers to send our review survey too, and then we get 3 nurses to review. The survey focuses on core performance areas, as well as areas the unit is focusing on (such as CLABSI bundles, etc.). There is an area at the bottom to write 3 areas of strength, and 3 opportunities for improvement. Many of us struggle to find 3 opportunities for improvement and resort to suggestions like pursuing clinical ladder or becoming a charge nurse. 3) There is no middle man. The surveys go directly to our nurse manager. She reviews the surveys, and then incorporates the results with our own self assessment and her review. She then sits down with us for 20-30 minutes to talk about the past year and come up with goals for the upcoming year. I'm with everyone else who said that a locked box on the unit will only erode morale. I wish you luck in navigating this tricky situation.

Here's a short video from the Oncology nurses society that outlines what is known about hazardous drugs and reproductive health. There is a reference list at the end of the video if you want to do more research. Knowledge is power. :) https://www.ons.org/sites/default/files/Nurses_Chemo_Pregnancy_What_Do_We_Know.mp4 Edited because I haven't had my coffee yet, and made a typing error.

Hello YoBee, Sorry for taking a few days to respond to your post. I don't get on Allnurses every day. The resource nurses are part of our float pool, and our nursing supervisors try very hard to staff 2 resource nurses around the clock. It doesn't always happen, but it's the ideal. When there is only 1 resource nurse, then a charge RN from one of the onc floors has to travel with the resource nurse to give chemo if needed in the main house (our cancer hospital is separate). I'm not sure what the standard is on other onc floors that give less chemo, but on the hematology floor where I work all of our nurses are chemo certified. The time line is to be certified within 3 months of hire if you are an experienced nurse. Our nurse educator purposefully makes the new grads wait one year to take the chemo classes. She wants them to focus on skill acquisition, disease processes, and time management before throwing chemo administration into the mix.

I've had many a dream when I worked night shift (and slept at night on days off), where I would sit bolt upright in bed, panicking that I hadn't checked on my patients in awhile. Probably the craziest dream I had occurred while I still worked in pediatrics though. I dreamed that I came to work, and was told that I was floating to the NICU. Upon arriving, the charge nurse handed me my assignment with the 3 babies I was responsible for on it. When I walked over to the first bassinet and looked inside it was a baby *SQUIRREL*! I looked at my notecard for the patient, and it said "baby boy McNut". All I could think was "I can't believe I got floated to the NICU to take care of a squirrel!". Then I woke up. Ironically enough, when I went to work, I WAS floated to the NICU, but I cared for 3 human babies. ?