SilleLu

400+ beds, SE michigan but not Detroit. 3 ICU units, a makeshift ICU in an unused area, 2 out of 3 med/surg units, 1 large tele unit were ALL made into Covid units and ALL had a good number of covid and/or r/o patients. BiPaps made into vents because we had no more vents. This is ridiculously real. Deaths of several in their early 20s. IT IS REAL. Hopefully your area won't see what we see.

I'm wondering if you pushed the medication slowly, which of course is correct, while other nurses had been pushing it faster, giving her the quick buzz. Might explain why she is accusing you of not giving it.

How is the abx ordered? Our are all ordered IVPB, so to me that means if I run it as primary I'm not following the order as written. I would hang it piggyback even if I had a choice, for the reason many others have noted, and so that I can back flush and use the same set up for other IVPBs ordered instead of starting over with a new primary line if not compatible. It's annoying when the nurse before me runs as primary and runs the line partially dry.

Patient in respiratory distress, lungs sounded horrible, RR in the 50s, accessory muscle use, shallow, sat ok on just nasal canula however. Lasix given but patient getting worse by the minute. Resident comes to me and asks for STAT Flonase and saline nasal spray because she thinks she might have some nasal congestion. That was her entire plan of care. Luckily the senior resident was around the corner, and transferred patient to ICU on BiPap immediately.

I too was a CNA before I was an RN... The work of RN is more mental than physical, although I still do a fair amount of the physical care as well. So what is an RN doing while sitting at the computer or on the phone, other than charting? Reviewing labs - abnormals, trends, are labs missing? call the doctor to get orders. no result even though it was drawn hours ago? Call the lab. Result doesn't make sense? Call lab for redraw. Critical value? call the doctor for orders... Reviewing meds - patient getting lasix but no potassium? call the doctor. VS abnormal and home meds weren't ordered? call the doctor, enter tons of orders so you can get blood pressure under control. Medications can't be taken at the same time? reschedule meds. Medication prescribed and verified by pharmacy despite known allergy? Call pharmacy, call the doctor. Patient has new onset symptoms...review meds for side effects, call doctor for alternate treatment. Manager wants to know why this patient hasn't been discharged, review physician notes, see they wrote about several new orders yesterday but didn't enter orders for any of them...call the doctor to clarify, enter new orders. Patient was independent at home prior to admission, has been here 7 days and no one has attempted to get them up to a chair let alone ambulate. Get orders for PT/OT evaluation. Yay, patient is discharged! Get paperwork in order. Realize a new expensive medication was ordered, call Case Manager to check insurance coverage. Medication isn't affordable, discuss with doctor to come up with alternate plan. Another discharge...oops brand new diabetic and no teaching has been done, plus patient is forgetful and has little support at home...discuss with Case Manager. Review I/Os....looks like patient is putting out much less urine than previous day, review meds, IV fluids, PO intake. Bladder scan shows retention, get cath orders if toileting not successful. Review previous days assessments as you chart your own...this patient was alert and oriented but today only knows her name and seems lethargic, review medications administered previous 24 hours to see if there is an obvious cause... Honestly I could go on and on. I remember feeling the same way that you did when I was a CNA and was amazed at how much 'behind the scenes' work that RNs are responsible for. There is little time to be bored and it can be mentally challenging. Good luck to you whether you decide to go to nursing school or to follow a different path! edited to add: ok, I see I put a lot of "call the doctor" in there, generally anything not critical is discussed when they do rounds. I also didn't put in many nursing interventions, but there are a lot of things we can do independently too.

Sweet little couple both mid 90s, both sharp as tacks. Wife recovering from hip fx. I was helping her off the bedpan and pulling up her undies and pj pants. Husband pipes up, "I would have helped her, but I'm much better at taking them off...I've had more practice!" Wife couldn't stop giggling... Edited to add: They had 9 children

Getting complicated discharges done. The patient that has been medically stable for weeks, doctor are willing to write discharge orders, but difficulty getting patient placed somewhere? Gone on my shift. The challenging patient that keeps coming up with new issues so they don't get discharged? Gone. The difficult patient everyone just can't deal with anymore? yup, them too. The patient whose family is out at the nurse's station 10 times before you even get report? Put me on it, I'm the discharge queen! Edited to add: all appropriate candidates for discharge of course

Sounds like a hard decision if they won't change your preceptor. I recently accepted a new 12 hour position at my hospital and at no time did they bother to mention that during the three months of orientation I would be asked to work 5 8 hour shifts a week. Three months is a long time when it's your life that is impacted. Luckily I was able to talk to the educator and work it out to work 2 8s and 2 12s for 2 months, then 3 12s the last month. I agree it's wrong for the hiring manager/HR to not be clear about the difference in schedule between orientation and regular. It's irritating to be expected to just "suck it up" when you may have taken a different opportunity had the expectations been clearly communicated. If and when I move on, it will be a question I always ask before accepting a job offer.

, THIS!!! In two years in a hospital with over 1,000 RNs (granted I've only been on a handful of units), I've seen plenty of 'normal bad behavior'. I've called out a few of them on it when it has affected me personally, but going into my third year of nursing, I've yet to be eaten

I was asked by my manager to do charge after 1 year, was new grad to boot. This was in a 40+ bed med-surg unit. I told her I didn't know enough yet and I still went to my seniors with questions. Her reply was that I would learn a lot as charge, so I reluctantly said I would try it. She was right, I learned a lot and though some days were crazy busy, it was mostly good. Give it a good try, if you really hate it after 6 months, opt out.

Not questioning doctors orders can be dangerous. Dr. ordered toradol for my patient just last week. Patient's chart clearly states allergy with anaphylactic reaction. Doctor missed it, pharmacy missed it. Nursing didn't miss it luckily. It is so common for doctors to miss things, they make mistakes and they count on nursing to question them. In two short years I can't tell you how many times I've had to question lasix orders with no potassium replacement when potassium is already low, IVF at 150 ml/hr for the dyspneic, wet sounding lungs who is eating and drinking fine, two different docs ordering electrolyte replacement the same pt, same day, Coumadin with no INR check for days, etc. And plenty of things that I've questioned that Dr had a good reason for ordering that I just wasn't aware of, but rarely have they been upset with me for asking. I've learned a lot from questioning, no matter if the outcome is to confirm or dc the order in question. If the culture where you are is "don't question," I wouldn't want to stay there long personally.

"Walk this patient in the hallway without oxygen and then figure out how much oxygen he needs and record it to satisfy hoop-jumping to get patient what he needs."

I don't work in ER. However, having been on the other side, I wonder if a system like the OR waiting room would work? The patient is given a number/letter code which can be shared with family as the patient wishes. The board is color coded with the progress of the patient. Pre-op, operating room, post op, recovery, etc. Would that work in ER? No pager to lose, when the code comes up for patient to be called back, a flashing green color. Patient actively in ER another color, being admitted another color, pending discharge, etc. Of course if patient isn't watching, calling out name would be the backup.

to OP...we've all made mistakes. Yes, your nurse should have checked. Yes, you should have clarified. Learn from this mistake, and from the next one (yes, you will make another one). If every nurse that made a mistake quit, there wouldn't be any nurses :)

Some pumps don't...we have Alaris and if the drug is piggybacked, it will draw from the primary without alarming. That is assuming the primary is already running and it's the secondary clamp that wasn't opened.