nurse4theplanet

How do you currently perform shift report? What, if any, forms are you using? What have you found that works and staff remains compliant with vs. what were you doing that failed? New unit needs lots of insight to work out some change of shift issues/missed information. Thanks for any and all replies.

We are switching from scheduled visiting hours to open visitation. It has been quite chaotic so far. Visitors do not respect the nurses right to restrict visitation based on pt condition or the limit to the number of visitors that can come back at a given time. I have seen 10+ family members in the room at one time! Several pleas have been put into management. We'll see how long this lasts. The docs are getting a little frazzled as well.

ICU is the general term for any critical care unit, usually consisting of medical-surgical patients. CCU normally refers to the Coronary Care Unit which involves pts with severe cardiac problems and post-cardiac surgeries. However, smaller hospitals may not have two distinct units, where larger hospitals will. And even then, one type of unit may receive overflow from the other depending on census and staffing. Our CCU consists of 8 beds and we take 1-2 post-op CABG's a day, 3 on a busy day or when there is an emergency surgery. They are 1:1 for the first four hours. If they come back with a balloon pump or CRRT they are 1:1 for the duration of that intervention. Otherwise, each nurse has 2 patients just like in the med-surgical ICU. Other CCU pt's include post MI's, AAA's, Fem-Pop's, Acute CVA's, etc.

http://www.msnbc.msn.com/id/20212332/ Wondering if anyone else saw this and what your thoughts were? How would you react if the hospital you worked for enforced this policy? Where I work, we have a health and wellness incentive program where you can lower your premiums by participating in certain programs. However, it is not a punitive program. Therefore, if high cholesterol runs in your family then you are not docked for it on your paycheck. Also, this seems like a huge invasion of privacy. Health records are supposed to be confidential, so what gives this company the right to conduct its own mandantory health screenings and then use that information to charge you money and dock your pay? I guess there is a way around anything when you control the almighty dollar

I graduated in December. It took a month to get my ATT. Then I had 90 days to take the NCLEX. I took it in February. I also took a Hurst Review course. The test itself was difficult. I think it is impossible to study for it because there is so much information they can draw from. I felt very uneasy about it afterwards. But I passed with 75 questions. I think if you truly understand the basic nursing concepts, then you can answer questions about things that may appear like foreign material but are actually within your knowledge base. Does that make sense? Good luck to you.

1) Make sure your Piggyback is unclamped, otherwise you will return to find that it has not yet run in and you are behind on your other PB's that need to be hung next 2) Don't throw your report sheet in the shredder instead of the papers that really should have been shredded (LOL) 3) Always check your restraints to make sure they are not too tight and not too loose. If they can still reach their NG tube...what good is it to have them restrained? Rest assured you will be re-inserting that baby shortly. 4) Be very careful when doing mouthcare on pt's who are very confused or have trouble swallowing. They sometimes will bite down hard and can break off the little foam swabs or start sucking on the thing like a bottle and aspirate. 5) Check the siderails on the bed for blood and poo stains. You don't want to be leaning against that unknowingly while your cleaning or turning your pt until your co-worker points it out to you. 6) At the beginning of your shift, check your 'volume to be infused' levels on your pumps to prevent your fluids from running dry. Always keep ahead one bag of important drips...insulin/heparin/vasoactives. 7) (for monitored units) always check your alarm limit settings at the beginning of your shift and make sure they are activated and appropriate for your pt. *Just a few stupid mistakes I have learned not to repeat:lol2:

I don't know what the statistics are for pediatric nurses nationwide. But I do know that our local children's hospital started new grads out at a lower rate than other adult hospitals. It was also harder to obtain a job at the Pediatric hospital because the demand for pediatric nurses was very low. Many people wanted to work there and few left. I think that is why they were able to offer lower pay. People who really wanted to be employed there would not mind taking a dollar or so less in pay. However, in the adult hospitals there is a huge demand for nurses and a high turnover and hospitals are in stiff competition to draw and retain nurses. This is reflected in the higher pay they offer.

I completely agree! I commend those women who want to go through childbirth without pain medicine, induction, etc. for the benefit of the child. I'm not against all natural methods. However, there is no need to put your child's life or your own at risk unnecessarily. The difference between a home birth and a hospital birth during a normal delivery is not even worth discussing. Either will produce the same result. But the difference between a home birth and a hospital birth during a dire emergency could mean the difference between life and death. And that's not something I would personally take a gamble on. As to the parents mentioned in the OP.....these people are really pushing the natural approach too far. I don't consider it 'natural' to allow your newborn child to suffer from an infection and put their health, and possibly their life, at risk. I consider it stupid. I, too, wonder why they came to a hospital/MD anyway. Thank goodness for the child they did and that the mother came to her senses about allowing the antibiotics.

