RNlmk

I think report protocol varies depending on facility. I have never seen a Kardex! On my floor you are expected to take report immediately at 7a/p. some nurses come in early and look up pt info, some don't. Either way it is expected that you give the full rundown in handoff report. Giving report this way on 6 patients typically takes 20-30mins. It's unfair to expect nurses to come in early & unpaid- so unless you want to wait 15 minutes past shift change to start report? I don't think your new grads are doing anything wrong...

These things happen frequently. If a pt seems off- step away from the bed until you can determine their state of mind.

5 iv starts in year is just not enough practice. You need more live sticks to gain confidence. Are you changing outdated iv's? That is one way to get some more practice on your floor & ask other nurses for their iv starts. But I might ask to go to pre-op, endo, or er for a few hours and just start iv's. I think iv starts is just a skill you need to do a lot to become competent with it.

We have room service but meals don't arrive at shift change. They can't get breakfast til after 815. Dietary calls the floor ahead with delivery times for all the diabetics meals and the nurses are given the list. If a pt forgets to order a meal by the end of the meal time 8:15-11a breakfast -dietary rounds the floor when they deliver and reminds pt to order if they haven't. If you don't order dinner by 7pm you automatically get a "bag dinner" Pts unable to order are flagged and get a standard meal or the family can order for them. I thought it would be such an inconvenience but really if your facility does it right with a good dietary service dept it is great for the pts

I took my nclex in 2011 & passed with 75 questions. I did the entire Saunders review book and studied 2-5 hrs a day for a month before. My advice is to give yourself a few weeks to study bug don't wait too long. I took the test very fast 28 mins lol (I always take tests fast drove my classmates nuts but it works for me!) and a lot of it was eliminating options and guessing. Saunders was the best review in my opinion.

I work on a med surg/onc floor and our ratios are the same - occasionally we go up to 8 pts, once I had 10. I also had 12 wks orientation & that was enough time for me. Most of my patients are not walkie/talkies but we have amazing cna's I learned as much from them as I did from my preceptors. We also have a great charge nurse who helps keep us up on changing orders. It's busy and overwhelming sometimes but if you have a good team around you it will be ok and you will learn so much. Good luck!

The 3-way catheters are usually a pretty large gauge I would think that is possibly why the pt didn't complain of pain- the urethra was already kind of stretched from the 3- way cath. I have had this happen before with difficulty inserting a cath. What I do is bladder scan the pt if they have more than 100 then you know the catheter isn't patent if it isnt draining. If you keep messing with it with no return then I would see if they can try it in ultrasound- this is what we do and it's common in older men with bph.

I work m/s onc: 5 is minimum, 6-7 is typical, 8 on bad night. Once i ended my shift with 10 when another hospital had to divert their ER to us & we short with a call in and no float. We have a charge with a full team and usually 2 cna's.

Yeah reading dr handwriting is hard! We went CPOE a few months ago and it's a lot better except you have to keep checking the computer b/c the drs don't have to be on the floor to enter orders.

I still felt very anxious at 4mos into my job, somewhere around 6mos things started clicking and I felt better. I still have nights that are bad, but I feel like I have the flow of things down better. I no longer want to throw up when I walk off the elevator onto my unit. The biggest help to me was developing relationships with my coworkers I feel like I have friends at work who will back me up and not look at me like an idiot when i ask a question. if someone asks me for help I make it a point to help them even when I am in a time crunch. Quid pro quo and all that. The first time I had to run a rapid I had 4 nurses helping me and I didn't have an anxiety attack on the spot like I thought I would.

1 week is really not enough IMO, I think it's a threat to your license. I wouldn't even accept that position unless you are very confident in your skills. Just learning the flow of the floor takes time not to mention all the little things like learning which docs to call, how to use equipment etc. I got 13 wks with a preceptor then 2 wks of small teams where I was not counted in the nurse census so the other nurses had fewer patients and were available to help me. I work on a med/surg onc floor.

I work for CHS, med surg hired as a new grad. I think it's a decent place to work, on my unit there is not an issue with lateral violence, some difficult personalities but nothing much beyond that. Pay and benfits are decent. We don't flip shifts unless you want to. Our unit self schedules which I love. The orientation was good &I have seen other new grads get extended orientation if they needed it. Overall I am happy there.

I wouldn't have ignored the order, I would have called the md back stated that had assessed the pt and reviewed w/ my charge & wasn't comfortable giving that dose, could I give 5 or 7 instead and see how they did? If they said no give it I would either ask them to come to the floor or just give it depending on how strongly I felt about it and what my charge thought was appropriate. Most of my pts are not opiate naive so it's not a common problem on our unit.

I have been on my floor for a year, I promised myself I would give it that long no matter what. It's a hard floor med surg w/ oncology, head & neck / ENT and palliative beds- a good mix of med and surg pts. The variety has been great for learning but it's also very hard, and stressful to keep up with all these different diagnoses, treatments, so many comorbidities etc. I have friends who work on straight surg floors and it seems a lot easier b/c their pts are so similar hips, knees, backs and bariatrics. I float alot to these floors and I find I like the pt pop a lot better but there just isn't the same team atmosphere that we have. No one wants to help anyone, there's no joking around or chit chat, the whole team doesn't even show up for a rapid! Maybe this atmosphere comes from working on a higher acuity unit- like you better be ready to help out b/c tomorrow it's gonna be YOU running a rapid while you have to admits waiting. So basically I don't really like the patient population that I'm caring for but I love my coworkers. Is it worth it to make a change? What do you think?

I think it's important to develop a routine that works for you and then stick to it as much as possible. I work 11p-7a mostly here is my routine 2245 look up pts, fill out my brain, check orders 2300-2330- get handoff report, make sure pts are breathing 2330-100- review 00 vitals, give report to my cna, pass 00 & 01 meds, assess, take note of IVs that need to be changed, fluids need refills, check dressings change anything that doesn't look good, see what supplies need to be restocked in the room, q6h bgts, suction and trach care, make sure chest tube oasis aren't too full etc 0100-0300 call house docs / residents if needed for orders, check for new orders & chart. 2am quick rounds 300-400 get ready for morning chores pull all 5&6am meds, get supplies for blood draws, dressing changes, trach stuff, bladder irrigation etc. 4a-6a- review 0400 vitals, med pass, blood draws, dressing changes, IV changes, trach care, make sure outputs are good, 4am pulse ox's, give charge report 6a-715 review for new orders, call docs who arent on floor yet if i need something, final pain pass and make sure IV fluids are full so days doesn't hate me! Chart. 715-745ish - handoff report Of course things happen I never sit for two hours and chart but in general if I can stick to my routine I find I miss less. If I am really busy I don't chart until after morning report. This happens if a pt dies, I have a long rapid response, or 2-3 admits or just a really bad team. I try to at least chart my review of systems- everything else is low priority til I have time. I tried charting my assessments as I go but it's just to hard since I am doing a lot of cluster care and hoping my pts can get some sleep (ha!). I find that I can remember my assessments now that I am more comfortable I always have a good picture of the patient in my head. I do take note of things like what is tony appliance is, what size cath etc otherwise I wouldn't remember