Jenny P

After 34 years in critical care; I never went to work without my own favorite med book, my stethescope, scissors, 2 hemostats, a penlight, my own 2 pens, and a critical care pocket reference book that I added my own paper to so I could add my own little "perls" to: I would add certain MD's odd little quirks (ie: if one surgeon liked some different lab test done that others didn't); hosp. and MD telephone numbers for emergencies; and if there were certain tests that were difficult to remember how to do them. In other words, my extra pages of perls were the things I didn't use often but if I needed to use them I could find those things STAT.

Zee, when is the test? I'm too lazy today to read back. I think you will do okay if you remember to use your head. Sunnybrook had some excellent advise.

Congratulations HealingtouchRN; I have never heard of this exam before. How does it compare to the CCRN exam?

My hospital no longer calls them "incident reports;" they are now titled "safety forms" and are referred to as "Sentinel Events." These forms do not go in the chart either; nor are they referred to in the chart. We have supposedly switched to "blameless reporting," where all facts are stated clearly and concisely and anything that may have led to the incident is recorded there, including any department that may have added to the problem. These forms are then studyed by the Safety Committee who then try to correct what failures in the system caused the specific incidents. The person filling out the form is not considered the "guilty" party either; which really helps to make sure the forms are filled out and all incidents are reported so problems can be corrected in a timely manner.

Cyberkat; I've had an idea for a nursing show for a long time but don't know where to go with it. In my mind I'd call it "City Nurse, Country Nurse" and have it about 2 sisters who are nurses, following the Mom and Grandmother's footsteps in nursing. One sister would work in a rural setting in a small howpital; one as a float nurse in a city in either based in a large hospital or else as an outside agency nurse. In my mind, I'd have them have occasional flashbacks comparing their Mom's and G-Ma's work also and how it differs from their work. I've never thought of going anywhere with this idea; never thought it would be "saleable" to anyone. But if anyone has any idea of what to do and where to take this idea, please let me know; or if anyone thinks it is a good idea and would like to work it into something, please contact me! I think that in my years nursing I probably could provide hundreds of stories!!! :) JennyP

What type of facility are you talking about? Bellehill gave a good answer for a pt. in an acute care facility; but I think the approach would be different for a LTC facility.

jfpruitt, a couple of lovely smelling roses or a thoughtful hand-written card for the preceptor and a bouquet for the whole staff (or a 1 lb. box of chololates for each shift) would be enough of a Thank You gift for this new floor for you. If you go overboard; that may raise some suspicions or hostilities later if you have a problem with someone on the staff. My PERSONAL opinion is that a handwritten note to the preceptor and a bouquet of daisies for the staff would be the perfect touch myself. A hand-written note takes more effort than most people want to take these days; it requires a personal effort that ready-made thank you cards don't have. Most hand-wriiten cards I have recceived over the years are saved because of the effort involved. And a small bouquet of daisies always seems so cheery to me.

Zee, I believe you have to have at least a 76% in order to pass-- anyway, that was what it used to be the last time I took it back in 1996. I have re-certified with CE's since then; but had tested out at least 4-5 times for it between 1978 and 1996. I did let it lapse a few times also during this period; but I used to test out of it to prove to myself that I knew what I was doing; since '96 I've decided that things change too much for me to rely on my memory!

You know, I have seen elderly patients (and a few not so old ones too!) grab any and all available body parts when they are confused and agitated. I just don't feel like I want to give them one more thing to grab. I once had this tiny ancient lady grab my nipple and twist it for all she was worth- thank goodness I wasn't pierced or she would have ripped any jewelry out without trying. I also think that multiple piercings and tattoos should not be on any professionals, nurses in particular. The majority of our patients are the elderly, we are trying to help them heal and should not be presenting them with any mental or emotional discomfort at a time when they are already often stressed from their illness and from their needing to be dependant on others. Anything that we do that marks us as "our just being individuals" may be something that can alienate them from the very help they need. I think back to my DH's dear Aunt Hazel being 83 and in a rehab unit (after she broke her hip last year) where about 90% of the employees were black and she had never been exposed to any different races before. Her confusion was worsened by the fact that there were so few whites around (sorry, but her small town in Minnesota did not have blacks; I am not being racist here; just stating the fact). After her confusion cleared, she told me she thought that everyone "dressed funny" in that rehab unit-- I do remember her telling several of the CNA's that they had "nice outfits" but only later figured out what she meant. BTW, she was also legally blind, so don't judge her as racist either. As a nurse, I reallly feel my duty is to my patients: and sometimes the best thing I can do is try to blend in with what they recognize as familiar faces. Tattoos and multiple piercings just aren't that common here in the Midwest.

