lovin

I entered nursing with a similar background - I used to teach 7-12 grade Science and I have a BS and MS in other fields. I did a 12 month accelerated program and LOVED it. The great thing about accelerated RN programs is that most of the people there are motivated to succeed. We want to work hard, get out and get a job. My accelerated class was full of interesting and fun people who I enjoyed seeing everyday. All 30 of us passed the NCLEX and found jobs within 12 months - most had jobs at graduation. I have been working as a med/surg tele RN for the past few years and it is great. Yes, there is administrative BS, but I get paid better than I did as a teacher and, honestly, I like not ever having to worry about grading and lesson planning in my free time. Now, my free time is my own to spend as I see fit. P.S. THere were 2 other teachers in my RN class and they LOVE nursing - one went into Peds and one is a Psych RN.

This used to be me. I really miss the days when everything was new and I was just so darn grateful to have a job. Now, I am definitely more jaded and slightly less patient than I used to be. BUt, I do love having new nurses around to remind me why I became a nurse in the first place.

Thanks to everyone for your responses. I like the idea of a system that documents carbs as the patient orders meals. Even if they don't eat everything, at least it provides some data. It seems like a simple reminder to save the dietary sheets for the RN would be easy. Do you think it would be inappropriate to have the aides or the patients write how much of each carb item was consumed on the sheet? Or is that delegating assessment? I am anticipating a lot of RN unhappiness if we take something that is currently in the realm of aides - documenting meal % - and adding an RN task - documenting carb intake. However, it is a little crazy that right now we are giving insulin without taking carbs consumed into account at all.

I agree with the above, take a break. Once you start, I HIGHLY recommend getting a few NCLEX books and then studying for tests by going through questions related to those systems. The 2 books I used for fundamentals are listed below. Both of these books have sections that are relevant for fundamentals and then you can move on to the other sections when you get to med-surg. I liked the review of systems done by Hogan more than I liked the Saunder's book. - Prioritization, Delegation, and Assignment by LaCharity, Kumagai, and Bartz. - Comprehensive Review for NCLEX-RN by MaryAnn Hogan GOOD LUCK!

applewhitern. Thanks for taking the time to respond. We also are not in the practice of counting carbs, but occasionally have a diabetic on a pump who records this information themselves. The reason we change the system to have the RN count carbs and document that count is so that the provider would have more information to guide them when making decisions about insulin prescribing. We also have some providers order prandial insulin and RNs are dosing based on %meal eaten rather than %carbs. Most of our patients do not stay in the hospital very long, but while they are inpatient most are managed with insulin only. As for what happens when patients are discharged, that can be tricky, most of the time RNs and Diabetic educators do not know in advance what regimen patients will go home on - if they were well controlled they go back to what they were using prior to admission. From a teaching stand-point, it would be AMAZING if this were addressed prior to discharge. Finally, I don't think having RNs count and document carb intake would interfere with patients who have control of their diabetes without carb counting at home since this would just be done as a measure to help control blood sugars while in-patient. But, it can also be a teaching point for patients that have high A1Cs and Type Is.

I agree with many of the positive things here. Med-Surg is not just a starting point until you can get into a better specialty. For me, and for many of my passionate and amazing co-workers, med-surg is our top pick. I love my conscious patients and the opportunity to be there for them and their families for 12 hours. I agree that there are days the patient load can be absolutely overwhelming and I worry those days about not being as safe or as thorough as I would like to be for each patient each day, but I do what I can, have a glass of wine and come back to do my best the next day.

Hmmm. This is an interesting point, do we need to like our patients to give them high quality care? I try to give everyone my best regardless of my personal feelings for them. Personally, it rubs me the wrong way when someone assumes that because I have seen intimate parts of their body, or because I am caring towards them that it means that we have an intimate bond. I am a nurse because I care, but often, it is my professionalism that drives me to do the right thing for each patient, each day not my personal connection to the patient. I see everyone's point about emotional instability and illness and it is probably one of the things that I have the hardest time helping my patients with. I am very much a see a problem and fix it sort of person. Have you ever tried talking to a patient about their fears, emotional state, etc. when they are being inappropriate with the type of relationship they are trying to have with you?

Hello, I am getting involved with diabetes management at my hospital and one of the recommendations has been to start having RNs document carbohydrate intake for patients on insulin. Dietary sends up cards with each meal that shows the CCHO count for each item, but documenting what is eaten would be an extra task for RNs. Does anyone out there work at a facility that has RNs count carbs? How does it work? Do physicians use that information to guide treatment? Thanks for any input!

