Irish RN

5 days a year rolling calendar. No such thing as occurrences where I work so if you're truly sick and out for a few days in a row, you better hope the rest of the year goes well!

There's no harm in applying for other positions. If you go on an interview, UP talk the rehab and explain how much you learned there as a tech and a new grad. DO NOT say you're "bored" and have too much paperwork. Keep learning and growing where you are and stick it out until you get offered another position. To be honest, I work MedSurg and I have a lot to chart but also A LOT to physically do. Having my patients busy with PT for 3 hours sounds kinda nice! :) just remember it's not always greener but it very well can be.

Our hospital's solution is that we attend to every little need prior to the patient having to hit the call bell which means we all must read our patients' minds.

Disagree with this, only because I work medsurg and it's EXTREMELY stressful. I've called several code strokes and rapid responses (no code blues yet *knock on wood!*). I've had to transfer patients to tele units and ICU. Medsurg is not "stable patients" by any means, they're acutely ill. We also deal with a lot of detoxers, dementia/Alzheimer's, combative/noncompliant patients. If you're trying to avoid stress, which it sounds like this is the issue opposed to the stable vs. nonstable patients, medsurg is NOT for you!! I'd consider an office/clinic setting where you have set appointments and no walk-ins..then you know what to expect when you start your day.

I agree...I don't wear gloves when pushing meds through a PIV or PICC line but I DO wash my hands. Also, most PP are referring to the "cap" but it's actually called a clave. And the clave MUST be changed after each blood draw from a PICC line. Obviously this is determined by hospital policy but if you are not changing the clave between blood draws your PICC lumens will clot off and will require tPA or a new line. Claves are also changed with dressing changes. Claves do not need to be changed between med infusions or med pushes. I scrub the hub with alcohol similar to a PIV but use a push-pause motion with administration.

And what if the OP drew off the midline and then it clotted/the pressure affected the lumen/etc. and she/he couldn't bolus and give appropriate meds? then the patient would have REALLY been screwed. I used to work for an infusion company and if a radiologist or the RN who places the line writes an order to "do not draw" then usually there is a reason for that. I agree that in an emergency situation like this, SOMETHING must be done but I am very surprised at the above posters who agree with your charge RN. A couple suggestions: 1) you say other nurses tried to draw, but who?? If I have a really tough stick and my co-workers offer, sometimes I'll say No I think I need the ICU RN after assessing the patient's veins. 2) call the MD/radiologist/RN who placed the midline or whoever is on call. It doesn't matter if it's 0100 there has to be someone who is an EXPERT who you can consult. --clearly this is NOT the charge nurse. 3) If the fistula is all that's available, where are the dialysis RNs? again, isn't there someone on call you can consult? 4) Research the midline placement, what products were used, etc. Find out if it's a PICC lumen cut to a midline - this info will be useful when you talk to the radiologist on call, etc. Of course, what is happening to your patient during all of this?? Labs are important but not the tell all. Patient assessment, did the patient get relief from nitro, what are the VS -- your charge and coworkers should be doing the above while you are with the patient! Also, I'm surprised the MD didn't order anything ON TOP of the labs like say some studies? Chest x-ray, CT angio with the hx of dvt? did we check a blood sugar? Did we consult RT? EKG isn't a tell all either!! I had a patient whose EKG was normal (compared to baseline) and his TNI was > 9!

We do I&O's on every patient and I work medsurg. Our staff is pretty good about recording everything but I still think it's inaccurate. If I give my patient 360 mL and record it, how do I really know if he drinks it all? Obviously, you can get accurate IV fluid volume and urine output by using hats/urinals. We have several incontinent patients, impossible to get accurate I&O. We do chart incontinence under the I&O flow sheet so we can at least be sure our patients are voiding. As far as the original question, I do believe it's important to monitor but I think there are better methods to identify fluid volume changes such as labs, weight, assessment findings.

I work medsurg and only take VS prior to BP meds. I assess LOC prior to pain meds and I also ask the patient if they've ever had the med before, any previous rxns, I educate on s/s, etc. I dilute as needed and push slow. I usually stay in the room to complete an assessment, do wound care, hang meds, etc. so I'm there if the patient has initial rxn to the IV pain med. Wanted to add, change in VS is usually a late sign of clinical deterioration.

OP, I'm with you. I've lost about 15-20 lbs since working nights, most of it within the first few months.

Thanks for the input guys! I guess I needed some validation for my decision. I plan to only do classes up to 3k a year, maybe a little more (that I can afford). I disagree with "everyone has debt." I'm pretty crazy and check my loans daily. I pay FAR more than the minimum, I've paid off 14k since January. My goal is to pay my loans off within 3-5 years. I have NO other debt and refuse to buy a house until my debt is substantially lower. If I could go back and change my loan decisions, I 100% would! You live, you learn.

just to clarify: I have no problem caring for a patient with acute medical issues with a hx of psych issues on a medical floor. BUT their psych issues need to be controlled....it's very difficult to have a little old dementia lady trying to climb out of bed every 5 minutes and biting the LNA. If the LOL with dementia is sitting in her bed pleasantly confused, I have NO problem with that. I can certainly see both sides. I think psych units should be able to care for basic medical issues and medsurg units should take acutely sick psych patients (who are at least somewhat stable as far as PSYCH goes). What it comes down to for me is patient safety. I often feel I neglect my other patients because of my uncontrolled psych pts and to be quite honest, most of their acute medical issues are minor such as UTI. Wanted to add... we even have "sitters" who consist of housekeeping staff and dietary staff who do 1:1s. I HATE this. They are NOT trained whatsoever as far as medical/surgical and certainly have NO idea how to handle psych patients. ughh *cringe*

someone from the other side.... I am SO sick of having PSYCH patients on my medical/surgical floor. We ARE NOT equipped to handle these types of patients with 6 other sick patients as well. It's SO unsafe and I am FED up. These psych patients need to be on medical/psych floors until cleared to go to psych only. My hospital is too small... we don't even have a psych unit! SO I have a full assignment, most of the time 4-5 out of my 7 patients is confused, demented, yelling out, trying to hit me, thinks I'm arresting them, 1:1 for suicidal ideation....It's just not fair to us OR more importantly, these patients who need a different level of care.