I know exactly what you mean about "unwritten" policies and things that others just expect you to know because, "everybody knows that." For example, our radiologists won't read XRs after hours unless its a dire emergency and they get a call from a physician. So there is no such thing as a stat PCXR for NGT placement (which is the hospital policy) at 3AM. I spent an hour one night trying to track down the XRay tech and figure out why my PCXR was not done because I had meds to give and TF to restart before another nurse finally explained to me that it would not be done until 6 or 7am and that "everybody knows that."

Hello my allnurses buddies! It's been awhile since I've had time to cruise the forums, much less post anything...but here I am after one month of being on my own. Orientation lasted six months after graduation. My first preceptor put in her two weeks notice half-way through my orientation (had nothing to do with me lol), so I had to switch to a new preceptor to finish out. And they were as different as night and day, to say the least! But I survived, and now I have been a real nurse (carrying the full responsibility) for a full month. It has felt like an emotional rollercoaster. Sometimes, I beam with pride when I see myself picking up on things quickly. But most days I feel dumber than dirt, like all my self-esteem has been ripped away. I am amazed at how many questions I have still. Not about pt care and conditions, necessarily; I expected that. More about paperwork, facility policy, etc. reguarding situations that never arose during my orientation. Everyone is very helpful and supportive, which is why I chose this particular facilty and floor (ICU). But sometimes you ask a question and get 4 or more different answers! LOL I don't feel like a nurse at all, but I don't feel like a student anymore either. It's a strange place to be in..."new grad". In school, I excelled among my peers. But in the real world, my skills are as green as they come surrounded by nurses with years of experience. That transition alone is difficult. I am very aware of my lack of confidence and I keep telling myself that it is going to take time to feel comfortable (semi) in my role. Maybe "seasoned" is a better word. I'm getting good feedback so far. I hope I keep doing well and start to feel more confident.

At my facility, RNs have to go through a special training program to be a preceptor and I believe its on a volunteer basis. But, I do see very new nurses getting assigned sometimes two students at a time and they have voiced their frustration to no end with management. No changes yet.

I can understand the rationale for first responders who may happen upon a patient who has been dead for several hours or longer for liability issues. But to do this for a pt who is currently under the supervision and care of the hospital staff seems unethical to me. While I certainly do not agree with many family's decisions to rescuscitate their dying/terminal loved ones, I still do it. Promptly and correctly....until the doctor calls the code. I separate myself and my beliefs from the situation.

what do you mean by slow code

poor written english skills give room to doubt competence. if you are ever asked to recount an incident in writing for review, you may feel differently.

Least Relevant...American History. While it is fantastic information to have as an American, and I would have taken it even if it was not required because I love learning, it is the least relevant course I took in relation to nursing. Next would be Music Appreciation....which was more like the history of music lol. I have to say that I really put each component of my education to good use on a daily basis. I think that is one thing that sets nursing apart from other majors.

Excellent posts. I agree the most important thing you can do as a student in the ICU is to get a good report and perform a really thorough assessment. The learning opportunity for you is substantial, so soak up everything. When I take/give report I like to start out by finding out why the pt is in ICU. Where did they come from (ER, MRT call, Cath lab, OR, etc.?) What events lead up to their hospitalization/history. After I have a good idea of why they are in ICU, I go thru my ROS. Neuro...are they alert/sedated/confused. Respiratory...vent/o2/lung sounds. Cardiac...HR/BP/Rhythm. GI/GU...diet/feeding tubes/foley/I&O balance/accuchecks. Then I ask about IV access, Drips they are on, Incisions/drains/CTs, who their physician's are and what specialties they are, Labs, recent interventions, scheduled tests/diagnostics. I also like to know about the psycho/emotional needs and the family. As the report is given, feel free to ask questions. Ex: If they have had a fever ...have they recieved tylenol, have blood cultures been drawn, what abx are they on, do they need to be screened for sepsis, etc. After report, I like to take a minute to reflect on what my plan for the day is and 'worst case scenario' type situations to help me feel more prepared for the unexpected. Am I going to be weaning any drips? What do I do if my pressure bottoms out? If they are on an insulin gtt, do I have a copy of the hypoglycemia protocol on the chart? Do I need to call the physician about an abnormal lab? What happens if they pull out their ET tube? Once I feel prepared, I check my Mars for Meds that I need to give that day to make sure I am familiar with all of them and give me an idea of how I need to schedule my time for the day. Do I need to get a morning accucheck and take 8am meds in the room with me. It is important to try and get as much done while your in the room, instead of running back and forth...especially if they are in isolation. Once in the room, I go through my physical assessment in roughly the same manner that I recieved report...system by system. I give them the once over (are they in any distress? diaphoretic? possibly in pain? sleeping? etc.) Then I check my vitals and get a wt. Next I check my lines and infusions to make sure everything is connected appropriately and infusing at the correct dosage and rate, especially wt based meds. Then I go thru the systems...Neuro, Resp, Cardiac, etc. I compare my findings to the report I recieved. Are there any changes? If so, why? Maybe something was left out in report...maybe it has changed. After I get a good assessment on my patient, I then prepare myself for speaking to the physicians and family members. Are there important changes I need to report...which physician does it need to be reported to? Is it something that needs to be called ASAP or can it wait until the physician rounds? What updates need to be communicated to the family? The more you prepare yourself to answer questions, the more the families and physicians will feel confident in your competence. Finally, I chart. Our system allows you to copy the previous charting...so I always do that to check my charting against the nurse before me. Again, it is just one more way of catching some important info that may have been missed. Then I start working on my plans for the day. Dressing changes, transporting for tests, weaning drips/vent, giving blood, etc. etc. Whatever the pts needs are.

