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Additional volunteers to utilize as mentioned earlier in this thread is a great suggestion. Regarding utilizing technology, the two things I can think of are : -improved call bell system. If a patient can type in their request/select one for a non urgent issue like needing another blanket or another box of kleenex, or refill of water(if they aren't NPO), and have that be routed to a volunteer, that would be fantastic. -improved logistics for equipment. The amount of time I've wasted looking for/ordering routine equipment has been incredible. Its maddening when basic things like christmas trees aren't available and I have to go to another floor for one. Additionally this issue extends for equipment that is broken (we always seem to have only 1 working pulse ox on the floor since the others always were broken). I've also had issues with broken pumps, no portable oxygen tanks, etc. This is another area that a volunteer could handle. This also extends to medications not being available as well, so perhaps a volunteer could help the pharmacy department in some way so they could get the meds to us quicker and keep basic ones always stocked.

7:1 dayshift is absolutely unsafe, especially when you have no tech help for some of them. Ridiculous. Is the ratio the same on nights? Perhaps request a shift change.

I've worked both, and there are pros and cons to both. Inpatient all depends on the floor, the ratios that you will have and support staff available. I LOVE inpatient med surg work but the working conditions were enough to drive me away from inpatient. All the staff I worked with were phenomenal but every day you felt like the patients got bare-boned care despite you working as hard as you could. It sucks seeing patients have needs (like education) that you can't fulfill because you simply don't have time. It can be a very physical job as well, constantly on the move and when trying to move heavy patients with a lack of staff to help, coupled with oftentimes not getting a lunch. One of the first things I noticed when moving to outpatient was that I could go to the bathroom without a cell phone on my hip ringing. You know you make a big difference in inpatient, and the fruits of your efforts are obvious to see. And the experience you gain from inpatient opens up doors and expands your nursing knowledge which will be beneficial for the rest of your career.

Disturbed energy field. We talked in class about how ridiculous it was as we were learning about it.

During a meeting where staffing was brought up we were told by the manager that we had too much overtime to allow funds to hire more staff...... ...... ...

CNA experience can be helpful. The largest positive is that it will get you comfortable with working intimately with patients. You'll also get exposure to some of the basics, such as blood sugars, foley management and ekg setup, and may give you an intro to some emergency situations. Having some clinical experience might help you network a little too.

Unfortunately this is a routine complaint. The most common shortages I've experienced have been dynamaps, pulse ox's, and unfortunately even christmas trees and portable oxygen. It is a frequent waste of time trying to hunt down items and order them, delaying patient care. I'd say this is just below poor staffing as the top things that inhibit nurses being able to do their job/patients getting proper care.

Totally depends on your individual interests, goals, lifestyle(scheduling), staffing levels at your specific facility, etc. I LOVE working hospital med-surg but the physical aspect is something I could not keep up with since staffing in med surg is usually awful. Hospital hours are usually 12 hour shifts with holidays/nights, compared with 8-10 days/eve/Saturdays on outpatient. I greatly miss hospital work but a good thing about outpatient is that I have time to do a lot of patient education which I enjoy, and its much easier on my body. I always get lunch and breaks and I don't have a phone that's ringing constantly when I'm in the bathroom.