I agree that this nurse needs to be reported. Situation #1: I think the patient needed the Ativan. I think it's wrong "Nurse J" gave it. Situation #2: DNR (do not resuscitate) does mean do not do CPR so not sure why the (again really?!) comment, it doesn't mean do not TREAT as you know. If the patient is not comfort measures and has PNA, treatment for that is warranted (you did this)."Nurse J" sounds mean in this one. Situation #3: Clear med error. Needs to be reported.

I work in a small local community hospital. The major city hospitals around me require BSN and also pay more $. That's what I mean by "hold me back"

I'm not saying you need a doctor's order, I'm saying pharmacy should enter it as exactly what it is.. 2 different drugs, which happen to be given at the same time. Ours has to do this because we scan our meds.

I'm actually in the process of switching from nights to days. I love night shift but after 1 year, my sleeping schedule is SO bizarre! Even on my days off, I'll nap at odd hours and be wide awake at 0400, it sucks, especially for my poor boyfriend who comes home after work and I'm asleep. I'm nervous about the switch though, money being the biggest factor. Also, I've hated the "feel" of days since I started, night shift is a whole different world. And lastly, I'll be getting paid less to deal with a lot more. Night shift is not easy but I don't deal with discharges, meals, PT/OT, etc. We are, however, ALWAYS understaffed on nights. It's a really tough decision for me but I think I'd pick having a more normal life with my S.O. over money/"feel" any day.

Our pharmacy has the right to do "therapeutic interchanges" for any med ordered. For example, docs order IV Zosyn q6h but it's always changed to q8h based on industry standard....pharm can legally do this. Also, they interchange Protonix for Prilosec, etc. The pharmacy puts it in the EMAR properly so our meds scan. After all, pharmacists are the experts in medication, not MDs. Wanted to add... if pharm isn't involved with this and this is just management or other staff telling you to do this, then that's totally illegal!

how about before report....you walk in to 4 new admissions, 23 patients, 3 1:1's, 2 aides, 4 nurses including myself. hmmm that math doesn't sound too right either!

Thanks for the reply. I forgot to add that I currently work full time & my hospital pays $3k a year for tuition reimbursement. A big part of me agrees with you, but I am so worried that waiting to get my BSN will hold me back. I am already itching to move on from my current position..at least within the next year or 2.

Hi All, I need advice. I have my ASN, 1 year experience, and $81,000 in school associated debt (please, I already know the mistakes I've made....sigh, it's the only debt I have, only being a relative word here). I actually owed $91,000 as of graduation, I've paid the $10k off since January. But anyway, I am really struggling with making this decision. A BSN is highly preferred in my area especially in the bigger city hospitals where you'll find higher pay and greater job satisfaction. I've gone back and forth with going to an online school like WGU, Ohio, etc. Although they're accredited, they are not well known in my location. I'm very worried that going to the wrong school and having it turn out to be non accredited in my region or something will totally screw me. My family has urged me against WGU for that reason and for the "odd" pass/fail system. It does sound too good to be true.... I've done my research and actually spoke to a WGU admissions counselor on the phone for an hour. I was very close to applying to and attending WGU. There are 2 well known BSN programs near me. Both are private, Catholic universities, $300/credit. I'd be looking at anywhere between $12-20k depending on how many credits transfer. I just don't know if I can stomach that much money ... AGAIN as I'm already paying off so much. PLEASE... any and all advice is welcome, just don't bash me for my outrageous debt! thanks :)

At my facility we scrub the hub, flush with 10 mL NS, waste 10 mL blood, draw 10 mL blood (usually), flush with 20 mL NS, and then change the cap. No sterile technique. I only scrub the hub initially, not in between each step because the cap is never exposed. I leave the syringe attached until I have the next one right there.

On orientation, for some odd reason, I was assigned with my preceptor(yes an RN - such a waste of resources, ANYWAY haha) to a md ordered 1:1 for an ETOHer. So I was with this lady for 8.5 hours straight.... favorite line "GET ME OUTTA THIS CAKE BAKERY!!" my response "I wish I was at a cake bakery..." (sigh) and the best part was I didn't even think about it, that's just what came out! my preceptor was dying laughing!

Hi all! I am inquiring into the program....how are the assessments set up? Is it via webcam with instructor or is it point and click tests on blackboard?

Hey Guys! Can anyone give a TRUE estimate for tuition? I've been on the website but I often find they don't really reflect the true costs including books,etc. I do have some transfer credits I believe but I'd like a higher side estimate if possible. Cost is a very important factor in this decision. Thanks! (please include fees, books, I'd like TOTAL cost for entire RN to BSN program)

it seems to me like you did nothing wrong but the most important question is --- did you document?!? if in your note you wrote "CPAP applied to patient as ordered at HS. patient requires frequent redirection and orientation d/t dementia. patient repeatedly removed CPAP during shift (or last hour of shift if you worked 3-11 right?), this RN educated patient on need for CPAP, pt continues to remove mask. will frequently monitor and redirect patient as needed. etc etc" if you wrote one small note similiar to this, then there is NO WAY that'll hold up in court. however, if you didn't write a note, i suppose it's the facility's words vs. yours which is never pretty....good idea getting a lawyer. GOOD LUCK! sorry this is happening to you. move on and find a better job.