Rscarlatti, NURSES advocate for nurses; BUT only after they advocate for their patients first. Join your professional nursing organization (I noted that your profile does not say what type of nurse you are, whether RN or LPN) and get involved in your professional organizations. The nurse who substituted the KCl for the Kayexelate could have KILLED that patient! Would YOU have let it go if that patient was killed? How does one account for the missing dose of KCl; how does the nurse chart what she did; there are so many questions that are "what ifs" here. What if it was YOUR family member?? How would you feel if it was, and some nurse covered up for the other nurse? I do not condone any nurse eating their young; but I put my patients' lives above my co-workers' back any day. I have also found that it is necessary to expect 110% of myself when I am at work. I expect my co-workers to do at least 75% of their peak performance. When I have someone who doesn't give that much towards their patients, I will talk to them on a one to one basis, then if their is no improvement, I will talk to our manager. I do happen to work with a bunch of nurses who are willing to go the extra mile for our patients. We also are there for each other, and also help each other out as needed. The one thing that is so important though, is that we also have to learn to ASK for help when we are overwhelmed. Maybe if we would all do this, we would be more supportive of each other.

I worked nights for something like 12-14 years and started working evening Baylor shifts back in January. I still have nights when I can't sleep til 3AM or later. What worked for me was I always slept at the same time everyday. And for me my schedule was to come home and eat something light, use the room darkening shades, put on an Enya CD, take some tylenol (if needed, but not the PM or Benadryl) and then I'd get up somewhere between 3 and 4:30 PM. That way I'd be up when the kids got home from school, I'd be sociable in the eves for my family, and my schedule would not affect others. If I had nights off, I'd stay up until I felt tired (and it might not be til 4 or 5AM), then go to sleep til noon. I never got up before noon unless on vacation! That was MY SLEEP TIME, and my family and friends all knew it! For those who repeatedly would call or wake me before noon, I found that a telephone call at 1 or 2 AM a few times (just to "chat") would finally get my message across! If my DH would have insisted on my being up before that, I would have probably killed him. If there was a real reason for me to be up before noon; he always would bring me a strong cup of coffee and set it on the bedside table and then leave the room-- I'd hear him enter, and the smell of freshly-ground GOOD coffee would gently wake me! :)

Zee, you can do it! Like I said before, you are doing it for yourself and that is the best reason there is to take the test. If you want, we can be your cheering section here to help you stay motivated.

Zee, you can do it! I first became a CCRN in 1978 and have been a CCRN for the better part of that 25 years. You have the best motivation for taking the test -- doing it for yourself! That is the only reason I took the exam for so many different times; I have only recertified using CEUs for the past 2 times. My hospital has only recognized and paid extra for any certification for about 5 or 6 years now and that has increased the number of people interested in going for it. I don't know what book you have, but since you spent the $$$ on buying it; take a chapter a day and just read that chapter. Don't try to memorize it or anything; just read through it, then close the book each day and visualize what you read. A book is just a written bunch of information; it is up to you to use it in a way that you will benefit from it. After you have read the book or a series of chapters, then it is time to go back and study what you read. When I first took the test, I read Guyton's 2 volume Physiology book and also Harrison's Medical Diagnoses book. I don't even know if there was any CCRN study guides back then, although I would think there was at least one. Other posters have mentioned study guides in their posts, so I'd suggest that you follow their advice. Good luck! I know you can do it! We will expect ap thread saying you passed in about 3-4 months; okay?

I'm certified as a CCRN through the American Association of Critical Care Nurses. Back when I was first certified, I believe the requirements were 2 years in critical care experience but it is now less than that. It is a very hard exam and one needs to keep up with CEUs or retake the test every 3 years to remain certified. My current workplace pays $350/yr. for each certification a nurse has. And you are held to a higher standard when you are certified.

Agnus, you were 50 when you became a nurse? I thought you were one of us old-time nurses and not just one of us old-timers! You give such GOOD old NURSING advice!! Love you! Keep on giving that good advice!

