AnnersRN

As a nurse who frequently orients the newbies- these are my 2 biggest pieces of advice... 1- BE CONFIDENT!!!! You may have only done something once before, or never at all, but read the policy/procedure and talk with your preceptor before you start... But when you are in front of the patient - act like you have done it a million times! It helps the patient with anxiety levels and helps them trust you the most! 2- time management is what will make you or break you. Come up with a strategy that works for you. Spending an extra minute to organize yourself before going into a pt room can make a huge difference. Do as many tasks/assessments/meds as you can in 1 trip into the room. Good luck! I hope you love your job as an RN as much as I do!

The thing driving me crazy lately- 3x this year- an ER nurse and a 3rd year Resident telling me a patient rhythm was junctional in the 30's to 40's... it was clearly 3rd degree heart block. Actually had a small tiff with the resident until the Cardiology Fellow backed me up :)

I am not sure about you- but i have seen some messed up stuff in H&P dictations (i once saw "ventricular assist device" dictated into an h&p as "ventricular cyst of eyes"). I would assume that PA could be just pulseless arrest, but the dictating doctor misspoke. It happens all the time.

I have seen this combination given in some NYHA stg III/IV heart failure patients with afib issues as well- but only once they already had a BiV pacer/ICD implanted. Digoxin is an Inotrope- so it increases the strength of contractions in the patient with left ventricular systolic heart failure. The reason that Amio would be used instead of diltiazem in these patients is because dilt is contraindicated in patients with systolic dysfunction. Now that you know why- this man still should have a dig level checked! He may have had one outpatient that hadnt made it to the chart yet that the docs knew about- it does happen sometimes, especially if the outpatient center uses paper charts that have to be scanned into med records.

Like someone had said earlier- I work at a Level 1 Trauma Center, so I choose to be paranoid about my uncommon last name (my family is the only one in PA). Also- My real name is Anna (which is what it says on my badge) and my parents dont even call me that, so to avoid confusion when I tell people my name is Annie, I wear my badge inside a pocket. Anyway- there is a website that makes really nice name badges, Teddy's Rainbow, Inc. and most of our nurses wear these nametags with our first name and credentials. It is very easy to see my name, and that i am an RN, in fact I find more patients remember my name this way.