Nursing Fear Factor Stunts: See who can empty the most foley bags in 60 seconds. Hook themselves up to insulin drips and see who's blood sugar can get the lowest without passing out. See who can withstand the most joules from the defribrillator without having an arrythmia. Who can untie the most 'dummy patients' underwater strapped to their beds in four point restraints in under 4 min...restraints can only be untied one at a time. Who can keep control of their bladder the longest after 40mg of Lasix IV

It's more than just an on call policy...it's for you! If you could obtain a system to alert you when your phone rings through a non-profit organization at no cost, perhaps you should consider doing so for your own benefit, in case of emergencies, etc. regardless of whether you stay at this job. Good luck to you in whatever you choose.

I think you have received several good suggestions about how to keep your job and accomodate your needs, most of which you can get assistance for through different non-profit organizations. Unless you just decide you don't want to take call, then I don't see why you could not find a way to accomodate for the change in policy. The employer is only required to make 'reasonable' accomodations for you, that does not mean that you will not be required to make certain accomodations yourself. Just like you had to furnish your own special stethoscope to perform your job, you may have to furnish your own telephone system to wake you on your call nights.

Turn this experience into something positive. I understand how distressing it is that you have worked hard to accomplish a goal and have received little recognition in light of your brothers' problems. Instead of becoming angry with them, focus your energy on more positive ways to deal with the situation. You can certainly continue to be a mentor to your younger brother who is struggling in high school. Share some of your own experiences with him about how hard you worked to obtain your CNA and how great it felt when you completed your program, as well as how it will benefit you in the long run. As for your older brother...keep in mind that finding out you have an unfaithful spouse and facing divorce can be a devastating experience. He has been betrayed by one woman who was very close to him. Be a strong support system for him and an example that there are good and caring women in the world. Most importantly, remember that these brothers did not purposely set out to sabbotage your special day. Enjoy your time with your boyfriend and celebrate your own success. Just because others are not as in-tune to your achievement does not negate the fact that it is, in fact, an achievement...one worthy of a celebration. They can only steal your thunder if you let them.

Probably because other STDs don't have the same stigma that surrounded HIV...especially when the disease first emerged. Alot of people lost their jobs, their families and friends, insurance, and were even killed by former partners, etc. People didn't understand that is wasn't just a 'gay disease' or how it was spread. People just react differently to someone who has HIV vs. someone who has herpes or gonorrhea. So laws were put in place to protect those individuals from the social stigma that surrounded the disease. Unfortunately, this also can create moral and ethical situations like the one discussed in this thread.

I agree that this is the best course of action. I believe that the pregnant partner needs to know that he was HIV+, as it could affect her and the baby. Getting the ethics committee involved may put some pressure on the physician to do so, if she/he had decided to not get involved. There is a chance the partner already knew. However, if she did not, then I believe that her right to know and get proper care for her and her child is greater than the need to protect the privacy of a deceased individual.

I agree with having a great preceptor program for new nurses. Also, employing a clinical ladder for nurses to move up through to get raises, take on more responsibility, and have short/long term goals to work towards.

Asoldierswife05's List of Productive Ways to Pass the Time at Work: 1) Check your pt...again 2) Ask a fellow co-worker if they need help 3) Straighten up the nursing station 4) Restock the Med Room 5) Fill the Copy Machine with Paper 6) Brush up on some of your P&P's...they do update them with changes from time to time 7) Read a professional magazine 8) Look up that new medicine that the drug rep is pushing at your facility 9) Read through your pt's charts...who knows, maybe you missed something during the beginning shift rush 10) Check in with the newbie nurse on your unit and see how he/she has progressed and let them know you are a resource 11) Check the code cart...if you are the next one that needs it you want to be sure its in order even if someone else was responsible...things get overlooked 12) Ask your coworkers if they need help (again)...afterall, where have they been while you have been attending to all the above? 13) Make a list of broken equipment, lights that need to be replaced, etc. Feel free to add on

Completely inappropriate. IPODs, cell phones, etc. should be used during break times in non-patient care areas. This is a huge pet peeve of mine. If you have your IPOD in your ear, even on low, you cannot devote your full attention to your patient. To use the excuse that the patient is vented and sedated is laughable. There are still monitors and IV poles, vent alarms, overhead paging systems, call systems, and your fellow coworkers to listen out for. What ever happened to professionalism?