RNAnna

Let's hear it for being a "do gooder"! I would rather be labled as a "do-gooder" than go against my pricipals, beliefs, and the law where people's lives are concerned. I know and understand the need for Hospice care and comfort measures - I administer them myself. But I am not, as some nurses have told me, going to hasten the end of their lives just because it might be easier on the family. It's just not right. As to a He said, She said issue, you can use this thread as documentation of what you observed about your preceptor. I see nothing wrong with going to your manager and discussing this with them. If your manager comes off as being less than concerned, it is time to get out. As nurses, we are not supposed to play around with drug orders or dosages. It is not in our scope of practice and it is against the law. In this situation, I would have to say that you should think about your own license and take appropriate action. It would be interesting to see how much of your preceptor's drug practices are documented. There are a lot of people who think that they are doing good in the world who are actually taking away something from others. In this case, the preceptor took away the family's time with the pt and their natural grieving process. RNAnna

Hi I actually took a year and a half after I graduated to get my first job. It was a year after I was licensed that I started. Everyone wanted to know what I was doing during that time. Actually, it really is none of their business. They can't technically ask you that question. I always answered politely that I was taking care of family matters. If there was a place where I was really interested in working, I might go into a few details...... Father-in-law had a stroke.... ended up passing away..... nursing the family instead of nursing others at that time. That was all that they wanted to know. Once they heard there was a death in the family, it usually ended the conversation. Why did you "wait so long"??? Well, there could be many reasons. You were studying for the NCLEX, concentrating on getting licensed..... you were taking a well deserved brake after graduation before starting what you knew would be a demanding time in your life (orientation).... you were taking care of personal matters .... You were looking in different areas and now are widening your search (be careful of that one, they may ask what areas you were looking). There are so many reasons why someone might take care of some business after graduation that the answers could be endless. Think about what your reason was and then try to use different words that would sound good to an HR person without being dishonest. It is never what you say, but always how you say it. Anna

Hello. We don't tape our reports. We do them live, which has it's own set of anxiety provoking symptoms. I'm always afraid that I'm going to leave something out, or that someone is going to ask me something that I don't know. Anyway, the report follows a typical patturn: Pt. name, age, Dr., and Dx. Then it is Allergies, code status, and current assessment. Abnormal labs that have been passed on from the day shift, or that have come in on my shift (I work pms), then I do what I did on my shift.... prns, dressing changes, diet eaten and tollerated, new orders, if I called the Dr. for anything, any changes in condition.... things like that. I end up with the I & Os with IV and PCA amounts thrown in. There are sometimes when I have the night shift interrupt me to ask questions inthe middle of my report and that throws me off. I'm getting better at asking for questions at the end. If I don't know something, I tell them I don't know. We are all human and there are somethings that we just can't do when we are as busy as we all are. Just try to do your best. That is all anyone can ever ask. You might try to tape a "fake" report at home and see how it goes. Eventually it will flow a lot easier. I have the sheet that I take report on on the opposite side of the sheet that I do all my work. That way I have all the information together when I give report. It works for me. Hopefully you will find a system that works for you. I've always thought that they more systems that we are exposed to, the easier it will be to find our own. Hope everything turns out for you. Let us know. Anna

Hi. I've been having a hard time lately. Not only because I am working way more hours than I am scheduled for and we are really busy at the moment, but also because at our rural hospital (25 beds) we also have some hospice pts that come in. A couple of weeks ago, durring the busiest time of night, one of my hospice pts died. He went peacefully and wasn't in any pain. It was really a blessing in a way. It took a lot out of me mentally and emotionally. I haven't recieved any training on berevement for nurses who work with these pts. I don't even know if any is available. I would like to know what other facilities do. If you have a pt that passes on, does your facility support you in any way? And if so, how? I could have used a "debriefing" of sorts after this incident but I haven't had time to talk about it to anyone because I'm either working or sleeping. I would love to hear from some others who may have some words of wisdom for me. Thanks Anna

