kbird03

I loved working with a LPN's and i was the new grad with the older more experienced LPN.It's a team. I can see their value. I do believe there is a place in the hospital for them! LPN'S have skills and a license that can be utilized for the betterment of patient care, but I do understand the difficulties of trying to figure out the division of labor, which is fair and cost efficient.

Maybe, the ones who pout carry on etc., should be asked to come in early to work on the assignment with charge, if they know better. Our staff who would stay over to help (8hr shifts) got to keep their patients which of course would infuriate people coming back and wanting "their" patients back, but they would shut up quick because the alternative would be they'd have more patients if the day shift didn't stay to help. I guess my point is, announce to all the whiners, come early if you are that determined to change things and if you can't do better than shut up!

I don't have this problem, but why can't she call/page the doctor. Actually, today we showed a case manager (during shift change while I was getting report) how to page the doctor because the doctor had put the wrong discharge in for a patient who didnt qualify for inpatient rehab! First time I've dealt with this, but thinking hospitals may be short on case managers, so hiring inexperienced not aggressive nurses to fill positions and/or insurance is fighting everything which is causing added pressure to case managers and they are trying to pass it on to us floor nurses

Congratulations! I think an LPN is an asset and especially in med/surg. Good luck!

It won't work! Obviously! The powers that be must assume nurses are dragging their feet with discharges and getting rooms cleaned! They will learn quickly when that brilliant idea get implemented and families are complaining! I'm sure you would give them a heads up, but will they listen?! We now get patients with no verbal report from EC just a print out of Sbar, but must go to a clean room! My goodness common sense is lacking as you know.

Research your area for surgical tech. for jobs and requirements. Speak to a guidance counselor at the school. Ask her all those questions! I'm am RN and must say there are so many more jobs and shifts. Contingent positions (per deim) usually require that you have experience. I know that nursing get has many shift, so having a family is much easier. Medical assistance or billing work is a good field and may not be as stressful as nursing.

I'm confused? You work 3 - 12 hour shifts Friday,Saturday, Sunday and are fine with thst?

Goodluck! Oral report and rounding doesn't help in trying to get out on time! We had taped report back in the day and you could actually get out on time! Taped=like a voice mail you would listen to, instead of having to wait for each nurse to sign off with each nurse!

Possible solution doctors need to put orders in and nurses unless it is night shift (doctors sleep) nurses wouldn't be allowed to take verbal orders (for these core issues)and doctors get constant notifications until it is ordered. I thought the push for computerized charting was to cut down on verbal orders.

QI should tell doctor to put the order in! I thought computerized charting was so doctors can put their own orders in and to cut down on the verbal orders. Crazy contradictions in management.

We also have many classes and money spent to train us on hourly rounding with a smile and a script to up play up our service!!

We have a piano too that plays to an empty lobby í ½í¸¤

I agree! Funny and sad how you never see a nurse in uniform in the hospital cafeteria! Hospitals need to hire waitresses and hotel personnel, so us nurses can do our job safely!

Remember you are not expected to know many things, don't be too hard on yourself!! Orientation is exciting but can be overwhelming and stressful, so try not to get discouraged!! Good luck!!

You summed up!! I do feel no one wants to lose their job and all hospitals are about the same! Where is JACHO? Really I've always wondered they are so concerned with sharps etc., but not patient safety ratios and acuity. I think floor nurses feel powerless and now they feel empowered to get some respect and teach the public in what seems to be the most misunderstood profession. We demand recognition and respect in the media because we feel we can educate and possibly have a voice to be heard. d. Unfortunately, we don't feel the same power in our facility or place of employment we fear the status quo and that is really sad.

