jjaye

Thank you, I appreciate your comment. Another question, he is not verbally responding but can squeeze my hand for yes or no. When he was verbal he very rarely took the ativan prescribed for him, sometimes at night he would ask for it. Last night he was restless so I told him I would give him some ativan. He wouldnt open his mouth for the syringe and when I told him to squeeze my hand if he wanted it, he didnt. I really feel it will comfort him but cant force it (its sublingual) but I feel as a nurse I should make him take it, as a dgtr I cant. Hospice nurse said to give it at least every 6 if not 4 hrs... what would you do ? ?

Hello all you awsum hospice nurses. I am an RN in the ER and took this week off as my dad was said to have a week left to live according to his hospice nurse. I need some advice if possible as I am having a hard time thinking critically or clinically bout my dad. (Terrible I know) ok, here goes He was diagnosed in Aug stage four with mets to liver and lungs. Previously he had a stroke in 2016 and had been bed bound ever since. I feel he is a day or two from going. Whenever he wakes (which is further and fewer in between today) he whispers drink. I sit him up and he is able to suck from the straw once and then falls back asleep still with straw in his mouth. Then he has these awful groan/hiccup/painful sounding noise, and that's it. He totally cognitive at this point and I dont want to deny him water. He ate last about 8 days ago. The tumor was large and towards the bottom of the esophagus. Do I keep letting him drink while he can (I am afraid of aspiration) . I am using the mouth sponges and doing oral care, but he still manages to utter the word water. It is the only thing he is saying as of today. I hope this is enough info. Thank you for any insights. I want him comfortable as possible and I dont want to cause anymore pain ...and yes he is on hospice but 3 different nurses have been in this week and I got three different answers.. so I am just feeling lost. I know all this is so hard to predict but maybe somebody has some experience and insight to offer. These hospice nurses actually talk about each other to my mother. ?‍♀️. Thank you again I will be eagerly awaiting your replies. Jill, RN, BSN

Thanks, that makes sense. I will definatley begin to look at results and focus more on my sickest pts. Makes sense and I feel I will learn more that way. One of my problems has been to rush and get all the tasks done that I dont feel like I have time to do anything else. But the longer I am there the more I am realizing that if I dont take the time to look at labs then I am not doing anyone any favors. Thanks for the info, it's been encouraging. Yesterday I had 6 so it was much more manageable. Those are the days where I need to hone my skills and I am hoping they become more second nature as time goes on. When I do have 8 or 10 pts I tend to feel lost because everyone has orders at the same time. And if course everyone comes to the ER thinking they will be helped, diagnosed and out the door all in 45 mns. I need to Thicken my skin and let these people know gently but firmly that isnt how it works. Also, when I am at the mercy of a couple docs that are real jerks.. it's difficult to tell them what I need. I need a course in assertiveness also. Sigh. SO MUCH TO LEARN. Thanks everyone!

My advice, keep sending resumes. I was a post partum nurse for 6 yrs (first job out of school cant be picky) I hated every day of it. Had someone (an icu rn) help me with my resume and I am now currently working in an ER. They needed staff and my resume came in. Had a great interview and now here I am. In a perfect world an ER wants experienced staff.. sometimes though, they ahave to just settle for staff. I am glad they did cuz I always wanted ER. And finally feel as if I am home.

Thanks , so long as someone doesn't have a magic answer that is eluding me I feel like I am doing ok then. Also I WISH it was 10 a shift it most certainly was 10 at a time. For that day and some others. Usually it is 1:8. And yes.. I am in NY since that seems to be the comment when people see that ratio.. it it's pretty much the same wherever you go so I can't just leave the job. My only saving grace is I do love it and feel like a true nurse finally. Thanks for everyone's info it is much appreciated.

So then is my thinking wrong in that I am trying to understand each disease process? Lol this is part of my confusion and apprehension I suppose. What is it I should be focusing on in order to "think like an ER nurse rather then a floor nurse" which is what I have told. As a new ER RN, what should I be focusing on. I cant formulate my real question into coherent thoguhts... sigh. Lab values , meds, disease process , symptoms, etc all sound important. What's the best way to look at things and become as knowledgeable as possible so I dont feel like a dunce..? I just feel like EVERYONE knows so much more then me..which is an good thing because I go to them to learn... but I cant retain everything.. where's the best place to start. What are the must knows.. ? Thanks !

