TopsDrop

We have the calm before the storm thing going on here too. We have 4 positive COVID patients in my ICU. All are vented and 2 are being proned. They seem to be slowly improving, but this virus is messed up, so hopefully that continues. We stopped visitation 2 or 3 weeks ago. PPE is rationed and we've "stolen" all the caprs/paprs we could from clinics, surgery etc. All electives surgeries are canceled. ER has been at about half normal flow and our unit has had about 12-15 patients (24 bed) mixed ICU. (We had been near capacity for months). Not sure how the hospital floors look, but we sure aren't getting our transfers out quickly. My midwest town is 70,000 population less than 20 miles from a large metro area for reference. Pretty interesting how many people aren't that sick when they have to stay home and surgeries are canceled. Our ICU manager is former military, so luckily we are using this time to come up with a game plan for when the stuff really hits.

I learned that: A long dilaudid-induced sleep can completely change someone's outlook on their situation and make them realize everything might be okay. Helping above person finally rest makes you the best nurse ever and make them indeed start dialysis. Retired police officers have just as many awesome/funny/ridiculous stories as nurses. Spending 45 minutes unwrapping cleaning and re-wrapping your century old patients legs also makes you the best nurse ever. That 8 times out of 10 if the patient is younger than 50 and admitted to the floor, they will be suddenly helpless, in extreme pain, or just a plain ****. Or worst, all of the above (not really new, just re-affirmed.) These weekly threads rock

I've always been a night person. So nights works well for me. Days off I usually sleep until 11 or Noon and stay up until 3 or 4. I almost always get 7-8 hours of solid sleep, guess I'm lucky from what I hear from co-workers. I do switch to a "normal schedule" when I am on vacation or off >4 days. Do all my chores/shopping/fun stuff on my days off since most other professions work until 15-1700 anyway I usually work out 4-5/week or more. Usually go to the gym after work. I figure if I'm spending 12 hours trying to make others better, then I can spend 1-2 making myself better. Everyone's routine is different, and some people just physically cannot do it.

I'll preface my post by saying this: EveryBODY is different, you'll have to try some of the very good suggestions and find what works for you. Here is my advice and what's worked for me for 3+ years: First off, your body doesn't care what time it is, if you need to be awake it needs fuel to function at 100 percent, so you should try to eat something every 3-4 hours during your shift. I work 7p-7a as well. You should eat something before going in, like 5p-6p then try to grab a snack every 3-4 hours. Avoid carbohydrates (Especially simple carbs) for about 2-3 hours before you think you'll go to bed. I pack high protien food for work, at least 2 snacks and 1 larger meal. I pass on all junk food 90% of the time and drink water throughout my shift. I also spend a few hours one night during the week cooking all my meals for the week. Here's a sample of what I do every shift: Wake up at 3p : Oatmeal and 3 scrambled eggs 6p: 6oz. chicken breast, garden salad, sweet potato fries 10-11p: Greek yogurt and 1 serving almonds 1-2a: 6 oz fish, fruit, brown rice side 4-5a: 1 oz beef jerky, 8 oz 2% milk Drive home: Whey/Casein protein shake Bed Just takes careful planning, but no one is usually around on nights so I just eat my food in the nurses station. My nutrition/health is very important to me so I make it my 2nd priority after my patients. And yes, I have a food scale and weigh out my portions. I also drink coffee on and off, but no caffeine after 3am for me, unless I'm going to the gym after my shift. If you can find time to exercise, that will also help. Hope my post helps.

I wear bright blue and neon green Nike trainers. Can walk all day and my feet don't hurt. Plus they start a bit of conversation. Less than 50 bucks at the outlet, can't beat that.

Of course it was the nurses fault. Why would the media report that sometimes the almighty physicians make mistakes too... While it is possible there was a failure in communication. I highly doubt we will hear anything other than "the nurse failed to communicate his travel hx properly". Which may also be the case, I guess we'll have to see what happens Ebola shouldn't be hard to contain in this, or many developed countries with modern healthcare practices and isolation practices, but now that we have "patient zero" here in the US, I guess we will see and we're not off to a promising start. Basically it is spread like HIV, body fluids. Unlike HIV, there are a lot of symptoms that indicate there is an infection, which is when a person becomes symptomatic and contagious. The scary thing about this epidemic is it is affecting a lot more people than past outbreaks, which gives a virus more chances to mutate. That's the scary part.