My favorite is that nurses are able to give medical advice in the grocery store. I live in Rural Iowa and in small towns everyone thinks that they can "get that looked at" by the nurse next door. Or the person who says "My sister-in-law says that she's having XYZ symptoms and I'm getting worried. What do you think it could be?". Don't they know that we can't diagnose? Here's another one: I had two pts this weekend who had MRIs. Each of the families hounded me about the results. They think that once a diagnostic test or study is done, we know the answers and results right away. There's my two cents. I think everything else was covered by DusktilDawn. Anna

It is really difficult to have that chatty pt and have to leave because you have other pts to care for. I just got off orientation and admit that was one of my problems too. I'm just tooo nice for my own good. I don't want to cut someone off and be rude, but I've learned ways to get around the "looking rude" thing. Always have a smile on your face when you tell them that you have to attend to something else, and asure them that you are never far away if they need anything. Can't stop them talking? Keep backing up toward the door, and when you get to the point of no return, let them know that you will be back. If you do that, make sure that you go back at some point in time. When you go back let them know that you only have a couple of minutes between things that you have to take care of. This lets them know that you care about them enough to come back, but you have other things to do as well as listen to them. Over time, you will be able to listen to them and program a pump at the same time. While they are talking, keep taking care of business. Check their IV site, IV pump, foley, PCA, dressing, anything to make you look busier. Then when you are done, you can say, "ok, well, I see you have your call light.....you know that I am never too far away. Call if you need anything." There are some pts that you know are chatty from the night before that the next evening, you have to go in and say hello, tell them how long you will be on shift, and let them know that you are caring for six others that evening. Most people understand the nursing shortage, and if you tell them that you are their nurse, but you have other people that you are caring for, they are less likely to take up your time. Then you have control of when you talk to them. I've also gone in when there are visitors. Said hi to all, and said, "Well, I'll let you visit.....". They then get the feeling that you care about them just because you stopped. I know that all of this sounds like tricking the pt. but sometimes we have to use different techniques just to get it all done. I've also posted my method of organizing my "brain" on another thread on this forum. so, if you want to see it, look for the other recient thread on organization and you will find it there. Anna

I had to grin at Haunted's post. I'm just off of orientation, but I am an "older new nurse" so I can understand the humor and smile with her. We all go throught the time management crisis. The thing that bothered me soooooo much while in school and on Orientation, was when I asked how to organize things, everyone just said, "well, you have to find your own system in time". What time? Who has time? Until one day, a wise younger than me nurse, and my DON sat down and said "this is what works for me". Then I just started looking at everyone's brain and checking out how they do it. And now, I'm going to pass it along to you. I have a two sided brain. One side is the report side, and the other is the working side. I take report at the beginning of shift on all of my pts and put all the information in the appropriate places that I've created on my computer. It took a little time for me to just know where all of it was, but now my eye just goes to the right spot when I want to write something or if I want to refer to it. There are places for not only the obvious name, room, dr.,dx, allergies, diet,and such, but some larger blank spots to write in lab values and med changes that occured throughout the day (I work pms). The second side of the brain is really the most important. It is layed out in a grid pattern. Along the top row is where I put the room and name of the pt. that I am caring for. The left hand collumn is labled with the hous of the shift. one hour for each grid space. This way, I can find any given hour and read across what has to be done with any given pt. So, I get report. Then I go and check the MAR to see what meds need to be given to what pt and when. I write that down on the grid in the appropriate time slot. PO x 2, IV x 1, things like that. There is an extra unlabled row at the bottom of the grid that I use to write the prns for each pt. Especially the pain meds with how often. "Toradol q 6". All of the other things, enemas, dressing changes, neuro checks, go into the grid as well. things that don't have a time frame, you have some discression as to when to put them down. I had a "enemas til clear" pt recently (yippy) and was able to space out the enemas so that they had time to work and could be spaced out around other things that I needed to do on the floor. You can look at your shift at a glance and see when you have things scheduled. Remember there may be some blank spaces. These spaces you use for charting, dinner, bathroom...... It works for me. I can't say that it will work for anyone else. But if you don't have an idea of how anyone else organizes, then you are lost without a map. Hope this all works out well for you