I feel so bad this happened to you as it could happen to many. As you are a new RN, I know that it can be difficult just knowing what we are allowed to do and not do can be overwhelming. There are certain working environments when we are new that we don't know what the norm is and what isn't. This could be an excellent learning opportunity and policy changing event. First off the doctor who doesn't have access to the pyxis and MAR, shouldn't be giving medications, but as we all know many environments allow for that and that should be addressed. Fast and hard rules should be in place. I know 14 years ago when I was a new nurse on a med/surg. floor we only had paper charting, doctors would have us override in the pyxis many times so that they could get lidocaine, etc. what ever they wanted and we just did it and it was never even charted on. I did because I was told by the doctor to do it and it was meds. that nurses weren't allowed to even give on the floor. Nothing ever came of this, but had there been an event it would have been my name pulling out these meds. and no where documented given not given. It sounds like your process and system need to be addressed and fixed. There should be teaching for all that was involved in this incident, as you are not the only one at fault. In this case fast and hard rules should be implemented. Hard and fast rules are like when we hang blood in no way do we do it without another RN just not going to happen as we all know the weight of this rule that we could actually kill the patient if we don't follow this hard and fast protocol. The problem is trying to implement protocol and hard and fast rules if it isn't life or death, this is where we so busy we don't have time to always follow what we know we should. Hard and fast rule would be like if you pull out of pyxis you have to give it no matter what no exceptions. Yeah, try telling that to a doctor who is rushing to relieve pain, not always realistic, or we have meds. pulled not unwrapped but someone else gives them and charts them no big deal and why should I have to put them all back, so she can pull them again what a wast of time. In a perfect world there would be no verbal orders and we would all scan all meds given prior to giving. Unfortunately, real world hospital situations call for us to break rules and processes and that is what leads to problems. Another fast and hard rule anything STAT has to be given by the nurse taking care of that patient and not a covering RN no exceptions. This is also a hard rule to enforce because STAT these days is an order so often really what does it mean. Our hospital STAT is 15 minutes no more, ASAP 30 minutes no more, Routine within 2 hours. No one really follows that because how often is anyone really timing anything, or looking at their watch. If the rule was ordered STAT that nurse in charge of that patient should be the only one to carry it out, that is hard because we all need a break at some point where does it end? I would even go as far as any order STAT must be addressed as to why not given and only by the nurse who was in charge of that patient at the time it was ordered STAT. In other words, I'm assigned to this patient during 7-3p.m. STAT ordered at 3p.m. I have to address it by carrying the order out and completing charting, or some other plan etc. The only exception would be that STAT order could only be carried out by charge nurse once it was "confirmed" with the patient's assigned nurse - end of story no exceptions. The problem with a rule like this who has time to chase the nurse who didn't chart. I saw Zofran ordered stat for a patient (it was ignored never charted on and the system still had it in red this was four days later). No one cares it was only Zofran and it four days later. Just like when we hang blood there are some hard and fast rules that we just never break two RN verify this is just the way it is because if not done the patient will die! There is just a weight that hangs for certain nursing interventions that make us accountable. Just like medications I would never give a medication that someone else opened up or drew up and handed it to me. You know those fast and hard rules that you just don't break because it is part of the hospital environment and we all know better because it has been drilled in our heads. In this case sounds like I said your process and system is broken, and now you need to see that there are steps in place so that it doesn't happen again. Getting doctors to follow hard and safe is sometimes impossible, but us as nurses need to stick together and make sure they do or at least set up processes that help us cover our butts and ultimately keeps our patients safe. Also getting hard and fast rules to be followed is hard when it is only "Zofran" who cares if it wasn't charted on he not nauseous now, I'm not going chart on it that it was given by someone else even if the patient told me he got it. Sometime we are just too busy to call down to the ER nurse and find out did he get this did you forget to chart it etc. In this situation had you not been allowed to get medications, for the doctor it would have stopped there. Had STAT meant something to the covering nurse she would have questioned why it hadn't been given. If she wasn't allowed to carry out the STAT then she would had not done it. I know I am rambling but there are ways of fixing this, so that it doesn't happen. You being "new" may have been some of the reason, but hard and fast rules are made and need to be drilled in. Just like if there is in place narcotics ordered for the patient is only to be given by the nurse caring for the patient no exceptions that could have helped prevent this from happening too. That would be hard to follow because we have to go to lunch at some point and we can only give pain meds. when they are due and having 6 patients well you get the picture. This needs a hard and fast rule too. I had a sickle cell patient who was a frequent flyer and she had pain medications ordered q2h, other nurses would help out else the one who was assigned would have just drowned, so it is hard to implement fast and hard rules because there are so many situations that require a break down in safety. I hope your manager sees that because this is certainly a learning and changing policy moment, not just you were at fault.