Signing "RN" after my name at the store on the rent/bills etc. usually after a few days of work Waking up in the middle of my sleep because I swore I heard the bed/chair alarms Those are the main ones that stick out in my mind

I figured I would post a positive story today because there are enough rants (I understand) and I am sure some graduating nurses/nursing students are probably second guessing themselves about their career paths reading the stuff we post. I had one of those nights this last week that reminds me why I come to work each night and why I love this profession. You never know what you're walking into. Keeps me on my toes ya' know. Even though most nights are full of craziness, admissions, blah, blah, blah; it was not one of those nights. I came in to a full wing so right away I know I am not getting an admission right at shift change or at 0230 when the doctors are oh so happy to talk with me or not awake enough to give me coherent admission orders. I know most of my patients from the night before so report is short and sweet. My pt. in 3 admitted with hypoxia and an extensive psych history is sleeping wonderfully with her overnight pulse ox never dipping below 94% The one in 4, In with a new Atrial Flutter, completely stressed about her possible TEE and cardioversion in the AM, converts to NSR 3 hours before shift end. She then cries with happiness when I let her know she won't be going for the cardioversion; then she starts laughing when I give her the print out from the tele monitor showing her the minute her heart converted back to NSR. She happily proclaims she "is going to frame it and put it on the wall". Then there is 6. The 80 yr. old I admitted the night before on bipap cause he wasn't maintaining his oxygen sats d/t bad pneumona and probably COPD even though it's not in the hx. His lungs still sound horrible, but he is now on 4L and I can actually have a conversation with him. He goes on to tell me a bunch of stories from his youth in his serbian accent because I actually have some time to sit with him awhile. He later asks why I don't turn the lights on when I come to hang his antibiotics and I tell him "I work in the dark all the time, so I don't really need the light". He then tells me how he was once asked in his business how he could do good work in the dark and he would always say "I made all of my children in the dark and they all look pretty good". I almost fall over laughing with him. And finally there is 11. She is exhausted from her elopement from the hospital earlier in the day and tells me the story before getting a full nights sleep. 9 and 12 were wonderful too, but those are whole other stories in themselves and this post is probably too long for most readers as is. I even got to give report back to the same nurses who had them the day before, so we even get some continuity of care here. I even got out on time . Hope everyone who reads this enjoys and realizes that not all days are as bad as we nurses make them seem sometimes. Its just that nobody understands our profession other than those that are in it, and that's why we can come here to vent sometimes.

We recently undertook a pretty large intiative on this very subject at my hospital. Our HCAHPS scores were pretty low on the medications side effects portion. Over the past 6 months we have seen significant improvements in these scores. Here is a brief run down of what our practice council came up with. 1. Any time a new medication is to be administered to a patient. Pharmacy puts the word "new" next to it on both the computer screen and in the ADU so the nurse is alerted. 2. We have a binder of our most comonly prescribed medications and their side effects printed on stickers and placed in the med prep room. 3. We also have a sheet with grid for said stickers (or written info) on the new medication that is to be given to the patient and placed on the bedside for reference at any time. 4. The nurse giving the first dose of this new medication is to fill out the "new medications" sheet and go over the side effects with the patient and leave the sheet at the bedside for the patient and oncoming nurse to see/add on to if necessary. 5. We also have printable information we give at this time. We are still modifying this as we go along but has shown some very good promise. I can go more in depth if anyone is interested, either in thread or via PM.

It is very hard to tell someone else if it's worth it. Most people honestly have no clue what a typical bedside nurse has to put up with on a daily basis, including probably yourself. I personally feel getting your CNA and starting "at the bottom" is the best way to go, that way you get introduced to the very basics of nursing. That's what I did. It won't necessarily make you a good or bad nurse if you don't, but at least it gives you an idea of if nursing is something you can do, and jump starts your assessment abilities. You have to take a lot of the posts on here with a grain of salt. People come here to vent because only other nurses can truly understand, and relate, to the frustrations in this field. I don't think many nurses are as bitter as some of the posts make it seem. I personally love my job. There are a TON of things that drive me nuts about it, but I really do enjoy my work. It's challenging and always different every day. There are days I want to scream (like yesterday) and days where I really feel like I accomplished something to actually improve my patients well being; whether it be in education or helping to improve, or take their mind off their symptoms. Get your CNA, it's a great college job anyway. Do a lot of research and shadow some nurses and see if it's what you really want to do.

