nightbreak

Perhaps during January you could review head to toe assessments, lung sounds, iv inserts, etc on youtube? There are some really excellent channels and you might brush off some cobwebs! If you have the luxury and the $ a good basic review like Hurst would also help to freshen your assessment skills. Best of luck!

The California BRN has a position statement on floating, perhaps other states do as well? Of particular interest is section C. http://www.rn.ca.gov/pdfs/regulations/npr-b-21.pdf

California Ratios Pg 41+ http://www.nurseallianceca.org/files/2012/06/Title-22-Chapter-5.pdf

Warmest thoughts and internet hugs out to all of you. Thank you so much for all you do. Please take time to grieve and heal - we're here if you need anything.

This is a terrible and unacceptable situation. herring_RN has given you the best advice regarding ADOs and filing complaints with the state. Some nurses have a difficult time "making waves", but it is our responsibility as patient advocates to speak-up for safety. If your management is not responding by providing additional staff, then they have given you no recourse but to ask the state to investigate. You should specifically mention the incident of your patient pulling out the CL. Kudos to you for caring! Side Note/Soap Box: In California, barring an ongoing emergency/disaster situation, no nurse should ever accept a patient or assignment that violates the patient safety ratios. Just say no. And keep saying no. And mention Title 22. And refuse to take report.

I don't mind so much when patients are on the phone when I arrive with meds - my pet peeve is the patient that sets their smart phone to wake themselves up every two hours for their prn dilaudid. That kills me.

We had TeamStepps training at our hospital. I really didn't think there was anything cutting edge about it. Basically the same communication/hand-off skills that I learned as an EMT and during nursing school. I think the medical director had hopes that the medical staff would have more buy-in, but there was absolutely no follow through at our facility.

Our "white boards" have glass covering a paper template. The paper template ensures that we are not tied down to a format that might not work over time. We have times and lines for hourly rounding, a faces pain scale and sections for nurse, nurse manager, date, ambulation, diet... These boards really only work if your patient is coherent and can see well. I find that family is reassured by them, especially if you add something (anything), while you are talking to them. My favorite use is to write questions that the patient has for the doctor on them, that way the patient remembers during the three seconds of doctor rounding they might get a day.

newnurse - Unfortunately it is a fact of nursing life that some nurses are really horrible to give/get report from. You may have stumbled into a department where the unit culture is not supportive and the nurses enjoy belittling or gossiping about others. Try to ignore it. Concentrate on learning all you can as you make your way through your first year. Concentrate on the good you can do for your patients. Don't give the eye-rollers one more ounce of your energy. In the past I have used the "moment of silence" to curb bad behavior during report. The eye-roller says something rude and I just sit there looking them directly in the eye for 5-6 uncomfortable seconds, then I ignore their question/comment and continue on with my report as if nothing had happened. Sometimes during the silence the eye-roller will actually stammer out an apology, to which I reply "no worries" and again, continue with report as if nothing had happened. best wishes, nightbreak

Saw this earlier in a press report from the Dallas hospital where the ebola patient was originally sent home from the ED: "The hospital said in a statement today that the physician and the nurses followed protocol, but his travel history didn't automatically appear in the physician's standard workflow. "The documentation of the travel history was located in the nursing workflow portion of the EHR, and was designed to provide a high reliability nursing process to allow for the administration of influenza vaccine under a physician-delegated standing order," read the statement. "As designed, the travel history would not automatically appear in the physician's standard workflow."" I'm worried that our computerized charting systems, along with constant understaffing and stress, will lead to more cases being missed. And, of course, we can barely isolate for MRSA, given that none of the families want to follow protocols and the hospital admin is so focused on patient scores, they won't enforce anything that might make patients unhappy.

liberated847- As a flight nurse you would feel comfortable looking away from a patient while they pleasured themselves? How long would you be comfortable not visually monitoring the patient you were transporting?

Division of Labor Standards Enforcement (DLSE) Law section These sites from the CA labor board and the CA legislature might help.

I was wondering if you work an eight or twelve hour shift? When you were hired did you agree to an alternative work schedule (somewhat common for california nurses)? Are you an independent hospital? If not, how are other hospitals in your chain handling the breaks for their nurses? Where I work, in CA, the twelve hour nurses typically begin their 30min lunches at the six hour mark of the shift. We have done this for years and have never been dinged by the state, but we do sign an AWS when we are hired. It sounds like someone up the food chain is having a knee-jerk reaction - the nurses should draft a firm letter to the DON stating the reasons a lunch break right at beginning of shift is unsafe for patient care. good luck!