I did the exact switch 3-11 to the day shift med/surg with telemetry. It was an adjustment, but I liked it. The first part of the shift is crazy because of med. passing etc. kind of like the 8p.m. med pass is the busy time. Also there are so many doctors, case management, PT, wanting at your patients but usually less family members. I liked that I was able to actually talk to the other team members about our patients it felt more like a team. No on call doctors who don't know the patient made my life easier too. I also had some strong personalities on the day shift which intimidated me, but I knew that prior to the switch. I prepared myself for that so I just tried to be a team member and stayed out of their way. Smiled a lot and just really kept to myself. I liked having my evenings back with my family. Evening shift nurses have more patients (or at least we did), so it was a great change and I never blinked when we were under staffed and had to take on 6 during the day as opposed to 5 or 4 because of my 3-11 experience. Also day shift was nice if you did have demanding family come you can get the doctor for them, get case management, get their questioned answered. Those were the good old days because now our day shift has 6 patients too, but I am at another hospital where they have 12 hour shifts. I had a hard time getting up so early but I always the night before had everything laid out even untying my shoes, car keys ready, lunch ready, etc. lol! just to get a couple extra minutes to sleep. I am sure once you make the adjustment you will love it!! Some of the strong personalities did question my abilities in that they never worked with me, so there is a little bit of "proving" yourself in the beginning that you might have to deal with. I can't really say they questioned my abilities but I was a fairly "new" nurse among seasoned nurses, so it was just an adjustment. I also had some PCT's/Nursing Assistants who would challenge me but they learned quickly that I was all about the patient and a team player. I am not too good to wipe a butt or wash up a patient myself. Good luck to you!!

You are right. I guess it depends on the state in which you live. I have seen job postings wanting only experience in that area. Must have ER, L&D, ambulatory surgery, etc. experience there is no exception no job posting 3 years of med/surg equates, which I think if you've worked in med/surg you can learn and work anywhere. They are just being picky because they can. I feel bad for the new grads in this area there are no positions for them. When I graduated in 2001 in another state, many areas were open for new grads and yes the antiquated advice start in med/surg and you can go anywhere. My preceptor who had graduated in the 70's actually got to start her nursing career in the OR!

I don't think her attitude was very nice at all. No benefits doesn't sound like a place I would want to work. Like the other poster said it depends on what you can afford. If they are that unfriendly, you may not like the working environment. It is frustrating looking for a RN position. I've been a med/surg floor nurse for 13 years with my BSN and looking to do something else but all other areas and positions in this area require experience that I don't have like OR, maternity you name it all want exp. or certification. I saw a LPN position I would love to have, but not sure how that would be received. I guess sometimes the grass seems greener on the other side. Are you happy where you are? Do you like the people you work with? That can make all the difference and 6 wks vacation sounds awesome. I'm sure with 250 resumes out there you must feel really stuck like I do but for other reasons. Why did you want to put your start date back a week. Sounds like you are doubting the position prior to accepting that might be your red flag not to take you. Sorry if I am rambling.

I'm a RN and work on a med/surgical floor and float to other areas. I think the assignments are too heavy,nurse to patient ratio during day shift is 6 to 1 and I think it is dangerous. I don't understand JACHO they come in and make sure all the cabinets are locked all food and drinks are out of our nursing supply rooms, no food in the patient refrigerator, and all the petty little things are complied with but never address real issues like acuity of patients and staffing ratios. The amount of charting is crazy but I completely understand why that must be done, but no one has anytime to read any of the charts. I literally start my shift running and don't stop. I take about a 15 minute break on a 12 hour shift to eat something quick. The 12 hour shift turns into a 13 to 13.5 hour shift. Families are demanding and expect great service and care and deserve just that but under these conditions it is impossible. We could all be better nurses with better "customer service" if the ratios were changed and it is that simple but the hospital can get away with it and save money, so they continue to slam us all and expect us to smile and provide great care which is simply impossible. Job satisfaction is 0 for this floor nurse. I would take less pay if I could be guaranteed less patients. I know the acuity makes a difference and you can have 4 train wrecks and have a worse day than if you had 6 stable patients, but 6 patients is just too much and is dangerous. When I say 6 patients we all know that doesn't count the 6 you started with the two you discharged and two admissions you got during your shift. Sorry for this post, I know I'm babbling on and venting.