Don't believe the hype as far as "stability in nursing" or "nursing shortage" blah blah blah. While nurses are in short supply in some areas, it's not everywhere. Nursing is just as competitive as any other field. You need experience, or a foot in the door to get hired. The pay is decent, but for the enormous responsibility and BS we put up with, we should be making more. Honestly, a hospital can't function without the bedside nurse, or nurses in general. Sounds like you have a decent job and unless you truly want to be a nurse you will hate it and burn out quickly. I've only been a nurse for 2 years plus 1 year as an LPN, and I have already seen my fair share of new RN's that can't do it. They leave the profession before their first licence renewal. I love my job though. Can't really imagine doing anything else. I use my brain every single day. It's flexible and I do help people most days (I also feel like screaming at people most days, but management doesn't like that). Occasionally, I even help save someones life. Nursing is very frustrating and can be very rewarding at times, but you have to want to be there. There are a lot of other jobs that pay just as well or better and don't have to put up with as much BS as the bedside RN does. Do a lot of research before you think about spending 12-40+ grand on a degree you may hate.

If the 5 foot 110 pound nurse can help me boost/turn/clean my patients I think you'll be fine... Hitting the gym is never a bad thing for your health though.

This is usually how I start report after the day shift nurses ask how the night went lol

AHHHH that is awesome...seriously started laughing out loud as I love all zombie material... I've only been a nurse for 1.5 years but have been given quite a few orientees lately. Only issue I have had is arrogance. One newer nurse knew it all and didn't think my ADN education was up to snuff with her BSN education... until a patient started going downhill and she had no idea what to do. She couldn't find me fast enough then. She had a lot more questions after that patient went to ICU. She was very attentive to my guidance after that. She was very bright and is on her way to becoming a very good nurse. Or the one who was SHOCKED when I said we needed to clean our incontinent patient (with skin breakdown) up before moving on. "isn't that what the aide is for"? After I told her we were not going to leave our patient in poop to go find our lone aide who was probably in another room. She reluctantly agreed to help. Was like this every time. She didn't last long, not sure where she went. We have the bare minimum on nights and you got to get your hands dirty, sorry.

For my ADN it was ~10k. The 2 years I spent "enjoying the college experience" was 15k... So total was around 25k. Been working a year and a half and have 19k left... I should have 0 debt, but I was young lol. Oh well should be student loan free in about 7 years or less...Until I go back for my BSN:rolleyes: At least my place of employment offers tuition reimbursement.

Thought I was going to hate night shift when I started about 2 years ago. It is actually perfect for me. I've always been more of a night person anyway. Once I figured out my sleeping and got family to understand (for the most part) my schedule. I have no problems with that aspect. Love the teamwork. Due to limited resources, we work together so much more closely on nights and have much stronger working relationships than days/pms. I like that due to there only being one PCA I am usually pretty involved in the basic patient care as far as cleaning, turning, etc. etc. Enjoy the fact I'm not constantly interrupted for meetings, rounding etc. Rants: The few day shift people that think all we do is sit around all night because the patients are sleeping all night. Right... Having to yell at doctor's to get them to a semi-conscious state to give me orders for late night admissions/condition changes or being yelled at for waking them up (which I understand) lol.

First off: Congrats!! Second: Listen to your preceptors/educators, they know their stuff. Don't rush through orientation. Make sure you're ready for the full load before you are to be alone. Learn your cardiac rhythms/dysrythmias. Know the interventions for the comon ones and other things you can do for pts. Know the protocols surrounding arrhythmias. Most places offer or require EKG interpretation classes. Know the common heart medication classes and uses i.e. beta-blockers, calcium channel blockers, various anti-hypertensives etc... Sign up for an ACLS class ASAP. Even if your floor doesn't require it, it helps prepare you for worst case "code4/blue" and you generally learn a lot. Get a good tool to keep yourself organized. "brain sheet" if you will. I have only been an RN for a year and a half and my first/current job is cardio/pulmonary step down unit. Above is what helped me. Oh and ask questions if you don't know answers. You learn faster that way. I'm sure some of the more experienced nurses will chime in soon.

