nursejami

My #1: Tiene dolor? (Do you have pain?)

If you have an order from the MD, why would it be illegal...? You're just transcribing the order, just as if he had told you the order over the phone. Now, whether it's against facility policy is another question entirely...

Re: the metoprolol, why was his blood pressure in such a good range? Was it because his BP meds were keeping him there? :) How does he trend? Also, you always want to look at the history. WHY is he taking the metoprolol? For BP management, HR management, CHF management? That BP doesn't really worry me at all. But these are definitely the questions that kept me up at night after work when I was a new grad. Keep your head up! It gets better! :)

I floated to ICU after 6 months. I was scared, but felt comfortable as they gave me patients that had orders to be transferred to my floor anyway (just no available beds). After one month, there's no way I would've felt okay doing that.

Bottom line: IT WILL GET BETTER! Speed comes with time and experience. In a month, you'll feel better. In 6 months, you'll feel great! :) You're not alone. I felt the exact same way when I first started as a CNA, and again as an RN. You'll get through this, just breathe!! :)

Two weeks of "classroom" orientation, random scattered residency classes while orienting on the floor, 4 weeks of floor precepting. I was a tech and LPN on my floor previously also, thank God, because 4 weeks of orientation is ridiculous. Also, I have awesome co-workers, which helps. :)

I don't think I can say anything that hasn't been said. I love being a nurse and couldn't see myself doing anything else. Even on the worst days, I know I've made some sort of difference in someone's day and their health outcome.

Yep. If they're lower, I'll give a bedtime snack. People often drop in the middle of the night...

I think you pretty much cover it! I also work nights, and my typical shift goes something like... Look up orders/vitals/hx Get report Assess patients Obtain vitals from tech Give meds (scheduled and prn) Sign off tele strips Look up more info on patient (H&P, imaging results, MD progress notes, Social Services notes, etc) More vitals Put out fires as they occur (resp distress? Crazy vitals? Bad IV? Jumper?) Get admissions as they come Give morning med Get blood sugars Give am insulin Report critical/borderline am labs to MD as needed Give report Obviously, throughout your shift you're doing rounds, caring for your patients (bathroom, water, repositioning, etc), and giving needs as needed. Things like dressing changes rarely happen on nights, unless they're out of necessity. With everything else we're subjecting these patients to they're having a hard enough time sleeping without a random 3am dressing change. Being on nights, you will have to learn to prioritize about when something needs to be done NOW and when doing it NOW would not be beneficial to the patient. Skills you'll probably do include IV starts, catheter insertion (Foley and straight), drain and catheter removal (in the morning), suctioning, tube feeding, etc.

I've heard them called vital carts before...VC?

Working as an RN is not a pipe dream! :) However, you are smart to be realistic! *There ARE shortages. .. just not everywhere. You may need to b relocate after school to get a job. * You probably won't get your dream job right out of school. Peds and other specialties usually like you to have nursing experience first. * This is so important: GET A JOB IN HEALTH CARE! Getting your foot in the door in this economy is so important! Start volunteering in hospitals, get a job in the hospital kitchen, whatever! Get your CNA as soon as possible and start working. Nursing home, hospital, home health... Get in there! It's not impossible, but you may have to work hard for it! If it's your dream, make it happen.

Stick it out for the year! You'll feel more confident in yourself as a nurse, which will look great for you when you transfer to the new department. It'll also look better on your resume! Trust me, you'll get it down! It just takes time! One day you'll wake up and think, "...When did THIS happen?!?" I've been working as a nurse (off orientation) for 6 months so far and I got caught by a realization halfway through my night last night, "I'm really DOING this right now!"

Better safe than sorry, every time!! :)

I think you hit the nail on the head that the patient is probably being charged for the medication. THAT is the biggest issue here, to me.

I was just going to comment "if work doesn't, school will!" I see I'm not alone in that! In addition to the professionalism issue, having extra holes in your face probably won't be very good for your health. If you're planning on working in a germ-factory setting (AKA: hospital) you will be constantly exposed to various pathogens, not the least of which being MRSA or VRE.

1. State you work in: WI 2. Years of experience: 8 mo. 3. Specialty/unit and work setting (clinic, hospital, prison, etc): Med/Surg 4. Hourly Pay (base rate) or salary: $22/hr 5. Differentials (if any): +$3.00 night shift 6. Union?: Noooope

Also: take the opportunity to practice your skills whenever you can! I see so many nurses complain about being bad at IVs/NGs/etc. and then just ask charge to do it. You won't get good if you don't practice. :)

I work in acute care, so my answers are a little specific... Show initiative. If you notice something out of place, fix it (ex: I can't tell you how many times I walk into a room at night to find a patient SCD's are off. I love it when I have a CNA who will just put them on without me having to ask. Or who will notice before I even do!). Know your abnormals and report them to the nurse ASAP! If someone's blood pressure is 180/90, I want to know right away. Even if you've been told it's their norm, I need to know! I might be able to do something about it/find the cause behind it! :) Notice a little skin breakdown? Same thing! Tell me about it, even if you were told the nurses already knew! Stool looking a little funky? Show it to me (I love health care)! Give compassionate patient care. If someone's brief is wet, don't just stick a new brief on them. Clean them off! I hate, hate, hate when I catch someone doing this. How often do you use the bathroom without wiping?? Don't downgrade yourself. A CNA can make or break a nurse's night! When I was a CNA, I didn't fully understand my worth. A CNA who has been with a patient for a few days and gotten to know them can help out an RN more than another RN can, sometimes! Now that I'm a nurse, I appreciate every little thing. Just bringing fresh water into a room can not only make the patient happy, but it can save me time in my med pass!

Parental pressure, haha. My parents are very much against loans, and my dad was an alumni of the local community college. In the end, it was worth it because I graduated debt free and am working as an RN while working towards a BSN.

I married an engineer. We're high school sweethearts, so we're a little outside the norm. :)

I don't know how I would feel about this. I'm a newbie, and thank you notes to patients are a weird concept to me. I've only ever worked for one hospital, and this just isn't in our culture. I guess in theory this would just be a new, high-tech way of conveying the same message. The issue here, of course, is that she had to use her facebook account to contact the patient, and presumably she has personal information/pictures on her facebook account. That has the potential to open up a can of worms even if she doesn't have anything unprofessional on it. Now, had she "friended" the patient? Totally, unquestionably inappropriate.

This is what we did. The idea of also printing it on the program is a great one. I'm not sure if my dad really got to hear my thank you as we were both more concerned with him not stabbing me with the pin! It would have been nice to also have it in writing.

The director of our lab actually lists this as rationale for wiping away the first drop of blood (in addition to alcohol contamination). The trauma caused by fingerstick causes the first drop to be contaminated with extracellular fluid. The glucose in extracellular fluid is different than blood, so it skews the results.

Here in Wisconsin we're booming! My hospital has been at full capacity for weeks, which is so unusual for this time of year!

When I was in school, we were told to start applying a few months before graduation. Many hospitals go through hiring cycles around the end of semesters. If you wait until you pass the NCLEX, you will likely miss the hiring cycle. However, my only experience is in acute care. If your plan is to work in LTC or any other facility, I'm clueless!