I know several nurses that are still practicing here (in Mn.) in their mid 70's. These are very vital women who leave me awe-struck whenever I run into them. What is even more impressive is the group of retired nurses that I know who still put in full days of work as volunteers at several hospitals around here. These gals are ages 75-85 and are still globe-trotting and working in busy specialty hospitals (3 work in the eye hospital I've taken relatives to; these 3 have been there 3-4 days /week in between their trips to Israel, Turkey, and Eygpt!). There are also several nurses who volunteer in our very busy surgical waiting room--they don't get paid for the stress they put themselves in! I think it's the old saying "Once a nurse, always a nurse!"

When I work with newbies who don't ask questions, I find my speech slows down and I hear myself asking "do you know what I'm saying?" all of the time. I go into great detail and end up repeating myself several times in different ways in order to help them understand what is going on. Happened last night when I gave report to an on-coming nurse..... Of course, I really love it when someone new asks me questions about things. I do love to share my knowledge and teach new things! This also happened last night; but not to someone I gave report to; just a newbie who is smart enough to ASK!.....

I just got off working about 14 years of nights-- first (full time) 12 hour nights, and for the past umteen years working an 8-12 night shift mix (12 hr. shifts only on weekends). I thouroughly enjoyed them, BUT in the past 2-3 years my health started to suffer. I've just started working a Baylor evening shift this past w/e, and hopefully this will work better for me. I work with many nurses who rotate day/night and find it both good for them and for their bodies. Most of these are younger people, though. To work nights and be successful with it, always sleep at the same time of day. Several of the long time night shifters that I work with stay up after work and do all of their normal life stuff during the AM after work; then go to bed (somewhere around 10 or 11A if they are 12 hr. shifters or around 2 or 3 P if they work 8 hr shifts). I was never able to do that-- I'd go to bed by 9A at the latest after my shifts; then get up around 4 or 5P and do the stuff that needed doing before I'd go to work (this is what lots of people do when working nights; but do try the other way of staying up after work and see if that helps). I do believe that many nurses do view the night shift as a way of "paying dues" for newbies; unfortunately hospitals are a 24/7, 365days/yr. work environment and unless you find a workplace with a group of people who ENJOY nights, you will be stuck working on them for at least a short period of time. I've been an RN for 34 years, I've worked as a staff nurseat least 3/4 time for most of those years, and I do believe that senior nurses should have perks when we've put in the time like that. Okay, I'm prejudiced, but back when I started there just weren't many older nurses at the bedside! They had either retired to raise families or moved up the ladder to be managers {and often battle axes if I remember right}.

Wolf, there are a couple of threads here about patient abandonment; do a search for threads titled like that. A nurse can be charged with patient abandonment; but there are certain requirements to do so and the nurse should check with their own State Board of Nursing for more information. On the whole, Boards of nursing are on the nurses' side in cases such as this IF the nurse folows the rules properly.

Remember, it's YOUR license on the line everytime you go to work; and I find that 3 12's are enough to cause serious judgement lapses in me as I age! That is my limit; I will NOT be scheduled for more than that. Definitely write a letter of resignation to your manager, with copies to your CEO, and any one in between (hey even the Board of Directors and the Medical Director of the hospital!) and write as objectively as possible your reason for resigning is mainly related to PATIENT SAFETY-- and employee safety, health, and satisfaction. And throw in the abuse of nurses causes the nursing shortage. You have lots of good advice from other posters here.

Way back 30+ yrs. ago when I was a County Health nurse, I had a 96 yr. old lady who had a severe uterine prolapse (are they graded? I seem to remember that it was a grade IV prolapse). Anyway, she had an inflatable pessary that I had to teach how to put it in, inflate with a little bulb (like the hand pump for inflating a BP cuff), then unscrew the bulb and remove that. She was to remove it and clean it and re-insert it once a week; the tricky part for us was to know when it was inflated enough-- until she pumped it up far enough, it would fall right out again when she'd stand up or strain a bit. That was a bit disconcerting because she complained it felt like she was giving birth when she least expected it! BUT she still walked at least a mile a day and was in excellent shape for her age (no modern conveniences in HER house! She still had a wood stove, a hand pump for water, and an outhouse!).