I am pretty good at letting things roll, but for some reason this patient got under my skin. As a nurse, I am sometimes in situations that are personal with my patients, but it bothers me when patients then assume that our relationship is personal rather than professional.

Don't quit. Sounds like you are a conscientious and caring nurse and that you did everything right including assessing your patient. Just keep reading the drug book before administration and go slow with IV meds. Be gentle on yourself.

I had a patient today who claimed that I was "dumping" him because I transferred him to a higher level of care. This is is what I wished I had said, "It is not my job to be friends with my patients. It is my job to take care of you while you are here. To look at everything, even your member, especially if you tell me it hurts and you have a foley. It is my job to advocate for you, to make sure lab comes on time and the provider knows your concerns and mine. When I finish giving you blood and emptying your drain, I am going to go down the hall and care for a vet with missing front teeth who feels dizzy, alone and afraid, then I am going to care for a bus driver who was in a motor cycle crash, then I am going to discharge a 22 year old kid who was drinking and riding an ATV who has a brain injury and is now going back home to live with his parents. As soon as I finish explaining to this kid and his parents that he cannot be left alone and learn about how they are going to manage this massive life change, the room will be cleaned and I will get another patient. This patient will also get the best care I can provide. I am a med-surg nurse, I care for everyone whose room number has my name next to it. I am going to do what I think is best for you today, not because I like you or because you are nice, but because it is my job.

I am also a new nurse and have started taking on more students. One thing I do with each student is take report together and then discuss priorities for the shift - which pt to see first, what tasks are time sensitive, what things can we delegate safely, etc. Then, I have them chart a full assessment on at least one patient and go through that with them. Otherwise, I let the student guide the day- some want to care for one pt, some want to tag along. If a student is clueless / not motivated, I have them read up on Drs. notes, lab values, and orders for one of the patients they assessed to get a full picture. I often learn something from what they find since I usually do not have time to read anything but the most recent progress note and I can ask them questions about care such as "why are daily weights ordered for this pt?" or "what is the purpose of ordering a sed rate?" Can't wait to hear more tips from others! Teaching is hard and an important part of being a nurse.

Nursing is 3rd career for me and I love it. Yes, the hours are long and a lot of the work is tough. But, there are days/ or nights when you have the opportunity to be there for someone when they are scared, alone and vulnerable. Also, look carefully at different hospitals and units. I was was an aide in a unit where the manager was such a $&@@$)!!!! that we were all miserable. Now, I am a nurse in a hospital that values nurses and I have amazing and supportive coworkers. I agree with other posters. Shadow a few nurses and you will have the opportunity to see the good and bad aspects of nursing for yourself.

I had a similar experience. I was a second degree student -35 when I graduated and I got the lowest score on the first test. I got 4 nclex books and worked questions before every test. The prioritization book has lots of fundamentals questions. I graduated with honors. Learning how to answer NCLEX style questions is tough, but with practice you can do it!

THank you for all your responses. To utadahikaru, I did check the BP at 15 and 30 min after pushing the hydrazine. It went down to the 150's then back up again. Sorry for the incomplete picture. This pt had been at the hospital for several nights and there are no reports of her screaming in her sleep. Per the patient, this sort of thing had never happened to her before. To others, I did not think to use the rapid team since I had already had the MD evaluate her. Great suggestion!

Excellent reminder. Clear, accurate charting is difficult and it is best to use exact quotes and to describe the situation precisely. Although, it is more time consuming than simply checking the box for agitated and irritable. Thank you.

Find the fattiest part of belly you can - sometimes this is close to the love handles. Let the alcohol dry. Use a fresh needle. Push it fast.