I believe in this: everyone is legally entitled to rest and meal periods. I believe in this: rest and meal periods should include complete relief from patient care duties. I believe in this: patient safety is increased when staff is well-rested and fed. I believe in this: nurses are not martyrs, they are educated professionals. I believe in this: break nurses for everyone!!!

Your facility needs a union. Your manager needs a public shaming (and, apparently, a soul). Prayers and love to your coworker.

I answer the phone if it is convenient for me to do so. If I am interested in picking up hours I will state when I am able to come in and what type of assignment I would be willing to take. If I am not interested, I say (politely) "No, but thank you for thinking of me". I never get any guff from the staffing office or my manager.

Chocolates, sit-down breakfast served by department managers and door prizes. Cake later in the week.

Our hospital is happy to hire RNs with who come from skilled nursing facilities. If your current employer receives monies from medicare and is accredited, they will even give you credit for years of experience. If you bridge from LVN to RN, you are also eligible for our new hire grad program straight out of school. I would look at the hiring policies or union contracts at your nearby hospitals as the best way to gauge what your options are. Good luck with your studying!

Congratulations Providence nurses! A great move for nurse and patient safety. Good luck with negotiating your contract!

Dear Blackvans, In my second to last semester of nursing school, I had the same sinking feeling of a lack of clinical education. I tried to prioritize what seemed to me to be the biggest and most important missing component and made a plan from there. I came up with an idea of how to address a very specific goal/learning opportunity and then: 1) had two floor nurses agree to mentor me r/t to the specific goal 2) approached the nurse manager and had her agree to plan; she liked that I had already arranged for nurses who were willing 3) approached nursing school professor with whom I had the best rapport and presented the plan along with the news that the nurses and the nursing manager were agreeable to the plan Luckily, I worked at the hospital where our school held clinicals, so it was easier for me to get the nurses and nursing manager to sign on to my plan. However, I did have to agree to not do any direct patient care. My specific mentoring plan included chart review, prioritization skills and theoretical mentoring. Because this provided a decreased liability for the hospital and the nursing school, everybody felt comfortable signing on. I ended up getting extra hours on the hospital floors and an extra independent study school credit. I encourage you to advocate for yourself and your education! -nightbreak

; ) Everyone on our med-surg unit gets their full 30mins plus 3 tens - it's my job to make it so!

... be kind to yourself. ... to ask for help when you need it. ... offer help when others need it. ... always max inflate a versacare before moving a patient. ... to try to read one nursing policy a shift. ... never stop asking questions.

Dear Elizabeth Renee - Thank you so much for being so calm and considerate in your replies on this thread. Obviously this is a hot-topic and some posters may sound as if they are attacking you, when they are just appalled at the situation. Thank you also for bringing the type of 'delegation' up for discussion. I, for one, had never heard of such a practice and do not support it. Perhaps your thread will energize each of us to watch our state nursing regulations carefully and to actively protest any move to 'delegation' where we practice. About the insulin administration - we educate people every day to go home and do exactly what you have been taught: monitor daily BGs, administer insulin per sliding scale, eat correctly, etc. Most of the patients and families we educate have no medical background or training at all and yet we do not insist that a registered nurse appear in their home each time they need insulin. It sounds like you really care about patient safety and that you have a strong sense of working within safe boundaries. I wish you much success with your nursing studies and thank you again for bringing this topic to our attention. - nightbreak

Cadman - go for it! My dad became a nurse in his mid-forties with absolutely no background in healthcare. Zip Zilch. He made a pragmatic decision to enter a career that would provide well for his family and one that also provided value in his community. It wasn't always his 'dream', but it did offer him 20yrs of financial stability and the opportunity to become a top-notch ICU nurse. School districts everywhere are downsizing due to years of declining birth rates. What a perfect time to segue into a job where the user population is growing! Being a technology guy is going to be a plus for you - tons of technology being utilized by nurses in hospitals. DJ, drafter and surveyor? You'll be surprised how some of the 'soft' skills that you utilized in those careers (and in teaching) will be extremely helpful in a nursing career. I've just finished my first year as a hospital RN and I'm half a century old. The slog to get through school was definitely worth it; I love the people I work with, and enjoy every day I spend on our unit. Also, the fact that I made almost 90 grand in the last twelve months doesn't hurt. Warning: start networking for a job position now, while you are still in school. Treat every clinical you attend as a learning opportunity AND an opportunity to present yourself as a future job candidate. Never sit down, always offer help, bring donuts.

Two years of psych nursing will come in extra handy on a med-surg floor - as many as a quarter of our patients can have a mental diagnosis that is being treated concurrently with an acute or chronic medical problem. Your new co-workers will probably really appreciate your experience. And yes, ask for a wage based on your experience!