STEMIRN

If a pt falls, what is the best way to document? I've always been told to not document falls in a chart. Why? Also, if a nurse leaves without giving report, how do you document that, when you take over the assignment?

WOW!! Can I just say, that I am glad that I am NOT the only nurse that feels the way you do??!! I have zero motivation, and absolutely zero pride in what I do for a living. Nursing is no longer a career to me, it's just a job and it pays the bills. I can't afford to go back to college, so I just suck it up, and go to work. People get away with murder in the ER where I work! I keep my nose clean, and try to lay low. It really is sad, just how many nurses feel this way. I wanted to be a nurse since I was 5 yrs old, and now I find myself constantly thinking "What if." Bottom line, money runs the world, and there are plenty of greedy people out there!

Are you trained how to search pts, as a inpt psych nurse/tech? I've had a pt wrap a razor blade in Kleenex and hide it under his scrotum! I had no idea, and didn't even think to look under his scrotum! My mgr was going to write me up, and I had some very good CCL (Clinical Care Leaders) who stuck up for me, and reminded my mgr that we were never trained how to properly search a psych pt. I would also look for your hospital policy to help CYA!

I need some advice to pass along and/or recommendations! A former co-worker of mine works in a small community ER, and they typically only has 3 RN's after 11p, and a ER medic, which can make it very challenging when a critical pt arrives via EMS or walk-in. Recently she and another nurse were with a 1:1, and the she asked the nursing supervisor to look after her pt assignment (which was 5 rooms, and she had 3 pts at the time). One of the pts charts was audited and NOTHING was charted for almost 3 hours, and the supervisor did not follow through with monitoring her pts. She is basically being blamed for not charting that she gave verbal report to the supervisor. She is concerned that since only her name is on the chart, and a sentinel event occured, that she is at risk if the family decides to sue. She expressed her concerns with her manager, and was told if she feels she needs to quit, then she should do what is best for her. This is the norm for the hospital she works in unfortunately. The nursing care is poor due to minimal education/adequate orientation for new grads and new hires. I have been advising her for months to find another job, and her license is jeopardized every time she steps foot in that place! The manager is very laid back, and does not hold employees responsible for anything (including leaving meds out on the counter or in pt rooms, undocumented waste(s), concerns with an employee arriving to work intoxicated numerous times, sexual harassment, etc, etc, etc). She took her concerns to the director of nursing, and no changes have been made. The hospital is a joke, and I tell everyone and anyone who will listen to NEVER take a loved one to her place of employment. She has FINALLY started to look for a new job, but still feels the need to stay where she is and does not want to be "pushed out" because she actually follows rules/policies.

I am going to tell you, what I had a former nurse manager told me when I was in nursing school. First, no one is going to give a sh@# what grade you made in med/surg or any of your nursing classes, (yes, she said this to me in her office), just as long as you pass and successfully pass the NCLEX. Second, everyone learns different (some people are "hands on" learners, while others learn best by reading a book and taking a test), so stop beating yourself up. She told me she was a "C" student, and to this day, she is one of THE SMARTEST nurses I have ever known! She is currently the nurse manager on a heart floor in a ICU at a level I trauma center, and graduated with her doctorate a few years ago. YES, nursing school sucks! YES, you have to study your butt off! BUT...it will be worth it in the end, and you will never have to take the NCLEX again after passing. I failed nursing school the first time, because I listened to that voice in my head, and I would put myself down all the time. I also had an instructor tell me, "Maybe nursing is not for you, and you should look into other things, like maybe landscaping." SERIOUSLY LADY?! I'm also terrified of snakes, and could never be a landscaper! I know you have heard the saying "If you want something bad enough, you'll make it happen." Believe me, it is true! My daughter is struggling with math, cries in school, and calls herself dumb. I told her to GET MAD, and pretend that "math" is a bully, and to punch "math" and say "You won't beat me, I will beat you, and I will learn how to do this, and I am not stupid!" That advice might sound kind of stupid to you, because you're not a 3rd grader, learning subtraction either. But seriously, get mad and start telling yourself that you can do it. Stop worrying about other people in class, and worrying about grades. I was always the last student to finish a test. Are the other students paying for your nursing classes? NOPE! So who cares about them! Worry about the day you are looking down at your patient, and all of a sudden they go into cardiac arrest. No one is going to care what grade you made in med/surg! It's all about critical thinking. That is what you want to master! Just DON'T GIVE UP! Try the site simplenursing.com, and see if it helps. GOOD LUCK :)

When I get subpoenas, a police officer hand delivers them, and they are always in uniform! This definitely sounds fishy to me as well. You could even call the commonwealth attorney where you live to confirm. What if that person is going to different peoples' homes' to get signatures, and then using those signatures to open credit cards or something. People can be crazy these days and identity theft is so common.

Absolutely agree with you! Other things can be discussed in a private room, BEFORE entering the room with the off-going RN, such as when their is a difficult/demanding family member, you don't exactly want to discuss in front of the pt, AND the difficult/demanding family member.

I feel with some pts, bedside report can be overrated. For example, in the ED with hallway pts that came in with "c/o foot pain from stepping on a cat toy" would not exactly be at the top of my pt "bedside report" turn over.

I am all FOR BEDSIDE REPORT!!!! I've had a nurse tell me in report, that a pt was currently being administered 2mg of Mg+, and after report at the nurses station, I went to introduce myself to my pt. When I looked at the pump, the IV tubing was not attached to the pt, and the Mg+ was dripping all over the stretcher. The pt was also not on the cardiac monitor, and side rails were not up. We all work with that one (or two, or three) nurse, who does not exactly follow protocols. Bed side report does not have to be long and drawn out. It can be a quick introduction, and to verify any meds currently being administered. It helps with medications errors, and keeps your pt(s) up to date with the plan of care, and knowing who the next nurse is. I feel with any critical med drip (cardiac meds, etc) the next nurse coming on should perform a rate verification at the beginning of their shift anyway. Pumps malfunction, and pts disconnect themselves are just two examples that I'm sure all of us have come across.

Trauma shears, hemostats, stethoscope, pen light, pens, small pad of paper (I take blank computer paper and fold it up and put it in my pocket, so I can make quick notes when getting turn over from EMS. You will see a lot of nurses use a paper towel to jot down info quickly). I use to tape an ammonia inhalant to my badge, but the ED I work in now has the ammonia inhalant's in the pyxis. I would also not recommend using a lanyard for your name badge. A co-worker of mine, has had a pt attempt to choke him, by grabbing the lanyard and pulling back as he walked away. Hope this helps :)