So KindaBack, you quoted me, where I said that I had just responded to this issue in my last post. That post (#153) quoted/responded to you specifically and gave specific examples. So I guess you are saying instead of doing a chart(thread) review, you'd like a verbal report? Sure, I'll go over it again. The portion you quoted from SC wasn't the one I quoted. Report itself doesn't have to be verbal, BUT, it can not be just a chart review. You have additional information that is important to be handed off. For example, you can fax over a report and then call in with additional information and see if there are questions. This technique might not technically be considered verbal report but you still have the nurse-nurse final handoff which is key. So I guess to be technical, what I'm saying is a verbal report (of basic information like iv gauge) is not needed but a verbal handoff is. The whole point of handoffs (and of nursing itself on a wider scale), is to catch/prevent issues and keep the patient's care managed appropriately and smoothly. Patients being dropped off without the nurse's knowledge is absolutely an issue connected to verbal handoff as it simply wouldn't have happened with verbal report/handoff in place! You want to assign the responsibility to 'some other system'(but you give no alternative suggestion for solution) but transfer issues happen in every single hospital and you already have a solution(verbal handoff) that's basically 100%. As a previous poster mentioned, she had a patient who was airborne precautions in a room which was not set up for that, and because of lack of verbal handoff, many people were placed at risk. Others have talked about inappropriate floor admissions which I personally have experienced, which can be stopped at verbal handoff stage. I remember one patient in particular where the charge nurse told me to not accept report from the ER if they tried to call it in to me as it was inappropriate for our floor. A few minutes later ER did try to give report to me. I would have been screwed if the patient was simply brought up and we had to try to sort this mess out on the floor. Not good for patients and not good for nurses. Verbal report saved the day again! In my last post I gave specific examples of important information which can not be placed in the chart, such as that the husband who's wife my patient killed was being admitted to the same floor. Other social or police related information (I gave an example that I was getting a shooting victim, and the shooter was threatening to come back to finish the job which is very important for me to know), or concerns/suspicions such as abuse, can be important to know which is not written in the chart either. And again, as I said in my last post, when reviewing a chart you are more likely to miss a random piece of important information which can be easily highlighted and elaborated upon with verbal handoff. Muno had previously written about a patient on Revatio - this important information can be highlighted during a verbal handoff to prevent the nitro issue. In addition, any other unusual information such as strange HIPAA issues can be highlighted. I had one young adult non English speaking patient who had no idea what her birthday was. Thankfully her family was there at the time and could reassure me that was normal for her. Night shift was grateful for me to highlight that information to them. Little tips to manage dementia patients are also very common to be passed along in report and can give a clearer picture of what is 'normal' for a patient. It happens so often that just a minute of extra verbal information can make the care so much smoother. There are also things which can be stated so much more bluntly and clearly verbally, than in the chart. You can't write "her breathing sounds terrible" but you can say it on verbal report. I had one patient where it was her norm that her breathing sounded awful. I was grateful to hear this from the offgoing nurse so that I could give her appropriate care. Bottom line there are things which are important to know which can not be written in the chart, and important things which are in the chart but can be emphasized so as to not be overlooked. Verbal handoff can be a quick thing to do and can be very helpful to the care the patient receives and the safety of both the patient and nurse. Many problems can be prevented with verbal handoff and clarification of issues. So with all the good that verbal report/handoff can do... instead of trying to remove it and assign blame for the multiple holes it leaves on other things, why not instead assign focus on the one issue of why someone can't give report in a reasonable amount of time? Perhaps say that if report/handoff can't be given within 30 minutes then it can be given to the floor charge?

Several people including myself have already responded to this.

People have already touched upon this issue. Report highlights important areas that might otherwise take a longer amount of time to glean from the chart and could be overlooked. In addition, there are a lot of subjective/family dynamic/random issues that can't really be put in the chart. A few things that pop into mind readily are the drunk driving patient I received, and the man who's wife he killed is admitted to the same floor (worked with my charge to get him transferred to another unit). Or how about the guy who was shot and there was a possibility that the shooter would come back to finish the job? (said patient ended up being moved to a locked unit when that threat became credible). Jessy_RN wrote 2 posts before you about issues she's encountered, as well as other people on this thread. In my hospital the ER records are not tied to our floor EMR also.

Ugh, that's awful! Reports are very important to highlight critical areas of information/concern, including social issues that aren't appropriate to be written in the chart. Is there any way they can do a taped report at the very least?

Loved bedside report as a patient. Once I received important information about my condition that no one bothered to tell me earlier. Liked bedside report as a nurse too - too often something about the patient is 'off' and its nice to lay eyes on them and have confirmation from the offgoing nurse that that's their baseline. Very nice to start the day having already eyeballed all your patients, knowing there is no urgent issue. Management doesn't require waking sleeping patients which is good.

Always offer 2 weeks notice. It is up to the manager if they want to take you up on that offer or not. Always word your resignation letter very vague and positive "This letter is to inform you of my resignation, with last day worked to be XXX. I appreciate the opportunity XX facility has given me and wish them the best. Sincerely XXX"

Working conditions are a major difference between the two. It is SO nice to be able to go to the bathroom in the clinic without your phone ringing in there. You can get an actual lunch and sometimes even breaks, and, depending on the department you are in you can have a lot more opportunity/time to educate patients on preventative care. Regarding the hospital, it is a far, far more physical job. You get to keep up with the latest skills and personally I felt like I was using my nursing skills to the max in the hospital setting, whereas in the clinic it is a subset. However, hospital experience is a fantastic foundation for use in the clinic and will serve you well. Many clinics do operate into the evenings and on Saturdays, but nights and Sundays are basically always off so you can schedule family events on Sunday with confidence far into the future. RN jobs in the clinic more and more are focused on the phone so some people may be bored. Personally I loved the work of floor nursing but physically it was too much for me, and, the constant short staffing made me feel like I was not allowed to be the type of nurse I wanted to be. I really enjoy the education aspect of nursing so that's a big plus to working in the clinic too. Its all about what works best for you personally.