Hi - It sounds like a lot of you are from central and southern Iowa. I feel like the lone person from the beautiful Northeast Iowa bluff country - where nursing is not bluffing. It's Decorah for me. But I work at Mercy Medical in New Hampton, Iowa. It's a little bit of a commute, but it's a good time to change gears and get the head into the game. If there are any of you from Luther College or Northeast Iowa Community College out there, I've been to both. Now the question I have is why in the world is it that if I cross the boarder either north or east (Mayo or Gundersen in LaCrosse) would I get payed at least $4 more an hour at a base pay rate? Let's get that changed. Anna

I just got off orientation. Things are going great. I love my job. I love what I do. I just am really frustrated giving report to the next shift and the new "know it all" who is just orienting. She is being oriented by an experienced nurse who was hired at our facility less than a year ago. The preceptor has a lot of knowledge, but the two are feeding off of each other's "superior knowledge" and making it difficult to give report. They interrupt continually and break the train of thought and information that is being passed along. Because of that, there is something that gets missed no matter how small and they will find it and use it. It's as if they are starting to start a shift war. Our facility was never a back biting environment before this. We were a very respectful place. Let's face it, we are all human, and we all understand that there are some days that are just crazy and something may get left for the next shift. In this case the next shift is the night shift. I've talked to my supervisor about this and I'm not sure how to handle it. I am not a confrontational type of person. It is difficult for me to tell them to stop giggling in report about something that happened last night or to have a little respect when I am telling them something that they may already know from the previous night's work instead of saying "Yeah, yeah, we know, we had him last night.......did he ride the call light for you too???" I just think it is unprofessional and I am trying to learn the right way to do things rather than acting like a child when it comes to patient care. I know that I don't know it all. I got a really good GPA just like this other gal, but I still don't know it all. Thanks for letting me vent. Anna

Gradiated compression knee hi's. I broke my ankle in three places in November and I have to wear them to keep the ankle stable and to keep the swelling under control. I've tried lot's of brands. In fact, I was wearing Nursemates when I broke the ankle. I didn't like the Nursemates because I found them tight across the calf. They cut off my circulation. I now buy Jobst opaque knee hi's. They aren't like the Jobst that we use in the hospital and they certainly are not TEDs. They are like regular hose only stronger, better, and more expensive. I was able to have my doctor prescribe them so that they are covered under my insurance. Jobst also makes trouser socks and sports socks that are gradiated compression socks. They are all wonderful and I wouldn't go a day at work without them. Anna

Hi Redred, The Nursing made Incredibly Easy series of books has one specifically on charting. I've never looked at it myself, but I've heard good things about it. There are also quite a few books about nursing and the law - which is what charting is all about. Go to amazon or barnes and noble and do a search on nursing documentation. There may even be a documentation book in Mosbey's little pocket handbook series. This may even be a good question to post in the specialty pages so you can hit a few more nurses in your field. They might know which resources will fit your specialty the best. Anna

At our facility we always ask the pt on admission what meds they take and when they take them. So, if the pt isn't taking X,Y, and Z together at home, they aren't taking them together in the hospital. I think every facility has thier own times as to what BID and QID times are. In our facility bid means 08 and 2000. So, we adjust as neccessary for the particular client. We try to match thier schedule with our schedule as closely as possible and it seems to work well. There are some things that we have to give on a "off schedule" to accomodate the pt. but not many. If the pt is not taking the medications together at home, I would consult the physician and explain the situation and document that you notified someone. That would at least cover your rear if it isn't changed. And if you don't feel right about giving particular meds together, don't do it. Always notify the charge nurse and possibly the dr., document, and if they say do it, and you still don't feel right about it, stand firm. Your pt's life and license is more important than what a dr. orders. They are human too. Dr.s do make mistakes. Anna