Each day when I go to work, I remember being in a hospital myself and being scared and afraid. I imagine that each one of my patients may feel like I did at that time. I work CV-ICU and see lots of stressed families and patients. My goal is to make my patients and families relaxed and able to trust me. I am focused on the moment and that patient or person I am talking to. Direct eye contact and sincerity do help. So do slow deep breaths which I imagine that I'm ridding myself of stress when I exhale. Co-workers tease me that I'm sighing all of the time; but they also tell me that I seldom am flustered or upset. I often use some gentle humor, but am careful it is not anything hurtful for or to the patient. Sometimes when I have a frightened patient on a ventilator, I'll say something like "oh goody, I get to do all the talking tonight!" And I DO TALK to them, all of the time, explaining what I'm doing, etc. I have found that sometimes the grumpy, demanding patients are the ones who may need more attention. I'm assuming that you work in a LTC facility from the way you worded your post. Would it help if when you are assigned to that particular hallway you select one person that you will spend an extra 5-10 minutes with, just talking to them? Pick the crankiest one on the hall, then just go and ask them all night if there is anything else you can do for them. Pick a different patient each time you work that hall, it may make a difference. I started out back in high school working in a nursing home and the grumpiest guy was an old cowboy who I'd tried this on. He realized I was trying to make him more comfortable; we became friends over the year and I still have the last bread board he ever made hanging on my kitchen wall almost 40 years later. The crabbiest woman had been a nurse during WWI and she'd had a stroke that left her totally paralyized on the right side. She was in her upper 80's and would yell at everybody that we had to "maintain proper body positioning" and to pull her hip out further to reposition her. After putting up with her nagging at me one day, I did burst into tears and tell her that I'd tried my best but I couldn't get her hip out any further than that- she was already pulled as far to the right as her hip could possibly move and she was already curved into an "S" shape. Turns out she had right side "neglect" (I realized this AFTER the neuro component of nursing school) and was unaware of how crooked she was! I held up her little hand mirror for her to see her postion, and -- we got along fine after that. No one had ever bothered to show or tell her she was crooked before that!

Hmmm, it sounds like the Baylor shift programs are very popular; no one has hated them so far. And there really seems to be quite a variety of ways they are done too. Dennie, I will have to check about any time off on our Baylor shifts. I don't know what our rules are. Thanks for that info. Capgirl, I have never heard of that type of plan where you get an extra $10.00 for each hour you actually work after 4 weeks of work-- so essentially your paid $10./hr MORE than the normal rate for doing Baylors, right? And Konni, the idae of the diff. for only the hours worked is interesting also. I shall add that to my list of things to check on when I apply for this position. I have never heard of a "weekday baylor" plan, Jude, that sounds quite unique-- AND exhausting too-- working 16 hours in row! I hope these aren't back-to-back! I could never do that myself. Oh so many things to think about! But it definitely looks like Baylor plans are very helpful for nurses so far!

Thanks for your input. I didn't check to see if our Baylor shifts are allowed any weekends off; I will have to ask about that. We don't have a huge group of nurses doing Baylor where I work, so I wouldn't be doing the bonding thing --yet, anyway with co-workers. I do get along great with most of my co-workers, though, so I'm not too worried about that. I'm also not much of a shopper, but maybe that may change if I go to this type of work schedule. Any other suggestions? All info is appreciated. :) :)

I'm looking at doing a Baylor-shift type of work pattern right now. This one is in my current unit, it's an 8hr evening shift every Fri-Sat-Sun; work 24hr, get paid for 36. I'd like input from nurses who work Baylor shifts; do you do 8 or 12 hr shifts; 2 or 3 shifts Q weekend; and how hard is it to get a day off here and there? Also, do you have any type of social life with it? Bear in mind that I'm a mid-50's aged empty nester (not young and single any more, LOL!) and am wondering if this would be a good move for me at my age. What do you do for holidays that fall on weekends? What do you feel are the pros and cons of such a shift? I've also been offered a 12 hr Baylor shift at a smaller hospital in the float pool for just Fri-Sat. nights. I haven't worked in that hospital for about 28 years, and I don't like to float in my current hospital (it's so big and I'm set in my ways I think!) Please give me any and all advice ASAP. I'd like to make some decision (for myself at least) by early next week if at all possible. Thanks for your help. JennyP