Not something you have to bring from home, but when you get to work put a bunch of alcohol swabs and a few small gauzes in your pocket. You never know when you'll need one!

sounds like your best bet is to find another RN to switch days with if the PRN one can't cover no big deal for you but when you have 4 other people you are responsible for, lining up childcare is a huge deal. If you don't use family then it is a very large daycare cost. Employees/employers can do anything they want as long as it is in the contract. PRN status working here and there, scheduled in advance, is a very common way to go. I think this is the crux of your problem. As needed does not mean she's on-call (for whenever needed). Instead, it is a generic term for working 'here and there'.

Our techs generally have 8-10 patients day shift, while the nurse has 6 days and 7-8 nights. If the tech can't start their pre shift rounds earlier, then there are several other options. The offgoing nurse can help with bathroom issues during their pre shift rounds. Or if it is asked during shift change, the offgoing nurse can do it after report or the patient can wait for the oncoming tech to get to them. Find what works best for your floor. It is not set in stone that the oncoming nurse must take care of shift change bathroom requests.

That's why I wrote unusual wounds, I'm definitely not referring to your daily skin assessment We don't wake patients. I could see how that would be a problem if we had to. I'm referring to things that can be easily taken care of during a round before shift change. Especially when it comes to pain, patients should not have to wait 20+ minutes for the oncoming nurse to finish report and get settled before they can be medicated. That's not fair to the patient or oncoming nurse. This is similar to how the ER should medicate patients for pain before sending them up to the floor. right, which is why patients who need the bathroom should wait for the techs, and why the techs are supposed to round before shift change to catch these. Yes, nursing is 24/7 for passing along non urgent tasks such as an IV change, tubing/dressing change, or a late order they couldn't get to such as blood transfusion. However I expect the patient to not have urgent matters like pain when I come on shift. When you consider that an oral pain medicine will take 30-45 minutes to start working, why make the patient wait any longer than they have to? Its professional courtesy that an offgoing nurse will make sure the patient is properly medicated before handing off. Which is fine. This isn't an urgent issue and it definitely can be either nurse that answers it. I was just thinking if a patient is super anxious and asking a ton of questions then as professional courtesy I'd stay as the offgoing nurse, as I feel its my duty that patients should be somewhat OK before I pass them along to the next nurse.

That really stinks. In my hospital its the norm that the offgoing nurse round prior to giving report so that these issues don't pop up. If they haven't and there's an immediate need such as pain, the offgoing nurse always volunteers to get it right away. I've never had an offgoing nurse not offer to do that, and I always do the same when I'm leaving shift. Its just not fair for the patient to have to wait 20+ minutes for the oncoming nurse to finish report and get settled before they can get the pain medicine for them. Regarding bathroom requests, these can almost always wait for the tech, and, our techs round before shift change as well to try to catch all of these as much as possible.

As a patient I loved bedside report. I found out additional information that I never was told before and it really helped me better understand my condition and plan of care. As a nurse, I think one of the best pieces of bedside reporting is that you get to eyeball your patient and get a clear understanding of what is the norm for them, plus you can look at unusual wounds/etc. Immediate pain needs can be taken care of by offgoing shift instead of being inundated at the start of your shift. If the patient asks a million questions the offgoing nurse can come back to answer them. If the patient needs to go to the bathroom the tech can do it or the offgoing nurse can take care of it after report. The offgoing nurse rounding on the patients prior to shift change can take care of a lot of these issues that people are bringing up. Again, as an oncoming nurse you would be inundated with this if you did not do bedside reporting so I'm not sure why its a bad thing get those things out of the way with the offgoing nurse. If the patient is sleeping we just do report outside of the room, or, if there is sensitive information we do it at the nurse's station. As both a nurse and patient I feel it is really beneficial.

Most hospitals will let you become a nursing assistant (health care tech/et) after you've completed your first semester of nursing school, so no additional classes are needed. You could always work the higher paying job and do a 0 hour/PRN health care tech job. Doing this job not only helps smooth the way to being a better RN (gets you comfortable working with patients, teaches you tricks/tips for things like transferring patients, etc) but also helps get your foot in the door so you can apply as an internal candidate for a RN job which is a huge plus.

I've noticed that I only care about being shown appreciation from management when they are coming down on us. This may be for frivolous things, or, when we are stretched super thin and they are blaming us for not doing more when we are already working like mad. The "never good enough" phrase makes it sound like management is coming down on them. The best thing to do is evaluate if management is complaining for one of the above reasons (frivolous issues or pushing them to do an absurd amount). One thing I wish more management did is to ask the staff what their barriers to good patient care are (whether that be equipment issues, process issues like not having written standard order sheets from physicians, etc, mechanical issues like not having an outlet in a particular spot, etc), and to work with them on fixing those barriers.

Narrowing it down to what area of nursing would help too.

The time it takes to chart would probably be the biggest factor.