Hello, I am a new nurse - 3 months out on my own - and I just had my first experience with a patient changing condition rapidly while on my shift. It was the first time that I did not want to leave after my shift because I wanted to stay with that patient. Now, I am looking back and wondering what I could/should have done. Here is the story: Pt is transferred from a step down unit to me on the tele floor around MN. I get in report that she has high blood pressures (190s/80s) but is asymptomatic. Her first BP for me is 205/90s, she denies HA and dizziness, and I give her Hydralazine. 3 hours later her pressure is 228/90s and she is complaining of throbbing in her head. I call MD, he tells me he is aware she has high BP and that I should have gotten that information from step down. I tell him I am calling because the BP is higher than it has been since she was admitted and because she is symptomatic. He says to give hydralazine. I give hydrazine and when I come back to recheck BP, pt is at 205/90s. Pt is lethargic and unable to open eyes on command. Blood sugar is 110. Sats are over 95%. I tried to do a quick stroke assessment - smile, push pull etc. But cannot because pt is unable to participate. As I am preparing to call the MD we hear the pt screaming from the nurses station. WHen I walk into room, pt is sleeping and clearly having a vivid dream. I am able to awaken her, but she goes right back to sleep. MD is called. He comes to floor to assess pt. Determines that pt is anxious and asks me to give her Xanax and her am BP meds early (this is now 4am). My inner voice is screaming -- "there is something wrong with this pt!" So, I tell the MD again that this patient was alert and conversing with me less than an hour ago. He is able to get minimal pt cooperation for a quick neuro and tells me that pt was just having a bad dream and is, in his opinion, just fine. So, I give meds and and get help from other nurses so that I can observe pt more closely. Bp comes down to 170's. Pt still lethargic and having difficulty answering questions. Day doc arrives at 6:30am. Assess pt and determines she is sleepy since she was transferred at MN. Doc had to manually hold pt eyes open to assess responsiveness. I again state that the patient was alert and oriented and able to ambulate at 2am - 4 hours ago. Doc decides to order a CT scan, just in case. At shift change (7:30), pt is still in room waiting for CT when I give report to oncoming nurse. Pt is still very lethargic, knows name and date but is minimally responsive. Asks us to call her son but cannot remember son's phone number and has to think about what his name is. Nurse and I recheck BP - 205/90 and now she has a noticeable facial droop on one side. Oncoming nurse was very kind, but in report I gave her the "well the doc says she is fine, so she is probably fine" line and when we went into the room that pt was CLEARLY not fine. I feel like I should have done more for this pt. WHat would you do in this situiation? WHat can I do differently next time?

Thank you all for your insight. The PA never followed up with me about how the patients were different. I agree with Esme12, that a good teaching moment involves both the question and the answer.

SATA = Select all that apply

Yesterday I rounded with the PA. Upon learning that I was a new grad, the PA felt the need to quiz my knowledge. I failed the quiz. But, here is the question: You have 2 trauma patients. Patient one has a left facial droop, but can raise both eyebrows. Patient two has a left facial droop and cannot raise the left eyebrow. What is the difference between the injuries in these two patients. He told me it has nothing to do with cranial nerves.

Best of luck. Hope you find yourself and a path that works for you.

Thanks for the responses. I did assess for overload, although the bolus was given late in my shift. Embarrassingly, I did not think about double checking albumin levels or asking for albumin to go with the fluids. This was an interesting patient because he had very little edema -- I don't know where the fluids were going.... Esme 2, Your suggestion to add more background information before calling the doc is a good one. They have so many patients and I am realizing that giving them a full clinical picture, rather than just a brief sketch would benefit my patients and myself. I love being a new nurse, but there is SOOO much to learn. Thank you all for your input!

1. State you work in ----------------------------------------------------------AZ 2. Years of experience --------------------------------------------------------New Grad 3. Specialty/unit and work setting (clinic, hospital, prison, etc)------------Med Surg Tele Unit 4. Hourly Pay (base rate) or salary-------------------------------------------$28.50 for BSN, $28 for ADN 5. Differentials (if any) -------------------------------------------------yes, Night shift is an extra $3.00 per hour and there is holiday and on-call pay. 6. Union? --------------------------------------------------------------------no

I am a new nurse and I have a few lingering questions from my last shift. Here is a little about my patient: - end stage renal disease - end stage liver disease - non complaint with meds and dialysis - found down with ammonia over 130. Ammonia levels below 90 for the past few days after dialysis. After getting report from the night nurse here is what I found: - ammonia over 190 in results from the am labs - increasing confusion and lethargy - itchy skin My action: - Notified provider about lab result and lethargy. He increased lactulose (45g QID). - Continued monitoring Throughout the 12 hour shift: - Pt became increasingly lethargic. - no pee or poop My final action: - Called the provider. Received order for fluid bolus and more lactulose (60g QID). My question: - I gave the fluid bolus, and went home. But now I am wondering if I should reminded the provider that this is a patient with end stage renal disease on dialysis. What would you do? Could I have been a better advocate for this patient? Thanks for your input.