Ok, so here is the delema. I have several charge nurses that are telling me different things about piggybacking meds. I'm a new nurse and trying to do everything right which is impossible since we are all human, but I am getting frustrated by this piggyback issue. One charge tells me that each med needs it's own secondary tubing. Another charge tells me that if you back flush the tubing, there should be no reason to use more than one secondary tubing line no matter how many meds you piggyback in a night. I'm feeling like I'm caught in the middle because the multiple line charge is a very strong personality that makes me feel stupid as if it is her mission in life, and the single line charge is my manager. So, here is the question. how do you piggyback in your facility? Multiple or single lines? backflush or not? I'd like to hear from some other nurses so I can understand this issue without feeling in the middle of an arguement that should be taking place on the management level. Anna

It seems that there are quite a few of us that look at ourselves as the "old new nurse". I'm 41 and in my first nursing job. Sometimes I wonder why. I remember in school when we all were excited about the prospect of finally "being there" and now that we are, we're scared to death. At least I am. There are a lot of night that I come home and know that I've done the right thing and have chosen the right field. There are other times that I've come home and toss and turn all night trying to remember why I wanted to do this. We currently have a pt. who is very young who came in with acute paritonitis. When she was in surgery, they were shocked to find that she had CA everywhere. she had a complete historectomy, bowel resection, and a colostomy - talk about a life changing situation. She is the pt. that I know that I made the right decision for. She is the reason that I got into this. No matter how much I screw up in my first year, this pt. will stick with me always. She's already talking about walking in the relay for life next year! We all have our days. I'm just learning that I need to leave my day at the hospital and when I'm at home, do the things that I do at home. It is a hard lesson to learn. Keep the faith. Give it a year. There are always other aspects of nursing if you find that what you are doing doesn't suit you. What finally made me realize that I am doing ok was watching another older nurse being oriented to the job several months after I started. I watched him draw up a med during his first week and It took forever. I remember being where he was right then and realized that it really does get better. Anna

Believe me I understand how you feel both physically and emotionally right about now - or at least I have a bit of understanding. I'm 41 yrs. Three days after I was hired for my current position, I fell down some stairs (not at work) and broke my ankle in three places. Trimalliolar fracture. I live in a rural area and the ER doc looked at the x-rays and asked if I wanted to be transfered south to the University of Iowa hospitals or north to the Mayo Clinic. So, I spent the next week in bed in the mayo clinic and had surgery on the ankle. Three months at home, most of it in bed (you know they love you when they empty your commode), and I was finally released for work. I'm on a med/surg floor but being a rural 18 bed facility, it is all med/surg. We run our tails off. I still limp from the surgery, but I have found that gradiated compression knee hi's are the way to go. I alway take some sort of NSAID before I go to work because I know that it will work to keep the swelling down while the compression socks do their thing. As nurses we all abuse our bodies to a certain extent. Those of us with some physical challenges need to work with our doctors and come up with some creative ways to keep us upright. I also have orthotics in my nursing shoes (Rockers R-clogs lites). My feet and ankles still hurt to the point of keeping me up at night sometimes. My doctor and I are trying various things to keep that at a minimum. As a first year nurse neither my doctor or I know exactly how my body will react, so we are taking it as it comes. I also have some narcotics left from the surgery that I take very sparringly when I absolutely have to (with the doc's blessing). Med/surg is very demanding. I'm learning how to run my tail off. luckily we only work hour shifts and I work pms. Sometimes it is "quiet", if that is possible, and sometimes it is like the evening this week when we had 4 admits within an hour. I figure I will do this for a year or two, and then see what my options are. I'm sorry for the very long post. I hope you find your way in the world of nursing. Remember in nursing, there are no limitations - except your nurse practice act. You can go anywhere and do anything in nursing. But right now, just figure out how to get through tomorrow. Anna