No worries, but your comment just made me roll around laughing trying to envison doing that and how massive a "pimple" that would be lol

I'm not judging anybody, stating my opinion. In fact the bolded line re-enforces my first sentence. I apologize I struck a nerve, I didn't mean to, I feel my breakdown is fair. I have not taken a break since I became a nurse, so I understand, I really do. However; My body is my temple, the only one I have, and I'm not going to let somebody else, or my job break it down. I understand it's much more difficult when water isn't allowed on the floor, but why is it like that? Are we just laying down to the policy makers who never have, or no longer do work the floor, who have their water bottle on their desks. We are in healthcare, should we not practice what we preach? Is it not hypocritical to be telling people how many things they can do to stay hydrated, when we aren't? It is unhealthy to not drink water. And you really mean to tell me you have time to get your patients some water, but not drink some yourself, or can not drink a little something while charting. Again, if water is not allowed...That needs to be changed. Again not judging anyone, I try to avoid it. Just sharing my opinion.

I'm sorry, but if you don't have time to drink water or go to the bathroom then there is a problem with either your time management or staffing imho. Let's break this down. It takes at max 15 seconds to grab some swigs of water and a max of maybe ~3 minutes to go to the bathroom and wash your hands if you are just peeing. And maybe another 2 minutes to grab a couple mouthfuls of food. I understand not getting time to take a lunch break and eat, don't remember the last time I actually took a break, but Let's be serious, if your not able to grab some water or go pee there is something else going on. I drink water all shift, and when I have to go to the bathroom I let people know that's where I'll be. I have my zone phone if there is an emergency and yes I've answered while going to the bathroom. The doctor was happy to call me back in a couple minutes...

Sarcasm I'm assuming, Unless I've been taught wrong, the primary intervention when a hematoma is felt forming during, or just after a sheath is taken out is to reapply pressure to the site, as well as the hematoma and try to spread it out. Generally reducing size, amount of bruising, swelling etc. Also in primary scenario this is occurring around 10pm, no doctor is bringing me anything or coming in to fix when it can wait until morning. I did talk to doc multiple times and all he wanted was to just apply a re-endforced pressure dressing and leave it til morning. Was a slow ooze, pt was in no danger/discomfort there was nothing else occurring at site until hematoma probably d/t plug at skin, but continued bleeding under tissue. As I am relatively new didn't know about the L/E trick, as I've said I have not ever seen it ordered on our floor before.

That's what I mean... It is the physician, unless the nurse is not advocating this need and trying to move the patient out.... I am just not sure which one is the issue...

Funny, most of our lab, pharmacy, housekeeping people are great on my shift. And our standard PRN's help with a lot! But I swear if I get one more new admit from ED with a BP of 220s/110s, a pounding headache and additional risks for stroke and an explanation of "we didn't want to bottom them out" I'm going to take the patient back down personally. It takes me at least 40 min. to get orders from admitting doc when you have one right there!

General rule of thumb if there is a rhythm change, first thing to do is assess your patient. If they are symptomatic with the rhythm change it usually warrants a call to MD after you assess and do what you can for the patient per whatever protocols you have. LBBB v. RBBB. Doesn't really matter to RN scope of practice, sure its nice to know, but all it means is where in the Bundle of His the delay is occurring, its a "normal" rhythm for in most of patients you see. Same with 1st degree AV block. Just means there is a slight delay from AV node to rest of conduction system, but HR almost always 60-100. These are both sinus rhythms with a small delay somewhere in the conduction system and very common in a lot of pts. that a lot of doctors don't care about as is the same, so they would probably not be thrilled about a call if the patient is asymptomatic. As for which leads to look at, I feel its up to the nurse, I always look at lead 2 as its oriented along normal conduction path of heart. IIRC the aVR angled at less of an angle and goes more through the Bundle of His. Any significant change in rhythm should show up on all leads.

I've never seen it ordered on our floor.... Only been an RN a little over a year, but we get a lot of post caths and have not seen it once. I wonder why that is if it's so effective? Would be great because this one Doc in particular's pts. ALWAYS ooze lol