OMG, I totally feel you. I just got off orientation and am in the SAME boat. I actually just posted about it. I just fell so lost, and feel my pts are unsafe. Our ratios are usually 1:8. However sometimes they do get a little higher, but to be avoided if possible. So most of the time it is 8. I feel I cant remember names, complaints, or anything for that matter. I feel task oriented and I want to be able to do my tasks but know why I am doing them. The nurses that have been there longer then me are great, they know their stuff and I get great support from them. The manager does come and pass out unsafe assignment forms when necessary to try to get us the staffing we need. They all keep saying with time I wont feel so "lost". Its hard to believe but when I look at the nurses around me (many who have been there 2yrs or longer and some right out of school) I feel encouraged, however I dont want to feel as if I am not doing the best for my pts well being than I possibly can. And that's how I feel a lot of the time. One nurse told me to learn 1 new thing a shift to increase my knowledge. I dont know what the answer is.. if its time... courses (which I have taken) or what.. but I have to believe that with time my thinking will evolve and I will have a better time of it... or is this naive of me ? I only started in May... and I feel better now then back on the first day I was on my own... but still feel ....uneducated... maybe?

Hi everyone, I know this topic has been introduced before, but I need some guidance if possible. I work in a community ER. Previously I have only worked in Post Partum for about 6 yrs. I have always wanted to work in ER. And surprisingly I got this job in May. My orientation was 12 weeks. August was was my first month on my own. I am usually in a district with a 8 patients. Mostly level 3 with a few 2s mixed in. And pain, chest pain, SOB. Not to mention sometimes our frequent fliers that I have already come to know and recognize. Anyway, my problem is that I run around doing all my tasks...and have little time to look at labs or results, not to mention the fact that I feel this is important so I can learn values and what they mean. I have been reading and trying to grasp emergency medicine books to change my mentality. Obviously, there are big changes I need to make when it comes to my ER pts. I LOVE it. But feel I am failing my pts as well as myself because when I am asked questions I dont always know the answers (and cant wait to get to my phone to google what the hell might possibly be going on). Yesterday I had 10(!) Pts. I felt as if I was drowning (other exp nurses said the same thing, so I kept pushing ahead), but I guess what I am really asking is what is the best way to become more knowledgeable about the care I am giving. Is it just a matter of time? My mngr keeps telling me I am doing g fine and these things will come with time and it can take at least a yr to feel "comfortable". She tells me at this stage to just be able to recognize when and if my pt is about to crap out. Everyone keeps saying the rest will come in time. Is this true. What can I do to facilitate this happening. I am willing to do anything. I really like ER nursing but hate feeling like I am the stupidest person in the room Thank you ! JJ

thanks for the reply... thats what i have been oing..and thankfully everyone has been great... i have heard nurses eat their young...but this unit i am on has the best bunch of people around!! thanks again!

hi aspiringmidwife, i am looking for an online rn to bsn and was between chamberlain or empire state... empire is cheap and is a suny school... i also work at stonybrook hosp and was considering going there but not sure i want to sit in a classroom again... was wondering if you coukd tell me a bit more about chamberlain? they are more expe sive then empire but empire has two group projects that i dont like the sound of. empire says i need 11 more classes... chamberlain only took you a yr...was that going 12 months in a row or was it semesters? ty for any info jj

Hi everyone .. I am a new grad and got a job in october as a mother/baby nurse. we rotate between the newborn nursery and the postpartum floor. In the nursery we take care of new admits, boarder babies, and any other babies that need bili lights and such. On the floor we have couplets..the moms that choose to room in with their new little ones. I am still on orientation but will be going to nights on my own this week.I feel more comfortable in the nursery because i have had more time there. i love my job and am so excited to have been blessed with such a great job. I worry at night when i get home that i will overlook something on a newborn and make a mistake. my preceptor is awesome..very knowledgeable and is a great teacher. i feel confident at work and am learning as much as i can. To everyone who is experienced, are there any tips you can give me? Books i can read to increase my knowledge and help my pts even more? I am going to ask to follow a lactation specialist because the joy i see on a moms face when she is able to breastfeed is sooo rewarding.... what can i do to help my new moms ? Any advice would be greatly appreciated. Thanks! JJaye